Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Postmenopausal bleeding

Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Oncology, Reproduction & Development
Progress Test Topic(s)
Women's health
A 55 year old Indian woman presents to her GP complaining of lower abdominal pain and bloating. Her periods stopped 14 months ago but recently she has had some vaginal bleeding. Her body mass index (BMI) is 32kg/m2
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and function of the normal female reproductive tract
   - Endometrial and tubo-ovarian pathology including hyperplasia and neoplasia
   - Risk factors in the aetiology of gynaecological malignancies (including genetic)
   - Routes of metastatic spread of gynaecological malignancies
Clinical and Communication Skills 
   - Elicit a full gynaecological history; consider risk factors for gynaecological cancer and recognise early symptoms of gynaecological malignancy
   - Gynaecological examination including abdomen, pelvis, inguinal nodes, speculum
   - Interpret cervical smear, swabs, tumour markers, reports from transvaginal ultrasound, endometrial biopsy/curettings
   - Understand difference between screening and diagnostic tests used in the diagnosis of gynaecological cancer
   - Differential diagnosis and management plan for postmenopausal bleeding
   - Symptoms and signs of gynaecological cancer
   - Awareness of the different grades of endometrial hyperplasia, treatment options and risk of progression to endometrial cancer
   - Staging and prognosis of gynaecological malignancies
   - Treatment of gynaecological cancers: curative and debulking surgery, principles of radiotherapy, chemotherapy and palliative care
Personal and Professional Skills 
   - Intimate examination and use of a chaperone
   - Breaking bad news in cases of confirmed cancer
   - Discussions relating to potential diagnosis of cancer; not causing undue anxiety but emphasizing urgency of making a diagnosis
   - Understand the role of multidisciplinary team in management of gynaecological malignancy
Population Health 
   - Epidemiology of gynaecological cancers and their risk factors (obesity, human papilloma virus, polycystic ovarian syndrome, unopposed oestrogen use)
   - Sensitivity and specificity of screening tests for ovarian cancer in general and high risk population (CA-125, transvaginal ultrasound)
Conditions to be considered relating to this scenario
endometrial polyps, endometrial hyperplasia, endometrial carcinoma, atrophic vaginitis, vaginal trauma, sexual assault, cervical polyps, cervical dysplasia / carcinoma, sexually transmitted infections, vulval skin disorders, medication (warfarin, hormone therapy, tamoxifen)
Less common but 'important not to miss'
ovarian carcinoma, cervical cancer
primary peritoneal and fallopian tube carcinomas, metastatic cancer from non-gynaecological primary
Related Scenarios
[Menopause], [Heavy menstrual periods]