Scenario Worth Points Explained for Students (Easy Guide)

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Scenario 7 Worth 6.000 points. PREOPERATIVE DIAGNOSIS Endometrial intraepithelial neoplasia, grade III, on cervical biopsy and endocervical curettage. POSTOPERATIVE DIAGNOSIS Endometrial intraepithelial neoplasia, grade III, on cervical biopsy and endocervical curettage. PRIMARY PROCEDURE 1. CONE BIOPSY. 2. ENDOCERVICAL CURETTAGE. 3. ENDOMETRIAL CURETTAGE WITH BIOPSY. FINDINGS AND PROCEDURE After the induction of adequate general endotracheal anesthesia, the patient was placed in the dorsal lithotomy position. Examination under anesthesia demonstrated a small cervix and uterus without any adnexal masses. The cervix was firm to palpation. The speculum demonstrated a cervix that was smooth and without lesions. Colposcopy was performed and was noted to be unsatisfactory. No lesions were seen. Cone biopsy was then performed with a sound in the cervix. This was difficult to accomplish due to the cervix being flush with the uterus. The cone biopsy was tagged at 12 o’clock. No cone tip was cut. Endocervical curettage was performed. Endometrial curettage was then performed. The uterus sounded to 4 cm, and scant tissue was obtained. Hemostasis was then assured. The Bovie was used to control any bleeding. Patient tolerated the procedure satisfactorily; however intraoperatively the patient did have an increased blood pressure that was controlled quickly with nadolol. The patient’s blood pressure then was stable at 120/60. Anesthesia: General endotracheal. Estimated blood loss: 10 mL. Intravenous fluids: 1600 mL. Lines: IV and arterial line. Urinary output during the procedure: 700 mL. Drains: None. Count: Correct. The specimens that were sent to pathology: (1) Cone biopsy, (2) endocervical curettage, (3) endometrial curettage. Urine was sent for cytology.

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