IntroductionPelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound.MethodWe examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women.ResultsIn total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys).ConclusionIndiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence‐based and represents a low‐yield examination with extremely low rate of incidental findings of clinical significance.

DESCRIPTIONA 60-year-old man presented to the hospital with a large, unusual looking mass protruding from his right infra/supraclavicular region (figure 1). He first noticed a small lump at the base of his neck while shaving and over the course of 6 months, the painless lump grew rapidly and soon extended from the anterior fold of his axilla almost up to his jaw.He reported feeling dyspnoeic on exertion but denied having haemoptysis. He also reported back pain and bilateral lower limb paraesthesia. He has a 45 pack-year smoking history and had previously worked in the dry cleaning industry. His right arm was oedematous and there was an associated weakness and paraesthesia, consistent with a lower brachial plexopathy.Despite his worrying symptoms, the patient was reluctant to seek medical attention as he had a fear of doctors and profoundly disliked the idea of being hospitalised. It was only at the insistence of his daughter that he eventually attended his local general practitioner.A CT of the thorax ( figure 2A) demonstrated a large tumour in the apical lobe of the right posterior lung with an associated large infra/supraclavicular nodal mass. The fine needle aspirate revealed an adenocarcinoma. MRI spine (figure 2B) revealed diffuse bone metastases and a soft tissue mass encroaching on the thecal space at S2 level.The patient declined chemotherapy but was agreeable to palliative radiation therapy (RT). Hypofractionated RT (16 Gray, 2 fractions) was delivered to his right upper chest and singlefraction RT (8 Gray) targeted towards the bone lesions. Figure 1 An unusually shaped large mass protruding from the patient's infra/supraclavicular region. There is also an associated area of local skin involvement (red arrow).

Background: Peer to peer learning is a well-established learning modality which has been shown to improve learning outcomes, with positive implications for clinical practice. Surgical students from across Ireland were invited to upload learning points daily while paired with their peers in a peer-reviewing process. This study was designed to assess content accuracy and evaluate the benefit of the review process. Method: A reflective content sample was selected from the database representing all gastrointestinal (GI) surgical entries. All questions and answers were double corrected by four examiners, blinded to the "review" status of the entries. Statistical analysis was performed to compare accuracy between "reviewed" and "non-reviewed" entries. Results: There were 15,569 individual entries from 2009-2013, 2977 were GI surgery entries; 678 (23%) were peer reviewed. Marked out of 5, accuracy in the reviewed group was 4.24 and 4.14 in the nonreviewed group. This was not statistically different (p = 0.11). Accuracy did not differ between universities or grade of tutors. Conclusion: The system of student uploaded data is accurate