Thursday, 3 October 2019

Tutorial 3rd. October 2019




30
Role-play. Sterilisation request.
31
Viva. Waiting list prioritisation
32
Role-play. Fraser guidelines
33
Viva. Clinical governance

30. Roleplay.  Sterilisation request.
Candidate’s Instructions.
You are a 5th. year SpR. You are about to see Mrs. Mary Fecund in the gynaecology clinic. There is a referral letter from the GP.
Read the letter and then conduct the consultation with Mrs. Fecund as you would do in the clinic in your hospital.
Referral letter.
Perfect Health Centre,
Paradise Lane,
Slagheap. SLH 678.
Your ref: BRI 07/54843.
Re. Mary Fecund,
The Shoe,
High Street,
Slagheap.
Dear Doctor,
Please see Mrs Fecund who has too many children. She wishes to be sure she has no more and has asked to be sterilised – one of her friends was sterilised recently which has put her in the mood to have it done.
Yours sincerely, Dr. John Williams.

31. Structured discussion.  Waiting list prioritisation.
Candidate’s instructions
Your consultant is away. The waiting-list manager comes to see you.
The following patients have been listed by junior staff.
The waiting-list manager wants you to:
confirm the appropriateness of the proposed treatment,
decide the degree of urgency,
confirm the appropriateness of the proposed venue,
decide any special requirement(s) for each patient.
Name    Age         Clinical problem                                         Proposed operation
JK
5
chronic discharge.
? foreign body
EUA
JM
32
1ry. infertility
Laparoscopy + tubal patency tests
GN
77
Vulval cancer. Coronary thrombosis x 2. Unstable angina.
Radical vulvectomy agreed at MDT.
RU
55
PMB x1. BMI 35.
D&C.
LD
32
Menorrhagia. Fibroids. Anaemia.
Vaginal hysterectomy.
DT
22
Does not want children.
Lap. Steril.
HB
14
Unwanted pregnancy at 10/52.
TOP
JY
44
GSI.
Anterior colporrhaphy.
JS
23
Discharge. Cervical ectropion.
Diathermy to cervix.
DT
55
3 cm. ovarian mass.
Laparoscopy ? proceed to Hyst + BSO.
EV
32
CIN3.
Cone biopsy.
UW
34
Endometriosis
Laparoscopic ablation
HT
88
Cystocoele/ rectocoele/ 2nd. degree uterine prolapse
Manchester Repair.

KN
58
Haematuria
Cystoscopy
JW
18
Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.
Hysterectomy
TB
30
Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.
Vaginal hysterectomy and repair.
BM
55
Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin.
Wertheim’s hysterectomy.
NU
60
Recurrent rectocoele.
Posterior colporrhaphy.

32. Role-play. Fraser guidelines
You are the SpR on call for gynaecology. You have had a call from the main reception desk of the hospital. Margaret Barcode has come to the desk asking for details of Jenny, her daughter. Jenny was admitted earlier in the day for TOP and has been kept overnight as she bled more than usual during the procedure. When Jenny first attended the hospital she stated that she did not want her parents involved in any way as they did not know she was pregnant. She was clearly intelligent and ‘Fraser-competent’, so this was agreed. She arranged with Anne, one of her friends, to stay at Anne’s home and Anne’s mother had accompanied her to all her visits. Mrs Barcode had had a query from Jenny’s school about some minor matter and it had come to her attention that Jenny was not at school. When she phoned Anne’s mother, she had been evasive but had let it slip that she was in hospital. She refused to give any details, saying that Jenny had sworn her to secrecy.
You phoned the child protection lead and the hospital lawyer. Both are in meetings and not available for a couple of hours. You have spoken to your Consultant who said he knows no more than you about such matters and told you to go to the reception area and use your wits to deal with the matter.


33. Structured discussion. Clinical governance.
Candidate’s instructions.
This is a structured clinal discussion station about clinical governance. The examiner will ask you 5 questions.
When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.


Monday, 30 September 2019

Tutorial 30th. September 2019


Website



28
Role-play. Explain, dyskaryosis, dysplasia, CIN etc.
29
Viva. Laboratory results
30
Role-play. Sterilisation request.
31
Viva. Waiting list prioritisation
32
Viva. Clinical governance

28. Roleplay.  Explain, dyskaryosis, dysplasia, CIN etc..
Candidate's Instructions.
This is a role-play station. You are a 4th. year SpR.
Jane Smith is a 1st. year student nurse who has joined the department. She has heard the following terms used in the gynaecology and colposcopy clinics:
mild, moderate and severe dyskaryosis in relation to cervical smears,
mild, moderate and severe dysplasia and CIN 1 – 3,
simple, complex and atypical endometrial hyperplasia,
She would like to know what they mean and their significance as the explanations given by the medical staff in the clinics were not clear and patients asked her for clarification. Her knowledge was insufficient for her to provide this, which she found very unsatisfactory for the patients and her. Your consultant has delegated the explanation to you.

29. Structured discussion. Laboratory results.
Candidate’s instructions.
Your consultant is on annual leave.
Her secretary has asked you to look through the following results and decide what administrative action should be taken in relation to each.
1.     +ve MSSU at booking. No symptoms.
2.     GTT at 34 weeks. Peak level 11.5.
3.     FBC with ­ MCV at booking.
4.     Thrombocytopenia at booking. 50,000.
5.     Hydatidiform mole after evacuation of suspected miscarriage.
6.     Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.
7.     Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.
8.     Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.
9.     Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.
10.   HVS: trichomonas.
11.   Clue cells on smear. 12/52 pregnant.
12.   Antenatal discharge: endocervical swab: chlamydia
13.   Actinomyces on smear.
14.   Herpes in pregnancy
15.   Severe dyskaryosis on cervical smear at booking.
16.   Primary infertility: FSH & LH ­ at 25 on day 3 of cycle.
17.   Primary infertility. FSH 3, LH 12 on day 3 of cycle.
18.   Treated with cabergoline for ­ prolactin and pituitary adenoma. +ve beta HCG.
19.   3 cm. ovarian cyst. ­ Ca 125.

30. Roleplay.  Sterilisation request.
Candidate’s Instructions.

You are a 5th. year SpR. You are about to see Mrs. Mary Fecund in the gynaecology clinic. There is a referral letter from the GP.
Read the letter and then conduct the consultation with Mrs. Fecund as you would do in the clinic in your hospital.
Referral letter.
Perfect Health Centre,
Paradise Lane,
Slagheap. SLH 678.
Your ref: BRI 07/54843.
Re. Mary Fecund,
The Shoe,
High Street,
Slagheap.
Dear Doctor,
Please see Mrs Fecund who has too many children. She wishes to be sure she has no more and has asked to be sterilised – one of her friends was sterilised recently which has put her in the mood to have it done.
Yours sincerely, Dr. John Williams.

31. Structured discussion.  Waiting list prioritisation.
Candidate’s instructions
Your consultant is away. The waiting-list manager comes to see you.
The following patients have been listed by junior staff.
The waiting-list manager wants you to:
confirm the appropriateness of the proposed treatment,
decide the degree of urgency,
confirm the appropriateness of the proposed venue,
decide any special requirement(s) for each patient.
Name    Age         Clinical problem                                         Proposed operation
JK
5
chronic discharge.
? foreign body
EUA
JM
32
1ry. infertility
Laparoscopy + tubal patency tests
GN
77
Vulval cancer. Coronary thrombosis x 2. Unstable angina.
Radical vulvectomy agreed at MDT.
RU
55
PMB x1. BMI 35.
D&C.
LD
32
Menorrhagia. Fibroids. Anaemia.
Vaginal hysterectomy.
DT
22
Does not want children.
Lap. Steril.
HB
14
Unwanted pregnancy at 10/52.
TOP
JY
44
GSI.
Anterior colporrhaphy.
JS
23
Discharge. Cervical ectropion.
Diathermy to cervix.
DT
55
3 cm. ovarian mass.
Laparoscopy ? proceed to Hyst + BSO.
EV
32
CIN3.
Cone biopsy.
UW
34
Endometriosis
Laparoscopic ablation
HT
88
Cystocoele/ rectocoele/ 2nd. degree uterine prolapse
Manchester Repair.

KN
58
Haematuria
Cystoscopy
JW
18
Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.
Hysterectomy
TB
30
Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.
Vaginal hysterectomy and repair.
BM
55
Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin.
Wertheim’s hysterectomy.
NU
60
Recurrent rectocoele.
Posterior colporrhaphy.

32. Structured discussion. Clinical governance.
Candidate’s instructions.
This is a structured clinal discussion station about clinical governance. The examiner will ask you 5 questions.
When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.