Monday, 14 April 2014

Tutorial 14 April 2014

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Viva. Preparatory station. Incomplete audit on ECV and breech.
Viva. RCOG, GMC, NICE and BMA.
Roleplay: menorrhagia. Referral letter lost.
Viva. Breast feeding. Discuss the main issues relating to breastfeeding.

27. Incomplete audit.

Candidate’s instructions.

A colleague who has left the hospital was conducting an audit of ECV.
The audit is incomplete.

The data are:
Consultant A offered ECV to one group of women and had an 70% success rate,
Consultant B offered ECV to a different group and had a 30% success rate,
Consultant C did not offer ECV at all.

Tell the examiner how you would go about completing this audit.`

28. Topic. RCOG, GMC, NICE and BMA.

Candidate's Instructions.
This is a viva station about the RCOG, GMC, NICE and the BMA.
The examiner will ask you 2 questions about each: what they are and what their role is.

29. Candidate’s instruction.
You have been asked to see this woman in the gynaecology clinic.
The GP referral letter has been lost.
Your task is to take an appropriate history and advise about necessary investigations and the available treatment options.

30.  Candidate’s instructions.
This is a viva station about breastfeeding.
The examiner will ask you 6 questions.

Tutorial 13 April 2014

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This tutorial was to talk about the stations that caused problems on the Bolton course.
We had a morning session, stopped for lunch and then an afternoon session.
I saved the morning session before recording the afternoon one.
When I uploaded them later to Dropbox, I found that I had not saved the morning one correctly.
I have no idea what I did wrong - apologies if you were keen to hear it.

Among other things they had found the labour ward prioritisation difficult.
We discussed the following scenario to help clarify technique.
I have an answer to this station - send your answer and I'll  forward it.
You are given 15 minutes to prepare and then see the examiner with instructions that you will put the patients in priority order and decide which members of staff will see them.

Labour Ward Scenario 1.

Sunday 13.00 hours.

Labour Ward.

Mrs JH
Primigravida. T+8. In labour. 6 cms.
Mrs AH
Primigravida at T. In labour. 5 cms.
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
Mrs SB
Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Type 1 decelerations.
Mrs RJ
Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
Mrs KC
Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post operative cases who have been seen on the morning ward round and are stable. Husband of patient who has had Wertheim's hysterectomy asking to see a doctor for a report on the operation.

Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.

Midwifery staff:
Senior Sister.           Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.

Thursday, 10 April 2014

Tutorial 10 April 2014

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10th. April 2014.
Viva. Postnatal mental health
EMQ. Puerperal psychiatric disease.
Risk management: laparoscopic injury
Teach a FY1 about shoulder dystocia.

23. Topic. Postnatal mental health.
Candidate's Instructions.
This is a viva station about postnatal mental health.
The examiner will ask you 7 questions.

24. EMQ Puerperal psychiatric disease.
The following scenarios relate to puerperal mental illness.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
If I had put all the answers into the option list it would have been enormous. So there are quite a few where you need to decide what your answer would be. Opting for “none of the above” is not exercising your brain – make sure you come up with an answer.

Option list.
a.       arrange admission to hospital under Section 5 of the Mental Health Act
b.      send a referral letter to the perinatal psychiatrist requesting an urgent appointment.
c.       send an e-mail to the perinatal psychiatrist requesting an urgent appointment.
d.      phone the community psychiatric team.
e.      phone the on-call psychiatrist.
f.        arrange to see the patient in the next ante-natal clinic.
g.       arrange to see the patient urgently.
h.      send a referral letter to the social services department.
i.         phone the fire brigade.
j.        phone the police.
k.       there is no such thing.
l.         4 weeks
m.    6 weeks
n.      12 weeks
o.      26 weeks
p.      1 year
q.      <1%
r.        1-5%
s.       5-10%
t.        10-20%
u.      25%
v.       50%
w.     60%
x.       70%
y.       80%
z.       True
aa.   False
bb.  none of the above.

Scenario 1
What is the internationally agreed classification for postpartum psychiatric disease?
Scenario 2
What time limits does DSM-IV use for postpartum psychiatric disorders?
Scenario 3
What time limits does ICD-10 use pro postpartum psychiatric disorders?
Scenario 4
What clinical classification would you use in a viva or SAQ?
Scenario 5
What is the incidence of suicide in relation to pregnancy and the puerperium?
Scenario 6
What are the main conditions associated with suicide in pregnancy and the postnatal period?
Scenario 7
Most suicides occur in single women of low social class who have poor education. True / False
Scenario 8
The preferred method of suicide reported in the MMR was drug overdose.  True / False.
Scenario 9
When are women with Social Services involvement particularly at risk of suicide.
Scenario 10
Which women have the highest risk for puerperal psychosis and what is the risk?
Scenario 11.
What is the risk of puerperal psychosis for a primigravida with BPD?
Scenario 12
What is the risk of PP in a woman with no history of psychiatric illness but who has a FH of PP?
Scenario 13
Should screening include the identification of women with no history of psychiatric illness but who has a FH of PP?
Scenario 14
What do the Confidential Enquiries into Maternal Deaths say about the use of the term “postnatal depression”?
Scenario 15
Women with schizophrenia have a ≥ 25% risk of puerperal recurrence. True / False
Scenario 16
If lithium therapy for BPD is stopped in pregnancy, there is an increased risk of severe puerperal illness. True / False.

25. Viva. Laparoscopic injury.
In this station you will tell the examiner how the risk of injury during laparoscopic surgery and its consequences can be minimised.

26. Roleplay. Shoulder dystocia.
You have been asked by your consultant to teach an FY1 the key points about shoulder dystocia.