Monday, 24 April 2017

Tutorial 24th. April 2017

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24 April 2017

You need to go to the "Materials for the tutorials" folder on Dropbox to get the blank prescription form and the forest plot diagram.

36
Role-play. Write a prescription
37
Viva. Obstetric surveillance systems
38
Role-play. Cochrane & Forest plots
39
Role-play. Anencephaly. Does not want TOP.
40
Viva. Mayer–Rokitansky–Küster–Hauser syndrome

36. Role-play. Write a prescription
Candidate's instructions.
You have seen Mary Smith who wishes is trying to conceive. She has had a full work-up and has very infrequent periods. PCOS has been diagnosed. She is not overweight. You have discussed her treatment with the consultant and a trial of clomifene has been agreed.
Your task is to explain this to Mary and write her a prescription for a one-month supply.
Mrs. Mary Smith, DoB: 15 March 90.
5 Mansion Row,
Richtown.

37. Viva. Obstetric surveillance systems
Candidate's Instructions.
This is a viva station.
The examiner will ask you 2 questions about surveillance systems used in obstetrics.
The first question has 4 marks; the second 16 marks.
The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.

38. Role-play. Cochrane & Forest plots
Candidate’s instructions.
This is a viva about the Cochrane Collaboration.
The examiner will ask 8 questions and give one instruction.

39. Viva. Anencephaly.
Candidate’s instructions.
You are an SpR5 and running the ante-natal clinic – your consultant has been called to help a consultant colleague with an emergency on the labour unit and is not available for advice.
You are about to see Jean Hathersage. She is 25 years old and had a 10-week scan last week that showed anencephaly. She stated that she did not want TOP. She was counselled, given information leaflets and asked to return to the antenatal clinical today for further discussion.
It is your task to conduct that discussion.

40. Viva. Mayer–Rokitansky–Küster–Hauser syndrome
Candidate’s instructions.
This is a viva station about the Mayer–Rokitansky–Küster–Hauser syndrome.

The examiner will ask you 17 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.

Thursday, 20 April 2017

Tutorial 20th. April 2017

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20 April 2017

31
Viva. Enhanced recovery
32
Viva. Incomplete ECV audit
33
Role-play. Explain normal labour & delivery
34
Role-play. Teach vaginal breech delivery
35
Viva. Apgar score

31. Viva. Enhanced recovery.
Candidate's instructions.
You are a newly-appointed consultant.
The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery.
As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery.
She suspects that little is known by most of the staff about the subject and hopes that your talk will encourage their enthusiastic participation.
The examiner will ask you 9 questions pertinent to your talk.

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

33. Viva. Teach normal labour and delivery.
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

34. Viva. Teach breech delivery.
Candidate’s instructions.
You are an SpR5 and on duty of the labour ward. For once things are quiet and the consultant has asked you to teach a new FY1 about breech delivery.

35. Viva. Apgar score.
Candidate's Instructions.
This is a viva station.
The examiner will ask you 8 questions.

You are not allowed to return to earlier questions. You will not be awarded any marks if you do, even for correct answers.

Thursday, 13 April 2017

Tutorial 13th. April 2017

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13 April 2017

27
Viva. Headache
28
Role-play. Explain, dyskaryosis, dysplasia, CIN etc.
29
Viva. HPV immunisation programme
30
Viva. Critique RCOG’s Pt. Info leaflet on Genital Herpes.


27. Viva. Headache
Candidate's Instructions.
This is a viva station.
The examiner will ask a series of questions.

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. Viva. Routine HPV immunisation.
Candidate’s instructions.
This is a viva station about the UK programme for routine HPV immunisation.
The examiner will ask you 4 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.


30. Viva. Critique RCOG’s Pt. Info leaflet on Genital Herpes.

Monday, 10 April 2017

Tutorial 10th. April 2017

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10 April 2017
23.
24
Role-play. Fragile X syndrome

25
Viva. Diathermy

26
Role-play. Teach an FY1 the basics of audit



Candidate’s instructions.
Monday. 0900 hours.  You have just come on duty.
1
Mrs A
Para 0+0
25 yrs
41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG
2
Mrs B
Para 1+2
31 yrs
28 weeks. Just admitted. "Show" + contractions
3
Mrs C
Para 5+3
40 yrs
In labour 8 hours. Cx 6 cm. dilated
4
Mrs D
Para 1+3
27 yrs
37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section.
5
Mrs E
Para 1+2
32 yrs
40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours.
6
Miss F
Para 0+0
15 yrs
34 weeks. Concealed pregnancy. In labour. Just admitted. Breech presentation
7
Mrs G
Para 1+2
34  yrs
26 weeks. Admitted with severe abdominal pain
8
Mrs H
Para 2+1
32  yrs
39 weeks. In early labour.
9
Mrs I
Para 1+0
29 yrs
Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery
10
Mrs J
Para 1+0
30 yrs
Normal delivery + PPH >1,500 ml. one hour ago

Medical staff:
Consultant:                      in his Rooms.
You:                                   Registrar.
Foundation Year 2          six months’ experience.
Registrar in anaesthetics.
Midwifery staff:
Senior Sister.
Two staff midwives.
One community midwife.
Two student midwives.

24. Roleplay. Fragile X syndrome.
Candidate's Instructions.
You are about to see Mary White who has been booked in with her first pregnancy by the midwife in the antenatal clinic. The midwife has asked you to see her as Mary has told her that there is a family history of Fragile X syndrome.
Your task is to discuss Fragile X syndrome and the implications for Mary, the pregnancy and her father.

25. Viva. Diathermy
Candidate's Instructions.
This is a viva station about diathermy and its uses and complications.
The examiner will ask you 8 questions.

26. Role-play. Teach an FY1 the basics of audit.
Candidate’s instructions.
You are the SpR on call for the labour ward.
It is a quiet afternoon: all the patients are healthy and in normal labour.
Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination.
A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it.
Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.


Thursday, 6 April 2017

Tutorial 6th. April 2017

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6 April 2017
19.
Role-play. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s
20.
Role-play. Abnormal cervical smear.
21.
Role-play. Neonatal screening.
22.
Viva. Clinical governance and the labour ward

19. Role-play. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s
Candidate's Instructions.
You are the SpR in the pre-pregnancy counselling clinic.
Mary Smith has been referred.
The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”
Your task is to take a history and advise about appropriate investigations.

20. Roleplay. Abnormal cervical smear.
Candidate's Instructions.
This is a role-play station.
You are the SpR in the colposcopy clinic.
The patient is attending after a smear showed severe dyskaryosis.
Your tasks are to take a history and explain the management you propose

21. Role-play. Neonatal screening.
Candidate’s instructions.
You are a SpR in year 5.
You are in the antenatal booking clinic and about to see Mary Eccles. She has been booked by a midwife at 10 weeks’ gestation and all is well. She has recently arrived in the UK from the USA and asked about the routine neonatal screening that is done in the UK. She will be having the baby in the UK.

22. Viva. Clinical governance and the labour ward
Candidate's Instructions.
This is an unstructured viva. Your task is to explain to the examiner the key issues in relation to clinical governance and the labour ward.



Monday, 3 April 2017

Tutorial 3rd. April 2017

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3 April 2017
14.
Roleplay. Booking. Previous SB
15.
Viva. Breastfeeding
16.
Roleplay. Pre-pregnancy counselling. Phenylketonuria
17.
Viva. UTI & pregnancy

14. Role-play. Booking. Previous SB.
Candidate's Instructions.
This is a roleplay station.
You are an SpR in the booking clinic. You are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn.
She has had all the routine booking, including investigations, dealt with by the midwife who has asked you to see her to advise about her first pregnancy and its implications for the management of this pregnancy.
Take an appropriate history, advise about the necessary investigations and how the history of stillbirth will influence the management of the pregnancy.

15. Viva. Breastfeeding.
Candidate’s instructions.
This is a viva station about breastfeeding.
The examiner will ask you 7 questions.

16. Role-play. Phenylketonuria.
Candidate’s instructions.
You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic.
You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy.

The GP letter reads:
Prime Health Practice,
Primetown,
Sussex.
0298766543.
Practice Manager:
Mrs Willhelmina Bland.

Dear Doctor,
Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice.
I look forward to receiving your expert report.
Dr. John Worthy.

17. Viva. UTI.
Candidate’s  instructions.
This is a viva station.
The examiner will ask you 8 questions about UTI & pregnancy.


Thursday, 30 March 2017

Tutorial 30th. March 2017

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30 March 2017
10.
Role-play. Primigravida. 8 weeks. Some bleeding.
Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.
11.
Viva. Critique of Menozac website
12.
Viva. Laboratory results
13.
Roleplay. PMB

10. Role-play. Bleeding in early pregnancy.
Candidate's Instructions.
This is a role-play station. The role-player will act as the patient. An examiner will be present.
You are the SpR in the ante-natal clinic. The Consultant who was in clinic has been asked to assist her Consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary.
One of the midwives asks you to see a patient who has just had a scan in the EPU.
She is primigravid and the gestation is 8 weeks. She has had some bleeding.
An ultrasound scan = IUP. CRL = 12 mm. No fetal heart activity. No adnexal masses.

11. Critique of website.
Your task is to read the extract from the Menozac website, prepare a critique and present it to the examiner. The examiner will not prompt or help you in any way.

12. 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.

13. Roleplay. PMB.
Candidate’s Instructions.
You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.
A 55 year old woman is referred by her General Practitioner.
Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.

Referral letter from the General Practitioner.

Manor Lodge,
High Street,
Bestown.
BE5 S00

Re: Mrs. Mary Smith,   Age 55.
5b High Street,
Bestown.
BE5 SO1

Dear Doctor,
Please see Mrs. Smith who has had bleeding down below. It is a number of years since she reached the menopause.
Yours sincerely,
James Fewords,
General Practitioner.