Monday, 23 May 2016

Tutorial 23rd. May 2016

Website.

23 May 2016.

1
How to prepare
2
SBA. RCOG sample obstetric
3
SBA.  RCOG sample gynaecological
4
Basic communication skills
5
SBA. Placenta accreta, increta & percreta
6
EMQ. Antenatal steroids.

1.  How to prepare.
1st. time and repeat candidates
Advice on website
         “How to pass first time”
         Section called “topics like "CNST" & communication”
Study buddy
Going on a course
2.  RCOG sample obstetric SBAs.
3.  RCOG sample gynaecological SBAs.
4.  Basic communication skills.
Things to start practising:
         introducing yourself & anyone else present
         finding out what a woman knows about a subject
         encouraging questions
5. SBA. Placental accreta, increta and percreta.
This topic has been chosen to remind you of the existence of UKOSS and the various Reports it has produced as they would make perfect EMQs or SBAs.
Abbreviations.
Creta:      term to describe accreta, increta or percreta.
PET:         pre-eclampsia
PIH:          pregnancy-induced hypertension
Question 1.
Lead-in
Choose the best option from the option list for the definition of placenta accreta.
Option List
A.       
Placenta which is difficult to remove, but can be separated digitally
B.       
Placental villi  invade the decidua, but not the myometrium
C.       
Placental villi  invade the decidua and myometrium but not the serosa
D.       
Placental villi  invade the decidua, myometrium and serosa
E.        
Placental villi  invade adjacent organs, e.g. the bladder
Question 2.
Lead-in
Choose the best option from the option list for the definition of placenta increta.
Option List
A.       
Placenta is difficult to remove, but can be separated digitally
B.       
Placental villi  invade the decidua, but not the myometrium
C.       
Placental villi  invade the decidua and myometrium but not the serosa
D.       
Placental villi  invade the decidua, myometrium and serosa
E.        
Placental villi  invade adjacent organs, e.g. the bladder
Question 3.
Lead-in
Choose the best option from the option list for the definition of placenta percreta.
Option List

A.       
Placenta is difficult to remove, but can be separated digitally
B.       
Placental villi  invade the decidua, but not the myometrium
C.       
Placental villi  invade the decidua and myometrium but not the serosa
D.       
Placental villi  invade the decidua, myometrium and serosa
E.        
Placental villi  invade adjacent organs, e.g. the bladder
Question 4.
Lead-in
What is the approximate incidence of placenta creta in the UK?
Option List
A.       
1-2 per   1,000 deliveries
B.       
1-2 per   1,000 maternities
C.       
1-2 per   5,000 deliveries
D.       
1-2 per   5,000 maternities
E.        
1-2 per 10,000 deliveries
F.        
1-2 per 10,000 maternities
Question 5.
You need to be able to define “maternity” and know why it is important.
Lead-in
What is a “maternity”?
Option List
A.       
Any pregnancy, including ectopic pregnancy
B.       
Any pregnancy, excluding ectopic pregnancy
C.       
Any pregnancy resulting in a live birth
D.       
Any pregnancy resulting in live birth or stillbirth
E.        
Any pregnancy ending from 24 completed weeks plus any pregnancy resulting in a live birth.
Question 6.
Lead-in
Why is the term “maternity” important.
Option List
A.       
We should take best possible care of our pregnant patients
B.       
It is used as the denominator in calculations of the maternal mortality rate
C.       
It is used as the numerator in calculations of the maternal mortality rate
D.       
It is used as the denominator in calculations of the maternal mortality ratio
E.        
It is used as the numerator in calculations of the maternal mortality ratio
Question 7.
This question relates to risk factors for placenta accreta
Lead-in
Match each of the risk factors  listed below with an adjusted odds ratio from the Option List. Each option can be used once, more than once or not at all.
Note that some of the adjusted odds ratios show a reduced risk.
Risk factors and adjusted odds ratio.
Risk factor
Adjusted odds ratio
BMI > 30

Cigarette smoking in pregnancy

Ethnic group non-white

IVF pregnancy

Maternal age > 35

Parity ≥ 2

PIH or PET

Placenta previa diagnosed pre-delivery

Previous Caesarean section > 1

Previous Caesarean section x 1

Previous uterine surgery – not C. section





Option List
Adjusted odds ratio
0.53
0.57
0.66
0.9
1.0
2.0
3.06
3.4
3.48
10
14
16.31
32.13
65.02
102
Question 8.
Lead-in
This question relates to estimated incidence of placenta creta for various risk factors.
Match the risk factors with the estimated incidence in the option list. Each option can be used once, more than once or not at all.
Risk factors and estimated incidence per 10,000 maternities.
Risk factor
Estimated incidence
No previous C section

≥ 1 C section

Placenta previa not diagnosed pre-delivery

Placenta previa diagnosed pre-delivery

Previous C section but placenta previa not diagnosed pre-delivery

Previous C section + placenta previa diagnosed pre-delivery









Option List
0.3
0.6
1
3
5
9
108
577
1,000

6. EMQ. Antenatal steroids.
Antenatal steroids and the neonate.
Lead-in.
The following scenarios relate to antenatal steroid use and the neonate.
Option list.
There is no option list.
I want you to come up with your answers.
Scenario 1.
What are the benefits to the neonate of appropriate administration of antenatal steroids?
Scenario 2.
At what gestations should antenatal steroids be offered to women with singleton pregnancies who are at risk of premature labour?
Scenario 3.
At what gestations should antenatal steroids be offered to women with multiple pregnancies who are at risk of premature labour?
Scenario 4.
What advice is contained in the GTG in relation to very early gestations, threatened premature labour and the use of antenatal steroids.
Scenario 5.
What advice is contained in the GTG in relation to antenatal steroids and Caesarean section?
Scenario 6.
What advice is given in the GTG about ANS in relation to the fetus with FGR at risk of premature delivery?
Scenario 7
What advice is given in the GTG in relation to ANS for women with IDDM?
Scenario 8
What advice is in the GTG in relation to adverse effects of ANS on the fetus?
Scenario 9
What advice is in the GTG in relation to short-term maternal adverse effects?
Scenario 10
What contraindications to ANS are cited in the GTG?
Scenario 11
What is the recommended drug regime for ANS administration?
Scenario 12.
What is the time-scale for maximum effect of ANS in reducing RDS?
Scenario 13.
When should repeat courses of ANS be given?
Scenario 14.
When may antenatal steroids be beneficial to the fetus apart from accelerating lung maturation?







Monday, 2 May 2016

Tutorial 2nd. May 2016



2 May 2016

41
Roleplay. Complaint procedures
42
Roleplay. Forceps delivery
43
Viva. Bullying and harassment
44
Roleplay. Hydatidiform mole

41. Roleplay. Complaint procedures.
Candidate's instructions.
You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.
Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report had been filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20 week scan. The ultrasonographer found the report in the notes, realised that no action had been taken and sent her to see the midwife in the antenatal clinic. The midwife told her the result and made arrangements for the patient to see you today.

42. Role-play. Forceps delivery.
Candidate's Instructions.
This is a role-play station.
You are a year 5 SpR. It is a quiet day on the labour ward.
The consultant has asked you to instruct a new trainee in the use of forceps.

43. Viva. Bullying and harassment.
Candidate’s instructions.
This is a structured viva about bullying and harassment.
The examiner will ask you X questions.

44. Role-play. Hydatidiform mole.
Candidate's Instructions.
You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient.
She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks.
The histology report showed a complete mole.
The GP was contacted and asked to see her. An appointment was sent to her to attend today.
Your task is to take a history and explain the implications of the diagnosis.


Thursday, 28 April 2016

Tutorial 28th. April 2016


Website.
28 April 2016

39
Jenny Myers. Maternal medicine
40
Viva. Ureteric injury during gynaecological surgery
41
Roleplay. NHS Complaint procedures

Jenny is Senior Lecturer/Consultant Obstetrician at the University of Manchester and St. Mary’s Hospital, Manchester.

40. Viva. Ureteric injury during gynaecological surgery
Candidate's instructions.
This is a viva station about ureteric injury and gynaecological surgery.
The examiner will ask you 12 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.

41. Role-play. NHS complaint procedures.
Candidate's Instructions.
You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.
Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report had been filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20 week scan. The ultrasonographer found the report in the notes, realised that no action had been taken and made arrangements for the patient to see you today. 


Thursday, 21 April 2016

Tutorial 21st. April 2016



Website.

21 April 2016

33
Viva. Explain how to perform abdominal hysterectomy
34
Viva. Diathermy
35
Roleplay. Teach a FY1 about shoulder dystocia
36
Viva. Apgar score

33.   Role-play.
Candidate’ instructions.
This is an unstructured viva. The examiner will not ask questions or respond in any way. It is up to you to include what you think is important.

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

35. Viva.
Candidate's Instructions.
This is a role-play station about shoulder dystocia.
You are the on-call SpR for the labour ward.
It is fairly quiet, with only two patients, both of whom have uncomplicated normal labours.
There is a new FY1 and the consultant has asked you to teach the key aspects of shoulder dystocia.

36. Role-play.
Candidate's Instructions.
This is a viva station about the Apgar score.
The examiner will ask you 8 questions.


Monday, 18 April 2016

Tutorial 18th. April 2016

Website.


18 April 2016

29
Role-play. Mechanisms of normal labour & delivery.
30
Viva. Enhanced recovery.
31
Viva. Obstetric surveillance systems.
32
Roleplay. Abnormal cervical smear.

29. Role-play. Mechanisms of normal labour & delivery.
Candidate's Instructions.
Explain the mechanisms of normal labour and delivery to the role-player, who is a medical student and keen to learn how to do a normal delivery. Your consultant has said that she needs a clear understanding of the mechanisms before considering conducting a delivery.

30. 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.

31. Viva.
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.

32. Role-play.
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