Thursday, 12 October 2017

Tutorial 12th. October 2017



Website





14
Viva. Hydatidiform mole. Genetics.
15
Viva. Laboratory results
16
Viva. Breastfeeding
17
Roleplay. Teach breech delivery to new trainee
18
Roleplay. Pre-pregnancy counselling. Phenylketonuria

14. Viva. Hydatidiform mole.
Candidate’s instructions.
This is a viva. Tell the examiner what you know about the genetics of hydatidiform mole & placental site trophoblastic tumour. The examiner will just listen and not guide you in any way.

15. Viva. 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.

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

17. Roleplay. Teach breech delivery to new trainee .
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is still unusually quiet. The on-call consultant has been told that you did a brilliant job of explaining normal labour and delivery. She has asked you to explain vaginal breech delivery to a new FY2, who is keen on a career in O&G.

18. 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.


Monday, 9 October 2017

Tutorial 9th. October 2017


Website



9 October 2017
17
Viva. Obstetric surveillance systems
9
Oct
2017
18
Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.
Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.
9
Oct
2017
19
Role-play. Hydatidiform mole.
9
Oct
2017
20
Viva. Laboratory results
9
Oct
2017
21
Viva. Breastfeeding
9
Oct
2017

17. Obstetric Surveillance Systems.
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.

18. Breaking bad news. Bleeding in early pregnancy.
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.

19. Hydatidiform mole.
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.

20. 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.

21. Breastfeeding.
Candidate’s instructions.
This is a viva station.
The examiner will ask you 7 questions.


Thursday, 28 September 2017

Tutorial 28th. September 2017


Website


8
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance etc.
9
Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
10
Viva. The uses of MgSO4 in O&G.
11
Viva. Labour ward scenario 1.

8. Basic “blurbs”.
There are a lot of chunks of text that come up time and again when chatting to patients. It is good to get these practised so that you can deliver them quickly and efficiently and not miss important points. An absolute basic is the GP referral letter. Likewise basic pre-pregnancy counselling, which gets and extra mark or two in any appropriate station.

9. Roleplay. Pre-pregnancy counselling.
Candidate's Instructions.
You are the SpR in the gynaecology clinic. You have been asked to see Jenny Williams, who has come for pre-pregnancy counselling.

Letter from the General Practitioner.
5 High Street,
Deersworthy,
Kent.
DO9 1JY.

Re Mrs. J. Williams,
Manor Place,
Deersworthy.
Dear Dr.,
Please see this woman who is planning pregnancy. I understand that her sister has had a baby with Down’s syndrome.
Regards,
Dr. Jolly.

10. Roleplay. Magnesium sulphate in O&G.
Candidate’s instructions.
This is a viva station about the uses of MgSO4 in O&G.
The examiner will not ask questions, prompt or otherwise assist. It is up to you to give as full an account of the uses as you can muster.

11. Roleplay. Labour Ward Scenario 1.
Candidate's Instructions.
You are the senior trainee and are starting your shift on the labour ward. Explain to the examiner how you will prioritise the patients, allocate staff and the reasons for your decisions.

1
Mrs JH
Primigravida. T+8. In labour. 6 cms.
2
Mrs AH
Primigravida at T. In labour. 5 cms.
3
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4
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.
5
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
6
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
8
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.
9
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.

1
Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2
Ms AS
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.





Monday, 18 September 2017

Tutorial 18th. September 2017




18 September 2017
1
How to prepare. Picking a course. Communication skills. Study partner
2
What topics did not feature in the part 2 and might be expected in the part 3?
3
Urodynamics, CTG interpretation, Statistics, Paper critique
4
Barriers to communication. What communication barriers exist between me and those attending the tutorial? We can use this as a basis to consider the communication problems between us, patients and colleagues.
5
Viva. The examiner will ask you 2 questions about the part 3 exam.
6
Role-play. How to introduce oneself.
7
Role-play. Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.

1. Background information.
How to prepare. Picking a course. Communication skills. Study partner

2. Trying to ‘spot’ topics.
What topics did not feature in the part 2 and might be expected in the part 3?

3. Specialist tutorials we can arrange if there is enough interest.
Urodynamics, CTG interpretation, Statistics, Paper critique

4. Barriers to communication.
Good communication skills are essential for the Part 3. A starting point is to work out likely barriers to good communication in any situation.

5 Role-play.
Candidate's Instructions.
You need to know the format of the exam. The examiner will ask you 2 questions about it.

6. Role-play.
Candidate's Instructions.
It is essential to get Role-plays off to a fluent start, something that needs preparation and practice. We will cover the key aspects. There is additional advice on the website.

7. Role-play.
Candidate's Instructions.
This is a roleplay station.
You are a year 4 SpR and are in the gynaecology clinic.
The consultant has just left you in charge as she is feeling unwell and has gone to lie down.
Your task is to deal with the patient as you would in real life.

GP referral letter.

Best Medical Centre,
High Road,
Anytown.
Phone: 01882 78998.

Practice Manager: Mary Wright. B.SC., RGN.
Phone: 01882 78998 ext. 23.

Re. Mrs. Bonnie Black,
25 Low Road,
Anytown.
DOB: 28 January 1990.
Phone: 07889 888 132.

Dear Doctor,
Please see Mrs Black who is planning her first pregnancy. Her main concern is that her brother has cystic fibrosis.
This was the first time I had met her although she has been registered with us for 5 years – her health is good and she has no history of serious illness or surgery.
I have explained that I don’t know much about the implications of the brother’s cystic fibrosis for her potential pregnancies and that she needs to talk to an expert. I have stressed that the risk of her having a child with cystic fibrosis is high and that she needs to be aware that there is a distinct likelihood that any pregnancy would be likely to be affected and need TOP.
Yours sincerely,
John P. Clatter.