Tutorial 27th. September 2012

Tutorial 27th. September 2012
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We started with a role-play about PMB and then had two vivas:
    Discuss the recent changes in relation to immunisation and screening for cervical cancer.
    You have been asked to write a protocol. Discuss how you would go about it. 

The candidate's instructions for the roleplay were:

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.

Your task is to take an appropriate history and advise her about the investigations you feel are appropriate.

Referral letter from the General Practitioner.

Manor Lodge,

High Street,

Bestown.

BE5 S00

Re: Mrs. Mary Smith,

5b High Street,

Bestown.

BE5 SO1

Dear Doctor,

Please see Mrs. Smith who has had bleeding.

Yours sincerely,

James Fewords,

General Practitioner.

Tutorial 24th. September 2012

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Tonight we only managed to get through one station.
A station has come from time to time on how to deal with the various reports that a consultant receives.

Laboratory results.

Your consultant is on annual leave.

Her secretary has asked you to look through the following results and decide what action should be taken in relation to each.

+ve MSSU at booking. No symptoms.

GTT at 34 weeks. Peak level 11.5.

FBC with ­ MCV at booking.

Thrombocytopenia at booking. 50,000.

Hydatidiform mole after evacuation of suspected miscarriage.

Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.

Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.

Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.

Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.

HVS: trichomonas.

Clue cells on smear. 12/52 pregnant.

Antenatal discharge: endocervical swab: chlamydia

Actinomyces on smear.

Herpes in pregnancy

Severe dyskaryosis on cervical smear at booking.

Primary infertility: FSH & LH ­ both 25 on day 3 of cycle.

Primary infertility. FSH 3, LH 12 on day 3 of cycle.

Treated with cabergoline for ­ prolactin and pituitary adenoma.

+ve beta HCG.

3 cm. ovarian cyst. Elevated ­ Ca 125.

Send your version and I'll send mine.

Tutorial 20 September 2012

Tutorial 20 September 2012
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Tonight we had labour ward scenario 2, then a critique of the RCOG's patient information leaflet about genital herpes and finally a role-play.
The genital herpes document is here: http://www.rcog.org.uk/genital-herpes-pregnancy-information-for-you.
The roleplay was: 

"Break bad news. Primigravida. 8 weeks. Some bleeding. Scan =  IUP. CRL = 12 mm. No fetal heart activity. Counsel". 

Scenario 2.

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		26 weeks. Admitted with severe abdominal pain
8	Mrs H	Para 2+1		39 weeks. In early labour.
9	Mrs I	Para 1+0		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		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.