Thursday, 18 September 2014

Tutorial 18 September 2014

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OSCE topics. Autumn 2014


1.
How to prepare. Picking a course.
10
March
2014
2.
Barriers to communication. What communication barriers exist between me and the trainees attending the tutorial? We can use this as a basis to consider the communication problems between us, patients and colleagues.
10
March
2014
3.
Roleplay: how to introduce oneself.
10
March
2014
4.
Labour ward scenario 1.
10
March
2014
5.
Labour ward scenario 2.
10
March
2014
6.
Roleplay: Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.
10
March

Labour Ward Scenario 1. Sunday 13.00 hours.

Labour Ward.

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. Type 1 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.


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.

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