Tutorial 17th. November 2014

17 November 2014.

Website.
Contact us.

1.	How to prepare	17	November	2014
2.	RCOG sample obstetric SBA	17	November	2014
3.	RCOG sample gynaecological SBA	17	November	2014
4.	Mode of inheritance EMQ	17	November	2014
5.	Cancer staging EMQ	17	November	2014

How to prepare.

This is on the website:

http://www.drcog-mrcog.info/MRCOG%20how%20to%20pass_first_time.htm.

You need to start thinking about OSCE preparation. Read the stuff on the website about communication skills and start practising.

I mentioned the Bolton OSCE course and its particular merits. What I had not checked was its pass rate, which was 100%.

This is even better than the 90% for those who used the tutorials.

Practice SBAs from the RCOG website.

We went through the sample SBAs from the RCOG website. These tend to turn up in the exam, so make sure you can answer them.

You will learn most by answering the questions before reading the answers.

I put them on to highlight the fact that most of the EMQs and SBAs will come from guidelines, both Green-tops and NICE, SIPs and other stuff from the RCOG website and recent TOG articles.

You can find the sample SBAs here:

https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-2-mrcog/format/part-2-mrcog-sbas-single-best-answer-questions/.

EMQs.

I chose these EMQs to make a couple of points: last-minute revision and having a good revision system.

Detail such as cancer staging tends to fade fast from memory, highlighting the need to have a week before the exam for last-minute revision.

You can't start doing a lot of new work at this time - do it now, so that you are revising it then.

Information such as rare syndromes is also hard to remember - you need a good revision system so that you can go over it time and again until it sticks.

Send you answers for the following and I will send mine.

Ca Cx staging.

Lead-in.

The following scenarios relate to cervical cancer staging.

For each, select the most appropriate staging.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Scenario 1.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 2 mm and 6 mm in width. The resection margins are tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 2.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The resection margins are tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 3.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The resection margins are not tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 4.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 6 mm and 3 cm in width. The resection margins are tumour-free. There is no evidence of extension outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 5.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 6 mm and 5 cm in width. The resection margins are tumour-free. She is nulliparous and wishes to retain her fertility.

Scenario 6.

A woman of 38 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 4 mm and 6mm in width. The resection margins are tumour-free. An MR scan shows involvement of the lymphatic nodes in the left of the pelvis.

Scenario 7.

A woman of 45 has carcinoma of the cervix. It extends into the parametrium, but not to the pelvic side-wall. It involves the upper 1/3 of the vagina. There is MR evidence of para-aortic node involvement.

Scenario 8.

A woman of 55 has carcinoma of the cervix. It extends to the pelvic side-wall. It involves the upper 1/3 of the vagina. She has a secondary on the end of her nose.

Scenario 9.

A woman of 55 has carcinoma of the cervix. It involves the bladder mucosa.

Scenario 10.

A woman of 35 has a proven cancer of the cervix with extension into the right parametrium, but not to the pelvic side-wall. Left hydroureter and left non-functioning kidney are noted on IVP and there is no other explanation for the findings. Cystoscopy shows bullous oedema of the bladder mucosa.

Scenario 11.

A woman of 25 has a cone biopsy. It shows malignant melanoma. The lesion invades to a depth of 3 mm and is 5 mm in width. The margins of the biopsy are clear. There is evidence of lymphatic vessel involvement. There is no evidence of spread outside the uterus.

Option list.

Micro-invasive cervical cancer.

Stage Ia1

Stage Ia2

Stage Ia3

Stage Ib1

Stage Ib2

Stage Ib3

Stage IIa

Stage IIb

Stage IIc

Stage IIIa

Stage IIIb

Stage IIIc

Stage IVa

Stage IVb

Stage IVc

Stage Va

Stage Vb

Stage Vc

None of the above.

This question illustrates the problems surrounding staging. If you are not a cancer specialist, it is not something that you think about very often, if ever. So you have to put it into your list of things to revise in the days before the exam. If you haven’t started this list, do so now.

Mode of inheritance.

Lead-in.

The following questions relate to the mode of inheritance – some not quite to “mode”, but I am sure you will indulge me!

For each question, write what you think is the mode of inheritance or appropriate answer. There is no option list.

Comment.

You are expected to know a lot of basic genetics and it is hard to remember the details. A list to go over in the days before the exam makes sense. Use this one and add anything else you can think of – and let me know of your additions so I can add them to this list. Don’t add a load of rare syndromes – you will just end up confused. But add anything that you know has featured in the exam.

List of questions.

1.       achondrogenesis.

2.       achondroplasia.

3.       acute fatty liver of pregnancy (AFLP).

4.       adreno-genital syndrome

5.       adult polycystic kidney disease.

6.       androgen insensitivity syndrome.

7.       albinism.

8.       Angelman syndrome.

9.       Apert syndrome.

10.   Becker muscular dystrophy.

11.   Beckwith-Wiedemann syndrome.

12.   BRCA 1.

13.   BRCA2.

14.   Cavanan syndrome.

15.   Charcot-Marie-Tooth disease.

16.   chondrodystrophy.

17.   Christmas disease.

18.   congenital adrenal hyperplasia.

19.   Cowden syndrome.

20.   cri-du-chat syndrome. 

21.   cystic fibrosis.

22.   Dandy-Walker syndrome.

23.   developmental dysplasia of the hip.

24.   Down’s syndrome.

25.   Duchenne muscular dystrophy

26.   Dwarfism. See isolated growth hormone deficiency.

27.   Edward’s syndrome.

28.   exomphalos.

29.   Ehlers-Danlos syndrome

30.   Fanconi anaemia

31.   Fitz-Hugh-Curtis syndrome.

32.   Fragile X syndrome.

33.   galactosaemia.

34.   gastroschisis.

35.   glucose-6-phosphatase deficiency. G6PD.

36.   glucose-6-phosphate dehydrogenase deficiency. G6PDD.

37.   haemochromatosis.

38.   haemosiderosis..

39.   haemophilia A:

40.   haemophilia B:

41.   Hunter syndrome.

42.   Huntington’s disease.

43.   ichthyosis.

44.   isolated growth hormone deficiency.

45.   juvenile polycystic kidney disease.

46.   Kallmann’s syndrome.

47.   Klinefelter’s syndrome.

48.   Lesch Nyhan syndrome.

49.   Lynch syndrome (HNPCC).

50.   Malignant hyperthermia.

51.   Maple syrup urine disease. 

52.   Marfan’s syndrome.

53.   Martin-Bell syndrome.

54.   Mayer-Rokitansky-Kuster-Hauser syndrome.

55.   McCune-Albright syndrome.

56.   Meckel-Gruber syndrome.

57.   Medium-chain acyl-CoA dehydrogenase deficiency.

58.   mucopolysaccharidosis type I.

59.   Myotonic dystrophy.

60.   neurofibromatosis.

61.   Niemann-Pick disease.

62.   Noonan syndrome.

63.   ocular albinism.

64.   osteogenesis imperfecta.

65.   osteoporosis.

66.   Patau’s syndrome.

67.   Perrault syndrome.

68.   phenyketonuria.

69.   polydactyly.

70.   porphyria.

71.   Potter’s syndrome.

72.   Prader-Willi syndrome. 

73.   Prune-belly syndrome

74.   pyruvate kinase deficiency.

75.   sickle cell disease.

76.   spherocytosis.

77.   Syndrome X.

78.   Tay-Sach’s disease.

79.   Thalassaemia.

80.   Thrombophilia.

81.   Triple X syndrome.

82.   Turner’s syndrome.

83.   Swyer’s syndrome.

84.   Uniparental disomy.

85.   VACTERL.

86.   vitamin D resistant rickets

87.   von Willebrand’s disease.

88.   A mother has spina bifida. What is the risk of a child being affected? 

89.   A mother has had a child with spina bifida, what is the risk of the next child being affected?  

90.   A mother has had two children with spina bifida. What is the risk of the next child being affected?

91.   A mother has grand-mal epilepsy. What is the risk of her child having epilepsy?

92.   A mother and her partner both have grand-mal epilepsy. What is the risk of their child having epilepsy?

93.   A mother has insulin-dependent diabetes mellitus. What is the risk of a child being affected?

94.   A mother has congenital heart disease. What is the risk of a child being affected? 

95.   A mother takes lithium for bi-polar disorder throughout her pregnancy. What is the risk of the child having congenital heart disease?

96.   A mother has a nuchal translucency scan at 11 weeks. The result is 6 mm. What is the risk of the fetus having congenital heart disease?