Tutorial 16 March

16 March 2015.

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We planned to do the following, but did not have time for number 9 - we will do it on Thursday.

6	Critique of GP letter.
7	Role-play. Healthy primigravida. 8 weeks. Some bleeding. Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.
8	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
9	Viva station. You are a year-4 SpR and have been asked by your consultant to assess Mrs Mimi Dresden on the orthopaedic ward. She is 85 years old and has been admitted with a hip fracture after a fall from the nursing home where she lives. She has Alzheimer’s disease. The nursing staff have noted blood on her underwear. The examiner will ask you a series of questions:    what history will you take?    what examination will you perform and your reasoning?    what investigations will you arrange?    what management will you propose?

6. Critique of GP letter.

You have a 15 minute preparatory station to read the following letter and prepare yourself to deliver a critique to the examiner you will meet at the next station.

The examiner will not ask questions or guide you in any way. It is up to you to decide what you need to say.

GP letter.

The Medical Centre,

Green Lane,

Broadforth-on-Sea.

Your ref: BRI 07/54843.

Re. Jennifer Houseside,

45 The Maltings,

Broadforth-on-Sea.

Dear John,

It was wonderful to see you and Mary again on Saturday and so kind of you to invite us. The meal was up to Mary’s high standards and the company convivial. We may be getting older, but Mary’s fragrant beauty does not diminish.

Please see this woman who complains of unacceptably heavy periods. She is huge, malodorous and is more like a whale than a human being. One can see how the family name originated! I do not envy you the task if you feel that you have to examine her.

She is as stupid as she is fat. I doubt that she has more than one brain cell. If she has, they are not inter-connected. She talks incessantly and brings complete sense of the old adage “empty vessels make most sound”. Despite the vacuum in her cranium she is awash with idiotic ideas most of which she gets from her monumentally stupid mother. She is too thick for logical reasoning to have any impact on her ridiculous views – you might as well attempt a philosophical discussion with your dog.

The father is a dirty, unpleasant sort and I would not be surprised if incest had contributed to their low IQs. If the human race has advanced though evolution and natural selection, what on earth were their ancestors like?

They are social parasites. None of the family has ever worked and they live off Social Security payments. I have had the misfortune to have to do the occasional home visit to various members of the family. They live in disgusting squalor. If they were pigs their living conditions would give the species a bad name. Theirs are houses in which you wipe your feet on the mat as you leave and not as you enter and pray that you never have to visit again. I am sure the Court of Human Rights would regard a second visit as a cruel and unnatural punishment. They always ask you to sit, but I would not wish to ruin my clothes. Their hospitality also extends to offering cups of tea. Perish the thought! I would rather take my chance with neat hemlock.

Despite living on Social Security payments, they have the latest widescreen TVs and associated DVD equipment. The husband looks to me as though he indulges in low-level crime, probably shoplifting. He is a shifty character whom you would not trust and I strongly advise you to make sure that all valuables are locked up and out of sight when he or any of her family is around. One brother is in prison for theft to feed a heroin habit, which typifies the contribution this family makes to the greater good. Her sister is said to be a prostitute and I would think it true. Certainly she has a lot of children and I doubt that any of them have the same father or that she would be able to enlighten them as to who their fathers might be. She (the sister) is a regular visitor to the Sexually Transmitted Diseases clinic where she displays a surprising range of conditions needing treatment. She is a one-woman update course for the staff ensuring they are abreast of all aspects of STDs. I was going to say she was a one-woman refresher course, but there is nothing refreshing about her. The sister is as fat and ugly as my patient, making one marvel at the mentality of her clients. I cannot imagine how anyone would want to come within smelling distance of her, far less have sexual relations and pay for the privilege. Some exotic form of masochism, I guess.

I wish you well in your dealings with her and apologise for sending such an unpleasant lump to your clinic. This is a family that makes you wish the Abortion Act could be made retrospective!

Please do your best not to send her back to see me.

Yours sincerely,

7. Role-Play.

Candidate’s instructions.

You are the SpR on-call for the Early Pregnancy Unit. You have been called to see a patient. The phone message summoning gave you the following information:

“Healthy primigravida. Presents with some bleeding at 8 weeks. Scan = IUP. CRL = 12 mm. No fetal heart activity”.

Your task is to counsel her as you would normally in the EPU.

8. Role-play. Booking clinic counselling.

Candidate’s instructions.

You are the SpR running the booking clinic – the consultant is on leave.

You have been asked to see Susan Sharpe who has attended for booking.

The GP letter reads as follows.

Dr. J. Mills,

25 High Street,

Lowtown.

Re: Mrs S. Sharpe, 28 High Street, Lowtown.

Please see Mrs. Sharpe who wants to talk about amniocenteses.

J. Mills.

Your task is to counsel her as you would such a patient in a booking clinic

9. Viva station.

Candidate’s instructions

You are a year-4 SpR and have been asked by your consultant to assess Mrs Mimi Dresden on the orthopaedic ward.

She is 85 years old and has been admitted with a hip fracture after a fall from the nursing home where she lives. She has Alzheimer’s disease. The nursing staff have noted blood on her underwear.

The examiner will ask you a series of questions:

   what history will you take?

   what examination will you perform and your reasoning?

   what investigations will you arrange and why?

   what management will you propose?