Thursday 31 March 2016

Tutorial 31st. March 2016



31 March 2016

You would have a 15 minute preparatory stations for questions 9 and 11.
9
Critique of Menozac website
10
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance etc.
11
Critique RCOG Pt. Info leaflet Genital Herpes.
12
Roleplay. PMB.
13
Viva. Pertussis & pregnancy.

9. Viva. Critique of Menozac website.
Candidate’s instruction.
You are to provide a critique of a website.
Then you have 15 minutes with the examiner to detail your critique.

10. Basic “blurbs”.
You need a number of basic texts that you can use without too much thought. Examples include setting the scene for breaking bad news, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance etc. Write some suitable headings.

11. Critique. The RCOG’s Patient Information Leaflet on genital herpes.

12. Role-play. PMB.
PMB. Role-play.
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.
A 55 year old woman is referred by her General Practitioner.
Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.

Referral letter from the General Practitioner.
Manor Lodge,
High Street,
Bestown.
BE5 S00

Re: Mrs. Mary Smith,   Age 55.
5b High Street,
Bestown.
BE5 SO1

Dear Doctor,
Please see Mrs. Smith who has had bleeding down below. It is a number of years since she reached the menopause.
Yours sincerely,
James Fewords,
General Practitioner.

13. Viva. Pertussis and pregnancy.
Candidate’s Instructions.

The examiner will ask you 5 questions.

Monday 21 March 2016

Tutorial 21st. March 2016



 21 March 2016

6
Viva. Abusive GP letter.
7
Role-play. Break bad news. 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 from the nursing home where she lives with a hip fracture after a fall. 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. Viva. Abusive GP letter.
Candidate’s instruction.
You are the SpR in the gynaecology clinic.
List the things that are wrong with this letter.
What action(s) would you take after seeing the patient with regard to the letter?

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. Breaking bad news.
Candidate's Instructions.
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.

8. Role-play. 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.
9. Viva.
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 4 questions.

6. Viva. Abusive GP letter.
Candidate’s instruction.
You are the SpR in the gynaecology clinic.
List the things that are wrong with this letter.
What action(s) would you take after seeing the patient with regard to the letter?

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. Breaking bad news.
Candidate's Instructions.
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.

8. Role-play. 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.
9. Viva.
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 4 questions.

Thursday 17 March 2016

Tutorial 17th. March 2017

Website.

17 March 2016
1
How to prepare. Picking a course.
2
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.
3
Role-play: how to introduce oneself.
4
Viva. Labour ward scenario 1.
5
Role-play: Healthy, nulliparous woman. Brother with cystic fibrosis. Pre-pregnancy counselling.

4. Viva. 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. 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.


5. Roleplay. Cystic fibrosis.
Candidate's Instructions.
You are the SpR running the pre-pregnancy counselling clinic. You have a GP referral letter relating to the patient you are about to see. You are to deal with the patient as you would in a real pre-pregnancy clinic.

GP Letter.
The Surgery,
High Street,
London.

Dear Doctor,
Please see Mary White who is planning her first pregnancy. Her brother has cystic fibrosis. I am not an expert in this subject but 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.
Regards,
Dr. N. O. Yews.