Tutorial 17th. March 2017

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Contact us.

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.