Tutorial 28th. April 2016

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28 April 2016

39	Jenny Myers. Maternal medicine
40	Viva. Ureteric injury during gynaecological surgery
41	Roleplay. NHS Complaint procedures

Jenny is Senior Lecturer/Consultant Obstetrician at the University of Manchester and St. Mary’s Hospital, Manchester.

40. Viva. Ureteric injury during gynaecological surgery

Candidate's instructions.

This is a viva station about ureteric injury and gynaecological surgery.

The examiner will ask you 12 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer.

If you return, no marks will be awarded, even for correct answers.

41. Role-play. NHS complaint procedures.

Candidate's Instructions.

You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.

Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report had been filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20 week scan. The ultrasonographer found the report in the notes, realised that no action had been taken and made arrangements for the patient to see you today. 

Tutorial 21st. April 2016

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21 April 2016

33	Viva. Explain how to perform abdominal hysterectomy
34	Viva. Diathermy
35	Roleplay. Teach a FY1 about shoulder dystocia
36	Viva. Apgar score

33.   Role-play.

Candidate’ instructions.

This is an unstructured viva. The examiner will not ask questions or respond in any way. It is up to you to include what you think is important.

34. Viva.

Candidate's Instructions.

This is a viva station about diathermy and its uses and complications.

The examiner will ask you 8 questions.

35. Viva.

Candidate's Instructions.

This is a role-play station about shoulder dystocia.

You are the on-call SpR for the labour ward.

It is fairly quiet, with only two patients, both of whom have uncomplicated normal labours.

There is a new FY1 and the consultant has asked you to teach the key aspects of shoulder dystocia.

36. Role-play.

Candidate's Instructions.

This is a viva station about the Apgar score.

The examiner will ask you 8 questions.

Tutorial 18th. April 2016

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18 April 2016

29	Role-play. Mechanisms of normal labour & delivery.
30	Viva. Enhanced recovery.
31	Viva. Obstetric surveillance systems.
32	Roleplay. Abnormal cervical smear.

29. Role-play. Mechanisms of normal labour & delivery.

Candidate's Instructions.

Explain the mechanisms of normal labour and delivery to the role-player, who is a medical student and keen to learn how to do a normal delivery. Your consultant has said that she needs a clear understanding of the mechanisms before considering conducting a delivery.

30. Viva. Enhanced recovery.

Candidate's instructions.

You are a newly-appointed consultant.

The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery.

As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery.

She suspects that little is known by most of the staff about the subject and hopes that your talk will encourage their enthusiastic participation.

The examiner will ask you 9 questions.

31. Viva.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 2 questions about surveillance systems used in obstetrics.

The first question has 4 marks; the second 16 marks.

The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.

32. Role-play.

Candidate's Instructions.

This is a role-play station.

You are the SpR in the colposcopy clinic.

The patient is attending after a smear showed severe dyskaryosis.

Your tasks are to take a history and explain the management you propose

Tutorial 14th. April 2016

14 April 2016

Are you going to the RCOG OSCE course on the 28th. April?
Ehsan Ulhaq booked to attend this course on the 29th. but can no longer attend on that day. He could attend on the 28th. and wonders if there is anyone who can help him out of this difficulty. If you can, please send me an e-mail and I'll forward it.

24	Viva. Headache.
25	Role-play, Audit. Teach the basics to a new FY1.
26	Viva. Parvovirus.
27	Role-play. Fragile X syndrome

24. Viva. Headache.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 17 questions.

25. Role-play, Audit. Teach the basics to a new FY1.

Candidate’s instructions.

You are the SpR on call for the labour ward.

It is a quiet afternoon: all the patients are healthy and in normal labour.

Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination.

A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it.

Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.

26. Viva. Parvovirus.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 22 questions.

27. Role-play. Fragile X syndrome

Candidate's Instructions.

You are about to see Mary White who has been booked in with her first pregnancy by the midwife in the antenatal clinic. The midwife has asked you to see her as Mary has told her that there is a family history of Fragile X syndrome.

Your task is to discuss Fragile X syndrome and the implications for Mary, the pregnancy and her father.

Tutorial 11th. April 2016

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11 April 2016

21	Candidate’s instructions. You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic. You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy. The GP letter reads: Prime Health Practice, Primetown, Sussex. 0298766543. Practice Manager: Mrs Willhelmina Bland. Dear Doctor, Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice. I look forward to receiving your expert report. Dr. John Worthy.
22	Candidate’s instructions. This is a viva station about breastfeeding. The examiner will ask you 6 questions.
23	Candidate’s instructions. You are a SpR in year 5. You are in the antenatal booking clinic and about to see Mary Eccles. She has been booked in by a midwife at 10 weeks’ gestation and all is well. She has recently arrived in the UK from the USA and asked about the routine neonatal screening that is done in the UK. She will be having the baby in the UK.

Tutorial 7th. April 2016

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7 April 2016

18	Roleplay. Booking. Previous SB on holiday in Mongolia. No records.
19	Viva. Uses of magnesium sulphate in obstetrics.
20	Role-play. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s.
21	Viva. Incomplete ECV audit.

18. Roleplay. Candidate's Instructions.

You are an SpR in the booking clinic. You are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn.

She has had routine booking, including investigations, dealt with by the midwife who has asked you to see her to advise about her first pregnancy and its implications for the management of this pregnancy.

Take an appropriate history, advise about the necessary investigations and how the history of stillbirth will influence the management of the pregnancy.

19. Viva. The uses of Magnesium sulphate in obstetrics.

Tell the examiner about the uses of MgSO₄ in obstetrics. This is an unstructured viva, the worst kind, as the examiner will not ask any questions or respond in any way. The content is entirely up to you.

20. Candidate's Instructions.

You are the SpR in the pre-pregnancy counselling clinic. Mary Smith has been referred.

The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”

Your task is to take a history and advise about appropriate investigations.

21. Viva. Incomplete ECV audit.

In a recent exam there was a station about an "incomplete" audit.

The audit topic was ECV.

The data was that:

Consultant A offered ECV to one group of women and had an 70% success rate,

Consultant B offered ECV to a different group and had a 30% success rate,

Consultant C did not offer ECV at all.

You were given this data and were asked to discuss how you would go about completing the audit process.

Tutorial 4th. April 2016

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4 April 2016

14	Roleplay. Candidate’s instructions. You are an ST4 in the pre-pregnancy counselling clinic. The patient’s referral letter is not in the notes. Your task is to take an appropriate history and to discuss any investigation or management issues that may be relevant with appropriate diagrams.
15	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 has a hip fracture after a fall. She has Alzheimer’s disease, is 85 years old and has been admitted from the nursing home where she lives. The nursing staff have noted blood on her underwear. The examiner will ask you 4 questions and will expect to hear the reasoning underlying your answers.
16	Viva. UTI & pregnancy. The examiner will ask you a series of questions on this topic.
17	Candidate’s instructions. Your consultant is on annual leave. Her secretary has asked you to look through the following results and decide what administrative action should be taken in relation to each. +ve MSSU at booking. No symptoms. GTT at 34 weeks. Peak level 11.5. FBC with ­ MCV at booking. Thrombocytopenia at booking. 50,000. Hydatidiform mole after evacuation of suspected miscarriage. Histology after ERPC for incomplete miscarriage: no trophoblastic tissue. Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy. Endometrial cancer: MR scan: reaching serosa and upper endocervical canal. Consultant does lap drainage of normal-looking ovarian cyst. Malignant cells. Nulliparous. Wants children. HVS: trichomonas. Clue cells on smear. 12/52 pregnant. Antenatal discharge: endocervical swab: chlamydia Actinomyces on smear. Herpes in pregnancy Severe dyskaryosis on cervical smear at booking. Primary infertility: FSH & LH ­ at 25 on day 3 of cycle. Primary infertility. FSH 3, LH 12 on day 3 of cycle. On cabergoline for ­ prolactin and pituitary adenoma. +ve β-hCG. 3 cm. ovarian cyst. ­ Ca 125.