Tutorial 29 September 2016

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29 September 2016

18	Roleplay. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s.
19	Viva. UTI & pregnancy
20	Roleplay. Abnormal cervical smear.
21	Roleplay. Neonatal screening.

18. Roleplay. Huntington’s chorea.

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.

19. Viva. UTI & pregnancy.

The examiner will ask you 8 questions.

20. Roleplay. Abnormal cervical smear.

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.

21. Roleplay. Neonatal Screening.

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 22 September 2016

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22 September 2016

15	Roleplay. Booking. Previous SB.
16	Viva. Breastfeeding.
17	Roleplay. Pre-pregnancy counselling. Phenylketonuria.
18	Roleplay. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s.

15. Roleplay. Previous stillbirth.

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 all the 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.

16. Viva. Breastfeeding.

Candidate’s instructions.

This is a viva station.

The examiner will ask you 7 questions.

                                                          

17. Viva. Phenylketonuria.

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 Wilhelmina 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.

18. Roleplay. Huntington’s chorea.

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.

Tutorial 19 September 2016

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19 September 2016

11	Roleplay. Bleeding in early pregnancy.
12	Viva. Menozac website critique
13	Viva. Laboratory results
14	Roleplay. PMB.

11. Roleplay. Bleeding in early pregnancy.

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.

12. Viva. Critique of HRT internet website.

Candidate's Instructions.

Patients may attend a consultation with information obtained from a website.

You must be able to provide a balanced critique of the information.

You have 12 minutes to read the document provided for this station.

Then you have 12 minutes with the examiner to detail your critique.

The document about the website is on Dropbox in the folder "Materials for the tutorials".

13. Viva. Laboratory results.

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.

1	+ve MSSU at booking. No symptoms.
2	GTT at 34 weeks. Peak level 11.5.
3	FBC with ­ MCV at booking.
4	Thrombocytopenia at booking. 50,000.
5	Hydatidiform mole after evacuation of suspected miscarriage.
6	Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.
7	Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.
8	Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.
9	Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.
10	HVS: trichomonas.
11	Clue cells on smear. 12/52 pregnant.
12	Antenatal discharge: endocervical swab: chlamydia
13	Actinomyces on smear.
14	Herpes in pregnancy
15	Severe dyskaryosis on cervical smear at booking.
16	Primary infertility: FSH & LH ­ at 25 on day 3 of cycle.
17	Primary infertility. FSH 3, LH 12 on day 3 of cycle.
18	Treated with cabergoline for ­ prolactin and pituitary adenoma.
19	3 cm. ovarian cyst. ­ Ca 125.

14. Roleplay. PMB.

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.

Tutorial 15 September 2016

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15 September 2016

6	Viva. The examiner will ask you 2 questions about the part 3 exam.
7	Homework. Basic “blurbs” to write and practise. Setting the scene for breaking bad news, general pre-pregnancy counselling, dominant, recessive & x-linked inheritance etc.
8	Viva. Labour ward scenario 1.
9	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
10	Viva. The uses of MgSO4 in O&G.

8. 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.

9. Roleplay. 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.

10. Viva. Use of MgSO₄ in O&G

Candidate’s instructions.

This is a viva station about the uses of MgSO₄ in O&G.

The examiner will not ask questions, prompt or otherwise assist. It is up to you to give as full an account of the uses as you can muster.

Tutorial 12th. September 2016

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Welcome to the OSCE cycle as we prepare for the Part 3 exam in November.

12 September 2016

1	How to prepare. Picking a course. Communication skills partner
2	Urodynamics, CTG interpretation
3	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.
4	Role-play: how to introduce oneself.
5	Role-play: Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.