Thursday, 15 September 2016

Tutorial 15 September 2016

15 September 2016

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

8. Labour Ward Scenario 1.

Sunday 13.00 hours.
Labour Ward.

Mrs JH
Primigravida. T+8. In labour. 6 cms.
Mrs AH
Primigravida at T. In labour. 5 cms.
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
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.
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
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.
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.

Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
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,
DO9 1JY.

Re Mrs. J. Williams,
Manor Place,

Dear Dr.,
Please see this woman who is planning pregnancy. I understand that her sister has had a baby with Down’s syndrome.
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.

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