Monday, 19 September 2016

Tutorial 19 September 2016


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.

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