Thursday, 28 September 2017

Tutorial 28th. September 2017


Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance etc.
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.
Viva. Labour ward scenario 1.

8. Basic “blurbs”.
There are a lot of chunks of text that come up time and again when chatting to patients. It is good to get these practised so that you can deliver them quickly and efficiently and not miss important points. An absolute basic is the GP referral letter. Likewise basic pre-pregnancy counselling, which gets and extra mark or two in any appropriate station.

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. Roleplay. Magnesium sulphate 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.

11. Roleplay. Labour Ward Scenario 1.
Candidate's Instructions.
You are the senior trainee and are starting your shift on the labour ward. Explain to the examiner how you will prioritise the patients, allocate staff and the reasons for your decisions.

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.

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