Thursday 12 October 2017

Tutorial 12th. October 2017



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14
Viva. Hydatidiform mole. Genetics.
15
Viva. Laboratory results
16
Viva. Breastfeeding
17
Roleplay. Teach breech delivery to new trainee
18
Roleplay. Pre-pregnancy counselling. Phenylketonuria

14. Viva. Hydatidiform mole.
Candidate’s instructions.
This is a viva. Tell the examiner what you know about the genetics of hydatidiform mole & placental site trophoblastic tumour. The examiner will just listen and not guide you in any way.

15. 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.  +ve beta HCG.
19
3 cm. ovarian cyst. ­ Ca 125.

16. Viva. Breastfeeding.
Candidate’s instructions.
This is a viva station.
The examiner will ask you 7 questions.

17. Roleplay. Teach breech delivery to new trainee .
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is still unusually quiet. The on-call consultant has been told that you did a brilliant job of explaining normal labour and delivery. She has asked you to explain vaginal breech delivery to a new FY2, who is keen on a career in O&G.

18. 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 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.


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