MRCOGManchester: April 2018

Monday, 30 April 2018

Tutorial 30th. April 2018

Website

30 April 2018

52	Role-play. Androgen insensitivity syndrome
53	Role-play. Shoulder dystocia
54	Viva. Website critique. Menozac
55	Viva. Pertussis

52. Androgen insensitivity syndrome.

Candidate's Instructions.

This is a role-play station.

The patient is Anastasia Johnstone. She is 17 years old. She attended the gynaecology clinic 1 month ago with primary amenorrhoea.

Clinical examination showed an apparently normal young woman with normal breast development but absent pubic and axillary hair. The external genitalia appeared normal. Vaginal examination was not attempted.

She has come today for the results of the ultrasound scan and blood results.

The scan has shown absence of the uterus. There are no ovaries in the pelvis. There are bilateral groin masses that could be gonads.

The blood tests which were done are reported as:

Karyotype. 46XY.

Your tasks are to explain the results and their implications and to answer her questions.

53. Teach shoulder dystocia.

Candidate’s instructions.

You are the on-call SpR for the labour ward. It is an unusually quiet afternoon, with only one patient in labour and she is a healthy para 1 with a previous normal delivery.

There is a new FY1 in the department. She was on call yesterday when there was a difficult delivery due to shoulder dystocia. The baby needed to be resuscitated and the mother sustained a 4^th. degree tear. The FY1 felt completely useless and would like an introduction to shoulder dystocia so that she can be of some practical use the next time she is involved with a case.

The examiner will not react, respond to questions or offer advice.

54. Website critique.

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 on the website.

Read the document provided, which is an extract from the Menozac website as it was a few years ago, and formulate a critique.

This is an unstructured viva and the examiner will not ask any questions or make any comments.

55. Pertussis.

Candidate’s instructions.

The examiner will ask you 5 questions about pertussis and pregnancy.

Thursday, 26 April 2018

Tutorial 26th. April 2018

Website

26 April 2018

50	Julie Morris. How to critique a paper.
51	Role-play. Complaint. Misfiled combined Down’s syndrome test report.
52	Role-play. Teach management of shoulder dystocia

50. Julie Morris.

51. Complaint. Misfiled combined Down’s syndrome test report.

Candidate's Instructions.

You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.

Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report had been filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20 week scan. The ultrasonographer found the report in the notes, realised that no action had been taken, informed the patient and made arrangements for the patient to see you today.

52. Teach shoulder dystocia.

Candidate’s instructions.

You are the on-call SpR for the labour ward. It is an unusually quiet afternoon, with only one patient in labour and she is a healthy para 1 with a previous normal delivery.

The examiner will not react, respond to questions or offer advice.

Monday, 23 April 2018

Tutorial 23rd. April 2018

Website

23 April 2018

46	Viva. Suspected bowel injury at laparoscopy
47	Role-play. Suspected bowel injury at laparoscopy: follow-on
48	Viva. Diathermy
49	Role-play. Teach breech delivery to new trainee

46. Suspected bowel injury at laparoscopy

Candidate’s instructions.

This is a viva station.

You are an SpR. You are in the process of performing laparoscopy for a patient with 1ry. infertility. On inserting the laparoscope you suspect that the cannula is in the bowel.

Your task is to explain to the examiner all the steps you will consider taking from recognising the possibility through to the woman’s discharge.

This is an unstructured viva and the examiner will not ask any questions.

47. Suspected bowel injury at laparoscopy: follow-on

Candidate’s instructions.

This is a follow-on from the previous station.

It is now 4 hours since the operation: the woman had a laparotomy to repair the bowel defect. The woman has asked why she has not been allowed to go home. Her sister has come to collect her. The patient is still feeling drowsy and has some pain, so has asked her sister to find out what happened, when she can go home and what it means for her fertility.

48. Diathermy.

Candidate's Instructions.

This is a viva station about diathermy and its uses and complications.

The examiner will ask you 8 questions.

When you have completed an answer you are not allowed to return.

49. Teach breech delivery to a 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 on a previous occasion. She has asked you to explain vaginal breech delivery to a new FY2, who is keen on a career in O&G.

Monday, 16 April 2018

Tutorial 16th. April 2018

Website

42	Role-play. Premenstrual syndrome
43	Role-play. Sterilisation request
44	Viva. Enhanced recovery
45	Viva. Mayer–Rokitansky–Küster–Hauser syndrome

42. Premenstrual syndrome.

Candidate's Instructions.

This is a roleplay station. Your task is to take a history and advise about initial investigations and management.

GP Letter.

The Medical Centre,

Haversham Way,

Lasttown. XS89 9JH.

Re Jenny Smith,

55 Town Street, Lasttown.

Dear Doctor,

Please see this woman who complains of premenstrual syndrome. I don’t really believe in this condition so have not attempted to treat it.

Regards, Dr. N. O. G. Ood.

43. Sterilisation request.

Candidate’s instructions.

This is a roleplay station. You are about to see Anne Jones who requests sterilisation. Your tasks are to take a history and discuss her request.

GP letter.

Castle Surgery,

Gambit Grove,

Chesstown. CHS1 U99.

Re Anne Jones.

25 Checkmate Street,

Chesstown. CHS7 Y86.

Dear Doctor,

Please see Mrs Jones who wishes to be sterilised. Our family planning specialist is on leave and I know little about modern contraception, so have not offered any advice.

Regards,

Dr. O.U.T. de Touche.

44. Enhanced recovery.

Candidate's instructions.

You are a newly-appointed consultant. The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery.

As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery. She suspects that little is known by most of the staff about the subject and hopes that your talk will encourage their enthusiastic participation.

The examiner will ask you 9 questions pertinent to your talk.

45. Mayer–Rokitansky–Küster–Hauser syndrome.

Candidate’s instructions.

This is a viva station about Mayer–Rokitansky–Küster–Hauser syndrome. The examiner will ask you 17 questions. When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.

Thursday, 12 April 2018

Tutorial 12th. April 2018

Website

12 April 2018

38	Role-play. Write a Prescription
39	Viva. Zika virus & pregnancy
40	Viva. Cochrane Collaboration
41	Role-play. Forceps: teach a junior.

38. Prescription.

Candidate’s instructions.

You are about to see Mary Smith who is nulliparous and trying to conceive. She has had a full work-up and has very infrequent periods. PCOS has been diagnosed. She is not overweight. You have discussed her treatment with the consultant and a trial of clomifene has been agreed.

Your task is to explain this to Mary and write her a prescription for a one-month supply.

Mrs. Mary Smith, DoB: 15 March 90.

5 Mansion Row,

Richtown.

39. Zika virus & pregnancy.

This is a structured “conversation” about Zika virus & pregnancy. The examiner will ask 33 questions. When you have answered a question you will not be allowed to return as subsequent questions may yield the answers to earlier ones. If you do return no marks will be allocated, even for correct answers.

40. Cochrane Collaboration.

Candidate’s instructions.

This is a viva about the Cochrane Collaboration.

The examiner will ask 8 questions and give one instruction.

You will be asked to explain the diagram below.
The diagram did not upload.
You will need to get it from the Dropbox folder "materials for the tutorials".

41. Forceps.

Candidate’s instruction.

This is a role-play station. You are a year-5 SpR. It is a quiet day on the labour ward.

The consultant has asked you to instruct a new trainee in the use of forceps.

Monday, 9 April 2018

Tutorial 9th. April 2018

Website

34	Viva. PPH. Review of management in the Unit
35	Role-play. Anencephaly
36	Role-play. Pre-op clinic. Hysterectomy
37	Viva. Parvovirus

34. PPH. Review of management in the Unit.

Candidate’s instructions.

You are a new consultant with a main interest in obstetrics and the labour ward.

A patient had a major PPH 2 months ago and almost died. She made a good recovery after intensive treatment and has gone home.

The lead consultant for the delivery unit has asked you to conduct an in-depth review of management of PPH in the unit and make recommendations.

This is an unstructured viva: it is up to you to decide what to include.

The examiner will not assist you in any way.

35. Anencephaly.

Candidate’s instructions.

You are an SpR5 and running the ante-natal clinic – your consultant has been called to help a consultant colleague with an emergency on the labour unit and is not available for advice.

You are about to see Jean Hathersage. She is 25 years old and had a 10-week scan last week that showed anencephaly. She stated that she did not want TOP. She was counselled, given information leaflets and asked to return to the antenatal clinical today for further discussion.

It is your task to conduct that discussion.

36. Role-play. Pre-op clinic. Hysterectomy.

Candidate’s instructions.

You are a fifth-year SpR and are running the pre-op clinic. You are about to see Mary Smith.

The notes say that her uterus is enlarged to the size of a 16 week pregnancy by fibroids and she has been listed for hysterectomy. She has menorrhagia and medical treatments have not worked.

Your task is to complete the tasks you feel are appropriate in the pre-op clinic.

37. Candidate’s instructions.

This is a structured “conversation” about parvovirus infection and pregnancy. The examiner will ask 22 questions. When you have answered a question you will not be allowed to return as subsequent questions may yield the answer. If you do return no marks will be allocated, even for correct answers..

Thursday, 5 April 2018

Tutorial 5th. April 2018

Website

5 April 2018

30	Viva. HPV immunisation.
31	Role-play. Teach an FY1 the basics of audit
32	Viva. Fragile X syndrome
33	Viva. Maternity Dashboard.

30. HPV immunisation.

Candidate’s instructions.

This is a viva station about the UK programme for routine HPV immunisation.

The examiner will ask you 18 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate earlier answers. If you return, no marks will be awarded, even for correct answers.

31. Teach an FY1 the basics of audit

Candidate’s instructions.

You are the SpR on call for the labour ward.

It is a quiet afternoon: all the patients are healthy and in normal labour.

Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination.

A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it.

Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.

32. Fragile X syndrome.

Candidate’s instructions.

This is a structured viva station about Fragile X syndrome.

The examiner will ask you 20 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.

33. Maternity Dashboard.

Candidate’s instructions.

This is a viva station about the RCOG’s maternity dashboard.

The examiner will ask you 14 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.