Tutorial 2 September 2019

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7	Structured discussion. Pertussis.
8	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
9	Structured discussion. The uses of MgSO4 in O&G.
10	Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.
11	Viva. Labour ward scenario 1.

7. Pertussis. Structured discussion.

Candidate’s instructions.

The examiner will ask you 9 questions about pertussis & pregnancy.

1.     What is pertussis caused by, how is it spread, what kind of vaccine is available and can it be used in pregnancy? 

2.     What are the important epidemiological facts in relation to pertussis in the UK?

3.     What is the current advice in the UK about pertussis in pregnancy and who creates the advice?                 

4.     Critically evaluate the justification for the advice.                                                            

5.     What advice should be given to a woman who has been in close contact with pertussis?

6.     What advice should be given to a woman with suspected pertussis?

7.     What advice should be given to a woman with proven pertussis?

8.     Which vaccine is recommended for use in pregnancy in the UK and what are its main features?

9.     What does PHE recommend abut which antibiotic(s) to use and when in pregnancy.?

Boostrix

8. Pre-pregnancy counselling role-play.

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,

Deersworthy,

Kent. DO9 1JY.

Re Mrs. J. Williams,

Manor Place,

Deersworthy.

Dear Dr.,

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

Regards, Dr. Jolly.

9. The uses of MgSO₄ in O&G. Structured discussion.

Candidate’s instructions.

This is about the uses of MgSO₄ in O&G. It says ‘Structured discussion’, but I have made it like a viva to make it harder.

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.

10. Role-play. Break bad news.

Candidate’s instructions.

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.

Your instructions are to deal with the patient as you would in clinic.

11. Structured discussion.

Labour ward scenario 1.

Candidate’s instructions.

You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to care for them.

This station was written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are a number of phrases and concepts that reveal this distant origin, but I have retained them for nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call and using what was happening on the labour and gynae wards that day.

Labour Ward. Sunday 13.00 hours.

1	Mrs JH	Primigravida. T+8. In labour. 6 cms.
2	Mrs AH	Primigravida at T. In labour. 5 cms.
3	Mrs. BH	Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4	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.
5	Mrs KW	Para 1. In labour. Cx. 5 cm. Ceph at spines.
6	Mrs KT	Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7	Mrs TB	Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
8	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.
9	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. The husband of a patient who had Wertheim's hysterectomy on the Friday was asking to see a doctor for a report on the operation.

1	Mrs JB	10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2	Ms AS	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 IVs 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.