Tutorial 23 September 2019

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18	EMQ. Gestational trophoblastic disease
19	Viva. Obstructive sleep apnoea
20	Roleplay. Pre-pregnancy counselling. Phenylketonuria
21	Viva. Tentorium cerebelli.
22	Role-play. PMB
23	Viva. Obstetric surveillance systems

18. EMQ. Gestational trophoblastic disease.

This is a follow-on from the previous tutorial and should ensure that you have all the relevant facts about this topic. Send your answers and I’ll link you to mine, which are on Dropbox. Make sure you take the facts into your revision mechanism.

19. Structured conversation. Obstructive sleep apnoea.

Candidate's Instructions.

The examiner will ask you 11 questions.

When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.

20. Roleplay. Pre-pregnancy counselling. 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.

21. Viva. Tentorium cerebelli.

Candidate's Instructions.

This is an old-fashioned  viva, which is harder than the new ‘structured discussion’. Do the origami and make the model. Tell the examiner what you know about the mechanics of tentorial tears. The examiner will just listen and not guide you in any way.

22. Role-play. 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.

23. Viva. Obstetric surveillance systems

Candidate's Instructions.

This is a structured discussion station.

The examiner will ask you 2 questions about surveillance systems used in obstetrics.

The first question has 4 marks; the second 16 marks.

The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.