Website
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28
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Role-play. Explain, dyskaryosis, dysplasia, CIN etc.
|
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29
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Viva. Laboratory
results
|
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30
|
Role-play.
Sterilisation request.
|
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31
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Viva. Waiting
list prioritisation
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32
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Viva. Clinical
governance
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28. Roleplay. Explain,
dyskaryosis, dysplasia, CIN etc..
Candidate's Instructions.
This is a role-play station. You are a 4th.
year SpR.
Jane Smith is a 1st. year student nurse who
has joined the department. She has heard the following terms used in the
gynaecology and colposcopy clinics:
mild, moderate and
severe dyskaryosis in relation to cervical smears,
mild, moderate and
severe dysplasia and CIN 1 – 3,
simple, complex and
atypical endometrial hyperplasia,
She would like to know what they mean and their
significance as the explanations given by the medical staff in the clinics were
not clear and patients asked her for clarification. Her knowledge was
insufficient for her to provide this, which she found very unsatisfactory for
the patients and her. Your consultant has delegated the explanation to you.
29. Structured discussion. 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.
30. Roleplay. Sterilisation
request.
Candidate’s
Instructions.
You
are a 5th. year SpR. You are about to see Mrs. Mary Fecund in the
gynaecology clinic. There is a referral letter from the GP.
Read
the letter and then conduct the consultation with Mrs. Fecund as you would do
in the clinic in your hospital.
Referral letter.
Perfect
Health Centre,
Paradise
Lane,
Slagheap.
SLH 678.
Your
ref: BRI 07/54843.
Re.
Mary Fecund,
The
Shoe,
High
Street,
Slagheap.
Dear Doctor,
Please
see Mrs Fecund who has too many children. She wishes to be sure she has no more
and has asked to be sterilised – one of her friends was sterilised recently
which has put her in the mood to have it done.
Yours
sincerely, Dr. John Williams.
31. Structured discussion. Waiting list prioritisation.
Candidate’s
instructions
Your
consultant is away. The waiting-list manager comes to see you.
The
following patients have been listed by junior staff.
The
waiting-list manager wants you to:
confirm the appropriateness of the proposed
treatment,
decide the degree of urgency,
confirm the appropriateness of the proposed
venue,
decide any special requirement(s) for each
patient.
Name Age
Clinical problem Proposed
operation
|
JK
|
5
|
chronic
discharge.
?
foreign body
|
EUA
|
|
JM
|
32
|
1ry.
infertility
|
Laparoscopy
+ tubal patency tests
|
|
GN
|
77
|
Vulval
cancer. Coronary thrombosis x 2. Unstable angina.
|
Radical
vulvectomy agreed at
|
|
RU
|
55
|
PMB
x1. BMI 35.
|
D&C.
|
|
LD
|
32
|
Menorrhagia.
Fibroids. Anaemia.
|
Vaginal
hysterectomy.
|
|
DT
|
22
|
Does
not want children.
|
Lap.
Steril.
|
|
HB
|
14
|
Unwanted
pregnancy at 10/52.
|
TOP
|
|
JY
|
44
|
GSI.
|
Anterior
colporrhaphy.
|
|
JS
|
23
|
Discharge.
Cervical ectropion.
|
Diathermy to cervix.
|
|
DT
|
55
|
3
cm. ovarian mass.
|
Laparoscopy ? proceed to Hyst + BSO.
|
|
EV
|
32
|
|
Cone biopsy.
|
|
UW
|
34
|
Endometriosis
|
Laparoscopic ablation
|
|
HT
|
88
|
Cystocoele/
rectocoele/ 2nd. degree uterine prolapse
|
Manchester Repair.
|
|
KN
|
58
|
Haematuria
|
Cystoscopy
|
|
JW
|
18
|
Menorrhagia
& copes badly with menstrual hygiene. Has Down’s syndrome. Sexually
active.
|
Hysterectomy
|
|
TB
|
30
|
Menorrhagia.
2nd. degree uterine descent. Been sterilised. Jehovah’s witness.
|
Vaginal hysterectomy and repair.
|
|
BM
|
55
|
Stage
Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor
V Leiden. VTE on Pill. On warfarin.
|
Wertheim’s hysterectomy.
|
|
NU
|
60
|
Recurrent
rectocoele.
|
Posterior colporrhaphy.
|
32. Structured discussion. Clinical governance.
Candidate’s
instructions.
This
is a structured clinal discussion station about clinical governance. The
examiner will ask you 5 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.
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