10
|
|
11
|
|
12
|
Teaching. Breech delivery.
|
13
|
Role-play. Pre-pregnancy counselling. Dad
recently diagnosed with Huntington’s disease.
|
10. Structured
discussion. Labour ward scenario 1.
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.
11.
Structured discussion. The uses of MgSO4 in O&G.
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.
12. Teach
a trainee the essentials of breech delivery.
You are an SpR5
and on duty of the labour ward. Things are quiet and the consultant has asked
you to teach a new FY1 about breech delivery.
13. Role-play.
Pre-pregnancy counselling.
Candidate's Instructions.
You are the SpR in the pre-pregnancy counselling clinic.
Mary Smith has been referred.
The GP referral letter is brief. “Please see this woman
who is considering becoming pregnant. Her father has Huntington’s chorea, about
which I know very little.”
Your task is to take a history and advise about
appropriate investigations.
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