Thursday, 21 November 2019

Tutorial 21st. November 2019


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1
Role-play. How to practise for the Part 3.
2
Part 2 TOG & RCOG sample questions. Go through all of them as they make for easy marks. TOG has CPD questions in every issue. Make sure you can answer all of them from the last 2 – 3 years.
3
EMQ. Gordon, Holmes & Semmelweis.
4
EMQ. Fragile X syndrome
5
EMQ. Montgomery & consent.
6
SBA.  Cowden syndrome.
7
Role-play. Pre-pregnancy counselling. Cystic fibrosis.

1.     Role-play. How to practise for the Part 3.
Candidate’s instructions.
Use your own name. You are an SpR5 and passed the MRCOG exam. There is a new SpR3 in the department who plans to sit the Part 2 in 6 months. You consultant has had a chat with them about preparation for the Part 2 but thinks it is important that the use all the opportunities that come their way to prepare for the Part 3 as well. The consultant has asked you to discuss how to do this with the new trainee.

2.     Part 2 TOG & RCOG sample questions.
         Go through all of them as they make for easy marks. TOG has CPD questions in every issue. Make sure you can answer all of them from the last 2 – 3 years.

Which, if any, of the following statements are true in relation to Semmelweis?
Option list.

A
his full name was Ignác Fülöp Semmelweis, but he was known to friends as "Naci".
B
he lived from 1818 to 1865
C
he revolutionised understanding of ‘childbed fever’
D
he revolutionised understanding of rheumatic fever
E
he revolutionised understanding of tuberculosis
F
he pioneered proton beam therapy
G
his professional ‘Damascene moment’ came after the death of his colleague, Kolletscha, at the hands of a medical student in 1847
H
his work was vilified by the majority of his professional contemporaries
I
he died in a lunatic asylum
J
he died in a road traffic accident
K
he died at home in bed with his mistress

Which, if any, of the following statements are true in relation to Gordon?
Option list.

A
his full name was Hamish Gordon, but he was known to friends as "Hamy".
B
he lived from 1801 to 1864
C
he revolutionised understanding of ‘childbed fever’
D
he revolutionised understanding of rheumatic fever
E
he revolutionised understanding of tuberculosis
F
he pioneered proton beam therapy
G
his professional ‘Damascene moment’ came after epidemics of erysipelas and puerperal fever in Aberdeen in the late 18th. century
H
his work was vilified by the majority of his professional contemporaries
I
he died in a lunatic asylum
J
he died in a road traffic accident
K
he died at home in bed with his mistress

Scenario 3.                
Which, if any, of the following statements are true in relation to Wendell Holmes?
Option list.

A
his full name was Wendell Holmes, but he was known to friends as "Wellie".
B
he lived from 1801 to 1864
C
he revolutionised understanding of ‘childbed fever’
D
he revolutionised understanding of rheumatic fever
E
he revolutionised understanding of tuberculosis
F
he pioneered proton beam therapy
G
he was a fan of the work of Gordon.
H
his work on childbed fever was vilified by the majority of his professional contemporaries
I
he died in a lunatic asylum
J
he died in a road traffic accident
K
he died at home in bed with his mistress


4.     Fragile X syndrome
Abbreviations.
FXS:               Fragile X syndrome
TR:                 trinucleotide repeat
Question 1.
Lead-in
Which, if any, of the following are features of FXS in males?
Option List
A.       
autism
B.       
epilepsy
C.        
hyper-extensible joints
D.       
learning difficulty
E.        
post-pubertal macroorchidism
Question 2.
Lead-in
Which, if any, of the following are features of FXS in females?
Option List
A.       
autism
B.       
epilepsy
C.        
hyper-extensible joints
D.       
learning difficulty
E.        
post-pubertal ovarian enlargement
Question 3.
Lead-in
Why are women thought to be less affected by FXS than men?
Option List
A.       
two X chromosomes dilutes the effect of affected X chromosome
B.       
leonisation
C.        
lionisation
D.       
lyonisation
E.        
none of the above
Question 4.
Lead-in
How common is FXS in males?
Option List
A.       
1 in 1,000
B.       
1 in 4,000
C.        
1 in 8,000
D.       
1 in 20,000
E.        
1 in 100.000
Question 5.
Lead-in
How common is FXS in females?
Option List
A.       
1 in 1,000
B.       
1 in 4,000
C.        
1 in 8,000
D.       
1 in 20,000
E.        
1 in 100.000
Question 6.
Lead-in
Which gene is implicated in the causation of FXS?
Option List
A.       
fragile X mental retardation 1
B.       
fragile X mitochondrial recognition 1
C.        
fragile X 1
D.       
the gene has not yet been identified
E.        
none of the above
Question 7.
Lead-in
Which is the leading hereditary cause of learning difficulty?
Option List
F.        
Down’s syndrome
G.       
fragile X syndrome
H.       
galactosaemia
I.          
homocystinuria
J.         
phenylketonuria
Question 8.
Lead-in
Which is the most common genetic cause of autism?
Option List
A.       
Down’s syndrome
B.       
fragile X syndrome
C.        
galactosaemia
D.       
homocystinuria
E.        
phenylketonuria
Question 9.
Lead-in
Which mode of inheritance occurs with FXS?


Option List
A.       
autosomal dominant
B.       
autosomal recessive
C.        
X-linked dominant
D.       
X-linked recessive
E.        
none of the above
Question 10.
Lead-in
What is the story about trinucleotide repeats and FXS. What are TRs? Which TRs are involved with FXS? How are TRs categorised in relation to FXS?
There is no option list – just write your answers.
Question 11.
Lead-in
What is the FXS premutation?
What are its key features?
There is no option list – just write your answers.

5.     Montgomery Ruling.
Abbreviations.
BMA:    British Medical Association.
GMC:    General Medical Council.
Question 1.              
Which, if any, of the following statements are true?
Lead-in
A.       
The Montgomery ruling largely replaces the Bolam ruling
B.       
The Montgomery ruling largely replaces the Chester ruling
C.        
The Montgomery ruling largely replaces the Sidaway ruling
D.       
The Montgomery ruling is being contested in the European Court by the GMC as it infringes the rights of doctors
E.        
The Montgomery ruling is being contested in the European Court by the BMA as it infringes the rights of doctors
Question 2.              
Which, if any, of the following statements are true?
Lead-in
A.       
the level of risk, however small, must be disclosed if a patient requests it
B.       
the level of risk of damage from a procedure need not be disclosed if < 1%
C.        
the level of risk of damage from a procedure need not be disclosed if < 10%
D.       
a material risk is one that would be reflected in damages > £100,000 if negligence were proved in court
E.        
a material risk is one that would be reflected in damages > £1,000,000 if negligence were proved in court
F.        
a material risk is one that involves anatomical damage, not emotional or psychological
G.       
a material risk is one that a reasonable person in the patient’s situation would be likely to regards as significant

6.     Cowden syndrome.
Scenario 1.
Lead in.
Which feature is associated with Cowden syndrome?


Option list.
A.     albinism
B.     hamartoma
C.     hammer-toe
D.     hypertrichosis
E.     stammer
Scenario 2.
Lead in. Which condition has the highest risk of occurrence in women with Cs?
Option list.
A.     breast cancer
B.     bowel cancer
C.     congenital absence of Müllerian tract derivatives
D.     hypertension
E.     hypothyroidism
Scenario 3.
Lead in. Which gynaecological cancer is a particular risk for women with Cs?
Option list.
A.     Bartholin’s gland cancer
B.     cervical cancer
C.     choriocarcinoma
D.     endometrial cancer
E.     vulval cancer
Scenario 4.
Lead in.

Option list.
A.     breast cancer
B.     colon cancer
C.     melanoma
D.     renal cancer
E.      thyroid cancer
F.      all of the above

6.     Pre-pregnancy counselling. Brother has cystic fibrosis.
Candidate's Instructions.
This is a roleplay station. You are a year 4 SpR and are in the gynaecology clinic.
The consultant has just left you in charge as she is feeling unwell and has gone to lie down.
Your task is to deal with the patient as you would in real life.
GP referral letter.
Best Medical Centre,
High Road,
Anytown.
Phone: 01882 78998.  E-mail: besthealth@gmail.com
Practice Manager: Mary Wright. B.SC., RGN.
Phone:  01882 78998 ext. 23.
Re. Mrs. Bonnie Black,
25 Low Road,
Anytown.
DOB: 28 January 1990.
Phone: 07889 888 132.

Dear Doctor,
Please see Mrs Black who is planning her first pregnancy. Her main concern is that her brother has cystic fibrosis.
This was the first time I had met her although she has been registered with us for 5 years – her health is good and she has no history of serious illness or surgery.
I have explained that I don’t know much about the implications of the brother’s cystic fibrosis for her potential pregnancies and that she needs to talk to an expert. I have stressed that the risk of her having a child with cystic fibrosis is high and that she needs to be aware that there is a distinct likelihood that any pregnancy would be likely to be affected and need TOP.
Yours sincerely,
John P. Clatter.



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