14
|
EMQ.
Anti-D.
|
15
|
Role-play.
Developmental
dysplasia of the hip.
|
16
|
Structured
conversation. Labour ward scenario 1.
|
17
|
Role-play.
PMB.
|
Role-players.
Beatrice Lamb.
Candidates.
Shradha Chakhaiyar India.
Sagnika Dash
Marlon Hamsworth Malta
Zakia Hussain UK.
Labour ward scenario.
Kimmee Khan UK.
Atya Rehman Oman.
Nandita Sanyal India.
Girija Swaminathan UK
14. EMQ. Anti-D.
15. Role-play. Developmental dysplasia of the hip.
Candidate’s instructions.
You are the SpR in the antenatal clinic. Jenny Brown has
been booked in her second pregnancy by the midwife. She has some questions
about congenital dislocation of the hip, which affected her first child, now 6
years old. The midwife who did the booking does not feel able to provide
adequate answers and has asked you to see the patient.
16. Structured discussion. Labour Ward Scenario
1.
Candidate’s instructions.
You are the registrar on duty and
responsible for the labour and gynae wards. I know you won’t have both duties
nowadays, but I have kept the original to make it harder.
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 IV infusions 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.
17. Role-play. PMB.
Candidate’s
Instructions.
You are an SpR in the
“one-stop” PMB clinic. Mary Smith, 55 years old, has been referred by her
General Practitioner. She has had some bleeding since the menopause. 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.
James Fewords, General
Practitioner.
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