Tutorial 26 January 2023

 Contact me

Website  

11	Role-play. Break bad news. Non-viable early pregnancy
12	Role-play. Topic to be announced on the day
13	Role-play. Explain balanced translocation to FY1
14	SBA. Fitz-Hugh-Curtis Syndrome

 

11.   Role-play. Break bad news. Non-viable early pregnancy.  Role-player Riffat.

Candidate’s instructions.

You are the SpR in the ante-natal clinic. The consultant who was in clinic has been asked to assist her consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary. 

One of the midwives asks you to see Jane Brown, who has just had a scan in the early pregnancy unit.  She is primigravid and the gestation is 8 weeks. She has had some bleeding.   

Ultrasound scan report: “Intra-uterine pregnancy. Single pregnancy. CRL = 12 mm.  No fetal heart activity.  No adnexal masses”.

 

12.   Role-play. Role-player: Ammara.

Candidate’s instructions.

You are a SpR5 in the gynae clinic and about to see Caroline Faulkner. Your tasks are to take an appropriate history and advise about investigation and management.

GP referral letter. This will be read out on the day.

 

13.   Role-play. Explain balanced translocation to FY1. Role-player: Dhwany.

Candidate’s instructions.

You are the registrar on duty for the labour ward. It is quiet and the consultant has asked you to explain balanced translocation to the FY1, saying it will be good preparation for the Part 3 exam that you have applied to sit.

 

14.   Fitz-Hugh-Curtis Syndrome. SBA.

Scenario 1.    Which one of the following best fits with FHCs?

Option List

A	It is a complication of Caesarean section
B	It is a complication of Crohn’s disease
C	It is a complication of ovarian fibroma
D	It is a complication of pelvic inflammatory disease
E	None of the above.

Scenario 2.    Which of the following is a key feature of FHCs?

Option List

A	ascites + unilateral hydrothorax
B	amenorrhoea
C	anlagen
D	unilateral ‘Coast of Maine’ pigmentation
E	none of the above

Scenario 3.    Which of the following is a common feature in the development of FHCs?

Option List

A	auto-immunity
B	Chlamydia trachomatis infection
C	Mycoplasma genitalium infection
D	TB
E	none of the above

 

 

 

 

Tutorial 30th. January 2023

 

Contact me

Website  

 

15	Role-play. Complaint. Mis-filed combined Ds test report
16	Structured conversation. Labour ward scenario
17	Structured conversation. Waiting list prioritisation
18	EMQ. Mayer-Rokitansky-Küster-Hauser syndrome

 

15.   Role-play. Complaint. Mis-filed combined Ds test report.

Candidate's Instructions.

You are the SpR in the ante-natal clinic. The consultant has been called to the labour ward to help with a case of placenta accreta and you have been put in charge of the clinic.

Mrs Jones had a “combined test” at 11 weeks which gave a risk of Down’s syndrome of 1: 40. The report was filed in the notes in error by a clerk without being shown to any of the medical or midwifery staff. She attended today for the routine 20-week scan. The ultrasonographer found the report in the notes, realised that no action had been taken, informed the patient and made arrangements for her to see you urgently.

 

16.   Structured conversation. Labour ward scenario.

Candidate’s instructions.

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 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. You won’t be asked about gynae patients in a labour ward station!

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.   Structured conversation. 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	Venue	Special Needs	Urgency
JK	5	chronic discharge. ? foreign body	EUA	Main theatre
JM	32	1ry. infertility	Laparoscopy + tubal patency tests	Main theatre
GN	77	Vulval cancer. Coronary thrombosis x 2. Unstable angina.	Radical vulvectomy agreed at MDT.	Main theatre
RU	55	PMB x1. Weight 20 stones. (127 kg.) 1 kg. = 2.2 lb. 1 stone = 14 lb.	D&C.	DCU.
LD	32	Menorrhagia. Fibroids. Anaemia.	Vaginal hysterectomy.	Main theatre.
DT	22	Does not want children.	Lap. Steril.	DCU
HB	14	Unwanted pregnancy at 10/52.	TOP	DCU. TOP list.	.
JY	44	GSI.	Anterior colporrhaphy.	Main theatre.
JS	23	Vaginal discharge. Cervical ectropion.	Diathermy to cervix.	DCU
DT	55	3 cm. ovarian mass.	Laparoscopy ? proceed to Hyst + BSO.	Main theatre.
EV	32	CIN3.	Cone biopsy.	DCU
UW	34	Endometriosis	Laparoscopic ablation	DCU
HT	88	Cystocoele/ rectocoele/ 2nd. degree uterine prolapse	Manchester Repair.	Main theatre.
KN	58	Haematuria	Cystoscopy	DCU
JW	18	Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.	Hysterectomy	Main theatre
TB	30	Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.	Vaginal hysterectomy and repair.	Main theatre.
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.	Main theatre.
NU	60	Recurrent rectocoele.	Posterior colporrhaphy.	Main theatre.

 

18.   Structured conversation. Mayer-Rokitansky-Küster-Hauser syndrome.

Candidate’s instructions.

This is a viva station about Mayer-Rokitansky-Küster-Hauser syndrome. The examiner will ask you 17 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.