MRCOG tutorial 26th. October 2023

Contact me

Website

26 October 2023.

 

79	Role-play. Androgen insensitivity syndrome
80	Role-play. Miscarriage. Seems anxious and depressed
81	Role-play. Shoulder dystocia
82	Viva. Enhanced recovery

 

79. Role-play. Androgen insensitivity syndrome.

Candidate's Instructions.

The patient is Anastasia Johnstone. She is 17 years old. She attended the gynaecology clinic 1 month ago with primary amenorrhoea. Clinical examination showed an apparently normal young woman with normal breast development but absent pubic and axillary hair. The external genitalia appeared normal. Vaginal examination was not attempted.

She has come today for the results of an ultrasound scan and blood tests. The scan shows absence of the uterus. There are no ovaries in the pelvis. There are bilateral groin masses. The karyotype is 46XY.

Your tasks are to explain the results and their implications and to answer her questions.

80. Role-play. Androgen insensitivity syndrome.

Candidate’s instructions.

You are the on-call SpR. The Sister on the gynaecology ward has asked you to see Margaret Barber who had surgical evacuation of retained products under general anaesthesia yesterday evening after incomplete miscarriage. She is physically well, but the Sister is concerned as she appears distressed and depressed. She and some of the nurses have tried to find out what is going on, but she is withdrawn and uncommunicative. They are concerned that she has some kind of mental health problem.

Your task is to deal with the patient as in real life.

81. Role-play. Shoulder dystocia.

Candidate’s instructions.

You are the on-call SpR for the labour ward. It is an unusually quiet afternoon, with only one patient in labour and she is a healthy para 1 with a previous normal delivery.

There is a new FY1 in the department. They were on call yesterday when there was a difficult delivery due to shoulder dystocia. The baby needed to be resuscitated and the mother sustained a 4^th. degree tear. The FY1 felt completely useless and would like an introduction to shoulder dystocia so that they can be of some practical use the next time they are involved with a case.

82. Viva. Enhanced recovery.

Candidate's instructions.

You are a newly-appointed consultant.

The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery. As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery. She suspects that little is known by most of the staff about the subject and hopes that your talk will encourage their enthusiastic participation.

Your task is to tell the examiner the key points you would wish to cover in the talk.

This is not a structured viva: the examiner will not ask questions or help you in any way.