MRCOGManchester

Thursday, 9 August 2018

Tutorial 9th. August 2018

Website

11	Viva. Labour ward scenario 1.
12	Role-play. Explain normal labour and delivery.
13	Role-play. Hydatidiform mole.
14	Viva. Obstructive sleep apnoea

11. 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 see them.

Sunday 13.00 hours.

Labour Ward.

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. Type 1 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. Husband of patient who has had Wertheim's hysterectomy 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.

12. Normal labour and delivery.

Candidate’s instructions.

You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

13. Hydatidiform mole.

Candidate's Instructions.

You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient. She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks. The histology report showed a complete mole. The GP was contacted and asked to see her. An appointment was sent to her to attend today. Your task is to take a history and explain the implications of the diagnosis.

14. Obstructive sleep apnoea.

Candidate's Instructions.

This is a viva station, now called a ‘structured discussions’. The examiner will ask you 11 questions.

When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.

Monday, 6 August 2018

Tutorial 6th. August 2018

Website

7	Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance, how to ask if role-player has questions, dealing with information such as a relative with a serious problem, etc. Make a list!
8	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1^st. pregnancy. Her sister recently had a baby with Down’s syndrome.
9	Viva. The uses of MgSO₄ in O&G.
10	Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.
11	Viva. Labour ward scenario 1.

7. “Blurbs” to write and practise.

8. Role-play. Pre-pregnancy counselling.

Candidate’s instructions.

You are the SpR in the gynaecology clinic. You have been asked to see Jenny Williams, who has come for pre-pregnancy counselling.

Letter from the General Practitioner.

5 High Street,

Deersworthy,

Kent.

DO9 1JY.

Re Mrs. J. Williams,

Manor Place,

Deersworthy.

Dear Dr.,

Please see this woman who is planning pregnancy. I understand that her sister has had a baby with Down’s syndrome.

Regards,

Dr. Jolly.

9. Viva. The uses of MgSO₄ in O&G.

This is not a ‘structured discussion’. This is harder as you have to think of all the answers and not just respond to questions. The examiner will not ask any questions or give you any prompts or help. It is all up to you!

10. Role-play. Break bad news.

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 a patient who has just had a scan in the EPU. She is primigravid and the gestation is 8 weeks. She has had some bleeding.

An ultrasound scan = IUP. CRL = 12 mm. No fetal heart activity. No adnexal masses.

11. Labour ward.

Candidate’s instructions.

Sunday 13.00 hours.

Labour Ward.

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. Type 1 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. Husband of patient who has had Wertheim's hysterectomy 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.

Thursday, 2 August 2018

Tutorial 2 August 2018

Website

2 August 2018

1	How to prepare. Picking a course. Communication skills. Study partner, CTG interpretation. Part 3 Basics document.
2	What topics did not feature in the part 2 and might be expected in the part 3?
3	Possible specialist tutorials: urodynamics, statistics, paper critique
4	Viva. The examiner will ask you 2 questions about the part 3 exam.
5	Role-play. how to introduce oneself.
6	Role-play. Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.

The ‘communication skills’ and ‘Part 3’ documents are in the answers folder under today’s date.

1. Background information.

How to prepare. Picking a course. Communication skills. Study partner

2. Trying to ‘spot’ topics.

What topics did not feature in the part 2 and might be expected in the part 3?

3. Specialist tutorials we can arrange if there is enough time interest.

Urodynamics, Statistics, Paper critique

4. Viva: now called ‘structured discussion’.

Candidate's Instructions.

You need to know the format of the exam. The examiner will ask you 2 questions about it.

5. Role-play.

Candidate's Instructions.

It is essential to get Role-plays off to a fluent start, something that needs preparation and practice. The first thing is to introduce yourself.

6. Role-play.

Candidate's Instructions.

You are the SpR running the pre-pregnancy counselling clinic. You have a GP referral letter relating to the patient you are about to see. You are to deal with the patient as you would in a real pre-pregnancy clinic.

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.

E-mail: MWbesthealth@gmail.com

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.