Tutorial 20th. March 2014

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There was no tutorial tonight as only one girl turned up.

Tutorial 13 March 2014

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6.	Critique GP letter.
7.	Roleplay. Primigravida. 8 weeks. Some bleeding. Scan =  IUP. CRL = 12 mm. No fetal heart activity. Counsel.
8.	Roleplay. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.

GP letter.

The Medical Centre,

Green Lane,

Broadforth-on-Sea.

Your ref: BRI 07/54843.

Re. Jennifer Houseside,

45 The Maltings,

Broadforth-on-Sea.

Dear John,

It was wonderful to see you and Mary again on Saturday and so kind of you to invite us. The meal was up to Mary’s high standards and the company convivial. We may be getting older, but Mary’s fragrant beauty does not diminish.

Please see this woman who complains of unacceptably heavy periods. She is huge, malodorous and is more like a whale than a human being. One can see how the family name originated! I do not envy you the task if you feel that you have to examine her.

She is as stupid as she is fat. I doubt that she has more than one brain cell. If she has, they are not inter-connected. She talks incessantly and brings complete sense of the old adage “empty vessels make most sound”. Despite the vacuum in her cranium she is awash with idiotic ideas most of which she gets from her monumentally stupid mother. She is too thick for logical reasoning to have any impact on her ridiculous views – you might as well attempt a philosophical discussion with your dog.

The father is a dirty, unpleasant sort and I would not be surprised if incest had contributed to their low IQs. If the human race has advanced though evolution and natural selection, what on earth were their ancestors like?

They are social parasites. None of the family has ever worked and they live off Social Security payments. I have had the misfortune to have to do the occasional home visit to various members of the family. They live in disgusting squalor. If they were pigs their living conditions would give the species a bad name. Theirs are houses in which you wipe your feet on the mat as you leave and not as you enter and pray that you never have to visit again. I am sure the Court of Human Rights would regard a second visit as a cruel and unnatural punishment. They always ask you to sit, but I would not wish to ruin my clothes. Their hospitality also extends to offering cups of tea. Perish the thought! I would rather take my chance with neat hemlock.

Despite living on Social Security payments, they have the latest widescreen TVs and associated DVD equipment. The husband looks to me as though he indulges in low-level crime, probably shoplifting. He is a shifty character whom you would not trust and I strongly advise you to make sure that all valuables are locked up and out of sight when he or any of her family is around. One brother is in prison for theft to feed a heroin habit, which typifies the contribution this family makes to the greater good. Her sister is said to be a prostitute and I would think it true. Certainly she has a lot of children and I doubt that any of them have the same father or that she would be able to enlighten them as to who their fathers might be. She (the sister) is a regular visitor to the Sexually Transmitted Diseases clinic where she displays a surprising range of conditions needing treatment. She is a one-woman update course for the staff ensuring they are abreast of all aspects of STDs. I was going to say she was a one-woman refresher course, but there is nothing refreshing about her. The sister is as fat and ugly as my patient, making one marvel at the mentality of her clients. I cannot imagine how anyone would want to come within smelling distance of her, far less have sexual relations and pay for the privilege. Some exotic form of masochism, I guess.

I wish you well in your dealings with her and apologise for sending such an unpleasant lump to your clinic. This is a family that makes you wish the Abortion Act could be made retrospective!

Please do your best not to send her back to see me.

Yours sincerely,

Tutorial 10 March 2014

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10 March 2014

10 March 2014

1. How to prepare. Picking a course.

2. Roleplay: how to introduce oneself.

3. Labour ward scenario 1.

4. Labour ward scenario 2.

5. Roleplay: Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. She is healthy. Her brother has cystic fibrosis

Labour Ward Scenario 1.

Sunday 13.00 hours.

You are given 15 minutes to prepare and you then have a viva with an examiner. Your instructions are to prioritise the patients and allocate staff to go to see them.

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.

Scenario 2.

Monday. 0900 hours.  You have just come on duty.

1	Mrs A	Para 0+0	25 yrs	41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG
2	Mrs B	Para 1+2	31 yrs	28 weeks. Just admitted. "Show" + contractions
3	Mrs C	Para 5+3	40 yrs	In labour 8 hours. Cx 6 cm. dilated
4	Mrs D	Para 1+3	27 yrs	37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section.
5	Mrs E	Para 1+2	32 yrs	40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours.
6	Miss F	Para 0+0	15 yrs	34 weeks. Concealed pregnancy. In labour. Just admitted. Breech presentation
7	Mrs G	Para 1+2		26 weeks. Admitted with severe abdominal pain
8	Mrs H	Para 2+1		39 weeks. In early labour.
9	Mrs I	Para 1+0		Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery
10	Mrs J	Para 1+0		Normal delivery + PPH >1,500 ml. one hour ago

Medical staff:

Consultant:               in his Rooms.

You:                            Registrar.

Foundation Year 2  six months’ experience.

Registrar in anaesthetics.

Midwifery staff:

Senior Sister.

Two staff midwives.

One community midwife.

Two student midwives.