Tutorial 13 April 2015

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13th. April 2015.

31	Viva. Waiting list prioritisation.
32	Roleplay. Teach a FY1 about shoulder dystocia.
33	Role-play. Neonatal jaundice.
34	Viva. Adverse incident report. 4th. degree tear.
35	Viva. Whooping cough & pregnancy.

31    Viva. 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
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.

32    Roleplay. Shoulder dystocia

Candidate’s instructions.

You are a year 5 SpR. It is a quiet afternoon on the delivery unit and your consultant has asked to teach a newly-arrived FY1 about shoulder dystocia.

33    Roleplay. Neonatal jaundice.

         Candidate’s instructions.

         Explain the important issues relating to neonatal jaundice to a newly-arrived FY1.

34    Viva. Adverse incident report. 4^th. degree tear.

Candidate’s instructions.

         Mrs Penelope Jane Brown sustained a 4^th. degree tear after the delivery of her second baby.

         Dr. James Peter White conducted the delivery and was asked to write a statement for the Risk Management Team (RMT), to whom the incident has been reported as an adverse clinical incident.

         You have been asked to look at Dr. White’s report, comment on it and identify issues that the RMT needs to explore further. You have 15 minutes to read Dr. White’s report, after which you will have a viva with the examiner. The examiner will not lead the discussion and will simply listen to what you have to say.

         Dr. White’s Report.

         I am Dr. J. White. I have been SpR in obstetrics and gynaecology at the Royal Infirmary for over a year.

         On the 27^th. September I was bleeped by a midwife on the labour ward and asked to see a Mrs Brown who needed to be delivered as there had been delay in the second stage and she was becoming exhausted.

         On arrival on the labour ward I felt that Mrs Brown was not trying very hard to deliver the baby naturally and that the midwives were not making much effort to encourage her. I advised that they should get her pushing properly and that I would go for a coffee and return in half an hour.

         I returned in 50 minutes, having had an important phone call from my wife about arrangements for our forthcoming holiday which was under threat of cancellation. The situation was unchanged and I was not impressed with either the woman’s endeavours or the midwives’ encouragement of her efforts..

         Examination showed the head to be mid-cavity. I felt that it could get it out using forceps. The midwives told me that her bladder was empty. I applied the forceps with ease. The baby delivered in good condition. I then noted that she had a 4^th. degree tear. I repaired this in the usual way.

         I went on holiday the next day for two weeks and did not see this woman again.

35    Viva. Whooping cough and pregnancy.

         Candidate’s instructions.

         The examiner will ask you 4 questions about pertussis and pregnancy.