Tutorial 8th. October 2015

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8 October 2015

31	Role-play. Fragile X syndrome
32	Viva. Adverse incident report. 4th. degree tear.
33	Roleplay. Abnormal cervical smear
34	Viva. Neonatal jaundice.
35	Viva. Apgar score.

31.   Roleplay. Fragile X syndrome.

Candidate's Instructions.

You are about to see Mary White who has been booked in with her first pregnancy by the midwife in the antenatal clinic. The midwife has asked you to see her as Mary has told her that there is a family history of Fragile X syndrome. There were no other significant issues in the history.

Your task is to discuss Fragile X syndrome and the implications for Mary.

32.   Viva. Adverse incident. 4^th. degree tear.

Adverse incident report.

Candidate’s instructions.

Mrs Penelope Jane Brown sustained a 4^th. degree tear during 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 which the RMT need 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 Statement.

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.

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.

33.   Roleplay

Candidate's Instructions.

This is a role-play station.

You are the SpR in the colposcopy clinic.

The patient is attending after a smear showed severe dyskaryosis.

Your tasks are to take a history and explain the investigations you propose.

34.   Viva. Neonatal jaundice.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 6 questions.

35.   Viva. Apgar score.

Candidate's Instructions.

This is a viva station.

The examiner will ask you 8 questions.

You are not allowed to return to earlier questions.

You will not be awarded any marks if you do, even for correct answers.