Tutorial 4th. April 2016

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4 April 2016

14	Roleplay. Candidate’s instructions. You are an ST4 in the pre-pregnancy counselling clinic. The patient’s referral letter is not in the notes. Your task is to take an appropriate history and to discuss any investigation or management issues that may be relevant with appropriate diagrams.
15	Viva station. You are a year 4 SpR and have been asked by your consultant to assess Mrs Mimi Dresden on the orthopaedic ward. She has a hip fracture after a fall. She has Alzheimer’s disease, is 85 years old and has been admitted from the nursing home where she lives. The nursing staff have noted blood on her underwear. The examiner will ask you 4 questions and will expect to hear the reasoning underlying your answers.
16	Viva. UTI & pregnancy. The examiner will ask you a series of questions on this topic.
17	Candidate’s instructions. Your consultant is on annual leave. Her secretary has asked you to look through the following results and decide what administrative action should be taken in relation to each. +ve MSSU at booking. No symptoms. GTT at 34 weeks. Peak level 11.5. FBC with ­ MCV at booking. Thrombocytopenia at booking. 50,000. Hydatidiform mole after evacuation of suspected miscarriage. Histology after ERPC for incomplete miscarriage: no trophoblastic tissue. Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy. Endometrial cancer: MR scan: reaching serosa and upper endocervical canal. Consultant does lap drainage of normal-looking ovarian cyst. Malignant cells. Nulliparous. Wants children. HVS: trichomonas. Clue cells on smear. 12/52 pregnant. Antenatal discharge: endocervical swab: chlamydia Actinomyces on smear. Herpes in pregnancy Severe dyskaryosis on cervical smear at booking. Primary infertility: FSH & LH ­ at 25 on day 3 of cycle. Primary infertility. FSH 3, LH 12 on day 3 of cycle. On cabergoline for ­ prolactin and pituitary adenoma. +ve β-hCG. 3 cm. ovarian cyst. ­ Ca 125.