Tutorial 22 September 2016

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22 September 2016

15	Roleplay. Booking. Previous SB.
16	Viva. Breastfeeding.
17	Roleplay. Pre-pregnancy counselling. Phenylketonuria.
18	Roleplay. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s.

15. Roleplay. Previous stillbirth.

Candidate's Instructions.

You are an SpR in the booking clinic. You are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn.

She has had all the routine booking, including investigations, dealt with by the midwife who has asked you to see her to advise about her first pregnancy and its implications for the management of this pregnancy.

Take an appropriate history, advise about the necessary investigations and how the history of stillbirth will influence the management of the pregnancy.

16. Viva. Breastfeeding.

Candidate’s instructions.

This is a viva station.

The examiner will ask you 7 questions.

                                                          

17. Viva. Phenylketonuria.

Candidate’s instructions.

You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic.

You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy.

The GP letter reads:

Prime Health Practice,

Primetown,

Sussex.

0298766543.

Practice Manager:

Mrs Wilhelmina Bland.

Dear Doctor,

Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice.

I look forward to receiving your expert report.

Dr. John Worthy.

18. Roleplay. Huntington’s chorea.

Candidate's Instructions.

You are the SpR in the pre-pregnancy counselling clinic.

Mary Smith has been referred.

The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”

Your task is to take a history and advise about appropriate investigations.