Tutorial 9th. October 2017

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9 October 2017

17	Viva. Obstetric surveillance systems	9	Oct	2017
18	Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding. Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.	9	Oct	2017
19	Role-play. Hydatidiform mole.	9	Oct	2017
20	Viva. Laboratory results	9	Oct	2017
21	Viva. Breastfeeding	9	Oct	2017

17. Obstetric Surveillance Systems.

This is a viva station. The examiner will ask you 2 questions about surveillance systems used in obstetrics. The first question has 4 marks; the second 16 marks.

The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.

18. Breaking bad news. Bleeding in early pregnancy.

This is a role-play station. The role-player will act as the patient. An examiner will be present.

You are the SpR in the ante-natal clinic. The Consultant who was in clinic has been asked to assist her Consultant colleague in the labour ward theatre. She is unlikely to return for some time as the case is one of massive PPH and hysterectomy may be necessary.

One of the midwives asks you to see a patient who has just had a scan in the EPU.

She is primigravid and the gestation is 8 weeks. She has had some bleeding.

An ultrasound scan = IUP. CRL = 12 mm. No fetal heart activity. No adnexal masses.

19. Hydatidiform mole.

You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient. She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks.

The histology report showed a complete mole.

The GP was contacted and asked to see her. An appointment was sent to her to attend today.

Your task is to take a history and explain the implications of the diagnosis.

20. Laboratory results.

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.

1	+ve MSSU at booking. No symptoms.
2	GTT at 34 weeks. Peak level 11.5.
3	FBC with ­ MCV at booking.
4	Thrombocytopenia at booking. 50,000.
5	Hydatidiform mole after evacuation of suspected miscarriage.
6	Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.
7	Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.
8	Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.
9	Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.
10	HVS: trichomonas.
11	Clue cells on smear. 12/52 pregnant.
12	Antenatal discharge: endocervical swab: chlamydia
13	Actinomyces on smear.
14	Herpes in pregnancy
15	Severe dyskaryosis on cervical smear at booking.
16	Primary infertility: FSH & LH ­ at 25 on day 3 of cycle.
17	Primary infertility. FSH 3, LH 12 on day 3 of cycle.
18	Treated with cabergoline for ­ prolactin and pituitary adenoma.  +ve beta HCG.
19	3 cm. ovarian cyst. ­ Ca 125.

21. Breastfeeding.

Candidate’s instructions.

This is a viva station.

The examiner will ask you 7 questions.