Tutorial 15th. March 2018

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15 March 2018

15	Role-play. Mechanisms of normal labour & delivery. Explain these to the role-player, who is a medical student and keen to learn how to do a normal delivery. Your consultant has said that she needs a clear understanding of the mechanisms before considering conducting a delivery.
16	Viva. Tentorium cerebelli
17	Viva. Laboratory results
18	Roleplay. Pre-pregnancy counselling. Phenylketonuria

15. Role-play. Mechanisms of normal labour and delivery.

Candidate’s instructions.

You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

16. Viva. Tentorium cerebelli

Tentorium cerebelli.

Candidate’s instructions.

This is a viva. Do the origami and make the model. Tell the examiner what you know about the mechanics of tentorial tears. The examiner will just listen and not guide you in any way.

17. Viva. 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 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.

Treated with cabergoline for ­ prolactin and pituitary adenoma. +ve beta HCG.

3 cm. ovarian cyst. ­ Ca 125.

18. Roleplay. Pre-pregnancy counselling. 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 Willhelmina 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.