Tutorial 20 August 2018

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23	Viva. Trophoblastic disease. Genetics.
24	Role-play. Emergency contraception.
25	Role-play. PMB
26	Role-play. Sterilisation request.
27	Viva. Laboratory results

23. Trophoblastic disease. Genetics.

Candidate's Instructions.

This is a structured clinical discussion. The examiner will ask you 7 questions about the genetics of trophoblastic diseases. When you have answered a question and moved on you are not allowed to return and if you do, you are wasting time as you will earn no marks, even for correct answers.

24..

Candidate’s instructions.

You are the SpR on call for gynaecology and have been asked to see Jennifer Jones who has attended the A&E department requesting EC.

25. PMB.

Candidate’s Instructions.

You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.

A 55 year old woman is referred by her General Practitioner.

Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.

Referral letter from the General Practitioner.

Manor Lodge,

High Street,

Bestown.

BE5 S00

Re: Mrs. Mary Smith,  Age 55.

5b High Street,

Bestown.

BE5 SO1

Dear Doctor,

Please see Mrs. Smith who has had bleeding down below. It is a number of years since she reached the menopause.

Yours sincerely, James Fewords, General Practitioner.

26. Sterilisation request.

Candidate’s instructions.

This is a roleplay station. You are about to see Anne Jones who wishes to be sterilised.

Your tasks are to take a history and discuss her request.

GP letter.

Castle Surgery,

Gambit Grove,

Chesstown. CHS1 U99.

Re Anne Jones.

25 Checkmate Street,

Chesstown. CHS7 Y86.

Dear Doctor,

Please see Mrs Jones who wishes to be sterilised. Our family planning specialist is on leave and I know little about modern contraception, so have not offered any advice.

Regards,

Dr. O.U.T. de Touche.

27. Laboratory results. Administrative action.

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.