Tutorial 15 March 2021

15 March 2021. 8. Role-play. Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling. 9. SBA. Molluscum contagiosum. 10. Viva. Part 3 exam. 11. Viva. Labour ward scenario. 12. EMQ. Kallmann’s syndrome 8. Role-play. Pre-pregnancy counselling. Candidate's Instructions. This is a roleplay station. You are a year 4 SpR and are in the gynaecology clinic. The consultant has just left you in charge as she is feeling unwell and has gone to lie down. Your task is to deal with the patient as you would in real life. GP referral letter. Best Medical Centre, High Road, Anytown. Phone: 01882 78998. E-mail: besthealth@gmail.com Practice Manager: Mary Wright. B.SC., RGN. Phone: 01882 78998 ext. 23. E-mail: MWbesthealth@gmail.com Re. Mrs. Bonnie Black, 25 Low Road, Anytown. DOB: 28 January 1990. Dear Doctor, Please see Mrs Black who is planning her first pregnancy. Her main concern is that her brother has cystic fibrosis. This was the first time I had met her although she has been registered with us for 5 years – her health is good and she has no history of serious illness or surgery. I have explained that I don’t know much about the implications of the brother’s cystic fibrosis for her potential pregnancies and that she needs to talk to an expert. I have stressed that the risk of her having a child with cystic fibrosis is high and that she needs to be aware that there is a distinct likelihood that any pregnancy would be likely to be affected and need TOP. Yours sincerely, John P. Clatter. 9. SBA. Molluscum contagiosum. Abbreviations. MC: molluscum contagiosum. STI: sexually-transmitted infection. Question 1. Which, if any, of the following is correct in relation to the infecting organism in MC? A it is a DNA arbovirus B it is a RNA arbovirus C it is a DNA herpesvirus D it is a RNA herpesvirus E it is a DNA poxvirus F it is a RNA poxvirus G it is a bacteriophage H it is a mycoplasma I none of the above Question 2. Which, if any, of the following are correct about MC? A is most common in children B is most commonly a STI C the typical lesions are known as ‘mollusca’ D the typical lesions are pink with a blue-purple halo E the typical lesions have a central depression F the typical lesions have a central endogenous depression G the typical lesions have a ‘lacy’ appearance. Question 3. Approximately what proportion of molluscum contagiosum occurs in children? A < 1% B 5% C 7.5% D 10% E 30% F 50% G 70% H 90% Question 4. Which, if any, of the following is true of the main reservoir of MC? A the main reservoir is cats B the main reservoir is children C the main reservoir is dogs D the main reservoir is goats E the main reservoir is sheep F the main reservoir is shellfish G none of the above Question 5. Which, if any, of the following is true in relation to the diagnosis of MC? A it is most often made clinically B it is most often made on biopsy C it is most often made on PCR testing D it is most often made on viral culture E it is most often made using the Wolff-Hertzhammer test on serum F none of the above Question 6. Which, if any, of the following should be in the list of differential diagnoses? A chickenpox B cowpox C hand foot and mouth disease D measles E orf F smallpox G none of the above Question 7. Is MC a notifiable disease? A no B yes C haven’t a clue and totally unconcerned about the matter Question 8. Which, if any, of the following is the recommended 1st. line treatment for MC? A aciclovir B colchicine C doxycycline D oseltamivir E tenofovir F none of the above Question 9. Which, if any, of the following are true in relation to MC and pregnancy? A the incidence of miscarriage is ↑ B the risk of neural tube defect is ↑ with 1st trimester infection C the incidence of preterm premature rupture of membranes is ↑ D the incidence of preterm birth is ↑ E the incidence of puerperal endometritis is ↑ F none of the above 10. Structured conversation. Part 3 exam. Candidate’s instructions. This is a viva station. The examiner will ask you 7 questions about the Part 3 exam. This would not feature in the exam, but you need to have a clear idea of what the stations are like and I hope the ensuing discussion will provide this. 11. Labour Ward Scenario 1. Candidate’s instructions. You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to care for them. This station was written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are phrases and concepts that reveal this distant origin, but I have retained them for nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call and using what was happening on the labour and gynae wards that day. Labour Ward. Sunday 13.00 hours. 1 Mrs JH Primigravida. T+8. In labour. 6 cms. 2 Mrs AH Primigravida at T. In labour. 5 cms. 3 Mrs. BH Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3. 4 Mrs SB Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan. 5 Mrs KW Para 1. In labour. Cx. 5 cm. Ceph at spines. 6 Mrs KT Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor. 7 Mrs TB Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations. 8 Mrs RJ Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours. 9 Mrs KC Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral. Gynaecology ward. 8 major post-operative cases who have been seen on the morning ward round and are stable. The husband of a patient who had Wertheim's hysterectomy on the Friday was asking to see a doctor for a report on the operation. 1 Mrs JB 10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding. 2 Ms AS 19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst. Medical staff: Consultant at home. Registrar - you. Senior House Officer with 12 months experience. Registrar in Anaesthesia. Consultant Anaesthetist on call at home. Midwifery staff: Senior Sister. Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears. 3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions. 1 Community midwife looking after Mrs. KW. 2 Pupil Midwives. 12. Kallmann’s syndrome. Lead-in. Pick one option from the option list. Abbreviations. Ks: Kallmann’s syndrome Scenario 1. Which of the following might be included in descriptions of Kallmann’s syndrome? Option list. A hypogonadotrophic hypogonadism B hypogonadotrophic hypogonadism + anosmia C hypogonadotrophic hypogonadism + anosmia + colour-blindness. D hypogonadotrophic hypogonadism due to uterine agenesis Scenario 2. Lead in. Which, if any, of the following are features of the Kallmann phenotype? A absent or minimal breast development B aortic stenosis C blue eyes D blue hair E hot flushes F short stature G tall stature H vaginal agenesis I none of the above Scenario 3. How common is Kallmann’s syndrome and what is the female: male ratio? A 1 in 1,000 and F:M ratio 1:1 B 1 in 5,000 and F:M ratio 1:1 C 1 in 10,000 and F:M ratio 1:4 D 1 in 50,000 and F:M ratio 1:4 E 1 in 100,000 and F:M ratio 1:8 F 1 in 250,000 and F:M ration 1:10 Scenario 4. What is the most common mode of inheritance of Ks? Option list. A autosomal dominant B autosomal recessive C X-linked recessive D new mutation of the ANOS1 gene E the most common mode of inheritance is not known Scenario 5. How is Kallmann’s syndrome diagnosed? A abdominal and pelvic ultrasound scan B cell-free fetal DNA C chromosome analysis D CT scan of hypothalamus / pituitary E MR scan of hypothalamus / pituitary F none of the above. Scenario 6. How is Kallmann’s syndrome treated initially? Which of the following statements are true? Option list. A GnRH analogue depot B pulsatile GnRH therapy C combined oral contraceptive D counselling & education re gender re-assignment E depot progestogen F none of the above Scenario 7. A woman was diagnosed with Kallmann’s syndrome at 16 and had successful initial treatment. She is now 25, married and wishes to have a pregnancy. She has had pre-pregnancy assessment and counselling. Which of the following should be considered? A GnRH analogue depot B induction of ovulation with clomiphene C gonadotrophin therapy D pulsatile GnRH therapy E none of the above