|
1 |
How to prepare. Patient information
leaflets. Part 2 stuff,
TOG questions & answers, study buddies, practice, courses.
Communication skills. Importance of polished introduction to role-plays. ?
adopt user-friendly name for role-play if you are ‘Clementina’, ‘Cressida’
‘Maximilian’ or ‘Vladymir’. ‘Blurbs’. How to deal with GP referral letter. Agendas
and hitting all the bullet points in 10 minutes. Senior doctor thinking:
staffing, training, audit, critical incident reporting and analysis etc.
Avoiding medical jargon, abbreviations and acronyms ‘registrar’,
‘anaphylaxis’, PCOS, PMB. Trans patients. |
|
2 |
Role-play. Cystic fibrosis. Brother has cystic fibrosis |
|
3 |
Role-play. Chickenpox. Pre-pregnancy counselling. Friend
has child with FVS |
|
4 |
EMQ. Fowler syndrome |
1.
How
to prepare.
2.
Role-play
1.
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.
Phone: 07889 888 132.
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.
3.
Role-play
2.
Candidate’s instructions.
You are a SpR5 and about to see Mary Brown. Your instructions are to deal
with her as you would in real life.
The
GP letter is as follows.
Model Health Centre,
Modeltown.
Please see Mary Brown who is planning her first pregnancy. She is in good
health and is a rare attendee at the health centre. She has concerns about
chickenpox in pregnancy. I have not seen a case of this and feel ill-equipped
to advise. I look forward to having your expert advice.
Dr. Elizabeth Merryweather.
4.
Fowler syndrome..
Abbreviations.
Fs: Fowler syndrome.
MSA: multiple system atrophy.
OASI: obstetric anal sphincter injury.
PCOS: polycystic ovary syndrome.
Question
1. Which of the following fits best with Fowler syndrome?
|
A |
faecal frequency |
|
B |
faecal incontinence |
|
C |
faecal retention |
|
D |
urinary frequency |
|
E |
urinary incontinence |
|
F |
urinary retention |
|
G |
none of the above |
Question
2. Which, if any, of the following are true of Fs. There may
be > 1 correct answer.
|
A |
it is a feature of cauda equina syndrome |
|
B |
it is associated with menstrual migraine |
|
C |
it is more common in males |
|
D |
it is more common in those with endometriosis |
|
E |
it is more common in those with PCOS |
|
F |
it is more common with use of opioids |
|
G |
it is most common in those aged > 65 years |
|
H |
is often an early feature of multiple sclerosis |
|
I |
it is usually due to diabetic neuropathy |
|
J |
it is usually due to benign prostatic hypertrophy |
|
K |
it is usually due to OASI |
Question 3.
Which of the following are typical Fowler syndrome symptoms?
|
A |
fecal
incontinence |
|
B |
frequent,
painful bowel movements |
|
C |
frequent,
painless bowel movements |
|
D |
painful
urinary incontinence |
|
E |
painful
urinary frequency |
|
F |
painful
urinary retention |
|
G |
painful
urinary incontinence |
|
H |
history of
difficulty emptying bladder |
|
I |
history of
enuresis |
|
J |
history of
late completion of “potty training” |
|
K |
history of
psychological problems |
|
L |
history of
infertility |
|
M |
history of
comorbidities |
|
N |
history of
difficulty emptying bowel |
|
O |
discomfort
during and after bladder catheterisation |
|
P |
discomfort
during and after rectal examination |
|
Q |
post-voiding
residual bladder volume <50 mL |
|
R |
post-voiding
residual bladder volume >1 litre |
|
S |
sense of
incomplete bladder emptying |
|
T |
sense of
incomplete bowel emptying |
|
U |
occurrence
after surgery under general or regional anaesthesia |
Question 4.
Which of the
following feature significantly in the differential diagnosis of Fs?
|
A |
adenomyosis |
|
B |
cauda equina
syndrome |
|
B |
Crohn’s
disease |
|
C |
diabetes |
|
D |
diverticular
disease |
|
E |
multiple
system atrophy |
|
F |
Munchausen
syndrome |
|
G |
multiple
sclerosis |
|
H |
none of the
above |
Question
5. Which of the following are useful in
the investigation of possible Fowler syndrome?
|
A |
frequency / volume micturition charting |
|
B |
frequency of bowel movement charting |
|
C |
rectal sphincter electromyography |
|
D |
rectal ultrasound |
|
E |
urodynamics |
|
F |
urethral pressure profile |
|
G |
urethral ultrasound |
|
H |
urethral sphincter electromyography |
Question
6. Which of the following are recommended
for the treatment of Fowler syndrome?
|
A |
aspirin |
|
B |
azathioprine |
|
C |
botulinum toxin |
|
D |
corticosteroids |
|
E |
mirabegron |
|
F |
oxybutynin |
|
G |
sacral neuromodulation |
Fowler's syndrome: a primary
disorder of urethral sphincter relaxation
Urinary retention,
1.
is more commonly
reported in women than in men. True / False
2.
occurs in multiple
system atrophy (MSA) most often as the disease progresses. True / False
3.
rarely occurs
following injury to the cauda equina. True / False
Fowler's syndrome,
4.
is a condition
affecting both men and women. True / False
5.
is seen most commonly
in the postmenopausal age group. True / False
Women with Fowler's syndrome,
6.
most often present
with overactive bladder symptoms. True / False
7.
find abdominal
straining to be an efficient way of emptying the bladder. True / False
8.
rarely suffer from
co‐existing gynaecological problems. True / False
9.
have a primary
disorder affecting the urethral sphincter. True / False
In Fowler's syndrome,
10. decelerating bursts are a finding in the urethral sphincter
electromyogram. True / False
11. urodynamics is an essential investigation for the
diagnosis. True / False
12. women often complain of difficulty in
self‐catheterisation. True / False
With regard to urodynamics,
13.
the normal capacity of
the bladder is in the region of 500 ml. True / False
14.
standard cystometry
involves filling the bladder with contrast agent. True / False
15.
the expected maximum
urethral closure pressure (MUCP) is determined as 92–age (years). True / False
16.
an atonic detrusor is
a common finding in women with Fowler's syndrome. True / False
Sacral
neuromodulation,
17. is effective in managing urethral obstruction secondary to
stricture disease. True / False
18. involves the placement of a tined lead in the S4 nerve root
foramen. True / False
19. is more effective in women with urinary retention diagnosed
as having Fowler's syndrome compared to women without Fowler's syndrome. True / False
20. has a success rate exceeding 70% in women with Fowler's
syndrome. True / False
