MRCOG Part 3 tutorial. 4 August 2025

 

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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