Tutorial 14th. April 2011

Webpage: www.drcog-mrcog.info.
Podcast:    http://soundcloud.com/drtmcf/tutorial-14-april-2011

First we went through the technique applicable to a waiting list prioritisation.
Then we did a labour ward prioritisation. Again to look at technique. We had done this before, but it was one of the early tutorials and many people missed it.
The scenarios we used are below.
If you want my versions of the answers, send me an e-mail with your versions.

Waiting List Prioritisation.

Your consultant is away.

The waiting-list manager comes to see you.

The following patients have been listed by junior staff.

The waiting-list manager wants you to:

confirm the appropriateness of the proposed treatment,

decide the degree of urgency,

confirm the appropriateness of the proposed venue,

decide any special requirement(s) for each patient.

Name	Age	Clinical Problem	Proposed operation	Venue	Special Needs	Urgency
JK	5	chronic discharge. ? foreign body	EUA	Main theatre
JM	32	1ry. infertility	Laparoscopy + tubal patency tests	Main theatre
GN	77	Vulval cancer. Coronary thrombosis x 2. Unstable angina.	Radical vulvectomy agreed at MDT.	Main theatre
RU	55	PMB x1. Weight 20 stones. 1 stone = 14 lb. 1 kg = 2.2 lb. So, 1 stone = about 6.3 kg. I think they would give you kg in the exam.	D&C.	DCU.
LD	32	Menorrhagia. Fibroids. Anaemia.	Vaginal hysterectomy.	Main theatre.
DT	22	Does not want children.	Lap. Steril.	DCU
HB	14	Unwanted pregnancy at 10.52.	TOP	DCU. TOP list.	.
JY	44	GSI.	Anterior colporrhaphy.	Main theatre.
JS	23	Vaginal discharge. Cervical ectropion.	Diathermy to cervix.	DCU
DT	55	3 cm. ovarian mass.	Laparoscopy ? proceed to Hyst + BSO.	Main theatre.
EV	32	CIN3.	Cone biopsy.	DCU
UW	34	Endometriosis	Laparoscopic ablation	DCU
HT	88	Cystocoele/ rectocoele/ 2nd. degree uterine prolapse	Manchester Repair.	Main theatre.
KN	58	Haematuria	Cystoscopy	DCU
JW	18	Menorrhagia & copes badly with menstrual hygiene. Has Down’s syndrome. Sexually active.	Hysterectomy	Main theatre
TB	30	Menorrhagia. 2nd. degree uterine descent. Been sterilised. Jehovah’s witness.	Vaginal hysterectomy and repair.	Main theatre.
BM	55	Stage Ib cancer cervix. Been discussed at MDT. For Wertheim’s hysterectomy. Factor V Leiden. VTE on Pill. On warfarin.	Wertheim’s hysterectomy.	Main theatre.
NU	60	Recurrent rectocoele.	Posterior colporrhaphy.	Main theatre.

Scenario 2.

Monday. 0900 hours.  You have just come on duty.

1	Mrs A	Para 0+0	25 yrs	41 weeks. In labour 12 hours. Cx 8 cm. No progress for 4 hours. "Dips" reported on CTG
2	Mrs B	Para 1+2	31 yrs	28 weeks. Just admitted. "Show" + contractions
3	Mrs C	Para 5+3	40 yrs	In labour 8 hours. Cx 6 cm. dilated
4	Mrs D	Para 1+3	27 yrs	37 weeks. Diabetes. Admitted ½ hour previously. Previous Caesarean section.
5	Mrs E	Para 1+2	32 yrs	40 weeks. Previous 9 lb. baby. In the second stage for 1 ½ hours.
6	Miss F	Para 0+0	15 yrs	34 weeks. Concealed pregnancy. In labour. Just admitted. Undiagnosed breech presentation
7	Mrs G	Para 1+2		26 weeks. Admitted with severe abdominal pain
8	Mrs H	Para 2+1		39 weeks. In early labour.
9	Mrs I	Para 1+0		Delivered two hours previously by Caesarean section for severe pre-eclampsia. Diastolic BP / 110. Urine output 50 ml. since delivery
10	Mrs J	Para 1+0		Normal delivery + PPH >1,500 ml. one hour ago

Medical staff:

Consultant:               in his Rooms.

You:                            Registrar.

Foundation Year 2  six months’ experience.

Registrar in anaesthetics.

Midwifery staff:

Senior Sister.

Two staff midwives.

One community midwife.

Two student midwives.

Tutorial 7th. April 2011

Website: www.drcog-mrcog.info.
Podcast: http://soundcloud.com/drtmcf/tutorial-7-april-2011

Tonight we talked about diathermy, shoulder dystocia and "breaking bad news". There is eough stuff on the website to give you all you need about diathermy.

Tutorial 4th. April 2011

Website.
Podcast.
Tonight was all OSCE basics. How to survive a viva. This one was on risk management. Then how to deal with a viva on an emergency case. Again there are techniques to learn. Finally explaining balanced translocation which took us into explaining chromosomes and genes. Very, very necessary to start practising such explanations so that you can do them fluently in the exam. You definitely do not want to be trying to find appropriate words for the first time in the exam.
The next tutorial is on Thursday.

Tutorial 28 March 2011

Podcast
Website

The last two tutorials were terrible.
I have bought a couple of new microphones to try to improve things.
I don't have time to listen to the whole thing, so let me know how you find it.
We started with a SpR teaching a junior the use of forceps.
A typical station, but one that needs structure.
Then we went on to a roleplay in the colposcopy clinic, which had a number of interesting aspects.

Tutorial 21st. March 2011

Website: www.drcog-mrcog.info.
Podcast: http://soundcloud.com/drtmcf/tutorial-21-march-2011.

Tonight we discussed how to deal with the "laboratory results" station.

The scenarion is that the consultant is away and the secretary gives you a load of results and asks you what action needs to be taken.

The results we discussed were:

Laboratory results.

+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.

“Miscarriage” → ERPC. Histology report: Decidual reaction. No trophoblastic tissue seen.

If you e-mail me your answers, I'll send what I think.

Tutorial 17th. March 2011

Website: www.drcog-mrcog.info.
I am afraid that the quality of this podcast is terrible. I must have done something wrong in setting it up.
Fortunately, it was all roleplay technique and we will do this over and over in the tutorials.
So, you will be able to catch up.
Tonight we did our first roleplay, demonstrating the difficulties.
The process needs to be broken into bits and each needs to be practised.
Make sure you get plenty of practice.
Ideally this should be with someone with good English but who is not a doctor.
You tell them to stop you every time you say something they don't understand.
And that includes medical jargon.

Tutorial 14 March 2011

Website: http://www.drcog-mrcog.info/.
Tonight we covered the technique for dealing with a labour ward scenario.
I e-mailed the scenarios before the tutorial.
If you did not get a copy, send me an e-mail.
The next tutorial will be on Thursday.