Tutorial 21 July 2011

Website.
Podcast.
Tonight we attempted an EMQ on statistics. I had only finished writing it before the tutorial, so it was a bit of a test run. I immediately spotted several errors and we found that one of the questions seemed to cause more confusion than enlightenment. I'll need to re-write it. As you will see, I split the tutorial into two as there was a bit in the middle when there was no conversation. But I messed up starting the recording again and the second half is missing. I need to get better at this podcasting business.
The EMQ was e-mailed to everyone. If you did not get it, your name is not on my mailing list. Send me an e-mail.

Tutorial 18 July 2011

Podcast.
Website.
Tonight's essays.

Question 1.

A 25-year-old primigravida attends for a routine scan and echogenic bowel is noted.

1. What is the advice of the National Screening Committee in relation to “soft markers"? 
                                                                               6 marks.

2. What conditions are linked to echogenic bowel?      6 marks.

3. Justify your management.                                    12 marks.

Question 2.

A woman is referred to the pre-pregnancy counselling clinic. She had Caesarean section with her previous pregnancy.

1.  Outline the history you will take.                   6 marks.

2.  Justify the investigations you will arrange.      4 marks.

3.  Justify the advice you will give.                    10 marks.

Question 3.

With regard to epidural anaesthesia in obstetrics:

1.  Outline the main differences between it and spinal anaesthesia.       6 marks.

2.   Outline the main techniques and drugs used.                                4 marks.

2.  Evaluate the main contraindications.                                              4 marks.

3.  Discuss the main uses.                                                                6 marks.

Question 4.

A woman attends the antenatal clinic at 36 weeks. She had read an article in a woman’s magazine about the merits of commercial umbilical cord blood banking and would like to have this done.

1.   Justify the history you will take.                  4 marks

2.   Justify the investigations you will arrange.    2 marks

3.  Justify your management.                          14 marks

Tutorial 14 July 2011

Podcast.
Website.
Tonight we managed four essay plans. I have been helping run the local MRCOG course for the past week and have not had time for much else. In particular, I have not managed to write any EMQs, for which I know there is an insatiable demand. I'll try to do some for the next session.
Tonight's essays were:

With regard to female genital mutilation (FGM).

1. what are the key aspects of the law in the UK relating to FGM.                                                  2 marks.

2. what are the responsibilities of the doctor who suspects that a child may be subjected to FGM?  2 marks.

3. how is FGM graded?                                                                                                                 3 marks.

4.  outline the management of woman found at booking to have had FGM.                                    13 marks.

With regard to blood transfusion in obstetrics:

1. outline the main hazards of blood transfusion.                 2 marks

2. how may the incidence of transfusion be reduced?         4 marks

3. outline the key factors relating to red cell use.                 6 marks

4. critically evaluate the use of fresh frozen plasma.             4 marks

5. critically evaluate the use of platelets.                              2 marks

6. critically evaluate the use of recombinant factor VIIa.      2 marks          

A 41-year-old woman attends for review after a normal hysteroscopy. She now wishes treatment for her incapacitating heavy periods which have not responded to medical management.

1. Outline the history you will take.                                                           4 marks.   

2. Outline the investigations you will consider.                                           4 marks.

3. Critically evaluate your advice on the available management options.    12 marks

A patient is referred for management of premenstrual syndrome.

1. Define PMS and its grades of severity.          4 marks.

2. Outline the investigations you will arrange.      6 marks.

3. Critically evaluate the management options.  10 marks.

Tutorial 11 July 2011

Podcast: http://soundcloud.com/drtmcf/tutorial-11-july-2011
Website: www.drcog-mrcog.info.
Tonight we dicussed 4 topics and demonstrated that we had not read the GTGs in sufficient detail!

Question 1.

A primigravida collapses 1 hour after normal vaginal delivery.

1. Critically evaluate the differential diagnosis of maternal collapse.    6 marks.

2. How may impending maternal collapse be recognised.                 4  marks.

2. Critically evaluate the management of this woman.                      10 marks.

Question 2.

Obstetric cholestasis.

1. Outline the symptoms associated with OC.                                                               4 marks.

2. Critically evaluate the differential diagnosis of OC and the key investigations.        6 marks.

3. Outline the maternal and fetal risks of OC.                                                           4 marks.

4. Justify your management of a case of OC diagnosed at 28 weeks.                        6 marks.

Question 3.

Critically evaluate alternatives to oestrogen HRT in the management of the menopause.

Question 4.

In relation to diagnostic laparoscopy, critically evaluate:

1. the issues to be discussed in obtaining informed consent                       4 marks.

2. the factors that increase the incidence of entry-related injury                 4 marks.

3. how entry-related injuries may be minimised                                       12 marks.

Tutorial 7th. July 2011

Podcast.
Website.

Tonight we had 4 essays.
I hope you find them interesting.

Question 1.

A woman is found to have a haemoglobin value of 10 gm. / dL. at 28 weeks gestation.

1.      list the main causes of anaemia in pregnancy.                                     6 marks.

2.      outline the main concerns you will have about this level of anaemia.    4 marks.

2.      critically evaluate the main elements of the investigation.                     4 marks.

3.      critically evaluate the management.                                                    6 marks.

Question 2.

A healthy primigravid woman is found to have a breech presentation at 36 weeks. Critically evaluate the management.

1.      outline the investigations you will arrange.    6  marks.

2.      critically evaluate your management.           14 marks.

Question 3.

A woman is found to have a temperature of 39.⁰ C. on the second day after a normal delivery.

1.      what is the definition of puerperal pyrexia?    2 marks.

2.      is puerperal pyrexia a notifiable disease?         2 marks.

3.      critically evaluate your investigation.                8 marks.

3.      critically evaluate the management.                 8 marks.

Question 4.

In relation to “Surviving sepsis”.

1.      outline the key elements of the initial management.                   6 marks.

2.      outline the key elements of monitoring the patient’s condition.  4 marks.

2.      outline the key elements of fluid management.                          4 marks.

3.      critically evaluate the use of corticosteroids.                             2 marks.

4.      critically evaluate antibiotic therapy.                                         4 marks.

Tutorial 4 July 2011

Podcast.
Website.
Soundcloud has been having problems and it has taken me a few attempts to upload this file.
But it is now finally working.

Tonight we discussed 4 essay plans.

Question 1.

With regards to antenatal corticoids administered for benefit to the fetus:

1.      outline the benefits and risks of antenatal corticosteroids.  8 marks.

2.      critically evaluate the use of antenatal steroids.                12 marks.

Question 2.

Critically evaluate the statement: “fortification of flour with folate is overdue in the UK”.

Question 3.

A nulliparous woman of 20 years attends the A&E department with abdominal pain and vaginal discharge. The A&E SpR suspects acute pelvic inflammatory disease and has asked you to see her. Justify:

1.      the history you will take.                                  6 marks.

2.      the investigations you will arrange.                    4 marks.

3.      the immediate management.                             6 marks.

4.      the follow-up arrangements you will discuss.    4 marks.       

Question 4.

With regards to uterine fibroids.

1.      critically evaluate the reasons for treating fibroids.                                               4 marks.

2.      critically evaluate the benefits and risks of surgical management of fibroids.          8 marks

3.      critically evaluate the benefits and risks of non-surgical management of fibroids.   8 marks.

Tutorial 30 June 2011

Podcast.
Website.
I bought some new equipment this week to try to improve the quality of the sound.
Let me know if you think it is better.

Tonight we tackled 4 essay topics.

Question 1.

A 16-year-old virgin is referred with dysmenorrhoea. You are the SpR and see her in the gynaecology clinic. She is accompanied by her mother.

a.            justify the history you will take.                             8 marks

b.            justify the investigations you will arrange.               4 marks

c.             critically evaluate your management.                     8 marks.

Question 2.

With regard to ovarian hyperstimulation syndrome (OHSS):

1. how is OHSS graded?                                             4 marks.

2. what is the aetiology of OHSS?                                2 marks.

3. how may the incidence of OHSS be reduced?          6 marks.

4. justify your management of a case of OHSS.             8 marks.            

Question 3.

You are the SpR in the antenatal clinic. The consultant is absent due to illness and no other consultant is available. A midwife asks you to see a woman whose scan has shown anencephaly.

1. What steps will you take before seeing the woman?         6 marks

2. Justify the approach you will use during the interview.     10 marks

3. What will you do when the interview is over?                   4 marks         

Question 4.

With regard to uterine rupture:

1. how is uterine rupture graded?                                  2 marks

2. critically evaluate the risk factors for uterine rupture.  6 marks

3. critically evaluate the diagnosis of uterine rupture.      6 marks     

4, outline the management.                                            6 marks                         

                                                               

 As usual, send me your essays and I'll send whatever I manage to get time to write.