Tutorial 19 September

Website: www.drcog-mrcog.info.
Tutorial: http://soundcloud.com/drtmcf/tutorial-19-september-2011.
We started with a role-play with a SpR teaching a junior doctor how to do a forceps delivery.
The we had a "breaking bad news" roleplay.
Primigravida. 8 weeks. Some bleeding. Scan = non-viable pregnancy. CRL = 16 mm. No fetal heart activity. Counsel.
Sounds really easy, but it isn't and illustrates the need for loads of practice.

Tutorial 15 September

Website.
Tutorial.
Tonight we had a basic roleplay.
Then another labour ward scenario as people are not clear about the technique of answering despite Monday's tutorial. I hope it will be clearer after tonight.

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. 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 12 September 2011

Website:
Tutorial:

Tonight we had a roleplay and then a labour ward scenario. The scenario was written many years ago - when OSCEs were first used in the MRCOG - as you will see from some of the language.

It illustrates the techniques for this type of station.
Send me your answer and I'll send what actually happened - this was a real scenario.

  

Labour Ward Scenario 1.

Sunday 13.00 hours.

Labour Ward.

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. Type 1 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. Husband of patient who has had Wertheim's hysterectomy 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.

Tutorial 31st. August 2011

Tutorial.
Website.

Tonight we had the long-awaited statistics tutorial from Julia Morris from the Medical Statistics Department at the University and it was well worth the wait.
She has suggested that everyone go through the basic statistics tutorials on their website: 
http://www.south.manchester.ac.uk/medicalstatistics/information.asp.
I e-mailed the questions she was going to discuss a few days ago.
If you haven't got them, send me an e-mail - you can get it from the website if you don't have it.
Send me your answers and I'll send the answers Julie has prepared.
As it is the exam next Tuesday, there will be no tutorial next week.
We will restart with OSCE practice on Monday 12th. September.

My best wishes go to all of you who are sitting the exam.

Tutorial 29 August 2011.

Website.
Tutorial.
Tonight Claire Candelier took the tutorial and it was very good.
She followed the script she had prepared.
I e-mailed this, but if you don't have it, let me know.

Tutorial 22 August 2011.

Website: http://www.drcog-mrcog.info/
Tonight we kicked off with a tutorial on modes of inheritance. A lot of questions on this are common in the exam and it is another "last minute revision" topic. I hope the EMQ helps with this. Then we discussed how to tackle 4 essays.

Mode of inheritance.

Lead-in.

The following questions relate to the mode of inheritance.

For each question, choose the answer from the option list that best matches. Each option can be used once, more than once or not at all.

List of questions.

1.         achondroplasia

2.         adreno-genital syndrome

3.         androgen insensitivity syndrome

4.         Angelman syndrome. Dandy-Walker syndrome

5.         Dandy-Walker syndrome

6.         Down’s syndrome

7.         Duchenne muscular dystrophy

8.         Edward’s syndrome

9.         Ehlers-Danlos syndrome

10.     Fitz-Hugh-Curtis syndrome

11.     Fragile X syndrome

12.     Glucose-6-phosphate dehydrogenase deficiency X-linked recessive

13.     haemophilia A

14.     haemophilia B

15.     Lynch syndrome (HNPCC). Marfan’s syndrome

16.     Marfan’s syndrome

17.     Mayer-Rokitansky-Kuster-Hauser syndrome

18.     Noonan syndrome.

19.     Prader-Willi syndrome

20.     Potter’s syndrome

21.     Sickle cell disease

22.     Tay-Sach’s disease

23.     thalassaemia

24.     Triple X syndrome

25.     Turner’s syndrome

26.     Swyer’s syndrome

27.     VACTERL

28.     von Willebrand’s disease

29.     A mother has spina bifida. What is the risk of a child being affected?

30.     A mother has had a child with spina bifida, what is the risk of the next child being affected?

31.     A mother has had two children with spina bifida. What is the risk of the next child being affected?

32.     A mother has grand-mal epilepsy. What is the risk of her child having epilepsy?

33.     A mother and her partner both have grand-mal epilepsy. What is the risk of their child having epilepsy?

34.     A mother has insulin-dependent diabetes mellitus. What is the risk of a child being affected?

35.     A mother and her partner have insulin-dependent diabetes mellitus. What is the risk of a child being affected?

Essays 22 August 2011.

Question 1.

A nulliparous woman attends the antenatal clinic at 36 weeks. She has no health problems and the pregnancy has been normal. The presentation is cephalic and the head is engaged. She states that she wishes Caesarean section. Outline your management.  

Question 2.

2. A primigravid woman has a normal delivery of a baby with the facial features of Down’s syndrome. She has recognised that the baby has Down’s syndrome. The paediatricians are all busy in the A&E department due to a crash involving a school bus and you have been asked to see her. Outline your management.      

Question 3.

A primigravid woman is admitted with severe abdominal pain at 36 weeks. Outline how you will go about establishing a diagnosis.

Question 4.

A nulliparous woman is admitted to the Early Pregnancy Unit with abdominal pain and bleeding. Her hCG is 2,000 i.u. per litre. An ultrasound scan shows an empty uterus and a left adnexal mass.

1.  Discuss the differential diagnosis.   4 marks.

2.  Discuss the treatment options.      10 marks.

3.  Discuss the advice you will give for when she has recovered. 6 marks.