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7
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Structured
discussion. Pertussis.
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8
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Role-play. Woman attends
for pre-pregnancy counselling as she plans her 1st. pregnancy. Her
sister recently had a baby with Down’s syndrome.
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9
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Structured
discussion. The uses of
MgSO4 in O&G.
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10
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Role-play. Break bad
news. Primigravida.
8 weeks. Some bleeding.
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11
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Viva. Labour ward
scenario 1.
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7.
Pertussis. Structured discussion.
Candidate’s instructions.
The examiner will ask you 9
questions about pertussis & pregnancy.
1. What is pertussis caused by, how is it
spread, what kind of vaccine is available and can it be used in pregnancy?
2. What are the important epidemiological
facts in relation to pertussis in the UK?
3. What is the current advice in the UK about
pertussis in pregnancy and who creates the advice?
4. Critically evaluate the justification for
the advice.
5. What advice should be given to a woman who
has been in close contact with pertussis?
6. What advice should be given to a woman with
suspected pertussis?
7. What advice should be given to a woman with
proven pertussis?
8. Which vaccine is recommended for use in
pregnancy in the UK and what are its main features?
9. What does PHE recommend abut which antibiotic(s)
to use and when in pregnancy.?
Boostrix
8. Pre-pregnancy
counselling role-play.
Candidate’s instructions.
You are the SpR in the gynaecology clinic. You have been asked to see
Jenny Williams, who has come for pre-pregnancy counselling.
Letter from the General Practitioner.
5 High Street,
Deersworthy,
Kent. DO9 1JY.
Re Mrs. J. Williams,
Manor Place,
Deersworthy.
Dear Dr.,
Please see this woman who is planning pregnancy. I understand that her
sister has had a baby with Down’s syndrome.
Regards, Dr. Jolly.
9. The
uses of MgSO4 in O&G. Structured discussion.
Candidate’s instructions.
This
is about the uses of MgSO4 in O&G. It says ‘Structured
discussion’, but I have made it like a viva to make it harder.
The
examiner will not ask questions, prompt or otherwise assist. It is up to you to
give as full an account of the uses as you can muster.
10. Role-play.
Break bad news.
Candidate’s
instructions.
You are the SpR in the
ante-natal clinic. The Consultant who was in clinic has been asked to assist
her Consultant colleague in the labour ward theatre. She is unlikely to return
for some time as the case is one of massive PPH and hysterectomy may be necessary.
One of the midwives asks
you to see a patient who has just had a scan in the EPU. She is primigravid and the gestation is 8
weeks. She has had some bleeding.
An ultrasound scan =
IUP. CRL = 12 mm. No fetal heart activity. No adnexal masses.
11. Structured
discussion.
Labour ward scenario 1.
You are the
registrar on duty and responsible for the labour and gynae wards. You have just
had the handover. Your task is to discuss the overall management of the wards
with the examiner, to prioritise the patients and decide the allocation of
staff to care for them.
This station was
written for the first tutorial I ran for the OSCE exam when it was introduced
more than 20 years ago. There are a number of phrases and concepts that reveal
this distant origin, but I have retained them for nostalgic reasons. I ran the
tutorial on a Sunday afternoon when I was on-call and using what was happening
on the labour and gynae wards that day.
Labour
Ward. Sunday 13.00 hours.
1
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Mrs JH
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Primigravida. T+8.
In labour. 6 cms.
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2
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Mrs AH
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Primigravida at
T. In labour. 5 cms.
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3
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Mrs. BH
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Para 2. 30 days
post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
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4
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Mrs SB
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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.
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5
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Mrs KW
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Para 1. In
labour. Cx. 5 cm. Ceph at spines.
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6
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Mrs KT
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Para 0+1.
38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
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7
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Mrs TB
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Para 1. T+4.
Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
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8
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Mrs RJ
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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.
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9
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Mrs KC
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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.
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Gynaecology
ward.
8 major
post-operative cases who have been seen on the morning ward round and are
stable. The husband of a patient who had Wertheim's
hysterectomy on the Friday was asking to see a doctor for a report on the
operation.
1
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Mrs JB
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10 week
incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
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2
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Ms AS
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19 years old.
Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular
5 cm. ovarian cyst.
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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 IVs 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.
