Thursday, 23 August 2018

Tutorial 23 August 2018






28
Roleplay. Booking. Previous SB.
29
Viva. Ovarian torsion.
30
Role-play. Teach an FY1 the basics of audit
31
Role-play. Fragile X syndrome
32
Viva. Breastfeeding.

28. Roleplay. Booking. Previous SB.
Candidate's Instructions.
This is a roleplay station. You are an SpR in the booking clinic. You are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn.
She has had all the routine booking, including investigations, dealt with by the midwife who has asked you to see her to advise about her first pregnancy and its implications for the management of this pregnancy.
Take an appropriate history, advise about the necessary investigations and how the history of stillbirth will influence the management of the pregnancy.

29. Viva. Ovarian torsion.
Candidate’s instructions.
This is a ‘structured conversation’ about ovarian torsion. The examiner will ask 19 questions. You are not allowed to return to earlier questions and will just waste time if you do as no marks will be awarded even for correct answers. The examiner may suggest that you move to the next question to ensure that you have the opportunity to answer all the questions.

30. Role-play. Teach an FY1 the basics of audit.
Candidate’s instructions.
You are the SpR on call for the labour ward. It is a quiet afternoon: all the patients are healthy and in normal labour.
Dr. Jane Jones has started in the department as a new FY1. She is keen to specialise in O&G and has already passed the Part 1 examination. A measure of her enthusiasm is that she has asked her consultant if she can be involved in doing an audit, but she is aware that she knows little about it. Her consultant happens to be the consultant on duty for the labour ward and has asked you to ensure that she has enough knowledge to be a useful member of a team conducting an audit.

31. Role-play. Fragile X syndrome.
Candidate's Instructions.
You are about to see Mary White who has been booked in with her first pregnancy by the midwife in the antenatal clinic. All is well and she has been given the usual advice and leaflets. The midwife has asked you to see her as Mary has told her that there is a family history of Fragile X syndrome.
Your task is to discuss Fragile X syndrome and the implications for Mary, the pregnancy and her father.

32. Viva. Breastfeeding.
Candidate’s instructions.
This is a viva station.
The examiner will ask you 6 questions.



Monday, 20 August 2018

Tutorial 20 August 2018





23
Viva. Trophoblastic disease. Genetics.
24
Role-play. Emergency contraception.
25
Role-play. PMB
26
Role-play. Sterilisation request.
27
Viva. Laboratory results

23. Trophoblastic disease. Genetics.
Candidate's Instructions.
This is a structured clinical discussion. The examiner will ask you 7 questions about the genetics of trophoblastic diseases. When you have answered a question and moved on you are not allowed to return and if you do, you are wasting time as you will earn no marks, even for correct answers.

24..
Candidate’s instructions.
You are the SpR on call for gynaecology and have been asked to see Jennifer Jones who has attended the A&E department requesting EC.

25. PMB.
Candidate’s Instructions.
You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.
A 55 year old woman is referred by her General Practitioner.
Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.
Referral letter from the General Practitioner.
Manor Lodge,
High Street,
Bestown.
BE5 S00

Re: Mrs. Mary Smith,  Age 55.
5b High Street,
Bestown.
BE5 SO1
Dear Doctor,
Please see Mrs. Smith who has had bleeding down below. It is a number of years since she reached the menopause.
Yours sincerely, James Fewords, General Practitioner.

26. Sterilisation request.
Candidate’s instructions.
This is a roleplay station. You are about to see Anne Jones who wishes to be sterilised.
Your tasks are to take a history and discuss her request.
GP letter.
Castle Surgery,
Gambit Grove,
Chesstown. CHS1 U99.
Re Anne Jones.
25 Checkmate Street,
Chesstown. CHS7 Y86.
Dear Doctor,
Please see Mrs Jones who wishes to be sterilised. Our family planning specialist is on leave and I know little about modern contraception, so have not offered any advice.
Regards,
Dr. O.U.T. de Touche.

27. Laboratory results. Administrative action.
Candidate’s instructions.
Your consultant is on annual leave.
Her secretary has asked you to look through the following results and decide what administrative action should be taken in relation to each.
1.     +ve MSSU at booking. No symptoms.
2.     GTT at 34 weeks. Peak level 11.5.
3.     FBC with ­ MCV at booking.
4.     Thrombocytopenia at booking. 50,000.
5.     Hydatidiform mole after evacuation of suspected miscarriage.
6.     Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.
7.     Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.
8.     Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.
9.     Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.
10.   HVS: trichomonas.
11.   Clue cells on smear. 12/52 pregnant.
12.   Antenatal discharge: endocervical swab: chlamydia
13.   Actinomyces on smear.
14.   Herpes in pregnancy
15.   Severe dyskaryosis on cervical smear at booking.
16.   Primary infertility: FSH & LH ­ at 25 on day 3 of cycle.
17.   Primary infertility. FSH 3, LH 12 on day 3 of cycle.
18.   Treated with cabergoline for ­ prolactin and pituitary adenoma. +ve beta HCG.
19.   3 cm. ovarian cyst. ­ Ca 125.




Thursday, 16 August 2018

Tutorial 16 August 2018


16 August 2018

19
Viva. Tentorium cerebelli.
20
Viva. Clinical governance
21
Role-play. Pre-pregnancy counselling. Dad recently diagnosed with Huntington’s disease
22
Role-play. Explain, dyskaryosis, dysplasia, CIN etc.
23

19.  Tentorium cerebelli.
Candidate’s instructions.
This is a viva. Do the origami and make the model. Tell the examiner what you know about the mechanics of tentorial tears. The examiner will just listen and not guide you in any way.

20.  Clinical governance.
Candidate’s instructions.
This is a structured clinal discussion station about clinical governance. The examiner will ask you 5 questions.
When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.

21.  Huntington’s disease.
Candidate's Instructions.
You are the SpR in the pre-pregnancy counselling clinic. Mary Smith has been referred.
The GP referral letter is brief. “Please see this woman who is considering becoming pregnant. Her father has Huntington’s chorea, about which I know very little.”
Your task is to take a history and advise about appropriate investigations.

22.  Dyskaryosis, dysplasia, CIN etc.
Candidate's Instructions.
This is a role-play station. You are a 4th. year SpR.
Jane Smith is a 1st. year student nurse who has joined the department. She has heard the following terms used in the gynaecology and colposcopy clinics:
mild, moderate and severe dyskaryosis in relation to cervical smears,
mild, moderate and severe dysplasia and CIN 1 – 3,
simple, complex and atypical endometrial hyperplasia,
She would like to know what they mean and their significance as the explanations given by the medical staff in the clinics were not clear and patients asked her for clarification. Her knowledge was insufficient for her to provide this, which she found very unsatisfactory for the patients and her. Your consultant has delegated the explanation to you.

23. Trophoblastic disease. Genetics.
Candidate's Instructions.
This is a structured clinical discussion. The examiner will ask you questions about the genetics of trophoblastic diseases. When you have answered a question and moved on you are not allowed to return and if you do, you are wasting time as you will earn no marks, even for correct answers.



Monday, 13 August 2018

Tutorial 13 August 2018


Website



14
Viva. Obstructive sleep apnoea
15
Roleplay. Pre-pregnancy counselling. Phenylketonuria
16
Viva. Apgar score.
17
Role-play. Neonatal screening.
18
Viva. Obstetric surveillance systems

14.  Obstructive sleep apnoea.
Candidate's Instructions.
This is a viva station, now called a ‘structured discussions’. The examiner will ask you 11 questions.
When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.

15. Pre-pregnancy counselling. Phenylketonuria.
Candidate’s instructions.
You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic.
You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy.

The GP letter reads:
Prime Health Practice,
Primetown,
Sussex.
0298766543.
Practice Manager:
Mrs Willhelmina Bland.

Dear Doctor,
Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice.
I look forward to receiving your expert report.
Dr. John Worthy.


16. Apgar score.
Candidate’s instructions.
This is a structured discussion station.
The examiner will ask you 8 questions.
You are not allowed to return to earlier questions. You will not be awarded any marks if you do, even for correct answers.

17. Neonatal screening.
Candidate’s instructions.
You are a SpR in year 5.
You are in the antenatal booking clinic and about to see Mary Eccles. She has been booked by a midwife at 10 weeks’ gestation and all is well. She has recently arrived in the UK from the USA and asked about the routine neonatal screening that is done in the UK. She will be having the baby in the UK.

18. Obstetric surveillance systems.
Candidate's Instructions.
This is a structured discussion station.
The examiner will ask you 2 questions about surveillance systems used in obstetrics.
The first question has 4 marks; the second 16 marks.
The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.



Thursday, 9 August 2018

Tutorial 9th. August 2018




11
Viva. Labour ward scenario 1.
12
Role-play. Explain normal labour and delivery.
13
Role-play. Hydatidiform mole.
14
Viva. Obstructive sleep apnoea

11.   Labour ward scenario.
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 see them.

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.

12.   Normal labour and delivery.
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

13.   Hydatidiform mole.
Candidate's Instructions.
You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient. She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks. The histology report showed a complete mole. The GP was contacted and asked to see her. An appointment was sent to her to attend today. Your task is to take a history and explain the implications of the diagnosis.

14.  Obstructive sleep apnoea.
Candidate's Instructions.
This is a viva station, now called a ‘structured discussions’. The examiner will ask you 11 questions.
When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.


Monday, 6 August 2018

Tutorial 6th. August 2018


Website



7
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance, how to ask if role-player has questions, dealing with information such as a relative with a serious problem,  etc. Make a list!
8
Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
9
Viva. The uses of MgSO4 in O&G.
10
Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding.

11
Viva. Labour ward scenario 1.

7.     “Blurbs” to write and practise.

8.     Role-play. Pre-pregnancy counselling.
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.     Viva. The uses of MgSO4 in O&G.
              This is not a ‘structured discussion’. This is harder as you have to think of all the answers and not just respond to questions. The examiner will not ask any questions or give you any prompts or help. It is all up to you!

10.   Role-play. Break bad news.
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. Labour ward.
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 see them.

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.