Thursday 24 September 2015

24th. September 2015

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24 September 2015

15
Viva. Laboratory results
16
Viva. UTI & pregnancy
17
Roleplay. Booking. Previous SB on holiday in Mongolia. No records
18
Viva. Uses of magnesium sulphate in obstetrics.

15.   Laboratory results.
         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 laparoscopic 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.
19.    
+ve beta HCG.
20.    
3 cm. ovarian cyst. ­ Ca 125.

16.   Viva. UTI & pregnancy.
Candidate’s  instructions.
This is a viva station.
The examiner will ask you 8 questions.

17. Role-play. Booking. Previous SB on holiday in Mongolia. No records
Candidate's Instructions.
This is a viva station.
You are in the booking clinic and are about to see a woman who is at 10 weeks gestation in her second pregnancy. Her first baby was stillborn. She has no records as the birth took place in Mongolia. She had booked  for antenatal care but then had to go to Mongolia to look after a sick relative.
The examiner will ask you a series of questions about how you will proceed.

18. Viva. Uses of magnesium sulphate in obstetrics.
Candidate’s instructions.
This is a viva station about the uses of MgSO4 in O&G.
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.




21st. September 2015



21 September 2015.

10
Critique of Menozac website
11
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance etc.
12
Critique RCOG Patient Information Leaflet. Genital Herpes.
13
Roleplay. PMB.
14
Roleplay. Fibroids. UAE.

10.      Critique of Menozac website.
           The supplied document was extracted from the Menozac website a few years ago and is a good example of the genre. You would have 15 minutes to prepare your critique and then face a viva with an examiner. A variant on the theme would be a role-play with a patient who has brought the extract and wishes to discuss it. Critique is not just the bad points – it means overall analysis.

11.      Basic “blurbs”.
           You do not want to try to explain X-linked recessive inheritance for the first time in the exam! Make a list of things that you are likely to be asked and start preparing. Pre-pregnancy counselling is another good example. It comes up in lots of stations and there are probably 2 marks – easy marks if you have practised.

12.      Critique RCOG Patient Information Leaflet. Genital Herpes.
           You can download this from the RCOG website.
           The RCOG’s patient information leaflets used to be appalling! They were like mini-textbooks and totally unfit for purpose. This made them very easy to criticise. They are now very good. You need to have some idea about technique otherwise you may have very little to say to the examiner.

13.      Roleplay. Postmenopausal bleeding.
Candidate’s Instructions.
You are a 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.

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.

14.      Roleplay. Fibroids. UAE.
           Candidate’s instructions.
You are the Consultant in the gynaecology clinic. You are about to see Beth White.
Your instructions are to take the history, advise about appropriate investigations and management and to discuss her concerns.

GP referral letter.
The Medical Centre,
Anytown,
Shropshire.
Re: Mrs. Beth White,
22 Main Street,
Anytown.

Dear Doctor,
Please see Mrs. White who complains of heavy periods. She is 35 years old and a teacher – a very good one, I must say, as she taught my younger daughter last year.  She has read an article about UAE. I thought this was a country in the Middle East, but she informed me that it is a treatment for heavy periods that involves blocking the uterine arteries. I would have thought that this would cause uterine gangrene, but she assures me it is for real, so it sounds like a good option. Whatever will they think of next?
Please see and advise.
Dr. I. G.N. O’Ramus.





Thursday 17 September 2015

17th. September 2015

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17 September 2015.


6 Viva. Abusive GP letter.
7 Role-play. Break bad news. Primigravida. 8 weeks. Some bleeding. Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.
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 station.
You are a year 4 SpR and have been asked by your consultant to assess Mrs Mimi Dresden on the orthopaedic ward. The examiner will ask questions,.

6.     Viva. Abusive GP letter. This is the topic we did not complete on Monday.

7.     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.

8.     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.     Viva station.
         You are a year 4 SpR and have been asked by your consultant to assess Mrs Mimi Dresden on the orthopaedic ward.
She is 85 years old and has been admitted with a hip fracture after a fall in the nursing home where she lives. She has Alzheimer’s disease. The nursing staff have noted blood on her underwear.
The examiner will ask you a series of questions:
             


14th. September 2015

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1 How to prepare. Picking a course.
2 Barriers to communication. What communication barriers exist between me and those attending the tutorial? We can use this as a basis to consider the communication problems between us, patients and colleagues.
3 Role-play: how to introduce oneself.
4 Labour ward scenario 1.
5 Role-play: Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.
6 Abusive GP letter.