Tutorial 30th. March 2017

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30 March 2017

10.	Role-play. Primigravida. 8 weeks. Some bleeding. Scan = IUP. CRL = 12 mm. No fetal heart activity. Counsel.
11.	Viva. Critique of Menozac website
12.	Viva. Laboratory results
13.	Roleplay. PMB

10. Role-play. Bleeding in early pregnancy.

Candidate's Instructions.

This is a role-play station. The role-player will act as the patient. An examiner will be present.

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. Critique of website.

Your task is to read the extract from the Menozac website, prepare a critique and present it to the examiner. The examiner will not prompt or help you in any way.

12. Laboratory results.

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.

13. Roleplay. 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.

Tutorial 27th. March 2017

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27 March 2017

6	Viva. The examiner will ask you 2 questions about the part 3 exam.
7	Homework. Basic “blurbs” to write and practise. Setting the scene for breaking bad news, general pre-pregnancy counselling, dominant, recessive & x-linked inheritance etc.
8	Viva. Labour ward scenario 1.
9	Role-play. Woman attends for pre-pregnancy counselling as she plans her 1st. pregnancy. Her sister recently had a baby with Down’s syndrome.
10	Viva. The uses of MgSO4 in O&G.

6. The examiner will ask 2 questions about the part 3 exam.

The exam committee has highlighted some key aspects that will be expected to be reflected in the exam. This is meant to make you think about them and use them on the big day.

7. Basic “blurbs”.

You need to develop and practise some basics: setting the scene for breaking bad news, general pre-pregnancy counselling, dominant, recessive & x-linked inheritance etc. These are things that come up time and again and it helps a lot of you can deliver them swiftly and smothly.

8. Labour ward scenario 1.

We are told that preparatory stations won’t be used. Quite how they will devise stations about important topics like labour ward management remains to be seen.

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. Early 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.

9. Roleplay. 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.

10. Viva. Use of MgSO₄ in O&G

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.

Tutorial 20th. March 2017

20 March 2017

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1	How to prepare. Picking a course. Communication skills partner
2	Urodynamics, CTG interpretation
3	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.
4	Role-play: how to introduce oneself.
5	Role-play: Healthy, nulliparous. Brother with cystic fibrosis. Pre-pregnancy counselling.

1. Picking a part 3 course.

2. Urodynamics / CTG interpretation.

3. Barriers to communication.

4. How to introduce oneself.

5. Role-play. Pre-pregnancy counselling.

Candidate's Instructions.

This is a roleplay station.

You are a year 4 SpR and are in the gynaecology clinic.

The consultant has just left you in charge as she is feeling unwell and has gone to lie down.

Your task is to deal with the patient as you would in real life.

GP referral letter.

Best Medical Centre,

High Road,

Anytown.

Phone: 01882 78998.

E-mail: besthealth@gmail.com

Practice Manager: Mary Wright. B.SC., RGN.

Phone: 01882 78998 ext. 23.

E-mail: MWbesthealth@gmail.com

Re. Mrs. Bonnie Black,

25 Low Road,

Anytown.

DOB: 28 January 1990.

Phone: 07889 888 132.

Dear Doctor,

Please see Mrs Black who is planning her first pregnancy. Her main concern is that her brother has cystic fibrosis.

This was the first time I had met her although she has been registered with us for 5 years – her health is good and she has no history of serious illness or surgery.

I have explained that I don’t know much about the implications of the brother’s cystic fibrosis for her potential pregnancies and that she needs to talk to an expert.

Yours sincerely,

John P. Clatter.