TEALE FENNING

Stavroulis · Joined: 06 Jun 2009 Posts: 3

# Prep station- Website on PCOS (info from a non-medical Dr promoting a questionnaire for diagnosing PCOS on line and then taking on their nutrition/weight reduction treatment of symptoms and prevention of implications.

# Structured viva Re:website.

# Structured viva Re: 12/40, history of RTA with "complex" pelvic fructure. What info you would ask, advice for pregnancy and labour, presents on LW at term with mild lower pelvic pain - management and last question: pushing for 90 min, epidural on board, CTg normal, clear liqour, no caput/moulding, station at +1to +2, management.

# Strucutred viva on Chickenpox- questions - answers from the guideline.

# Role play-Breaking bad news- Primigravida: open spina bifida and ventriculomegaly at 21/40 scan. Decline NT and and wouldn't have invasive testing. Explain diagnosis, options. From taking the history you get that she had no dating scan. When she heard the (option) word termination went off upset and shouting why would she do that.

# Prep station- Risk management- Folder of "notes given".

# Structured viva: discuss immediate clinical management then risk management issues.

# Role play: Severe dyskariosis on HIV pt (taking HAART), husband knows and is negative- explain dx, management and answer patient's questions.

# Structured viva on Uterine inversion: questions included: called in and saw mass in the vagina and placenta in situ-what would you do, then becomes obs hypotensive and tachycardic, finally results given: DIC and Hb 4.2. Management.

# Role play: 14 days post TAH-BSO for severe endometriosis-constant leaking of fluid and from the Hx, Lt flank pain. Marks for history, investigations & management.

# Role play: 44yrs menorrhagia not responding to TXA and OCP. Hypothyroid on thyroxine and normal TFTs. Hb 8.9. USS shows 20/40 size uterus, endometrium distorted by fibroids. Hx, Investigations, management.

# Role play: 37 yrs old, 36/40 wanting c/s. From the history taking: had ELCS for breech followed by vaginal delivery and MROP and bad labour experience ie no getting epidural on time, not listened by the MW... Not demanding c/s, quite sensible pt who needs to listen the pros and cons of each option.

Andreas

Nick Raine-Fenning · Posted: Thu Nov 19, 2009 8:25 am Post subject:

Thanks Andreas ... how did it go?

What was the risk management case?

Stavroulis · Joined: 06 Jun 2009 Posts: 3

Forgot to add that the uterine inversion patient was grandmultip - ?P8.

Risk management case: CPP patient with 5 previous laparotomies for different reasons including TAH for severe endometriosis and c/s. The consultant sees her in the GOPD and advises lap oophorectomy. He had seen Harmonic scalpel once and decided to use it for the first time. Patient returns back ?48hrs with acute abdomen seen by the FY1 in A+E. Tasks: Immediate management (Hx,Ex,Inv,2 differential diagnosis,Mx). Then risk management questions: poor documentation, incomplete consent, no preop assessment, lack of appreciation of severity, next day FY1 reviews and sends home after updating the consultant on the phone etc. One question was about how/what Clinical Governance does for the use of new instrument: I said about teaching-training, number of cases to do under supervision-auditing and risk management of cases with unexpected outcome, but apparently the examiner wanted something more as well. ?any ideas