TEALE FENNING

Nick Raine-Fenning · Posted: Tue Nov 14, 2006 11:51 am Post subject: So ... how was it then?

The last group will be firmly locked up within the College so it is not an appropriate time to ask you all about the OSCE. I very much hope you did yourselves justice and that every single one of you passed.

Please share your experiences with us - the high points and the low Smile

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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

aamera · Joined: 23 Oct 2006 Posts: 4

glad its finally over.
just wanted to wait till the last lot were done with their osces.
it was very stressful.
preparatory stations were case notes review one with a shoulder dystocia at delivery followed by erbs palsy in the neonate,second one was briefing patient post op after laparotomy for uterine perforation at ERPC.(seemed as if it was the same patient we managed at the written essay)
then there was structured vivas on chicken pox and pregnancy,hyperthyroidism and sec amenorrhoea, results interpretation and management,atypical antibodies at 20 weeks rising subsequently.interestingly,eachthe structured vivas were broken down as 4 parts to be dealt with in sequence and no coming back to the previous section once done.
role play stations - substance misuse in pregnancy,endometrial hyperplasia with atypia in a nullip, patient with 2 previous sections requesting a normal delivery,uterine prolapse and stress incontinence in 38 year old completed family but declining vag hyst.

Nick Raine-Fenning · Posted: Tue Nov 14, 2006 8:19 pm Post subject:

Thanks aamera & well done - I really hope you pass.

From the questions you had I presume you sat the Exam yesterday?

I wonder how similar today's questions were.

We actually covered a considerable amount of those questions on the OSCE Theory and Circuits. The brachial plexus injury and uterine perforation were both covered for the preparatory and all, if I remember correctly, of the role play stations were discussed. We did briefly discuss atypical hyperplasia but only superficially addressed the other structured vivas.

Your comments about the structured viva are very interesting. I would be keen to know if the rest of you had the same experience.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

rpeevor · Joined: 27 Aug 2006 Posts: 28

Morning! (Sore head)
Tuesday questions:

5 vivas:

-2 amenorrhoea
-cholestasis and recent controversies
-results
-sickle cell in preg
-case review of planned vaginal breech with hydrocephalus and trapped head (commonly seen these days!!)

5 role plays:

-debrief following laparotomy ruptured ectopic
-urge incontinence hx and mx
-alcohol in pregnancy
-CGIN
-elective section request following previous ventouse and stressful del

Fingers crossed for friday!

Nick Raine-Fenning · Posted: Wed Nov 15, 2006 8:50 am Post subject:

Hi Richard

"Sore head" - I can imagine (but not understand Wink

)

Similar questions it seems as expected and quite rightly so to ensure a fair assessment of all candidates.

The breech question is quite bizarre Shocked

Can you remember any of the result questions?

rpeevor · Joined: 27 Aug 2006 Posts: 28

The breech question was the risk management / case notes review so the hydrocephalus was only a small part of it.. it was all poor documentation, absent counselling etc etc and so she could have delivered a chicken and the answers wouldnt have changed much!!

Results:

There were 8 and you got pushed through them very quickly, they just wanted a timescale and method of informing the patient, further tests/ Mx and treatment..

raised prolactin
chlamydia and CIN1 on patient
vaginal polyp biopsy cancer malignant melanoma
endometrial curettings G3 endo. ca (unexpected)

need 4 more... can anyone else help...
was there a hormone profile in this one or was it just in the amenorrhoea station?

Nick Raine-Fenning · Posted: Thu Nov 16, 2006 9:05 am Post subject:

Nick Raine-Fenning · Posted: Thu Nov 16, 2006 9:07 am Post subject:

rpeevor · Joined: 27 Aug 2006 Posts: 28

I think I finished pretty close to the time.. reading each scenario and making sure you havent missed anything beofre speaking and saying how quickly you want to see pt or write to them, any further investigations and then treatments takes a while...

I certainly followed the Hx Ex Ix Rx plan but got pushed on a couple of times by them saying "yes, yes, good treatment please..."

If I remember the others I will post them on the site.

Nick Raine-Fenning · Posted: Thu Nov 16, 2006 1:25 pm Post subject:

Do you feel we should stick to our recommendation of forcing you to always consider histroy, examination, and investigation prior to treatment therefore or do you think it would be more appropriate to go straight for the treatment?

If he said "good, good" that would reassure me.

I would be really worried if they expected you to treat with no further information.

It is also pleasing to hear that you took your time before replying and that you still completed the 8 results.

aamera · Joined: 23 Oct 2006 Posts: 4

61 year old with PMB. 20 mm endometrial thickness on TVS,ovaries not visualised, pipelle piopsy shows atrophic changes.
? 52 year old, PMB.atrophic vaginitis on exam,TVS shows ET 2mm and ovarian unilocular cyst 4.1 x 3x 3 cm size.
Chlamydia screen positive in a pt waiting for STOP later this week.
Irregular bleeding and pain in a woman with history of sterilisation 10 yrs ago, amenorrhoea of 6 weeks.EB shows decidual reaction.
40 year old pt referred by GP to check suitability for fitting mirena.few months history of menorrhagia,Hb 8.5 gm.EB proliferative endometrium.
HPE: unilateral salpingooophorectomy shows dysgerminoma ovary,invading serosal surface,negative peritoneal washings.fallopian tube not involved.
cant remember the other two.

bronwyn · Posted: Thu Nov 16, 2006 5:53 pm Post subject:

"Can't remember the other two"

TAH BSO for menorrhagia (I think) and histology shows CIN II
Pipelle biopsy for irregular bleeding showing decidual reaction in someone who's had a steri

I was definitely encouraged to just discuss management only and found the pages being turned before I thought I was finished!
Still think your approach of hx/ex/ix/mx is the right thing, management then flows naturally.

Good luck to all for tomorrow Cool

B
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Bronwyn Bell
SpR
Portsmouth

m.karoshi · Joined: 24 Oct 2006 Posts: 11

Tuesday's OSCEs

Results interpretation

1. 30 year old with Chlamydia positive and mild dyskaryosis

2. 20 year old with right lower abdominal pain and positive pregnancy test and scan shows empty uterus and Beta HCG of 879

3. 60 year old with vaginal bleeding PV and mass in the vagina and biopsy report shows malignant melanoma

4. 60 year old with postmenopausal bleeding and scan shows 4 mm endmoetrial thickness

5. 30 year old with oligmenorrhoea and hormonal profile shows

FSH -5.7
LH- 3.2
Prolactin of 1370

rest can't remember

In the structured viva what I found very funny was in the secondary amenorrhoea station

1. Examiner asks what are the possiblities,

So, I said rule out pregnancy, Recent change in weight on either side (Anorexia, obesity, bullemia, family h/o premature menopause etc,

then the examiner gives a ready made answer sheet telling patient has no family h/o of premature menopause and no recnet change in weight and is not sexually actuve

then the next question was what tests will you do?

I said LH,FSH, Prolactin, TFTs if symptomatic and Karyotyping

Then the examiner showed the College's standard answer sheet, I was surprised to see that, Urine pregnacy test was the first test (which I did not mention, because she was not sexually active) and then the rest as I mentioned above plus autoantibody screen. Then I queried the examiner as this is not correct when the college says, she is not sexually active, I have to take its face value and we were briefed before the examination that there are no hidden catches. I told the examiner that this is not right, she did agree with me and said she will bring this up during the discussion after the OSCEs.

aamera · Joined: 23 Oct 2006 Posts: 4

congrats to all of those who passed this time.

I would like to say a big THANK YOU to NICK, JULLIEN, AND GEETA.

You guys do a great job. Smile

Nick Raine-Fenning · Posted: Fri Nov 17, 2006 7:11 pm Post subject: Re: congrats to all who made it.

WINSOMHO · Joined: 17 Nov 2006 Posts: 1

Also my sincere thanks to NICK, JULLIEN, AND GEETA for teaching me all the necessary skills to pass the exam.

Srin · Joined: 06 Nov 2006 Posts: 5 Location: Nottingham

Just wanted to wish congratulations to all those who passed the dreaded Part II!!
Also wanted to thank Nick, Julien and Geeta for your excellent coaching - you guys do a fantastic job and helped me pass both the written and OSCE component of the exam . Keep up the great work!

Thanks again
Srin

Very Happy

Srin · Joined: 06 Nov 2006 Posts: 5 Location: Nottingham

This is what I remember of the exam...

1) The station about the endometrial hyperplasia was in a 40yr old with a BMI 40 who had no children and the GP tried some hormonal treatment . The biopsy showed endometrial hyperplasia with atypia and the object was to inform the patient of the diagnosis and discuss treatment options . I found it a bit tricky as I wanst sure to proceed down the TAH BSO route straightaway or not . She asked specifically " Do I have cancer?" I found the station quite harrowing as it wasnt bog standard cancer and breaking bad news.

2) There was one about preparing a lecture about chickenpox in pregnancy for GPs and had to decide what to put in the lecture and this was split into 4 sections and all the content was lifted straight out of the greentop guideline - I thought they made it unnecessarily complicated by intoducing the concept of a lecture to GPs - kind of threw me a bit but I think they just wanted hard facts - fairly straightforward if you knew the guideline

3) The Anti D sensitisation one was tough as the examiner was poker faced to the ultimate which is quite unnerving . The scenario involved a 20 week pregnant woman who was Rh-ve and had atypical antibodies in her blood . The first part concentrated on what features in the history were important. The second was I think how do you manage her. The third one was at 26 weeks her Anti D levels were 8 - how would you proceed? And the 4th was she presents at 34 weeks after two intrauterine transfusions with abdo pain - how do you proceed??
I thought this was one of the trickiest stations Shocked

4) The other role play was about a women 6/12 post partum who had urinary incontinence (stress only) - This was quite straightforward!
She said that the consultant had to come and repair her last tear which took an hour and that her bladder had been injured during delivery ?? Question

I will post more as I remember them

Srin

Nick Raine-Fenning · Posted: Sun Nov 19, 2006 5:46 pm Post subject:

Good man srin - well done and thanks.

Thanks Winsom - knew you would be fine Smile

chandra · Joined: 21 Oct 2006 Posts: 6

Thank you Nick, Julianne and Geetha.

Can't forget your teahing at OSCE and hollywood role player scenarios - in reality the role players didn't perform better than you guys!!

chandra
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chandra