Thursday, 3 December 2020

Tutorial 3 December 2020

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21

Talk. Neonatal jaundice

22

EMQ. Coroner and Medical Examiner.

23

EMQ. Education

24

SBA. Kisspeptin

 

21. Neonatal jaundice. Talk.

 

22. EMQ. Coroner and Medical Examiner.

The Coroner.

This topic has featured in the exam and makes for easy marks if you know the basics.

Abbreviations.

CC:                Chief Coroner.

CJA9:            Coroners and Justice Act 2009.

MCCD:         medical certificate of the cause of death.

NOD:            notification of deaths.     

SB:                stillbirth

Option list 1.

A.       an independent judicial officer

B.       a barrister acting for the Local Police Authority

C.       the regional representative of the Home Office

D.       the regional representative of the Queen.

E.        an employee of the High Court.

F.        the Local Authority

G.       the Local Police Authority

H.       the Home Office

I.         the High Court

J.         the Queen

Use option list 1 for scenarios 1 - 3.

Scenario 1.           

What is the best description of the status of the Coroner?

Scenario 2.           

Who appoints the Coroner?

Scenario 3.           

Who pays for the Coroner and the coronial service?

Scenario 4.           

Which, if any, are current titles for coroners?

Option list.

A

area coroner

B

assistant coroner

C

district coroner

D

deputy coroner

E

lead coroner

F

national coroner

Scenario 5.           

Which, if any, of the following is a function of the Chief Coroner?

Option list.

A

to appoint coroners

B

to approve coronial appointments

C

to negotiate coroners’ salaries

D

to negotiate coroners’ terms and conditions

E

to oversee the disciplinary procedures for coroners

F

to keep an eye on coronial investigations that have taken too long

G

to organise advice from coroners about how deaths may be prevented

Option list 2. Use for scenarios 6-8.

A.       must have had experience as a detective with the rank of Inspector or above

B.       must be a barrister, lawyer or doctor with at least 5 years’ experience

C.       must be a legally qualified individual with at least 5 years’ experience

D.       must be a trained bereavement counsellor

E.        must be able to play the bagpipes

F.        Monday - Friday; 09.00 - 17.00 hours, including bank holidays

G.       Monday - Friday; 09.00 - 17.00 hours excluding bank holiday

H.       All the time

I.         to arrest people suspected of unlawful killing

J.         to manage traffic in the vicinity of the Coroner’s court

K.       to make enquiries on behalf of the Coroner

L.        to make enquiries on behalf of the Coroner and provide administrative support

Scenario 6.           

What qualifications must the Coroner have?

Scenario 7.           

What are the hours of availability of the Coroner?

Scenario 8.           

What is the role of the Coroner’s Officers?

Scenario 9.           

Who or what is responsible for appointing medical examiners?

Option list.

A

Local authorities

B

the Chief Coroner

C

the Chief Medical Examiner

D

the local Senior Coroner

E

the Lord Chancellor

F

NHS Trusts

G

the Queen

Scenario 10.        

Which, if any, of the following are applicable to the role of medical examiner?

Option list.

A

to decide if a post-mortem is required

B

notification of deaths to the coroner

C

supervision of the quality of MCCDs

D

attendance at post-mortems

E

performance of post-mortems

Scenario 11.        

When was the Chief Medical Examiner for England & Wales appointed?

Option list.

A

2005

B

2010

C

2015

D

2017

E

2019

F

the post does not exist

G

none of the above

Scenario 12.        

What was the specialty of the 1st. appointee to the post of the lead medical examiner for England & Wales?

Option list.

A

accident and emergency medicine

B

forensic medicine

C

forensic pathology

D

forensic psychiatry

E

obstetrics & gynaecology

F

pathology

Scenario 13.        

Which, if any, of the following are requirements for those wishing to become a medical examiner?

Option list.

A

full registration with the General Medical Council

B

consultant status

C

> 10 years’ experience as a fully-registered doctor

D

to have the Diploma of the Faculty of Medical Examiners

E

to have membership of the RCP

F

none of the above

Option list 3. Use for the remaining scenarios, unless they have an option list.

A.       the death must be reported to the Coroner

B.       the death does not need to be reported to the Coroner

C.       the Coroner must order the return of the body for an inquest

D.       the Coroner must order a post-mortem examination

E.        the Coroner must hold an inquest

F.        the Coroner should arrange for the death to be investigated by the Home Office

G.       the death must be reported to the authorities of the country in which it took place in order that a certificate of death can be issued

H.       a certificate of live birth

I.         a certificate of stillbirth

J.         a certificate of miscarriage

K.       yes

L.        no

M.     none of the above

Scenario 14.        

A resident of Manchester dies suddenly while visiting the town of his birth in Scotland. His family decides that he will be buried in the town of his birth. His body is held at the premises of a local funeral director to arrange the funeral and burial. What actions should be taken with regard to the Manchester coroner?

Scenario 15.        

A resident of London dies suddenly while visiting Manchester, where he was born. His family decides that he will be buried in Manchester. His body is held at the premises of a Manchester funeral director who will arrange the funeral and burial. What actions should be taken with regard to the Manchester coroner?

Scenario 16.        

A resident of Manchester dies on holiday in his native Greece. The family decide that he will be buried in Greece. What steps must be taken to obtain a valid death certificate?

Scenario 17.        

A man of 65 dies of terminal lung cancer. The GP who had visited daily up to three weeks before the death has been on holiday for three weeks. He has now returned and says that he will sign a death certificate, but needs to visit the funeral director to see the body first.  Will this be a valid death certificate?

Scenario 18.        

A man of 65 dies of terminal lung cancer. The GP, who has visited daily up to the day of his death and attended to confirm the death, is on holiday. However, he says that he will sign a death certificate and put it in the post, so that it will arrive in the morning. Will this be a valid death certificate?

Scenario 19.        

A man of 65 dies of terminal lung cancer. The GP who has visited daily up to the day before his death has been on holiday since. However, he says that he will sign a death certificate and put it in the post, so that it will arrive in the morning. Will this be a valid death certificate?

Scenario 20.        

A 65-year-old man dies suddenly 12 hours after admission to the local coronary care unit with chest pain, despite apparently satisfactory insertion of a coronary artery stent after a diagnosis of coronary artery thrombosis. What action should be taken with regard to the Coroner?

Scenario 21.        

A 16-year-old girl is admitted at 36 weeks’ gestation in her first pregnancy with placental abruption. She is given the best possible care but develops DIC and hypovolaemic shock and dies after 48 hours. What action should be taken with regard to the coroner?

Scenario 22.        

A 28-year-old woman is admitted with placental abruption at 36 weeks. She has bruising on the abdominal wall and the admitting midwife suspects that she has been the victim of domestic violence, though the woman denies it. Despite best possible care she dies as a consequence of bleeding. What action should be taken with regard to the coroner?

Scenario 23.        

A 30-year-old woman delivers normally at home attended by her husband, but has a PPH. The husband practises herbal medicine. He applies various potions but her condition deteriorates. She is admitted to hospital by emergency ambulance. She is given best possible care and is admitted to the ICU. She dies 7 days later of multi-organ failure and ARDS attributed to hypovolaemic shock. What action should be taken with regard to the coroner?

Scenario 24.        

A woman is admitted at 23 weeks in premature labour. There is evidence of fetal heart activity throughout the labour, with the last record being 5 minutes before the baby delivers. The baby shows no evidence of life at birth. The mother requests a death certificate so that she can register the birth and arrange a funeral. What form of certificate should be issued?

Scenario 25.        

A woman is admitted at 26 weeks’ gestation in premature labour after being kicked in the abdomen by her partner. The presentation is footling breech. At 8 cm. cervical dilatation the trunk is delivered and the cord prolapses. There is good evidence of fetal life with fetal movements and pulsation of the cord. The head is trapped and it takes 5 minutes to deliver it. The baby is pulseless, apnoeic and without visible movement at birth. Intubation and CPR are carried out for 20 minutes when the baby is declared dead. What action should be taken with regard to the coroner?

Scenario 26.        

A woman is admitted at 26 weeks’ gestation in premature labour after being kicked in the abdomen by her partner. She says that he did not want the pregnancy to continue.

Pick the best option from the option list.

Option list.

A.  dial 999

B.  get advice from the BMA

C.  get advice from the Department of Health

D.  get advice from the legal department

E.  get advice from the police

F.  none of the above.

Scenario 27.        

A 65-year-old man dies 2 hours after admission to hospital with an apparent stroke. The coroner requests access to the notes. What access should be provided?

Option list.

A

provide access to the records by the Coroner in person

B

provide unrestricted access to the medical records by the coroner’s officers

C

provide a copy of the hospital records to the coroner or her officers

D

provide a medical report, but no access to the medical records

E

provide a copy of the letter to the GP about the recent admission

F

none of the above

Scenario 28.        

You have been swimming in the sea at Broad Beach, Rhosneigr. As you walk back to the shore your foot hits something in the sand. You explore and find a number of gold coins that look ancient. What should you do?

Option list.

A

put them back as they may have been an offering to the Gods

B

put them in a safe place with a view to having them valued and sold

C

take them to the local museum for identification and advice about informing the coroner

D

take them to the nearest police station for advice

E

take them to your favourite pub and trade them for a meal and round of drinks

Scenario 29.        

When was the Chief Medical Examiner for England & Wales appointed?

Option list.

A

2005

B

2010

C

2015

D

2017

E

2019

F

the post does not exist

G

none of the above

Scenario 30.        

What was the specialty of the 1st. appointee to the post of the lead medical examiner for England & Wales?

Option list.

A

accident and emergency medicine

B

forensic medicine

C

forensic pathology

D

forensic psychiatry

E

obstetrics & gynaecology

F

pathology

Scenario 31.        

Which, if any, of the following are requirements for those wishing to become a medical examiner?

Option list.

A

full registration with the General Medical Council

B

consultant status

C

> 10 years’ experience as a fully-registered doctor

D

to have the Diploma of the Faculty of Medical Examiners

E

to have membership of the RCP

F

none of the above

 

23. EMQ. Education.

Education.

Option list.

  1. brainstorming.
  2. brainwashing
  3. cream cake circle.
  4. Delphi technique.
  5. demonstration & practice using clinical model.
  6. doughnut round.
  7. interactive lecture with EMQs.
  8. lecture.
  9. 1 minute preceptor method.
  10. teaching peers / junior colleagues
  11. schema activation.
  12. schema refinement.
  13. small group discussion.
  14. snowballing.
  15. snowboarding.
  16. true
  17. false

Scenario 1.

A woman is admitted with an eclamptic seizure. The acute episode is dealt with and she is put on an appropriate protocol. You wish to use the case to outline key aspects of PET and eclampsia to the two medical students who are on the labour ward with you. Which would be the most appropriate approach?

Scenario 2.

You have been asked to provide a summary of the key aspects of the recent Maternal Mortality Meeting to the annual GP refresher course. There are likely to be 100 attendees. Which would be the most appropriate approach?

Scenario 3.

You have been asked to teach a new trainee the use of the ventouse. Which would be the most appropriate approach?

Scenario 4.

You have been asked to teach a group of medical students about PPH. To your surprise you find that they have good basic knowledge. Which technique will you apply to get the most from the teaching session?

Scenario 5.

Your consultant has asked you to get the unit’s medical students to prepare some questions about breech delivery which they can ask of their peers when they next meet. Which technique will you use?

Scenario 6.

You have been asked to discuss 2ry. amenorrhoea with your unit’s medical students. You are uncertain about the amount of basic physiology and endocrinology they remember from basic science teaching. Which technique will you use?

Scenario 7

The RCOG has asked you to chair a Green-top Guideline development committee. You find that there is very little by way of research evidence to help with the process. The College has assembled a team of consultants with expertise and interest in the subject. Which technique would be best to reach consensus on the various elements of the GTG?

Scenario 8

Which of the listed teaching techniques is least likely to lead to deep learning?

Scenario 9

An interactive lecture with EMQs is the best method of teaching. True or false.

Scenario 10

Only 20% of what is taught in a lecture is retained. True or false.

Scenario 11.

The main role of the teacher is information provision. True or false.

Scenario 12.

The main role of the teacher is to be a role model.  True or false.

 

24. SBA. Kisspeptin.

Which, if any, of the following options are true?

Option list.

A

is a pheromone released by the salivary glands during passionate embraces

B

is a digestive enzyme released by the salivary glands during passionate embraces

C

is a digestive enzyme found in human carnivores but not vegetarians

D

is thought necessary for trophoblastic invasion and low levels have been linked to miscarriage, recurrent miscarriage and risk of PET

E

is named after “Kiss me quick” chocolate

F

does not exist and this question is a very poor joke by someone who should know better