Thursday, 20 September 2018

Tutorial 20th. September 2018


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20 September 2018
8
EMQ. Coroner 1-3
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
Basic “blurbs” to write and practise. Setting the scene for breaking bad news, dealing with the information in a GP referral letter, general pre-pregnancy counselling, recessive inheritance, x-linked inheritance, how to ask if role-player has questions, dealing with information such as a relative with a serious problem,  etc. Make a list.
11
Viva. C section scar pregnancy.
12
EMQ. Uterine transplant.

8. Coroner.
The Coroner. Question 1.
Lead-in.
The following scenarios relate to the role of the Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Option list.
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
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?
The Coroner. Question 2.
Lead-in.
The following scenarios relate to the role of the Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Option list.
A.        must have had experience as a detective in the police force with  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 holidays
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
M.      to play bagpipes at coronial funerals
Scenario 1.
What qualifications must the Coroner have?
Scenario 2.
What are the hours of availability of the Coroner?
Scenario 3.
What is the role of the Coroner’s Officers?
The Coroner. Question 3.
Lead-in.
The following scenarios relate to the role of the Coroner.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
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 1.
A resident of Manchester dies suddenly while visiting the town of his birth in Scotland. His family decides that he will be buried there. His body is held at the premises of a local funeral director. What actions should be taken with regard to the Manchester coroner?
Scenario 2.
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. What actions should be taken with regard to the Manchester coroner?
Scenario 3.
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 4.
A man of 65 dies of terminal lung cancer. The GP visited daily until going on holiday three weeks before the death. 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 5.
A man of 65 dies of terminal lung cancer. The GP, who visited daily up to the day of his death and attended to confirm the death, is on holiday. 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 6.
A man of 65 dies of terminal lung cancer. The GP, who 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 7.
A 65-year-old man dies suddenly 12 hours after admission to the local coronary care unit with chest pain, despite the 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 8.
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 9.
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 10.
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 some hours later in a shocked condition. She is given the 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 11.
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 12.
A woman is admitted at 26 weeks’ gestation in premature labour. 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 13.
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

9. Pre-pregnancy counselling: Down’s syndrome.
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. How to prepare. Basic ‘blurbs’ to write and practise.

11. C. section scar pregnancy.
The examiner will ask 17 questions about C section scar pregnancy ( CSSP).

12. EMQ. Uterine transplant.
Uterine transplant.
Abbreviations.
ET:         embryo transfer.
UT:        uterine transplant
Scenario 1.                
When was the 1st. human uterine transplant performed?
Option list.
A
2000
B
2015
C
2010
D
2011
E
2012
F
2013
G
2014
H
2015
I
2016
J
2017
Scenario 2.                
When was the 1st. livebirth after human uterine transplant?
Option list.
A
2000
B
2015
C
2010
D
2011
E
2012
F
2013
G
2014
H
2015
I
2016
J
2017
Scenario 3.                
How many live births had occurred worldwide after UT up to the end of 2017?
Option list
A
< 5
B
5 - 10
C
11 - 20
D
21 - 50
E
51 - 100
F
> 100
Scenario 4.                
For which of the following conditions is UT a possible treatment?
Option list.
A
Androgen Insensitivity syndrome. AIS.
B
Congenital Adrenal hyperplasia. CAH.
C
Kallmann’s syndrome. KS.
D
Mayer-Rokitansky-K├╝ster-Hauser syndrome. MRKH.
E
McCune-Albright syndrome. MCAS.
F
Swyer’s syndrome. SS.
G
Turner’s syndrome. TS.
Scenario 5.                
Which, if any, of the following are commonly used for donor selection?
Option list.
A
absence of adenomyosis
B
absence of fibroids
C
age < 65 years
D
good general health
E
negative cervical smear and no high-risk HPV
F
no cancer in past 5 years
G
parous
H
vaginal length > 7 cm.
Scenario 6.                
What is the rate of graft survival at 1 year, failure being the need for hysterectomy?
Option list.
A
< 10%
B
11 – 20%
C
21 – 30%
D
31 – 40%
E
41 – 50%
F
51 – 60%
G
> 60%
H
the figure is unknown
Scenario 7.                
Which of the following statements is correct?
Option list.
A
donor surgery is more extensive than recipient surgery
B
donor surgery is less extensive than recipient surgery
C
donor surgery is as extensive as recipient surgery
Scenario 8.                
What are the risks to the donor in addition to the usual ones of bleeding,  infection, haematoma and thrombosis? There is no option list.
Scenario 9.                
Which condition has been the reason for recipients needing uterine transplant and which complication is more likely in addition to the usual ones of bleeding,  infection, haematoma and thrombosis? There is no option list.
Scenario 10.            
When is IVF and cryopreservation of eggs done?
Option list.
A
before uterine transplantation
B
at the time of uterine transplantation
C
12 months after uterine transplantation to ensure graft rejection does not occur
D
when the recipient chooses
E
none of the above
Scenario 11.            
Which maintenance therapy was used immediately before embryo transfer in the first case resulting in livebirth?
Option list.
A
azathioprine + corticosteroids + tacrolimus
B
azathioprine + ciclosporin + corticosteroids + mycophenolate mofetil
C
azathioprine + corticosteroids + mycophenolate mofetil + tacrolimus
D
azathioprine + corticosteroids + tacrolimus
E
ciclosporin + corticosteroids + mycophenolate mofetil + tacrolimus
F
ciclosporin + mycophenolate mofetil + tacrolimus
G
corticosteroids + mycophenolate mofetil + tacrolimus
H
corticosteroids + tacrolimus