Tutorial 11 February 2013

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Tonight we had a shorter tutorial than usual.
Only James and Patrice came and James was on call and had to leave early.
We discussed the EMQ and first essay.
Write your answers for all the essays and EMQ and send them.

EMQ. Mental Capacity Act.

A 16-year-old virgin is referred with dysmenorrhoea. You are the SpR and see her in the gynaecology clinic. She is accompanied by her mother.

a.         justify the history you will take.                      8 marks

b.         justify the investigations you will arrange.    4 marks

c.         critically evaluate your management.           8 marks.                     

A woman is referred after her third consecutive miscarriage at 10 weeks.

1. outline the key features in the history you will take.                                 4 marks

2. list the main causes of recurrent miscarriage.                                          4 marks

3. critically evaluate the investigations you will arrange.                             6 marks

4. critically evaluate the available treatments for recurrent miscarriage.              6 marks                                                                

           

A girl of 15 is referred to the gynaecology clinic. She is concerned because she has not started to menstruate although all her friends have.

1. Justify the history you will take.                 6 marks

2. Justify the investigations you will arrange.            6 marks

3. Justify your management                              8 marks       

With regard to vulval cancer.

1. critically evaluate screening.                                                       2 marks.

2. outline the FIGO staging system.                                                6 marks.

3. critically evaluate the modern approach to management.  12 marks     

 Mental Capacity Act 2005.

Lead-in.

The following scenarios relate to the Mental Capacity Act 2005.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Abbreviations.

CAD:      Court-appointed Deputy.

COP:      Court of Protection.

FGR:      fetal growth restriction.

LPA:       Lasting Power of Attorney.

MCA:    Mental Capacity Act 2005.

PoA:      Power of Attorney.

Option list.

A.        Yes

B.        No

C.        True

D.        False

E.         Does not exist

F.         The husband

G.       A parent

H.        The child

I.          the General Practitioner

J.          the Consultant

K.        the Registrar

L.         The Consultant treating the patient

M.      A Consultant not involved in treating the patient

N.       The Medical Director

O.       A person with Powers of Attorney

P.        The sheriff or sheriff’s deputy

Q.       Balance of probabilities

R.        Beyond reasonable doubt

S.         None of the above.

Scenario 1.

A person with LPA is normally not a family member.

Scenario 2.

A Sheriff’s Deputy is normally not a family member.

Scenario 3.

A person with PoA can consent to treatment for the patient who lacks capacity.

Scenario 4.

A Court-appointed Deputy can consent to treatment for the patient who lacks capacity, but must go back to the Court of Protection if further consent is required for additional treatment.

Scenario 5.

A person with PoA can authorise withdrawal of all care except basic care in cases of individuals with persistent vegetative states.

Scenario 6.

An advance decision can authorise withdrawal of all but basic care in cases of persistent vegetative states.

Scenario 7

A person with PoA cannot overrule an advance direction about withdrawal or withholding of life-sustaining care.

Scenario 8

A woman is seen in the antenatal clinic at 39 weeks’ gestation. Her blood pressure is 180/110 and she has +++ of proteinuria on dipstick testing. She has mild epigastric pain. A scan shows evidence of FGR with the baby on the 2^nd. centile. Doppler studies of the umbilical artery are abnormal and a non-stress CTG shows loss of variability and variable decelerations. She is advised that she appears to have severe pre-eclampsia and is at risk of eclampsia and of intracranial haemorrhage. She is told of the associated risk of mortality and morbidity. She is also advised that the baby is showing evidence of severe FGR and has abnormal Doppler studies and CTG which could lead to death or hypoxic damage. She declines admission or treatment. She says she trusts in God and wishes to leave her fate and that of her baby in His hands. She is seen by a psychiatrist who assesses her as competent under the MCA and with no evidence of mental disorder. The obstetrician wants to apply to the COP for an order for compulsory treatment. Can he do this?

Scenario 9

A woman is admitted at 36 weeks’ gestation with evidence of placental abruption. She is semi-comatose and shocked. There is active bleeding and the cervical os is closed. Fetal heart activity is present but with bradycardia and decelerations. The consultant decides that Caesarean section is the best option to save her live and that of the baby. When reading the notes, the registrar comes across an advance notice drawn up by the woman and her solicitor. It states that she does not wish Caesarean section, regardless of the risk to her and the baby. The consultant tells the registrar that they can ignore it now that she is no longer competent and get on with the Caesarean section for which she will be thankful afterwards. The registrar says that the advance notice is binding. Who is correct?