Thursday, 19 December 2013

Tutorial 19th. December 2013

Tutorial.
Website.
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https://soundcloud.com/drtmcf/19-december-2013

Tonight we wrote 5 essay plans and answered an EMQ.

For the next 2 weeks we will have tutorials on the Mondays, but not the Thursdays.


Topics 19 December 2013
9
EMQ. Mental Capacity.
33
You have been put in charge of introducing a policy in the antenatal clinic for the management of domestic violence. Your recommendations have been accepted by the senior staff in the department and the launch date for the new policy in is 3 months. You have been asked to give a lecture to the midwives detailing the important issues relating to the introduction of the policy. Critically evaluate the topics you will include in the lecture.
34
A 20-year-old woman is referred to the gynaecology clinic with a complaint of hirsutism. Critically evaluate the management.
1.  Outline the necessary facts to obtain from the history.  6 marks.
2.  Justify the investigations you would arrange.                    8 marks.
3.  Outline the key aspects of the management.                                  6 marks.
35
A 41-year-old woman attends for review after a normal hysteroscopy. She now wishes treatment for her incapacitating heavy periods which have not responded to medical management.
1. Outline the history you will take.                        4 marks.   
2. Outline the investigations you will consider.        4 marks.
3. Critically evaluate your management.               12 marks
36
Critically evaluate neonatal screening.
37
Discuss the key aspects of neonatal jaundice.
a. why it is important.                        4 marks.
b. the causes of neonatal jaundice. 8 marks.
c. the management.                            8 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.
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 2nd. 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?

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