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26 June 2014
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6
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EMQ Confidentiality
& Consent.
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19
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A 30-year-old
woman presents for booking at 8 weeks. Her father has recently been diagnosed
with TB. She wishes to know what the risks are to her and the pregnancy and
child of possible TB.
1. Critically evaluate the investigation. 4 marks
2. Outline the management in pregnancy. 2 marks
3. Critically evaluate the issues relating to the
puerperium. 14 marks
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20
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In relation to
diagnostic laparoscopy, critically evaluate:
1. the issues to be discussed in obtaining informed
consent. 4 marks.
2. the factors that increase the incidence of
entry-related injury 4 marks.
3. how entry-related injuries may be minimised 12 marks
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21
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Critically
evaluate the statement: “fortification of flour with folic acid is overdue in
the UK”.
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22
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With regard to
Systemic Lupus Erythematosis (SLE):
1. outline the
clinical manifestations of SLE. 4 marks.
2. outline the
implications of SLE for pregnancy . 4 marks.
3. critically
evaluate how the diagnosis is made.
4 marks.
4. critically
evaluate the management in the woman wishing to be
pregnant.
8 marks.
4a.critically evaluate the management of a woman
booking at 8 weeks.
8
marks.
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Confidentiality.
Lead-in.
The
following scenarios relate to confidentiality.
For
each, select the number that best fits the scenario.
Pick
one option from the option list.
Each
option can be used once, more than once or not at all.
Option list.
This
EMQ has no option list. This is to make you decide your answers. Send them to
me and I’ll send my version including what I think an option list might have
looked like.
Scenario 1.
A 15-year-old girl attends the TOP clinic requesting TOP. She is
assessed as Fraser competent. After full discussion arrangements are made for
her admission for TOP. She does not wish her parents to be informed. Her mother
attends clinic 1 hour after the child has left. She demands full information
about her daughter. The consultant has delegated you to deal with her. Which
option best fits the action you will take?
Scenario 2.
A 17-year-old A-level student attends the gynaecology clinic
requesting TOP. She is accompanied by her 30-year-old mathematics teacher, who
is her lover and wishes to give consent. Which option best fits the action you
will take?
Scenario 3.
A 12-year-old girl attends the gynaecology clinic with her mother
seeking contraceptive advice. She has an 18-year-old boyfriend whom the parents
like and she wishes to start having sex. Which option best fits the action you
will take?
Scenario 4.
A
15-year-old girl who is Fraser competent is referred to the gynaecology clinic
with a complaint of vaginal discharge. She reveals that she has been having
consensual sexual intercourse for six months with her 18-year-old boyfriend.
She asks for advice about suitable contraception as she is happy in the
relationship and wants to continue to have sex. Which option best fits the
action you will take?
Scenario 5.
You
are the new oncology consultant and have just operated on the wife of a local
General Practitioner for suspected ovarian cancer. The diagnosis is confirmed
and you proceed with appropriate surgery. On completion of the operation you go
to the surgeon’s room for a coffee. The senior consultant anaesthetist who was
not involved in theatre but is the Medical Director and tells you he is a close
friend of the woman, asks what the diagnosis and prognosis are. Which option
best fits the action you will take?
Scenario 6.
You are phoned by a doctor looking for information about his
wife’s results from the booking clinic she attended two weeks ago. He says that
she has given consent for disclosure. She has given a history of 2 terminations
but no other pregnancies. She is Rhesus negative, but has Rhesus antibodies. Which
option best fits the action you will take?
Scenario 7
You are phoned by a doctor looking for information about his
wife’s results from the booking clinic she attended two weeks ago. He says that
she has given consent for disclosure. Her serology tests have proved +ve for
syphilis. You have spoken to the consultant bacteriologist who says that they
have run confirmatory tests and they are +ve too. He is sure the woman has
active syphilis. Which
option best fits the action(s) you will take?
Scenario 8
A 15-year-old girl attends the TOP clinic requesting TOP. She is
assessed as Fraser competent. After full discussion arrangements are made for
her admission for TOP. She does not wish her parents to be informed despite
your best efforts to persuade her. Who will give consent for the procedure?
Scenario 9
An immature 15-year-old girl attends the gynaecology clinic
requesting TOP. She is accompanied by her 25-year-old sister who is a lawyer
with whom she has been staying since she knew she was pregnant. She does not
want her parents to be informed. The girl is assessed as not Fraser competent.
The sister says that she is happy to act in loco parentis and to give consent. Which
option best fits the action(s) you will take?
Scenario 10
A
25-year-old woman with Down’s syndrome attends the clinic accompanied by her
mother. She has menorrhagia and copes badly with the hygiene aspects. The
menorrhagia is bad enough for her now to be on treatment for iron-deficiency
anaemia. She has tried all the standard medical methods. To complicate the
problem, she has become close friends with a young man she has met at College,
to which she travels independently each weekday. Her mother fears that she may
already be involved in sexual activity and cannot get an accurate answer from
her about it. The mother is keen for her to have hysterectomy to deal with both
problems. If you agree that the surgery is appropriate, who can give consent?
Scenario 11
A
25-year-old woman with Down’s syndrome is admitted from College after
collapsing. The clinical features are of ectopic pregnancy and she states that
she has UPSI with her boyfriend of six months. She has tachycardia and
hypotension and it is felt that she should have urgent surgery. You reckon that
she is not competent to consent for surgery. Who can give consent?
Scenario 12
A
25-year-old woman with Down’s syndrome is admitted from College after
collapsing. The clinical features are of ectopic pregnancy and she states that
she has UPSI with her boyfriend of six months. She has tachycardia and
hypotension and it is felt that she should have urgent surgery. You reckon that
she is not competent to consent for surgery. What limits are there on the
surgery?
Scenario 13.
You
are the SpR on call and are asked to see a 10-year-old child in the A&E
department. She has been brought because of vaginal bleeding. She is
accompanied by her parents who give a story of her injuring herself falling of
her bike. Examination shows vaginal bleeding and you think the hymen looks
torn. You suspect sexual abuse and don’t believe the parents’ story. When this
is discussed with the parents they say it is impossible and that they do not
want involvement of police or social workers. What action will you take?
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