Contact us.
18th. January 2016.
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40
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SBA. Chickenpox and
pregnancy
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41
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EMQ. Haemophilia
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42
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EMQ. Surrogacy
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43
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EMQ. Confidentiality
& consent
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44
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Communication skills
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40 Chickenpox
in pregnancy
Chickenpox +
pregnancy.
Abbreviations.
FVS: fetal varicella syndrome
NPV: negative predictive value
PPV: positive predictive value
VZV: varicella-zoster virus.
Question 1.
Lead-in
What type of virus causes chickenpox?
Option List
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avian virus
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herpes virus
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retrovirus
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picovirus
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pox virus
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Question 2.
Lead-in
Which of the following best describes the chickenpox virus
Option List
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DNA virus
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RNA
virus
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Prion
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All
of the above
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None
of the above
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Question 3.
Lead-in
What is the main reservoir of the chickenpox virus?
Option List
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domestic chickens
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chickens
in battery farms
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sparrows
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humans
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earthworms
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Question 4.
Lead-in
How
is the chickenpox virus spread?
Pick
the option from option list that best fits.
Possible modes of spread.
A respiratory
droplets
B direct contact
with the fluid from the vesicles
C contact with
fomites
D contact with
stalactites
E from lavatory
seats
Option List.
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A
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A +
B
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A
+ C
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A +
B + C
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A +
B + C + D + E
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Question 5.
Lead-in
Fomites - which of the following statements are true?
Statements.
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fomites are bedclothes infested with bed bugs which can carry the
chickenpox virus
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“fomites” in Latin is the plural of “fomes”, the noun meaning “tinder”
in English
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fomites are inanimate objects that can effect the transfer of
communicable diseases from the infected person to someone who is not infected
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fomites are horizontal stalagmites, particularly found in the Dolomite
mountains and capable of fostering the growth of viruses, including the
chickenpox virus
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fomites are the viral particles in vomit that form the aerosols
particular associated with the respiratory spread of viruses such as the
chickenpox virus.
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Option List
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A +
B + C + D + E
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A +
B + C + E
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A +
B + C + D
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B +
C + D
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B +
C + E
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B +
C
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Question 6.
Lead-in
Which of the following are listed in GTG13 as examples of fomites?
A bathtubs used by
person with chickenpox at the infectious stage
B bedding
C blood, fresh or
dried, from person with chickenpox at the infectious stage
D clothing
E hair
F paper money
G kin cells
H viral remnants
in vomit from person with chickenpox at the infectious stage
Option List
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A +
B + C + D + E + F + G + H
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A +
B + C + D + E + F
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B +
C + D + E + F + G
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B +
C + E + G
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None
of the above
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Question 7.
Lead-in
With regard to the epidemiology of chickenpox in the UK, which of the
following statements are true?
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A
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Chickenpox is endemic
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B
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Chickenpox is endemic with mini-epidemics every 3-4 years in the early
part of the year
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C
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The main reservoir is chickens, particularly those that are reared
intensively
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D
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The main reservoir is human sensory nerve root ganglia after primary
infection
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E
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The main reservoir is fomites
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Option List
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1
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A
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3
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A +
C
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4
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A +
D
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5
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A +
E
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2
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B
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6
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B +
C
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7
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B +
C + D + E
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7
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B +
C + D + E
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Question 8
Lead-in
What proportion of the ante-natal population of the UK is immune to
chickenpox?
Option List
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50%
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60%
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70%
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80%
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90%
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≥
90%
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Question 9.
Lead-in
Which population of immigrant women is least likely to have immunity to
chickenpox?
Option List
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Middle-Eastern
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Those
from Antarctica
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Those
from the EEC
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Those
from tropical and sub-tropical Africa
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One-eyed
Mongolians with the bad habit of spitting in public
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Question 10.
Lead-in
What is the incidence of chickenpox in pregnancy in the UK?
Option List
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1 in 1,000
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3
in 1,000
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5
in 1,000
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8
in 1,000
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14
in 1,000
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20
in 1,000
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Question 11.
Lead-in
What is the usual presentation of chickenpox in a child?
Option List
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Mild fever with malaise then
vesicles which appear after 2 days and
disappear after 4 – 5 days
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Mild fever with malaise then
vesicles which appear after 2 days and
disappear after about 7 days
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Mild
fever, malaise, pruritic maculopapules that develop into vesicles and
normally crust over within 5 days
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Mild
fever, malaise, pruritic maculopapules that develop into vesicles and
normally crust over within 7 days
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Mild
fever, malaise, pruritic maculopapules that develop into vesicles and
normally crust over within 10 days
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Question 12.
Lead-in
What is the duration of infectivity after primary infection?
Option List
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From the onset of fever until 48 hours after the vesicles form
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From
the onset of fever until 5 days after the vesicles form
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From
48 hours before the development of the vesicles until 5 days later.
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From
48 hours before the development of the vesicles until they crust over
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From
the development of the vesicles until 5 days later.
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From
the development of the vesicles until they crust over
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Question 13.
Lead-in
A woman books at 8 weeks. Her 6-year-old son lives with her and has
recently developed chickenpox? She is tested and found to be non-immune. What
is her risk of infection from the domestic contact with her son?
Option List
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50%
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60%
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70%
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80%
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90%
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Question 14.
Lead-in
Which of the following contacts with a case of chickenpox would be
significant?
I contact
with the mother of a child who has just developed the typical chickenpox rash
II contact
with the mother of a child who has not developed the typical chickenpox rash
III a four-hour journey on a school bus with 20
children, one of whom develops the typical chickenpox rash the next day
IV having a coffee with a neighbour who is
having chemotherapy and has just developed shingles
V visiting a neighbour who has developed
ophthalmic shingles and has been admitted to an old-fashioned 20-bed ward
VI having a coffee with an 80-year-old neighbour who is in good health but has just
had recurrence of thoracic shingles.
Option List
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all of the above
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I
+ III + IV + V
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I
+ III + IV + V
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I +
II + III + IV + VI
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II
+ III + IV + V
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Question 15.
Lead-in
In relation to shingles, which of the following statements are true ?
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Shingles
is due to reactivation of the virus which has lain dormant in the sensory
nerve root ganglia
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Shingles
is due to reactivation of the virus which has lain dormant in the motor nerve
root ganglia
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Shingles
is due to reactivation of the virus which has lain dormant in the autonomic
nerve root ganglia
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Shingles
should always be regarded as infectious.
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Shingles
in the immuno-compromised should always be regarded as infectious.
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Ophthalmic
shingles should always be regarded as infections
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Option List
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A + D
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A +
E
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A +
E + F
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B + D
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C +
E + F
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Question 16. This
is about chickenpox vaccine.
Lead-in
Which of the following statements are true? Pick the best option from
the option list.
Statements.
A Chickenpox vaccine does not exist.
B Chickenpox vaccine uses a killed virus of
the Okra strain.
C Chickenpox vaccine uses an attenuated
virus of the Oka strain.
D All children who have not had chickenpox
should be offered the vaccine after 1 year of age.
E Women should be screened for immune status
as part of pre-pregnancy counselling or fertility treatment with ART
Option List
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1.
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A.
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2.
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B.
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3.
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C.
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4.
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B +
D
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5.
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B +
D + E
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6.
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C +
D
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7.
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C +
D + E
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8.
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None
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Question 17. This
relates to vaccination in early pregnancy
Lead-in
A 25-year-old woman is given varicella vaccine. Her period is due the
next day, but does not occur. A pregnancy test a few days later is +ve. What
should be the management?
Option List
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She should be advised that there is a 5% risk of congenital varicella
syndrome and be offered TOP.
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She
should be advised that there is a 10% risk of congenital varicella syndrome
and be offered TOP.
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She
should be advised that the level of risk of congenital varicella syndrome
after vaccination in early pregnancy is unknown and be offered TOP.
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She
should be advised that the level of risk of congenital varicella syndrome
after vaccination in early pregnancy is unknown and be offered referral to a
feto-maternal medicine expert.
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She
should be advised that the manufacturer has monitored occurrences of
inadvertent vaccination for nearly 20 years and that no increase of the risk
of congenital varicella syndrome has been identified after inadvertent
vaccination in early pregnancy.
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She
should be advised that the vaccine contains no live virus and cannot cause
fetal infection.
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Question 18.
Lead-in
A woman has been referred to the booking clinic by her GP. Screening for
immunity to chickenpox showed her to be seronegative. What advice would you
give her?
Option List
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Advise her that there is no risk unless she comes into contact with a
case of chickenpox or shingles and to speak to GP or midwife if possible
contact occurs..
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Advise
her to have the chickenpox vaccine because of the 10% risk and high mortality
associated with varicella in pregnancy.
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Advise
her to have VZIG to reduce her risk of infection.
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Advise
her to take oral acyclovir until two weeks post-delivery.
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None
of the above.
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Question 19.
Lead-in
A woman is referred to the booking clinic by her GP for urgent
assessment as she was in contact with a case of chickenpox two days before.
What action should be taken?
Possible actions.
I take a detailed history to determine the
significance of the contact and her history of and likely immunity to
chickenpox.
II check for VZV immunity if there is a
history of a significant contact and possibility that she is not immune.
III if the contact was significant and the
tests for VZV immunity show her to be seronegative, offer oral acyclovir
IV if the contact was significant and the
tests for VZV immunity show her to be seronegative, offer VZIG.
V if the contact was significant and the
tests for VZV show her to be seronegative, discuss TOP.
Option List
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I + II + III
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I + II + III + IV
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I + II + III + V
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I + II + IV
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V
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Question 20.
Lead-in
Which, if any, of the following statements about VZIG are correct?
- VZIG is manufactured using recombinant technology
- VZIG is effective in pregnancy
when given within 10 days of the contact
- If VZIG is given, the woman is
potentially infectious for up to 28 days
- Repeat doses of VZIG should not
be given in the event of repeated significant contact
- There are reliable supplies of
VZIG and no problems regarding availability
Option List
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I + II + III
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I + II + III + IV
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I + II + III + IV + V
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II + III
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II
+ III + V
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Question 21.
Lead-in
How does the administration of VZIG affect the duration of infectivity
for the woman?
Option List
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With no VZIG the woman is potentially infectious from day 8 to 28.
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VZIG
destroys virus and the woman is potentially infections from day 8 to 21.
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VZIG
does not alter the period in which the woman is potentially infections.
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VZIG
reduces the risk of shingles in later life
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None
of the above
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Question 22.
Lead-in
With regard to established varicella in pregnancy, which, if any, of the
following statements are true? Choose the best option from the option list.
- the main risk to the mother comes from pneumonia,
with an incidence of about 10%
- the main risk to the mother
comes from pneumonia, with an incidence of about 40%
- hepatitis and encephalitis are
more common compared to the non-pregnant state
- mortality from varicella
pneumonia have fallen to < 15%
- the death rate from varicella
pneumonia is estimated to be 5 times greater than in the non-pregnant
Option List
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I + III + IV + V
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II + III + IV + V
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I + IV + V
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II + IV + V
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I + IV
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Question 23.
Lead-in
A GP phones to say that a patient of his at 10 weeks’ gestation has
developed the typical rash of chickenpox. Her son had proven chickenpox a
couple of weeks previously. She had been tested and found to be non-immune, but
declined VZIG. Which, if any of the following statements would you include in
your advice to the GP.
- admit the woman for assessment, VZIG and
acyclovir after counselling re risks and benefits.
- arrange for her to be seen in the next antenatal
clinic.
- advise re prevention of secondary bacterial
infection of the lesions
- advise about her avoiding contact with
susceptible individuals until at least 7 days after the lesions crust over
- advise the GP of the criteria for hospital
admission and the need for the woman to be informed of them.
- advise the GP to discuss the risks and benefits
of acyclovir 800mg five times daily for seven days and to prescribe it if
the woman agrees.
- advise that acyclovir is contraindicated once the
rash appears
- advise that VZIG is ineffectual once the rash has
appeared
Question 24.
Lead-in
What kind of drug is aciclovir?
There is no option list
Question 25.
Lead-in
How effective is aciclovir?
There
is no option list.
Question 26.
Lead-in
Which, if any, of the following statements are true in relation to the
diagnosis of fetal varicella syndrome?
Option List
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detailed ultrasound examination by a fetal medicine expert should be
offered
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fetal
MRI is superior to US examination and should be the 1ry test if available
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amniocentesis
should be offered as detection of varicella DNA makes FVS probable
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amniocentesis
should be done as early as possible, avoiding any varicella lesions
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PCR
which is –ve for varicella DNA in amniotic fluid has a strong NPV for FVS
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PCR
which is +ve for varicella DNA in amniotic fluid has a strong PPV for FVS
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Question 27.
Lead-in
Which, if any, of the following statements are true in relation to fetal
varicella syndrome?
Option List
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FVS occurs in relation to 1ry. infection in-utero
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FVS
occurs in relation to 2ry. infection in-utero
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the
risk of FVS is ~ 5% when 1ry. infection in-utero occurs < 13 weeks
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the
risk of FVS is ~ 10% when 1ry. infection in-utero occurs between 13 and 20 weeks
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the
risk of FVS is greatest when 1ry. infection in-utero occurs within 4 weeks of
birth
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Question 28.
Lead-in
Which, if any, of the following statements are true in relation to
administration of varicella vaccine in pregnancy.
Option List
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varicella vaccine is a recombinant vaccine and licensed for use in
pregnancy
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varicella
vaccine contains a live, attenuated vaccine and is contraindicated in
pregnancy
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varicella
vaccine contains a live, attenuated vaccine and is safe to use after 12 weeks
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varicella
vaccine should not be given to women who are breastfeeding
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TOP
should be advised if varicella vaccine is given in the 1st.
trimester
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VZV
immunoglobulin should be given if varicella vaccine is given in the 1st.
trimester
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Question 29.
Lead-in
Which, if any, of the following statements are true in relation to
neonatal varicella (NV)
Option List
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the risk of NV is 90% with fetal infection in the 1st.
trimester
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the
risk of NV is 50% with fetal infection in the 2nd. trimester
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the
risk of NV is 10% with fetal infection in the 4 weeks before delivery
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planned
delivery should be delayed, if safe, until 7 days after start of the maternal
rash
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women
with active chickenpox should not breastfeed until 10 days after the lesions
crust
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41. Haemophilia.
Lead-in.
The following scenarios relate to haemophilia A and
pre-pregnancy counselling.
For each, select the most appropriate risk from the
option list.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
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A.
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0 %
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B.
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0.1 %
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C.
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1 %
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D.
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12.5 %
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E.
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13.3%
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F.
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20 %
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G.
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25 %
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H.
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33 %
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I.
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50 %
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J.
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66.6%
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K.
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68 %
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L.
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75 %
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M.
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80 %
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N.
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90 %
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O.
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100 %
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P.
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200 %
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Scenario 1.
A nulliparous 20-year-old
wishes to know the risk of her being a carrier as her father has mild
haemophilia A.
Scenario 2.
A nulliparous 20-year-old wishes to know the risk of her
being a carrier as her father has severe haemophilia A.
Scenario 3.
A para 3, 30-year-old wishes to know the risk of her
being a carrier as her mother is a carrier.
Scenario 4.
A para 0+4, 25-year-old wishes to know her
risk of being a carrier as her sister has an affected son.
Scenario 5.
A para 6, 40-year-old wishes to know the risk of her
being a carrier as her daughter has had an affected baby.
Scenario 6.
A nulliparous woman wishes to know the risk of a son
having haemophilia as she is a carrier.
Scenario 7.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her husband has haemophilia A.
Scenario 8.
A nulliparous woman wishes to know the risk of a daughter
being a carrier as she is a carrier.
Scenario 9.
A nulliparous woman wishes to know the risk of a daughter
being a carrier as her husband has haemophilia A.
Scenario 10.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her paternal grandfather had haemophilia A.
Scenario 11.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her maternal grandfather had haemophilia A.
Scenario 12.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her husband’s paternal grandfather had haemophilia A.
Scenario 13.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her husband’s maternal grandfather had haemophilia A.
Scenario 14.
A nulliparous woman wishes to know the risk of a son
having haemophilia as her mother’s brother has haemophilia A.
Scenario 15.
A nulliparous woman wishes to know her risk of being a
carrier as she has read about it in a magazine. There is no family history of
haemophilia A.
42. Surrogacy
Abbreviations.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
SM: surrogate mother
Option List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman of the HFEA
f)
Senior judge at the Children and Family Court
g)
traditional surrogacy
h)
gestational surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG Surrogacy Sub-Committee
l)
false
m)
true
n)
none of the above
Scenario 1
List the
different types of surrogacy.
Scenario 2.
“Gestational”
surrogacy has better “take-home-baby” rates than “traditional” surrogacy.
Scenario 3.
There are
approximately 1,000 surrogate pregnancies per annum in the UK. True/False
Scenario 4.
Which
national body regulates surrogacy in England?
Scenario 5.
Privately-arranged surrogate pregnancies are illegal and those involved
are liable to up to 2 years in prison. True/False
Scenario 6.
List the risks of surrogacy.
Scenario 7.
Obstetricians are legally obliged to take the CPs’ wishes into
consideration in managing pregnancy complications or problems.
Scenario 8.
The
psychological outcomes of surrogacy are fully understood. True/False.
Scenario 9.
The psychological
outcomes of surrogacy are more severe after traditional surrogacy. True/False
Scenario 10.
Who has the
right to arrange TOP if the fetus is found to have a major congenital
abnormality?
Scenario 11.
A SM decides at 10 weeks that she does not wish to be pregnant and
arranges to have a TOP. The CPs. hear about this and object strongly. To whom
should they apply to have the TOP blocked?
Scenario 12.
A woman has hysterectomy and BSO to deal with extensive endometriosis at
the age of 30. She marries two years later and her sister offers to act as
surrogate. She undergoes IVF and 4 embryos are created. One is transferred and
a successful pregnancy ensues. The baby is adopted by the woman and her husband.
The 3 remaining embryos were frozen. Four years later the woman falls out with
her sister, but finds another surrogate and wishes to proceed with another
pregnancy. The sister says she does not want her eggs to be used and that the
frozen embryos should not be transferred. Does the sister have the legal right
to block the use of the embryos? Yes / No.
Scenario 13.
A girl born from donor sperm reaches the age of 16 and wishes to know the
identity of her genetic father. Does she have the right to this information? Yes / No.
Scenario 14.
A girl born from donor sperm reaches the age of 18 and wins a place at
Oxford University to read medicine. Does she have the legal right to get the
donor to contribute to her fees? Yes / No.
Scenario 15.
A PO is
active from the moment it is completed and signed by the relevant parties. True/False
Scenario 16.
A SM can
change her mind at any time and keep the child, even if the egg was not hers. True/False
Scenario 17.
The CPs can
change their mind, leaving the SM as the legal mother. True/False
Scenario 18.
A SM’s
husband is the legal father until adoption is completed or a PO comes into
force.
Scenario 19.
A lesbian couple is a stable, co-habiting relationship can be CPs and
become the legal parents of the child of a SM.
Scenario 20.
CPs are likely to get faster legal status as the legal parents through
application for a PO rather than applying for adoption.
43. Confidentiality
& consent.
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 not 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?
Scenario 14.
You are the SpR in theatre with your consultant. Mrs Mary
White, age 45, has been listed for abdominal hysterectomy and bilateral
salpingo-oophorectomy – she has a long history of menorrhagia that has not
responded to conservative measures. Her mother had ovarian cancer diagnosed at
55 and died from the disease 3 years later. A 10 cm., solid tumour of the left
ovary is found on opening the abdomen. Which of the following options is the
correct course of action?
|
A
|
close the abdomen, see her to explain the findings and
book a follow-up appointment in the gynaecological clinic to discuss further
management
|
|
B
|
close the abdomen, arrange to see her to explain the
findings and refer to the gynaecological oncologist to discuss further
management
|
|
C
|
continue with the operation, but don’t remove the left
ovary
|
|
D
|
continue with the operation, removing the uterus and
both ovaries and tubes
|
|
E
|
continue with the operation, removing the uterus and
both ovaries and tubes and obtaining peritoneal washings
|
|
F
|
ask the gynaecological oncologist to attend to perform
definitive surgery on the basis that the cyst is likely to be malignant
|
|
G
|
phone the legal department for advice
|
|
H
|
phone the Court of Protection for advice
|
Scenario 15.
You are an SpR in theatre with
your consultant.
Mrs Mary White, age 45, has
been listed for abdominal hysterectomy and bilateral salpingo-oophorectomy –
she has a long history of menorrhagia that has not responded to conservative
measures. Her mother had ovarian cancer diagnosed at 55 and died from the
disease 3 years later.
You perform examination under
anaesthesia prior to the abdomen being opened. You find a 10 cm., mass to the
left of the uterus. It feels solid. There is no evidence of ascites or other
pathology.
Which of the following options is the correct
course of action?
|
A
|
Cancel the operation and
arrange review in the gynaecology department in 6 weeks
|
|
B
|
Cancel the operation and
arrange review by the oncology team
|
|
C
|
Cancel the operation and
arrange an urgent scan
|
|
D
|
Continue with the planned
procedure
|
|
E
|
Ask the gynaecological
oncologist to attend theatre to examine the patient and advise
|
|
F
|
Perform laparoscopy to
identify the nature of the mass
|
|
G
|
Phone the legal department
|
ANSWRS TO 18 TH JAN QUESTIONS:
ReplyDelete40
Q1-B
2-A
3-D
4-4
5-2
6-5
7-4
8-F
9-D
10-B
11-D
12-D
13-E
14-A
15-3
16-7
17-D
18-A
19-D
20-D
21-E
22-B
23-VIII
24-SYNTHETIC NUCLEOSIDE ANALOGUE
25-
26-A
27-A
28-B
29-D
41
SCENARIO1-O
2-O
3--I
4-O
5-A
6-I
7-A
8-I
9-O
10-A
11-G
12-A
13-A
14-G
15-A
-
42SCENARIO
1-
2-m
3-l
4-e
5-l
6-l
7-
8-l
9-m
10-d
11-k
12-yes
13-yes
14-no
15-m
16-m
17-m
18-m
19-l
20-m
-
43:
1-any competent young adult can give consent irrespective of age
2-consent can be given by girl
3-offer barrier
4-offer barrier
5-will not discuss , dr –pt confidentiality
6-discuss with husband
7-treat condition
8-girl
9- legal guardian
10-mother or legal guardian
11-boyfriend
12-
13-inform police
14-E
15-D
-
ANSWRS TO 18 TH JAN QUESTIONS:
ReplyDelete40
Q1-B
2-A
3-D
4-4
5-2
6-5
7-4
8-F
9-D
10-B
11-D
12-D
13-E
14-A
15-3
16-7
17-D
18-A
19-D
20-D
21-E
22-B
23-VIII
24-SYNTHETIC NUCLEOSIDE ANALOGUE
25-
26-A
27-A
28-B
29-D
41
SCENARIO1-O
2-O
3--I
4-O
5-A
6-I
7-A
8-I
9-O
10-A
11-G
12-A
13-A
14-G
15-A
-
42SCENARIO
1-
2-m
3-l
4-e
5-l
6-l
7-
8-l
9-m
10-d
11-k
12-yes
13-yes
14-no
15-m
16-m
17-m
18-m
19-l
20-m
-
43:
1-any competent young adult can give consent irrespective of age
2-consent can be given by girl
3-offer barrier
4-offer barrier
5-will not discuss , dr –pt confidentiality
6-discuss with husband
7-treat condition
8-girl
9- legal guardian
10-mother or legal guardian
11-boyfriend
12-
13-inform police
14-E
15-D
-