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24 November 2016.
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14
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EMQ. Mental Capacity Act
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15
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EMQ. The Coroner
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16
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EMQ. Mode of inheritance
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17
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Air Travel & Pregnancy. How to read exercise & SBA.
Extract the key facts for Qs. from SIP 1. 2013
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18
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Communication skills. Pre-pregnancy counselling
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14 EMQ.
Mental Capacity Act.
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 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?
Scenario 10
An 8 year old girl is admitted
with abdominal pain. Appendicitis is diagnosed with peritonitis and surgery is
advised. The parents decline treatment on religious grounds. Can the consultant
in charge overrule the parents and give consent?
15. The Coroner. Question 1.
Lead-in.
The following scenarios relate to the role of the
Coroner.
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.
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.
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.
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A
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provide access to the records by
the Coroner in person
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B
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provide unrestricted access to
the medical records by the coroner’s officers
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C
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provide a copy of the hospital
records to the coroner or her officers
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D
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provide a medical report, but no
access to the medical records
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E
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provide a copy of the letter to
the GP about the recent admission
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F
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none of the above
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16. Mode of
inheritance.
Lead-in.
The following questions relate to the mode of inheritance
– some not quite to “mode”, but I am sure you will indulge me! Write what you
think is the mode of inheritance or appropriate answer.
Option List. There is no option list.
Comment.
You are expected to know a lot
of basic genetics and it is hard to remember the details. A list to go over in
the days before the exam makes sense. Use this one and add anything else you
can think of – and let me know of your additions so I can add them. Don’t add a
load of rare syndromes – you will just end up confused. But add anything that
you know has featured in the exam.
List of questions.
1. achondrogenesis.
2. achondroplasia.
3. acute fatty liver of pregnancy (AFLP).
4. adreno-genital syndrome
5. adult
polycystic kidney disease.
6. androgen insensitivity syndrome.
7. albinism.
8. Angelman syndrome.
9. Apert syndrome.
10. Becker muscular dystrophy.
11. Beckwith-Wiedemann syndrome.
12. BRCA 1.
13. BRCA2.
14. Cavanan syndrome.
15. Charcot-Marie-Tooth disease.
16. chondrodystrophy.
17. Christmas disease.
18. congenital adrenal hyperplasia.
19. Cowden
syndrome.
20. cri-du-chat syndrome.
21. cystic fibrosis.
22. Dandy-Walker syndrome.
23. developmental dysplasia of the hip.
24. DiGeorge syndrome.
25. Down’s syndrome.
26. Duchenne muscular dystrophy
27. Dwarfism. See isolated growth hormone deficiency.
28. Edward’s syndrome.
29. exomphalos.
30. Ehlers-Danlos syndrome
31. Fanconi anaemia
32. Fitz-Hugh-Curtis syndrome.
33. Fragile X syndrome.
34. galactosaemia.
35. gastroschisis.
36. glucose-6-phosphatase deficiency. G6PD.
37. glucose-6-phosphate dehydrogenase deficiency. G6PDD.
38. haemochromatosis.
39. haemosiderosis..
40. haemophilia A:
41. haemophilia B:
42. Hunter syndrome.
43. Huntington’s
disease.
44. ichthyosis.
45. isolated
growth hormone deficiency.
46. juvenile
polycystic kidney disease.
47. Kallmann’s
syndrome.
48. Klinefelter’s
syndrome.
49. Lesch Nyhan syndrome.
50. Lynch syndrome (HNPCC).
51. Malignant hyperthermia.
52. Maple syrup urine disease.
53. Marfan’s syndrome.
54. Martin-Bell syndrome.
55. Mayer-Rokitansky-Kuster-Hauser syndrome.
56. McCune-Albright
syndrome.
57. Meckel-Gruber syndrome.
58. Medium-chain acyl-CoA dehydrogenase deficiency.
59. mucopolysaccharidosis type I.
60. Myotonic
dystrophy.
61. neurofibromatosis.
62. Niemann-Pick
disease.
63. Noonan syndrome.
64. ocular albinism.
65. osteogenesis imperfecta.
66. osteoporosis.
67. Patau’s
syndrome.
68. Perrault syndrome.
69. phenyketonuria.
70. polydactyly.
71. porphyria.
72. Potter’s syndrome.
73. Prader-Willi syndrome.
74. Prune-belly syndrome
75. pyruvate kinase deficiency.
76. sickle cell disease.
77. spherocytosis.
78. Syndrome
X.
79. Tay-Sach’s disease.
80. Thalassaemia.
81. Thrombophilia.
82. Triple X syndrome.
83. Turner’s syndrome.
84. Swyer’s syndrome.
85. Uniparental disomy.
86. VACTERL.
87. vitamin D resistant rickets
88. von Willebrand’s disease.
89. A
mother has spina bifida. What is the risk of a child being affected?
90. A
mother has had a child with spina bifida, what is the risk of the next child
being affected?
91. A mother has had two children with spina bifida. What is
the risk of the next child being affected?
92. A mother has grand-mal epilepsy. What is the risk of her
child having epilepsy?
93. A mother and her partner both have grand-mal epilepsy. What
is the risk of their child having epilepsy?
94. A mother has insulin-dependent diabetes mellitus. What is
the risk of a child being affected?
95. A
mother has congenital heart disease. What is the risk of a child being
affected?
96. A mother takes lithium for bi-polar disorder throughout her
pregnancy. What is the risk of the child having congenital heart disease?
97. A mother has a nuchal translucency scan at 11 weeks. The
result is 6 mm. What is the risk of the fetus having congenital heart disease?
17. Air travel & pregnancy. How to read exercise & SBA.
Extract the
key facts from SIP1 that you think could be used for an EMQ or SBA..
18.
Basic communication skills. Role-play.
Candidate's Instructions.
You are a 5th. year SpR. You are about to see
Mrs. Jane Brown who has been referred for pre-pregnancy counselling as she is
planning her first pregnancy and has a brother with cystic fibrosis.
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