Monday 12 June 2017

Tutorial 12th. June 2017

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12 June 2017.

20
EMQ. Mental Capacity Act
21
Air Travel & Pregnancy. How to read exercise & SBA. Extract the key facts for Qs. from SIP 1. 2013
22
EMQ. Cancer incidence & mortality
23
Communication skills. Role-play. PMB.

20.   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?

21.   Air Travel & Pregnancy.
How to read exercise. Extract the key facts for Qs. from SIP 1. 2013

22.   EMQ. Cancer incidence & mortality.
Cancer incidence and mortality.
These questions relate to the incidence of female cancer and associated mortality.
Pick one option from the option list.
Abbreviations.
NHL:      non-Hodgkin Lymphoma
Question 1.
Lead-in
Which is the most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 2.
Lead-in
Which is the 2nd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 3.
Lead-in
Which is the 3rd. most common female cancer?
Option List
A.       
Bowel
B.       
Breast
C.       
Cervix
D.       
Endometrium
E.        
Lung
Question 4.
Lead-in
Which is the 4th. most common female cancer?
Option List
A.       
Bowel
B.       
Cervix
C.       
Endometrium
D.       
Lung
E.        
Pancreas
Question 5.
Lead-in
Which is the 5th. most common female cancer?
Option List
A.       
Cervix
B.       
Malignant melanoma
C.       
Non-Hodgkin’s lymphoma
D.       
Ovary
E.        
Vulva
Question 6.
Lead-in
Which is the 6th. most common female cancer?
Option List
A.       
Cervix
B.       
Malignant melanoma
C.       
Non-Hodgkin’s lymphoma
D.       
Ovary
E.        
Vulva
Question 7.
Lead-in
Where does cervical cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
11th.
C.       
15th.
D.       
20th.
E.        
24th.
Question 8.
Lead-in
Where does vulval cancer feature in the list of the most common female cancers?
Option List
A.       
10th.
B.       
12th.
C.       
16th.
D.       
20th.
E.        
none of the above
Question 9.
Lead-in
Which is the most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas
Question 10.
Lead-in
Which is the 2nd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas
Question 11.
Lead-in
Which is the 3rd. most common cancer causing female death in the UK?
Option List
A.       
Breast
B.       
Bowel
C.       
Lung
D.       
Ovary
E.        
Pancreas
Question 12.
Lead-in
Which is the 4th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 13.
Lead-in
Which is the 5th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 14.
Which is the 6th. most common cancer causing female death in the UK?
Option List
A.       
Brain
B.       
Oesophagus
C.       
Ovary
D.       
Pancreas
E.        
Uterus
Question 15.
Lead-in
The incidence of cervical cancer has fallen from the late 1970s until now. What is the approximate figure for the fall?
Option List
A.       
10%
B.       
25%
C.       
50%
D.       
60%
E.        
75%
Question 16.
Lead-in
The incidence of cervical cancer fell in the past decade. What is the approximate figure for the fall?
Option List
A.       
5%
B.       
10%
C.       
15%
D.       
20%
E.        
25%
Question 17.
Lead-in
What proportion of cervical cancer is diagnosed in women < 45 years?
Option List
A.       
20%
B.       
30%
C.       
40%
D.       
50%
E.        
60%
Question 18.
Lead-in
When was routine HPV vaccination of girls introduced in the UK?
Option List
A.       
2000
B.       
2002
C.       
2004
D.       
2006
E.        
2008
Question 19.
Lead-in
From what year might we expect to see a reduction in cervical cancer incidence as a result of the HPV vaccination programme?
Option List
A.       
2020
B.       
2025
C.       
2030
D.       
2040
E.        
2050
Question 20.
Lead-in
When was routine HPV vaccination of boys introduced in the UK?
Option List
A.       
2010
B.       
2011
C.       
2012
D.       
2014
E.        
None of the above

23.   Communication skills. Role-play. PMB.
PMB. Role-play.
Candidate’s Instructions.
You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.
A 55 year old woman is referred by her General Practitioner.
Your task is to take an appropriate history and advise her about the investigations you feel are appropriate and why.

Referral letter from the General Practitioner.
Manor Lodge,
High Street,
Bestown.
BE5 S00
Re: Mrs. Mary Smith,   Age 55.
5b High Street,
Bestown.
BE5 SO1

Dear Doctor,
Please see Mrs. Smith who has had bleeding down below. It is a number of years since she reached the menopause.
Yours sincerely,
James Fewords, General Practitioner.


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