|
33 |
Role-play. Sterilisation request |
|
34 |
EMQ. Mental Capacity Act |
|
35 |
EMQ. Cri du chat syndrome |
|
36 |
EMQ. Anatomy of the fetal skull |
33. Role-play. Sterilisation request..
Candidate’s Instructions.
You are a 5th. year SpR. You are about to see
Mrs. Mary Fecund in the gynaecology clinic. There is a referral letter from the
GP.
Read the letter and then conduct the consultation with
Mrs. Fecund as you would do in the clinic in your hospital.
GP letter.
Perfect Health Centre,
Paradise Lane,
Slagheap.
SLH 678.
Your ref: BRI 07/54843.
Re. Mary Fecund,
The Shoe,
High Street,
Slagheap.
Dear Doctor,
Please see Mrs Fecund who has too many children. She
wishes to be sure she has no more and has asked to be sterilised.
Yours sincerely,
Dr. John Williams.
34. Mental
Capacity Act 2005.
Many of the questions are not true EMQs as there is more
than 1 correct answer.
Abbreviations.
ACP: advance care planning.
ADRT: advance decision to refuse treatment.
ALMC: an adult who lacks mental capacity.
ALMCs: adults who lack mental capacity.
ANH: artificial nutrition and hydration.
CAD: Court-appointed Deputy.
COP: Court of Protection.
FGR: fetal growth restriction.
IMCA: Independent Mental Capacity Advocate.
LOC: lack of capacity.
LPA: lasting power of attorney.
MCA: Mental
Capacity Act 2005.
PLC: person lacking capacity.
PLPA: person with lasting power of
attorney
PoA: power of attorney.
Option list. Use this list unless the question has its own.
|
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 Lasting Power
of Attorney |
|
P |
The sheriff or sheriff’s
deputy |
|
Q |
Balance of probabilities |
|
R |
Beyond reasonable doubt |
|
S |
None of the above. |
Question 1.
Which, if any, of
the following statements about the MCA are true?
Option list.
|
A |
it applies to England only |
|
B |
it applies to England &
Wales only |
|
C |
it applies to England, N.
Ireland, Scotland & Wales |
|
D |
it applies to adults > 18
years only |
|
E |
it applies to children 16 –
18 years |
|
F |
it applies to children <
15 years |
|
G |
it applies to men, but not to
women |
|
H |
None of the above |
Question 2.
Which, if any, of
the following statements about the MCA are true?
Option list.
|
A |
about ½ million people fall
within its remit |
|
B |
about 1 million people fall
within its remit |
|
C |
about 2 million people fall
within its remit |
|
D |
about 5% of acute
gynaecological admissions are of people
lacking capacity at the time |
|
E |
about 10% of acute
gynaecological admissions are of people
lacking capacity at the time |
|
F |
about 10% of acute medical
admissions are of people lacking capacity at the time |
|
G |
about 30% of acute medical
admissions are of people lacking capacity at the time |
|
H |
about 25% of psychiatric
admissions are of people lacking capacity at the time |
|
I |
about 45% of psychiatric
admissions are of people lacking capacity at the time |
|
J |
None of the above. |
Question 3.
Which, if any, of
the following terms are used in relation to the MCA Act?
Option list. Use this list unless the question has its own.
|
A |
advance decision |
|
B |
advance declaration |
|
C |
advance directive |
|
D |
advance statement |
|
E |
independent mental capacity
adviser |
|
F |
lasting power of attorney |
|
G |
lingering power of attorney |
|
H |
living will |
|
I |
one-stage test of capability |
|
J |
two-stage test of capability |
|
K |
public guardian |
|
L |
temporary power of attorney |
|
M |
none of the above |
Question 4.
Which of the
following are legally obliged to ‘have regard’ to the MCA’s Code of
Practice in their dealings with
those who lack capacity?
Option list. Use this list unless the question has its own.
|
A |
anyone involved
professionally in the person’s care |
|
B |
any attorney with lasting
power of attorney |
|
C |
any court-appointed deputy |
|
D |
any independent mental
capacity advocate |
|
E |
anyone engaged in research
involving the person lacking capacity |
|
F |
anyone paid for acts relating
to the person lacking capacity |
|
G |
any care assistant involved
with the person lacking capacity |
Question 5.
When must the COP
be involved about the implementation of
advance decisions?
Question 6.
What are the main
roles of the Court of Protection?
Option list.
|
A |
to oversee implementation of
MCA |
|
B |
to deal with emergency applications
in relation to individuals who lack capacity |
|
C |
to appoint deputies to make
decision on behalf of individuals who lack capacity |
|
D |
to appoint individuals with
LPA |
|
E |
to provide legal advice to
family members of someone lacking capacity |
|
F |
none of the above |
Question 7.
What are the key
capabilities a person must have in relation to information provided
to them to have capacity under
the MCA?
Option list.
|
A |
the person must be able to
read the information provided |
|
B |
the person must be able to
give a clear account of the information provided |
|
C |
the person must be about to
understand the information provided |
|
D |
the person must be able to
retain the information provided for at least 12 hours |
|
E |
the person must be able to
reach a conclusion that is logical to the doctor |
|
F |
the person must be able to communicate
their decision |
Question 8.
Which, if any, of the following are necessary for the appointment of
someone as an
IMCA?
|
A |
IMCA training |
|
B |
approval by the local authority |
|
C |
membership of an approved organisation |
|
D |
been cleared by the Criminal Records Bureau |
|
E |
none of the above |
Question 9.
What does an IMCA
do?.
Question 10.
A person with LPA
is normally not a family member. True?
Question 11.
A Sheriff’s Deputy
is normally not a family member. True?
Question 12.
A person with Power
of Attorney can consent to treatment for the patient who lacks
capacity. True?
Question 13.
A Court-appointed Deputy can consent to
treatment for the patient who lacks
capacity, but must go back to the CoP if further consent
is required for additional treatment.
Question 14.
A person with PoA
can authorise withdrawal of all care in cases of individuals with
persistent vegetative states.
Question 15.
An advance
decision can authorise withdrawal of all but basic care in cases of
persistent vegetative states.
Question 16.
A person with PoA
cannot overrule an advance direction about withdrawal or
withholding of life-sustaining
care.
Question 17.
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?
Question 18.
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?
Question 19.
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?
The TOG CPD questions for Volume
12.1 from 2010 are open access and available
here.
Answer True or False.
Understanding the Mental
Capacity Act 2005: a guide for clinicians
Under the Mental Capacity Act
2005:
1. competent
adults have a legal right to refuse life-threatening treatment. True / False
2. unwise
decisions do not need to be adhered to if made by competent adults. True / False
Advance directives:
3. can be made by
anyone aged >16 years. True / False
4. need only be drawn
up in general terms as to a person’s wishes. True / False
5. must be in
writing if life-sustaining treatment is being refused. True / False
The following statements about advance directives are true:
6. Refusal of
basic nursing care such as oral hydration and feeding cannot be made. True / False
7. Oral advance
decisions are never binding. True / False
8. Failure to
recognise an advance decision may give rise to a civil wrong of trespass. True / False
Capacity:
9. is age related,
but never task orientated. True / False
10. cannot be
established by reference to a person’s previous behaviour or appearance.
True / False
The following statements about ‘best interests’ are true:
11. The decision
maker (doctor) is not legally obliged to consult with family members when
dealing with incapacitated adults. True / False
12. Where there are
disputes between the doctor and the family members regarding a patient’s best interests,
getting a court appointed deputy is considered good practice. True / False
13. Restraint of a
patient by the decision maker is allowed, as long as it is proportionate and
there is a reasonable belief of harm in failing to do so. True / False
The following statements about Lasting Powers of Attorney
(LPAs) are true:
14. There are two
types of LPA: one for property and affairs, the other for personal welfare.
True / False
15. Anyone aged >16
years and with the requisite capacity is able to appoint an LPA. True / False
16. Where there is
contradiction between a LPA and an advance directive, the latter will be the effective
one. True / False
Under the Mental Capacity Act 2005:
17. patients who are
only able to retain information for a short period are regarded as lacking capacity.
True / False
Which of the following statements are true?
18. Capacity is not
fixed in time and can therefore change depending on the circumstances.
True / False
19. Parents can
overrule their 16 to 17-year-old’s refusal to be admitted into a mental institution.
True / False
20 The person
making an advance directive does not have to draw the attention of healthcare professionals
to their decision. True / False
The TOG CPD questions for Volume
20.1 are open access and available
here.
Decision-making framework in gynaecology
for patients who lack mental capacity
The Mental Capacity Act of 2005:
1. is applicable
to individuals aged ≥18 years. True / False
2. is applicable
to individuals residing in England and Scotland. True / False
3. is not
applicable to individuals who are under the influence of drugs or substance
abuse.
True / False
4. ensures that
affected individuals do not make any unwise decision with regard to their
treatment. True / False
With regard to the decision-making model:
5. substituted
judgement is made to overturn an advanced decision by an individual. True / False
6. substituted
judgement is based on the values of the concerned individual. True / False
7. a decision made
by the method of substituted judgement is an objective means of arriving at a
decision. True / False
8. the Court of Protection
is able to appoint a deputy to make a decision on behalf of a mentally
incapacitated individual. True / False
9. someone with
advance directive is able to demand specific life-sustaining treatment in the
event of mental incapacitation. True / False
10. advance
statements are not valid unless they are made in writing. True / False
Regarding lasting power of attorney (LPA):
11. only a person
aged 18 years or more can be appointed as a donee. True / False
12. a donor can appoint
only one attorney with authority to make decisions. True / False
13. an advance
directive is still valid even when the affected person later appoints a donee
with the relevant authority. True / False
14. an individual
with an LPA can decide at his or her own discretion about withdrawal of life
sustaining treatment. True / False
Regarding the best interests model of care:
15. decisions made
in the ‘best interests’ meeting have legal authority. True / False
16. decisions taken
on this basis should be based upon personal opinion and preferences of the decision
maker. True / False
17. decisions taken
on this basis should be based upon the current condition of the incapacitated person.
True / False
For assessment of mental capacity:
18. the opinion of a
psychiatrist should always be sought before a decision of mental incapacity is
confirmed. True / False
19. a mini-mental
state examination score of below 20 increases the likelihood of mental incapacity.
True / False
Regarding the provision under the Mental Capacity Act of
2005,
20. it allows for a
decision to be taken to place a child for adoption on behalf of a mentally incapacitated
person. True / False
35. Cri du
Chat syndrome..
Abbreviations.
CDC: cri du chat.
CDCs: cri du chat syndrome.
Question
1. Which of the following are recognised alternative names for
cri-du-chat syndrome?
Option list.
|
A |
5p minus syndrome |
|
B |
5p- syndrome |
|
C |
6p minus syndrome |
|
D |
6p- syndrome |
|
E |
trisomy 5 |
|
F |
trisomy 6 |
Question
2. Which, if any, of
the following are associated?
Option list.
|
A |
gene mutation |
|
B |
partial deletion of short arm of a chromosome |
|
C |
partial deletion of long arm of a chromosome |
|
D |
partial deletion of both arms of a chromosome |
|
E |
genetic mutation |
|
F |
translocation |
|
G |
trisomy |
|
H |
none of the above |
Question
3. Which, if any, of the following is the main cause of CDC?
Option list.
|
A |
autosomal dominant inheritance |
|
B |
autosomal recessive inheritance |
|
C |
new mutation |
|
D |
X-linked dominant inheritance |
|
E |
X-linked recessive inheritance |
|
F |
translocation |
|
G |
trisomy |
|
H |
triploidy |
|
I |
none of the above |
Question
4. What is the approximate prevalence of CDC in neonates?
Option list.
|
A |
1 in 1,000 - 5,000 |
|
B |
1 in 5,000 - 10,000 |
|
C |
1 in 10,000 - 20,000 |
|
D |
1 in 20,000 - 50,000 |
|
E |
1 in 50,000 - 100,000 |
|
F |
< 1 in 1,000,000 |
Question
5.
Which, if any, of
the following are common features of CDCs?
Option list.
|
A |
distinctive cry |
|
B |
behavioural difficulty |
|
C |
developmental delay |
|
D |
epicanthic folds |
|
E |
hypertelorism |
|
F |
hypotonia |
|
G |
leaning difficulty |
|
H |
low birthweight |
|
I |
low-set, anteriorly-rotated ears |
|
J |
microcephaly |
|
K |
small jaw |
36. Anatomy
of fetal skull and maternal pelvis.
Question 1. How many bones make
up the vault of the skull?
Option list.
|
A |
3 |
|
B |
5 |
|
C |
6 |
|
D |
7 |
|
E |
8 |
Question 2. What is
the origin of the word “bregma”?
Option list.
|
A |
the Greek word meaning “arrow” |
|
B |
the Greek word meaning “front of the head” |
|
C |
the Greek word meaning “top of the head” |
|
D |
the Greek word meaning “where lines intersect” |
|
E |
none of the above |
Question 3. What is the origin
of the word “lambdoid”?
Option list.
|
A |
it is derived from “lambda”, the 11th.
letter of the Greek alphabet, with the symbol “λ” |
|
B |
it is derived from the shape of the rear end of a
newborn lamb, with legs apart for balance in the shape of an inverted “V” |
|
C |
it derives from the Norse noun “lam” meaning to hit |
Question 4. What is the origin of the word “sagittal”?
Option list.
|
A |
it derives from the Latin verb “sagire” meaning to be
wise |
|
B |
it derives from the Latin noun “sagitta” meaning
“arrow” |
|
C |
it derives from the Latin adjective “sagitta” meaning
“pointing north” |
|
D |
it derives from the Latin adjective “sagitta” meaning
“lacking tension” |
Question 4. What is the meaning of the word “coronal”?
Option list.
|
A |
it is the 11th. letter of the Greek alphabet |
|
B |
it derives from the Latin “corona” meaning “crown”. |
|
C |
it derives from the sun’s corona, meaning equator |
Question 6. What is
the definition of “vertex”?
Option list.
|
A |
the most prominent part of the occiput |
|
B |
the area around the posterior fontanelle |
|
C |
the area bounded by the anterior fontanelle and the
posterior fontanelle |
|
D |
the area bounded by the anterior & posterior
fontanelles and the parietal bones |
|
E |
the area bounded by the anterior & posterior
fontanelles and the parietal eminences |
|
F |
the area bounded by the anterior & posterior
fontanelles and the parietal cardinals |
Question 7. What is the
definition of the anterior fontanelle?
Option list.
|
A |
the anterior end of the sagittal suture |
|
B |
the area where the sagittal and coronal sutures meet |
|
C |
the area between the frontal and parietal bones |
|
D |
the posterior end of the sagittal suture |
|
E |
the area between the parietal bones and the occiput |
Question 8. What is the definition of the posterior fontanelle?
Option list. Use the option list for Question 7
Question 9. How many other fontanelles are there?
|
A |
0 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
6 |
Question 10. What is
the falx cerebri?
Option list.
|
A |
an area of dura mater at the back of the skull like a
roof over the cerebellum |
|
B |
is an artefact on ultrasound suggesting the presence of
cerebral tissue where there is none |
|
C |
is the horizontal fibrous platform on which the
cerebellum rests |
|
D |
is a crescent-shaped fold of dura mater separating the
cerebral hemispheres |
Question 11. What is the importance of the falx cerebri in relation to
delivery, particularly breech delivery?
Option list.
|
A |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears
and intracranial bleeding |
|
B |
the falx cerebri is inserted into the bone of base of
the skull and traction on the base of the skull may lead to tears of the falx
and intracranial bleeding |
|
C |
the falx cerebri is inserted into the tentorium
cerebelli and traction on the base of the skull may lead to tentorial tears leaving
the cerebellum unsupported and liable to trauma |
Question 12. What
diameter presents to the pelvis with vertex presentation?
Option list.
|
A |
suboccipito-bregmatic |
|
B |
suboccipito-frontal |
|
C |
occipito-frontal |
|
D |
mento-vertical |
|
E |
submento-bregmatic |
|
F |
none of the above |
Question 13. What
diameter presents to the pelvis with typical occipito-posterior position?
Option list. Use the list for
Question 12.
Question14. What
diameter presents to the pelvis with brow presentation?
Option list. Use the list for Question 12.
Question 15. What diameter presents to the pelvis with mento-anterior
face presentation?
Option list. Use the list for Question 12.
Question 16. What
diameter presents to the pelvis with mento-posterior face presentation?
Option list. Use the list for Question 12.
Question 17. What is the average length of the suboccipito-bregmatic
diameter in a term baby?
Option list.
|
A |
9.0 cm. |
|
B |
9.5 cm. |
|
C |
10.0 cm. |
|
D |
10.5 cm. |
|
E |
11.0 cm. |
|
F |
11.5 cm. |
|
G |
12.0 cm. |
|
H |
12.5 cm. |
|
I |
13.0 cm. |
|
J |
13.5 cm. |
|
K |
14.0 cm. |
Question 18. What is the average length of the suboccipito-frontal
diameter in a term baby?
Option list. Use the option list for Question 17.
Question 19 What is
the average length of the occipito-frontal diameter in a term baby?
Option list. Use the option list for Question 17
Question 20. What is the average
length of the mento-vertical diameter in a term baby?
Option list. Use the option list for Question 17
Question 21. What is the average length of the submento-bregmatic
diameter in a term baby?
Option list. Use the option list for Question 17
