|
62 |
EMQ. Medical Examiner |
|
63 |
Role-play. Medical examiner. Explain to
FY1. |
|
64 |
EMQ. Coroner |
|
65 |
EMQ. Gordon, Holmes & Semmelweis |
|
66 |
EMQ. Vulval conditions |
|
67 |
EMQ. Screening for anxiety and depression
in pregnancy |
62. EMQ. Medical
Examiner.
Abbreviations.
MCCD: medical
certificate of the cause of death.
ME: medical
examiner.
Do I really need to know
this stuff? This
is ‘hot’: MEs were an innovation in 2018.
Question
1.
Which, if any, of
the following are included in the role of the ME?
Option list.
|
A |
scrutiny of all death certificates from the NHS Trust |
|
B |
scrutiny of all death certificates from the local area |
|
C |
scrutiny of non-coronial death certificates from the
local area |
|
D |
deciding if postmortem examination is appropriate |
|
E |
supervision of postmortem examination |
|
F |
deciding on and arranging further investigations to
establish the cause of death |
|
G |
liaison with the coroner |
|
H |
discussing the cause of death with the family of the
deceased |
|
I |
directing police investigations in cases of suspicious
death |
Question
2.
What qualifications
must a ME have?
Option list.
|
A |
be registered with the GMC |
|
B |
be licensed to practise or be < 5 years into retirement |
|
C |
be a member or fellow of a Royal Medical College |
|
D |
be a member or fellow of the Royal College of
Pathologists |
|
E |
none of the above. |
Question
3.
Which, if any, of
the following are included in the role of the medical examiner?
Option list.
|
A |
discussing the case with the doctor who provided care
during the final illness |
|
B |
reviewing the medical records |
|
C |
deciding the cause of death to be put on the certificate
of death |
|
D |
discussing the cause of death with next of kin |
|
E |
identifying any concerns the next of kin may have about
the care |
|
F |
providing medical advice to the coroner |
|
G |
identifying deaths that should trigger a mortality case
record review |
Question
4.
Which, if any, of
the following are included in the role of the National ME?
Option list.
|
A |
being a member of the medical team responsible for the
Queen’s health |
|
B |
appointing Trust MEs |
|
C |
disciplining errant MEs |
|
D |
producing reports |
|
E |
arbitrating in disputes between MEs and coroners about
the cause of death |
|
F |
dealing with appeals by families who are dissatisfied with
the MCCD or the care |
63. Role-play.
Explain the Medical Examiner system to a FY1.
I have made this easy!! I guessed that most people would not
know enough about it to role-play confidently, so we will start with the EMQ which
will give the necessary facts.
Abbreviations.
ME: medical
examiner.
Candidate’s instructions.
You are the registrar on call on the labour ward. It is
quiet. You were having a coffee with the consultant and FY1. The FY1 mentioned
that she had heard mention of medical examiners yesterday and had not heard of
MEs before. The Consultant has told you to tell her about the ME system as if
it was a Part 3 station as you are preparing for your Part 3 exam. The
Consultant is a Part 3 examiner and has told you that you need to think of how
to display senior doctor thinking to the process and not just outline the basics
so that you impress as an outstanding candidate.
64. Coroner.
This topic has featured in the exam and makes for
easy marks if you know the basics.
CC: Chief Coroner.
CJA9: Coroners and Justice Act 2009.
MCCD: medical
certificate of the cause of death.
NOD: notification
of deaths.
SB: stillbirth
Option list 1.
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
Use option list 1 for scenarios
1 - 3.
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?
Scenario
4.
Which, if any, are current titles for coroners?
Option
list.
|
A |
area
coroner |
|
B |
assistant
coroner |
|
C |
district
coroner |
|
D |
deputy
coroner |
|
E |
lead
coroner |
|
F |
national
coroner |
Scenario
5.
Which, if any, of the following are functions of the Chief Coroner?
Option list.
|
A |
to
appoint coroners |
|
B |
to
approve coronial appointments |
|
C |
to
negotiate coroners’ salaries |
|
D |
to
negotiate coroners’ terms and conditions |
|
E |
to
oversee the disciplinary procedures for coroners |
|
F |
to
keep an eye on coronial investigations that have taken too long |
|
G |
to
organise advice from coroners about how deaths may be prevented |
Option list 2. Use for scenarios
6-8.
A. must have had experience as a
detective in the police force with the 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 holiday
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
Scenario
6.
What qualifications must the Coroner have?
Scenario
7.
What are the hours of availability of the Coroner?
Scenario
8.
What
are the roles of the Coroner’s Officers?
Scenario
9.
Who or what is responsible for appointing medical examiners?
Option list.
|
A |
Local authorities |
|
B |
the Chief Coroner |
|
C |
the Chief Medical Examiner |
|
D |
the local Senior Coroner |
|
E |
the Lord Chancellor |
|
F |
NHS Trusts |
|
G |
the Queen |
Scenario
10.
Which, if any, of the following are applicable to the role of
medical examiner?
Option list.
|
A |
to decide if a post-mortem is required |
|
B |
notification of deaths to the coroner |
|
C |
supervision of the quality of MCCDs |
|
D |
attendance at post-mortems |
|
E |
performance of post-mortems |
Scenario
11.
When was the 1st. Chief Medical Examiner for England &
Wales appointed?
Option list.
|
A |
2005 |
|
B |
2010 |
|
C |
2015 |
|
D |
2017 |
|
E |
2019 |
|
F |
the post does not exist |
|
G |
none of the above |
Scenario
12.
What was the specialty of the 1st. appointee to the
post of the lead medical examiner for England & Wales?
Option list.
|
A |
accident and emergency medicine |
|
B |
forensic medicine |
|
C |
forensic pathology |
|
D |
forensic psychiatry |
|
E |
obstetrics & gynaecology |
|
F |
pathology |
Scenario
13.
Which, if any, of the following are requirements for those wishing
to become a medical examiner?
Option list.
|
A |
full registration with the General Medical Council |
|
B |
consultant status |
|
C |
> 10 years’ experience as a fully-registered doctor |
|
D |
to have the Diploma of the Faculty of Medical Examiners |
|
E |
to have membership of the RCP |
|
F |
none of the above |
Option list 3. Use for the
remaining scenarios, unless they have an 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
14.
A
resident of Manchester dies suddenly while visiting the town of his birth in Scotland.
His family decides that he will be buried in the town of his birth. His body is
held at the premises of a local funeral director to arrange the funeral and
burial. What actions should be taken with regard to the Manchester coroner?
Scenario
15.
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 who will arrange the funeral and
burial. What actions should be taken with regard to the Manchester coroner?
Scenario
16.
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
17.
A man of 65 dies of terminal lung cancer. The GP who had visited
daily up to three weeks before the death has been on holiday for three weeks.
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
18.
A man of 65 dies of terminal lung cancer. The GP, who has visited
daily up to the day of his death and attended to confirm the death, is on holiday.
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
19.
A man of 65 dies of terminal lung cancer. The GP who has 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
20.
A 65-year-old man dies suddenly 12 hours after admission to the
local coronary care unit with chest pain, despite 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
21.
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
22.
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
23.
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. She is given 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
24.
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
25.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. 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
26.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. She says that he did not want
the pregnancy to continue.
Pick the best option from the option list.
Option list.
A. dial 999
B. get advice from the BMA
C. get advice from the Department
of Health
D. get advice from the legal
department
E. get advice from the police
F. none of the above.
Option list.
|
A |
provide
access to the records by the Coroner in person |
|
B |
provide unrestricted
access to the medical records by the coroner’s officers |
|
C |
provide a copy
of the hospital records to the coroner or her officers |
|
D |
provide a
medical report, but no access to the medical records |
|
E |
provide a
copy of the letter to the GP about the recent admission |
|
F |
none of the
above |
Scenario
28.
You have been swimming in the sea at Broad Beach,
Rhosneigr. As you walk back to the shore your foot
hits something in the sand. You explore and find a number of gold coins that
look ancient. What should you do?
Option list.
|
A |
put them back as they may have been an offering to the Gods |
|
B |
put them in a safe place with a view to having them valued and sold |
|
C |
take them to the local museum for identification and advice about
informing the coroner |
|
D |
take them to the nearest police station for advice |
|
E |
take them to your favourite pub and trade them for a meal and round
of drinks |
65. EMQ. Gordon,
Holmes & Semmelweis
Scenario
1. Which, if any, of the following statements are true in
relation to Semmelweis?
Option list.
|
A |
his full name was
Ignác Fülöp Semmelweis, but he was known to friends as "Naci". |
|
B |
he lived from
1818 to 1865 |
|
C |
he
revolutionised understanding of ‘childbed fever’ |
|
D |
he
revolutionised understanding of rheumatic fever |
|
E |
he
revolutionised understanding of tuberculosis |
|
F |
he pioneered
proton beam therapy |
|
G |
his
professional ‘Damascene moment’ came after the death of his colleague, Kolletschka,
at the hands of a medical student in 1847 |
|
H |
his work was
vilified by the majority of his professional contemporaries |
|
I |
he died in a
lunatic asylum |
|
J |
he died in a
road traffic accident |
|
K |
he died at
home in bed with his mistress |
Scenario
2. Which, if any, of the following statements are true in
relation to Gordon?
Option list.
|
A |
his full name was
Hamish Gordon, but he was known to friends as "Hamy". |
|
B |
he lived from
1801 to 1864 |
|
C |
he revolutionised
understanding of ‘childbed fever’ |
|
D |
he
revolutionised understanding of rheumatic fever |
|
E |
he
revolutionised understanding of tuberculosis |
|
F |
he pioneered
proton beam therapy |
|
G |
his
professional ‘Damascene moment’ came after epidemics of erysipelas and
puerperal fever in Aberdeen in the late 18th. century |
|
H |
his work was
vilified by the majority of his professional contemporaries |
|
I |
he died in a
lunatic asylum |
|
J |
he died in a road
traffic accident |
|
K |
he died at
home in bed with his mistress |
Scenario 3.
Which, if
any, of the following statements are true in relation to Wendell Holmes?
Option list.
|
A |
his full name was Wendell Holmes, but he was known to
friends as "Wellie". |
|
B |
he lived from 1801 to 1864 |
|
C |
he revolutionised understanding of ‘childbed fever’ |
|
D |
he revolutionised understanding of rheumatic fever |
|
E |
he revolutionised understanding of tuberculosis |
|
F |
he pioneered proton beam therapy |
|
G |
he was a fan of the work of Gordon. |
|
H |
his work on childbed fever was vilified by the majority
of his professional contemporaries |
|
I |
he died in a lunatic asylum |
|
J |
he died in a road traffic accident |
|
K |
he died at home in bed with his mistress |
66. Vulval
conditions.
Option list.
|
A. |
Acne. |
|
B. |
Behçet’s syndrome. |
|
C. |
Candidiasis. |
|
D. |
CIN 3 |
|
E. |
CIN1 |
|
F. |
Crohn’s disease. |
|
G. |
Dermatitis. |
|
H. |
Eczema. |
|
I. |
Genital warts. |
|
J. |
Hidradenitis suppurativa. |
|
K. |
Leprosy. |
|
L. |
Lichen planus |
|
M. |
Lichen sclerosis |
|
N. |
Lymphogranuloma venereum |
|
O. |
Normal skin. |
|
P. |
Psoriasis. |
|
Q. |
Seborrhoeic dermatitis. |
|
R. |
Type 1 diabetes mellitus |
|
S. |
Type 2 diabetes mellitus |
|
T. |
Ulcerative colitis. |
|
U. |
VIN III. |
Scenario 1. A 22 year-old
woman attends the colposcopy clinic after 2 smears showing
minor atypia.
The cervical appearances are of aceto-white with punctation.
Scenario 2. A 60-year old
woman has an erythematous rash of the vulva extending to the
inner thighs. A
similar rash is noted under the breasts. She is not known to have diabetes.
Scenario 3. A woman attends
the gynaecology clinic with a vulval rash. It has a “lacy”
appearance.
Scenario 4. A 35-year old
woman attends is noted to have a vulval fistula. She has a history
of episodic
diarrhoea.
Scenario 5. A 25-year old
woman attends the gynaecology clinic with a history of intense
vulval itching
and soreness. The appearances are of diffuse erythema with excoriation.
Diabetes, candidiasis
and other local infections have been eliminated by the GP.
Scenario 6. A 35-year old
woman attends the gynaecology clinic with vulvitis. She also has
a scalp rash.
Clinical examination shows scaly, pink patches with signs of excoriation. Skin
samples grow Malassezia ovalis.
Scenario 7. A 40-year old
woman has evidence of chronic vulval ulceration. She has
recently been
seen by a dermatologist for mouth ulceration and has been started on
thalidomide.
Scenario 8. An African
woman of 35 years attends the gynaecology clinic. She has a ten-
year history of
chronic vulval ulceration. Examination shows multiple, tender vulval and
pubic
subcutaneous nodules, some of which have ulcerated.
Scenario 9. A Caucasian
woman of 29 years attends the gynaecology clinic with a chronic
vulval rash.
Examination shows erythematous areas with clearly defined margins and white
scaly
patches.
Scenario 10. A 30-year old
woman attends the gynaecology clinic with vulval itching.
Examination
shows erythema of the labia minora and perineum. Full-thickness biopsy shows
abnormal cell
maturation throughout the epithelium with increased mitotic activity.
Scenario 11. Which condition
is described in GTG58 as presenting with polygonal lesions?
Scenario 12. Which condition
is described in GTG58 as presenting with “well-demarcated,
glazed erythema
around the introitus?
Scenario 13. What is the
aetiology of lichen planus? There is no
option list – just write your
answer.
67. Screening for
anxiety and depression in pregnancy.
Questions.
1. When does NICE advise checking for depression
in relation to pregnancy?
2. What is the title of the questions NICE advises
asking?
3. Where were these questions first validated?
4. What are the actual questions?
5. When does NICE advise checking for anxiety
in relation to pregnancy?
6. What is the title of the questions NICE advises
asking?
7. What are the actual questions?
Option list.
|
A. |
Acne. |
|
B. |
Behçet’s syndrome. |
|
C. |
Candidiasis. |
|
D. |
CIN 3 |
|
E. |
CIN1 |
|
F. |
Crohn’s disease. |
|
G. |
Dermatitis. |
|
H. |
Eczema. |
|
I. |
Genital warts. |
|
J. |
Hidradenitis suppurativa. |
|
K. |
Leprosy. |
|
L. |
Lichen planus |
|
M. |
Lichen sclerosis |
|
N. |
Lymphogranuloma venereum |
|
O. |
Normal skin. |
|
P. |
Psoriasis. |
|
Q. |
Seborrhoeic dermatitis. |
|
R. |
Type 1 diabetes mellitus |
|
S. |
Type 2 diabetes mellitus |
|
T. |
Ulcerative colitis. |
|
U. |
VIN III. |
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