|
56 |
EMQ. Jacob’s syndrome |
|
57 |
MCQ. Folic acid fortification of
flour |
|
58 |
EMQ. Mental Capacity Act |
|
59 |
EMQ. Medical Examiner |
|
60 |
EMQ. Coroner |
|
61 |
SBA. Quinolone antibiotics |
|
62 |
SBA. Fetal origins of adult disease |
56. EMQ. Jacob’s syndrome .
Abbreviations.
ADHD: Attention-Deficit, Hyperactivity Disorder
ASD: autistic spectrum disorder.
Question 1.
What is the
approximate incidence of Jacob’s syndrome in newborn females?
Option list. There is none – just give a figure.
Question 2.
What is the
approximate incidence of Jacob’s syndrome in newborn males?
Option list. There is none – just give a figure.
Question 3.
What type of
disorder is Jacob’s syndrome?
Option list.
|
A |
autosomal dominant |
|
B |
autosomal recessive |
|
C |
autosomal trisomy |
|
D |
sex chromosome trisomy |
|
E |
X-linked dominant |
|
F |
X-linked recessive |
|
G |
trinucleotide repeat |
Question
4. What proportion of cases of Jacob’s syndrome are believed
to go undiagnosed?
Question
5. Which, if any, of the following are true of the Jacob’s
phenotype?
Option list.
|
A |
ataxia |
|
B |
clinodactyly |
|
C |
hypertelorism |
|
D |
hypotonia |
|
E |
macrocephaly |
|
F |
microcephaly |
|
G |
macroorchidism |
|
H |
microorchidism |
|
I |
premature ovarian failure |
|
J |
short stature |
|
K |
tall stature |
|
L |
tremor |
Question
6. Which, if any, of the following are more common in Jacob’s
syndrome.
Option list.
|
A |
ADHD |
|
B |
ASD |
|
C |
aggressive behaviour |
|
D |
asthma |
|
E |
criminal behaviour |
|
F |
diabetes |
|
G |
epilepsy |
|
H |
hypogonadotrophic
hypogonadism |
|
I |
hypertension |
|
J |
infertility |
|
K |
low IQ |
|
L |
schizophrenia |
57. MCQ. Folic acid fortification of flour.
Abbreviations.
FFF: fortification of flour with
folic acid.
NTD: neural tube defect.
Scenario 1.
What is the incidence of NTD in the UK?
Scenario 2.
What is the risk of an affected sibling for the woman who becomes
pregnant after having a baby with NTD?
Scenario
3.
Which foods contain significant amounts of folic acid?
Scenario 4.
What percentage of folic acid is destroyed by cooking / food
storage?
Scenario 5.
How many people in the UK are estimated to have a folate-deficient
diet?
Scenario 6.
What is the significance of the MTHFR (Methylenetetrahydrofolate reductase gene)?
Scenario 7.
What is the significance of the Meckel-Gruber syndrome to this
issue?
Scenario 8.
By what gestation has the neural tube closed?
Scenario 9.
What proportion of pregnant women have taken folic acid
preconceptually?
Scenario 10.
What dose and duration of folic acid is advised for routine
periconceptual use?
Scenario 11.
List the women to whom a higher dose should be offered.
Scenario 12.
How effective is periconceptual folic acid consumption in reducing
NTD risk in the low-risk population?
Scenario 13.
How effective is periconceptual folic acid consumption in reducing
NTD risk in women who have had an affected baby?
Scenario 14.
What is the risk of NTD recurrence for a woman who has had two
affected babies?
Scenario 15.
What is the risk of NTD in Ireland?
Scenario 16.
What is the significance of the name
“Bukowski” in relation to folic acid?
Scenario 17.
What effect does periconceptual folic acid have on the risk of
stillbirth?
Scenario 18.
What effect does periconceptual folic acid have on the risk of
autistic spectrum disorder?
Scenario 19.
What effect does periconceptual folic acid have on maternal haemoglobin
levels?
Scenario 20.
What recommendations have been made by the RCOG to improve folic
acid levels in pregnancy?
Scenario 21.
Which names are of importance in the history of folic acid and
NTD?
Scenario 22.
What neurological condition has been thought potentially
problematic with folic acid supplementation?
58. EMQ. Mental Capacity Act.
Abbreviations.
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.
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
59. 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
King’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 |
60. EMQ. 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 |
61. SBA. Quinolone antibiotics.
Abbreviations.
FQ: fluoroquinolone.
SLE: systemic lupus erythematosus.
QUI: quinolone.
Question 1. Which, if any, of the following drugs are QUIs or
FQs?
Drugs
|
A |
cimetidine |
|
B |
ciprofloxacin |
|
C |
nalidixic acid |
|
D |
neomycin |
|
E |
nitrofurantoin |
Option
List
|
1 |
A + B |
|
2 |
A + B + C |
|
3 |
B + C |
|
4 |
B + C + D + E |
|
5 |
A + B + C + D + E |
Question 2. Which, if any, of the following statements are true in
relation to QUIs & FQs? This is
not a true SBA as there may be
more than one answer.
Statements
|
A |
nalidixic acid is an older
quinolone and is mainly excreted in the urine |
|
B |
ciprofloxacin is effective against most Gram +ve and –ve
bacteria and 1st- line treatment for pneumococcal pneumonia. |
|
C |
ciprofloxacin is contraindicated in pregnancy due to the ↑ risk
of neonatal haemolysis |
|
D |
many staphylococci are resistant to quinolones |
|
E |
quinolones are particularly useful in the treatment of MRSA |
Question 3. Which was the first QUI antibiotic?
Option
List
|
A |
acetylsalicylic acid |
|
B |
nalidixic acid |
|
C |
oxalic acid |
|
D |
pipemidic acid |
|
E |
none of the above |
Question 4. How do QUI and FQ antibiotics work? There is only one
correct answer.
Option
List
|
A |
impair bacterial DNA coiling |
|
B |
impair bacterial DNA binding |
|
C |
impair bacterial RNA action |
|
D |
impair bacterial mitochondrial
action |
|
E |
none of the above. |
Question 5. Which, if any, of the following QUIs & FQs is not available
for prescription in the UK.
There is only one correct answer.
Option
List
|
A |
ciprofloxacin |
|
B |
levofloxacin |
|
C |
nalidixic acid |
|
D |
moxifloxacin |
|
E |
ofloxacin |
Question 6. Which, if any, of the following statements are true in
relation to the quinolones and
fluoroquinolones and pregnancy?
This is not a true SBA as there may be more than one answer.
Option
list.
|
A |
FQs are newer than QUIs with
better systemic spread and efficacy |
|
B |
QUIs concentrate in urine but have a special affinity for
cartilage |
|
C |
consumption of a FQ in the 1st. trimester is grounds
for TOP |
|
D |
if an FQ is used, norfloxacin and ciprofloxacin should be
considered 1st. |
|
E |
FQs are linked to a risk of discolouration of the teeth of
offspring |
Question 7. Which of the following is true about the warning issued
by the FDA in 2008 in relation
to QUIs & FQs?
Option
List
|
A |
they may cause congenital
cartilage defects |
|
B |
they may cause congenital
deafness |
|
C |
they may cause tendonitis and
tendon rupture |
|
D |
they may cause prolongation of
the Q-T interval |
|
E |
none of the above |
Question 8. Which of the following is true about the warning issued
by the FDA in 2011 in relation
to QUIs & FQs?
Option
List
|
A |
they may cause exacerbation of
eczema |
|
B |
they may cause exacerbation of
hypertension |
|
C |
they may cause exacerbation of
multiple sclerosis |
|
D |
they may cause exacerbation of
myasthenia gravis |
|
E |
they may cause exacerbation of
SLE |
Question 9. Which of the following is true about the warning
emphasised by the FDA in 2013 in
relation to QUIs & FQs?
Option
List
|
A |
they may cause aortic
dissection |
|
B |
they may cause mitral stenosis |
|
C |
they may cause pancreatitis |
|
D |
they may cause peripheral
neuropathy |
|
E |
they may cause flare of SLE |
Question 10. FDA issued a warning in July 2016. Which, if any, of the
following were included? This
is not a true SBA as there may be
more than one answer.
Option
List
|
A |
the risks generally outweigh
the benefits |
|
B |
QUIs & FQs should not be
used for acute sinusitis, |
|
C |
QUIs & FQs should not be
used for exacerbation of chronic
bronchitis |
|
D |
QUIs & FQs should not be
used for uncomplicated UTI |
|
E |
QUIs & FQs may be useful
for anthrax and plague |
Question 11. FDA issued a warning in July 2018 about the use of FQs in
pregnancy. Which, if any, of
the following were included in
the reasons for its publication?
Option
List
|
A |
to strengthen previous warnings
about hyperglycaemia and mental health risks |
|
B |
to strengthen previous warnings
about hypoglycaemia and mental health risks |
|
C |
to strengthen previous warnings
about the risk of ASD in the offspring |
|
D |
to strengthen previous warnings
about the risk of acute pancreatitis |
|
E |
to strengthen previous warnings
about the risk of PET |
Question 12. The FDA issued a warning in December 2018 about the use
of FQs in pregnancy.
Which, if any, of the following
was included? This is an SBA with only one correct answer.
Option
List
|
A |
↑ risk of atrial fibrillation |
|
B |
↑ risk of aortic aneurysm and
rupture |
|
C |
↑ risk of mitral stenosis |
|
D |
↑ risk of pulmonary
hypertension |
|
E |
↑ risk of ulcerative colitis |
62. Fetal origins of adult disease.
Abbreviations.
ADHD: attention-deficit,
hyperactivity disorder
Scenario 1. What eponymous title is given to
the concept that adverse intra-uterine conditions
predispose to the development of disease in adulthood?
Option List
|
A |
the Barker hypothesis |
|
B |
the Baker’s dozen |
|
C |
the Broadbank theory |
|
D |
PIPAD: Placental Insufficiency Programmes Adult Disease |
|
E |
SIMCARD: Stop In-utero Malnutrition to Conquer Adult-resulting
Disease |
Scenario 2. Which other term is used for the
concept that adverse intra-uterine conditions
predispose to the
development of disease in adulthood?
Option List
|
A |
FDAD: fetal determination of adult disease |
|
B |
FIAD: fetal influences
on adult disease |
|
C |
FIDAD: fetal and infancy determinants of adult disease |
|
D |
FIGO: fetal influences
on genomic outcomes |
|
E |
FP: fetal
programming |
Scenario 3. Which of the following is thought
to increase the risk of adult disease?
Option
List
|
A |
low birthweight (LBW) |
|
B |
LBW
followed by poor weight gain in infancy and childhood |
|
C |
LBW followed by poor weight gain in infancy but above-average
weight gain in childhood |
|
D |
above-average birthweight (AABW) |
|
E |
AABW followed by poor weight gain in infancy but above-average
weight gain in childhood |
|
F |
AABW followed by above-average weight gain in infancy and
childhood |
Scenario 4. Which adult diseases are
generally believed to be more likely in relation to adverse
influences on the fetus, infant and child.
Diseases.
|
A |
asthma |
|
B |
chronic bronchitis |
|
C |
coronary heart disease |
|
D |
diabetes type I |
|
E |
diabetes type 2 |
|
F |
hypertension |
|
G |
Mendelson’s syndrome |
|
H |
Stroke |
Scenario 5. What adult condition has been
linked to raised maternal c-reactive protein levels?
Option List
|
A |
asthma |
|
B |
ADHD |
|
C |
autism |
|
D |
inflammatory bowel disease |
|
E |
schizophrenia |
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