|
24 |
Role-play. Anencephaly |
|
25 |
Blurb. The GP referral letter |
|
26 |
Blurb. Agenda setting in Part 3 station |
|
27 |
EMQ Surrogacy |
|
28 |
SBA. McCune Albright syndrome |
Candidate’s instructions.
You are an SpR5 and running the ante-natal clinic – your
consultant has been called to help a consultant colleague with an emergency on
the labour unit and is not available for advice.
You are about to see Jean Hathersage. She is 25 years old
and had a 10-week scan last week that showed anencephaly. She stated that she
did not want TOP. She was counselled, given information leaflets and asked to
return to the antenatal clinical today for further discussion.
Your task is to conduct that discussion.
25. Blurb. The GP referral letter.
We will
discuss the possible content of a ‘blurb’.
26. Blurb. Agenda setting in Part 3 station.
As for 25.
27. Surrogacy.
Surrogacy.
Pick the best choice from the option list for each scenario.
Abbreviations.
ART: assisted
reproductive technology
Bhatia: Bhatia K, Martindale E, Rustamov O &
Nysenbaum A: “Surrogate pregnancy: an essential
guide for clinicians”. TOG. 2009;11:49-54.
B&O: Burrell & O’Connor. TOG 2013.
“Surrogate pregnancy: ethical and medico-legal issues in modern obstetrics.” TOG. 2013;15:113-19.
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
Option List.
a)
CM
b)
CF
c)
CPs
d)
SM
e)
Chairman of the HFEA
f)
Senior judge at the Children and Family Court
g)
traditional surrogacy
h)
gestational surrogacy
i)
HFEA
j)
SSAEW
k)
RCOG Surrogacy Sub-Committee
l)
false
m)
true
n)
none of the above
Scenario 1. List the
different types of surrogacy.
Scenario 2. “Gestational” surrogacy has better
“take-home-baby” rates than “traditional” surrogacy.
Scenario 3. There are approximately 1,000 surrogate
pregnancies per annum in the UK. True/False
Scenario 4. Which national body regulates surrogacy in
England?
Scenario 5. Privately-arranged
surrogate pregnancies are illegal and those involved are liable to up to 2 years
in prison. True/False
Scenario 6. List the risks of surrogacy.
Scenario 7. Obstetricians
are legally obliged to take the CPs’ wishes into consideration in managing
pregnancy complications or problems.
Scenario 8. The psychological outcomes of surrogacy are
fully understood. True/False.
Scenario 9. The psychological outcomes of surrogacy are
more severe after traditional surrogacy.
True/False
Scenario 10. Who has the
right to arrange TOP if the fetus is found to have a major congenital
abnormality?
Scenario 11. A SM decides
at 10 weeks that she does not wish to be pregnant and arranges to have a TOP.
The CPs. hear about this and object strongly. To whom should they apply to have
the TOP blocked?
Scenario 12. A woman has
hysterectomy and BSO to deal with extensive endometriosis at the age of 30. She
marries two years later and her sister offers to act as surrogate. She
undergoes IVF and 4 embryos are created. One is transferred and a successful
pregnancy ensues. The baby is adopted by the woman and her husband. The 3
remaining embryos were frozen. Four years later the woman falls out with her
sister, but finds another surrogate and wishes to proceed with another
pregnancy. The sister says she does not want her eggs to be used and that the
frozen embryos should not be transferred. Does the sister have the legal right
to block the use of the embryos? Yes / No.
Scenario 13. A girl born
from donor sperm reaches the age of 16 and wishes to know the identity of her
genetic father. Does she have the right to this information? Yes / No.
Scenario 14. A girl born
from donor sperm reaches the age of 18 and wins a place at Oxford University to
read medicine. Does she have the legal right to get the donor to contribute to
her fees?
Yes / No.
Scenario 15. A PO is
active from the moment it is completed and signed by the relevant parties.
True/False
Scenario 16. A SM can
change her mind at any time and keep the child, even if the egg was not hers.
True/False
Scenario 17. The CPs can change their mind, leaving the SM
as the legal mother. True/False
Scenario 18. A SM’s husband is the legal father until
adoption is completed or a PO comes into force.
True/False
Scenario 19. A lesbian
couple in a stable, co-habiting relationship can be CPs and become the legal
parents of the child of a SM. True/False
Scenario 20. CPs are
likely to get faster legal status as the legal parents through application for
a PO rather than applying for adoption. True/False
TOG questions. See B&O in Abbreviations.
With regard to different types of surrogacy,
1. the practice of ‘straight surrogacy’
produces a child who has no genetic link to the surrogate mother. True/False
When medical interventions in pregnancy (such as
amniocentesis) are recommended,
2. a doctor should obtain consent from both the
commissioning parents and the surrogate if the baby is the genetic child of the
commissioning mother. True/False
3. In 2013, professional medical bodies are
totally opposed to surrogacy arrangements in the UK. True/False
After delivery,
4. the community healthcare visitor should only
visit a baby if it resides with the surrogate mother. True/False
If the surrogate mother has a miscarriage,
5. the doctor may be asked to provide
evidence to support this. True/False
Commissioning parents,
6. previously knew the surrogate mother in
about 10% of cases. True/False
7. are free to consent to medical treatment for
the baby while waiting for parental responsibility to be granted, provided that
the child resides with them. True/False
With regard to the surrogacy contract,
8. it is legally enforceable and therefore the
involvement of the Trust’s legal team is unnecessary. True/False
With regard to current legislation surrounding the
practice of surrogacy in the UK,
9. the introduction of The Human Fertilisation
and Embryology Act 1990 makes it likely that there will be more cases of
surrogacy in the future. True/False
10. if the surrogate or a foreign commissioning
parent domiciles in the UK, then UK laws apply regardless of where conception occurred.
True/False
11. organisations and agencies involved are
legally allowed to operate in the UK, and can charge membership fees provided
that they operate on a non-profit basis. True/False
12. if a surrogate mother feels emotional and unsure
about handing over the baby to the intended parents after birth, since she has
already accepted payment from the intended parents she is bound by the terms of
her contract and must continue with the arrangement. True/False
13. advertising the availability of surrogate
service is illegal in the UK. True/False
Regarding parental responsibility,
14. the court will grant a parental order if the
commissioning couple are either married or cohabitees and both are >16 years
old. True/False
15. a parental order can only be granted to a
same-sex couple if they have been together for at least 10 years. True/False
16. the commissioning couple should apply for
parental responsibility within 6 months after the birth of the child. True/False
With regard to the surrogate mother,
17. if she changes her mind about handing over the
baby after birth, it is possible that she may be able to retain legal custody
of the child if she has a genetic link to the child. True/False
18. if her husband was unaware that his wife underwent
artificial insemination and became pregnant as a surrogate, he is still the
legal father of the child. True/False
If a woman has donated an egg,
19. she is legally considered to be the mother of the
child. True/False
The commissioning mother,
20. will be entitled to normal maternity rights
with her employer if she has a genetic link to the child. True/False
28. SBA. McCune Albright syndrome.
Abbreviations.
CPP: central precocious
puberty.
MCA: McCune Albright syndrome.
PFD: polyostotic fibrous dysplasia.
PP: precocious puberty.
These
are not true SBAs as there may be > 1 correct answer – laziness on my part
as it saves typing!
Scenario
1. Which, if any, of the following are
components of the classical triad of MCA?
Option List
|
A |
albinism |
|
B |
“cafè Cubano” spots |
|
C |
“Coast of California” pigmented areas |
|
D |
lentigo |
|
E |
macroorchidism |
|
F |
osteomalacia |
|
G |
polyostotic fibrous dysplasia |
|
H |
precocious puberty |
|
I |
premature menopause |
|
J |
primary amenorrhoea |
Scenario
2. Which, if any, of the following are
true in relation to MCA?
Option List
|
A |
it is an example of central primary amenorrhoea |
|
B |
it is an example of central secondary amenorrhoea |
|
C |
it is an example of central precocious puberty |
|
D |
it is an example of peripheral primary amenorrhoea |
|
E |
it is an example of peripheral secondary amenorrhoea |
|
F |
it is an example of peripheral precocious puberty |
|
G |
none of the above |
Scenario
3. Which, if any, of the following are
believed to be true in relation to the abnormality of
onset of
puberty associated with MCA?
Option List
|
A |
it is due to abnormal FSH production |
|
B |
it is due to abnormal LH production |
|
C |
it may be due to abnormal androgen production |
|
D |
it may be due to abnormal oestrogen production |
|
E |
it is linked to ovarian cysts with ↑ malignant potential |
|
F |
none of the above |
Scenario
4. Which, if any, of the following are
true in relation to polyostotic fibrous
dysplasia?
Option List
|
A |
polyostotic means resembling parrot bone |
|
B |
polyostotic means resembling pigeon bone |
|
C |
polyostotic means affecting long bones |
|
D |
fibrous dysplasia refers to replacement of marrow by
fibrous tissue |
|
E |
PFD is a variant of osteomalacia |
|
F |
PFD may be unilateral |
|
G |
PFD is associated with a 1% risk of malignancy |
Scenario
5. Which, if any, of the following are
true in relation to MCA?
Option List
|
A |
hyperthyroidism is common |
|
B |
hypothyroidism is common |
|
C |
thyroid function is similar to those without MCA |
Scenario
6. Which, if any, of the following are
true in relation to MCA?
Option List
|
A |
excess growth hormone production is common |
|
B |
inadequate growth hormone production is common |
|
C |
growth hormone production is similar to those without
MCA |
Scenario
7. Which, if any, of the following is
true in relation to MCA?
Option List
|
A |
inheritance is autosomal dominant |
|
B |
inheritance is autosomal recessive |
|
C |
inheritance is X-linked dominant |
|
D |
inheritance is X-linked recessive |
|
E |
inheritance is multifactorial |
|
F |
it is not a hereditary disorder |
|
G |
it is not genetic |
|
H |
none of the above |
Scenario
8. Which, if any, of the following are
true in relation to MCA?
Option List
|
A |
renal artery stenosis is more common |
|
B |
renal cortex wasting is more common |
|
C |
renal phosphate wasting is more common |
|
D |
renal waisting is more common |
|
E |
none of the above. |
Scenario
9. Approximately what % of children born
to women with MCAS will have MCAS?
Option List
|
A |
0 |
|
B |
1 in 105 - 106 |
|
C |
1 in 104 |
|
D |
1 in 100 |
|
E |
1 in 50 |
|
F |
1 in 10 |
|
G |
1 in 2 |
|
H |
All |
TOG includes MCAS in CPD
Questions for volume 14, number 2, 2012, which are open access, so reproduced
here. There are only two questions on MCAS. Note that the second includes CPP.
McCune–Albright syndrome
1. is caused by activating mutations of the GNAS1 gene. True / False
2. is characterised by polyostotic fibrous dysplasia, café-au-lait
spots and CPP. True / False
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