Tutorial 17 June 2013

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Confidentiality.

Lead-in.

The following scenarios relate to confidentiality.

For each, select the number that best fits the scenario.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Option list.

This EMQ has not option list. This is to make you decide your answers. Send them to me and I’ll send my version including what I think an option list might have looked like.

Scenario 1.

A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed. Her mother attends clinic 1 hour after the child has left. She demands full information about her daughter. The consultant has delegated you to deal with her. Which option best fits the action you will take?

Scenario 2.

A 17-year-old A-level student attends the gynaecology clinic requesting TOP. She is accompanied by her 30-year-old mathematics teacher, who is her lover and wishes to give consent. Which option best fits the action you will take?

Scenario 3.

A 12-year-old girl attends the gynaecology clinic with her mother seeking contraceptive advice. She has an 18-year-old boyfriend whom the parents like and she wishes to start having sex. Which option best fits the action you will take?

Scenario 4.

A 15-year-old girl who is Fraser competent is referred to the gynaecology clinic with a complaint of vaginal discharge. She reveals that she has been having consensual sexual intercourse for six months with her 18-year-old boyfriend. She asks for advice about suitable contraception as she is happy in the relationship and wants to continue to have sex. Which option best fits the action you will take?

Scenario 5.

You are the new oncology consultant and have just operated on the wife of a local General Practitioner for suspected ovarian cancer. The diagnosis is confirmed and you proceed with appropriate surgery. On completion of the operation you go to the surgeon’s room for a coffee. The senior consultant anaesthetist who was not involved in theatre but is the Medical Director and tells you he is a close friend of the woman, asks what the diagnosis and prognosis are. Which option best fits the action you will take?

Scenario 6.

You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. She has given a history of 2 terminations but no other pregnancies. She is Rhesus negative, but has Rhesus antibodies. Which option best fits the action you will take?

Scenario 7

You are phoned by a doctor looking for information about his wife’s results from the booking clinic she attended two weeks ago. He says that she has given consent for disclosure. Her serology tests have proved +ve for syphilis. You have spoken to the consultant bacteriologist who says that they have run confirmatory tests and they are +ve too. He is sure the woman has active syphilis. Which option best fits the action(s) you will take?

Scenario 8

A 15-year-old girl attends the TOP clinic requesting TOP. She is assessed as Fraser competent. After full discussion arrangements are made for her admission for TOP. She does not wish her parents to be informed despite your best efforts to persuade her. Who will give consent for the procedure?

Scenario 9

An immature 15-year-old girl attends the gynaecology clinic requesting TOP. She is accompanied by her 25-year-old sister who is a lawyer with whom she has been staying since she knew she was pregnant. She does not want her parents to be informed. The girl is assessed as not Fraser competent. The sister says that she is happy to act in loco parentis and to give consent. Which option best fits the action(s) you will take?

Scenario 10

A 25-year-old woman with Down’s syndrome attends the clinic accompanied by her mother. She has menorrhagia and copes badly with the hygiene aspects. The menorrhagia is bad enough for her now to be on treatment for iron-deficiency anaemia. She has tried all the standard medical methods. To complicate the problem, she has become close friends with a young man she has met at College, to which she travels independently each weekday. Her mother fears that she may already be involved in sexual activity and cannot get an accurate answer from her about it. The mother is keen for her to have hysterectomy to deal with both problems. If you agree that the surgery is appropriate, who can give consent?

Scenario 11

A 25-year-old woman with Down’s syndrome is admitted from College after collapsing. The clinical features are of ectopic pregnancy and she states that she has UPSI with her boyfriend of six months. She has tachycardia and hypotension and it is felt that she should have urgent surgery. You reckon that she is not competent to consent for surgery. Who can give consent?

Scenario 12

A 25-year-old woman with Down’s syndrome is admitted from College after collapsing. The clinical features are of ectopic pregnancy and she states that she has UPSI with her boyfriend of six months. She has tachycardia and hypotension and it is felt that she should have urgent surgery. You reckon that she is not competent to consent for surgery. What limits are there on the surgery?

Essays 17 June 2013

14	Critically evaluate risk management in relation to shoulder dystocia.
15	With regard to ovarian hyperstimulation syndrome: a. Outline the risk factors. 4 marks b. Discuss the classification system. 6 marks c. Outline the key aspects of the management. 10 marks
16	With regard to precocious puberty. 1.      What is the definition?                                      4 marks. 2.      Critically evaluate the main causes in a girl. 6 marks. 3.      Outline the investigation of a girl with PP.   4 marks. 4.      Outline the main issues in the management of a girl with PP.                                                                                      6 marks.
17	A 28-year-old woman is referred to the gynaecology clinic with suspected premature ovarian failure. She has “hot flushes”, has not menstruated for 8 months and a FSH level was found to be 40 iu/l. 1. Outline the main causes of premature ovarian failure.   10 marks 2. Critically evaluate the management options.                    10 marks

Tutorial 6 June 2013

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We started with an EMQ.
Then we had four SAQs.

The Coroner. Question 1.

Lead-in.

The following scenarios relate to the role of the Coroner.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Suggested reading.

I will put all you need to know into the answer to MCQ Paper 13, question 5.

Option list.

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

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?

The Coroner. Question 2.

Lead-in.

The following scenarios relate to the role of the Coroner.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Option list.

A.        must have had experience as a detective in the police force with  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 holidays

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

M.      to play bagpipes at coronial funerals

Scenario 1.

What qualifications must the Coroner have?

Scenario 2.

What are the hours of availability of the Coroner?

Scenario 3.

What is the role of the Coroner’s Officers?

The Coroner. Question 3.

Lead-in.

The following scenarios relate to the role of the Coroner.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

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 1.

A resident of Manchester dies suddenly while visiting the town of his birth in Scotland. His family decides that he will be buried there. His body is held at the premises of a local funeral director. What actions should be taken with regard to the Manchester coroner?

Scenario 2.

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. What actions should be taken with regard to the Manchester coroner?

Scenario 3.

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 4.

A man of 65 dies of terminal lung cancer. The GP visited daily until going on holiday three weeks before the death. 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 5.

A man of 65 dies of terminal lung cancer. The GP, who visited daily up to the day of his death and attended to confirm the death, is on holiday. 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 6.

A man of 65 dies of terminal lung cancer. The GP, who 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 7.

A 65-year-old man dies suddenly 12 hours after admission to the local coronary care unit with chest pain, despite the 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 8.

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 9.

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 10.

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 some hours later in a shocked condition. She is given the 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 11.

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 12.

A woman is admitted at 26 weeks’ gestation in premature labour. 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?

10	A 35-year-old woman plans to go to a malarial area of Africa to join her husband who works there. She is 6 weeks pregnant. Critically evaluate the advice you will give her.	6	June	2013
11	A 30-year-old woman presents for booking at 8 weeks. Her father has recently been diagnosed with TB. She wishes to know what the risks are to her and the pregnancy of possible TB. 1. Critically evaluate the investigation.       4 marks 2. Outline the management in pregnancy.  2 marks 3. Critically evaluate the issues relating to the puerperium.  14 marks	6	June	2013
12	Critically evaluate vitamin supplementation in pregnancy.	6	June	2013
13	With regard to the Clinical Negligence Scheme for Trusts. a. What it the CNST?            8 marks b. Describe the impact of the CNST on obstetric practice. 12 marks	6	June	2013