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Contact us.
https://soundcloud.com/drtmcf/9-december-2013
Tonight we wrote 4 essay plans and anwered an EMQ.
6
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EMQ 6. Confidentiality & Consent.
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19
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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.
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20
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In relation to diagnostic laparoscopy,
critically evaluate
1. the
issues to be discussed in obtaining informed consent. 4 marks.
2. the
factors that increase the incidence of entry-related injury. 4
marks.
3. how
entry-related injuries may be minimised 12 marks
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21
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Critically evaluate the statement: “fortification of flour is overdue
in the UK”.
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22
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With regard to Systemic Lupus
Erythematosis (SLE):
1. outline the clinical manifestations of
SLE. 4 marks.
2. outline the implications of SLE for
pregnancy . 4 marks.
3. critically evaluate how the diagnosis is
made. 4 marks.
4. critically evaluate the management in the woman
wishing to be pregnant. 8 marks.
4a.critically
evaluate the management of a woman booking at 8 weeks. 8 marks.
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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?
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