17th. December 2015.
27
|
EMQ. Mental Capacity
Act.
|
28
|
MgSO4 :
what points might feature in the exam?
|
29
|
SBA. Progestogen-only
implants
|
30
|
EMQ. COC: starting and
missed pills.
|
31
|
Communication skills.
|
27. EMQ. Mental
Capacity Act.
Lead-in.
The following scenarios relate to the Mental Capacity Act
2005.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
CAD: Court-appointed
Deputy.
COP: Court of Protection.
FGR: fetal
growth restriction.
LPA: Lasting
Power of Attorney.
MCA: Mental
Capacity Act 2005.
PoA: Power of
Attorney.
Option list.
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 Powers of
Attorney
|
P.
|
The sheriff or sheriff’s
deputy
|
Q.
|
Balance of probabilities
|
R.
|
Beyond reasonable doubt
|
S.
|
None of the above.
|
T.
|
Scenario 1.
|
U.
|
A person with LPA is normally
not a family member.
|
V.
|
Scenario 2.
|
W.
|
A Sheriff’s Deputy is
normally not a family member.
|
X.
|
Scenario 3.
|
Y.
|
A person with PoA can consent
to treatment for the patient who lacks capacity.
|
Z.
|
Scenario 4.
|
AA.
|
A Court-appointed Deputy can consent to treatment for
the patient who lacks capacity, but must go back to the Court of Protection
if further consent is required for additional treatment.
|
Lead-in.
The following scenarios relate to the Mental Capacity Act
2005.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
CAD: Court-appointed Deputy.
COP: Court of Protection.
FGR: fetal growth restriction.
LPA: Lasting Power of Attorney.
MCA: Mental
Capacity Act 2005.
PoA: Power of Attorney.
Option list.
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 Powers
of Attorney
P.
The sheriff or
sheriff’s deputy
Q.
Balance of
probabilities
R.
Beyond reasonable
doubt
S.
None of the above.
Scenario 1.
A person with LPA is normally
not a family member.
Scenario 2.
A Sheriff’s Deputy is normally
not a family member.
Scenario 3.
A person with PoA can consent
to treatment for the patient who lacks capacity.
Scenario 4.
A Court-appointed Deputy can consent to treatment for the
patient who lacks capacity, but must go back to the Court of Protection if
further consent is required for additional treatment.
Scenario 5.
A person with PoA can authorise
withdrawal of all care except basic care in cases of individuals with
persistent vegetative states.
Scenario 6.
An advance decision can
authorise withdrawal of all but basic care in cases of persistent vegetative
states.
Scenario 7
A person with PoA cannot
overrule an advance direction about withdrawal or withholding of
life-sustaining care.
Scenario 8
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?
Scenario 9
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?
Scenario 10
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?
28. EMQ. MgSO4
use in O&G.
Write down
all the things about the use of MgSO4 in O&G that you
think might come in the exam. Think EMQ, SBA and viva.
29. EMQ. Progestogen-only
implants.
Progestogen-only Implants.
Abbreviations.
ENG: etonorgestrel
LNG: levonorgestrel
Question 1.
Lead-in
Pick the
best option from the list below in relation to the hormone in Nexplanon.
Option List
A.
|
68 mg.
ENG
|
B.
|
100 mg. ENG
|
C.
|
100 mg. LNG
|
D.
|
150 mg. LNG
|
E.
|
50 mg. ENG + 100 mg. LVG
|
Question 2.
Lead-in
How does Nexplanon act as a contraceptive?
I.
mainly by inducing anovulation
II.
mainly by altering cervical mucus to the
detriment of sperm transport
III.
mainly by thinning the endometrium, preventing
implantation
IV.
mainly by inducing loss of libido
Choose the best option from the list below.
Option List
A.
|
I
|
B.
|
I + II
|
C.
|
I + III
|
D.
|
II + III
|
E.
|
III + IV
|
Question 3.
Lead-in
What is
the age range, if any, for which Nexplanon is licensed in the UK?
Option List
A.
|
15 – 50
years
|
B.
|
18 – 40 years
|
C.
|
18 – 45 years
|
D.
|
20 – 50 years
|
E.
|
None of the above.
|
Question 4.
Lead-in
A woman who is not in the licensed age range requests a
Nexplanon. How should the advising doctor proceed?
Option List
A.
|
Advise
her about alternative licensed contraceptive methods, but decline to insert
Nexplanon
|
B.
|
Advise her about alternative licensed contraceptive
methods and insert Nexplanon
|
C.
|
Fit her with a LNGIUS
|
D.
|
Refer her to a colleague who fits anyone who asks with
a Nexplanon
|
E.
|
None of the above
|
Question 5.
Lead-in
Which, if
any, of the following statements about the pregnancy rate for women using
Nexplanon are true?
Option List
A.
|
The
pregnancy rate is < 1 per 1,000 women during 3 years of use
|
B.
|
The
pregnancy rate is < 5 per 1,000 women during 3 years of use
|
C.
|
The
pregnancy rate is < 10 per 1,000
women during 3 years of use
|
D.
|
The pregnancy rate is 10-20 per 1,000 women during 3
years of use
|
E.
|
None of the above
|
Question 6.
Lead-in
Which, if
any, other implants are licensed in the UK?
Option List
A.
|
Implanon
|
B.
|
Norplant
|
C.
|
Norplant-2
|
D.
|
Jadelle
|
E.
|
None of the above
|
Question 7.
Lead-in
What are
the main differences between Nexplanon and Implanon?
Pick the most suitable answer from the list below.
Option List
A.
|
The
dosage was increased from 60 to 68 mg. etonorgestrel
|
B.
|
The dosage was increased from 150 – 175 mg. levonorgestrel
|
C.
|
Barium sulphate was added to Nexplanon to make it
radio-opaque
|
D.
|
The number of rods was reduced to 2
|
E.
|
None of the above
|
Question 8.
Lead-in
What
problems is the new applicator designed to minimise?
I.
non-insertion
II.
deep insertion
III.
difficulty with one-handed insertion
IV.
difficulty with left-handed insertion
V.
difficulty with insertion in very thin women.
Option List
A.
|
I + II +
III + IV
|
B.
|
I + II +
III + IV + V
|
C.
|
II + III
|
D.
|
II + III
+ IV
|
E.
|
II + III
+ IV + V
|
Question 9.
Lead-in
How long
is Nexplanon licensed for?
Option List
A.
|
1 year
|
B.
|
2 years
|
C.
|
3 years
|
D.
|
5 years
|
E.
|
10 years
|
Question 10.
Lead-in
What does
NICE recommend that patients be told about bleeding patterns with Nexplanon?
I.
menstrual bleeding may cease
II.
menstrual bleeding may become prolonged
III.
bleeding may become more frequent
IV.
menstrual bleeding may become less frequent
V.
intermenstrual bleeding can be a problem in the
first 6 months
Option List
A.
|
I + II +
III
|
B.
|
I + II + III + IV
|
C.
|
II + III + IV + V
|
D.
|
I + III + IV
|
E.
|
I + III + IV + V
|
Question 11.
Lead-in
What information should women be given about the effect
of Nexplanon on pain?
Option List
A.
|
Dysmenorrhoea
may increase
|
B.
|
Dysmenorrhoea may decrease
|
C.
|
Mittelschmerz
is likely to cease
|
D.
|
Pain due to endometriosis is likely to decrease
|
E.
|
Dyspareunia is likely to be alleviated
|
Question 12.
Lead-in
A 25-year old nulliparous woman has been found to have a
few spots of endometriosis in the pouch of Douglas at laparoscopy for pelvic
pain. She wishes to avoid pregnancy for 5 years but then wishes to have two
children. She has read an article suggesting that a progesterone-only implant
provides high levels of contraceptive efficacy and good results in suppressing
endometriosis. What advice will you give?
Option List
A.
|
Recommend
a low-dose COC and tricycling as the best means of suppressing endometriosis plus
providing effective contraception
|
B.
|
Recommend
a low-dose COC taken continuously as the best means of suppressing
endometriosis plus providing effective contraception
|
C.
|
Recommend Nexplanon as the best means of suppressing
endometriosis plus providing effective contraception
|
D.
|
Recommend Depot-Provera as the best means of suppressing
endometriosis plus providing effective contraception
|
E.
|
None of the above
|
Question 13.
Lead-in
When can a Nexplanon be inserted with no need for
additional contraception in a woman with
regular menstrual cycles and no contraindication to its use?
Option List
A.
|
Up to
and including day 3 of menstruation
|
B.
|
Up to and including day 5 of menstruation
|
C.
|
Up to and including day 7 of menstruation
|
D.
|
Never
|
E.
|
None of the above
|
Question 14.
Lead-in
A healthy 25 year-old-woman is recovering well from a
normal delivery. She is not breastfeeding and wishes to start Nexplanon.
Option List
Pick the
best statement from the list below.
A.
|
No
additional contraception is needed if Nexplanon is inserted by day 7
|
B.
|
No additional contraception is needed if Nexplanon is
inserted by day 14
|
C.
|
No additional contraception is needed if Nexplanon is
inserted by day 21
|
D.
|
No additional contraception is needed if Nexplanon is
inserted by day 28
|
E.
|
No additional contraception is needed if Nexplanon is
inserted by day 42
|
Question 15.
Lead-in
A healthy 20-year-old woman wishes to switch from a COC
to Nexplanon. What rules apply to the need for additional contraception?
I.
If insertion takes place on day 1 of the
hormone-free week, no additional contraception is needed.
II.
If insertion takes place on day 5 of the
hormone-free week, additional contraception is needed for 7 days.
III.
If insertion takes place in week 2 after the
hormone-free week, no additional contraception is needed.
IV.
If insertion takes place in week 3 after the
hormone-free week, no additional contraception is needed.
Option List
A.
|
I
|
B.
|
I + II
|
C.
|
I + II + III
|
D.
|
II + III + IV
|
E.
|
I + II + III + IV
|
Question 16.
Lead-in
I.
Women switching from a POP to Nexplanon should
be advised that additional contraception is required for 7 days.
II.
Women switching from a POP to Nexplanon should
be advised that additional contraception is not required.
III.
Women switching from a LNGIUS to Nexplanon
should be advised that additional contraception is required for 7 days.
IV.
Women switching from a LNGIUS to Nexplanon,
should be advised that additional contraception is not required.
Option List
A.
|
I + III
|
B.
|
I + IV
|
C.
|
II + III
|
D.
|
II + IV
|
E.
|
none of the above
|
30. EMQ. COC:
starting and missed pills.
Lead-in.
The following scenarios relate to the combined oral
contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at
all.
Abbreviations.
UPSI: unprotected
sexual intercourse.
Option list.
A.
pill that is ≥ 12
hours late.
B.
pill that is > 12
hours late.
C.
pill that is ≥ 24
hours late.
D.
pill that is > 24
hours late.
E.
two missed pills at
any time in a single cycle.
F.
the first pill taken
in one’s first love affair, now recalled with fond nostalgia for its
effectiveness in preventing pregnancy, the Prince having been truly a loathsome
toad.
G.
no additional
contraception required.
H.
additional
contraception required for 7 days.
I.
emergency
contraception should be considered.
J.
emergency contraception
should be recommended.
K.
take the missed pill
immediately, but not if it means 2 pills in one day; no additional
contraception needed; pill-free interval as normal.
L.
take the missed pill
immediately, even if it means 2 pills in one day; no additional contraception
needed; pill-free interval as normal.
M. take the missed pill immediately, even if it means 2 pills
in one day; additional contraception for 7 days; pill-free interval as usual.
N.
take one of the missed
pills immediately, discard the other missed pills, use extra contraception for
7 days and discuss emergency contraception with your doctor.
O.
take the missed pills
immediately, use extra contraception for 7 days and discuss emergency
contraception with your doctor.
P.
continuous combined preparation.
Q.
bi-phasic preparation.
R.
quadriphasic
preparation.
S.
cannot be answered
from the data given.
T.
none of the above.
Scenario 1.
What is the definition of a
missed pill?
Scenario 2.
What is the definition of two
missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice
should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What
advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of
menstruation. The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a
21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a
21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the
first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the
second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack.
What advice should be given?
Scenario 11
What kind of preparation is
Qlaira?
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