Website
12 June 2017.
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20
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EMQ. Mental Capacity Act
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21
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Air Travel & Pregnancy. How to read exercise & SBA.
Extract the key facts for Qs. from SIP 1. 2013
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22
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EMQ. Cancer
incidence & mortality
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23
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Communication skills. Role-play. PMB.
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20. 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.
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?
21. Air Travel & Pregnancy.
How to read exercise. Extract the key
facts for Qs. from SIP 1. 2013
22. EMQ. Cancer incidence & mortality.
Cancer incidence and mortality.
These
questions relate to the incidence of female cancer and associated mortality.
Pick one
option from the option list.
Abbreviations.
NHL: non-Hodgkin Lymphoma
Question 1.
Lead-in
Which is
the most common female cancer?
Option List
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A.
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Bowel
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B.
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Breast
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C.
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Cervix
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D.
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Endometrium
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E.
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Lung
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Question 2.
Lead-in
Which is
the 2nd. most common female cancer?
Option List
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A.
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Bowel
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B.
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Breast
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C.
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Cervix
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D.
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Endometrium
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E.
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Lung
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Question 3.
Lead-in
Which is
the 3rd. most common female cancer?
Option List
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A.
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Bowel
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B.
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Breast
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C.
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Cervix
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D.
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Endometrium
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E.
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Lung
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Question 4.
Lead-in
Which is
the 4th. most common female cancer?
Option List
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A.
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Bowel
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B.
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Cervix
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C.
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Endometrium
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D.
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Lung
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E.
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Pancreas
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Question 5.
Lead-in
Which is
the 5th. most common female cancer?
Option List
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A.
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Cervix
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B.
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Malignant melanoma
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C.
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Non-Hodgkin’s lymphoma
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D.
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Ovary
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E.
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Vulva
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Question 6.
Lead-in
Which is
the 6th. most common female cancer?
Option List
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A.
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Cervix
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B.
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Malignant melanoma
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C.
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Non-Hodgkin’s lymphoma
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D.
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Ovary
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E.
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Vulva
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Question 7.
Lead-in
Where does
cervical cancer feature in the list of the most common female cancers?
Option List
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A.
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10th.
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B.
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11th.
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C.
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15th.
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D.
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20th.
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E.
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24th.
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Question 8.
Lead-in
Where does
vulval cancer feature in the list of the most common female cancers?
Option List
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A.
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10th.
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B.
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12th.
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C.
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16th.
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D.
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20th.
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E.
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none of the above
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Question 9.
Lead-in
Which is
the most common cancer causing female death in the UK?
Option List
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A.
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Breast
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B.
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Bowel
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C.
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Lung
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D.
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Ovary
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E.
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Pancreas
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Question 10.
Lead-in
Which is
the 2nd. most common cancer causing female death in the UK?
Option List
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A.
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Breast
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B.
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Bowel
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C.
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Lung
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D.
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Ovary
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E.
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Pancreas
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Question 11.
Lead-in
Which is
the 3rd. most common cancer causing female death in the UK?
Option List
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A.
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Breast
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B.
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Bowel
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C.
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Lung
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D.
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Ovary
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E.
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Pancreas
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Question 12.
Lead-in
Which is
the 4th. most common cancer causing female death in the UK?
Option List
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A.
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Brain
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B.
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Oesophagus
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C.
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Ovary
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D.
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Pancreas
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E.
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Uterus
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Question 13.
Lead-in
Which is
the 5th. most common cancer causing female death in the UK?
Option List
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A.
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Brain
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B.
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Oesophagus
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C.
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Ovary
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D.
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Pancreas
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E.
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Uterus
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Question 14.
Which is
the 6th. most common cancer causing female death in the UK?
Option List
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A.
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Brain
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B.
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Oesophagus
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C.
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Ovary
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D.
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Pancreas
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E.
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Uterus
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Question 15.
Lead-in
The
incidence of cervical cancer has fallen from the late 1970s until now. What is
the approximate figure for the fall?
Option List
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A.
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10%
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B.
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25%
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C.
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50%
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D.
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60%
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E.
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75%
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Question 16.
Lead-in
The
incidence of cervical cancer fell in the past decade. What is the approximate
figure for the fall?
Option List
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A.
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5%
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B.
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10%
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C.
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15%
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D.
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20%
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E.
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25%
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Question 17.
Lead-in
What
proportion of cervical cancer is diagnosed in women < 45 years?
Option List
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A.
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20%
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B.
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30%
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C.
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40%
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D.
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50%
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E.
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60%
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Question 18.
Lead-in
When was
routine HPV vaccination of girls introduced in the UK?
Option List
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A.
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2000
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B.
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2002
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C.
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2004
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D.
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2006
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E.
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2008
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Question 19.
Lead-in
From what
year might we expect to see a reduction in cervical cancer incidence as a
result of the HPV vaccination programme?
Option List
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A.
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2020
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B.
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2025
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C.
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2030
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D.
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2040
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E.
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2050
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Question 20.
Lead-in
When was
routine HPV vaccination of boys introduced in the UK?
Option List
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A.
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2010
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B.
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2011
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C.
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2012
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D.
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2014
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E.
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None of the above
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23. Communication skills. Role-play. PMB.
PMB. Role-play.
Candidate’s Instructions.
You are an SpR in the “one-stop” PMB clinic. You are
about to see a woman with bleeding some years since her menopause.
A 55 year old woman is referred by her General
Practitioner.
Your task is to take an appropriate history and advise
her about the investigations you feel are appropriate and why.
Referral letter from the General
Practitioner.
Manor Lodge,
High Street,
Bestown.
BE5 S00
Re: Mrs. Mary Smith,
Age 55.
5b High Street,
Bestown.
BE5 SO1
Dear Doctor,
Please see Mrs. Smith who has had bleeding down below. It
is a number of years since she reached the menopause.
Yours sincerely,
James Fewords, General Practitioner.
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