|
58 |
Role-play. Anencephaly |
|
59 |
EMQ. Coroner |
|
60 |
EMQ. Medical examiner system |
|
61 |
SBA. Cowden syndrome |
|
62 |
EMQ. Peutz-Jeghers syndrome |
|
63 |
EMQ. Education |
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.
59. EMQ. Coroner.
This topic has featured in the exam and makes for
easy marks if you know the basics.
CC: Chief Coroner.
CJA9: Coroners and Justice Act 2009.
MCCD: medical
certificate of the cause of death.
NOD: notification
of deaths.
SB: stillbirth
Option list 1.
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
Use option list 1 for scenarios
1 - 3.
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?
Scenario
4.
Which, if any, are current titles for coroners?
Option
list.
|
A |
area
coroner |
|
B |
assistant
coroner |
|
C |
district
coroner |
|
D |
deputy
coroner |
|
E |
lead
coroner |
|
F |
national
coroner |
Scenario
5.
Which, if any, of the following are functions of the Chief Coroner?
Option list.
|
A |
to
appoint coroners |
|
B |
to
approve coronial appointments |
|
C |
to
negotiate coroners’ salaries |
|
D |
to
negotiate coroners’ terms and conditions |
|
E |
to
oversee the disciplinary procedures for coroners |
|
F |
to
keep an eye on coronial investigations that have taken too long |
|
G |
to
organise advice from coroners about how deaths may be prevented |
Option list 2. Use for scenarios
6-8.
A. must have had experience as a
detective in the police force with the 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 holiday
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
Scenario
6.
What qualifications must the Coroner have?
Scenario
7.
What are the hours of availability of the Coroner?
Scenario
8.
What
are the roles of the Coroner’s Officers?
Scenario
9.
Who or what is responsible for appointing medical examiners?
Option
list.
|
A |
Local
authorities |
|
B |
the
Chief Coroner |
|
C |
the
Chief Medical Examiner |
|
D |
the
local Senior Coroner |
|
E |
the
Lord Chancellor |
|
F |
NHS
Trusts |
|
G |
the
Queen |
Scenario
10.
Which, if any, of the following are applicable to the role of
medical examiner?
Option
list.
|
A |
to decide
if a post-mortem is required |
|
B |
notification
of deaths to the coroner |
|
C |
supervision
of the quality of MCCDs |
|
D |
attendance
at post-mortems |
|
E |
performance
of post-mortems |
Scenario
11.
When was the 1st. Chief Medical Examiner for England &
Wales appointed?
Option
list.
|
A |
2005 |
|
B |
2010 |
|
C |
2015 |
|
D |
2017 |
|
E |
2019 |
|
F |
the
post does not exist |
|
G |
none
of the above |
Scenario
12.
What was the specialty of the 1st. appointee to the
post of the lead medical examiner for England & Wales?
Option
list.
|
A |
accident
and emergency medicine |
|
B |
forensic
medicine |
|
C |
forensic
pathology |
|
D |
forensic
psychiatry |
|
E |
obstetrics
& gynaecology |
|
F |
pathology |
Scenario
13.
Which, if any, of the following are requirements for those wishing
to become a medical examiner?
Option
list.
|
A |
full
registration with the General Medical Council |
|
B |
consultant
status |
|
C |
>
10 years’ experience as a fully-registered doctor |
|
D |
to have
the Diploma of the Faculty of Medical Examiners |
|
E |
to
have membership of the RCP |
|
F |
none
of the above |
Option list 3. Use for the
remaining scenarios, unless they have an 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
14.
A
resident of Manchester dies suddenly while visiting the town of his birth in Scotland.
His family decides that he will be buried in the town of his birth. His body is
held at the premises of a local funeral director to arrange the funeral and
burial. What actions should be taken with regard to the Manchester coroner?
Scenario
15.
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 who will arrange the funeral and
burial. What actions should be taken with regard to the Manchester coroner?
Scenario
16.
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
17.
A man of 65 dies of terminal lung cancer. The GP who had visited
daily up to three weeks before the death has been on holiday for three weeks.
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
18.
A man of 65 dies of terminal lung cancer. The GP, who has visited
daily up to the day of his death and attended to confirm the death, is on holiday.
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
19.
A man of 65 dies of terminal lung cancer. The GP who has 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
20.
A 65-year-old man dies suddenly 12 hours after admission to the
local coronary care unit with chest pain, despite 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
21.
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
22.
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
23.
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. She is given 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
24.
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
25.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. 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?
Scenario
26.
A woman is admitted at 26 weeks’ gestation in premature labour
after being kicked in the abdomen by her partner. She says that he did not want
the pregnancy to continue.
Pick
the best option from the option list.
Option
list.
A. dial 999
B. get advice from the BMA
C. get advice from the Department of Health
D. get advice from the legal department
E. get advice from the police
F. none of the above.
Option list.
|
A |
provide access to the
records by the Coroner in person |
|
B |
provide unrestricted access
to the medical records by the coroner’s officers |
|
C |
provide a copy of the
hospital records to the coroner or her officers |
|
D |
provide a medical report,
but no access to the medical records |
|
E |
provide a copy of the letter
to the GP about the recent admission |
|
F |
none of the above |
Scenario
28.
You have been swimming in the sea at Broad Beach,
Rhosneigr. As you walk back to the shore your foot
hits something in the sand. You explore and find a number of gold coins that
look ancient. What should you do?
Option
list.
|
A |
put
them back as they may have been an offering to the Gods |
|
B |
put
them in a safe place with a view to having them valued and sold |
|
C |
take
them to the local museum for identification and advice about informing the
coroner |
|
D |
take
them to the nearest police station for advice |
|
E |
take
them to your favourite pub and trade them for a meal and round of drinks |
60. EMQ. Medical examiner system.
Abbreviations.
MCCD: medical
certificate of the cause of death.
ME: medical
examiner.
Do I really need to know
this stuff? This
is ‘hot’: MEs were an innovation in 2018.
Question
1.
Which, if any, of
the following are included in the role of the ME?
Option list.
|
A |
scrutiny of all death certificates from the NHS Trust |
|
B |
scrutiny of all death certificates from the local area |
|
C |
scrutiny of non-coronial death certificates from the
local area |
|
D |
deciding if postmortem examination is appropriate |
|
E |
supervision of postmortem examination |
|
F |
deciding on and arranging further investigations to
establish the cause of death |
|
G |
liaison with the coroner |
|
H |
discussing the cause of death with the family of the
deceased |
|
I |
directing police investigations in cases of suspicious
death |
Question
2.
What qualifications
must a ME have?
Option list.
|
A |
be registered with the GMC |
|
B |
be licensed to practise or be < 5 years into retirement |
|
C |
be a member or fellow of a Royal Medical College |
|
D |
be a member or fellow of the Royal College of
Pathologists |
|
E |
none of the above. |
Question
3.
Which, if any, of
the following are included in the role of the medical examiner?
Option list.
|
A |
discussing the case with the doctor who provided care
during the final illness |
|
B |
reviewing the medical records |
|
C |
deciding the cause of death to be put on the certificate
of death |
|
D |
discussing the cause of death with next of kin |
|
E |
identifying any concerns the next of kin may have about
the care |
|
F |
providing medical advice to the coroner |
|
G |
identifying deaths that should trigger a mortality case
record review |
Question
4.
Which, if any, of
the following are included in the role of the National ME?
Option list.
|
A |
being a member of the medical team responsible for the
Queen’s health |
|
B |
appointing Trust MEs |
|
C |
disciplining errant MEs |
|
D |
producing reports |
|
E |
arbitrating in disputes between MEs and coroners about
the cause of death |
|
F |
dealing with appeals by families who are dissatisfied with
the MCCD or the care |
61. EMQ. Cowden syndrome .
Abbreviations.
Cs: Cowden syndrome.
HNPCC: hereditary
non-polyposis colon cancer.
PTEN: Phosphatase and tensin homolog.
Scenario 1. Which feature is associated with
Cowden syndrome?
Option list.
A. albinism
B. hamartoma
C. hammer-toe
D. hypertrichosis
E. stammer
Scenario 2. Which
condition has the highest risk of occurrence in women with Cs?
Option list.
A. breast
cancer
B. bowel
cancer
C. congenital
absence of Müllerian tract derivatives
D. hypertension
E. hypothyroidism
Scenario 3. Which
gynaecological cancer is a particular risk for women with Cs?
Option list.
A. Bartholin’s
gland cancer
B. cervical
cancer
C. choriocarcinoma
D. endometrial
cancer
E. vulval
cancer
Scenario 4. Which cancer is more common in men
with Cs?
Option list.
A. breast
cancer
B. colon
cancer
C. melanoma
D. renal
cancer
E. thyroid
cancer
F. all
of the above
Beirne.
TOG CPD. 2015. 17.4. These are open-access.
Inherited cancer risk in gynaecology
With regard to inherited cancers,
1. germline
mutations are the cause of inherited cancer syndromes. True / False
2. they
make up 5–10% of all cancers. True / False
3
the autosomal dominant mode of inheritance is the most common. True / False
4. multifactorial
interaction between low penetration and environmental factors occurs in 20–25%
of cases. True / False
Concerning
hereditary breast and/or ovarian cancer,
5. BRCA1
and BRCA2 germline mutations are inherited in an AR fashion. True / False
6. the
prevalence of BRCA1 and BRCA2 germline mutations in the UK is about 1%. True / False
7. a
woman with a BRCA2 mutation has a lifetime risk of ovarian cancer of about 30%. True / False
8. aberrant
promoter hypermethylation of the BRCA1 gene causes it to be functionally deficient
in up to 35% of sporadic ovarian cancer cases. True / False
9. women
with ovarian carcinoma who harbour a BRCA mutation generally have a worse prognosis
compared with sporadic disease. True / False
10. serous
carcinoma of the endometrium is now an accepted member of hereditary breast ovarian
cancer syndrome. True / False
11. the
RAD51C mutation is associated with high grade epithelial ovarian tumours of
both the serous subtype. True / False
12. RAD51D
mutation carriers have an approximately 10% cumulative life time risk of
ovarian cancer. True / False
13. a
distinctive phenotype of cancers associated with BRCA2 mutation is early stage at
presentation. True / False
Concerning
hereditary non-polyposis colon cancer syndrome (Lynch Syndrome),
14. endometrial
carcinomas that present on a background of Lynch Syndrome have a predilection
for arising from the lower uterine segment. True / False
15. the
prevalence of Lynch Syndrome in endometrial cancer patients is less than 1%. True / False
16. MLH1
and MSH2 account for the majority (90%) of all identified HNPCCalterations. True / False
17. germline
mutations in MSH6 have greater penetrance for endometrial than for colorectal
carcinomas. True / False
Concerning
Peutz-Jeghers syndrome,
18. the
associated risk of malignancy is ↑ 10–18 fold over the general
population. True / False
With regard to
Cowden syndrome,
19. 80%
of patients have an identifiable germline mutation in PTEN. True / False
In the
hypercalcaemic type of small cell ovarian carcinoma,
20. there
is a high incidence of SMARCA4 germline mutations. True / False
62. EMQ. Peutz-Jeghers syndrome.
Abbreviations.
PJS: Peutz-Jeghers
syndrome.
Scenario 1.
Which, if any, of
the following are characteristics of PJS?
Option list.
|
A |
buccal pigmentation |
|
B |
gastro-intestinal hamartomas |
|
C |
perianal pigmentation |
|
D |
increased risk of breast cancer |
|
E |
increased risk of cervical adenoma malignum |
|
F |
increased risk of colo-rectal cancer |
|
G |
increased risk of endometrial cancer |
|
H |
increased risk of ovarian cancer |
|
I |
increased risk of pancreatic cancer |
|
J |
increased risk of prostate cancer |
|
K |
increased risk of stomach cancer |
Scenario 2.
What is the
approximate prevalence of PJS?
Option list.
|
A |
< 1 in 1,000 |
|
B |
1 in 1,000 to 1 in 10,000 |
|
C |
1 in 10,000 to 1 in 100,000 |
|
D |
1 in 25,000 to 1 in 100,000 |
|
E |
1 in 25,000 to 1 in 200,000 |
|
F |
1 in 25,000 to 1 in 300,000 |
|
G |
1 in 300,000 to 1 in 500,000 |
|
H |
< 1 in 500,000 |
Scenario 3.
What is the mode of inheritance in PJS?
Option list.
|
A |
autosomal dominant |
|
B |
autosomal recessive |
|
C |
X-linked dominant |
|
D |
X-linked recessive |
|
E |
Y-linked dominant |
|
F |
Y-linked recessive |
|
G |
triplet repeat |
Scenario 4.
Which, if any, of the following statements are true of PJS?
Option list.
|
A |
PJS only occurs in families with other affected members |
|
B |
PJS mainly occurs in families with other affected
members |
|
C |
PJS may arise de-novo in families with no other
affected members |
|
D |
PJS may arise de-novo in families with other affected
members |
|
E |
PJS does not arise de-novo in families with no other
affected members |
Scenario 5.
What is the
approximate lifetime risk of developing cancer in PJS?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
30% |
|
D |
40% |
|
E |
50% |
|
F |
60% |
|
G |
70% |
|
H |
80% |
|
I |
90% |
|
J |
>90% |
Scenario 6.
What is the
relevance of STK11 to PJS?
Option list.
|
A |
It is part of the postcode of the Peutz-Jeghers Society |
|
B |
It is the name of the gene most commonly associated
with PJS |
|
C |
It is the Ornithological Society’s code for the Orkney
Skua |
|
D |
Somatic mutations have been found in cervical cancer |
|
E |
None of the above |
63. Education.
Option list.
- brainstorming.
- brainwashing
- cream cake circle.
- Delphi technique.
- demonstration &
practice using clinical model.
- doughnut round.
- interactive lecture with
EMQs.
- lecture.
- 1 minute preceptor
method.
- teaching peers / junior
colleagues
- schema activation.
- schema refinement.
- small group discussion.
- snowballing.
- snowboarding.
- true
- false
Scenario 1. A woman is
admitted with an eclamptic seizure. The acute episode is dealt with and she is
put on an appropriate protocol. You wish to use the case to outline key aspects
of PET and eclampsia to the two medical students who are on the labour ward
with you. Which would be the most appropriate approach?
Scenario 2. You have
been asked to provide a summary of the key aspects of the recent Maternal
Mortality Meeting to the annual GP refresher course. There are likely to be 100
attendees. Which would be the most appropriate approach?
Scenario 3. You have
been asked to teach a new trainee the use of the ventouse. Which would be the
most appropriate approach?
Scenario 4. You have been asked to teach a group
of medical students about PPH. To your surprise you find that they have good
basic knowledge. Which technique will you apply to get the most from the teaching
session?
Scenario 5. Your consultant has asked you to get
the unit’s medical students to prepare some questions about breech delivery
which they can ask of their peers when they next meet. Which technique will you
use?
Scenario 6.
You have been asked to discuss
2ry. amenorrhoea with your unit’s medical students. You are uncertain about the
amount of basic physiology and endocrinology they remember from basic science
teaching. Which technique will you use?
Scenario 7. The RCOG
has asked you to chair a Green-top Guideline development committee. You find
that there is very little by way of research evidence to help with the process.
The College has assembled a team of consultants with expertise and interest in
the subject. Which technique would be best to reach consensus on the various
elements of the GTG?
Scenario 8. Which of
the listed teaching techniques is least likely to lead to deep learning?
Scenario 9. An interactive lecture with EMQs is the best method of
teaching. True or false.
Scenario 10. Only 20% of what is taught in a
lecture is retained. True or false.
Scenario 11. The main role of the teacher is
information provision. True or false.
Scenario 12. The main role of the teacher is to
be a role model. True or false.
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