MSFinals-1276
As an orthopaedic surgeon practicing in Scotland, can I proceed with investigations and treatments if a 16-year-old patient arrives alone to an appointment that was booked by their parent?
Archives: Medical Student Finals
MSFinals-1277
A Scottish resident in his early twenties presents with repeated acts of self-harm. He generally agrees to go to hospital (or presents himself) but sometimes refuses treatment. This evening, he took a large overdose of paracetamol and called a friend to tell her. An ambulance was called and he reluctantly agreed to come to hospital. Blood tests show his paracetamol levels are so high that he risks acute liver failure and death. Urgent treatment with the antidote Parvolex via an intravenous infusion is started. He tries several times to pull the cannula out, saying he wants to die. No legal provisions have been applied at this point.
Can he be physically restrained from removing the drip?
MSFinals-1278
You are a General Practitioner in Scotland who has been called to an elderly man who has become very confused over a period of a few days. He has a previous history of depressive illness. On examination, which he was reluctant to consent to, it is clear that he has a severe chest infection. He has hallucinations, a high fever and refuses all treatment. It is clear that the chest infection is the cause of an acute delirium.
Can you use provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 to admit him to hospital?
MSFinals-1279
You work in A&E in a hospital located in Scotland. A 7-year-old girl is brought in by ambulance with a stick lodged in her upper thigh, very close to the femoral artery. She is accompanied by her father, who reports that they were playing in the park and the girl fell onto a pile of sticks. The girl confirms this. On examination, it is clear that surgery will be needed to remove the stick. Whilst talking to the girl and her father, it becomes clear that the father and mother are divorced, though both live locally, and the girl’s main residence is with the mother. However, the girl is staying at her father’s house for the weekend whilst her mother is away on a business trip. The mother is uncontactable for the next six hours whilst on a flight. With discrete questioning, you find out that they were married for eight years and divorced three years ago. Surgery is needed urgently due to the risk of perforating the femoral artery, and to reduce the risk of serious infection.
Both the patient and her father are consenting. Is this sufficient consent?
MSFinals-1280
A 15-year-old patient comes to your clinic in Scotland requesting a blood test for urea and electrolytes and a full blood count. The appointment was scheduled during their consultation yesterday. Can you proceed with the requested tests?
MSFinals-1281
An ST1 doctor working in Scotland issues an emergency detention certificate for a 17-year-old inpatient being treated for acute Crohn’s disease who was demanding to go home because voices were telling him that everyone in the hospital may kill him, and was making threats of harm towards his girlfriend. He is not delirious. You have contacted a psychiatrist, who initially told you that she would be there within the 6 hours, but has since contacted you to say that due to unforeseen circumstances she cannot attend until the next day. The patient consented to taking a sedative, which was administered 3 hours ago. He is making no attempts to leave, and there has been a marked reduction in his responses to apparent auditory hallucinations and threats towards his partner.
Can you revoke the Emergency Detention Order?
MSFinals-1282
A 26-year-old man presents to his General Practitioner as he would like to be signed off from work over the winter period. He has a history of cystic fibrosis and is worried about being at increased risk of secondary bacterial infections in the colder months. He is particularly concerned as he has to take overcrowded public transport to work and back every day. He works for a marketing company, and although he may not be able to go into the office every day, he agrees that he may be able to work from home.
Which of the following recommendations may be the most appropriate when filling in this man’s ‘fit note’?
MSFinals-1283
A 70-year-old woman visits her doctor and expresses concern about her ability to manage her finances in the future. She wishes for her daughter to have the authority to make financial decisions on her behalf and knows that she must complete a form to make this possible.
What organization is responsible for registering these forms?
MSFinals-1252
A 25-year-old man has a 10-week history of auditory hallucinations and delusions, on a background of a two-year history of personality change, low mood and disorganisation. He attends his GP with his mother but then refuses emergency psychiatric admission. His GP is concerned that he is at risk to himself and others in the community and does not have the capacity to make decisions about his medical care. Assessment with regard to need for involuntary admission is arranged to his local psychiatric unit.
Which section of the Mental Health Act would apply to his admission for treatment following assessment by a mental health specialist?
MSFinals-1253
You are asked to attend the death of a patient who has died suddenly at home. The patient is aged 92 years and, when you take the phone call from a distressed neighbour who found the patient dead, it appears he has been well recently. On reviewing the notes, you find he was last seen by a colleague 5 weeks previously for a routine review of medication, but not since. You note that he was known to have a 7.8-cm abdominal aortic aneurysm (AAA) and hypertension, which was treated with ramipril. There is no other past medical history of note. You attend to verify death and find the patient is still warm and slumped over his kitchen table. You suspect he died from a ruptured AAA. It is 1800 h and the Coroner’s Office is closed.
In addition to telephoning the patient’s family to advise what has happened, what should you do next?