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Question 1
Correct
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A colleague of yours admits to being romantically involved with a patient who was discharged 2 days ago. She claims they hit it off when he was an in-patient and have now started dating.
Which of the following is the most appropriate action if the patient was a minor?Your Answer: Express your concerns about her dating a recent patient and ask her to consider the implications of it
Explanation:Addressing Concerns About a Colleague Dating a Recent Patient
When faced with a situation where a colleague is dating a recent patient, it is important to address any concerns directly with the colleague involved. Spreading rumours or threatening the colleague would be unprofessional and unproductive. Congratulating the colleague on their new relationship may not be appropriate either. The best course of action is to express your concerns about the appropriateness of the relationship and ask your colleague to consider the implications of it. While it may be tempting to do nothing, addressing the situation directly is the most appropriate action.
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This question is part of the following fields:
- Ethics And Legal
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Question 2
Incorrect
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A 16-year-old is brought in by her friend to the Emergency Department (ED). She is intoxicated, and you suspect that she has taken an overdose of an unknown drug. Her friend leaves before you can gather any additional information from her.
Despite your best resuscitation efforts, the patient ultimately passes away. Upon reviewing her medical records, you discover that she has no prior medical or psychiatric history and has never been hospitalized before.
In terms of medicolegal considerations, who should you notify first in this situation?Your Answer: The police
Correct Answer: The coroner
Explanation:Roles and Responsibilities in a Suspicious Death Case
In cases where a death is deemed suspicious or unnatural, it is important to involve the appropriate authorities. In the case of a patient who has taken an overdose and passed away, the following individuals may be involved:
1. The Coroner: The death should be referred to the coroner as there are reasonable grounds to believe that the death is suspicious. The coroner may request a post-mortem.
2. The Pathologist: If a post-mortem is carried out, the pathologist will be involved in determining the cause of death.
3. The Police: The police will likely be involved in investigating the circumstances surrounding the death.
4. The On-Call Registrar: The on-call registrar may already be aware of the situation, but the priority should be informing the coroner.
5. The Registrar for Births and Deaths: The next of kin should be traced and informed, and the registrar for births and deaths will be informed when the death certificate is issued.
Overall, it is important to follow proper procedures and involve the appropriate authorities in cases of suspicious or unnatural deaths.
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This question is part of the following fields:
- Ethics And Legal
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Question 3
Incorrect
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An 88-year-old man is brought to the Emergency Department (ED) via ambulance with central crushing chest pain. An electrocardiogram (ECG) in the ambulance shows 3 mm ST elevation in the anterior leads consistent with a STEMI. His wife says he has a history of ischaemic heart disease and congestive cardiac failure. He has a cardiac arrest in the ED secondary to ventricular fibrillation. Despite resuscitation using advanced cardiac life support, he dies. His wife asks what will happen to his body.
What is the most appropriate next step in management for this deceased patient?Your Answer:
Correct Answer: Refer to the coroner
Explanation:Guidelines for Filling out a Death Certificate
When filling out a death certificate, it is important to follow certain guidelines to ensure accuracy and completeness. If the death was sudden and unexpected, it should be referred to the coroner. In part 1 of the certificate, the specific disease, illness, or complication that led to death should be stated, not a mode of dying. Terms such as cardiac arrest, old age, and coma are not suitable for part 1. In part 2, any conditions that may have contributed to the death should be listed, but terms such as heart failure, liver failure, and kidney failure are not acceptable. By following these guidelines, death certificates can provide valuable information for medical research and public health purposes.
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This question is part of the following fields:
- Ethics And Legal
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Question 4
Incorrect
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A 80-year-old woman is admitted to hospital with pneumonia. She has extensive comorbidities and following a discussion with her family, treatment is withdrawn. She dies six days after admission, and you are asked to complete her cremation form.
Prior to cremation, what needs to be reported and checked?Your Answer:
Correct Answer: Pacemaker
Explanation:Implants and Cremation: What Needs to be Reported and Checked
Implants such as pacemakers, implantable defibrillators, cardiac resynchronization devices, and ventricular assist devices can potentially cause explosions during cremation. Therefore, it is important for the first and second signing doctors to confirm the presence of these devices and inform the bereavement office prior to cremation. This information should also be documented on the cremation forms. However, porcine implants and fake eyes do not pose any restrictions to cremation. Knee implants are also not on the list of problematic implants, while programmable ventricular peritoneal shunts should be reported. Non-programmable shunts, on the other hand, do not need to be checked prior to cremation.
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This question is part of the following fields:
- Ethics And Legal
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Question 5
Incorrect
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You went away for the summer and are driving back to school on the Monday morning. You are involved in a minor accident but are okay although very shaken. You will miss the morning class because of the delay caused by the accident.
Which of the following is the most appropriate action?Your Answer:
Correct Answer: Telephone a team member to inform them what has happened
Explanation:The Importance of Informing Your Team of Absences in Medical Settings
As a junior doctor, your health and safety is important. In the event of illness or emergencies, it is crucial to inform your team members of any absences. This allows them to arrange adequate cover and ensures that patient care is not compromised.
Simply going into work and hoping to get over an illness or emergency may not be the best course of action. If you are shaken or unable to focus on your work, your team members need to be aware of this and act accordingly.
In addition to informing your team, it may also be necessary to contact HR or the rota co-ordinator if you need to take further time off.
On the other hand, keeping your absence a secret or hoping that it will go unnoticed is unprofessional and may put patient care at risk.
In summary, informing your team of absences is a crucial step in ensuring the safety and well-being of both yourself and your patients.
The Importance of Informing Your Team of Absences in Medical Settings
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This question is part of the following fields:
- Ethics And Legal
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Question 6
Incorrect
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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?Your Answer:
Correct Answer: Examine the patient to verify death and call the police to report a sudden death, so that they can investigate the cause and notify the Coroner’s Office to arrange further examination of the body, including a post-mortem examination, if appropriate
Explanation:Procedures for Handling Sudden Deaths as a Doctor
As a doctor, it is important to know the proper procedures for handling sudden deaths. Here are some scenarios and the appropriate actions to take:
1. Examine the patient to verify death and call the police to report a sudden death, so that they can investigate the cause and notify the Coroner’s Office to arrange further examination of the body, including a post-mortem examination, if appropriate.
2. Examine the patient to verify death and make arrangements for the patient’s body to be transferred to the local hospital mortuary to await a post-mortem examination and advise the family that the death certificate will be issued only after this examination is complete.
3. Examine the patient to verify death and issue a death certificate to the patient’s family with ‘ruptured abdominal aortic aneurysm’ recorded as the cause. However, as the doctor, you are expected to examine the body to certify death, but given this was an unexpected death, you are unable to issue a death certificate until the police are informed and the case reported to the Coroner’s Office.
4. Examine the patient to verify death and ask the patient’s family to enlist the services of a local undertaker in removing the patient’s body, but discuss the case with the Coroner the following day before issuing a death certificate with ‘ruptured abdominal aortic aneurysm’ recorded as the cause. However, the body cannot be removed until the police is notified of the death and attends to investigate the circumstances of the death.
5. Contact the police to report an unexpected and sudden death. Do not examine the body any further, and remove yourself and anyone else from the vicinity of the body in case the police wish to designate the area as a crime scene. It is important to ensure you do not contaminate the scene if you suspect that it could be a forensic cause of death. However, as a doctor, your duty is to examine the body and verify death. Once verification occurs, the police is notified of an unexpected death and carry out appropriate investigations.
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This question is part of the following fields:
- Ethics And Legal
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Question 7
Incorrect
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You are called to confirm the death of a 86-year-old man who is registered with your practice. The person used to live alone. You complete the necessary checks to verify this man’s death.
In which one of the following scenarios would it be most acceptable to issue a death certificate immediately?Your Answer:
Correct Answer: History of chronic alcohol-related liver disease
Explanation:When to Report a Death to the Coroner: Guidelines for Different Scenarios
Reporting a death to the Coroner is not always necessary, but there are certain situations where it is required. Here are some guidelines for when to report a death to the Coroner:
1. History of chronic alcohol-related liver disease: Deaths due to chronic conditions like alcoholic liver disease do not need to be reported unless other criteria for reporting are met.
2. Lack of adequate nourishment: If neglect is suspected, such as an elderly person not having adequate shelter or nourishment, then the death should be reported to the Coroner.
3. History of asbestos-related disease: Any deaths due to injury or disease that could be due to a person’s employment must be reported to the Coroner, such as jobs in coal mining or construction work where patients could be susceptible to diseases like pneumoconiosis, asbestosis, or mesothelioma.
4. Suspicion of suicide: Deaths that are thought to be due to self-harm and/or suicide as a result of poisoning, trauma, or injuries to self must always be reported to the Coroner.
5. Suspicion of violence: If there is suspicion or evidence of violence, trauma, or injury, then the death should be reported to the Coroner.
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This question is part of the following fields:
- Ethics And Legal
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Question 8
Incorrect
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A 78-year-old man with a history of dementia was admitted to your medical ward from a nursing home in Scotland a week ago. A swallow assessment was performed after the patient was noticed to have difficulty eating and drinking; which concluded that the patient was at high risk of aspiration. The care team therefore wish to make him nil by mouth and start intravenous (IV) fluids. You have explained the situation to him and asked for his consent, which he refused. You are not content that he has fully understood the gravity of the situation, as a result of his dementia. You note that the patient does not have a welfare attorney or guardian with power to consent.
Which of the following would be the most appropriate way to proceed in this scenario?Your Answer:
Correct Answer: Issue a certificate under section 47 of the Adults with Incapacity (Scotland) Act 2000 and begin the treatment
Explanation:How to Proceed with Medical Treatment for an Incapacitated Adult in Scotland
When an adult lacks capacity and there is no welfare attorney or guardian with power to consent, medical treatment decisions can be difficult. However, in Scotland, the Adults with Incapacity (Scotland) Act 2000 provides a solution. Under section 47 of the Act, a medical practitioner can issue a certificate of incapacity in relation to the treatment in question. This authorizes the practitioner or others under their direction to provide reasonable interventions related to the treatment authorized.
It is important to note that medical treatment is defined as any healthcare procedure designed to promote or safeguard the physical or mental health of the adult. Therefore, if the treatment is necessary to safeguard or promote the patient’s health, a section 47 certificate should be issued and the treatment commenced.
It is not necessary to contact the nursing home or seek consent from relatives. Instead, the medical practitioner can proceed with treatment under the principle of necessity, as authorized by the Act. There is no need to apply to a court to make a decision.
In summary, when faced with a medical treatment decision for an incapacitated adult in Scotland, the Adults with Incapacity (Scotland) Act 2000 provides a clear path forward. By issuing a section 47 certificate and proceeding with necessary treatment, medical practitioners can safeguard and promote the health of their patients.
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This question is part of the following fields:
- Ethics And Legal
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Question 9
Incorrect
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An 88-year-old man with advanced Parkinson’s disease and dementia is admitted with aspiration pneumonia. He is under the care of your team. You are the FY2. You saw this patient yesterday on the ward round with your consultant. His pneumonia has not responded to antibiotic treatment, and the decision to palliate was made by the consultant after discussion with the family. The patient passes away peacefully, with his family around him, and you verify his death. You have been asked to fill in the death certificate after your ward round. His family wish to have him cremated.
In England, which of the following is correct with regard to completing this patient’s death paperwork?Your Answer:
Correct Answer: Complete the death certificate and the form Cremation 4
Explanation:Completing the Death Certificate: Guidelines for Medical Practitioners
When a patient passes away, it is the responsibility of the attending medical practitioner to issue the certification of death. However, there may be some confusion regarding who is eligible to complete the death certificate and the accompanying forms. Here are some guidelines to help medical practitioners navigate this process.
Requirements for Completing Form Cremation 4
If the deceased is to be cremated, a separate form (Form Cremation 4) must be completed by a registered medical practitioner. To be eligible to sign this form, the practitioner must:– Be registered with a licence to practise from the General Medical Council (GMC)
– Have treated the deceased during their last illness and seen them within 14 days of death
– Have cared for the patient before death or been present at the time of death
– Have examined the body after deathReferral to the Coroner
If the death was sudden or unexpected, or if the cause of death is unknown, the practitioner must refer the case to the coroner. Other indications for referral include suspicious or violent deaths, deaths due to accidents or neglect, deaths related to prior employment or abortion, deaths during police custody, and suicides.Completing the Death Certificate
The attending medical practitioner is responsible for completing the death certificate. There is no clear legal definition of attended, but it generally refers to a doctor who has cared for the patient during the illness that led to death and is familiar with their medical history, investigations, and treatment. The certifying doctor should also have access to relevant medical records and investigation results.Navigating the Process of Completing Death Certificates for Medical Practitioners
As a medical practitioner, it is important to understand the guidelines for completing death certificates and accompanying forms. This includes eligibility requirements for signing Form Cremation 4, indications for referral to the coroner, and guidelines for completing the death certificate itself. By following these guidelines, practitioners can ensure that they are fulfilling their statutory duty and providing accurate information for the deceased’s family and loved ones.
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This question is part of the following fields:
- Ethics And Legal
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Question 10
Incorrect
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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?Your Answer:
Correct Answer: Yes – administration of treatment under the Mental Health (Care and Treatment) (Scotland) Act 2003 may be appropriate where the physical disorder is a direct cause or consequence of the mental disorder
Explanation:Using the Mental Health (Care and Treatment) (Scotland) Act 2003 to Treat Physical Disorders with Underlying Mental Disorders
In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 can be used to treat physical disorders that are a direct cause or consequence of a mental disorder. This means that if a physical disorder, such as a chest infection, is causing delirium in a patient with an underlying mental disorder, the Act can be used to treat both the delirium and the infection. However, if a patient with a history of mental disorder refuses treatment for a purely physical disorder, the Act cannot be used. Instead, the Age of Legal Capacity Act may be used to determine the patient’s capacity to consent to treatment. Suicidal ideation is not relevant in this context.
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This question is part of the following fields:
- Ethics And Legal
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Question 11
Incorrect
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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?Your Answer:
Correct Answer: Yes – the father, having been married to the boy’s mother, has parental responsibility and can therefore give consent
Explanation:Understanding Parental Responsibility and Consent for Medical Treatment
When it comes to medical treatment for a child, it is important to understand who has the right to give consent. In the case of a boy whose parents are separated, some may believe that the mother, who spends more time with the child, has the legal right to make medical decisions. However, this is not necessarily true.
If the father was married to the mother when the child was conceived or marries her at any point afterwards, he has parental responsibility and can give consent for medical treatment. In Scotland, the Family Law (Scotland) Act 2006 also confers parental responsibility and rights on unmarried fathers who are registered as the child’s father.
It is important to note that the amount of time spent with a parent does not determine legal guardianship or the right to give consent. Additionally, simply looking after a child with permission from the mother does not give the father the right to consent.
In any case, consent must be obtained before any medical procedure is performed. Even if it is believed to be in the child’s best interest, consent cannot be bypassed.
Understanding parental responsibility and consent for medical treatment is crucial in ensuring that the child’s best interests are always taken into account.
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This question is part of the following fields:
- Ethics And Legal
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Question 12
Incorrect
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A 35-year-old man is brought to the Intensive Care Unit following a severe head injury. The medical team suspects that he has fulfilled all the requirements for brainstem death testing and wishes to verify this. What reflex is expected to persist even in the event of brainstem death?
Your Answer:
Correct Answer: Spinal reflexes
Explanation:Assessing Brainstem Death: Reflex Tests
When determining brainstem death, several reflex tests are performed to confirm the absence of brainstem function. Spinal reflexes, such as limb movements, may still be present even after brainstem death, so they are not used as criteria. However, the absence of corneal reflexes (blinking in response to a cotton wisp), gag reflexes (response to a tongue depressor), and pain reflexes (response to pressure on the supraorbital ridges) are all part of the criteria used to confirm brainstem death. Pupillary reflexes (response to a pen torch) are also tested, but their absence alone is not enough to confirm brainstem death.
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This question is part of the following fields:
- Ethics And Legal
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Question 13
Incorrect
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Based on the most recent guidance regarding cosmetic surgery from the General Medical Council, (GMC), which of the following statements is true if we consider the latest age criteria?
Your Answer:
Correct Answer: The person undertaking the procedure must not delegate the responsibility of discussing it with the patient and seeking their consent
Explanation:Understanding GMC Guidelines for Cosmetic Procedures
The General Medical Council (GMC) has provided guidelines for cosmetic procedures that must be followed by all medical professionals. It is important to understand these guidelines, even as a junior doctor, as you may be asked to be involved in cosmetic procedures.
Firstly, the person performing the procedure must be the one to discuss it with the patient and obtain their consent. Consent must be obtained by someone with the experience to perform the procedure and answer any questions the patient may have. For cosmetic procedures, the doctor performing the procedure must seek consent themselves.
While cosmetic procedures can be performed on patients under 18 years old, certain conditions must be met. The procedure must be in the best interest of the child, the environment must be suitable for young people, and advertising must not target children directly.
It is important to discuss the procedure with the patient’s GP, but only with the patient’s consent. If the patient does not want their GP involved, this must be recorded in the notes and the surgeon should consider whether the procedure should still go ahead.
Cosmetic services must not be provided as a prize, according to the GMC guidelines. Injectable cosmetic medicines, such as Botox, cannot be prescribed by telephone. A physical examination of the patient must be carried out before prescribing these medicines.
In conclusion, understanding the GMC guidelines for cosmetic procedures is crucial for all medical professionals. It is important to follow these guidelines to ensure the safety and well-being of patients undergoing cosmetic procedures.
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This question is part of the following fields:
- Ethics And Legal
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Question 14
Incorrect
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A 14-year-old girl presents to her GP requesting contraception.
In which of the following scenarios could contraception be legally withheld?Your Answer:
Correct Answer: She does not have an understanding of the implications of contraception
Explanation:Legal Considerations for Prescribing Contraception to a 15-Year-Old Girl
When considering prescribing contraception to a 15-year-old girl, there are legal criteria that must be met. The Fraser criteria state that the patient must have the ability to understand the implications of contraception for herself and her family. If this is the case, and there is no medical contraindication, the girl can request whichever form of contraception she prefers.
The Fraser criteria also state that the girl must have made a decision to start or continue to have sexual intercourse, despite attempts at persuasion, and that prescribing contraception is in her best interests. In Scotland, the legal underpinnings are statutory, and the girl must be capable of understanding the nature and possible consequences of the procedure or treatment.
It is important to note that the type of contraception used will not have legal implications on whether contraception should be provided. However, if the girl is frightened to say no to her boyfriend, this may be a child safeguarding issue that requires careful handling. In this case, contraception can still be legally prescribed.
If the girl refuses to discuss matters with her parents, this is not a legal reason to withhold contraception. As long as the sustained and consistent refusal to discuss with parents criteria are met, contraception can be supplied. Similarly, if the girl’s parents are abroad, this does not affect the decision to provide contraception as long as all other criteria are met.
In conclusion, when considering prescribing contraception to a 15-year-old girl, it is important to ensure that the legal criteria are met and that the decision is in the girl’s best interests.
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This question is part of the following fields:
- Ethics And Legal
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Question 15
Incorrect
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A 16-year-old girl has been admitted to the acute medical unit for a mild exacerbation of her asthma. She has recovered well, and her peak flow measurements have almost returned to normal. After being seen on the ward round, she asks an FY1 for contraceptive advice. She mentions that she is sexually active with one partner, her 19-year old boyfriend.
What is the first most appropriate action?Your Answer:
Correct Answer: Determine if the Fraser guideline criteria are met and ask questions about her relationship to ascertain if there are any safeguarding concerns
Explanation:Providing Contraceptive Advice to Young Girls: Following Fraser Guidelines and Safeguarding Protocols
Explanation:
When a young girl under the age of 16 requests contraception, doctors must follow the Fraser guidelines to ensure that they meet the criteria for providing contraceptive advice and treatment without informing their parents. Additionally, if the partner is over 16 years old, doctors must also exclude any safeguarding concerns before providing contraceptive advice.
It is crucial to sensitively ask the patient about their relationship to ascertain if there are any safeguarding issues. If both Gillick competence and the Fraser guidelines are met, then providing contraceptive advice is appropriate. However, it is prudent to involve senior members of the medical team.
If the patient is below the age of 13, the doctor must escalate the case to their child protection lead, as the partner would be committing a criminal offence.
It is inappropriate to decline providing contraceptive advice by telling the patient that it is illegal to have sex at their age. This could potentially antagonize the patient and make any assessment relating to the Fraser guidelines and safeguarding issues much more difficult.
Informing the parents or escalating the case to the child protection lead without first assessing the Fraser guidelines and safeguarding concerns would be a breach of doctor-patient confidentiality and inappropriate.
Instead, doctors should explain the various contraceptive options available and arrange an appointment with the patient’s GP to discuss these options further. By following the Fraser guidelines and safeguarding protocols, doctors can provide appropriate contraceptive advice to young girls while ensuring their safety and well-being.
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This question is part of the following fields:
- Ethics And Legal
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Question 16
Incorrect
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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?Your Answer:
Correct Answer: Detainment under section 2 of the Mental Health Act
Explanation:Understanding the Different Sections of the Mental Health Act
The Mental Health Act provides a legal framework for the assessment and treatment of individuals with mental disorders. There are several sections within the act that allow for different forms of detainment and treatment.
Detainment under section 2 of the Mental Health Act allows for a person to be detained in hospital for up to 28 days for assessment and treatment of their mental disorder. This section is applicable when the person is potentially suffering from a mental disorder that warrants their detention in hospital and it is in their best interest for their own health, safety, or the protection of others.
Section 3 of the Mental Health Act, also known as a treatment order, allows for the detention of a service user for treatment in the hospital. This section is applicable when the person is suffering from a mental disorder that warrants their care and treatment in hospital and there is a risk to their health, safety, or the safety of others.
Community treatment order under section 17 of the Mental Health Act allows for the Responsible Clinician to grant a detained patient leave of absence from the hospital. This is the only legal means by which a detained patient may leave the hospital site.
Emergency detainment under section 4 of the Mental Health Act is an emergency application for detention in hospital for up to 72 hours. This section requires only one medical recommendation from a doctor and is usually applied by an Approved Mental Health Professional.
Holding under section 5 of the Mental Health Act allows for nurses to detain someone in hospital for up to six hours and doctors for up to 72 hours. This section is applicable when an assessment is needed to determine if further detention under the Mental Health Act is necessary.
Understanding the different sections of the Mental Health Act is crucial for healthcare professionals to provide appropriate care and treatment for individuals with mental disorders.
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This question is part of the following fields:
- Ethics And Legal
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Question 17
Incorrect
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A 65-year-old patient attends their general practitioner (GP) having been discharged from hospital the day before. They are due to fly to Rome in three days’ time for a friend’s wedding and have asked for a letter saying they are fit to fly.
Which of the following reasons for admission would be a contraindication to them flying?Your Answer:
Correct Answer: Pneumothorax
Explanation:Medical Contraindications to Flying: Choosing the Best Answer
When it comes to flying, certain medical conditions can pose a risk to passengers. Here are some examples of medical conditions and their potential impact on air travel:
Pneumothorax: This is an absolute contraindication to flying within the preceding two weeks due to the risk of a tension pneumothorax developing.
Colles fracture: Patients who have sustained a fracture requiring a plaster cast are advised not to travel by plane for 24-48 hours, depending on the length of the flight, due to the risk of tissue swelling and compression.
Asthma attack: If the patient’s asthma attack has improved, it may still be appropriate for them to fly. However, patients should have stable asthma and carry inhalers with them during the flight.
Colonoscopy: Patients are advised not to fly for 24 hours after a colonoscopy due to the risk of gas inserted during the procedure expanding.
Hypoglycemic episode: A recent hypoglycemic episode is not in itself a contraindication to flying, but more information would be needed to determine the cause and prevent a recurrence.
Overall, while there are several medical conditions that can impact air travel, it’s important to choose the best answer based on the specific situation. In this case, pneumothorax within the preceding two weeks is an absolute contraindication to flying, making it the correct answer.
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This question is part of the following fields:
- Ethics And Legal
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Question 18
Incorrect
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A 30-year-old is admitted to A&E with seizures. He is advised not to drive. You spot him in the parking lot of a nearby grocery store, having just parked the car he was driving. He has an upcoming clinic appointment in a week.
What is the most suitable course of action?Your Answer:
Correct Answer: Stop him in the car park and remind him that he shouldn't be driving
Explanation:Appropriate Actions to Take When a Patient Shouldn’t Be Driving
As a healthcare professional, it is important to ensure the safety of both your patients and the public. If you witness a patient who shouldn’t be driving, there are several appropriate actions you can take.
Stopping the patient in the car park and reminding them that they shouldn’t be driving is the most appropriate action. This shows that you have a duty of care and are taking responsibility for the safety of the public. It is not ideal, but approaching the patient and asking why they are driving is the most sensible option.
Reporting the patient to the DVLA is also an option if they persist in driving. However, it is the patient’s responsibility to inform the DVLA of any medical conditions that may affect their ability to drive.
Calling the police as a first action is drastic and should only be considered if the patient is putting themselves or others in immediate danger.
Waiting until you are next at work to address the issue may be too late. It is important to deal with the matter straight away to prevent any potential harm.
Ignoring what you have seen is unprofessional and puts the public at risk. It is important to take action and ensure the safety of everyone involved.
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This question is part of the following fields:
- Ethics And Legal
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Question 19
Incorrect
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You suspect your colleague John has been taking more ‘sick days’ than needed. You happened to see one of his social media posts of him out for lunch when he was allegedly at home because he was sick.
Which of the following is the most appropriate action?Your Answer:
Correct Answer: Speak to your friend in private about what is really going on
Explanation:Appropriate Actions to Take When Concerned About a Friend’s Behavior
When you notice a friend’s behavior that is concerning, it can be difficult to know what to do. However, there are appropriate actions to take that can help your friend and maintain your relationship. The most appropriate action is to speak to your friend in private about what is really going on. This gives your friend the chance to open up to you and share any issues they may be going through. Reporting your friend to their educational or clinical supervisor should be done in stages, starting locally and working your way up. Spreading rumors about your friend is unprofessional and will not solve the issue. Sharing your concerns with another friend who knows your friend well can also be helpful, but it is important to approach your friend first. By taking appropriate actions, you can help your friend and maintain a healthy relationship.
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This question is part of the following fields:
- Ethics And Legal
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Question 20
Incorrect
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You are an FY1 in a busy A&E department. In your haste to finish all the jobs in time, you attain a needle stick injury while taking blood samples from a patient. The patient is known as an IV drug user.
Which of the following is the most appropriate action?
You are an FY1 in a busy A&E department. In your haste to finish all the jobs in time, you attain a needle stick injury while taking blood samples from a patient. The patient is known as an IV drug user.
Which of the following is the most appropriate action?Your Answer:
Correct Answer: Run the injury under a cold tap and allow it to bleed
Explanation:Proper Response to Needlestick Injuries: Running the Injury Under a Cold Tap
Needlestick injuries can be frightening, especially when dealing with patients with a history of IV drug use. However, it is important to remain calm and take immediate action. The most appropriate response is to run the injury under a cold tap and encourage it to bleed. This will help to flush out any potential pathogens. Afterward, seek advice and treatment from A&E or the Occupational Health department. It is also important to report the incident to Occupational Health, but only after taking care of the injury. Going through the patient’s notes may be helpful in ordering tests for HIV and hepatitis, but it is not the first thing to do. Leaving work and going home is not an option as it is a probity issue. Remember to prioritize your own safety and seek help when needed.
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This question is part of the following fields:
- Ethics And Legal
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Question 21
Incorrect
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A 28-year-old woman with a history of bipolar disorder is exhibiting erratic behavior, causing concern among her neighbors who fear for her safety. Despite attempts to reach out to her at home, she has not responded. To ensure she can be assessed in a place of safety, which Section of the Mental Health Act would be most appropriate to issue?
Your Answer:
Correct Answer: Section 135
Explanation:Understanding the Different Sections of the Mental Health Act
The Mental Health Act provides legal frameworks for the assessment, treatment, and detention of individuals with mental health disorders. Here are the different sections of the Act and how they apply in different situations:
Section 135: This section allows the police to break into a person’s property if they refuse to be assessed and their safety is at risk. A court order is required before the person can be sectioned under Section 135. The police can then assess the person with an approved mental health practitioner and a doctor in their home or in a place of safety.
Section 2: This section allows for the admission of a person for assessment for up to 28 days if necessary. However, the immediate concern is gaining access to the person’s property to assess whether this is required.
Section 3: This section can be used if, after assessment, it is determined that the person needs to be admitted for treatment for up to six months.
Section 5(2): This section can only be used by a doctor to detain someone for 72 hours when they are already in hospital voluntarily. It is not applicable to a person in their private property.
Section 136: This section allows the police to remove a person from a public place who appears to have a mental health disorder. It is not applicable to a person in their own private property.
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This question is part of the following fields:
- Ethics And Legal
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Question 22
Incorrect
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A 75-year-old man was admitted to a medical ward in Scotland a week ago, after a fall. This is his second admission due to a fall in the last 3 months. He is known to have mild dementia, hypertension and osteoporosis with previous hip fracture.
He lives alone in his own home, with the bathroom and bedroom upstairs. He has poor balance, but refuses to use a walking aid as he doesn't want people to think that he is an ‘old man’. His Mini-Mental State Examination (MMSE) was 23/30.
The team recommend a move into sheltered housing, which he declines. After a week in hospital, you are called to see the patient, who insists on going home. A discharge plan of ‘meals-on-wheels’ and a package of care including a community alarm and twice-daily visits have been arranged, but he firmly declines these offers as well.Your Answer:
Correct Answer: Make every effort to get her to stay in hospital at least until the morning, and then arrange discharge in an orderly way
Explanation:Ethical Approaches to a Patient Refusing Help
When a patient refuses help, it can be a difficult situation for healthcare professionals to navigate. In this scenario, a patient is refusing a package of help and wants to leave the hospital. Here are some possible approaches and their ethical implications:
1. Make every effort to get her to stay in hospital at least until the morning, and then arrange discharge in an orderly way. This approach respects the patient’s autonomy while also ensuring a safe and orderly discharge.
2. Detain her under the Mental Health (Care and Treatment) (Scotland) Act 2003, since she is clearly a danger to herself. This approach is not appropriate as there is no evidence that the patient is a danger to herself.
3. Ignore her wishes since, by making these demands, she clearly has no understanding of the seriousness of the situation. This approach disregards the patient’s autonomy and is not ethical.
4. Ignore her demands because of the potential for bad publicity if anything happens to her following discharge. This approach prioritizes the hospital’s reputation over the patient’s well-being and is not ethical.
5. Conceal a sedative in a cup of tea and wait for the morning when someone else can make the decision. This approach is unethical and unprofessional, and delaying a difficult decision is not appropriate.
In conclusion, the best approach is to respect the patient’s autonomy while also ensuring a safe and orderly discharge. It is important to document all discussions and decisions made with the patient.
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This question is part of the following fields:
- Ethics And Legal
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Question 23
Incorrect
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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’?Your Answer:
Correct Answer: Workplace adjustments
Explanation:Considerations for Workplace Adjustments
When assessing a patient’s ability to work, it is important to consider whether any adjustments need to be made to the workplace. In the case of a patient who is at high risk during the winter period, working from home may be the most appropriate option. Altered hours of working or amended duties may not be necessary, as the patient is able to continue their normal duties from home. It is important to assess whether the patient is fit for work in general, and note any adjustments that may be needed. A phased return to work may not be necessary in this case. Overall, workplace adjustments should be considered on a case-by-case basis to ensure the patient’s safety and ability to work effectively.
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This question is part of the following fields:
- Ethics And Legal
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Question 24
Incorrect
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An 80-year-old man visits his doctor requesting a form to confirm he is ‘fit to fly’. He plans to take a 3-hour flight to Italy in three days’ time. He has a medical history of cardiovascular disease.
What would be the safest diagnosis for air travel in this case?Your Answer:
Correct Answer: Uncomplicated myocardial infarction six days ago
Explanation:Airline Travel Restrictions for Patients with Cardiovascular Conditions
Patients with cardiovascular conditions may face restrictions when it comes to airline travel. Here are some guidelines to consider:
Uncomplicated Myocardial Infarction: Patients can typically fly after seven days of an uncomplicated myocardial infarction. This man would be eight days post-infarction by the time he is hoping to travel.
Complicated Myocardial Infarction: Patients should wait at least 4-6 weeks after a complicated myocardial infarction before flying. This man will not have reached four weeks by the time he is hoping to travel.
Decompensated Congestive Heart Failure: This condition is a contraindication for airline travel due to lower oxygen pressures at high altitudes, which may increase myocardial oxygen demands and make flying high risk.
Uncontrolled Cardiac Arrhythmia: Patients with cardiac arrhythmias can fly if they have occasional symptoms that are otherwise treated and stable.
Unstable Angina: Patients with chest pain at rest should defer their flight plans until stable.
It is important for patients with cardiovascular conditions to consult with their healthcare provider before making any travel plans.
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This question is part of the following fields:
- Ethics And Legal
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Question 25
Incorrect
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You are a general practice trainee at a surgery in London. A 14-year-old girl attends the surgery and requests the ‘morning-after pill’ following sexual intercourse with her 20-year-old boyfriend. She appears mature for her age and you assess her as being Fraser-competent. She says that there was an accident on this occasion and, in future, she will ensure her and her boyfriend use contraception. She doesn't want you to discuss emergency contraception or her relationship with her parents.
What is the best course of action?Your Answer:
Correct Answer: Issue a prescription for emergency contraception and refer the patient to social services, as well as informing the designated doctor for child protection and the police
Explanation:In the case of a young girl seeking emergency contraception, it is important to consider her age and ability to consent to sexual activity. If she is under 13 years old, sexual intercourse with her partner would be considered statutory rape and child protection measures must be taken immediately. It is important to consult with a general practitioner safeguarding lead or designated doctor for child protection, make an urgent social services referral, and inform the police. If the girl is deemed Fraser-competent, emergency contraception can be provided without necessarily involving her parents, but she should be encouraged to involve them in decision-making. It is crucial to prioritize the girl’s safety and well-being by providing emergency contraception and taking necessary child protection measures. Contacting the girl’s parents without her consent may damage the trust between the doctor and patient and delay necessary action.
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This question is part of the following fields:
- Ethics And Legal
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Question 26
Incorrect
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A 15-year-old Scottish resident presents to your Scottish Emergency Department with a 10-hour history of acute right-sided abdominal pain. On examination, she has acute appendicitis. She is keen to proceed with the recommended surgery. You are unable to contact a parent or any other contact given by the patient.
What do you need in order to proceed?Your Answer:
Correct Answer: Nothing; in Scotland, a 16-year-old person is deemed capable of consenting to treatment
Explanation:Capacity to Consent to Treatment in Scotland for 16-Year-Olds
In Scotland, the Age of Legal Capacity (Scotland) Act 1991 states that all people aged 16 and over are presumed in law to have the capacity to consent to treatment unless there is evidence to the contrary. This means that a 16-year-old person is deemed capable of consenting to treatment without the need for a court order or assessment of competence.
Furthermore, social workers do not have the power to consent on behalf of any patient, regardless of age. It is important to note that even if it is believed to be in the best interests of the person to have the surgery performed, it cannot be done without their consent if they are over 16 and have capacity.
Overall, the law in Scotland is clear regarding the age at which a person is deemed to have capacity to consent, providing clarity and protection for 16-year-olds seeking medical treatment.
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This question is part of the following fields:
- Ethics And Legal
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Question 27
Incorrect
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An 88-year-old man is admitted with severe community-acquired pneumonia, CURB-65 score is 4. He has been an inpatient on the ward where you are working as an FY1 for two weeks. His condition has progressively worsened, and the decision is made to switch to a palliative approach of management. He passes away the following morning, with his wife by his side. You confirm his death on the ward. He has a past medical history of ischaemic heart disease, mesothelioma, hypertension, type 2 diabetes and benign prostate hypertrophy (BPH).
Which of the following should you do when completing his death certificate?Your Answer:
Correct Answer: Complete part 1 stating community-acquired pneumonia, complete part 2 stating ischaemic heart disease type 2 diabetes and mesothelioma.
Explanation:Completing a Death Certificate
When completing a death certificate, it is important to accurately state the cause of death in part 1. If there were other conditions that were not part of the main causal sequence of death but likely played a role in hastening the death, they should be listed in part 2. However, it is not necessary to list the patient’s entire medical history in part 2. The form should be completed by the doctor who attended to the patient during their last illness and is familiar with their medical history, investigations, and treatment. Access to relevant medical records and investigation results is also important.
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This question is part of the following fields:
- Ethics And Legal
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Question 28
Incorrect
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A 55-year-old man was admitted to hospital two weeks ago, having collapsed at home. He has a history of hypertension and coronary artery disease and has suffered a myocardial infarction (MI) in the past. During admission, he was found to be short of breath and tachycardic, with an irregular heart rate. His electrocardiogram (ECG) showed a narrow complex tachycardia, with absent P waves. He is now medically fit for discharge.
What advice should you give to this patient about driving?Your Answer:
Correct Answer: He will need to have been successfully treated for four weeks before he can start driving again
Explanation:Understanding Guidelines for Driving After Atrial Fibrillation Treatment
After being diagnosed with atrial fibrillation (AF), a patient must be successfully treated for four weeks before resuming driving, according to guidelines. There is no need to inform the Driver and Vehicle Licensing Agency (DVLA) if the underlying cause of the collapsing episode is known. The patient can return to driving as soon as they are ready, but driving short distances initially is not a safe option. It is important to follow these guidelines to ensure the safety of both the patient and the public.
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This question is part of the following fields:
- Ethics And Legal
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Question 29
Incorrect
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A 6-month-old boy is brought to the Emergency Department by his concerned parents. They have observed that he has been experiencing painful swelling in his fingers and toes over the past few days. They have also noticed that he has been excessively fatigued and that his skin and eyes appear to have a yellowish tint. The family recently relocated from Ghana but were unable to access prenatal or postnatal screening tests. The parents had plans to travel by plane for a pre-booked vacation in three days.
What is the safe duration for the family to travel, given the probable diagnosis for this infant?Your Answer:
Correct Answer: Ten days
Explanation:Guidelines for Air Travel with Sickle-Cell Disease
Air travel can pose risks for individuals with sickle-cell disease, particularly following a sickle-cell crisis. The following guidelines are recommended:
– Wait ten days before travelling to reduce the risk of complications such as deep vein thrombosis.
– Patients with sickle-cell anaemia can travel with supplemental oxygen if needed, provided there are no recent crises or other medical concerns. Patients with sickle-cell trait can travel as normal.
– Avoid flying within three days of a crisis to reduce the risk of sickling.
– Patients without other medical concerns should not need to wait longer than four weeks following a crisis.
– Short flights of 4-6 hours should not pose issues for those with sickle-cell disease, as long as they stay hydrated during travel. There is no need to wait six months following a crisis.By following these guidelines, individuals with sickle-cell disease can safely travel by air.
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This question is part of the following fields:
- Ethics And Legal
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Question 30
Incorrect
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You are the FY1 working on a pediatric ward. You overhear the nurses speaking about the son of one of your patients in a derogatory way. This upsets you as you have built a good rapport with the patient and his family.
Which of the following is the most appropriate action?Your Answer:
Correct Answer: Speak to the nurses quietly at a later time
Explanation:Appropriate Actions in Response to Overhearing Inappropriate Conversation Among Nurses
When overhearing inappropriate conversation among nurses on the ward, it is important to respond in a professional and appropriate manner. One should not interrupt the nurses and tell them to keep quiet or start shouting at them. Instead, the most appropriate action is to speak to the nurses quietly at a later time when things have calmed down. Confronting them in the moment may lead to further tension and conflict. Informing the patient’s family immediately and asking for a ward change is also not recommended as it may create mistrust and ill feeling towards the nursing staff. Speaking to the Ward Sister is an option, but it may cause a delay in addressing the issue. Therefore, it is better to approach the nurses directly and share concerns in a calm and professional manner.
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This question is part of the following fields:
- Ethics And Legal
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