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Option List:
For each of the scenarios described choose the single most appropriate statement concerning the obtaining of patient consent with respect to the law in England. Each option may be used once, more than once, or not at all
A. Abandon operative procedure and reschedule
B. Defer the operative procedure
C. Fraser competence must be demonstrable before obtaining consent
D. Obtain legal advice on individuals who withhold consent for treatment 16
E. Obtain legal advice on interpretation on the Abortion Act 1967
F. Discuss with consultant and proceed for laparotomy.
G. Obtain legal advice on interpretation as she doesn’t have the Mental Capacity
H. Parental consent must be obtained before proceeding
I. Paternal consent need not be obtained before proceeding
J. Perform additional procedure without explicit consent to do so
K. Proceed without consent in order to save the fetus’ life
L. Proceed without consent in order to save the woman’s life
M. Respect the rights of the putative father of the fetus to withhold consent
N. Respect the rights of the unborn fetus and proceed to delivery
O. Respect the rights of the woman to withhold consent for treatment
P. Verbal consent of patient alone is acceptable
Q. Verbal consent with witness and case note documentation
R. Written consent must be obtained

1. Ms.X, 35-year-old suffering from Down syndrome, is diagnosed to have borderline ovarian tumour. She lives in home care and she has no relatives. She has been accompanied by home care nurse. She needs laparotomy as per MDT S opinion.

2. You are about to start seeing Ms Braganza in urogynecology clinic who has been referred by GP for prolapse uterus. Your junior colleague wants to sit with you during consultation of Ms Braganza

3. Mrs Suzi is 34-year-old is in surgical unit for Laparoscopic sterilization which she consented for a week before, in the outpatient clinic. She now appears somewhat upset and anxious and she is refusing to undergo the procedure.

Option List:
Each of the following clinical scenarios below relate to various ethical principles. For each patient select the single most appropriate Option from the list above. Each option may be used once, more than once or not at all.
A. Check advance directive
B. Sister can sign consent form
C. Don’t do the procedure give pain relief and send her home
D. Respect autonomy and document all the discussion and monitor
E. Inform named consultant, FGM midwife and place immediately
F. Issue a contraceptive and involve the Safeguarding team
G. Proceed in the best interest of the patient
H. Mother can’t give consent on her behalf
I. Respect religious views
J. Do only the procedure what is consented
K. No one can sign on behalf of her as she has capacity
L. Respect autonomy
M. Respect religious views
N. Cannot be done as it’s against law
O. Montgomery ruling
P. Involve safeguarding team immediately

4. A 14-year-old Katie, presented with severe right sided abdomen pain, her pain score is 7/10. On further imaging she has twisted right ovarian cyst probably dermoid. Katie has a capacity to make decision. She has passed Gillick test. She is refusing to undergo surgery she wants some tablets. Her mother who accompanied her is willing for surgery, what would u do now?

5. Mr. Marsha Ruqoriya, 34-year-old is yoga teacher and she has been referred from Midwife unit for abnormal CTG with thick Meconium stained liquor. On examination - she is 4 dilated, occiput posterior with grade 1 meconium stained liquor, minimal caput noted. CTG -pathological with prolonged bradycardia now lasting for 3minutes. You decide for Emergency LSCS in view of fetal distress. You spoke to Marsha; she wants natural delivery without any intervention. She has capacity to make decision. She is firm with her decision after understanding the pros and cons of it.  What would you do?

Option List:
For each of the following clinical scenarios please select the most appropriate method of termination of pregnancy from the list of options above. Each option may be used once, more than once or not at all.
A. Cannot offer termination under clause E
B. Hysterotomy
C. Induction of labour with mifepristone and prostaglandins
D. Potassium chloride feticide prior to induction of labour with mifepristone and prostaglandins
E. Selective feticide using potassium chloride
F. Selective feticide using umbilical cord occlusion
G. Surgical evacuation
H. Manual vacuum aspiration.
I. USG guided suction evacuation

6. A woman is diagnosed to severe hydrops at 22+6 weeks secondary to cystic hygroma. A karyotyping done from amniocentesis sample reveals Trisomy 18.

7. A lady with MCDA twins, with one twin detected to have skeletal dysplasia of a severe type. The other twin is found to be normal. The parents are keen on terminating the unhealthy twin but want to keep the healthy twin.

8. A 20-year-old girl has been sexually abused by her 40-year-old uncle. She doesn’t realize she is pregnant until 25 weeks.

9. An asylum seeker has been booked late in pregnancy. She has her first scan at 28 weeks when anencephaly and severe polyhydramnios is detected.

10. A lady at 20 weeks with low lying placenta comes to A & E, with life threatening bleeding. The bleeding is understood to be from the placental site. She has lost 2 litres so far and is continuing to bleed further.