Communication Skills and Ethics

Question 1

What is brain stem death?

Answer 1

Severe and irreversible damage to the brain stem - control breathing and basic functions for life

Question 2

How is brain stem death confirmed?

Answer 2

Examination by consultant and another senior doctor
2 Separate occasions - test brainstem functions to see if chance of recovery
If no response - patient is dead

Question 3

Brain stem death and pain?

Answer 3

Body is unable to feel pain when the brainstem died

Question 4

What should happen after a diagnosis of brainstem death has been made?

Answer 4

• Inform the family
• Allow time to say goodbye and have any religious/spiritual input they would like
• Discuss r.e. organ transplant

Question 5

DVLA rules for TIA

Answer 5

Group 1 license - no driving for 4 weeks. No need to inform DVLA

Group 2 - 1 year off.

Question 6

General DVLA rules

Answer 6

Group 1 - normal vehicles

Group 2 - HGV + often taxi’s. Typically always inform DVLA

Question 7

DVLA rules for Seizures

Answer 7

First/single with normal EEG/MRI
1 = 6 months
2 = 5 years

Medication change
1 = 6 months
2 = 5 years

Question 8

DVLA rules for ongoing simple partial seizures

Answer 8

1 = 1 year
2 = never

Question 9

DVLA rules for non simple partial seizures

Answer 9

1 = 1 year
2 = 10 years

Question 10

DVLA rules for withdrawal of anti-epileptic drug

Answer 10

1 = 6 months
2 = 10 years

Question 11

DVLA rules - unexplained syncope

Answer 11

Depend on risk

1 - low = 1 month, high = 6 months
2 - low = 3 months, high = 1 year

Question 12

DVLA rules for narcolepsy if untreated

Answer 12

Never

Question 13

DVLA rules following craniotomy

Answer 13

Non tumour:
1 = 6 months
2 = 2 years

High grade tumour:
1 = 2 year
2 = never

Question 14

DVLA rules for MI

Answer 14

ACS - untreated:
1 = 1 month
2 = 6 weeks (recommendation)

Successful PCI
1 = 1 week
2 = 6 weeks

CABG
1 = 4 weeks
2 = 3 months

Question 15

DVLA rules for Diabetes

Answer 15

Need DVLA assessment - usually provide 1-3 year license

Question 16

Conditions to think about dangers of flying

Answer 16

DVT
COPD
Diabetes

Question 17

Counselling r.e. flying for DVT

Answer 17

Advise r.e. general risk reduction - avoid alcohol
- remain mobile
- avoid tight fitting clothes on LL
- compression stockings

Consider Aspirin - polycythaemia

Consider LMWH - malignancy, personal or family Hx VTE, recent major surgery

Question 18

Counselling r.e. COPD for flying

Answer 18

If sats >95% on A at rest and pt. can go up flight of stairs or walk 50m without becoming overtly SOB - no issues

If less - consider resp assessment for supplemental in-flight O2
- ABG
- Hypoxic challenges

Question 19

Flight counselling for diabetes

Answer 19

If on insulin, need to carry with them.
Insulin shouldn’t be in hold as it can freeze
Carry something sugary
Dose adjust:
- reduce if flying east (shorter day)
- increase if flying west (longer day)

Question 20

Types of consent forms

Answer 20

1 - patient can consent themselves
3 - optional form for consenting patients which doesn’t involve impairment of consciousness
4 - lack capacity

Question 21

Key components regarding genetic testing

Answer 21

How test is performed

Allow time between discussion and making decision

Receive results in person

Discuss alternatives

Benefits
- early tx, prevention, screening
- poss. preimplantation genetic testing

Negative effects
- Life insurance policies + mortgage
- Implications of family members

Risk of inconclusive test

Issues with penetrance and effects of mutation
- may not necessarily get the disease

Question 22

Possible genetic conditions that may be tested

Answer 22

Huntington’s
Familial breast cancer
ADPKD, HNPCC etc.

Question 23

Key things to be aware of with Huntington’s in regards to genetic counselling

Answer 23

If affected parent, 50% chance they will have the mutation

If have mutation, will develop disease

Anticipation - develop symptoms earlier

No cure or treatments that can prevent disease

Benefits :
- negative test = peace of mind
- option for pre-implantation genetic testing for future pregnancies

Can’t say how disease will affect them

Question 24

Things to be aware of with breast cancer screening for a genetic counselling station

Answer 24

BRCA 1 - 80% breast, 40% ovarian. BRCA 2 - 45%

Negative test does not mean they will never get breast cancer.

Positive test doesn’t necessarily mean they will get breast cancer.

Can have treatment to prevent breast cancer

Advise r.e. reducing risk:
- lose weight
- reduce alcohol
- attend screening
- Increased risk breast cancer with OCP. Reduced risk ovarian cancer
- increased risk of breast cancer with progesterone containing HRT