pbl lobs

Question 1

clinical abnormalities of refeeding syndrome

Answer 1

hypomagnesiaemia, hypophosphataemia, hypokalaemia, and abnormal fluid balance

Question 2

what are the higher risks of refeeding syndrome:
lower BMI than 18.5
higher BMI than 18.5
chemotherapy
little nutritional intake for more than 10 days
unintentional weight loss more than 10% in 3-6 months

Answer 2

high risk:
BMI lower than 16, unintentional weight loss 15% in 3-6 months, little nutritional intake more than 10 days.
low risk:
BMI lower than 18.5, unintentional weight loss 10% in 3-6 months, little nutritional intake in more than 5 days, alcohol abuse, chemotherapy, insulin, diuretics

Question 3

What is the management for refeeding syndrome

Answer 3

if the patient has not been eating for more 5 ore more days, aim to re-feed at no more than 50% of daily requirements for the first two days

Question 4

What layers do you cut through during a tracheostomy

Answer 4

skin, subcutaneous fat, platysma muscle, thyroid, trachea

Question 5

What is the location of a emergency cricothyroidotomy

Answer 5

cricothyroid membrane

Question 6

What is the location of a tracheostomy

Answer 6

1-2cm inferior to the cricoid cartilage, between the 1st and 2nd tracheal ring

Question 7

What are the indications for a tracheostomy

Answer 7

cannot intubate or ventilate, laryngeal cancer or upper airway obstruction, pulmonary lung disease.

Question 8

What are the precautions for a tracheostomy

Answer 8

generally suctioning of secretions in the airway, humid airway and maybe a damp gauze in the hole

Question 9

two differences between cricothyroidotomy and a tracheostomy

Answer 9

1) one is in the cricothyroid membrane and other between the 1-2nd ring. 2) tracheostomy needs general/full anaesthesia

Question 10

What are the clinical features of upper airway obstruction

Answer 10

dysphagia, marked rep distress, inspiratory stridor, voice change, reduced breath sounds and tachycardia

Question 11

complications of tracheostomy

Answer 11

infection, collapsed lung, blocked tracheostomy tube

Question 12

what is a stridor

Answer 12

an high pitched inspiratory stridor suggestive of a tracheal or main bronchi obstruction

Question 13

presentation of oral cancer

Answer 13

recurrent mouth ulcers that do not heal, lumps in the neck or mouth that do not go away, dysphagia, unintentional weight loss,

Question 14

what is the needle and fluid is inserted into the neck for in a tracheostomy

Answer 14

needle is inserted into the space, apply negative pressure on the syringe and if air is found you are in a trachea

Question 15

risk factors for laryngeal carcinoma

Answer 15

smoking tobacco, drinking above the alcohol limit, unhealthy diet with low fruits and vegetables, exposure to asbestos and coal dust and stong family history

Question 16

Describe the social and historical developments that
have brought about changes in the meanings
associated with death and dying in contemporary
society

Answer 16

In many of the more traditional societies that continue
to exist around the world, the social processes
associated with dying and death remain culturally‘well
scripted’.
 This generally involves a distinct set of funeral rites
and mourning customs which serve to facilitate
the‘social death’ of a person following their ‘biological
death’.
 However, in modern high-income societies, this
intimate link between the biological and social death
of individuals has over time become more tenuous.
 In the past, death typically came suddenly, resulting
from traumatic injuries or acute infectious disease.
 However, with rising standards of living in the UK, with
improvements in public health infrastructures, and
more effective biomedical therapies, people began to
enjoy longer lives.
 As a consequence, the meanings and practices
associated with many traditional death rites in the UK
gradually lost much of their power.
 Death now typically comes after the prolonged
deterioration associated with chronic diseases in latter
life.
 This epidemiological shift has reversed the
traditional sequence: now social death typically
precedes biological death.
 The “work” of separating the dying from society
within hospitals and nursing homes, now routinely
occurs well before an individual’s definitive
biological death.
 Without what anthropologist’s term the ‘sheltering
canopy’ of cultural customs associated with death
and dying, the individual and their family can find it
difficult to achieve a satisfactory separation before
and after biological death.
 In such circumstances the lack of a cultural
script for dying, results in what has been
termed ‘disorderly deaths’, that is made all the
more painful because they typically occur in our
temples of hope - the modern hospital
(Joralemon:2002).Since the pre-modern period, much more rigid corporeal
boundaries now exist, both symbolic and actual, between
the dead and the living.
 This in part reflects the decline in the importance of the
sacred within modern secular societies, where death is
generally perceived as separated from life.
 It also reflects the decline in personal exposure to death
and dying associated with the ‘epidemiological transition’
(death occurring predominantly in later life and from chronic
disease).
 This decline in the culture of mourning in modern societies
has had important personal and social consequences for
the process of grieving for the death of a loved one.

Question 17

Describe the social and organisational processes that
are associated with the ‘medicalisation of death’
construct.

Answer 17

One of the major outcomes of this process of medicalisation
is termed iatrogenesis.
 ‘Clinical iatrogenesis’ refers to the potentially detrimental
consequences of medical interventions, but the process of
iatrogenesis goes beyond clinical interventions, and
involves the broader social and cultural spheres of life.
 The latter process is termed ‘cultural iatrogenesis’, and
refers to the way in which biomedical accounts serve to
undermine people’s ability to manage their own health, as
well as their autonomy in coping with pain, suffering, and
death. Leading to an ever greater reliance on medical
intervention to solve these issues.
 Related critical constructs such as ‘over-treatment’ and
‘heroic medicine’ also reflect this position that the
institutional focus on clinical intervention and treatment has,
until the recent past, too often blinded the medical
profession to attending to the needs of the dying patient.
That is, dying has too often been confused with illness
within the hospital environment.
 Hospitals seen as the institutional expression of the
modern desire to remove evidence of sickness and
death away from the public gaze (Mellor and
Shilling:1993).
 Bauman (1992) has argued that the nosologies
(classification of diseases i.e ICD-10) of biomedicine,
have inadvertently reduced death to nothing more than
a series of pathological anatomical and physiological
processes.
 This perspective sees the biomedical model as
inadvertently generating the illusion that death can
somehow be controlled.

Question 18

Outline the meaning of the concept of the ‘good death’.

Answer 18

(1) Awareness of Dying: A personal and social process
of greater openness about the prognosis of an illness
where it known that there is a high probability of death.
(2) Personal preparations and social adjustments: An
enablement of the settling of‘emotional accounts’.
(3) Public preparations: sorting out wills, putting practical
affairs in order.
(4) The relinquishing, where appropriate of formal work
roles. Too often it is automatically assumed that dying
individuals are beyond the age of retirement. This is
not the case with AIDS and forms of CHD and Cancer.
(5) A Good death involves formal and informal farewells.
 However, because a ‘Good Death’ involves the
gradual withdrawal from an individual’s social roles
and responsibilities, it requires the involvement of
other’s, family, friends, as well as appropriate
professional support.
 In doing so, it shifts death and dying from the
private to the collective sphere, thereby promoting
the social role of death in all our lives
However, because a ‘Good Death’ involves the
gradual withdrawal from an individual’s social roles
and responsibilities, it requires the involvement of
other’s, family, friends, as well as appropriate
professional support.
 In doing so, it shifts death and dying from the
private to the collective sphere, thereby promoting
the social role of death in all our lives.

Question 19

Outline the distinction that is drawn between ‘social’
and biological’ death.

Answer 19

In many ways, the origins of what was to become the
ideology of the ‘good death’ go back to the1960s and
the beginning of what became known as the ‘hospice
movement’.
 It was charitable organisations that first established
hospices as institutions for effective end of life care,
outside of the organisation of the NHS.
 Hospices sought to give more autonomy to the dying.
This involved proactive symptom management, and
attention to the religious, social and psychological
needs of the dying to achieve the normative goal of
accepting impending death.
 The hospice movement sought to ‘de-medicalise’ the
dying process and challenge the practices of clinical
professionals which frequently led to the isolation of
the dying patient within hospital.
 Whereas, hospice care was once on the periphery of health
care practice in the UK, it now constitutes part of a the much
wider shift in attitudes towards death and dying (discussed
above).
 The success of hospices led directly to the development of the
palliative care medicine specialism, and an associated shift in
professional practice.
 Professional attitudes have changed, with much greater
emphasis now placed on the emotional and psychological
dimensions of the experience of dying.
 The ‘medicalisation’ of death approach has become much less
pervasive in health care systems (Timmermans:2005).
 To the extent that the debate about the rights of individuals to
‘Assisted dying’ (voluntary active euthanasia and physician-
assisted death) has now opened up across European health
care systems

Question 20

define CPR

Answer 20

This is an emergency procedure for people
in cardio-respiratory arrest.in cardio-respiratory arrest.

Question 21

define DNACPR

Answer 21

Do Not Attempt Cardio Pulmonary
Resuscitation document states
resuscitation should not be attempted if a person suffers cardio-respiratory arrest..
 It is not legally binding if only a DNACPR document is
present
 An advance refusal of treatment (a legally binding advance decision) can give DNACPR legal grounding

Question 22

Outline the need for a DNACPR

Answer 22

CPR is unlikely to be successful (“futility”)
 The patient is mentally competent and does not want
to be resuscitated
 Patient lacks capacity but has a legally valid advance
directive stating that they do not want CPR
 Resuscitation is not in the best interests of the patient because the quantity and/or quality of life of the
patient following CPR is likely to be short/poor

Question 23

DNACPR & Competent Patients

Answer 23

It has long been recognised that competent adultsIt has long been recognised that competent adults
have the legal & ethical right to refuse treatment.have the legal & ethical right to refuse treatment.
This right includes theThis right includes the right to refuse life savingright to refuse life saving
treatment.treatment. Thus competent adult patients have theThus competent adult patients have the
legal & moral right to refuse CPR and demand alegal & moral right to refuse CPR and demand a
DNACPR order.DNACPR order.
 This right to refuse consent to treatment is vital toThis right to refuse consent to treatment is vital to
protect patientsprotect patients autonomyautonomy..

Question 24

DNACPR & Incompetent patients

Answer 24

 Where patients are incompetent, physicians must
Where patients are incompetent, physicians must
decide whether to issue a DNACPR order on the
decide whether to issue a DNACPR order on the
basis ofbasis of best interestsbest interests - MCA (2005)- MCA (2005)
 Questions:Questions:
 Can it ever be in a patient’s best interests not toCan it ever be in a patient’s best interests not to
be resuscitated?be resuscitated?
 Is this the same as saying that it is in theIs this the same as saying that it is in the
patient’s best interests to die?patient’s best interests to die?

Question 25

DNACPR & Advance Decisions

Answer 25

Competent patients, as we will learn shortly, can
issueissue advanceadvance decisions giving directives as todecisions giving directives as to
which treatments they do not wish to receive ifwhich treatments they do not wish to receive if
they become incompetent at a later datethey become incompetent at a later date
 AnAn advance decisionadvance decision can include acan include a communicationcommunication
to the effect that resuscitation should NOT beto the effect that resuscitation should NOT be
attemptedattempted
 This decision is legally binding (subject to someThis decision is legally binding (subject to some
caveats)

Question 26

define advanced decision

Answer 26

An advanced decisions is an oral or writtenoral or written
statementstatement, made by a, made by a competentcompetent individual, aboutindividual, about
how they would like to be treated in the futurehow they would like to be treated in the future ifif
they happen to fall ill and are no longer competentthey happen to fall ill and are no longer competent
to make decisions about their health care.to make decisions about their health care.
 Advanced decisions = advanced statements =Advanced decisions = advanced statements =
advanced directives = living willsadvanced directives = living wills

Question 27

DNAPCR orders

Answer 27

Effective recording of DNACPR decisions in a form
that is recognized by all those involved in giving carethat is recognized by all those involved in giving care
 Effective communication & explanation of DNACPREffective communication & explanation of DNACPR
decisions (where appropriate) with the patientdecisions (where appropriate) with the patient
 Effective communication & explanation of DNACPREffective communication & explanation of DNACPR
decisions (where appropriate & with due respect fordecisions (where appropriate & with due respect for
confidentiality) with patient’s family, friends etc.confidentiality) with patient’s family, friends etc.
 Effective communication of DNACPR decisionsEffective communication of DNACPR decisions
between all healthcare workers & organizationsbetween all healthcare workers & organizations
involved with the patientinvolved with the patient

Question 28

discuss the risks and benefits of cpr

Answer 28

he primary benefit of CPR is that it gives a
chance of extending life. However, the survivalchance of extending life. However, the survival
rates are low.rates are low.
 CPR is also invasive & includes the followingCPR is also invasive & includes the following
risks:risks:
 Rib/sternal fracturesRib/sternal fractures
 Hepatic/splenic ruptureHepatic/splenic rupture
 Prolonged ITU care (inc. ventilation & dialysis)Prolonged ITU care (inc. ventilation & dialysis)
 Brain damage following hypoxiaBrain damage following hypoxia
 “Traumatic” death“Traumatic” death

Question 29

Ethics of advanced decisions

Answer 29

Advanced decisions are advocated from an
ethical perspective because:
 Extend patient autonomyExtend patient autonomy
 It relies on a notion of precedent autonomy which recognises ourIt relies on a notion of precedent autonomy which recognises our
interests in making decisions about important matters in ourinterests in making decisions about important matters in our
futurefuture
 Improve patient welfare because patients will be less anxious aboutImprove patient welfare because patients will be less anxious about
the possibility of unwanted treatmentsthe possibility of unwanted treatments
 Advanced decisions are opposed from an ethicalAdvanced decisions are opposed from an ethical
perspective because:perspective because:
 What reasonably healthy patientsWhat reasonably healthy patients thinkthink they want when they arethey want when they are
very ill is often not what they want when they are very illvery ill is often not what they want when they are very ill
 The advanced decision may not be specific enoughThe advanced decision may not be specific enough
 People may change their mind, but fail to communicate this factPeople may change their mind, but fail to communicate this fact

Question 30

The legality of advanced decisions

Answer 30

he Mental Capacity Act 2005Mental Capacity Act 2005 clearly states thatclearly states that
advanced decisions are legally binding and mustadvanced decisions are legally binding and must
be respected (subject to important caveats)be respected (subject to important caveats)
 Failure to adhere to the patients wishes asFailure to adhere to the patients wishes as
expressed in a valid advanced decision may lead toexpressed in a valid advanced decision may lead to
a charge ofa charge of assault or batteryassault or battery

Question 31

Discuss when a advanced decision is not valid

Answer 31

Before losing capacity the individual annuls the
advanced directiveadvanced directive
 There is evidence that the patient has changed his mindThere is evidence that the patient has changed his mind
regarding the advanced directive.regarding the advanced directive.
 The advanced directive does not refer specifically to theThe advanced directive does not refer specifically to the
situation at handsituation at hand
 There are reasonable grounds for thinking thatThere are reasonable grounds for thinking that
circumstances now exist, which the patient did notcircumstances now exist, which the patient did not
anticipate, & which would have affected the patientsanticipate, & which would have affected the patients
decisions had he anticipated them.decisions had he anticipated them.
 The patient has created a lasting power of attorneyThe patient has created a lasting power of attorney
since the advanced directive was writtensince the advanced directive was written

Question 32

outline the PICOS framework; An Answerable Question
In randomised controlled trials, which
include children who have acute otitis
media treated in primary care, does a
course of antibiotics, in comparison to
a matching placebo, make a difference
to pain duration, side effects, time out
of nursery, long term hearing
problems or mastoiditis.

Answer 32

*Patient characteristics
*Intervention
*Comparison
*Outcome
*Study Design

Question 33

who is legally responsible for a prescription and what is the four fold duty

Answer 33

Four-fold duty
 correct patient name & drug name
 no contraindications
 correct dose and directions are
given
 provision for appropriate
monitoring & follow up

Question 34

norwell’s 10 commandments

Answer 34

Notes to be legible
 Date and Time of Consultation
 Signed by name and printed underneath
signature
 Use only approved/unambiguous abbreviations
 Never alter or disguise entries
 No insulting or ‘humorous’ comments
 Check everything written in your name
 See and evaluate notes thoroughly before filing
 Do not dispose of notes

Question 35

A nurse practitioner saw a newly registered
patient with a healthcare student in the room.patient with a healthcare student in the room.
During the consultation the nurse referred toDuring the consultation the nurse referred to
the patient’s HIV+ status. This wasthe patient’s HIV+ status. This was
mentioned in his transferred [electronic]mentioned in his transferred [electronic]
records. The patient was horrified and saidrecords. The patient was horrified and said
that he only wanted his GP and consultant tothat he only wanted his GP and consultant to
know about this diagnosis.know about this diagnosis.
 Does the patient have the moral/legal rightDoes the patient have the moral/legal right
to deny access to some health careto deny access to some health care
professionals and/or healthcare students?professionals and/or healthcare students?

Answer 35

a patient objects to particular personal information being shared for their own care, you should not disclose the information unless it would be justified in the public interest,12 or is of overall benefit to a patient who lacks the capacity to make the decision. You can find further guidance on disclosures of information about adults who lack capacity to consent in paragraphs 41 - 49.

31
You should explain to the patient the potential consequences of a decision not to allow personal information to be shared with others who are providing their care. You should also consider with the patient whether any compromise can be reached. If, after discussion, a patient who has capacity to make the decision still objects to the disclosure of personal information that you are convinced is essential to provide safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information

Question 36

difference between enteral and parenteral nutrition

Answer 36

enteral: through the gastrointestinal tract, parenteral: through the circulation- IV

Question 37

which type of shock has hypotension and bradycardia

Answer 37

neurogenic

Question 38

which types of shock have decreased CO and decreased TPR

Answer 38

septic and anaphylactic

Question 39

define inotropic, dromotropic and chromotropic

Answer 39

ino: contractility(force of contraction), dromo: conduction chromo: heart rate

Question 40

what are the alpha and beta receptors on the heart and their effect

Answer 40

beta1: contractility and heart rate, alpha1: contractility

Question 41

what are the alpha and beta receptors on the blood vessels and their effect

Answer 41

alpha 1 and2: constriction beta2: dilatation

Question 42

cholinergic receptor on heart and what does it do

Answer 42

m2 bradycardia

Question 43

draw out the clotting cascade

Answer 43

https://www.youtube.com/shorts/rY0dpkSxcOo

Question 44

sizes of small, medium and large sized AAA and management

Answer 44

If small AAA (3-4.4cm) – offered yearly repeat ultrasound
If medium AAA (4.5-5.4cm) – offered repeat ultrasound every 3 months
If large AAA (>5.5cm) – surgery generally recommended.The two main surgical options are open repair or Endovascular Aneurysm repair (EVAR).
The indications for repair are size >5.5cm or rapid expansion.

Question 45

worse prognostic factor for ALL:
WBC more than 10,000
more than 10 years
white ethnicity
testicular filtration
WBC more than 500,000

Answer 45

male, WBC more than 200,000, black, splenomegaly, testicular infiltration, CNS involvement, less than 1 or more than 10 years, hypoploidy

Question 46

different myeloid haematological malignancies

Answer 46

AML, myeloproliferative disorders: CML, myelofibrosis, essential thrombocytosis and polycythaemia

Question 47

different lymphoid haematological malignancies

Answer 47

CLL, ALL, lymphoma and myeloma

Question 48

which what are the four stages of ALL treatment. Which leukaemia is linked to downs syndrome

Answer 48

induction, consolidation, CNS prophylaxis and maintainence. AML is associated with downs

Question 49

which leukaemia develops into high grade non-hodgkins lymphoma and which ones are sudden onset

Answer 49

CLL (richter’s syndrome) , sudden: ALL and AML

Question 50

philadelphia chromosome, tyrosine kinase inhibitor, most common, BCR ABL

Answer 50

CML

Question 51

pruritis, plethora, JAK2 mutation

Answer 51

polycythaemia

Question 52

JAK2 mutation, digital ischaemia, recurrent abortions, budd-chiari

Answer 52

essential thrombocythaemia

Question 53

gout, platelet derived growth factor, teardrop and dry tap, extramedullary haematopoesis, megakaryocyte proliferation

Answer 53

primary myelofibrosis

Question 54

lytic lesions on the skull and plasma cell infiltration in bone marrow aspirate

Answer 54

multiple myeloma

Question 55

8 types of childhood cancers

Answer 55

leukaemia, bone cancer, brain cancer, lymphoma, neuroblastoma, wilms, rhabdomyosarcoma, retinosarcoma

Question 56

causes of petechial rash in adults and children

Answer 56

adults: ITP, DIC, bone marrow failure, drugs and nutritional deficiencies
children: meningiococcal sepsis, ITP, ALL, Henoch-Schonlein purpura

Question 57

6months landmark for gross motor, fine motor, language, social

Answer 57

sits up unassisted, palmar grasp, lalalalal, puts food in thier mouth

Question 58

when do they smile, crawl, runs, pincer grip

Answer 58

6 weeks, 9 months, 2-5 years, 10 months

Question 59

when do they walk and on tiptoes, tower of 3, 6, 8

Answer 59

walk from 12-18 months

Question 60

when can they draw a line, circle, square and triangle

Answer 60

2 years, 3 years, 4 years and 5 years

Question 61

what promotes a secure attachment style

Answer 61

Parents aware of infants signals
 Parent’s accurately interpreting signals
 Parent responsiveness of signals.
 Parent responding appropriately.
 More broadly, parents should be able to mentalize- appreciate the
child’s perspective and see the child as a separate person, not just
something that has to have its needs met.

Question 62

If no capacity MHU(CT) Regulations 2004 requires

Answer 62

that consent must be obtained from a “legal
representative” (e.g. an adult’s close relative)
 that research must be likely to benefit the patient or other people who suffer from the same condition
 that efforts are made to gain consent and that any consent and that any
sign of dissent should be taken seriously
 Is research always in the best interests of the participant? (cf. MCA 2005)

Question 63

equipose

Answer 63

In order for research (especially
interventional research) to be
justified it if often argued that
there must be genuine uncertainty
over whether or not the treatment will be beneficial. This is knows as
equipoise.
 Once there is sufficient evidence
the research is usually stopped
since clinical equipoise is not met

Question 64

when do we use placebos

Answer 64

Placebo controlled trials can be empirically and ethically acceptable especially where there is no alternative treatment available or if the research is non-therapeutic (e.g. phase non-therapeutic (e.g. phase 1 trial).

Question 65

what are REC’s

Answer 65

are local (LREC) or multi-centre (MREC)
 have 12-18 members (the membership must be balanced and must include lay people)
 offer ethical review but do not give legal advice.

Question 66

what do publication ethics involve

Answer 66

The pressures of “publish or perish” culture
 Biased trials and biased publications
 Potentially problematic pharmaceutical
involvement and perverse incentives

Question 67

facts and figures of drug testing

Answer 67

All drugs licensed for use in Britain have been
tested on animals.
 The number of experiments had been declining (1970s-1990s) but increasing again now.
 280 institutions currently carry out regulated procedures in the UK:
 Universities 40%
 Commercial companies 37%
 Charities 6%
 Government departments 5%
100 million animals are used in testing worldwideworldwide
 2.66million animals used in UK:
 52% for medical or veterinary research
 34% for fundamental scientific research
 66% for cosmetic research
 Rodents (e.g. rats) most commonly used (84%)
 Research with great apes - gorillas, chimpanzees,
orangutans and bonobos - was banned in 1998.

Question 68

What is the criterion which distinguishes animals from humans?

Answer 68

Criteria:
 Sentience / Ability to feel (esp. pain)?
 Reason/Rationality/Consciousness?
 Capacity for Moral Agency?
 Being human?

Question 69

The 3Rs of Ethical
Animal Experimentation

Answer 69

Replacement: Non-animal methods to be used where possible
 Reduction: The number of animals used should be kept to a minimum
 Refinement: The smallest amount of pain & distress should be caused to animals& should be caused only for a justifiable purpose.

Question 70

The Animals (Scientific Procedures) Act
1986:

Answer 70

regulates the use of all “protected” laboratory
animals where the research procedures might “cause “pain, suffering, distress or lasting harm”
 provides for special protection for primates, cats, dogs and horses
 requires that there be an ethics committee in institutions

Question 71

what should registered medical professionals do for notifiable diseases

Answer 71

1. A RMP has “reasonable grounds for suspecting” that a patient
   has a ND (or a disease which risks serious harm)
2. The RMP has a statutory duty to notify a “Proper Officer” of the local authority (e.g. CCDC)
3. Notifications of infectious diseases prompts local investigation and action to control the diseases. Proper officers are required to inform PHE of anonymised details of each case of each disease that has been notified.
4. PHE collates the weekly returns from proper officers and publishes analyses of local and national trends
   RMPs should NOT wait for laboratory confirmation.
   They should report if they have clinical suspicion.
   There are clear time limits for reporting:
   3 days max to report a case (in writing)
   24 hours max for urgent cases (by phone) and then asap in writing
   [The prime purpose of the notifications system is timely response to cases, clusters and epidemics of infectious diseases and incidents on non-infectious health hazard, in order to prevent further transmission or spread of disease.]

Question 72

notifiable disease

Answer 72

Acute encephalitis
Acute poliomyelitis Acute infectious hepatitis Anthrax Botulism
BrucellosisDiphtheria
Enteric fever Cholera
Food poisoning
Haemolytic Uraemic Syndrome
Leprosy
Infectious bloody diarrhoea Legionnaires’ Disease
Malaria Measles Invasive group A streptococcal disease Plague Rabies
Rubella SARS
Smallpox Tetanus
Tuberculosis Typhus
Viral haemorrhagic fever Whooping cough
Yellow fever SARS-Cov-2 Meningococcal septicaemia Mumps

Question 73

coronavirus act 2020

Answer 73

Signed by SoS 6.50am 10th feb 2020
 Can hold in isolation
 Police can return to isolation
 Can enforce 14d period
 Requires DPH to declare a risk, with travel
from infected area
 References Public Health [Control of Disease
] Act 1984
 Superseded by Coronavirus Act 202

Question 74

difference between reportable and notifiable disease

Answer 74

In addition to notifiable diseases there are also certain
categories of reportable diseases where employers must be reported to HSE if a doctor believes disease to be employment related

Question 75

Powers of Detention I
 An application can be made by a local authority under
s37of the 1984 Act to a JP for a Part 2A Order to Order to detain a patient when

Answer 75

precautions to contain a ND are not being taken
 there is a serious risk of harm to others
suitable NHS accommodation is available

Question 76

limitations of detention III for having a notifiable disease

Answer 76

Neither s37 nor s38 of the 1984 Act, even as
amended, provides specifically for treatment (or vaccination) of a patient with a ND once the patient has been detained.
 S 40 allows for the compulsory examination and detention of a patient found in a common lodging
house with a view to ascertaining whether he is suffering/has suffered from a ND – but again no treatment can be required

Question 77

The HRA 1998

Answer 77

The HRA 1998 applies to public (e.g. NHS)
 Articles Art 5 (liberty) & Art 8 (privacy) have a bearing on the detention of non-adherent patients
 ss 37 & 38 may not be compatible with HRA –
although recent amendments may help
 An automatic review system has been proposed & more rigorous requirements of proof of serious risk

Question 78

Giving HIV+ result

Answer 78

Be prepared
 Give immediately
 Allow space
 Don’t make assumptions
 Clarify understanding
 Avoid information overload
 Assess self-harm risk
 Arrange follow-up support

Question 79

the kubler ross model

Answer 79

https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=-tklqDo1JcjBjM&tbnid=krY6ejLrZ0H8ZM:&ved=0CAUQjRw&url=https://www.lucidchart.com/community/examples/view/4d41e4e1-4754-4c38-8c81-19b20ac17bf0&ei=NzZOU-TuIMmtO6S4gJAN&bvm=bv.64764171,d.ZWU&psig=AFQjCNEw2NzKfS3qen1BXAqZmRDqkVCcuw&ust=1397720968345115

Question 80

PROBLEMS OF COMPARING SCREEN
DETECTED VS NON-DETECTED DISEASE
(non-randomized comparison)

Answer 80

LEAD TIME BIAS
Earlier diagnosis leads to spurious improvement
in prognosis
* LENGTH BIAS
Screening more likely to detect slow-growing disease
SELECTION (REFERRAL) BIAS
Better prognosis among people who attend
screening vs those who do not
This emphasizes the need for really good randomized
controlled trials to evaluate screening programmes

Question 81

HTA 2004 deceased donations

Answer 81

No need for HTA approval
 If patient consents this is sufficient
If patient refuses to consent (‘opts out’) this must be respected
If patient has nominated a person to make the decision then the nominee can give proxy consent
If patient has not expressed any wishes either way people the donation is on the basis of ‘deemed consent’ with consultation with family

Question 82

excluded groups of HTA act

Answer 82

Those under the age of 18
 People who lack the mental capacity to understand the new arrangements and take the necessary action Visitors to England, and those not living here voluntarily
People who have lived in England for less than 12 months before their death

Question 83

Pros and cons of ‘deemed consent

Answer 83

PROS
 Beneficence – could save lives
 Maximizing utility(?)
Autonomy - consistent with a
view of a majority so
presumably better for autonomy
 Autonomy – neutral for
autonomy as replaces asking relatives for consent
 Alleviates some burned on family members
CONS
Autonomy: Potential
violation of donors
autonomy/nonsensical
 Is the organ no longer a)gift or donation(?)
Psychological harm to
family members (?)
 Misses the point
 Public trust/consequences

Question 84

Difference between quality planning, quality control, quality assurance and quality improvement

Answer 84

1. A surge in obesity in the local population has led to an increase in type
   II diabetes, hospital services are swamped and there is a need to review
   how care for diabetics is provided. Quality Planning
2. A GP practice reviews diabetic patients each year with a target that
   90% of diabetics will be seen for a foot check with a nylon thread of the
   correct diameter Quality Control
3. An intermediate diabetes service decides to survey all users of the
   service in the last three months to review the quality of care with respect
   to access, advice provided and any unmet health needs. Quality
   Assurance
4. A diabetes unit discovers that there are a significant number of type 1
   diabetics are never seen, and control is poor for this cohort. Quality
   Improvement

Question 85

methods and sources to collect data

Answer 85

Patient notes / records
* Staff / patient surveys (e.g. electronic)
* Interviews / focus groups
* Complaints / incident reports
* Clinical assessment
* Direct observation
* Pre-existing statistics: primary & secondary
care databases/morbidity/mortality/process
outcomes

Question 86

different types of outcomes

Answer 86

Outcome measures e.g. DVT Eg: Aim to reduce incidence of DVTs
Outcome = no. of patients presenting to GP/hospital with DVTs postop.
* Process measures e.g. Prescription Measures the changes you have made
* Easier to measure
* Show whether the process is working
* Balancing measures e.g. bleeds/cost: Measure other consequences
associated with the changes (side
effects- like a medication)
* Help show overall impact
* Not always necessary
* Structural measures e.g. availability: Structural measures look at the
environment in which healthcare is
being provided
* Including material resources (e.g.
electronic records), human
resources (e.g. staff expertise), and
organizational structure
* Not always necessary

Question 87

What is a chronic disease?

Answer 87

Long duration (3 months or more)
* Generally slow progression (though not always)
* May include periods of remission and relapse
* Current medical interventions can usually only control, not cure
* The life of a person with a chronic illness is forever altered – there
is no return to “normal”
* Impact on quality of life

Question 88

Crisis Theory of Chronic Illness

Answer 88

https://canvas.sgul.ac.uk/courses/4149/pages/pps-lecture-psychology-of-chronic-illness-dr-linda-perkins-porras

Question 89

coping strategies

Answer 89

Denying / avoiding
* Blaming self or others
* Guilt &/or shame
* Seeking information
* Acceptance
* Gaining a manageable perspective
* Adherence to treatment – medication, physio, diet etc
* Self management - Learning to provide own medical care
* Setting concrete, achievable goals
* Recruiting practical & emotional support from family & friends
* Considering possible future events and planning

Question 90

Perceptual-Practical Model of Adherence

Answer 90

Unintentional
non-adherence
Capacity &
Resources
Practical barriers

Motivational
beliefs/preferences
Intentional
non-adherence
Perceptual barriers
Motivational
beliefs/preferences
Intentional
non-adherence
(Horne, 2009)

Question 91

The Necessity-Concerns Framework

Answer 91

Operationalisation of the perceptual factors involved in intentional
non-adherence
Reflects a balance between personal beliefs about:
* The necessity of taking treatment/medication
* The concerns about taking the treatment/medication

Question 92

Psychological interventions for chronic
conditions

Answer 92

Educational, social support & behavioural approaches: Helpful to both
patient & family/carers
 Information provision
 Support groups, respite provision
 Training for self-care procedures
 Behavioural approaches to improve compliance (reminders, rewards)
* Relaxation & biofeedback
 Management of stress, anxiety

Cognitive methods: Helpful in changing feelings & thought processes
 Challenge & change incorrect and unhelpful beliefs
 Think more constructively & realistically
 Treat depression
* Insight & family therapy
 Deal with anxiety, changed self-concept
 Understand needs of family & friends
Acceptance & Commitment Therapy

Question 93

three phases of habit formation

Answer 93

Habit formation process: Three
phases
1. Initiation phase – define the new behaviour and context in which it
will be practiced
2. Learning phase – behaviour is repeated in chosen context to
strengthen the context-behaviour association
3. Stability phase – the habit has formed and its strength has plateaued,
habits persists over time with minimal effor

Question 94

COM-B model for taking medication

Answer 94

Capability
·Comprehension of disease and treatment
·Cognitive functioning—memory
·Dexterity to take medication
·Convinced that the treatment is beneficial
Opportunity
.Access (availability of medication)
.Cost (prescription £)
.Social support – approval, encouragement
.Religious and cultural beliefs
Motivation
.Perception of illness (chronic/acute)
.Beliefs about treatment
.Self-efficacy
.Associated with benefit
Target behaviour =
Take medication regularly

Question 95

Motivational Interviewing Principles

Answer 95

R: olling with resistance
Avoid telling the patient what to do, persuasion or
argument. Instead reflect & re-frame
U:nderstand motivations Understand values, needs, abilities, motivations and
barriers to change behaviours.
L: isten with empathy Seek to understand from the patients perspective
Respect decisions and choices
E: mpower Help patient to explore how they can make changes
Encourage patient to come up with own solutions
1. Open questions
2. Affirmation
3. Reflection
4. Summarising

Question 96

“A 55 year old male music teacher,
presents to his GP. He is overweight and
sedentary. He knows he needs to be
physically active but discusses his failed
attempts to make physical activity
habitual. He wants to become healthier
but does not know where to start”
How might the GP help this patient get into
the habit of regular, planned physical
activity?

Answer 96

Supporting change behaviour
 Define new behaviour – patient chooses
 Understand barriers to behaviour change
 Increase motivation – motivational interviewing
approach
 Choose an appropriate context to perform action ‘cue’
 Action planning & goal setting
 Goal setting needs to be SMART (Specific, Measurable,
Achievable, Realistic, Timely)
 Repetition!
 Review
Patient
example

Set small manageable goals
2. Focus on selecting a new habit
3. Disrupt the unwanted habit
4. Identify cues
5. Focus on long-term outcomes/reward

Question 97

The law states that the existence of a mental disorder
does not equate to a lack of mental capacity

Question 98

Statutory Homelessness

Answer 98

Unintentionally homeless and in priority need
* Intentionally homeless in priority need
* Homeless but not in priority need
* Local connection
* Hidden Homelessness

Question 99

The social structuring of dependency in
older age

Answer 99

The assumption of retirement policies such as exists in the UK,
is the idea that older age brings with it a reduction in
productivity and long-term health problems which affects the
ability to fully participate in the labour market beyond the age
of 66.
 These are ageist assumptions and reflect a normative set of
social and cultural expectations about the age at which people
should ‘transition’ to from the world of work to enforced
retirement (and for many, dependence on the limited state
pension).
 With the ‘transition’ in role status post-retirement come another
set of normative assumptions. This involves the assessment of
an individuals relative ‘success’ in maintaining their
independence in the activities of daily life.
 Those who are seen to require support are frequently
stigmatised as ‘dependent’
If older age is socially constructed as a period of
dependency in the life course, this belief can act as a
barrier to older people maintaining their pre-existing
interactions and activities ( ‘active ageing’).
 A reciprocal relationship has been found to exist
between social participation and health, such that low
levels of social participation lead directly to poorer
health outcomes.
 A system of social care should in principle be focused
on supporting initial care needs in order to reduce the
risk of dependency further down the line.
 However, in the UK, the social care system has
historically been underfunded, and so has focused
limited resources on what is known as ‘firefighting’,
managing problems as they arise rather than
developing long-term strategies of prevention.

Question 100

The 2014 Care Act

Answer 100

1. Managing and maintaining nutrition
2. Maintaining personal hygiene
3. Managing toilet needs
4. Being appropriately clothed
5. Being able to make use of the home safely
6. Maintaining a habitable home environment
7. Developing and maintaining personal relationships
8. Accessing and engaging in work, education or volunteering
9. Making use of facilities in the local community
10. Carrying out any caring responsibilities

Question 101

difference between DSM and ICD criteria

Answer 101

ICD was developed by the world health organisations and covers all disorders into 11 groups
DSM was developed by the american psychological association, it only covers mental health disorders in 18 groups

Question 102

advantages and diasadcantages for mental health disorders

Answer 102

advantages: * Diagnosis
* Shorthand communication
* Frames the problem
* Guidance for treatment
* Indication of prognosis
* Offers the patient an explanation
* Demystification of mental illness
disadvantages:
Labelling and stigmatization
* Illusion of understanding
* Limited information
* Some categories contentious & unreliable
* Difficulties if >1 condition

Question 103

diagnostic pyramid for disorders

Answer 103

personality disorders, neurotic disorders, affective disorders, psychotic disorders and organic

Question 104

biopsychosocial model of mental health illness

Answer 104

Biological
 Physical disorders and insults
 Genetic factors
 Changes in brain structure and functioning
 Psychological: Body of knowledge concerned with the emotional bonds
and affective interactions between human beings and the
psychological and psychopathological consequences
which arise when these process go awry
 Temperament and personality
 Psychodynamic and attachment theory
 Self-esteem
 Cognitive (IQ)
 Social / environmental
 Families
 Cultural
 Religion
 Social networks; neighbourhoods; work and school
 Life events (trauma)
 Socio-political factors; war and conflict; socio-economic
disadvantage

Question 105

CHILD SAFEGUARDING PRINCIPLES- GMC 2018

Answer 105

All children and young people have a right to be protected from abuse and neglect.
 All clinicians must consider the needs and well-being of children and young people.
 Decisions about child protection are best made with others.
 Clinicians must be competent to deal with child protection issues

Question 106

INDICATORS OF NON-ACCIDENTAL INJURY

Answer 106

INDICATORS OF NON-ACCIDENTAL INJURY
 Inconsistent history/information presented that does not fit with clinical signs
 Delay between injury and presentation
 Bruises- shape suggestive of hand/ligature marks, location not in keeping with level of mobility, multiple bruises
of varying ages on non-bony prominences
 Bite marks
 Watchful/subdued child
 Burns- clearly delineated lines (?immersion), shape (eg. Cigarette burns), location (buttocks/soles of feet)
 Fractures- different ages, spiral fractures, occult rib fractures.
 Intracranial injuries.

Question 107

STRATEGIES FOR MANAGING MEDICAL UNCERTAINTY

Answer 107

Empower yourself with relevant knowledge- be aware of the guidelines and their limitations, practice risk communication
 Consider your clinical and communication skills and how best to reduce patient uncertainty
 Be honest with patients where information is unclear or unknown
 Approach management as a shared-decision making process
 Don’t be afraid to ask for help- involve colleagues who can help you where needed
 Make provision for safety-netting +/- follow-up to ensure your shared plan has had the desired outcome

Question 108

Five Factor Model of
Personality

Answer 108

Introversion – extroversion
 Neuroticism
 Agreeableness
 Conscientiousness
 Openness
n detail - people high in extraversion and low in
neuroticism tend to see events and situations in
a more positive light, and tend to discount
opportunities that are not available to them.
 Differences in conscientiousness,
agreeableness, and openness to experience
are less strongly and consistently associated
with SWB

Question 109

Depression Diagnostic
Criteria DSM IV

Answer 109

5 or more of the following at least one is
either 1 or 2. Most of the day, nearly
every day:
1. Depressed mood
2. Markedly diminished
interest/pleasure in all activities
3. Sig weight loss/wt gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness/ excessive
or inappropriate guilt
8. Decreased ability to think/concentrate
9. Recurrent thoughts of death,
recurrent suicidal ideation

Question 110

MENTAL CAPACITY ACT 2005

Answer 110

Every adult has the right to make his/her own
decisions and must be assumed to have capacity to
do so unless it is proved otherwise
 Everyone should be encouraged and enabled to
make his/her own decisions, or to participate as fully
as possible in decision-making, by being given the help
and support s/he needs to make and express a choice
 Individuals must retain the right to make what might
be seen as eccentric or unwise decisions
Decisions made on behalf of people without
capacity should be made in their best interests,
giving priority to achieving what they themselves would
have wanted
 Decisions made on behalf of someone else should be
those which are least restrictive of their basic rights
and freedoms.

Question 111

THE CRITERIA FOR CAPACITY IN
MCA 2005

Answer 111

For the purposes of the Act, a person is unable to make
a decision for himself if he is unable to:
 (a) understand the information relevant to the decision
 (b) retain that information
 (c) use or weigh that information as part of the process of
making the decision, or
 (d) communicate his decision (whether by talking, using sign
language or any other means).
 The fact that a person is able to retain the information
relevant to a decision for a short period only does not
prevent him from being regarded as able to make the
decision.
 Note ‘belief’ has been removed from the test

Question 112

BMA/Law Society guidelines suggest that
individuals should be able to:-

Answer 112

understand in simple language what the medical treatment
is, its nature and purpose and why it is being proposed;
* understand its principal (note not all!) benefits, risks and
alternatives;
* understand in broad terms the consequences of not
receiving the proposed treatment;
* retain the information for long enough to make an
effective decision; and
* make a free choice

Question 113

HOW TO MAXIMISE
CAPACITY

Answer 113

appropriate timing and location
 treating inhibiting conditions
 diagrams
 educational models
 videos and audio
 translators and interpreters
 time

Question 114

WHERE A PATIENT IS NOT
CAPACITOUS

Answer 114

s there a valid Lasting Powers of Attorney [LPA] or advance
decision?
 Treat in patient’s best interests (construed holistically and not
limited to best medical interests) on the basis of ‘necessity’
 Is there anyone who can advocate the patient? (Note the role of
the Independent Mental Capacity Advocate [IMCA] Service)
 Document all assessments and rationale for
conclusion/decisions

Question 115

best interests of a patient

Answer 115

The legal concept of best interests (S.4 in MCA) puts weight
on patients’
1) past and present wishes and feelings (including any
written statements)
2) beliefs and values that would be likely to influence
his/her decisions
3) other factors that the patient would be likely to consider
* including the views of proxy decision makers
it is important to not make assumptions
consider all relevant circumstances relating to the patient
consider if the patient was to regain capacity, the decision maker must involve the person as much as possible, for life-sustaining treatment the patient must not be desired by the patients death

Question 116

ABSMTPCI

Answer 116

a ppearance, behaviour, speech, mood, thoughts, perception, cognition and insight

Question 117

Qualitative work has a role in health research

Answer 117

Qualitative work has a role in health research for
example, in addressing the ‘gap’ between evidence-
based approaches based on the findings of RCT`s, as
a population-orientated investigation, and the practice
of clinical decision-making in individual cases.
 The more individualised the clinical intervention, the
greater the role for qualitative work in the evaluation
of outcomes.
 Qualitative research can also help us to understand
why for example promising clinical interventions do
not always work in the real world; how patients
experience care; and practitioners reflections on their
engagement in patient care

Question 118

Qualitative Research Evaluation Criteria

Answer 118

Qualitative research cannot be judged by the same
measures of validity ( whether the research instrument
measures what it aims to measure) and reliability (the
reproducibility and consistency of the instrument
used), as applied to quantitative research.
In terms of generalisability, evaluation of qualitative
research focuses on the potential for transferability. Of
the ‘situated’ or contextual findings using small
samples
Qualitative research analysis should be able to
incorporate all observations and not leave out any
unexplained variance (‘confounding variables’) or
deviant cases’ (there are no normal distribution curves for qualitative material).  That is, it should seek to embrace social complexity rather than seeking to ‘reduce’ the data by eliminating ‘outliers’ / deviation from the mean.  Qualitative research should not be confined to an exploratory’ research role, but aim to achieve an
analytical depth rooted so offering the possibility of
generating formal hypothesis (that may then be tested
by the use of quantitative surveys).
Qualitative research should not be producing lists of
interpretative categories (applied to
interview/observation data) based purely on
`common-sense’ knowledge.

Question 119

The Social Causation /
Social Determinants Model

Answer 119

Mental illness is an objective, measurable ‘social fact’.
 The aetiology of mental illness can be explained
largely in social epidemiological terms.
 There are identifiable social factors correlated with a
predicable incidence of mental illness; depression in
particular.
 Social class is identified as key correlate of `social-
stress’.

Question 120

The impact of Neuroscience

Answer 120

The influence of the neurosciences represents a further
paradigm shift in the conceptualisation of mental illness as
a disorder of brain functioning.
 If the brain is perceived to be a material and self-contained
physiological system that can be known and therefore
predicted, then (in theory) it opens up mental illness to
effective interventions.
 Over the past two decades, developments in molecular
biology and in brain imaging have enabled neuroscientists,
to develop new ways of identifying neurophysiological
mechanisms, and psychopharmacologists to develop new
drugs to effect mood, behaviour, and to seemingly enhance
cognition.

Question 121

Social constructionism

Answer 121

Labelling theory focuses on the societal reaction to,
and categorisation of, behaviour that does not
conform to social roles and norms.
 The more socially visible the ‘deviant’ behaviour,
then usually the greater the chance of being labelled
as having a mental health problem.
 In acquiring the power to define ‘madness’, the
profession is seen as having taken on the (social)
authority to control and manage individuals now
defined as ‘insane’.
 As such, the designation of madness as psychiatric
illness was, ‘not a discovery of an objective truth but a
result of the convergence of internment and medicine’
(Cousins and Hussain:1984;139).
 Or as Foucault himself describes it, the imposition of
the new psychiatric ‘gaze’ meant that, ‘the victim of
mental illness is entirely alienated in the real person of
his doctor, the doctor dissipates the reality of the
mental illness in the critical concept of madness’
(Foucault:1967/1989;86).
 Insanity was now increasingly came to be seen as
curable, and patients urged in the direction of self-
restraint and self-control – an approach that became
known as the “Moral Treatment”

Question 122

Mental Health Act; functions

Answer 122

Enable the state to enforce hospital admission for the
assessment/treatment of patients with mental disorder
* For the protection of the patient
* For the protection of others
* Provide mechanisms (including appeal) to ensure such
powers are not misused
* English law suggests it is right to override a patient’s
refusal to treatment on the grounds of
* Best interests
* Mental disorder

Question 123

When the MHA is not needed

Answer 123

The majority of patients with mental disorders are
assessed and treated in circumstances where the
MHA 1983 (2007) does not (usually) apply:
* Competent patients who voluntarily consent to
assessment and treatment [common law]
* Incompetent patients where treatment is in their best
interests [Mental Capacity Act 2005]

Question 124

Non voluntary admission
* The key forms of mandatory admission are:

Answer 124

• S 2: admission for assessment
• S 3: admission for treatment
• S 4: emergency admission
• S 5(2): detention of patient already in hospital
• S 5(4): detention by a nurse

Question 125

Section 2: admission for
assessment

Answer 125

• 28 day detention
• Application made by nearest relative or AMHP and
  supported by 2 Drs (1 a specialist)
• Patient must be suffering from a “mental disorder of a
  nature or degree” warranting admission for assessment and
  this must be in the “interests of his own health or safety or
  the protection of others”
• Appeal via MHRT

Question 126

Section 3: admission for
treatment

Answer 126

Up to 6 month detention period (renewable and reviewable at 6
months and then every 12 months)
* Application made by nearest relative or AMHP and supported by
2 Drs (1 a specialist)
* Patient must be suffering from mental disorder for which they
need Rx in hospital and it is necessary for health or safety of
patient or others that Rx be given and appropriate medical
treatment is available
* Appeal via MHRT
Up to 6 month detention period (renewable and reviewable at 6
months and then every 12 months)
* Application made by nearest relative or AMHP and supported by
2 Drs (1 a specialist)
* Patient must be suffering from mental disorder for which they
need Rx in hospital and it is necessary for health or safety of
patient or others that Rx be given and appropriate medical
treatment is available
* Appeal via MHRT

Question 127

Section 4 - emergency admission

Answer 127

Up to 72 hours detention period
* Admitted on the recommendation of 1 doctor (who need not be
specialist but (ideally) knows the patient) if there is “urgent
necessity”
* Patient must be suffering from a mental disorder
* Time spent in hospital under s4 counts towards compulsory
periods of detention

Question 128

Section 5

Answer 128

S 5 (2)
* Detention of a patient who is already in hospital
voluntarily (usually psychiatric hospital) who then
changes his/her mind and wants to leave
* 72 hours detention (maximum)
* Can be done quickly without a second medical opinion
* S 5 (4)
* Detention by a nurse
* 6 hours detention (maximum)

Question 129

Non Voluntary Treatment

Answer 129

Once admitted competent patients who refuse treatment can be
treated against their will under Part IV of the MHA 1983 (2007)
* Exceptions
* Part IV (Section 63) permits treatment for mental disorder but not
for physical conditions unrelated to the mental disorder
* But this distinction is not easy to define…

Question 130

Discharge

Answer 130

f a patient is discharged after being detained under the MHA
1983 (2007) certain forms of after-care / support must be
provided
* The 2007 amendment also now allows for a “Community
Treatment Order” which is a form of “conditional discharge”

Question 131

CTO

Answer 131

Community Treatment Order: for patients who are sufficiently
well to be conditionally discharged (after detention under MHA)
but require on-going treatment – Section 17a
* Patients permitted to remain in the community if “compliant”
with treatment
* If non-adherent patients will be returned to hospital
* Compulsory treatment can only take place in community if it is
an emergency

Question 132

IMHA

Answer 132

Qualifying patients (e.g. those admitted under Section 3) are
legally entitled to access an Independent Mental Health
Advocates (IMHA)
* IMHAs will help qualifying patients understand the legal
provisions to which they are subject under the MHA, and the
rights and safeguards to which they are entitled

Question 133

The Unconscious Patient

Answer 133

Where unconscious, doctrine of necessity used to allow
emergency treatment
* Emergency to be interpreted conservatively (to avert
immediate danger/risks)
* Treatment must be in the patient’s best interests
* Covers treatment after self-harm
* Law allows emergency treatment but consider ethical
implications