AKT questions, nMRCGP exam

1. Which one of the following statements is true when assessing a teenager who has self harmed?

A. Assessing how the patient feels about the consequences of his / her actions is essential
B. A doctor centred approach is preferable
C. Questioning on suicidal ideation makes it more likely that a future attempt at self harm will occur
D. The severity of a self harming episode is approximately proportional to the suicidal intent
E. The presence of a suicide note is reassuring

Answer: A

The consultation should be patient centred and it is essential to enquire about thoughts of future self harm. It does not make matters worse for the future. The presence of plans prior to the attempt or a suicide note are concerning

2. Which one of the following statements regarding treatment of young people is true?

A. A 15 year old girl wishing to commence the oral contraceptive should always have parental consent
B. Gillick / Fraser competence only applies to contraceptive issues
C. Once a child is deemed to be Gillick / Fraser competent this competence applies to all future forms of medical treatment.
D. If a 15 year old is deemed Gillick / Fraser competent this judgement confers to them the right to accept treatment
E. The parents of a 17 year old girl with severe anorexia nervosa have the right to over-ride her decision to refuse feeding even though she is deemed competent

Answer: D

Gillick / Fraser competence confers the right of a 15 year old to accept treatment but not necessarily the right to refuse (except in Scotland where competent minors have an independent right to consent to or refuse treatment under the age of legal capacity). Answers 1-3 are clearly false. Regarding answer 5: - GMC Guidance – Young People refusing consent: In England, Wales and Northern Ireland, the law on parents overriding young people’s competent refusal is complex.You should seek legal advice if you think treatment is in the best interests of a competent young person who refuses.