MCQ ANSWERS
practitioner has been negligent in that he operated without valid
consent. A patient may also launch a civil action in assault or for
breach of contract.+In cases of gross negligence there could be a
criminal prosecution. A patient is always at liberty to complain to
the General Medical Council. Professional misconducr procedures
may well be applied where there has been a successful judgement
against a doctor.
Prophylactic oophorectomywith consent may be
justmed in the presence of
110 the BRCA 1 gene. . . . . . . . . . . . . . . . . . . . . . . . .TRUE
111 the BRCA 2 gene. . . . . . . . . . . . . . . . . . . . . . . . .TRUE
112 a family history of ovarian cancer. . . . . . . . . . . . .TRUE
113 a history of six months or more of clomiphene
therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FALSE
DISCUSSION: The lifetime risk of developing ovarian cancer in a
subject with the B R U 1 gene is in the region of 60N.5 There is also
a smaller increased risk in the presence of the BRCA 2 gene. There
is a documented increased incidence of ovarian cancer, in the case
of a positive family history and in patients with endometriosis and
this would warrant consideration of prophylactic oophorectomy.6
There have been accounts of an increased risk of ovarian cancer
following fertility treatment. The RCOG Guidelines, The Manage-
ment of Fertility in Secondary Care, suggest that the ovulation
induction drug clomiphene should only be used for a maximum of
twelve months, whereas the latest British National Formulary states
that the Committee on Safety of Medicines has recommended that
clomiphene should not normally be used for longer than six
cycles.5In either case, prophylactic oophorectomy would probably
not be justified unless there is another risk Factor.
Concerning hysterectomywith ovarian conservation,
114 there is no need to discuss the risk of earlier
ovarian failure prior to operation. . . . . . . . . . . . .FALSE
115 ovarian failure probably occurs about four years
earlier than in those whd have not had a
hysterectomy. . . . . . . . . . . . . . . . . . . . . . . . . . .TRUE
116 earlier ovarian Failure is avoided by only
removing one ovary. . . . . . . . . . . . . . . . . . . . . .FALSE
DISCUSSION: In the case of conservation of the ovaries, the risk
of earlier ovarian failure after hysterectomy must be discussed with
the patient. Studies have suggested that the mean age of ovarian
The MCQ Answers published in Volume 4 Number 1
Qanuary 2002) contained several errors, for which we
apologise.
Question 26: Answer is FALSE
Question 4 0 Answer is FALSE
Question 86: Answer is TRUE
Question 87: Answer is FALSE
Question 89 Answer is TRUE
Question 9 0 Answer is TRUE
Your CME credits should not be affected by these mistakes
as the cards were marked according to the answers above.
If you have any queries, please contact the CME Office.
The Obstetriciun G Gynaecologist April 2002 Vol. 4 No. 2
failure is on average four years earlier than in those who have not
had a hystereclomy.7 These patients should be given appropriate
advice about follow up. It is prudent to warn them that they may
seek medical advice if they have symptoms of the climacteric.
Consideration should be given to a yearly follow-up consultation.
Earlier ovarian Failure also occurs early if only one ovary is
removed? The ovaries may be conserved at hysterectomy at any
age, as long as this is in accordance with the patient’s wishes.
Concerning accidental removal of the ovaries,
117 it can often be justified. . . . . . . . . . . . . . . . . . . .FALSE
118 consent forms should be double-checked. . . . . . .TRUE
119 it is acceptable if performed by general surgeons. FALSE
120 claitns are likely to be settled out of court. . . . . . .TRUE
DISCUSSION: Accidental removal of the ovaries can never be
justified. Such problems can be minimised by avoiding
abbreviations on operating lists and double-checking of consent
forms. Accidental removal is more common in the hands of
inexperienced gnaecologists and where pelvic procedures are
carried out by general surgeons. Any claim for accidental removal
of the ovaries is likely to be settled out of court with the current
quantum of damages ranging from L25000 to in excess of
&I00000.’
References
1 General Medical Council. Seeking Patients Cunsent: The Ethical
Cowsiderutions London; 1998.
2 Mason]K, McCdll Smith KA. Law and Medical Ethics. London:
Butterworths; 1999. p. 277.
3 Smith v. Tunbridge Wells (1994) Med LK 334.
4 Schloendorff v. New York Hospital (1914)105 NE 92.
5 Royal College of Obstetricians and Gynaecologists. Zhe Managemen/
of Infertility in Seconduty Cure.London: RCOG; 2000. Evidence-based
Clinical Guideline No. 3.
6 Seidinan J. Prognostic importance of hyperplasia and atypia in
endomeuiosis. Int J ($~~~.uecol Puthol1996:15:1-9.
7 Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the
age at ovarian failure: identification of a subgroup of women with
premature loss of ovarian function and literature review. Fertil Steril
1987;47:94-100.
8 Bukovsky I, Halperin R, Schneider D. Golan A, Hertzianu I, Herman
A. Ovarian function following abdominal hysterectomy with and
without unilateral oophorectomy. Eur J Obsts Gyvzecol Rrprod Biol
1995;58:29-32.
9 Dyer C. Woman compensated for removal of ovaries. RMJ
1995;311:212.
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