Social science

Question 1

Analgesia in pregnancy

Answer 1

• Paracetaml is safe throughout pregnancy
• NSAID’s i.e. ibuprofen shouldn’t be used in the third trimester
• Codeine is the weak opioid of choice in pregnancy, best not to use opioids in the end of pregnancy as can cause neonatal respiratory depression
• Avoid analgesic doses of aspirin in the last few weeks of pregnancy can be teratogenic
• Try and avoid opioids in the first trimester

Question 2

High quality patient information

Answer 2

RCOG patient information, NHS Choices or patient information which has achieved the Information Standard

Question 3

Vulnerable people

Answer 3

• Pregnant women
• LGBT people
• Long term unemployed or precarious work
• Prisoners
• Drug or alcohol dependency
• Non English speakers
• Homeless people
• Children
• BAME ethnicity
• Disabled people
• Migrants, refugees, asylum seekers
• Chronic physical/mental illness
• Malnourished
• Elderly people
• Sex workers

Question 4

Symptoms of physical abuse

Answer 4

Cuts, scrapes and bruises, wounds, fractures, lost teeth, sexually transmitted diseases, unwanted pregnancy. Also non-specific symptoms like GI problems, gynaecological problems, chronic pain and seizures.

Question 5

Symptoms of social abuse

Answer 5

financial dependence on partner, impact on work, isolation from support networks, homelessness, impact on ability to parent child, impact on ability to make decisions, abuser attends appointments so harder to disclose.

Question 6

Symptoms of psychological abuse

Answer 6

emotional distress (low self esteem), depression, anxiety, suicide, self harm, PTSD, alcohol and substance abuse, eating and sleep disorders.

Question 7

Treatment for Hyperemesis Gravidarum

Answer 7

• Fluid replacement therapy
• Potassium chloride as excessive vomiting is likely to cause hypokalaemix
• Anti-emetic medications such as cyclizine (first line), metoclopramide or prochlorperazine. Ondansetron or domperidone may be used in severe cases.
• Thiamine and folic acid to prevent development of Wernicke’s encephalopathy
• Antacids to relieve epigastric pain
• Thromboembolic (TED) stockings and low molecular weight heparin as there is increased risk of venous thromboembolism.

Question 8

Epithelial ovarian tumours

Answer 8

• Originate from the epithelium which lines the fimbria of the fallopian tubes or the ovaries
• Epithelial tumours are partially cystic, and the cysts can contain fluid
• The initial metastatic spread typically involves the peritoneal cavity, with seeding particularly affecting the bladder, paracolic gutters and the diaphragm
• Around 90% of ovarian cancers are epithelial ovarian tumours.

Question 9

Germ cell tumours (ovarian)

Answer 9

• Originate from the germ cells in the embryonic gonad
• These tumours typically grow rapidly and spread predominantly via the lymphatic route
• Germ cell tumours most commonly arise in young women, which is atypical for most cases of ovarian cancer
• Tumour markers include alpha-fetoprotein and sometimes beta human chorionic gonadotrophin (B-HCG).

Question 10

Sex cord stromal tumours (ovarian)

Answer 10

• Originate from connective tissue
• They are rare, making up less than 5% of all ovarian tumours. They are malignant tumours, but are much less aggressive than epithelial tumours
• Additionally, ovarian cancer can be secondary to another cancer elsewhere, which has metastasised to the ovary. A Krukenberg tumour refers to a “signet ring” sub-type of tumour, typically gastrointestinal in origin, which has metastasised to the ovary.

Question 11

What happens if the women trying to conceive is not immune to rubella And alcohol consumption when trying to conceive

Answer 11

Give the vaccine then wait one month before trying to conceive

No more than 2 units per week for women
No more than 3/4 units per week for men

Question 12

When is the OGGT done and the anti-D injections given

Answer 12

OGGT: Ideally 26 weeks (24-28)

Anti-D: 28 and 34 weeks

Question 13

When are women screened for anaemia

Answer 13

Booking bloods
28 week gestation

Question 14

Pre-eclampsia medication

Answer 14

• In critical care for severe pre-eclampsia: IV hydralazine
• For mother: Enalapril (1st line), Nifedipine or amlodipine (1st line in African/Caribbean)
• Eclampsia: Magnesium sulfate IV, Hydralazine IV

Question 15

Antibiotics given in maternal sepsis

Answer 15

Pipercillin + tazobactam
OR
Amoxicillin + clindamycin + gentamycin

Question 16

MBRRACE UK

Answer 16

Where all stillbirths are reported to
Helps increase mother and babies health through confidential enquiries

Question 17

Stillbirth medication

Answer 17

Suppress lactation- Dopamine agonists i.e. cabergoline
Induction of labour- oral mifepristone and vaginal/oral misoprostol

Question 18

Approaches to reducing prescribing error

Answer 18

• Expanding professional roles: use more pharmacists
• Education roles: prescribing safety assessment introduced to the MBBS course
• Using computerised roles: prescribing mostly done online, integrated into patients medical records

Question 19

Medication error definition

Answer 19

Medication errors are any incident where there has been an error in the process of: prescribing, dispensing, preparing, administering, monitoring or providing medicines advice regardless of whether any harm occurred or was possible.

Question 20

Compliance, adherence and concordance

Answer 20

Compliance- the extent to which the patients behaviour matches the prescribers recommendation.

Adherence- the extent to which the patients action or behaviour matches the agreed recommendations from the prescriber.

Concordance- the relationship between the patient and the prescriber and the degree to which they agree about the treatment

Question 21

Things used to increased patient safety

Answer 21

• Datix (recording error on hospital system)
• New ‘learn not to blame culture’- means staff are more able to admit to mistakes
• Root cause analysis

Question 22

NHS programmes used to improve patient safety

Answer 22

1) Managing Deterioration Safety Improvement Programme (ManDetSIP)
2) Maternity and Neonatal Safety Improvement Programme (MatNeoSIP)
3) Medicines Safety Improvement Programme (MedSIP)
4) Adoption and Spread Safety Improvement Programme (A&S-SIP)
5) Mental Health Safety Improvement Programme (MH-SIP)

Question 23

Level of vulnerability

Answer 23

LOW – the person has no predisposing or anticipated factors to make them vulnerable in this regard.

MEDIUM – EITHER the person has predisposing factors but these are well-managed OR the patient is currently at risk of developing factors because of the nature of their condition or their treatment that would make them vulnerable in this regard.

HIGH – the patient has predisposing factors and/or current factors because of the nature of their condition or their treatment that already make them vulnerable in this regard.

Question 24

Vulnerable adult

Answer 24

An adult is at risk is any person who is aged 18 or over and at risk of abuse, harm or neglect because of their needs for care and/or support and who is unable to safeguard themselves

Question 25

Types of vulnerable adults

Answer 25

*is elderly and frail due to ill health *has a physical disability or cognitive impairment *has a learning disability *has a physical disability and/or a sensory impairment *has mental health needs including dementia or a personality disorder *has a long term illness/condition *abuses substances or alcohol.

Question 26

Temporary vulnerability

Answer 26

Any patient may become temporarily vulnerable whilst an inpatient in hospital due to a range of factors including temporary illness, disability and functional impairment

Question 27

Indicators of possible physical abuse

Answer 27

- unexplained bruising in well-protected areas or soft parts of the body - bruising in different stages of healing - unexplained burns in unusual locations - unexplained fractures to any part of the body - unexplained lacerations or abrasions -slap, kick, punch or finger marks - injury shape similar to an object - untreated medical problems - history of unexplained falls - weight loss due to malnutrition or dehydration.

Question 28

Causes of loss of libido

Answer 28

- relationship problems - stress, anxiety or depression - sexual problems like erectile dysfunction or vaginal dryness -pregnancy and having a baby - lower hormone levels as you get older, particularly during the menopause - taking certain medicines, such as medicine for high blood pressure or antidepressants - using hormonal contraception like the pill, patch or implant - drinking too much alcohol

Question 29

Mental capacity act

Answer 29

Presumption of capacity All practical help must be given first Unwise decisions do not mean no capacity Best interests Least restrictive option Must have an impairment on disturbance of the brain

Question 30

Normal menstrual cycle

Answer 30

Onset of menses is often associated with muscle spasm and pain Frequency - 24-35 days Duration of flow - 4-8 days Volume of blood loss - 5-80mls Associated symptoms - dysmenorrhoea, diarrhoea, nausea and headache

Question 31

Normal puerperium

Answer 31

From the third stage of labour until changes of pregnancy reverts to the non-pregnant state Takes place within 6 weeks postpartum

Question 32

Uterine involution in puerperium

Answer 32

Immediately after delivery, just below umbilicus, a process of autolysis, as early as 10-14 days, goes back into pelvic organ; below the pubic, uterus weigh about 1kg post-delivery and autolysis shrinks the uterus to less than 40-80g in a few weeks, breast feeding helps involution with oxytocin production

Question 33

Lochia in puerperium

Answer 33

vaginal loss after delivery. Made up mainly of necrotic superficial decidua and blood: - rubra-red after delivery till day 5-7 - serosa-red brown till day 10-14 - alba-yellow till 14-21

Question 34

Cervix in puerperium

Answer 34

floppy and 'curtains like' after delivery. Regains tone and consistency in a few days. External os may remain spread out for a few weeks but the internal os will be closed after a few days. The appearance of the external os is permanently elliptical after childbirth

Question 35

Vagina in puerperium

Answer 35

in first few days vagina is smooth, soft and oedematous. Returns to normal in 3-6 weeks

Question 36

Hormonal changes in the puerperium

Answer 36

falling levels of progesterone/oestrogen with delivery of the placenta, falling levels of prolactin unless breastfeeding, falling levels of T3/T4 over 4-6 weeks, fall in renin, aldosterone, cortisol

Question 37

Cardio changes in the puerperium

Answer 37

fall in plasma volume, cardiac output increases immediately after delivery then slowly declines

Question 38

Haematological changes in the puerperium

Answer 38

rise in Hb immediately after delivery, leukocytes rise at delivery and fall by day 6, platelets decrease 2 days then rapidly rise, hypercoagulable state up to 6 weeks postpartum, highest risk of VTE haematological changes in puerperium

Question 39

Gestational diabetes

Answer 39

fasting glucose of 5.6mmol/L or above or two-hour glucose of 7.8mmol/L or above

Question 40

Trichomoniasis

Answer 40

Frothy, green discharge accompanied by pruritus, vaginitis and post-coital bleeding. Small punctate haemorrhages are also commonly seen on speculum examination (often referred to as a ‘strawberry cervix’).

Question 41

Gillick competence

Answer 41

For a young person under the age of 16 to be competent, s/he should have: * the ability to understand that there is a choice and that choices have consequences * the ability to weigh the information and arrive at a decision * a willingness to make a choice (including the choice that someone else should make the decision) * an understanding of the nature and purpose of the proposed intervention * an understanding of risks and side effects * an understanding of the alternatives and the risks attached to them * freedom from undue pressure

Question 42

Tocophobia

Answer 42

Intense dread of childbirth that can lead to: - Woman avoiding pregnancy - Terminating an otherwse wanted pregnancy - Demanding a Caesarian section in first or subsequent pregnancies

Question 43

Primary and secondary Tocophobia

Answer 43

1) Primary Tocophobia- in nuliparous women. Transmission of fear of childbirth over generations. History of sexual assault or traumatic gynae exam 2) Secondary Tocophobia- following previous traumatic delivery. Occurs with depressive illness, anxiety or PTSD

Question 44

Impact of Tocophobia

Answer 44

- May decrease chances of uncomplicated vaginal delivery - May predict postnatal depression - Psychological input is beneficial- counselling/CBT - Elective caesarian section might need to be discussed

Question 45

Abortion under 24 weeks criteria

Answer 45

- would involve risk to the physical or mental health of the pregnant women - would involve risk of injury to the physical or mental health of any existing children of the family of the pregnant women

Question 46

Abortion after 24 weeks criteria

Answer 46

- There's a substantial risk the child would suffer from physical or mental abnormalities such that it would be seriously handicapped - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant women - The continuation of pregnancy would involve risk to the life of the pregnant women greater than if the pregnancy was terminated

Question 47

Criteria for IVF- under 40

Answer 47

In women who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 3 full cycles of IVF, with or without ICSI . If the woman reaches the age of 40 during treatment, complete the current full cycle but do not offer further full cycles.

Question 48

Criteria for IVF: 40-42

Answer 48

In women who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 1 full cycle of IVF, with or without ICSI, provided the following 3 criteria are fulfilled: o they have never previously had IVF treatment o there is no evidence of low ovarian reserve o There has been a discussion of the additional implications of IVF and pregnancy at this age.