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HYMS phase II H&S > Block 42 > Flashcards

Block 42 Flashcards

1
Q

1) When does the UK cervical screening programme start?
2) Describe how often cervical screening is carried out for a patient.
3) What is the aim of cervical screening?
4) By what percentage has cervical cancer mortality decreased since screening began?

A

1) 25 years old
2) every 3 years up to 49, then every 5 years up to 64 years.
3) Aims to detect pre-invasive disease and decrease the incidence of cervical cancer
4) 50% decrease in mortality since 1998.

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2
Q

What happens to the cells collected on a smear test?

A

Sent to test for high risk HPV. If hrHPV positive, sent for cytology.

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3
Q

Describe the basic management for the following scenarios which might arise upon results of a smear test:

1) hrHPV negative.
2) hrHPV positive.

A

1) Routine recall

2) Cytology

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4
Q

1) Since when has FGM been a criminal offence in the UK?

2) With relation to FGM, what also become a criminal offence in 2003?

A

1) Since 1985
2) UK nationals or permanent UK residents taking their child abroad to have FGM.

**It is also an offence to aid, abet or facilitate a non-UK national to carry out FGM overseas.

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5
Q

In order for a child to be adopted, what criteria must they meet?

A

1) They must be under the age of 18 when the adoption application is made.
2) They must not be (or ever have been) married on in a civil partnership.

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6
Q

There are 3 circumstances where it is not required for both parents to consent for a child to be adopted, what are they?

A

1) The other parent cannot be found
2) The other parent is incapable of giving consent (e.g. due to a mental disability)
3) The child would be put at risk if they weren’t adopted

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7
Q

1) The right for users of the NHS to complain is firmly written in what?
2) Systems are in place to allow people to express what within the NHS with regards to complaints?
3) Complaints initially are made directly to who?

A

1) The NHS constitution
2) Systems are in place to allow people to express their concerns formally.
3) The local NHS trust, GP practice, organisation or CCG.

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8
Q

1) What are patients encouraged to do before beginning the complaints process?
2) What can PALS (patient advice and liaison service) do?
3) If a patient wishes to make a formal complain, where can they get advice and meeting support from?

A

1) express their concerns directly to staff at the time in order to prevent the need for further escalation.
2) Offer advice about the complaints process and help to resolve issues informally.
3) An independent NHS complaints advocate which can be provided by the local council.

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9
Q

If an individual is not satisfied with the dealing or outcome of a formal complaint, what can they do?

A

Seek advice and/or help from a Parliamentary and Health service Ombudsman or a local government ombudsman.

**These services can also be contacted if there has not been a response to a complaint within 6 months.

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10
Q

What is the main thing that individuals who complain within the NHS want?

A

Better explanation of the organisation to use their (the patient’s) experience to change/ improve the service.

**Only a minority of those who complain would like financial compensation.

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11
Q

Name 4 different ways that a patient can feed back about NHS service received that is not a complaint.

A

1) Friends and family test - anonymous and fast feedback.
2) Patient reported outcome measures (PROMs) - to fill in following service such as hip/ knee replacement, varicose vein surgery or groin hernia.
3) Websites - to comment, feedback or even rate NHS service facilities.
4) CQC - contact if complaint is about the misuse of the MHS on someone who’s detained.

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12
Q

1) Teenage pregnancy is associated with what?

2) Give 3 examples of social problems that teenage mothers experience after birth.

A

1) Lower birth weight and higher incidence of infant mortality.
2) poorer education, fewer work opportunities, increased poverty (all leading to poorer outcomes for mother and child).

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13
Q

1) By what percentage has under 18 conception fallen by over the last 15 years?
2) By what percentage has U16 conception fallen by over the last 15 years.

A

1) 55%.

2) 60%.

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14
Q

In 2018, what did the government publish in order to support young people and prevent unplanned pregnancy?

A

The Teenage Pregnancy Prevention framework.

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15
Q

State what the ‘teenage pregnancy prevention framework’ aimed to do.

A

Decrease teenage pregnancies through sex education and providing friendly youth services that provide contraception.

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16
Q

State 3 things that teenagers who received good quality sex education were more likely to do.

A

1) Delay first sexual experience.
2) Have their first sexual experience with someone of a similar age
3) Report sexual abuse.
4) Use barrier or other forms of contraception for their first sexual encounter.

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17
Q

1) What is an extremely effective way of reducing STI and HIV transmission?
2) Which is a key group to target by encouraging condom use in order to reduce HIV transmission?

A

1) consistent condom use.

2) Men who have sex with men (promotion in this area has increased condom use to 55%).

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18
Q

1) In which age group are STIs generally most prevalent?
2) Which gender are more likely to get STIs?
3) What is the most common STI diagnosed in the UK?

A

1) 15-24 year olds.
2) Males.
3) Chlamydia.

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19
Q

Give 3 reasons why HIV prevalence in the UK has increased.

A

1) Destigmatisation.
2) The understanding that treatment is available which lengthens life expectancy.
3) Increase in overseas migrants coming to the UK who may already be infected.

**Overall though, the trend of AIDS and death is decreasing.

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20
Q

Which organisation are all perinatal and maternal deaths reported to?

A

MBBRACE-UK.

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21
Q

What is meant by ‘maternal mortality’?

A

Death of a woman whilst pregnant or within 42 days of the pregnancy ending from any cause related to or aggravated by the pregnancy or its management.

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22
Q

1) Which types of maternal deaths are classified as direct?

2) Which types of maternal deaths are classified as indirect?

A

1) Those caused by obstetric complications (interventions, omissions or natural disease).
2) Those arising from pre-existing diseases aggravated by pregnancy, or one which has developed during pregnancy (as a result of the pregnancy).

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23
Q

What types of maternal deaths are classified as late maternal deaths?

A

Those occurring 42 days to 1 year after termination, miscarriage or delivery (due to either a direct or an indirect cause).

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24
Q

1) Which type of maternal deaths are more common?

1a) What is the most common cause of this type of maternal death?

A

1) Indirect deaths are more common.

2) Most common cause of indirect deaths is cardiac disease.

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25
Q

What is the most common cause of direct maternal death?

A

Thrombosis and thromboembolism.

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26
Q

1) Direct and indirect deaths as a result of what cause have decreased recently?
2) Maternal mortality from what cause is now the lowest it has ever been?

A

1) Maternal sepsis.

2) Pre-eclampsia/ eclampsia.

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27
Q

In what groups of people are maternal deaths more likely?

A

Highest rates of maternal mortality are in black ethnic groups and in those living in the most deprived areas.

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28
Q

Define the term perinatal mortality.

A

The number of deaths (including still births) occurring from 24 weeks gestation to 7 days of life.

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29
Q

Define the term neonatal mortality.

A

The number of deaths occurring from birth to 28 days of life.

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30
Q

Describe the change in trend of neonatal deaths over time.

A

Rate is currently about 6/1000 which has rapidly decreased from 62.5/1000 in the 1930s.

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31
Q

State the risk factors for perinatal/ neonatal mortality. (5)

A

1) Teenage pregnancy
2) Mother >40 years old
3) 1st generation migrants
4) Mother in poverty
5) Obesity
6) Smoking
7) Chronic disease
8) Infection
9) substance abuse
10) Hx mental health issues
11) Nulliparous

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32
Q

Name the 3 most common causes of stillbirth.

A

1) Placental conditions
2) Ante/ intrapartum haemorrhage
3) Congenital abnormalities.

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33
Q

Name the 2 most common causes of neonatal death.

A

Complications associated with prematurity (48%) and malformation (22%).

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34
Q

Give 3 reasons why there has been such a decrease in perinatal and neonatal mortality since the 1930s.

A

1) Better medical care (antenatal monitoring, anti-D, surfactant).
2) Increased standard of living.
3) Increased maternal health.
4) Decrease in parity (and child = lowest risk, but from 4th child onwards, increased risk of neonatal death).

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35
Q

What is the aim of health promotion in pregnancy?

A

To minimise risk to mother, neonate and foetus by modifying pre-pregnancy conditions and risk factors.

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36
Q

Name 5 lifestyle factors which are promoted in order to improve health in pregnancy.

A

1) Stop smoking
2) Weight loss
3) Exercise
4) Avoid alcohol
5) Avoid recreational drugs

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37
Q

1) In pregnancy, immunity to what must be ensured?
2) Folic acid supplementation decreases risk of what?
3) When should aspirin be given in pregnancy?

A

1) Rubella
2) Neural tube defects and cleft lip.
3) From the start of pregnancy in HTN and obesity, from week 12 if 1 high RF for pre-eclampsia

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38
Q

1) When should vitamin D be given in pregnancy?
2) Which medications need reviewing if a woman becomes pregnant?
3) When might genetic counselling needed?

A

1) For all pregnant women.
2) Potentially teratogenic medications.
3) If there is a strong FHx of any genetic disorders.

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39
Q

When might a higher dose of folic acid be needed?

A

1) Obesity
2) PMHx of NTD
3) HIV positive on co-trimoxazole prophylaxis.
4) diabetic
5) SCD

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40
Q

1) What is done at a booking appointment?
2) If a pregnant woman is diabetic, what is offered?
2a) When will further screening for this be done?

A

1) Comprehensive history of everything.
2) Extra diabetic retinopathy screening.
2a) Another diabetic retinopathy screen at 16-20 weeks if 1sr screen showed abnormality. Further screen then at 28 weeks.

41
Q

What is assessed at the 11-12 week scan?

A

1) Date of the pregnancy by assessing crown-rump length and viability.
2) Nuchal translucency.

42
Q

1) How accurate is the dating of the pregnancy when done at the 11-14 week scan?
2) After 13 weeks, how is pregnancy dating done?

A

1) Accurate ± 3 days before 13 weeks gestation.

2) By using femur length and biparietal diameter instead.

43
Q

1) If an abnormality is detected on nuchal translucency scanning, what should be done?
2) Increased nuchal translucency may indicate what?
3) What does nuchal translucency have a strong association with?

A

1) Offer Aneuploidy T21/13/18 screening.
2) Foetal heart failure.
3) Chromosomal abnormalities

44
Q

What is involved in the ‘quadruple test’ used to check for chromosomal abnormalities?

A
  • Nuchal translucency
  • Maternal age
  • PAPP-A (pregnancy associated plasma protein)
  • Free-hcg

**This combined test has 98% specificity, >90% sensitivity.

45
Q

What is offered if there is a high risk of a chromosomal abnormality detected?

A

Invasive testing if risk >1:150 via amniocentesis or chorionic villous biopsy (CVS).

46
Q

1) When is screening for sickle cell disease and thalassaemia carried out?
2) When is the screening scan for nuchal translucency?
3) When can the dating scan be performed?

A

1) Before 10 weeks gestation.
2) 11-14 weeks gestation.
3) 8-14 weeks (normally 11-14 weeks).

47
Q

1) When can bloods be done to test early for Down’s syndrome?
2) When is the foetal anomaly scan carried out?

A

1) 10-14 weeks.

2) 18-21 weeks (aka. 20 week scan).

48
Q

What blood tests are carried out between 8 and 12 weeks gestation?

A

1) Hb
2) Blood group
3) Rhesus and antibodies
4) Syphilis
5) Hep B
6) HIV
7) Rubella

49
Q

What percentage of pregnancies where the baby is screened to have Down’s syndrome are terminated?

A

92% with a definitive diagnosis of trisomy 21 are terminated.

50
Q

How is the quality of the antenatal screening programme assessed in terms of structure?

A

1) Enough trained staff
2) Appropriate clinic spaces
3) Access to USS equipment
4) Labs available to test

51
Q

How is the quality of the antenatal screening programme assessed in terms of process?

A

1) Number of anomalies missed on USS

2) Number of inadequate blood samples

52
Q

How is the quality of the antenatal screening programme assessed in terms of outcome?

A

1) Number of births detected with serious abnormality
2) Maternal death rate
3) Perinatal death rate
4) Incidence of congenital rubella syndrome.

53
Q

At the 20 week anomaly scan (done between 18 and 21 weeks), what conditions are screened for?

A
  • anencephaly
  • open spina bifida
  • cleft lip
  • diaphragmatic hernia
  • gastroschisis
  • exomphalos
  • serious cardiac abnormalities
  • bilateral renal agenesis
  • lethal skeletal dysplasia
  • Edwards’ syndrome, or T18
  • Patau’s syndrome, or T13
54
Q

What are the 3 main relevant interests involved in reproductive ethics?

A

1) The parents
2) Future or existing children
3) Third parties, including the state.

55
Q

What is meant by ‘assisted reproductive technology’?

A

Any treatments or procedures involving in vitro handling of human oocytes and human sperm for the purpose of achieving pregnancy.

56
Q

State 2 arguments FOR ART.

A

1) procreative autonomy: parental rights to have children.

2) Welfare interests: of existing or future children (e.g. in cases of pre-implantation genetic diagnosis).

57
Q

State 3 ethical objections to IVF.

A

1) Involves destruction of human embryos (?moral status)
2) Harmful to those trying to conceive (high risk of multiple pregnancy, risk of morbidity and mortality)
3) Unnatural (although, much medicine can be said to be ‘unnatural’).

**Risks of conception reduced by regulations on the number of embryos that can be transferred.

58
Q

What are the chances of success with IVF?

A

About 30% for under 35s.

About 1.9% for 45+.

59
Q

When may it be difficult to justify the provision of ART?

A

If as a result of being conceived a child is likely to suffer serious physical or psychological harm, then it would be hard to justify provision of treatment as being in the child’s best interests.

60
Q

Describe the ‘right to an open future’ argument.

A

Dilemmas should be resolved so as to ensure that children will have a maximally open future. (i.e. will enjoy the widest possible range of opportunities).

This principle sometimes includes not selecting human embryos with genes that will cause an embryo to grow into a person with serious disabilities. As a person with serious disabilities will not have the widest range of opportunities available to them.

61
Q

Give an objection to the ‘right to an open future’ argument.

A

Harms that may incur aren’t acceptible grounds to interfere with a person’s right to conceieve naturally, so why just for ART?

62
Q

Describe a potential reply to the main objection to the ‘right to an open future’ argument.

A

Perhaps not giving a child access to the widest possible opportunities should be grounds for not being able to conceive naturally.

This distinguishes between negative right to not be interfered with and not having the positive right to demand help to conceive (i.e. state not obliged to help, but obliged not to interfere)

63
Q

What does the Human fertilisation and embryology act of 1990 state about providing ART and the interests of the future child?

A

A woman shall not be provided with fertility treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child of a father).

64
Q

Give 4 objections to the following statement in the human fertilisation and embryology act of 1990:

‘A woman shall not be provided with fertility treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child of a father)’.

A

1) ‘Welfare’ criteria is not defined.
2) Not fair, as fertile couples may not need to meet this criterion but are still allowed to conceive.
3) Difficult to predict future welfare.
4) Do not always need a father to flourish (2008 revision of article changed this to ‘need for supportive parenting’).

65
Q

Give 2 third party considerations of ART.

A

1) Is expensive (guidance from NICE = no more than 3 cycles for women aged 23-39).
2) A child may be conceived which may place a high burden on the state (in terms of care).

66
Q

How may ‘pre-implantation genetic diagnosis’ be used?

A

LESS CONTENTIOUS USES: to avoid genetic disease.

MORE CONTENTIOUS USES: sex selection, saviour siblings, selecting embryos on basis of potential intelligence of undesirable characteristics.

67
Q

State the positives of mitochondrial replacement techniques. (3)

A

1) Health benefits to future child.
2) Parents do not have to live with anxiety that comes with knowledge of a diseased child
3) Do not have to look after a child with serious mitochondrial disease

68
Q

What is a negative of mitochondrial replacement techniques?

A

1) Do these techniques constitute germline/ genetic modification?
2) There may be some residual mitochondrial DNA left.

69
Q

Since when has mitochondrial replacement therapy been allowed in the UK?

A

Since March 2017 - Newcastle, UK.

70
Q

Name the act which defines the law around abortion.

A

The abortion act 1967 (amended 1990).

71
Q

What are the 4 conditions that abortion is legally allowed under?

A

1) That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated.
2) That the termination is necessary to prevent grave permeant injury to the physical or mental health of the pregnant woman.
3) That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if terminated.
4) That there is a substantial risk that if the child were born is would suffer from such physical or mental abnormalities as to be seriously handicapped.

72
Q

How many medical professionals need to be in agreement that an abortion is necessary for termination to go ahead?

A

Abortion is legal if 2 registered medical practitioners are of the opinion, formed in good faith that the conditions outlined in the abortion act 1967 are met.

73
Q

Outline the pro-life argument.

A

1) Abortion ends the life of a foetus
2) Human foetus has the same moral status as a person
3) It is wrong to end the life of a person/ creature with the moral status of a person.

**CONC: Therefore, abortion is morally wrong.

74
Q

What considerations might argue against the pro-life argument?

A

Even if foetus is person, what about mother?

Does the foetus matter more than the mother?

75
Q

Describe the role of conscientious objection in the act of abortion.

A

Currently, the law allows doctors to refuse to terminate barring emergency situations, due to personal beliefs and values.

This is as long as objection doesn’t discriminate against or harass individual patients or patient groups.

76
Q

If a doctor wishes to conscientiously object form being involved in an abortion, what must they do?

A

Must tell the patient that they have the right to discuss with another practitioner who DOES offer the treatment and refer them, or give them sufficient information so they know who to approach.

77
Q

What are employers and contracting bodies entitled to in terms of doctors?

A

They are entitled to require doctors to fulfil contractual obligations which may restrict freedom of practice - if a practitioner knows that they would like to opt out of abortion care, this should be discussed prior to signing of contracts.

78
Q

In terms of ethics, why are children a concern?

A

1) They are dependent on others making decisions their best interests.
2) Under-developed decision-making capacity of value systems.
3) Limited power (physical, emotional, legal) with regards to defending their rights.
4) Difficulty in accessing services.

79
Q

1) When may an under 16 consent for themselves?
2) If an under 16 is not able to consent for themselves, what happens?
3) What happens if someone fails to consent in the under 16 year olds best interests?

A

1) If they are deepened Gillick competent.
2) Then they need consent from someone with parental responsibility, who is legally obliged to act in their best interests.
3) If there is failure to consent in best interests, the parent/ carer can be taken to court.

80
Q

1) What happens in an emergency situation for an U16 where consent cannot easily be sought?
2) With regards to consent, what is presumed when someone is aged >16?

A

1) In emergency situations, jut treat the child.

2) There is presumed competence to consent.

81
Q

What is the difference between rights to consent in a 16/17 year old and somebody of 18 or over?

A

> 16 can consent to having treatment, but is not deemed competent to refuse treatment.

Opposingly, >18 can consent to either having treatment or refusing treatment.

82
Q

What happens if someone aged 16/17 wants to refuse treatment?

A

If doctors think that having the treatment is in the best interests of the 16/17 year olds, a court order to overrule can be sought, even if the parents support the treatment refusal.

83
Q

What is meant by ‘Gillick competency’?

A

As a matter of Law the parental right to determine whether or not their minor child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed.

84
Q

What is the principle of parental autonomy?

A

That parents are allowed to make treatment decisions for their children, based on best interests.

**Can be overruled in cases where a child’s welfare is at stake.

85
Q

What is the principle of parental autonomy grounded in?

A

The assumption that parents know their child’s best interest and that the close parental bond motivates them to do what is best for their child.

86
Q

Name 2 cases where parental autonomy was overruled.

A

Neon Roberts: 7 y/o given radiotherapy for a brain tumour against mothers wishes.

Charlie Gard: court rules that life support should be turned off against parents wishes who wanted him to undergo experimental treatment in America.

87
Q

Describe what is meant by the ‘harm principle’.

A

The only purpose for which power can be rightfully exercised over any member of a civilised community against his/her will is to prevent harm to others.

88
Q

What percentage of child abuse goes unreported?

A

85%.

89
Q

Why is it thought that such a high percentage of child abuse goes unreported?

A

1) Fear within the child.

2) The child does not realise that what they are enduring is not normal.

90
Q

Describe the place of confidentiality when consulting with children.

A

Doctors owe a duty of confidentiality to children as much as they do to adults.

Must seek child’s permission before discussing with parent/ guardian.

However, this obligation is not absolute.

91
Q

What does the fact that confidentiality towards a child is not absolute mean?

A

GMC states:

1st concern should always be the safety of the child and so must inform person/ authority promptly of any reasonable concern that children are at risk of abuse or neglect.

92
Q

Describe the Fraser guidelines.

A

No need to get parental consent to prescribe contraception if:

1) Understand all aspects of advice + its implications
2) Cannot persuade them to tell parents or allow you to tell
3) Person v. likely to have sex w/out contraception (upon requesting it)
4) Their health is likely to suffer without such advice/treatment – in best interest for them to receive it without parental knowledge.

93
Q

Describe the Fraser guidelines.

A

No need to get parental consent to prescribe contraception or give advice on terminations/ STIs if:

1) Understand all aspects of advice + its implications
2) Cannot persuade them to tell parents or allow you to tell
3) Person v. likely to have sex w/out contraception (upon requesting it)
4) Their health is likely to suffer without such advice/treatment – in best interest for them to receive it without parental knowledge.

94
Q

The human fertility and embryo act is required by law to keep a register of what?

A

Information which records details of all regulated assisted reproduction treatment services in the UK.

95
Q

Give 4 reasons for why IVF might be indicated.

A

1) Tubal disease
2) Male factors
3) Endometriosis
4) Anovulation (not responding to clomifene)
5) Maternal age
6) Unexplained sub fertility >2 years.

96
Q

Very briefly describe the process of IVF.

A

Ovaries stimulated > eggs harvested > eggs artificially inseminated in vitro > embryo implanted into uterus > luteal support with progestogens.

97
Q

1) How many cycles of IVF are recommended by NICE for women aged 13 to 39?
2) What percentage of CCGs offer the above amount of IVF cycles?

A

1) 3

2) 12% (locally the rule is 1 cycle with an age restriction + no other children).

98
Q

Give 5 of the general inclusion criteria for IVF eligibility.

A

1) Couples with no children
2) Non-smokers
3) BMI <30
4) Under 42 y/o (<35 in some countries)
5) No gamete donation required

99
Q

What is considered to be the ‘IVF gold standard’ in Scotland?

A

Ensures that all eligible patients can access up to 3 cycles, including couples where one partner has no biological child.

HYMS phase II H&S (12 decks)

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