Tutorial 30 October 2014

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49	EMQ. Puerperal mental health.
50	Role-play. Maternity Dashboard.
51	Viva. Risk management. Laparoscopic injury.
52	Role-play. Laparoscopic injury.
53	Role-play. Androgen insensitivity syndrome.

49.   Puerperal mental health.

             

Lead-in.

The following scenarios relate to puerperal mental illness.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

If I had put all the answers into the option list it would have been enormous. So there are quite a few where you need to decide what your answer would be. Opting for “none of the above” is not exercising your brain – make sure you come up with an answer.

Option list.

a.         arrange admission to hospital under Section 5 of the Mental Health Act

b.         send a referral letter to the perinatal psychiatrist requesting an urgent appointment.

c.          send an e-mail to the perinatal psychiatrist requesting an urgent appointment.

d.         phone the community psychiatric team.

e.         phone the on-call psychiatrist.

f.          arrange to see the patient in the next ante-natal clinic.

g.         arrange to see the patient urgently.

h.         send a referral letter to the social services department.

i.           phone the fire brigade.

j.           phone the police.

k.         there is no such thing.

l.           4 weeks

m.       6 weeks

n.         12 weeks

o.         26 weeks

p.         1 year

q.         <1%

r.          1-5%

s.          5-10%

t.          10-20%

u.         25%

v.         50%

w.       60%

x.         70%

y.         80%

z.          True

aa.     False

bb.     none of the above.

Scenario 1

What is the internationally agreed classification for postpartum psychiatric disease?

Scenario 2

What time limits does DSM-IV use for postpartum psychiatric disorders?

Scenario 3

What time limits does ICD-10 use pro postpartum psychiatric disorders?

Scenario 4

What clinical classification would you use in a viva or SAQ?

Scenario 5

What is the incidence of suicide in relation to pregnancy and the puerperium?

Scenario 6

What are the main conditions associated with suicide in pregnancy and the postnatal period?

Scenario 7

Most suicides occur in single women of low social class who have poor education. True / False

Scenario 8

The preferred method of suicide reported in the MMR was drug overdose.  True / False.

Scenario 9

When are women with Social Services involvement particularly at risk of suicide.

Scenario 10

Which women have the highest risk for puerperal psychosis and what is the risk?

Scenario 11.

What is the risk of puerperal psychosis for a primigravida with BPD?

Scenario 12

What is the risk of PP in a woman with no history of psychiatric illness but who has a FH of PP?

Scenario 13

Should screening include the identification of women with no history of psychiatric illness but who has a FH of PP?

Scenario 14

What do the Confidential Enquiries into Maternal Deaths say about the use of the term “postnatal depression”?

Scenario 15

Women with schizophrenia have a ≥ 25% risk of puerperal recurrence. True / False

Scenario 16

If lithium therapy for BPD is stopped in pregnancy, there is an increased risk of severe puerperal illness. True / False.

50.   Maternity Dashboard.

         This is a role-play station.

         You are a 5^th. year SpR. You have been asked to explain the Maternity Dashboard and its uses to a new FY1.

51.   Viva. Risk management. Laparoscopic injury.

Candidate’s instructions.

You performed laparoscopy yesterday. On inserting the laparoscope you realized that the bowel had been injured. You have been asked to write a report about the incident for the risk management committee.

You have 15 minutes to prepare the contents of your report. Then you will present them to an examiner at the next station.

52.   Role-play. Laparoscopic injury.

Candidate’s instructions.

You are the SpR from the previous question. You are seeing the patient the following morning. Your task is to explain what happened and anything else you feel is relevant.

53.   Role-play. Androgen insensitivity syndrome.

       This is a role-play station.

The patient is Euphemia Johnstone. She is 17 years old. She attended the gynaecology clinic 1 month ago with primary amenorrhoea.

Clinical examination showed an apparently normal young woman with normal breast development but absent pubic and axillary hair. The external genitalia appeared normal. Vaginal examination was not attempted.

She has come today for the results of the ultrasound scan and blood results.

The scan has shown absence of the uterus. There are no ovaries in the pelvis. There are bilateral groin masses that could be gonads.

The blood tests which were done are reported as:

FSH: normal.

LH:   normal.

Prolactin: normal.

Karyotype. 46XY.

Your tasks are to explain the results and their implications and to answer her questions.