On this page
Certificate in Nursing · 2025
Surgical & Gynaecology UHPAB 2025 June Revision Guide
SECTION A: Objective Questions (20 marks)
💡 Exam Strategy: Surgical nursing questions test your understanding of priorities and emergency management. Gynaecology requires knowledge of normal vs pathological reproductive health!
1 Which of the following terms refers to programmed cell death?
(b) Apoptosis
Apoptosis is the genetically programmed, controlled process of cell death essential for tissue homeostasis, development, and removal of damaged cells. It’s characterized by cell shrinkage, chromatin condensation, and formation of apoptotic bodies without inflammation. Unlike necrosis (traumatic cell death), apoptosis is orderly and non-pathological.
APOPTOSIS FEATURES: “SHRINK” – Shrinkage, Heterochromatin, Round cells, Internucleosomal cleavage, No inflammation, Keep membranes intact
2 The most appropriate position a Nurse places a patient in shock is
(d) Trendelenburg
Trendelenburg position (supine with legs elevated 15-30°) is optimal for hypovolemic shock. It uses gravity to increase venous return from lower extremities, boosting preload and cardiac output. Increases cerebral and coronary perfusion during critical resuscitation phase. Contraindicated in cardiogenic shock (increases cardiac workload) and raised ICP.
⚠️ Modified Trendelenburg: Elevate legs only, keep torso flat. Avoid head-down tilt >30° as it increases intracranial pressure and compromises ventilation.
3 In which of the following conditions does the nurse NOT expect to prepare a patient for a blood transfusion?
(b) Moderate anaemia
Moderate anaemia (Hb 7-10 g/dL) is managed with iron supplementation, folic acid, and treatment of underlying cause. Transfusion is not indicated unless patient is symptomatic (angina, heart failure) or has pre-existing cardiovascular disease. The other conditions involve acute blood loss or hemolysis requiring immediate replacement. Severe burns cause plasma loss initially, but later require transfusion due to RBC destruction.
TRANSFUSION TRIGGER: “HARD” – Hemodynamic instability, Acute bleeding, Recent surgery, Drop in Hb >2g/dL
4 Patients suspected of tetanus may NOT present with
(b) Low blood pressure
Tetanus causes autonomic instability with HYPERtension, tachycardia, and hyperpyrexia, not hypotension. The exotoxin (tetanospasmin) blocks inhibitory neurotransmitters (glycine, GABA) causing sustained muscle contractions and sympathetic overactivity. Hypotension would suggest septic shock, not tetanus.
TETANUS SIGNS: “STAND” – Spasms, Trismus (lockjaw), Autonomic instability, Nuchal rigidity, Dysphagia
💉 Prevention is Key: Tetanus toxoid vaccine every 10 years. Wound prophylaxis if dirty wound and >5 years since last booster!
5 In which stage of shock does the blood pressure remain normal?
(a) Compensatory
In compensatory (early) shock, blood pressure remains normal due to robust physiological compensatory mechanisms. Baroreceptors trigger sympathetic response causing tachycardia, vasoconstriction, and increased cardiac contractility. BP is maintained at the expense of tissue perfusion. This is the “golden hour” for intervention. Pulse pressure narrows, extremities become cool, but BP is preserved until compensatory mechanisms fail.
SHOCK STAGES: “CPI” – Compensatory (BP normal), Progressive (BP drops), Irreversible (BP unresponsive)
6 Which of the following terms refers to Natural Immunity?
(a) Non-specific
Natural (innate) immunity is non-specific, providing immediate defense against a wide range of pathogens without prior exposure. Includes physical barriers (skin, mucus), chemical barriers (lysohydrolases), phagocytes (macrophages, neutrophils), and inflammatory response. It lacks immunological memory and is not antigen-specific.
IMMUNITY TYPES: “NAS” – Natural (Non-specific), Acquired (Specific), Specific (Adaptive)
7 Which of the following procedures does the Nurse perform for a patient with a simple fracture in the first 30 minutes of arrival?
(b) Immobilisation
Immobilisation is the immediate priority in fracture management (first aid principle). It prevents movement of bone ends, reducing pain, preventing further soft tissue injury, controlling bleeding, and minimizing risk of converting a closed fracture to open fracture. Can be done with splints, backslabs, or temporary casts before definitive reduction.
🦴 FRACTURE FIRST AID: RICE – Rest, Immobilize, Cold, Elevate. Then 6 Ps assessment: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Pressure (compartment syndrome).
8 Which of the following complications may result from mismatched blood?
(c) Renal failure
Acute hemolytic transfusion reaction from ABO incompatibility causes massive intravascular hemolysis. Free hemoglobin precipitates in renal tubules causing acute tubular necrosis and acute kidney injury. Complement activation triggers DIC, worsening ischemia. Other complications include shock, DIC, and death. This is a medical emergency requiring immediate transfusion cessation and aggressive fluid resuscitation.
TRANSFUSION REACTIONS: “HARD” – Hemolytic, Allergic, Febrile, Septic. Mismatch causes Hemolytic (most dangerous!)
9 Which of the following is NOT a cardinal sign of inflammation?
(b) Crepitus
Crepitus is the palpable grinding or crackling sensation caused by air in subcutaneous tissue (surgical emphysema) or bone fragments rubbing together. It is NOT a cardinal sign of inflammation. The classic 5 cardinal signs are: Rubor (redness), Tumor (swelling), Calor (heat), Dolor (pain), and Loss of Function (functio laesa).
CARDINAL SIGNS: “RTCHP” – Redness, Tumor (swelling), Calor (heat), Hyperaemia, Pain + Loss of Function
10 Which of the following is the most appropriate nursing diagnosis for a patient presenting at the hospital in the first 4 hours of sustaining burns of the lower limbs?
(b) Deficient fluid volume
Burns cause massive capillary leak and fluid shift from intravascular to interstitial space within minutes. In the first 4 hours, hypovolemia is the priority life-threatening problem due to loss of plasma proteins and electrolytes. The “burn shock” can lead to circulatory collapse if not aggressively managed with fluid resuscitation using Parkland formula. Pain is important but secondary to preserving circulation.
💧 Parkland Formula: 4 mL × kg × %TBSA. Give half in first 8 hours, half in next 16 hours. Use lactated Ringer’s to avoid hypernatremia!
12 Which of the following terms describes the period of time that begins with transfer of the patient to the operating room until when anaesthesia is administered?
(c) Pre-operative
The pre-operative phase begins when the patient is transferred to the operating room (or pre-operative holding area) and ends when anesthesia is induced. This includes final verification of consent, site marking, IV insertion, and pre-anesthesia monitoring. Peri-operative is the entire surgical experience (pre + intra + post). Intra-operative is from anesthesia induction to transfer to PACU. Post-operative begins in PACU.
OPERATIVE PHASES: “PRE-INTRA-POST” – Pre (OR entry to anesthesia), Intra (anesthesia to transfer), Post (PACU onward)
13 The most common site for ectopic pregnancy is
(a) Ampulla
The ampulla (distal 2/3 of fallopian tube) is the site of 70-80% of ectopic pregnancies. It is the widest, most vascular portion where fertilization normally occurs. The slow transit of the zygote through this region increases risk of implantation. This location allows pregnancy to persist longer (up to 12 weeks) before rupture compared to isthmic (narrow) ectopics.
🚨 Ampulla is “Safest” Ectopic: More time before rupture, allows medical management with methotrexate. Isthmic and interstitial are surgical emergencies!
14 Which of the following measures does the nurse encourage a young lady to use to decrease the severity of dysmenorrhoea?
(a) Regular exercises
Regular aerobic exercise reduces dysmenorrhoea by increasing endorphin release (natural painkillers) and improving uterine blood flow. Exercise also reduces prostaglandin production which causes uterine contractions. Studies show 30-45 minutes of moderate exercise 3x/week significantly decreases menstrual pain intensity and duration. It’s a non-pharmacological, evidence-based intervention.
DYSMENORRHEA MANAGEMENT: “HEAT” – Heating pad, Exercise, Analgesics (NSAIDs), TENS (transcutaneous electrical nerve stimulation)
15 The nurse records a discharging blind tract that extends from the organ surface to the underlying area as a/an
(c) Sinus
A sinus is a blind tract or cavity with one opening on the skin or mucosal surface that leads to a deeper area. It results from chronic infection, foreign body, or incomplete healing. Example: pilonidal sinus, dental sinus tract. Different from fistula which has TWO openings connecting two epithelial surfaces (e.g., vesicovaginal fistula).
TRACT DEFINITIONS: Sinus = Single opening, Fistula = Two openings, Abscess = Closed cavity, Wound = Surface break
16 Which of the following types of anthrax presents with the worst prognosis?
(b) Inhalation
Inhalation anthrax has the worst prognosis with mortality >90% if untreated, and still 45% even with aggressive treatment. Bacillus anthracis spores are inhaled, germinate in alveolar macrophages, and produce lethal toxin causing massive hemorrhagic mediastinitis, sepsis, and fulminant respiratory failure. Early flu-like symptoms progress rapidly to respiratory distress, mediastinal widening on CXR, and death within 24-36 hours of symptom onset.
☠️ Bioterrorism Agent: Inhalation anthrax is a Category A bioterrorism weapon due to high mortality and potential for mass dissemination. Requires immediate public health response!
17 Which of the following is NOT a risk factor for ectopic pregnancy?
(d) Use of intra uterine device
IUD use is NOT a risk factor for ectopic pregnancy. In fact, IUDs are highly effective at preventing both intrauterine AND ectopic pregnancies. However, IF pregnancy occurs with an IUD in place, there is a higher proportion that are ectopic (because IUD prevents intrauterine implantation more effectively). This is a subtle but important distinction – the IUD doesn’t increase risk, but changes the distribution if failure occurs.
ECTOPIC RISKS: “PAST” – Previous PID, Abortion (unsafe), Surgery (tubal), Tubal pathology
18 Which of the following bacilli is a normal flora in the vagina?
(d) Lactobacillus
Lactobacillus species (especially L. crispatus, L. jensenii, L. gasseri) are the dominant normal flora of the healthy vagina. They produce lactic acid, maintaining acidic pH (3.8-4.5) which inhibits pathogenic organisms. They also produce hydrogen peroxide and bacteriocins that suppress E. coli, Gardnerella, and anaerobes. This is called the “vaginal microbiome” and is essential for reproductive health.
🌸 Healthy Vagina = Lactobacillus dominant! Disruption leads to BV, yeast infections, and increased STI risk. Avoid douching which kills beneficial lactobacilli!
19 A client who complains of itching and irritation of the vulval region is most likely suffering from
(a) Pruritis vulvae
Pruritus vulvae is the medical term for itching of the vulva – it’s a symptom, not a diagnosis. It can be caused by infection (candidiasis, trichomonas), dermatitis, allergies, systemic diseases (diabetes, liver disease), or malignancy. The term specifically describes the symptom complex of itching and irritation. Nurses must differentiate causes through history, examination, and investigations to provide appropriate treatment.
VULVAL ITCH CAUSES: “ITCHES” – Infections, Topical irritants, Candida, Hormonal changes, Eczema, Systemic disease (diabetes)
20 While on ward round, a student hears that the patient has a vesico-vaginal fistula and understands that this is an opening between the
(a) Vagina and bladder
Vesicovaginal fistula (VVF) is an abnormal communication between the urinary bladder and vagina, causing continuous, uncontrollable leakage of urine per vaginum. Most common cause in developing countries is obstructed labor causing ischemic necrosis of vaginal wall and bladder. In developed countries, surgical injury during hysterectomy is more common. Severe social stigma, depression, and isolation result. Requires surgical repair (VVF repair) after 3 months of conservative management.
💔 Obstetric Fistula: Leading cause in Africa due to prolonged obstructed labor without C-section access. WHO estimates 2 million women affected worldwide. Preventable with quality obstetric care!
Fill in the Blank Spaces (10 marks)
21 An area in the operating room where only the scrub attire and surgical masks are allowed is referred to as ________________
Semi-restricted zone (or Scrub area)
The semi-restricted zone includes areas where scrub attire, surgical caps, and masks are required. This includes the scrub sink area, corridors leading to ORs, and areas with sterile supplies. The restricted zone requires full sterile gown and gloves (inside the OR itself). The unrestricted zone is the reception area, locker rooms where street clothes are permitted.
22 A patient’s voluntary decision to undergo a surgical procedure following a clear understanding of the associated risks and benefits is called ________________
Informed consent
Informed consent is a legal and ethical requirement where the patient (or guardian) voluntarily agrees to treatment after receiving comprehensive information about diagnosis, proposed procedure, benefits, risks, alternatives, and consequences of refusal. Must be obtained without coercion, with capacity to understand, and sufficient time to decide. Nurse’s role is as witness to signature and to confirm patient understanding.
23 Absence of menstruation in a woman of reproductive age is known as ________________
Amenorrhoea
Amenorrhoea is the absence of menstrual periods for 3 consecutive months in women with previously normal cycles, or 6 months in women with irregular cycles. Primary amenorrhoea: no menses by age 16 (or 14 without secondary sexual characteristics). Secondary amenorrhoea: cessation after previously normal cycles. Causes include pregnancy, hypothalamic-pituitary disorders, ovarian failure, uterine abnormalities, and systemic diseases.
24 Inflammation of the bone that results from an infection is called ________________
Osteomyelitis
Osteomyelitis is bone infection caused by bacteria (Staphylococcus aureus most common), fungi, or mycobacteria. Routes: hematogenous (children), contiguous spread (diabetic foot ulcers), direct inoculation (trauma, surgery). Presents with local pain, fever, swelling. Chronic osteomyelitis forms sequestrum (dead bone) and involucrum (new bone formation). Requires prolonged IV antibiotics (4-6 weeks) and surgical debridement.
25 The surgical removal of contaminated or dead tissue from a wound is referred to as ________________
Debridement
Debridement is the removal of devitalized tissue, foreign material, and bacteria from a wound to promote healing. Types: sharp (surgical), mechanical (wet-to-dry dressings), enzymatic (chemical agents), autolytic (moist dressings), and biological (maggot therapy). Essential for infected wounds, burns, and chronic ulcers. Creates clean wound bed and reduces bacterial load, allowing granulation tissue formation.
26 A complete or incomplete disruption in the continuity of the bone structure is called ________________
Fracture
Fracture is a break in bone continuity caused by trauma, stress, or pathological weakening. Types: complete/incomplete, open/closed, displaced/undisplaced. Clinical features: pain, swelling, deformity, loss of function, crepitus, abnormal movement. Requires immobilization (splint/cast) and possibly reduction (closed or open surgical fixation). Complications include compartment syndrome, infection, non-union, and neurovascular injury.
27 A gynaecological instrument used to measure the length of the uterine cavity is known as ________________
Uterine sound (or Uterine measuring probe)
A uterine sound is a long, slender, graduated metal instrument gently passed through the cervix to measure uterine depth and direction before procedures (IUD insertion, D&C, endometrial biopsy). Preures perforation of uterus and ensures correct placement of devices. Typically measures 6-10 cm in nulliparous women, 7-11 cm in multiparous. Must be performed under sterile technique.
28 The childhood infection that predisposes to infertility is called ________________
Mumps (specifically mumps orchitis) or Pelvic Inflammatory Disease sequelae from Chlamydia/Gonorrhea
Mumps orchitis in post-pubertal males causes testicular inflammation and atrophy in 30-50% of cases, leading to impaired spermatogenesis and infertility. In females, chlamydia and gonorrhea infections cause PID, leading to tubal scarring and infertility. The question likely refers to mumps given “childhood infection” context, but STIs are more common causes globally.
💉 MMR Vaccine: Prevents mumps and subsequent orchitis. Given at 9 months and 15 months per Uganda schedule. Critical for male fertility protection!
29 A condition characterized by spermatozoa that have an abnormal morphology is referred to as ________________
Teratozoospermia
Teratozoospermia is sperm morphology abnormality where <40% of sperm have normal shape (WHO criteria). Causes include varicocele, infections, toxins, smoking, fever. Normal morphology is crucial for fertilization. Abnormal forms include large/small head, double head, coiled tail. Severe teratozoospermia (<4% normal forms) is associated with infertility and may require ICSI (intracytoplasmic sperm injection) for conception.
30 The causative organism for gonorrhoea is called ________________
Neisseria gonorrhoeae (gonococcus)
Neisseria gonorrhoeae is a gram-negative diplococcus that infects columnar epithelium of urethra, cervix, rectum, pharynx, and conjunctiva. Transmitted sexually or perinatally (ophthalmia neonatorum). Causes purulent discharge, dysuria, PID, infertility. Increasing antibiotic resistance (multi-drug resistant strains). Diagnosis by NAAT (nucleic acid amplification test). Treatment: Ceftriaxone IM plus Azithromycin PO (dual therapy for resistance).
STI ORGANISMS: “G-C-H-S” – Gonorrhea = Neisseria, Chlamydia = Chlamydia trachomatis, Herpes = HSV, Syphilis = Treponema pallidum
SECTION B: Short Essay Questions (20 marks)
31 (a) Outline five (5) roles of a circulating Nurse in theatre. (5 marks)
(b) Outline five (5) actions nurses perform while providing pre-operative care. (5 marks)
(b) Outline five (5) actions nurses perform while providing pre-operative care. (5 marks)
(a) Roles of a Circulating Nurse:
1. Patient advocate and safety coordinator: Verifies patient identity, surgical site, consent, and allergies before procedure. Ensures “Time Out” protocol is performed. Prevents wrong-site, wrong-patient surgery.
2. Environmental management: Maintains sterile field integrity, controls traffic flow in OR, ensures proper temperature/humidity, manages waste disposal, and coordinates equipment positioning.
div class=”essay-point”>3. Instrument and supply management: Opens sterile supplies, manages instrument counts with scrub nurse, documents used items, anticipates surgeon’s needs, and procures additional items without contaminating sterile field.4. Documentation and communication: Records intra-operative events, medications administered, specimens collected, implants used, and maintains communication with family and other departments (blood bank, pathology).
5. Emergency response coordinator: Activates emergency protocols, assists with resuscitation, manages massive transfusion protocol, and ensures availability of emergency drugs and equipment.
(b) Pre-operative Nursing Actions:
1. Pre-operative assessment: Complete physical assessment, vital signs, verify pre-op orders, check lab results, ensure informed consent is signed, and identify risk factors (allergies, comorbidities).
2. Patient preparation: Ensure NPO status, administer pre-operative medications (antibiotics, anxiolytics), perform skin prep (shaving if required), and assist with bowel/bladder preparation.
3. Psychological support: Explain procedure, answer questions, alleviate anxiety, provide teaching about post-operative expectations (pain management, deep breathing exercises, early ambulation).
4. Safety measures: Remove jewelry, dentures, nail polish, ensure proper identification band, confirm surgical site marking, and verify blood availability if needed.
5. Documentation and handover: Complete pre-operative checklist, document baseline assessments, record medication administration, and provide structured handover to OR staff including patient concerns.
CIRCULATING NURSE: “C-SPAN” – Coordinator, Safety, Procurement, Advocate, Documentation
32 (a) Outline five (5) predisposing factors to cancer of the cervix. (5 marks)
(b) Outline five (5) clinical features of ectopic pregnancy. (5 marks)
(b) Outline five (5) clinical features of ectopic pregnancy. (5 marks)
(a) Cervical Cancer Risk Factors:
1. Persistent HPV infection: High-risk types 16 and 18 cause 70% of cervical cancers. Transmitted sexually, integrates into host DNA, causes cellular dysplasia and malignant transformation over 10-20 years.
2. Early sexual debut and multiple sexual partners: Increases exposure risk to HPV and other STIs. Early initiation (<16 years) when cervix is immature (metaplastic) increases susceptibility to oncogenic HPV.
3. Immunosuppression: HIV-positive women have 6-fold higher risk due to impaired immune surveillance of HPV infection. Also increased risk with chronic steroid use, organ transplantation.
4. Multiparity and oral contraceptive use: High parity (>5 children) causes cervical trauma and inflammation. Long-term OCP use (>5 years) may increase HPV persistence due to hormonal effects on cervical epithelium.
5. Smoking: Carcinogens in tobacco smoke concentrate in cervical mucus, causing DNA damage and impairing local immune response. Directly co-carcinogenic with HPV.
(b) Clinical Features of Ectopic Pregnancy:
1. Amenorrhoea: Missed period or delayed menses (6-8 weeks gestation) in 75-95% of cases. Patient may not realize pregnancy or have irregular cycles.
2. Abdominal pain: Unilateral lower abdominal pain (90% cases) – sharp, stabbing, colicky pain as tube distends. Sudden severe pain indicates rupture with peritoneal irritation.
3. Vaginal bleeding: Scanty, dark brown “spotting” (50% cases) due to decidual sloughing. Usually lighter than normal menstruation. Significant bleeding suggests miscarriage or rupture.
4. Dizziness and syncope: Signs of hypovolemia from internal bleeding. May present as fainting, weakness, pallor, tachycardia – indicates ruptured ectopic pregnancy requiring emergency surgery.
5. Cervical excitation tenderness: Extreme pain on gentle movement of cervix during bimanual exam due to peritoneal irritation from blood. Rebound tenderness and guarding in abdomen.
ECTOPIC TRIAD: “P-A-V” – Pain, Amenorrhoea, Vaginal bleeding + Dizziness (rupture sign)
SECTION C: Long Essay Questions (50 marks)
33 (a) Define burns. (2 marks)
(b) Describe nine (9) resuscitative care actions that nurses perform for a patient with burns in the first 24 hours of admission in the hospital. (18 marks)
(c) Outline five (5) complications of patients with burns may face. (5 marks)
(b) Describe nine (9) resuscitative care actions that nurses perform for a patient with burns in the first 24 hours of admission in the hospital. (18 marks)
(c) Outline five (5) complications of patients with burns may face. (5 marks)
(a) Definition of Burns:
Burns are injuries to body tissues caused by thermal (heat, flame, scald), chemical, electrical, or radiation energy, resulting in coagulative necrosis of skin and underlying tissues. Severity depends on temperature, duration of exposure, and depth of penetration, causing destruction of skin barrier, fluid loss, and systemic inflammatory response.
(b) First 24-Hour Resuscitative Care for Burns:
1. Airway assessment and management: Evaluate for inhalation injury (soot in mouth, hoarseness, stridor). Administer humidified oxygen at 100% if needed. Early intubation if airway compromise suspected (risk of edema worsening). RATIONALE: Inhalation injury is leading cause of early death; airway can obstruct within 12-24 hours.
2. Fluid resuscitation using Parkland formula: Calculate 4 mL × kg × %TBSA and give first half in first 8 hours from time of burn (not admission). Use lactated Ringer’s solution. Titrate to urine output (>0.5 mL/kg/hr). RATIONALE: Capillary leak peaks at 6-8 hours; restores intravascular volume and prevents burn shock.
3. Wound care and dressing: Apply sterile, cool (not cold) saline-soaked gauze to reduce pain and prevent further tissue damage. Cover with clean dry sheets. Avoid ice (causes vasoconstriction and deeper injury). RATIONALE: Reduces pain, bacterial contamination, and prevents progression of thermal injury.
4. Pain management: Administer IV opioids (morphine, fentanyl) in small frequent doses. Do NOT use IM route (poor absorption due to hypovolemia). Reassess pain every 15-30 minutes. RATIONALE: Severe pain increases sympathetic response, worsening tissue ischemia and metabolic demands.
5. Temperature regulation: Maintain warm environment (28-32°C), use warmed IV fluids, and cover patient with warm blankets. RATIONALE: Burn patients lose heat rapidly due to damaged skin barrier; hypothermia increases metabolic stress and coagulopathy.
6. Insertion of urinary catheter: Monitor urine output hourly as primary indicator of adequate perfusion. Target 30-50 mL/hr in adults (0.5-1 mL/kg/hr). RATIONALE: Most sensitive indicator of fluid resuscitation adequacy and renal perfusion; guides fluid rate adjustment.
7. Nasogastric tube insertion: Place NGT for burns >20% TBSA or patients with nausea/vomiting. Connect to low suction. RATIONALE: Ileus is common due to sympathetic stress; prevents aspiration and decompresses stomach.
8. Baseline investigations: Draw blood for FBC, electrolytes, creatinine, glucose, coagulation profile, blood type and crossmatch. Obtain blood/urine culture if infection suspected. RATIONALE: Establishes baseline, identifies pre-existing conditions, and prepares for potential surgery/transfusion.
9. Tetanus prophylaxis: Administer tetanus toxoid booster if last dose >5 years ago or unknown status. Give tetanus immunoglobulin for major/suspicious burns. RATIONALE: Burns are tetanus-prone wounds; Clostridium tetani spores survive in devitalized tissue.
(c) Complications of Burns:
1. Hypovolemic shock: Massive fluid loss and capillary leak leading to inadequate tissue perfusion and multi-organ dysfunction.
2. Infection and sepsis: Loss of skin barrier allows bacterial entry; impaired immunity and devitalized tissue promote infection leading to sepsis.
3. Acute Respiratory Distress Syndrome (ARDS): Inhalation injury, systemic inflammatory response, and fluid overload cause pulmonary edema and respiratory failure.
4. Acute kidney injury: Hypovolemia, myoglobinuria from muscle breakdown (electrical burns), and nephrotoxic drugs impair renal function.
5. Contractures and hypertrophic scars: Excessive collagen deposition during healing causes functional limitation, cosmetic disfigurement, and psychological distress.
🔥 Rule of Nines for TBSA: Head 9%, Arms 9% each, Legs 18% each, Trunk anterior 18%, Trunk posterior 18%, Perineum 1%
34 (a) Outline ten (10) menstrual disorders. (10 marks)
(b) Outline five (5) measures of preventing anaemia among women with heavy bleeding. (5 marks)
(c) Outline ten (10) coping measures taught to women with pre-menopausal syndrome. (10 marks)
(b) Outline five (5) measures of preventing anaemia among women with heavy bleeding. (5 marks)
(c) Outline ten (10) coping measures taught to women with pre-menopausal syndrome. (10 marks)
(a) Menstrual Disorders:
1. Amenorrhoea: Absence of menstruation – primary (no menses by 16 years) or secondary (cessation for >3 months in previously regular cycles).
2. Dysmenorrhoea: Painful menstruation – primary (no organic cause, due to prostaglandins) or secondary (endometriosis, fibroids, PID).
3. Menorrhagia (heavy menstrual bleeding): Excessive menstrual flow (>80 mL) or prolonged bleeding (>7 days), soaking pads, passing clots, leading to anemia.
4. Metrorrhagia: Bleeding between periods or irregular uterine bleeding at any time, often associated with anovulation, polyps, or malignancy.
5. Polymenorrhoea: Frequent menstrual cycles <21 days apart, often due to anovulation, thyroid disorders, or luteal phase defect.
6. Oligomenorrhoea: Infrequent menstruation >35 days apart, common in PCOS, thyroid disorders, hyperprolactinemia, perimenopause.
7. Premenstrual syndrome (PMS): Cyclical physical and emotional symptoms occurring 1-2 weeks before menses: mood swings, bloating, breast tenderness, fatigue.
8. Endometriosis: Ectopic endometrial tissue causing dysmenorrhoea, dyspareunia, chronic pelvic pain, and infertility. Presents as secondary dysmenorrhoea.
9. Polycystic ovary syndrome (PCOS): Menstrual irregularity (oligomenorrhoea/amenorrhoea), hyperandrogenism, polycystic ovaries on ultrasound, affecting 5-10% of women.
10. Menstrual migraine: Cyclical headaches occurring with menses due to estrogen withdrawal, often refractory to standard analgesics.
(b) Anemia Prevention in Heavy Bleeding:
1. Iron supplementation: Oral ferrous sulfate 65mg elemental iron daily or every other day during periods and for 3 months after. Corrects deficiency and builds stores.
2. Nutritional counseling: Encourage iron-rich foods (red meat, liver, beans, dark leafy greens), vitamin C (enhances absorption), avoid tea/coffee with meals (inhibits absorption).
3. Treat underlying cause: Hormonal therapy (combined oral contraceptives, progestins) to reduce menstrual flow, manage fibroids, endometriosis, or anovulation.
4. Regular hemoglobin monitoring: Check Hb every 3-6 months during periods of heavy bleeding. Early detection allows intervention before severe anemia (Hb <7 g/dL) develops.
5. Blood transfusion for severe cases: Transfuse packed red cells when Hb <7 g/dL or patient is symptomatic (angina, syncope, heart failure) despite oral therapy.
(c) Coping Measures for Pre-menstrual Syndrome:
1. Stress management techniques: Deep breathing exercises, progressive muscle relaxation, meditation, and yoga to reduce anxiety and irritability associated with PMS.
2. Regular aerobic exercise: 30 minutes of brisk walking, swimming, or cycling 3-4 times per week increases endorphins, reduces bloating, improves mood and fatigue.
3. Dietary modifications: Reduce salt intake 1 week before period to minimize fluid retention; limit caffeine/alcohol (worsen anxiety); eat small frequent meals to stabilize blood sugar and reduce irritability.
4. Sleep hygiene: Maintain 8 hours of sleep, consistent bedtime routine, avoid screens before bed, cool dark bedroom to combat insomnia and fatigue.
5. Symptom tracking: Keep menstrual diary to identify patterns, predict symptom onset, and plan coping strategies. Helps differentiate PMS from other mood disorders.
6. Cognitive behavioral therapy: Challenge negative thoughts, develop problem-solving skills, and reframe catastrophic thinking about symptoms.
7. Social support: Communicate needs to family/partner during symptomatic phase, delegate responsibilities, arrange self-care time, avoid major decisions.
8. Complementary therapies: Vitamin B6 (50-100 mg/day), calcium supplements, evening primrose oil, and herbal teas (chamomile) may reduce symptoms.
9. Pharmacological support: NSAIDs for pain and cramping, SSRIs (fluoxetine, sertraline) for severe mood symptoms in luteal phase, diuretics for bloating.
10. Education and reassurance: Understanding that PMS is physiological, temporary, and manageable reduces anxiety. Normalize the experience and emphasize self-compassion.
📅 PMS vs PMDD: PMDD is severe form affecting 3-8% of women, with functional impairment requiring DSM-5 diagnosis. SSRI treatment is first-line for PMDD but optional for mild PMS.
Original examination paper