Early Pregnancy Care(platinum) -EMQ

Option List :

A. Methotrexate
B. Etoposide, methotrexate, actinomycin D and folinic acid plus vincristine and cyclophosphamide
C. Repeat evacuation of uterus
D. No treatment required
E. On follow up for 1 year after the treatment
F. Methotrexate/folinic acid
G. Hysterectomy
H. Methotrexate and Hysterectomy
I. Follow up every bi weekly till Hcg becomes normal

Each of the above Options describes Various Treatment of gestational trophoblastic neoplasia . For each patient select the single most appropriate management for each scenarios. Each option may be used once, more than once or not at all

1. A 41-year-old woman has bleeding for 10 months following her third-term vaginal delivery. Uterine evacuation identifies choriocarcinoma on histological diagnosis. Ultrasound shows a 5-cm lesion in the myometrium and chest x-ray shows multiple (more than eight) lung nodules.

2. A 45-year-old woman has a hydatidiform mole evacuated uneventfully. The hCG decreases from a pre-evacuation value of 80 000 to 1000 IU/l 4 weeks after the evacuation but then persists at 1000 mIU/ml for 4 weeks. Clinical examination shows no abnormality or evidence of metastases. Ultrasound of the uterus shows a 2-cm lesion in the myometrium. Chest x-ray is negative.

3. Mrs.A, has been treated for completely molar pregnancy 8months back , she is on follow up .her BtaHcg is 20000 .from last 2 times it is showing increasing trend. On further evaluation CT. scan Shows Lung and GIT metstastasis .

Option List :
A. 200mg mifepristone
B. 800mcg vaginal misoprostol followed by 400mcg every 3 hourly
C. 400mcg misoprotol every 3hourly
D. 200mcg Misorpostol every 4th hourly
E. 200mcg Misorpostol every 6th hourly
F. 100mcg Misorpostol every 6th hourly
G. 100mcg Misorpostol every 4th hourly
H. 400mcg Misorpostol
I. 600mcg Misorpostol
K. 1000mcg misoprostol
L. 1200mcg misoprostol

Each of the following clinical scenarios below relate to of women choosing termination of pregnancy and appropriate regimen required . For each patient select the single most appropriate option from the list above. Each option may be used once, more than once or not at all.

4. Mrs, Rubina, 24 year old woman 7weeks of pregnancy presented with bleeding P/v and history of expulsion of product of conception at home.sonographer made diagnosis of incomplete miscarriage

5. Mrs.Saksha ,40year old, is 13 weeks pregnant , confirmed by scan as well is for medical termination of pregnancy . She has taken 200mg of mifepristone 2days before what’s next Recommended regimenZ

6. Mrs.Lisa, 26year old, late booker , diagnosed with potter syndrome, on anomaly scan at 21weeks for medical termination of pregnancy , the first drug to be considered to start with

7. Mrs Radha , 36 year old diagnosed with Intaruterine feral death secondary to Severe IUGR at 29 weeks , she was counselled and she wanted to start of with termination, she is given 200mg of mifepristone , what’s next Recommended regimen

8. Ms.rachel ,26year old late booker baby diagnosed with complex congenital cardiac disease at 27weeks , for termination of pregnancy , started with mifepristone 36hrs, what’s next Recommended regimen

Option List :

A. Clause A of abortion act 1967
B. Clause C of abortion act 1967
C. Clause E of abortion act 1967
D. Clause D of abortion act 1967
E. Clause B of abortion act 1967
F. Clause F of abortion act 1967
G. Clause G of abortion act 1967
H. Inappropriate for termination
I. None of the above
J. Clause M of abortion act 1967
K. Clause N of abortion act 1967

Each of the above Options describes Various clauses of abortion act 1967 . For each patient select the single most appropriate clause for termination from the list above. Each option may be used once, more than once or not at all

9. Messeh , 32 year old ,primigravida now 7weeks pregnant. She is a known case of pulmonary hypertension with recent 2D Echo done 10days back shows Ejection fraction of 45% .

10. Katie, 18 year old is at 7 weeks of pregnancy . She is here for termination of pregnancy as she and her boy friend are not yet ready for this pregnancy.

11. Hazel, 16 year old is now 9 weeks of pregnancy .This pregnancy was Result of sexual assault by her teacher. She is requesting for termination.

12. Mrs.Rasheeda , is a late booker second trimester screening at 18 high risk of Down’s syndrome of 1 in 20. Detailed anomaly scan shows VSD, duodenal atresia , short femur and nuchal fold thickness of 9mm

13. Mrs. sona is 32year old is known diabetic on insulin . Her blood sugars are well controlled .this is third pregnancy unplanned preganancy,her first two babies are diagnosed with Down’s syndrome. She is requesting for termination

14. Mrs. Rawia, is immigrant who has been. Diagnosed with severe mitral stenosis with diameter of 0.25cm 2,she is into 6 weeks pregnancy,

From the following clinical scenarios below, choose the single most appropriate management option from the option list. Where relevant, it can be assumed that in each case the woman has been registered with the nearest Trophoblastic Screening and Treatment Centre. Each answer may be used once, more than once or not at all.

Option List :

A. Dilatation of the cervix and uterine curettage
B. Hysterectomy and bilateral salpingo-oophorectomy
C. Intramuscular methotrexate and folinic acid
D. Intravenous multiagent chemotherapy
E. Measure serum hCG 6–8 weeks after the pregnancy
F. Medical termination of pregnancy
G. Oxytocin infusion to stop uterine haemorrhage prior to suction evacuation of the uterus
H. Prenatal invasive testing for fetal karyotype
I. Prostaglandin cervical ripening prior to suction evacuation of the uterus
J. Second suction evacuation of the uterus
K. Suction evacuation of the uterus
L. Suction evacuation of the uterus and insertion of Mirena® intrauterine delivery system
M. Suction evacuation of the uterus and postoperative antiD prophylaxis
N. Suction evacuation of the uterus with antibiotic prophylaxis
O. Tests and treatment not required
P. Register with screening centres
Q. write a letter back to GP.
R. Suction evacuation of the uterus and Register with screening centres .
S. Need to do Fetomaternal haemorrhage.

15. Mrs. Serena, 20 year-old nulliparous woman presents with some vaginal bleeding at 12 weeks of gestation and a pelvic ultrasound scan indicates a diagnosis of a molar pregnancy. Complains of vaginal bleeding
On examination
Per abdomen -16weeks gravid sized
Per vaginal examination - cervix -os admits 1finger.fresh blood clots noted in vagina
Investigation results are as follows:
Full blood count: haemoglobin 11. 2 g/l, otherwise normal
Liver and renal function tests: normal
Blood group: O Rh negative
Serum hCG: 100000iu/l
TSH: 1.5 mU/l

16. Mrs. Sara Ben , A 25 year-old woman, Par1living 1 presents with heavy vaginal bleeding and crampy period-like pains at 12 weeks of gestation.
On examination she looks pale;
BP: 100/60 mmHg
pulse rate: 104 bpm
Per abdomen - uterus is 16 week sized uterus
Per vaginal examination - cervix is open and there is a lot fresh blood and clots in the vaginal together with Copious vesicular placental tissue.
Investigation results are as follows:
Full blood count - haemoglobin 9.9. g/l,
Blood group: O Rh positive
Serum Hcg- 5000Iu/L

17. Mrs. Tina , A 39yearold woman, P4, presents at 10 weeks of gestation with recurrent vomiting and dehydration ,
On examination the uterus is palpated at approximately 16-week sized.
A pelvic ultrasound scan indicates a twin pregnancy with a possible diagnosis of a partial molar pregnancy in one of the twins.
Investigation results are as follows:
Full blood count: haemoglobin 10.2 g/l, otherwise normal
Liver and renal function tests: normal .
Blood group: AB Rh positive
Serum hCG: 120000IU/l
Thyroid function – free T4: 26 pmol/l free T3: 6.3 pmol/l TSH < 0.1 mU/l

18. Mrs. SARA , a 34-year-old woman, Para3 Living 3 presents with some vaginal bleeding at 16 weeks of gestation and a pelvic ultrasound scan indicates a diagnosis of a partial molar pregnancy.
On examination the uterus is palpated at the level of the umbilicus; the cervix looks normal and is closed; there is fresh blood and clots in the vaginal. Investigation results are as follows:
Full blood count: haemoglobin 9.2 g/l, otherwise normal
Liver and renal function tests normal
Blood group - AB Rh positive
Serum hCG: 148 457 IU/l
TSH: 3.1 mU/l

19. Mrs.Sabeera , A 23-year-old nulliparous woman presents with 1 week of brown vaginal bleeding.
Her LMP was 14 weeks ago
She does not feel as if she is pregnant any more.
On examination -uterus is 6-8 weeks -sized
Cervix looks normal and is closed
There is old blood and brown discharge in the vagina.
A pelvic ultrasound scan shows a small fetus with no fetal heart action and a collapsed gestational sac.
Investigation results are as follows:
Full blood count: haemoglobin 11.2 g/l
Blood group - AB Rh positive
Serum hCG: 557 IU/l
Thyroid function: normal.
After an evacuation of the uterus the histology confirms fetal parts and defective endovascular trophoblast invasion in decidual implantation site fragments from routine products of conception

Option List :

A. Vitamin B1
B. Vitamin B12
C. Proton pump inhibitors
D. Hydrocortisone
E. Normal saline with potassium chloride
F. Ginger
G. Pyridoxine
H. Metcalopramide
I. Phenothiazine
J. Procylcidine IV
K. Dextrose with potassium chloride
L. Termination of pregnancy

Each of the following clinical scenarios below relate to Management of women with Hypermesisgravidarum . For each patient select the single most appropriate management option from the list above. Each option may be used once, more than once or not at all.

20. Mrs. Sheeba , 32year-old primigravid woman having inpatient management of hyperemesis gravidarum. she is having an oculogyric crisis, tardive dyskinesia after she received fast Iv push of metaclopramide

21. Mrs. Ruby , 24 year old referred from ambulatory care , as her PUQE index is 15 She is dehydrated , Ketonuria 2+ ,Best rehydration regimen

22. Mrs. Lovely . A 19 year old, presenting with 2 episode of nausea and vomiting , she is not dehydrated , able to tolerate orally,wishes to avoid anti Emetics

23. Mrs. Rachel , 30 year old women, admitted for inpatient management of Hypermesis , manged with rehydration, regimen , thiamine, Iv phenothiazine, Iv metaclopramide, diet according to dietician advise, she is still not responding to treatment

24. This medication to be given before giving dextrose infusion

25. Mrs. Rita ,30 year old woman, presented with recurrent episodes of nause and vomiting , she complains of recurrent heart burn suggestive of women developing gastro-oesophageal reflux disease, additional medication along with antiemetics to be given .