Tonight we did 2 EMQs and 3 essays. If you send your answers, I'll send mine.
EMQ. Ulipristal.
Lead-in.
The following scenarios relate to Ulipristal. For each, select the most appropriate from the option list.
Each option can be used once, more than once or not at all.
Scenario 1.
What type of drug is Ulipristal?
Scenario 2.
How is Ulipristal broken down?
Scenario 3.
What is the half-life of Ulipristal?
Scenario 4.
Which drug may prolong the half-life of Ulipristal?
Scenario 5.
What is the main use of Ulipristal?
Scenario 6.
What is the dose of Ulipristal?
Scenario 7.
What time-scale applies to the licensed use of Ulipristal?
Scenario 8.
What contraceptive advice is given to those using Ulipristal?
Scenario 9.
What specific advice is given to women who are breast-feeding?
Scenario 10.
Can treatment with Ulipristal be repeated within 1 month?
Option list.
GnRH analogue.
Selective serotonin reuptake inhibitor.
19-nortestosterone derived progestagen.
21-hydroxyprogesterone-derived progestagen.
mifepristone derivative.
Selective oestrogen receptor modulator.
Selective progesterone receptor modulator.
Urinary excretion.
Metabolised by renal cytochrome P450 enzyme system.
Metabolised by hepatic cytochrome P450 enzyme system.
30 mg. with dose repeated if vomiting occurs within 3 hours.
100 mg. with dose repeated if vomiting occurs within 3 hours.
150 mg. with dose repeated if vomiting occurs within 3 hours.
phenobarbitone
valium
erythromycin
12 hours.
18 hours.
32 hours.
72 hours.
120 hours.
Depot-contraception.
Depression.
Emergency contraception.
Menorrhagia.
Termination of pregnancy.
Yes.
No.
Maybe.
Continue.
Discontinue for 36 hours.
Discontinue for 72 hours.
May interfere with contraception containing progestagen.
May interfere with contraception containing oestrogen.
No action if LARC being used.
EMQ. PPH.
Lead-in.
The following scenarios relate to post-partum haemorrhage.
For each, select the appropriate answer.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Scenario 1.
A 34 year-old, para 4 delivers the first twin and bleeds loses 250 ml. of fresh blood. A further 300 ml. is lost after the delivery of the second baby. What is the classification of the bleeding?
Scenario 2.
A 25 year-old nulliparous woman delivers a stillborn baby at 22 weeks. 1,000 ml. of fresh bleeding occurs in the next 2 hours. What is the classification of the bleeding?
Scenario 3.
A 45 year-old primigravid woman is readmitted at 10 weeks post-delivery as she has bled continuously for 3 weeks. What is the classification of the bleeding?
Scenario 4.
A 34 year-old woman passes placental tissue and 500 ml. of fresh blood 14 weeks after delivery of her second child. What is the classification of the bleeding?
Scenario 5.
Which drug is recommended by the GTG for routine use in the active management of the 3rd. stage?
Scenario 6.
By what amount does active management using syntometrine reduce the risk of 1ry. PPH?
Scenario 7.
What is the definition of primary PPH?
Scenario 8.
What is the definition of secondary PPH?
Option list.
Bleeding from the birth canal ≥ 500 ml.
Bleeding from the birth canal ≥ 500 ml. up to 24 hours after delivery of the placenta.
Bleeding from the birth canal ≥ 500 ml. from 24 hours after delivery of the placenta until 6 weeks later.
Bleeding from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the placenta until 6 weeks later.
Bleeding from the birth canal ≥ 500 ml. from 24 hours after delivery of the baby until 12 weeks later.
Bleeding from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the baby until 12 weeks later.
Abnormal bleeding from the birth canal from 24 hours after delivery of the baby until 12 weeks later.
APH.
1ry. PPH.
Major primary PPH.
2ry. PPH.
Syntocinon 5 i.u. i.m.
Syntometrine 5 mg. i.m.
Misoprostol 10 mg. orally.
Gemeprost 40 mg. rectally.
Vasopressin 5 i.u. s.c.
20%
40%
60%
80%
None of the above.
Essay 1.
Critically evaluate waterbirth.
Essay 2.
Critically evaluate asymptomatic bacteruria in pregnancy.
Essay 3.
In relation to cervical cancer:
1. describe the FIGO staging system. 12 marks.
2. outline how this impacts on treatment. 8 marks.
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