Tutorial.
We managed 1 EMQ and 4 essays.
The EMQ was on Ulipristal, which you need to know about as it is sure to be in the exam databases by now.
The questions are below the essays, which come next.
I am still getting essays that have been written with the Green-top guidelines and textbooks open.
This is a complete waste of time!
1. A 32 year-old woman with learning difficulty attends the gynaecology clinic with her mother. The referral is because of severe dysmenorrhoea and menorrhagia. The mother is keen for her to have hysterectomy and is prepared to give her consent.
1. What factors will you take into consideration before offering treatment? 8 marks.
2. Outline the treatment options, not including hysterectomy, that you will discuss. 6 marks.
3. If it is concluded that hysterectomy is the best option, justify the steps you will take to arrange this. 6 marks.
2. Endometriosis & fertility
A 32 year-old woman attends the clinic with her partner. A recent laparoscopy for pelvic pain and dyspareunia revealed endometriosis. The have not used contraception for 12 months but have not conceived. Neither has had a child before.
1. Outline the history you will take. 6 marks
2. Outline the investigations you will arrange. 6 marks
3. Outline the information you will wish to discuss with the couple. 12 marks
3. A woman of 18 attends the A&E Department requesting emergency contraception.
1. Outline the history you will take. 4 marks.
2. Justify the investigations you will arrange. 2 marks.
3. Outline the methods of emergency contraception and their pros and cons. 8 marks
4. Justify your management. 8 marks.
4. Justify your management. 8 marks.
4. A 25-year-old primigravida attends for a routine scan and echogenic bowel is noted.
1. What is the advice of the National Screening Committee in relation to “soft markers”? 6 marks.
2. What conditions are linked to echogenic bowel? 6 marks.
3. Justify your management. 12 marks.
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 / excreted?
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 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.
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