Last night the programme I use to record the tutorial crashed and wiped the tutorial. Unfortunately, I did not notice or I might have been able to salvage some of it. You can still answer the questions and send them to me.
One thing I mentioned was a recent paper which raises questions about the use of the discriminatory zone:
http://www.jultrasoundmed.org/content/30/12/1637.abstract.
Missed pills. Starting the Pill. COC.
Lead-in.
The following scenarios relate to the combined oral contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at all.
Abbreviations.
UPSI: unprotected sexual intercourse.
Option list.
A. pill that is ≥ 12 hours late.
B. pill that is > 12 hours late.
C. pill that is ≥ 24 hours late.
D. pill that is > 24 hours late.
E. two missed pills at any time in a single cycle.
F. the first pill taken in one’s first love affair, now recalled with fond nostalgia for its effectiveness in preventing pregnancy, the Prince having been truly a loathsome toad.
G. no additional contraception required.
H. additional contraception required for 7 days.
I. emergency contraception should be considered.
J. emergency contraception should be recommended.
K. take the missed pill immediately, but not if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
L. take the missed pill immediately, even if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
M. take the missed pill immediately, even if it means 2 pills in one day; additional contraception for 7 days; pill-free interval as usual.
N. take one of the missed pills immediately, discard the other missed pills, use extra contraception for 7 days and discuss emergency contraception with your doctor.
O. take the missed pills immediately, use extra contraception for 7 days and discuss emergency contraception with your doctor.
P. continuous combined preparation.
Q. bi-phasic preparation.
R. quadriphasic preparation.
S. cannot be answered from the data given.
T. none of the above.
Scenario 1.
What is the definition of a missed pill?
Scenario 2.
What is the definition of two missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation. The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a 21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a 21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack. What advice should be given?
Scenario 11
What kind of preparation is Qlaira?
A nulliparous woman is admitted to the Early Pregnancy Unit with abdominal pain and bleeding. Her hCG is 2,000 i.u. per litre. An ultrasound scan shows an empty uterus and a left adnexal mass.
1. Discuss the differential diagnosis. 4 marks.
2. Discuss the treatment options. 10 marks.
3. Discuss the advice you will give for when she has recovered. 6 marks.
A nulliparous woman presents at 37 weeks’ gestation with reduced fetal movements. No fetal heart activity can be detected on auscultation.
1. Outline the steps necessary for diagnosis of fetal death in utero. 2 marks.
2. Outline the investigation. 4 marks.
3. Outline the management. 10 marks.
4. Outline the advice she should be given. 4 marks.
An immigrant woman is seen in the gynaecology clinic six months after the delivery of a stillborn baby. She complains of continuous urinary incontinence.
Outline the main themes for a comprehensive assessment and the main issues related to them.
A woman is referred to the gynaecology clinic with premenstrual syndrome.
Critically evaluate the investigation and management.
Dear DrMcFarlane, did i understand correctly from the paper you linked to in the beginning, that if the bhcg is upto 2000 and an empty uterus, it should not be inferred that it is likely an ectopic?.....the would bear on management as you might not scope such patients so readily.
ReplyDeletethe alternative interpretation would be that an empty uterus and adnexa with a bhcg of upto 2000 should still be considered as PUL and thats that.
the bit that doesnt sit right is the mention in the end that of the 'highest bhcgs in general ad that preceded by a liveborn'. I didnt understand the relevance of these figures on their own. To my mind, if i am thinking on the right lines, which i possibly am not, it would have impact if quoted with results of laparoscopy our total outcome.
your comments please
The guidelines are guidelines ,these are not the rules so we have to apply them keeping in mind patient history(risk factor),clinical examination based on stable vitals and normal abdominal examination.
ReplyDeleteWe had experienced few cases of subnormal rising BHcg with negative scan finding one case turned out to be intrauterine multiple pregnancy with one blighted ovum,another case was ?? cornual pregnancy with small cystic structure near cornual end along with subnormally rising BHCg which later on remain stable size but another intrauterine gestational sac appeared.
Thanks
Scenario 1 -C pill that is ≥ 24 hours late.
ReplyDeleteScenario 2 -E two missed pills at any time in a single cycle
Scenario 3 -G no additional contraception required
Scenario 4 -H additional contraception required for 7 days
Scenario 5 -L take the missed pill immediately, even if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.
Scenario 6 - M
Scenario 7 - O
Scenario 8 - K
Scenario 9 - O
Scenario 10 - N
Scenario 11 - p
if you are planning to sit the MRCOG, send me an e-mail as there is information I can send.
Deletedrtmcf@gmail.com.
please corrent my answer.. thanks a lot dr
ReplyDelete