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Tonight we had four essays and an EMQ.
A 28-year-old woman is referred to the gynaecology clinic with suspected premature ovarian failure. She has “hot flushes”, has not menstruated for 8 months and a FSH level was found to be 40 iu/l.
1. Outline the definition and main causes of premature ovarian failure. 10 marks
2. Critically evaluate the management options. 10 marks
Critically evaluate the statement: “fortification of flour is overdue in the UK”.
A 23-year-old primigravida with no known risk factors for premature delivery presents at 26 weeks' gestation with a history of uterine contractions and vaginal fluid loss.
1. Describe your assessment. 10 marks
2. Discuss your management assuming premature rupture of the membranes is confirmed.
With regard to ovarian hyperstimulation syndrome:
1. Outline the risk factors. 4 marks
2. Discuss the classification system. 6 marks
3. Outline the key aspects of the management. 10 marks
EMQ. Early pregnancy.
Lead-in.
The following scenarios relate to early pregnancy.
For each, select the diagnosis you most want to exclude.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Scenario 1.
A 35-year-old primigravida is seen in the EPU with vaginal bleeding and severe left iliac fossa pain. The pregnancy occurred after four cycles of IVF and embryo transfer was performed six weeks ago. Her β-hCG is >1,000 iu/l. An ultrasound scan showed an intra-uterine pregnancy of an appropriate size for the gestation. Normal fetal heart activity was noted. No adnexal masses were seen.
Scenario 2.
A 25-year-old woman with known PCOS is seen in the early pregnancy unit after an episode of slight vaginal bleeding. Her LMP was 10 weeks ago. An ultrasound scan shows an intra-uterine pregnancy with CRL of 6 mm. No fetal heart activity is seen.
Scenario 3.
A GP phones for advice. She is conducting her morning surgery. A nulliparous woman at 6 weeks’ gestation has returned from France where she has enjoyed the local food, particularly unpasteurised soft cheese and pork meats. She has presented with diarrhoea and mild abdominal pain. A β-hCG is 25 iu/l. She is concerned about listeriosis and toxoplasmosis, about which she has read.
Scenario 4.
A 30-year-old parous woman attends the EPU with vaginal bleeding and lower abdominal pain. An ultrasound scan shows a 30 mm. intra-uterine sac but no evidence of fetal heart activity.
Scenario 5.
A 45-year-old para 6 is admitted to the A&E department with 6 weeks’ amenorrhoea. A β-hCG is positive. She complains of retrosternal pain and has a history of heartburn and acid reflux. Her BMI is 30. She smokes 40 cigarettes daily and has COAD.
Option list.
Complete miscarriage.
Incomplete miscarriage.
Missed miscarriage.
Pregnancy in a uterine horn.
Ectopic pregnancy.
OHSS.
Ovarian torsion.
Ovarian cyst accident.
Hydatidiform mole.
Listeriosis.
Toxoplasmosis.
Crohn’s disease
Ulcerative colitis.
Duodenal ulceration.
Pulmonary embolism.
Pneumothorax.
Coronary thrombosis.
None of the above.
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