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MRCOG PART 2 SBAs and EMQs

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EMQ1462
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EMQ set 3

EMQ set 3 Posted by PAUL A.

Options for questions 1-2

A)    Cerazette (desogestrel) progestogen-only pill

B)     Noriday (norethisterone) progestogen-only pill
Norgeston (Levonorgestrel) Progestogen-only pill

C)    Combined oral contraceptive pill

D)    Depo-medroxyprogesterone acetate

E)     Depo- Norethisterone oenanthate

F)     Copper IUCD

G)    Combined contraceptive patch

H)    Combined contraceptive ring

I)       Etonorgestrel implant

J)       Male condom

K)    Levonorgestrel post-coital contraception

L)     All options may be used

 

For each scenario described below, choose the contraceptive option that should not be used (UKMEC category 3 or 4) from the above list of options. Each option may be used once, more than once, or not at all.

 

1) A 32 healthy year old woman has undergone surgical evacuation of a complete molar pregnancy at 8 weeks gestation. She is a non-smoker and her BMI is 25 kg/m2

 

2) A healthy 23 year old woman attends the gynaecology clinic 3 weeks following surgical evacuation of a missed miscarriage. Histology confirms the presence of choriocarcinoma. She wishes to use effective contraception

 

Options for questions 3-4

 

A)    Total abdominal hysterectomy

B)     Total abdominal hysterectomy + BSO

C)    Total abdominal hysterectomy + BSO + pelvic lymphadenectomy

D)    Total abdominal hysterectomy + BSO + omentectomy

E)     Total abdominal hysterectomy + BSO + para-aortic lymphadenectomy

F)     Total laparoscopic hysterectomy + BSO

G)    Intracavitary radiotherapy

H)    Intracavitary + external beam radiotherapy

I)       Total abdominal hysterectomy + BSO + radiotherapy

J)       Total abdominal hysterectomy + BSO + chemotherapy

K)    Total abdominal hysterectomy + BSO + combined chemo-radiotherapy

L)     Radical abdominal hysterectomy + BSO

M)   Radical abdominal hysterectomy + BSO + pelvic lymphadenectomy

 

For each scenario described below, choose the appropriate treatment option that is associated with the lowest risk of morbidityfrom the above list of options. Each option may be used once, more than once, or not at all.

 

3) A 39 year old nulliparous woman with a history of polycystic ovary syndrome has been referred to the gynaecology clinic because of persistent vaginal bleeding. Endometrial biopsy shows a well differentiated endometroid adenocarcinoma. MRI scan shows that the tumour is confined to the body of the uterus and does not extend beyond the inner 20% of the myometrium.

 

4) A healthy 67 year old woman has been referred to the gynaecology oncology clinic with a 3 months history of post-menopausal bleeding. Endometrial biopsy shows a well differentiated endometrial carcinoma. MRI scanning shows that the tumour is confined to the inner 50% of the myometrium but extends to the endocervical glands. There is no invasion of the cervical stroma.

 

Options for question 5

A)    Intra-peritoneal chemotherapy

B)     External beam radiotherapy

C)    Intracavitary radiotherapy

D)    Combined chemo-radiotherapy

E)     Systemic chemotherapy + interval cytoreductive surgery

F)     Radiotherapy + interval cytoreductive surgery

G)    No additional treatment

H)    Palliative care

I)       Immunotherapy

J)       Intra-peritoneal radiotherapy

K)    Systemic chemotherapy

 

For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

5) A 47 year old woman with a complex ovarian mass has undergone staging laparotomy. Peritoneal washings are positive for adenocarcinoma. There was an omental cake with tumour deposits on the diaphragmatic peritoneum. The tumour was debulked with residual tumour deposits of 2-3cm. There is no evidence of distant or intra-hepatic metastases. Histology confirms a well differentiated endometroid adenocarcinoma.

 

Options for questions 6-7

 

A)    No further treatment

B)     Adjuvant chemotherapy

C)    External beam radiotherapy

D)    Intracavitary radiotherapy

E)     Intra-peritomeal chemotherapy

F)     TAH + unilateral salpingo-oophrectomy

G)    Unilateral salpingo-oophrectomy

H)    Monthly pelvic ultrasound scans

I)       Monthly pelvic ultrasound scans + tumour markers

J)       Ovarian stimulation + IVF

K)    TAH

 

For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

6) A 37 year old woman with a complex ovarian mass had a staging laparotomy with unilateral salpingo-oophrectomy to conserver fertility. Peritoneal washings, the omentum and peritoneal biopsies are negative. There is a well differentiated endometroid adenocarcinoma confined to the ovary and the ovarian capsule is not invaded. Biopsies from the conserved ovary and lymph nodes are normal.

7) A 35 year old woman with a complex ovarian mass had a staging laparotomy with unilateral salpingo-oophrectomy to conserver fertility. Peritoneal washings contain atypical cells but peritoneal biopsies are negative. There is a well differentiated endometroid adenocarcinoma extending to the surface of the ovary. Biopsies from the conserved ovary and lymph nodes are normal.

H H Posted by H H.

1 F   2  F   3  B   4  B   5  K   6  A   7  I

ans EMQS 3 Posted by vaneeza K.

1C   2C    3B   4B   5A   6A   7I

Ali Naveed Haq Posted by Ali Naveed Haq H.

1.c

2.c

3.b

4.d

5.k

6.i

7.b

sofia Posted by sofia  S.

1-F ,2-F, 3-B,4-B, 5-K,6-A,7-B

emq 3 Posted by SARO K.

1.F 2.F 3.B 4.B 5.K 6.I 7.B

yk Posted by rabhia B.

1-j

2-j

3-b

4-b

5-k

6-a

7-b

EMQ Set 3 Posted by Colin M.

1. J 2. J 3. B 4. B 5. K 6. A 7. B

ans to EMQ 3 Posted by anupama M.

1)F

2)F

3)C

4)J

5)K

6)A

7)B

seema Posted by seema D.

1-l,  2-f,  3-b,   4-c,  5-k,  6-a,  7-i

emq 3 Posted by dr sheela N.

1,L

2,L

3,A

4,L

5,K

6,A

7,B

EMQ 3 Posted by Gomathy G.

1. F, 2. F, 3. B, 4. B, 5. J, 6. A, 7. J

emq Posted by j  .

j reply

1.C

2.C

3.B

4.B

5.K

6.I

7.B

Dr.Mohanad Posted by vanosch M.

1F    -  2D     -   3A   -   4B    -   5D   -     6I     -   7I  

EMQ3 answer by N Posted by Sherif N.

1.C       2.F       3.B       4.B       5.E       6.I       7.B

Posted by amr G.

answers to emq3

1-f

2-f

3-b

4-b

5-f

6-i

7-f

EMQ Posted by I K.

1-f  2-f  3-f  4-m  5-k  6-a  7-b

Posted by Bader A.

1-J,  2-J,  3-B,  4-I,  5-A,  6-A,  7-B   

EMQ 3 Posted by Reena G.

1-F,2-F,3-A,4-1,5-B,6-F,7-I

emq 3 by vaneez Posted by vaneeza K.

1. f   2.f     3.d     4.m    5.k     6.a    7.b

EMQ 3 Posted by Reena G.

1-F,2-F,3-B, 4-b,5-E,6-A,7-B

anuradha n Posted by anuradha N.

EMQ set 3

1) F 

2) F

3) B

4) I

5) E

6)A

7)I

8)F

Posted by Bushra  A.

1 . F

2 . F

3 . B

4 .C

5 .K

6 .A

7 .B

Ali Naveed Haq Posted by Ali Naveed Haq H.

1.f

2.f

3.b

4.b

5.k

6. a

7.i

Posted by BHAWANA  P.

1.F  2.F  3.B  4.C  5.K  6.I  7.F

Posted by Zainab I.

EMQ3  ANS

1-C,2-C,3A,4-D,5-K,6A,7-B

EMQ 3 Posted by SRABANI M.

1F  2F  3B  4B  5K 6A  7B

EMQ-3 Posted by A A.

1) J

2) J

3) I

4) M

5) K

6) B

7) B

Posted by leena T.

1. F

2  J

3  F

4  M

5  K

6  J

7  B

EMQ set 3 Posted by naila A.

1- L , 2- F, 3- B, 4- L, 5- D, 6- A 7 - B.

Posted by Muthu M.

1-J, 2-J, 3-B, 4-M, 5-K, 6-A, 7-B

Answers Posted by PAUL A.

 

1)      F

2)      F

Note that gestational trophoblastic disease with decreasing or undetectable HCG, persistently elevated HCG or malignant disease are all UKMEC 1 (UNRESTRICTED USE) for COCP

  • Copper IUCD: UKMEC 3 – Risks outweigh benefits
  • Pregnancy
  • Less than 4 weeks post-partum (Post first / second trimester (up to 24 weeks) abortion = UKMEC 1 and 2 respectively). Septic abortion or puerperal sepsis = UKMEC 4
  • Gestational trophoblastic disease with persistently elevated HCG or malignancy (UKMEC 4). Falling or undetectable HCG = UKMEC 1

 

3)      F

4)      F

 

Stage 1 endometrial cancer

  • Current evidence on the safety and efficacy of laparoscopic hysterectomy (including laparoscopic total hysterectomy and laparoscopically assisted vaginal hysterectomy) for endometrial cancer is adequate to support their use.
  • Overall survival rates and disease-free survival rates are not significantly different in women treated laparoscopically compared to those treated by laparotomy.
  • The risk of intra-operative complications is not significantly different in patients treated by laparoscopy compared to those treated by laparotomy
  • The risk of post-operative complications is significantly lower in patients treated by laparoscopy compared to those treated by laparotomy

5) K

 

Treatment options for patients with sub-optimally cytoreduced disease:

Systemic chemotherapy

  • First line treatment is a combination of cisplatin or carboplatin and paclitaxel as induction chemotherapy. There is clinical response in over 60% of women, and median time-to-recurrence usually exceeds 1 year. A range of other agents like Topotecan, have been used as maintenance therapy but have not been shown to improve survival.

Interval cytoreduction

  • Overall, clinical trials have not demonstrated any advantage from the use of interval cytoreductive surgery (surgery followed by chemotherapy followed by further cytoreductive surgery then chemotherapy) The focus should therefore be optimal cytoreduction at the time of primary surgery. Although many patients with stage IV disease also undergo cytoreductive surgery at diagnosis, whether this improves survival has not been established.

 

6)      A

7)      B

 

Stage I and Stage IIOvarian cancer

Stage I

Tumour confined to the ovaries.

Stage Ia: tumour confined to one ovary with ovarian capsule intact and no tumour on the surface of the ovary. Peritoneal cytology is negative.

Stage Ib: tumour confined to both ovaries with ovarian capsule intact and no tumour on the surface of the ovary. Peritoneal cytology is negative.

Stage Ic: tumour on the surface of an ovary OR positive peritoneal cytology OR the tumour ruptures before / during surgery

Treatment options:

Well / moderately well differentiated Stage Ia / Ib

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy is adequate for patients with well differentiated or moderately well differentiated stage IA and stage IB disease.
  • The under-surface of the diaphragm should be visualized and biopsied
  • Pelvic and abdominal peritoneal biopsies and pelvic and para-aortic lymph node biopsies are required and peritoneal washings should be obtained.
  • In women who have not completed their family and have grade I tumours, unilateral salpingo-oophorectomy may be performed. Such women require full surgical staging including peritoneal washings and biopsies, biopsy of para-aortic nodes and omentectomy. Endometrial biopsy should also be taken as 10-29% have a co-existing endometrial malignancy. Laparoscopic staging may be performed.

Poorly differentiated Stage Ia / Ib or Stage Ic – stage II

  • The risk of relapse and death from ovarian cancer is up to 30%. Adjuvant chemotherapy has been shown to significantly improve survival (5 year survival improved from 74% to 82% with Carboplatin or Cisplatin single agent chemotherapy). Paclitaxel is an alternative.
adad Posted by PAUL A.

adad