Practice Questions – Early Pregnancy EMQ

Option list:
A. Methotrexate
B. Etoposide, methotrexate, actinomycin D and folinic acid plus vincristine and cyclophosphamide
C. Repeat evacuation of uterus
D. No treatment required
E. On follow up for 1 year after the treatment
F. Methotrexate/folinic acid
G. Hysterectomy
H. Methotrexate and Hysterectomy
I. Follow up every bi weekly till Hcg becomes normal
Instructions –
Each of the above Options describes Various Treatment of gestational trophoblastic neoplasia .
For each patient select the single most appropriate management for each scenarios.
Each option may be used once, more than once or not at all

1. A 41-year-old woman has bleeding for 10 months following her third-term vaginal delivery. Uterine evacuation identifies choriocarcinoma on histological diagnosis. Ultrasound shows a 5-cm lesion in the myometrium and chest x-ray shows multiple (more than eight) lung nodules.

2. A 45-year-old woman has a hydatidiform mole evacuated uneventfully. The hCG decreases from a pre-evacuation value of 80 000 to 1000 IU/l 4 weeks after the evacuation but then persists at 1000 mIU/ml for 4 weeks. Clinical examination shows no abnormality or evidence of metastases. Ultrasound of the uterus shows a 2-cm lesion in the myometrium. Chest x-ray is negative.

3. Mrs. A, has been treated for completely molar pregnancy 8months back , she is on follow up. Her BtaHcg is 20000. From last 2 times it is showing increasing trend. On further evaluation CT. scan Shows Lung and GIT metstastasis.

Option list:
A. 200mg mifepristone
B. 800mcg vaginal misoprostol followed by 400mcg every 3 hourly
C. 400mcg misoprotol every 3hourly
D. 200mcg Misorpostol every 4th hourly
E. 200mcg Misorpostol every 6th hourly
F. 100 mcg Misorpostol every 6th hourly
G. 100 mcg Misorpostol every 4th hourly
H. 400mcg Misorpostol
I. 600 mcg Misorpostol
K. 1000mcg misoprostol
L. 1200mcg misoprostol
Each of the following clinical scenarios below relate to of women choosing termination of pregnancy and appropriate regimen required .
For each patient select the single most appropriate option from the list above. Each option may be used once, more than once or not at all.

4. Mrs, Rubina, 24 year old woman 7weeks of pregnancy presented with bleeding P/v and history of expulsion of product of conception at home.sonographer made diagnosis of incomplete miscarriage

5. Mrs.Saksha ,40year old, is 13 weeks pregnant , confirmed by scan as well is for medical termination of pregnancy . She has taken 200mg of mifepristone 2days before what’s next Recommended regimen