A Serial beta-HCG assay B Laparoscopy
C Repeat trans-vaginal scan in 24h D Repeat trans-vaginal scan in 7 days
E Counsel and discharge F Offer surgical evacuation of products of conception
G Offer medical treatment with methotrexate H Laparotomy
I Serum progesterone assay J Serum AFP assay
K Refer to molar pregnancy centre L Refer to other specialty
Instructions: Instructions: For each patient described below choose the single most appropriate initial management option from the list. Each option may be used once, more than once, or not at all.
Question 23 An asymptomatic 30 year old woman with a previous ectopic pregnancy presents at 6 weeks amenorrhoea for trans-vaginal scan to exclude a repeat ectopic pregnancy. Her pregnancy test had been positive 2 weeks earlier. The scan is reported to show a 14mm endometrium with no gestation sac. There is a 4cm cystic structure in the right adnexum suggestive of an ectopic pregnancy but no free fluid in the pouch of Douglas Your answer: A
Correct answer: B
dear dr paul,
why is laproscopy indicated, she is stable . we need to know the beta hcg first then we can give methotrexate if indicated.kindly clarify.
Options for Questions 24-24
A Bilateral oophrectomy B CA-125 assays every 6-12 months
C TAH + BSO D Cyst aspiration for cytology
E Refer to cancer centre F Ovarian cystectomy
G Reassure H Measure serum CA-125
I Refer to palliative care team J TAH + BSO + Omentectomy
K Chemotherapy L Radiotherapy
Instructions: 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.
Question 24 A 40 year old nulliparous woman has had a laparotomy for suspected ovarian cancer. The findings were of disseminated malignancy with tumour involving both ovaries, the surface of the liver and bowel with a large omental cake. De-bulking was not possible and tissue for histology shows a poorly differentiated serous adenocarcinoma of the ovary. Your answer: E
Correct answer: K
can we give chemotherapy without consulting/refering to the cancer centre?
