Mrcog part 2 sept 2014

Discussion in 'MRCOG Forum' started by samuel, Aug 25, 2014.

  1. samuel

    samuel New Member

    levonorgestrel (LNG) MOA is
    1. inhibition of ovulation T
    2. prevent follicular rupture. T
    3.cause luteal dysfunction T
    4.LNG taken after luteinising hormone
    surge has been shown to result in ovulatory dysfunction. F

    Levonorgestrel (LNG)
    The precise mode of action of levonorgestrel (LNG) is incompletely understood but it is thought to work primarily by inhibition of ovulation.16,17 Administration of LNG appears to prevent
    follicular rupture or cause luteal dysfunction.16–21 LNG taken prior to the luteinising hormone
    surge has been shown to result in ovulatory dysfunction in the subsequent 5 days.17 LNG can
    thus inhibit ovulation for 5–7 days, by which time any sperm in the reproductive tract will have become non-viable. The closer to ovulation treatment is given, the less likely the probability of
    interfering with this process. Indeed LNG has been shown to be no better than placebo at suppressing ovulation when given immediately prior to ovulation17 and is not thought to be ffective once the process of fertilisation has occurred.22–25
    Studies looking at the effect of LNG on endometrial markers of receptivity have found little to
    no effect using different modes of administration.16,26,27 Evidence from an in vitro study indicates that LNG does not affect embryo-endometrial attachment.28 The available evidence suggests that pregnancies occurring after LNG failure are not associated with any major congenital malformations, pregnancy complications or other
    adverse pregnancy outcomes.
  2. samuel

    samuel New Member

    emergency contraception
    choice of EC

    1. All eligible women should be offered the Cu-IUD as it is considered the most effective method of EC. True
    Due to low documented failure rate

    2. LNG is licensed for upto 96hrs after UPSI. False
    licensed upto 72hrs

    3. CuIUD can be inserted up to up to 5 days after the earliest expected date of ovulation. True
    Therefore, to ensure that an IUD is inserted before the process of implantation begins an emergency Cu-IUD should be fitted within the first 5 days (120 hours) following first UPSI in a cycle or within 5 days from the
    earliest estimated date of ovulation

    4. Pregnancies arising from failed oral EC need to be managed differently from other pregnancies. False
  3. samuel

    samuel New Member

    Question 1 (EMQ)
    Treatment options:
    (A) Combined oral contraceptive pill
    (B) Danazol
    (C) GnRH analogue
    (D) Laparoscopic endometrial ablation
    (E) TAH
    (F) TAH, BSO
    (G) TAH, BSO with post-surgical HRT
    Please read each of the following scenarios and match
    them to the most appropriate treatment option from the
    list above.
    i. A 30-year-old patient returns to your clinic after having
    tried several hormonal (COCP & progestogens) and
    non-hormonal (mefenamic acid) treatments for her
    cyclical pelvic pain without success. She would like
    a diagnosis and a more effective treatment of her
    condition.
    ii. A 40-year-old lady complains of non-cyclical pelvic
    pain and deep dyspareunia. The symptoms are severe
    enough to disrupt her social and work life. Her BMI is
    40 and she has just started a new job and cannot take
    time off work.
    iii. A 25-year-old presents to your clinic with severe
    secondary dysmenorrhoea forcing her to take time off
    work. She has also been trying to conceive for the last
    15 months without success.
    iv. A 45-year-old patient with known endometriosis
    returns to your clinic with recurring dysmenorrhoea
    12 months after successful conservative laparoscopic
    surgery. She has previously responded well to progestogens
    and GnRH analogues, but she is not keen on
    hormonal treatment due to side-effects.
    v. An 18-year-old who is about to start university presents
    to your gynaecology clinic complaining of severe
    dysmenorrhoea. She has previously tried nonsteroidal
    anti-inflammatory drugs without much
    benefit.
  4. samuel

    samuel New Member

    Question 2 (EMQ)
    Treatment options:
    (A) Intra-uterine progesterone releasing system (IUS)
    (B) Combined oral contraceptive pill
    (C) Oral progestogens
    (D) Danazol
    (E) GnRH analogue.
    Please read each of the following side-effect profiles
    and match it to the appropriate treatment from the list
    above.
    i. Hirsutism, deepening of the voice and acne
    ii. Weight gain, breast enlargement, and depression
    iii. Hot flushes, vaginal dryness, and reduced libido
    iv. Breakthrough bleeding, acne and bloating
  5. samuel

    samuel New Member

    following act mainly by reducing sperm penetrability
    1.EE/LNG F
    2.LNG (T)
    3.EVRA (F)
    4.NET (T)
    5.EE/NET(F)
    you are correct.
    POPs act by inhibiting sperm penetration by cervical mucus changes.
  6. samuel

    samuel New Member

    Perinatal mortality in the united kingdom:
    1. Is defined as all stillbirths and all deaths in the 1st 28 days
    after birth.
    2. Is associated with low birth weight(less than 2.5Kg) babies
    in over 60% of cases.
    3. Is lower in babies of mothers who are primiparous. (F)

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