OCaPE: ESR #3
Pregnancy Test
You are a second year medical student at a reproductive health clinic. A patient presents:
A lady has just come into the clinic and says she is pregnant following a pregnancy test!
The lady says however that she has lost a lot of weight, has an increased appetite, has dry
and itchy eyes and noticed some swelling of the fingers. Further investigations were run on the patient
10 minutes
Q1)
What imaging technique is this and what is being shown?
Ultrasounds, scan of uterus which is empty (2)
What further test may you run?
- Quantitative beta-hCg (1)
The result comes back with hCG raised above the threshold, this coupled with
an empty uterus is indicative of what?
- Ectopic pregnancy (1)
What produces hCG?
- The trophoblast cells of the blastocyst and the chorion/placenta (1)
What procedure can be undertaken to remove the ectopic pregnancy?
Linear salpingostomy (1)
Further tests were run and it was seen that the TSH was low however the T4 and T3 was
high
What is the name for this condition?
Hyperthyroidism (1)
What do you think is the reason for this hyperthyroidism?
hCG can act on the thyroid gland to activate production of T4 and therefore T3, this then
causes a negative feedback on TSH resulting in its low levels. (2)
Why does hyperthyroidism result in itchy eyes?
TSI (Thyroid stimulating antibodies) also bind to orbital muscle antigens –> infiltration of
inflammatory cells + cytokines. (2)
What drugs are used to manage hyperthyroidism and what is the mechanism
of action of each?
PTU, carbimazole, both inhibit thyroid peroxidase, and PTU inhibits conversion of T4 to T3 (4)
If the pregnancy was successful the patient said that she would’ve wanted an abortion
What was the purpose for the abortion Act?
End backstreet abortions and protect women against the potential harm of undergoing
them (1)
How did the Human Fertilisation and Embryology Act of 1990 change the
rules on abortion? (2)
Reduced the general time limit from 28 weeks to 24 weeks, but allowed for circumstances of
abortion in which there is no time limit:
– Risk of death/serious permanent damage to the woman
– Serious foetal abnormality
(2)
What was the R vs Bourne case?
– 14 y/o sexually assaulted by 5 soldiers but turned away from St Thomas’ Hospital and
refused an abortion.
– Dr Bourne told the police what he’d done to force prosecution, but Court found that he had acted to preserve the health of the young woman and did not prosecute (2)
Key Concepts for this station:
Ectopic pregnancies occur when the fetalised egg attatches to outside the uterus. Therefore B-hcG levels will be raised, but there will not be any fetus forming.
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