This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Gestational Trophoblastic Disease, Subject name: Gynaecology & Obstetrics
[{'content': 'A 40-year-old woman complains of irregular bleeding for 7 months after delivery of her fourth baby. Curettage is performed and histology reveals a choriocarcinoma. Her serum beta hCG level is 2x105 IU/L.What is the most appropriate next step in the management? \nSelect and explain. \nA. Commence treatment with intramuscular methotrexate, B. Commence treatment with multi-agent combination chemotherapy, C. Perform a hysterectomy, D. Repeat serum hCG after 4 weeks', 'role': 'user'}, {'content': 'Answer: B \nExplanation: Ans. is b, i.e. Commence treatment with multi-agent combination chemotherapyThis woman is at high risk as she has a prognostic score of 7:Antecedent normal pregnancy - 2Age more than 40 years - 1Antecedent pregnancy 7 months ago - 2Serum hCG level 2x105-2Therefore, she needs treatment with multi-agent comnination chemotherapy with EMA-CO.', 'role': 'assistant'}]