MCQ on bleeding in early pregnancy

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DR Manal Behery

Zagazig University

2013

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Abortion

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1-What is wrong about recurrent abortion?

A-HSG is the best method to R/O anatomical etiologies

B-HSG is recommended several weeks after operative hysteroscopy

C-vaginal ultrasonography and MRI are the best techniques to detect anatomical defects

D-Septated uterus is the most common anatomical cause of recurrent abortion

Ans:A

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2- A 20yo, Rh -ve and unsensitised woman has missed miscarriage of 10wks all are true except

A- Anti-D immunoglobulin should be administered if surgical evacuation is performed

B-Anti-D immunoglobulin is unnecessary after medical evacuation

C- products of conception should be sent for histological examination to exclude molar tissue

Ans:B

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Recurrent abortion tests

• Karyotype• HSG• Luteal phase biopsy of endometrium• TSH and prolactin level• ACL antibodies• LAC (lupus anticoagulant) • CBC

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For cases of abortion without fever: Doxy 100 mg bidortetracycline 250 mg qid for 5-7 days

For cases of abortion without fever: Doxy 100 mg bidortetracycline 250 mg qid for 5-7 days

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3-What is wrong about postabortal or “redo” syndrome?

A- It is a complication of suction curettageB- It is a painful cramp in the first 2 hours

after curettageC-uterine bleeding is less than expectedD-treatment is D&C under anesthesia

Ans:D

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4- During a sharp curettage of an incomplete abortion uterine is perforated. What is the first step of management?

A- curettage should be completed and patient should remain under observation

B-laparatomyC-curettage should be stopped and patient should

remain under observation D- if there is no hemorrhage in the first 24 hours

after operation, the patient can be dischargedAns:B

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5-The clinical findings of a woman with GA=8 wks with the chief complaint of hemorrhage and clot passing is an open int os Uterine size about 8 wks and no bleeding. What should be done ?

A-No treatment is needed because abortion is complete

B-it is a case of threatened abortionC-it is an inevitable abortionD-Abdominal sonography

Ans:D

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6- A woman has undergone elective abortion one week ago. Now she comes to the clinic with the chief complaint of hemorrhage. In PE cervix is closed, uterine is contracted with no tenderness. Her temperature is normal . What is the best treatment?A-Doxy 100 mg bid for two weeksB-clinda +gentaC-observation and check of Hb and HctD-hormone therapy

Ans:D

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7- What is the most likely cause of abortion in a 27 year old woman with the past history of two abortions in 10 wks and one in 15 wks with normal Karyotype conceptus?

A- endocrineB-immunologicalC-anatomicD-infectious

Ans:BThe treatment of immunological recurrent

abortion is low dose Heparin sc 5000 units bid+Aspirin 80 mg daily

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8-What should be done for a woman 22 years old who has undergone suction curettage and now suffers severe pelvic cramps , sweating and tachycardia. Her uterus is large and tender. She also has spotting.

A-observation and oxytocinB-laparatomyCDilation and suction curettage without

anesthesiaD- CT scan

Ans:C

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9-What is the best way of pregnancy termination in a bicornuate uterus with a 14 w fetal death?

A-dilatation and curettage under USB-uterotonic drugsC-dilatation and curettage under laparascopyD-hysterotomy

Ans:B

Ectopic Pregnancy

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10-Where is the discriminatory zone?

A-3000 IU/L HCG + abdominal USB-1000-1500 IU/L HCG + vaginal USC-a constant value of HCG for any type of

USD-in multiple pregnancy it is lower than

singleton pregnancyAns:B

Beta HCG below 2000+no visible intrauterine sac+mass in tube below 3.5 cm______________________

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Repeat of beta HCG q 48 hA-If a dead IP is confirmed (beta HCG increase less than 50% or below 1000mIu/mL- P below 5 ng/mL + visible intrauterine sac) then curettage

B-If EP is confirmed (beta HCG more than 2000 and mass >3.5 cm) then laparascopyC-If a dead IP and EP is confirmed (beta HCG more than 2000 and mass < 3.5 cm) then MTX

FETUS SHOULD BE VISIBLE ON DAY 45 OF GESTATION

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Indication of MTX for EP

• Hemodynamic stability• No intra uterine pregnancy• Max sac diameter not equal or more than

4 cm

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11-What is your management of a 36 year old woman who is pregnant after primary infertity. She is referring to you for spotting and hypogastric pain, beta HCG is 1500 mu/l and ultrasound of uterus and ovaries are normal.

A-laparatomyB-laparascopyC-repeat of vaginal sonography several

days laterD-progesterone measurement

Ans:C

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12-A 30 year old woman has become pregnant after 5 years of infertility with ovulation induction and a history of EP in the right tube 2 years ago.She has undergone laparatomy for ruptured right fallopian tube. What is the best technique for this surgery?

A-MilkingB-linear salpingectomyC-right tube salpingectomyD-segmantal excision and delayed

anastomosis

Ans:C

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13- In a woman 31 years old who has undergone salpingectomy two weeks ago for EP, HCG level is increasing. What is your management?

A-MTXB-transvaginal sonographyC-salpingectomyD-chest x-ray

Ans:B

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14-RU486 can not attach to:

A-Progesterone receptorB-androgen receptorC-glucocorticosteroid receptorD-estrogen receptor

Ans: D

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15-What is your management for a woman with :HR=120 BP=80/60 mmHg T=37.5°c uterine size=8 wks beta HCG=2500 mIU/mL and no intrauterine pregnancy in sonography?

A-LaparatomyB- laparascopyC- D&CD-serum progesterone

Ans:A

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>laparatomy

Adenexal mass< 3.5 cm MTX

Adenexal mass=> 3.5 cm -> laparascopy

Uncertain US + beta HCG increase less than 50% -> D&C

Unstable conditions->laparatomy

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16- which is a predisposing factor for ovarian EP?

A-PIDB-infertility historyC-DES exposureD-present IUD

Ans:D

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17-All are among indications for conservative management of EP except::

A-ovarian EPB-reduced HCG levelC-sac of less than 3 cmD-lack of noticeable intra abdominal

hemorrhage

Ans:A

• Gestational trophoblastic disease

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Vesiculaer mole

CASE STUDY

• A 21 year old woman comes in for first prenatal visit .Her LMP was 12 wks ago of which she was certain .

• Upon examination you noted 20 wks uterus ,therefore an US is performed and revealed bilaterally enlarged adnexa and a snowstorm pattern in the uterus. You suspect a molar pregnancy what is your next step ?

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You should order B-HCG in serum

• The result comes back as 100,000 confirming your suspicion of a complete mole

• Of course the definite diagnosis will not be made until a D&C is performed

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18-Clinical features that distinguish a complete mole from a partiel mole are

A-Gestational age between 8-16 wksB-B HCG level 100,000C-Uterine size that is larger for gestational

ageD- Ultrasonographic features E- all of the aboveAns:D

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19-To optimally prepare for D&C you should take the following steps except

A-type and cross match for bloodB- full operating room settingC- suction cannulaD-General anathesiaE- A 22 gauge intravenous access

Ans:E

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20-With respect to complete mole all are true except

• A- Complete moles have 46XX karyotype•

B-Maternal serum AFP levels are undetectable in complete moles as there no fetal parts

•C-Medical evacuation using prostaglandins and oxytocin is the recommended treatment

•D-During surgical evacuation, oxytocin infusion shouldn’t be commenced before the uterus is empty

• ANS C

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21- All of the following are associated with an increased risk of malignant change in a woman with vesicular molar PPREPREpregnancy except • A-maternal age > 39years HSG• B-woman with BG-A with a partner of

BG-OTSH and prolactin level

• C-Complete mole more than partial moles

• D- smoking• Ans:D

Suction evacuation under general anathesia was performed

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How can you councel this case regarding contraceptive advice before the next pregnancy

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22-Which is true regarding contraception after molar evacuation ?

A-Women should be advised not to conceive until HCG levels have been normal for 12 mths

B-Use of the COCP after HCG levels have returned to normal is associated with increased need for chemotherapy

C-Use of IUDs in contraindicated until after HCG levels have returned to normal

Ans:C

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23-Which is true regarding molar pregnancy

• A-women presenting with persistent vaginal bleeding following evacuation of a complete molar pregnancy should undergo further uterine evacuation

B- women should be advised not to become pregnant until HCG levels have reverted to normal for 6/12 M

C-mifepristone is recommended for termination of a partial molar pregnancy at 14wks gestation

• ANS B

Thank you