MCQ "BLEEDING IN EARLY PREGNANCY FOR UNDERGRADUATE

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MCQ on bleeding in early pregnancy
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
• AnsA

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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
• AnsB

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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 curettage
• B- It is a painful cramp in the first 2 hours
  after curettage
• C-uterine bleeding is less than expected
• D-treatment is DC under anesthesia
• AnsD

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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-laparatomy
• C-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
  discharged
• AnsB

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5-The clinical findings of a woman with GA8 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 abortion
• C-it is an inevitable abortion
• D-Abdominal sonography
• AnsD

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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 weeks
• B-clinda genta
• C-observation and check of Hb and Hct
• D-hormone therapy
• AnsD

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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- endocrine
• B-immunological
• C-anatomic
• D-infectious
• AnsB
• The treatment of immunological recurrent abortion
  is low dose Heparin sc 5000 units bidAspirin 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 oxytocin
• B-laparatomy
• CDilation and suction curettage without
  anesthesia
• D- CT scan
• AnsC

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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 US
• B-uterotonic drugs
• C-dilatation and curettage under laparascopy
• D-hysterotomy
• AnsB

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Ectopic Pregnancy
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10-Where is the discriminatory zone?

• A-3000 IU/L HCG abdominal US
• B-1000-1500 IU/L HCG vaginal US
• C-a constant value of HCG for any type of US
• D-in multiple pregnancy it is lower than
  singleton pregnancy
• AnsB

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Beta HCG below 2000no visible intrauterine
sacmass 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 gt3.5
cm) then laparascopyC-If a dead IP and EP is
confirmed (beta HCG more than 2000 and mass lt 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-laparatomy
• B-laparascopy
• C-repeat of vaginal sonography several days later
• D-progesterone measurement
• AnsC

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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-Milking
• B-linear salpingectomy
• C-right tube salpingectomy
• D-segmantal excision and delayed anastomosis
• AnsC

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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-MTX
• B-transvaginal sonography
• C-salpingectomy
• D-chest x-ray
• AnsB

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14-RU486 can not attach to

• A-Progesterone receptor
• B-androgen receptor
• C-glucocorticosteroid receptor
• D-estrogen receptor
• Ans D

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15-What is your management for a woman with
HR120 BP80/60 mmHg T37.5c uterine size8
wks beta HCG2500 mIU/mL and no intrauterine
pregnancy in sonography?

• A-Laparatomy
• B- laparascopy
• C- DC
• D-serum progesterone
• AnsA

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gtlaparatomy
Adenexal masslt 3.5 cm? MTXAdenexal massgt 3.5
cm -gt laparascopyUncertain US beta HCG
increase less than 50 -gt DCUnstable
conditions-gtlaparatomy
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16- which is a predisposing factor for ovarian EP?

• A-PID
• B-infertility history
• C-DES exposure
• D-present IUD
• AnsD

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

• A-ovarian EP
• B-reduced HCG level
• C-sac of less than 3 cm
• D-lack of noticeable intra abdominal hemorrhage
• AnsA

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• Gestational trophoblastic disease

Vesiculaer mole
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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 DC 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 wks
• B-B HCG level 100,000
• C-Uterine size that is larger for gestational age
• D- Ultrasonographic features
• E- all of the above
• AnsD

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19-To optimally prepare for DC you should take
the following steps except

• A-type and cross match for blood
• B- full operating room setting
• C- suction cannula
• D-General anathesia
• E- A 22 gauge intravenous access
• AnsE

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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
  shouldnt 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 gt 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
• AnsD

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Suction evacuation under general anathesia was
performed
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
• AnsC

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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

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Thank you