Early Pregnancy Extra Questions Batch A – MCQ

1. The incidence of clinically recognised miscarriage in pregnancy is about

2. most common indication for women attending gynaecology emergency in theUK is:

3. Which of the following routes of administration is inappropriate for the drugmisoprostol:

4. Which one of the following ultrasound descriptions is diagnostic of miscarriage (GS, gestational sac; CRL, crown-rump length; FHR, fetal heart rate)?

5. A 20-year-old, who is at 12 weeks’ gestation, has a 2-day history of vaginal bleeding and lower abdominal pain. Ultrasound shows a 25 mm fetal pole with absentfetal heart rate. Pelvic examination reveals her cervix to be 4 cm dilated with bulging intact membranes. Which one of the following is the most likely diagnosis?

6. A 29-year-old, who is at 6 weeks’ gestation, is diagnosed to have a right tubal ectopic pregnancy by transvaginal pelvic ultrasound. Which one of the following factorswould enable systematic methotrexate to be offered as a medical treatment optionfor the ectopic pregnancy?

7.A 29-year-old, who is at 6 weeks’ gestation, presents with slight vaginal spotting.Transvaginal pelvic ultrasound shows no evidence of any intrauterine or extrauterine pregnancy. A serum βhCG is measured at initial presentation and repeated 48 hlater. Which one of the following βhCG results is suspicious for a clinically significant ectopic pregnancy?

8. A patient with a positive pregnancy test, small amount of PV bleeding and noabdominal pain present has a single transvaginal ultrasound scan, showing an intrauterine gestational sac, with a crown-rump length (CRL) of 5 mm, with no fetalheart beat. Which of the following would be the most appropriate management plan?

9. A 25-year-old woman presents to the A+E department with left iliac fossa pain,vaginal bleeding and a positive pregnancy test. Which symptoms may be associatedwith an ectopic pregnancy?

10. 25-year-old woman presents to the A + E department with abdominal pain and apositive pregnancy test (8/40). USS is performed to rule out a miscarriage. USSshows an intrauterine gestational sac with the ratio of transverse to anteroposterior dimension, greater than 1.5 with cystic spaces in the placenta. What is the likelyultrasonographic diagnosis?

11. XY is a primigravida who presents to the A + E department with dark-browndischarge PV for 1 day and mild lower abdominal discomfort. She is 7/40 pregnantas per her LMP. Her TV scan shows the presence of a gestational sac and yolk sacwith a fetal pole of 7.5 mm and no fetal heart activity.Which of the following treatment options are best suited to her?

12. XY is a primigravida who is 9/40 weeks’ pregnant and has confirmed diagnosisof missed miscarriage (she had 2 transvaginal scans a week apart). After discussion of the various options, she opts for medical management for missed miscarriage.She is extremely anxious about the discomfort associated with the procedure andhas a low pain threshold.Which of the following is appropriate for medical management of missedmiscarriage?

13. XY is a primigravida who presents to the A + E department with dark-browndischarge PV for 1 day and mild lower abdominal discomfort. She is 7/40 pregnantas per her LMP. Hertransvaginal scan shows the presence of a gestational sacmeasuring 26 mm with no fetal pole. Which of the following treatment options arebest suited to her?

14. XY is 9/40 weeks’ pregnant. She presents to the early pregnancy clinic with ahistory of a painful vaginal heavy bleed 96 h ago. Ultrasound reveals a live fetus at9/40 weeks with a 5 × 5 cm subchorionichaematoma. Booking bloods reveal she is A negative with no atypical antibodies.Which of the following treatment options are best suited to her with regard toadministration of anti-D?

15. A 25-year-old woman diagnosed with a complete mole (16/40) is scheduled toundergo surgical evacuation in theatre. Which is the only acceptable managementplan in her case?

16. Which of the following statements is appropriate in women presenting with earlypregnancy with bleeding:

17. Medical management for an ectopic pregnancy can be considered if:

18. The incidence of gestational trophoblastic disease in the UK is calculated as:

19. Which of the following is not an example of gestational trophoblastic disease:

20. Which of the following statements is correct about molar pregnancy:

21. A woman who is nine weeks pregnant comes to the early pregnancy assessment unit complaining of severe nausea and occasional vomiting. She is not keen on drug therapy. What is your advice?

22. A 33-year-old woman, gravida 3, para 2, comes to the emergency department complaining of excessive vomiting for the last three days. She is otherwise asymptomatic with a normal past medical history. She is admitted and her thyroid function tests showed a low thyroid stimulating hormone (TSH) level with raised free thyroxine (T4). What is the most important feature to differentiate transient hyperthyroidism of hyperemesisgravidarum (THHG) from hyperthyroidism?

23. A primigravida who is 10 weeks pregnant is complaining of slight vaginal bleeding and the occasional abdominal colic. Ultrasound showed a live singleton pregnancy 3 of corresponding to her last menstrual period. She is worried about losing this pregnancy and asks for any medication to help keep the pregnancy. She has read something about progesterone treatment. How will you counsel her?

24. A 20-year-old woman who was nine weeks into her first pregnancy has just had a complete miscarriage. She is distressed and very tearful. You have explained that miscarriage does not affect her future fertility. Her partner is worried her anxiety may persist and be a possible cause of a delayed pregnancy. What else will you tell them?

25. A woman who is 11+3 weeks pregnant complained of abdominal colic and an attack of brisk vaginal bleeding. A repeat ultrasound confirmed fetal demise. You diagnosed inevitable miscarriage. She is considering expectant management. How will you counsel her?

26.  A woman who is 11 weeks pregnant with confirmed miscarriage was very hesitant in deciding on medical or surgical management. She was still keen on avoiding the anaesthetic and surgical risks, if possible. What will you tell her about her chances of not having surgery if she opts for medical management?

27. A 20-year-old woman comes to the early pregnancy assessment unit with 7+6 weeks amenorrhea and mild to moderate vaginal bleeding with the occasional abdominal pain. She has a positive pregnancy test but refuses a transvaginal ultrasound scan. How will you handle the situation?

28. A woman who is eight weeks pregnant complains of vaginal bleeding. An ultrasound scan showed a crown rump length of 7 mm but no visible fetal heart. You advised her to come for a follow-up scan after seven days. She expressed her concern that waiting that long may harm the pregnancy or her health. How will you counter her concern?

29. The community midwife calls you about an eight-week pregnant woman who is complaining of vaginal bleeding and abdominal colic. A repeat scan confirmed fetal demise. She opted for expectant management. Her bleeding and abdominal pains have resolved. The woman wants to know how to confirm that miscarriage is complete. What is your advice?

30. A woman who is 11 weeks pregnant is diagnosed with incomplete miscarriage. She opts for medical management. What will you offer her?

31. A pregnant woman is diagnosed with miscarriage based on absent cardiac pulsation in repeat scans. She opted for surgical management as her work commitments would not allow for a long wait and she feels she may not be able to cope with bleeding and pain if she opts for medical management. She was undecided, however, about an outpatient setting manual vacuum aspirating (MVA) under a local anaesthetic or a hospital evacuation curettage (EVA) under a general anaesthetic. How will you counsel her?

32. A 23-year-old woman in her second pregnancy presents to you requesting surgical termination of the pregnancy. She is 11 weeks pregnant, verified by ultrasound scan. What is the risk of uterine perforation in this case?

33. A 31-year-old woman is booked for surgical termination of pregnancy at nine weeks’ gestation. Which of the following options is correct regarding prevention of infective complications?

34. The general practitioner calls you out of hours to ask what to do because she has an eight-week pregnant woman who is complaining of moderate right abdominal pain and slight vaginal bleeding. What is your advice?

35. The midwife in the early pregnancy assessment unit asks you to review a woman who has seven weeks of amenorrhea but the previous and current ultrasound could not locate the pregnancy. The human chorionic gonadotropin (BhCG) increased from 800 IU/L to 1600 IU/L after 48 hours. The woman is fit and well with no signs or symptoms. What is your next plan?

36. The serum BhCG of a symptomless woman with a pregnancy of unknown location (PUL) has dropped by more than 50% after 48 hours. What is the next step you advise?

37. A woman who is eight weeks pregnant is offered laparoscopic surgical management of an ectopic pregnancy. She had a previous normal pregnancy and vaginal delivery. How will you justify laparoscopic salpingectomy as opposed to salpingostomy?

1. Removing the diseased tube is easier and quicker to perform.
2. Removal of the diseased tube will not affect her future fertility.
3. Removing the ectopic pregnancy and keeping the tube will have a significantly higher incidence of a recurrent ectopic pregnancy requiring repeat surgery.
4. Removing the ectopic pregnancy and keeping the tube will require more followup visits and tests, currently.
5. There are no differences in the management options for the current or future pregnancies.

38. A 15-year-old single teenage girl comes to see you because she had an unplanned pregnancy. She is nine weeks pregnant after failure of an emergency post-coital contraception. She explains her great inability to handle either the pregnancy care or the child, if born, for personal and social reasons. How will you handle the situation?

39. The general practitioner calls to ask about the immediate follow-up of a woman who had a suction evacuation of a complete molar pregnancy. What is your advice?

40. A woman has an evacuation of a partial molar pregnancy. She was 11 weeks pregnant. What is your follow-up plan?

41. Following appropriate treatment of complete and partial molar pregnancies, what percentage of women need additional chemotherapy in each case, respectively?

42. A 36-year-old woman has had a suction evacuation because of a complete molar pregnancy. Her chorionic gonadotropin (hCG) levels started to rise six months after treatment. Her FIGO 2000 score was assessed as 6. What is your management?

43. A 28-year-old woman who has received single-agent chemotherapy because of a persistent rise in her chorionic gonadotropin levels after evacuation of a complete molar pregnancy asks about her future fertility options. What will you tell her?

44. To improve the results of treatment of gestational trophoblastic disease (GTD), what audit topic would you recommend?

45. You are counselling a couple who have had two consecutive miscarriages. She is 22 years old and wants to know if there are any age-related risks of miscarriage. Which of the following age groups is associated with the smallest risk of miscarriage?

47. There are cases of women who have recurrent miscarriages. What percentage of these women have antiphospholipid antibodies?

47. Your foundation year 2 trainee enquires about the different types of thrombophilia. Which of the following is an acquired thrombophilia?

48. A couple who have had three consecutive miscarriages have come to see you for advice after having a thrombophilia screen. The result showed that she was positive to one of the antiphospholipid antibodies. Which of the following is an antiphospholipid antibody?

49. A couple who have had three consecutive miscarriages have come to see you for counselling. Genetic screening showed a paternal balanced translocation. What is their chance of having a healthy baby?

50. A 20-year-old woman presents to the family planning clinic. She is requesting termination of a 10-week pregnancy. She had a surgical termination of a 14-week pregnancy six months previously. She had problems attending and complying with the different family planning options offered to her after completion of the termination of her previous pregnancy. What is your advice for an effective contraception in her situation?