FCPS OBG Part 2 Written – Module Mock – Early Pregnancy Disorders

1. Which one of the following ultrasound descriptions is diagnostic of miscarriage?

2. A 26-year-old, at 12 weeks’ gestation, presented with c/o of vaginal bleeding and lower abdominal pain. Ultrasound shows a 25 mm fetal pole with absent fetal 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?

3. A 29-year-old, at 6 weeks’ gestation, with a right tubal ectopic pregnancy on tvs. Which one of the following factors would enable systematic methotrexate to be offered as a medical treatment option for the ectopic pregnancy?

4. A patient with gestatonal amenorrhea of 5 weeks, with c/o PV bleeding and no abdominal pain. she has single transvaginal ultrasound scan, showing an intrauterine gestational sac, with a crown-rump length (CRL) of 5 mm, with no fetal heart beat. Which of the following would be the most appropriate management plan?

5. A 25-year-old woman presents to you with c/o left iliac fossa pain and vaginal bleeding. her pregnancy test is positive. Which symptoms may be associated with an ectopic pregnancy?

6. A 25-year-old woman presents to the you with Gestational amenorhea of 8 weeks and c/o abdominal pain. USS is performed to rule out a miscarriage. USS shows an intrauterine gestational sac with the ratio of transverse to an teroposterior dimension, greater than 1.5 with cystic spaces in the placenta. What is the likely ultra sonographic diagnosis?

7. Ms. XY is a primigravida who presents in emergency with dark-brown discharge PV for 1 day and mild lower abdominal discomfort. She is at 7 weeks of gestation. Her TVS scan shows the presence of a gestational sac and yolk sac with a fetal pole of 7.5 mm and no fetal heart activity. Which of the following treatment options are best suited to her?

8. A 24 years old lady with 9 weeks’ of gestation She presents to the early pregnancy clinic with a history of a painful vaginal heavy bleed from last 2 days. Ultrasound reveals a live fetus at 9 weeks with a 5 × 5 cm sub chorionic haematoma. Booking bloods reveal she is A negative with no atypical anti bodies. Which of the following treatment options are best suited to her with regard to administration of anti-D?

9. A 25-year-old woman diagnosed with a complete mole at 16 weeks of gestation is admitted to have surgical evacuation in theatre. Which is the only acceptable management plan in her case?

10. Which of the following is true regarding women presenting with early pregnancy and c/o bleeding?

11. Criteria for Medical management for an ectopic Pregnancy is fulfilled if?

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

13. What is the maximum crown rump length (CRL) that is accurate for dating before you measure gestational age by head circumference (HC)

14. A 30-year-old woman presented at 8 weeks gestation. She G2P1 with mild symptoms of nausea and vomiting of pregnancy. She had severe nausea and vomiting in her first pregnancy requiring hospital admission and is concerned that her symptoms will worsen. What is the most appropriate Management option for her?

15. What is the incidence of transient hyperthyroidism in patients with hyperemesis gravidarum?

16. A 25years old woman had medical management of miscarriage but no specimen was sent for histological analysis. What would be the advice to the patient following this procedure?

17. What is the use of oxytocin during a surgical evacuation of miscarriage?

18. What is the expected cure rate for multi agent chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) ?

19. A 25years old patient diagnosed with molar pregnancy at 22 weeks of gestation. What is the confirmatory diagnostic test?

20. A 26-year-old patient presents with gestational amenorrhea of 6weeks and left iliac fossa pain. The patient is clinically stable. An ultrasound confirms the presence of a left-sided ectopic pregnancy and 70 ml free fluid in the pouch of Douglas and the serum βHCG level is 3500 IU/l. How will you manage this patient?

21. Patient had a an ERPOC for incomplete miscarriage. Molar pregnancy confirmed on histopathology. Which immunohistochemistry marker is useful for distinguishing between partial and complete molar pregnancies?

22. A woman attends the early pregnancy unit having experienced her second successive miscarriage. She has been researching miscarriage on the internet and has read that most miscarriages are due to genetic problems. What percentage of first-trimester miscarriages are due to chromosomal abnormalities?

23. Which B vitamin has been shown to be effective in the reduction of nausea and vomiting of pregnancy ?

24. A 26years old patient presented with confirmed diagnosis of miscarriage. She is stable. What is the recommended first line management?

25. Patient had a an ERPOC for incomplete miscarriage. Molar pregnancy confirmed on histopathology, subsequently required treatment with single-agent chemotherapy on follow up. She returns to clinic after completion of treatment as she wishes to conceive again. How long should she wait?

26. A woman who has had a right sided salpingectomy for ectopic pregnancy has now been diagnosed with an ectopic pregnancy in the left fallopian tube. per operatively a decision for a salpingotomy was made as the woman still wishes to become pregnant. What is the possibility that she will require further treatment (methotrexate or salpingectomy)?

27. A 28-year-old patient at 8 weeks’ gestation. her scan show a mean sac diameter of 3.5 cm and a CRL of 10 mm with no visible heartbeat. The internal os appears closed on scan and there is no vaginal bleeding. What is you diagnosis?

28. A 28-year-old woman is admitted with severe right-sided lower abdominal pain. she is stable. her trans vaginal ultrasound scan shows a 2.5 cm complex right adnexal mass with no intrauterine pregnancy. There is colour flow on Doppler but no free fluid in the pouch of Douglas. beta hCG of 1600 IU/L. What is the most appropriate next step in her management?

29. A 24year old patient presents with abdominal distension and vaginal bleeding at 12 weeks’ gestation. A trans vaginal ultrasound scan shows a molar pregnancy with bilateral enlarged multicystic ovaries. The cysts are thin walled and have clear contents. There is no obvious free fluid in the pelvis. What is the most likely diagnosis?

30. A patient with h/o recurrent miscarriage, the diagnosis of anti phospholipid syndrome requires?

31. A 20years old primigravida presents with amenorrhea of 14weeks and c/o heavy vaginal bleeding. Her urine pregnancy test is positive. Tissue with the appearance of placenta is seen through an open cervical os. how will you manage this patient?

32. What can be successful management option for Incomplete abortion ?

33. With recurrent abortion, which of the following is a commonly found parental chromosomal abnormality?

34. Which is not true for cervical incompetence ?

35. Which of the following statement is true regarding cerclage?

36. A 24 years old pt had McDonald cerclage at 13 weeks gestation , 3 days back. Now presented with complaints of strong cramps. Her temperature is 102F , pulse 120/min, and BP 90/60. Speculum examination reveals no pooling fluid, and her cerclage is in place. Her uterus is tender, and fetal heart rate is 160 beats per minute. Laboratory and physical examination exclude urinary, respiratory, or gastrointestinal sources of fever. In addition to broad-spectrum antibiotics, antipyretics, and intravenous fluids, how is this patient best managed?

37. Which of the following a common side effect of prostaglandin E2 ?

38. Which contraceptive method has a relative increased risk of ectopic pregnancy if unsuccessful?

39. Contraindications for methotrexate therapy include all except which of the following?

40. Which of the following is not a feature of methotrexate embryopathy?

41. What minimum percentage fall in serum beta hcg on postoperative day 1 after treatment of ectopic pregnancy predicts a less likely persistent trophoblast ?

42. Sonographic findings that may suggest abdominal pregnancy include which of the following?

43. What is best management of an abdominal pregnancy at 18 weeks gestation?

44. Which of the following is appropriate treatment for ovarian ectopic pregnancy?

45. Increased serum free thyroxine levels in women with hydatidiform moles occurs due to which of the following?

46. Prior to the molar pregnancy evacuation, a chest xray is done to see?

47. What is routine treatment after treatment of molar pregnancy ?

48. Your patient is a 32yr old P0A1 who has undergone molar pregnancy evacuation and is using combination oral contraceptive pills. During her follow up β-HCG levels had previously dropped to an undetectable level but her recent level is 900mIU/mLwhat will you do next?

49. The hallmark sign of gestational trophoblastic neoplasia is which of the following?

50. What is most typical of invasive moles?