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MCQ > first trimester > Flashcards

first trimester Flashcards

1
Q

What is the smallest fetal pole that a competent ultrasonologist would confidently diagnose as nonviable due to absence of cardiac activity?

a. 7 mm
b. 9 mm
c. 13mm
d. 17mm
e. 21mm

A

7mm

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2
Q

What is the smallest gestational sac size that a competent ultrasonologist would confidently diagnose as a blighted ovum because of lack of fetal pole?

a. 11mm
b. 15mm
c. 19mm
d. 23mm
e. 27mm

A

25mm

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3
Q

A woman presents with abdominal pain at 6 weeks amenorrhoea, BHCG is 6000, US empty uterus. O/E tender adnexae. Best next step:

  1. serial BCHG
  2. rpt US in 1 week
  3. laparoscopy
  4. laparotomy
A
  1. laparoscopy
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4
Q

Presents at 7 weeks after TOP 1 week ago. Still symptoms of pregnancy. O/E 7/40 size uterus, urinary BHCG positive. Op notes from TOP report minimal tissue, histopath: decidual tissue only. Next step:

  1. TV U/S
  2. Expoloratory laparotomy
  3. Reassurance
A
  1. TV USS
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5
Q

What is the concern about a pregnancy after failed morning after contraception?

  1. multiple pregnancy
  2. abnormal fetus
  3. increased risk of ectopic pregnancy
  4. increased risk of miscarriage
  5. higher risk of premature labour
A
  1. increased risk of ectopic pregnancy
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6
Q

A 21 yo woman has an US at 7/40 for lower abdominal pain. A viable 7/40 pregnancy is seen, and an 8cm single locular cystic structure is noted in the right adnexa. What management option do you choose?

  1. Reassure and review regularly
  2. RSO through a Pfannensteil incision
  3. RSO through a midline incision
  4. US guided drainage of the cyst
  5. Rescan in 6/52
A
  1. Rescan in 6/52
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7
Q

The most common presenting symptom for molar pregnancy is:

  1. abnormal bleeding
  2. hyperemesis
  3. fundus larger than dates
  4. thryotoxicosis
  5. pre-eclampsia
A
  1. abnormal bleeding
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8
Q

Concerning partial moles, which statement is incorrect?

  1. the fetus may be alive
  2. most are triploidic
  3. more often progress to choriocarcinoma than complete moles
  4. pre-eclampsia is more common with partial moles
A
  1. more often progress to choriocarcinoma than complete moles
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9
Q

Regarding hydatidiform mole, which statement is correct:

  1. <3 % progress to chroiocarcinoma
  2. choriocarcinoma can be associated with thyrotoxicosis
  3. commonest karyotype is 45 XO
  4. association between prognosis and rhesus blood group
  5. less common in older women
A
  1. choriocarcinoma can be associated with thyrotoxicosis
  2. <3 % progress to chroiocarcinoma

“however persistence or change into malignant disease requiring chemotherapy occurs in 0.5 – 4 per cent of partial moles” - RANZCOG

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10
Q

Concerning partial moles, all true except:

  1. fetus may be alive
  2. mostly triploidy
  3. same follow up as complete moles – different now, follow up if negative within 8 weeks then 3/12
  4. more often go on to choriocarcinoma than complete moles
  5. preeclampsia occurs most commonly with partial moles
A
  1. more often go on to choriocarcinoma than complete moles
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11
Q

Least valuable predictor of missed abortion

  1. 5mm sac with no heart beat
  2. 15 mm sac with no fetal pole
  3. 20 mm sac and no fetal heart beat
A
  1. 5mm sac with no heart beat
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12
Q

Spontaneous ab, correct option:

  1. increased in women > 40
  2. DES associated with many pregnancy problems but no spont ab
  3. Most common chromosomal abnormality is triploidy
  4. Genetic abnormality in aborted fetuses are similar to those occurring in term fetuses
A
  1. increased in women > 40
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13
Q

A woman with 4 previous 1st trimester miscarriages has been fully investigated, no cause found. Management for the next pregnancy is:

  1. progesterone supplement empirically, or test serum progesterone
  2. aspirin and heparin
  3. serial BHCG
  4. US at 6/40
A
  1. US at 6/40
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14
Q

In first trimester, a PG presents with N & V, tachycardia. TFT show slight increase in free T4, decrease in TSH, and normal RT3. This is associated with:

  1. normal
  2. hyperemesis gravidarum
  3. Graves disease
  4. Hashimoto’s thyroiditis
  5. Non-toxic goitre
A
  1. hyperemesis gravidarum
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15
Q

A woman has three first miscarriages and presented to you at 6 weeks gestation. What is the next most appropriate step?

  1. perform an U/S
  2. serum bHCG
  3. reassurance
  4. lupus screen
  5. commence on progesterone
A
  1. perform an U/S
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16
Q

Patient 16 days after expected period. PV spotting in casualty. BHCG is 140,000. Most likely diagnosis?

  1. multiple pregnancy
  2. intrauterine pregnancy
  3. missed ab
  4. ectopic pregnancy
  5. intrauterine pregnancy and dysgerminoma of the ovary
A
  1. intrauterine pregnancy
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17
Q

After which procedure is the decay rate of BHCG the fastest?

  1. vacuum curette for termination of pregnancy
  2. vacuum curette for spontaneous abortion
  3. resection of ectopic pregnancy
  4. linear salpingotomy for ectopic pregnancy
  5. BHCG decays at the same rate for all procedures
A
  1. BHCG decays at the same rate for all procedures
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18
Q

Which investigation delivers the greatest dose of radiation to an 8 weeks fetus?

  1. IVP
  2. CXR
  3. Cholecystogram
  4. Barium enema
  5. Lumbar spine series
A
  1. Barium enema
19
Q

In a woman who conceives with an IUD insitu, all of the following are associated EXCEPT:

  1. miscarriage
  2. prematurity
  3. low birth weight
  4. fetal abnormalities
  5. chorioamnionitis
A
  1. fetal abnormalities
20
Q

Suction curettage for missed abortion at 10/40. What size suction catheter should you use?

  1. 6
  2. 8
  3. 10
  4. 12
  5. 14
21
Q

The most likely place of damage if haemorrhage and suction D&C?

  1. anterior laceration of corpus
  2. posterior laceration of corpus
  3. lateral laceration of corpus
  4. cervical laceration
A
  1. cervical laceration

(vs lateral laceration of corpus- uterines)

22
Q

At 7 weeks gestation, which of the following findings is most likely to be consistent with a tubal ectopic pregnancy?

  1. abdo US empty uterus + BHCG <600
  2. abdo US empty uterus + BHCG <1000
  3. abdo US empty uterus + BHCG >7000
  4. abdo pain and negative culdocentesis
A
  1. abdo US empty uterus + BHCG >7000
23
Q

A woman had a termination of pregnancy at 8/40 gestation at a local clinic under LA. The cervix was difficult to dilate and the uterus appeared to be perforated during this dilation. There was no bleeding or pain. A TVS was performed and showed a viable 8/40 fetus with an intact sac. What is the most appropriate management?

  1. continue with the termination
  2. transfer to hospital and continue termination under GA
  3. insert a cervagem vaginally and wait 4 hrs then attempt the suction termination
  4. perform a laparotomy and repair the defect, continue with suction termination with hysterotomy and removal of POC if necessary
  5. stop the procedure and wait 1-2 weeks then reconsider
A
  1. stop the procedure and wait 1-2 weeks then reconsider
24
Q

3 recurrent abortions, no cause found after investigation. Now 6/40 in next pregnancy, next step:

  1. aspirin
  2. progesterone
  3. quantitative HCG
  4. transvaginal US
25
Q

Regarding ectopics

  1. Continuing US and BHCG delays intervention and leads to greater risk of rupture
  2. Recurrence risk about 10%
  3. Better chance of subsequent live birth with salpingostomy vs salpingectomy
A
  1. Better chance of subsequent live birth with salpingostomy vs salpingectomy

recurrence risk 15%

RCOG : The three-year cumulative pregnancy rate was 62% after salpingotomy and 38% after salpingectomy

26
Q

37 yo has just had 4th 1st trimester miscarriage within her only marriage and no living children. Most likely cause

  1. idiopathic
  2. lupus
  3. chromosomal
  4. cervical incompetence
A
  1. idiopathic
27
Q

What is of proven value as treatment for recurrent 2nd trimester miscarriages associated with uterine contractions?

  1. erthromycin
  2. transfusing wife with husbands WBC
  3. Strassmann operations
  4. McDonald cerclage
A
  1. McDonald cerclage
28
Q

Recurrent abortion, no cause found. What do you do at 6-7/40 in next pregnancy?

  1. pelvic US
  2. cervical suture
  3. BHCG
  4. Progesterone injections
29
Q

A lady 12 weeks pregnant with a bicornuate uterus presents to A&E with pain and bleeding. US shows an empty uterus and 8 cm adnexal mass. Obs BP 90/60, PR 110:

  1. get A&E to organise laparoscopy with probable salpingostomy
  2. get A&E to organise laparoscopy with probable laparotomy
  3. do nothing until you arrive in 30 mins
  4. have a culdotomy tray ready for you
A
  1. get A&E to organise laparoscopy with probable laparotomy
30
Q

At 12 weeks gestation the corpus luteum is removed for bleeding, the most appropriate pregnancy support with the least fetal risk is:

  1. duphaston
  2. depo provera
  3. norethisterone
  4. progesterone and oestrogen
  5. no hormones
A
  1. no hormones
31
Q

Commonest cause of first trimester miscarriage?

  1. T21
  2. XO
  3. T16
  4. T18
  5. XXY
A
  1. XO

Altogether, the trisomies make up 50% of chromosomal causes, T16 being the most common and always lethal. On its own XO comprises 20% so is probably most common

32
Q

A woman you have been following with a bicornuate uterus had her LNMP 11/52 ago. A home pregnancy test was positive 2/52 ago. She has presented to ED with severe lower abdominal pain and bleeding O/E HR 110, BP 90/60, lower abdomen rigid and US 6 cm adnexal mass and empty uterus. Mx?

  1. ask for stat LFT’s plt in preparation for MTX
  2. ask for a culdocentesis tray to be organised
  3. have them do nothing until you arrive in < 30 mins
  4. begin arranging theatre for laparoscopy/likely linear salpingostomy
  5. begin arranging theatre for laparoscopy probably laparotomy
A
  1. begin arranging theatre for laparoscopy probably laparotomy
33
Q

A 21 yo primigravida at 14 weeks is found to have a BP of 180/110. The BP was noted to be normal at her first visit and prior to pregnancy. Of the possible diagnoses, the most lethal is?

  1. PIH
  2. Acute glomerulonephritis
  3. Essential HT
  4. Hydatidiform mole
  5. Phaeochromocytoma
A
  1. Phaeochromocytoma
34
Q

In a woman who is 8 weeks pregnant with an IUD in situ the correct management is?

  1. immediate removal of the IUD
  2. advise termination of pregnancy
  3. remove the IUD only if there is evidence of infection
  4. if the strings are visible cut them as high up in the cervical canal as possible
  5. immediate laparoscopy to exclude ectopic pregnancy
A
  1. immediate removal of the IUD
35
Q

The most common emotional response after a termination is

  1. severe depression
  2. shame
  3. relief
  4. anxiety
  5. psychosis
36
Q

27 yo female at 7/40 pregnant with 8 cm unilocular cyst presents with LIF pain. Mx?

  1. operative laparoscopy
  2. cystectomy via pfannensteil
  3. oopherectomy via midline incision and washings
  4. laparoscopy and aspiration of cyst
  5. repeat US in 6 weeks
A
  1. repeat US in 6 weeks
37
Q

Ectopic pregnancvy

  1. increased after legal TOP
  2. increased on progesterone only pill more than without contraception
  3. rate is higher with copper IUD’s than plastic ones
  4. increased with IUD more than normal population
  5. none of the above
A
  1. none of the above
38
Q

TOP at 6/52. One week later, no bleeding or pain but BHCG remains positive. There is a 6-7 week size uterus. The path showed scanty decidual tissue, no fetal parts. Next ?

  1. qualitative BHCG
  2. ultrasound
  3. repeat curette
  4. laparotomy
A
  1. ultrasound
39
Q

6/52 pregnant, 3 days of abdo pain and 2 days of PV bleeding. Bilateral adnexal tenderness. US – complex adnexal mass and free fluid in POD. Next?

  1. culdocentesis
  2. laparotomy
  3. quantitative BHCG
  4. laparoscopy
A
  1. laparoscopy
40
Q

12 weeks pregnant. HCG positive at 6 weeks. No other antenatal care. Feels pregnant. One week history of PCB without cramping. Speculum reveals bright red 3 cm mass on the ectocervix. Which test will give a definite diagnosis?

  1. real time US
  2. tissue biopsy
  3. colposcopy and biopsy
  4. stain with Lugo’s iodine
A
  1. real time US
41
Q

Risk of ectopic highest with?

  1. COCP
  2. Condoms
  3. No contraception
  4. POP
  5. diaphragm
A
  1. no contraception
42
Q

Threatened ab at 6 weeks shows cardiac activity and appropriate for dates. Risk of ab?

  1. <10%
  2. 50%
  3. 25%
  4. 90%
43
Q

Woman at 6/52 amenorrhoea with PV bleeding and lower abdo pain. HCG 3000 and US empty uterus. Options?

  1. do nothing
  2. serial HCG
  3. laparoscopy
A
  1. laparoscopy
44
Q

Pregnant lady in first trimester with the following GTT. Fasting BSL 6.8, 2 hrs post 100gm load 12.6. Mx?

  1. admit for stabilisation
  2. commence on oral hypoglycaemic agent
  3. commence on insulin as an outpatient
  4. repeat the test in the second trimester
  5. counsel on dietary measures
A
  1. commence on insulin as an outpatient

vs admit for stabilisation

MCQ (10 decks)

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