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L3 (1ST BMEX) > OB4 > Flashcards

OB4 Flashcards

1
Q

The most frequent site of tubal pregnancy

A. Ampulla
B. Cornual
C. Isthmic
D. Interstitial

A

A. Ampulla

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1
Q

The underlying risk factor for most tubal ectopic pregnancy

A. Previous ectopic pregnancy
B. Prior STD infection
C. Peritubal adhesions
D. Abnormal fallopian tube anatomy

A

D. Abnormal fallopian tube anatomy

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1
Q

Tubal abortion is most common in this type of tubal pregnancy

A. Isthmic
B. Cornual
C. Fimbrial
D. Interstitial

A

C. Fimbrial

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1
Q

Medical therapy with methotrexate for ectopic pregnancy is not indicated in which condition?

A. Initial serum HCG level is low
B. Absent fetal heart tones
C. Size of the ectopic pregnancy is <3.5 cm
D. Evidence of tubal rupture

A

D. Evidence of tubal rupture

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2
Q

What is the worst form of primary therapy failure in ectopic pregnancy?

A. Formation of a complex mass
B. Rupture of a persistent ectopic pregnancy
C. Hemoperitoneum formation
D. Abdominal pregnancy

A

B. Rupture of a persistent ectopic pregnancy

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2
Q

Radical surgery for ectopic pregnancy

A. Salpingotomy
B. Salpingostomy
C. Salpingectomy
D. Salpingo-oophorectomy

A

C. Salpingectomy

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3
Q

The type of abortion commonly seen in women over 35 years of age

A. Euploid abortion
B. Aneuploid abortion
C. Maternal gametogenesis errors
D. Paternal errors

A

B. Aneuploid abortion

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4
Q

What is a special risk factor for interstitial pregnancy?

A. Ipsilateral salpingectomy
B. IUD failure
C. Congenital anomalies of the uterus
D. ART

A

A. Ipsilateral salpingectomy

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5
Q

This type of ectopic pregnancy has a pathogenesis likened to a placenta accreta and carries similar risk for serious hemorrhage

A. PUL
B. CS scar pregnancy
C. Interstitial pregnancy
D. Abdominal pregnancy

A

B. CS scar pregnancy

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5
Q

This type of pregnancy occurs after an early tubal rupture or abortion with reimplantation

A. CS scar pregnancy
B. Interligamentous pregnancy
C. Cornual pregnancy
D. Abdominal pregnancy

A

D. Abdominal pregnancy

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6
Q

A 40-year-old G1P0 came in due to the passage of vesicular tissues admixed with blood. She has been amenorrheic for 8 weeks already. What is the strongest risk factor for this patient?

A. Prior H. mole
B. Age
C. Ethnicity
D. Vitamin C deficiency

A

B. Age

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7
Q

Which of the following types of trophoblast produces HCG and HPL?

A. Cytotrophoblast
B. Syncytiotrophoblast
C. Intermediate trophoblast
D. Trophoblast

A

B. Syncytiotrophoblast

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8
Q

What is responsible for the exuberant proliferation of trophoblastic growth in complete mole?

A. Excessive maternal genome
B. Excessive paternal and maternal genome
C. Excessive paternal and absence of maternal genome
D. Absence of paternal and excessive maternal genome

A

C. Excessive paternal and absence of maternal genome

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9
Q

A G6P5 (5005) came in with a sonographic report of a fetus with multicystic placenta. Which of the following would not characterize the fetuses with this condition?

A. Multiple congenital anomalies
B. Mental retardation
C. Severe growth restriction
D. High IQ

A

D. High IQ

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9
Q

A 42 yo G5P4 (4004) came in for intractable vomiting. She was already 12 weeks amenorrheic. On PE, the uterus was 20 weeks’ size, boggy, no fetal heart tone. Ultrasound was done, a snowstorm pattern and anechoic cystic mass about 8x6 cm was noted at the right adnexal mass. How would you manage this patient?

A. Suction curettage
B. Hysterectomy + cystectomy
C. Hysterectomy alone
D. Total abdominal hysterectomy + bilateral salpingo-oophorectomy

A

C. Hysterectomy alone

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10
Q

Medical conditions not associated with moles

A. Anemia
B. Hyperthyroidism
C. Cardiomyopathy
D. Hyperemesis gravidarum

A

C. Cardiomyopathy

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10
Q

Close biochemical surveillance for gestational neoplasia follows hydatidiform mole evacuation. What is the median time for the level of β-hCG titer to normalize for a complete mole?

A. 7 weeks
B. 10 weeks
C. 12 weeks
D. 14 weeks

A

A. 7 weeks

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11
Q

A G2P1 underwent suction curettage for H. mole. Post-operatively, which of the contraceptives would be ill-advised for the patient, except?

A. OCP
B. Progestin implant
C. IUD
D. Injectable depot-medroxyprogesterone acetate

A

C. IUD

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11
Q

A primigravida came in with severe hypogastric pain accompanied by heavy vaginal bleeding. The bleeding stopped after the passage of meaty tissues and blood clots. She is 7 weeks AOG based on her ultrasound 1 week ago. Which of the following findings would suggest a complete abortion?

A. Blood clots are seen grossly
B. Sonography documents a thickened endometrium of 5 mm
C. Closed cervix
D. Sonography documents first an IUP and then later an empty cavity

A

D. Sonography documents first an IUP and then later an empty cavity

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11
Q

Which of the following would indicate a case of missed abortion in a patient at 10 weeks amenorrhea by ultrasound?

A. A CRL threshold of <7 mm plus absent cardiac activity
B. A gestational sac with no embryo or yolk sac
C. Absence of embryo in a sac with a mean sac diameter (MSD) of ≥ 25 mm
D. A yolk sac diameter of <7 mm in pregnancies with 10 weeks gestation

A

C. Absence of embryo in a sac with a mean sac diameter (MSD) of ≥ 25 mm

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12
Q

A G3P0 (0020) came in for amenorrhea. She had spontaneous pregnancy losses at 8 and 12 weeks AOG. She underwent curettage for the 2 pregnancy losses. What is the most likely cause if the patient will experience this again?

A. Asherman’s syndrome
B. Infertility
C. APAS syndrome
D. Recurrent pregnancy loss

A

A. Asherman’s syndrome

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13
Q

Endocrine problem, which if uncontrolled, is a known abortifacient

A. Subclinical hypothyroidism
B. Progesterone deficiency
C. Hyperprolactinemia
D. Diabetes mellitus

A

D. Diabetes mellitus

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13
Q

A G2P1 (0010) at 16 weeks AOG came in and sought consult due to hypogastric pain. Upon cervical IE, it shows a 2-cm dilation with bulging of membranes. She had spontaneous labor to her previous pregnancy at the same AOG. What is the most likely cause of this condition?

A. Infection
B. Incompetent cervix
C. Trauma
D. Congenital abnormality of the cervix

A

B. Incompetent cervix

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13
Q

To avoid post-abortal infection, what should be done on a patient scheduled with surgical evacuation?

A. Screening for gonorrhea, syphilis, HIV, Hep B, and chlamydia
B. Assessment of hemoglobin level and Rh status
C. NSAIDs 1 hour prior to procedure
D. Doxycycline 100 mg 2 caps 1 hour prior to procedure

A

D. Doxycycline 100 mg 2 caps 1 hour prior to procedure

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14
Q

A medication that can be used for early pregnancy failure but can cause a transverse limb reduction

A. Mifepristone
B. Misoprostol
C. Potassium chloride
D. Dinoprostone

A

B. Misoprostol

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14
Q

After having an abortion, 35 yo G1P0 (0010) wants to get pregnant due to her age. What is the expected time for her to ovulate?

A. 5 weeks
B. 3 weeks
C. 1 week
D. 2 weeks

A

B. 3 weeks

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14
Q

Which of the following contraceptive methods cannot predispose to an ectopic pregnancy?

A. Progestin pills only
B. IUD
C. Tubal sterilization
D. Implanon

A

D. Implanon

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14
Q

A patient came in due to hypogastric pain at 8 weeks AOG. An emergency ultrasound was done. What findings in the ultrasound would suggest an ectopic pregnancy?

A. Anechoic fluid collection
B. A trilaminar endometrial pattern
C. Decidual cyst
D. An intradecidual sign

A

B. A trilaminar endometrial pattern

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15
Q

A 33 yo G3P2 PU 18 weeks AOG consulted at the ER because of watery vaginal discharge and hypogastric pain. Vital signs were normal. Uterus enlarged to 18 weeks AOG. Speculum exam revealed pooling of watery vaginal discharge. On IE, a 3-cm cervix, open with palpable fetal parts at the os. What is the diagnosis?

A. Recurrent abortion
B. Incomplete abortion
C. Inevitable abortion
D. Threatened abortion

A

C. Inevitable abortion

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15
Q

The patient came in due to abdominal pain and vaginal bleeding. Ultrasound and hCG titers inconclusive for ectopic pregnancy. What should be done next?

A. Give methotrexate immediately
B. Get serum progesterone
C. Do endometrial biopsy
D. Monitor hCG titer after 1 week

A

B. Get serum progesterone

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16
Q

A 21 yo primigravid came in to the ER due to severe abdominal pain associated with shoulder pain and
dizziness. BP 90/60, PR 110/min. (+) Rebound tenderness on examination of the abdomen and exquisite tenderness on wiggling of the cervix. Patient had a history of complete abortion at 6 weeks AOG 2 weeks PTA. Histopath findings revealed a decidual reaction. (+) Pregnancy test. The most likely diagnosis is

A. unruptured ectopic pregnancy
B. ruptured ectopic pregnancy
C. threatened uterine abortion
D. ruptured corpus luteum

A

B. ruptured ectopic pregnancy

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17
Q

Which of the following histological presentations is a characteristic of complete molar pregnancy?

A. Presence of blood vessels in the swollen villi
B. Hydropic degeneration and swelling of the villous stroma
C. Proliferation of trophoblastic epithelium with equal degree
D. Presence of fetus and amnion

A

B. Hydropic degeneration and swelling of the villous stroma

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17
Q

The primary goal in vaginal bleeding or abdominal pain

A. Exclude ectopic pregnancy
B. Do transvaginal ultrasound
C. Determine IUP viability
D. Obtain β-HCG

A

A. Exclude ectopic pregnancy

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18
Q

A 25-year-old woman, G5P4 (4004) came in due to heavy vaginal bleeding and abdominal pain associated with foul smelling tissue and fever. She is at 12 weeks AOG. On IE cervix is 2cm dilated with meaty tissue and foul smelling vaginal discharges. What is the appropriate management?

A. Prompt surgery after antibiotics
B. Expectant management
C. Antibiotics only
D. Antibiotics then wait for fever to lyse

A

A. Prompt surgery after antibiotics

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18
Q

Prophylactic cervical cerclage is done in this AOG

A. 16-18 weeks
B. 12-14 weeks
C. 24-28 weeks
D. 30 weeks

A

B. 12-14 weeks

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18
Q

A G1P0 was scheduled for elective curettage. Which of the following is the potential complication of first trimester curettage?

A. Uterine imperforation
B. Upper genital tract uterine lacerations
C. Hypercoagulability Hemorrhage
D. Asherman’s syndrome

A

D. Asherman’s syndrome

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18
Q

This surgical management of ectopic pregnancy makes a linear incision on the antimesenteric border of the fallopian tube and over the pregnancy and the products of conception is removed with the incision left unsutured

A. Salpingotomy
B. Salpingectomy
C. Salpingostomy
D. End to end anastomosis

A

C. Salpingostomy

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19
Q

This nuclear protein is both seen in partial molar and in a normal placenta.

A. p57kip2
B. Prolactin
C. TSH
D. CA 125

A

A. p57kip2

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19
Q

Medical therapy is offered for an unruptured ectopic pregnancy. What agents or activity is avoided by patients who have not completed therapy?

A. Paracetamol
B. Sunlight
C. Vitamin C
D. Bathing

A

B. Sunlight

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20
Q

Who among the following women will be at risk for development of ectopic pregnancy?

A. Arnie, a 24-year-old, previously diagnosed with salpingitis
B. Baby, a 21-year-old, newlywed with adenomyosis
C. Celia, a 28-year-old, widow, diagnosed with multiple myeloma
D. Dana, a 44-year-old S/P hysterectomy for multiple myoma

A

A. Arnie, a 24-year-old, previously diagnosed with salpingitis

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20
Q

Which of the following is most likely to be associated with profuse vaginal bleeding?

A. Incomplete abortion
B. Missed abortion
C. Threatened abortion
D. Dysfunctional bleeding

A

A. Incomplete abortion

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20
Q

Which of the following sonographic findings does not indicate ectopic abdominal pregnancy?

A. Fetus or placenta is eccentrically positioned within the pelvis
B. Lack of myometrium between the fetus and bladder
C. Bowel loops surrounding the uterus
D. Oligohydramnios

A

C. Bowel loops surrounding the uterus

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20
Q

What is the underlying theme for pregnancy loss in mothers with uncontrolled diabetes mellitus?

A. Inflammatory mediators
B. Direct exposure to radiation
C. Exposure to teratogen
D. Long exposure to high levels of glucose

A

A. Inflammatory mediators

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20
Q

In ectopic pregnancies, the absence of which tubal tissue layer facilitates rapid invasion of proliferating trophoblasts into the muscularis?

A. Serosa
B. Epithelium
C. Submucosa
D. Connective tissue

A

C. Submucosa

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21
Q

Which progesterone value threshold is most helpful to exclude ectopic pregnancy?

A. >10 ng/ml
B. >15 ng/ml
C. >20 ng/ml
D. >25 ng/ml

A

D. >25 ng/ml

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21
Q

What is an adnexal finding in an ectopic mass?

A. Placental blood flow within the periphery of the uterus
B. A trilaminar endometrial pattern
C. Anechoic space lying within the endometrium
D. A hyperechoic halo/tubal ring lying in the anechoic sac

A

D. A hyperechoic halo/tubal ring lying in the anechoic sac

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22
Q

What is the discriminatory βHCG level that indicates pregnancy is either not alive or ectopically located

A. ≥ 100
B. ≥ 500
C. ≥ 1000
D. ≥ 1500

A

D. ≥ 1500

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23
Q

A 26-year-old, G1, came in at the OPD due to amenorrhea and positive pregnancy test. UTZ: 3x3 cm left complex adnexal mass with minimal amount of fluid seen at the cul-de-sac. No tenderness noted. Best management is?

A. Medical management
B. Dilatation and curettage
C. Expectant management
D. Laparoscopic management

A

A. Medical management

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23
Q

A 31-year-old G3P1 at 6 to 7 weeks’ gestation by last menstrual period came in for abdominal pain, weakness, and dizziness. On sonographic exam, a complete left adnexal mass with free fluid was seen. What is the minimum amount of accumulated hemoperitoneum which could be expected at the time of surgery?

A. 100-200 mL
B. 200-300 mL
C. 300-400 mL
D. 400-600 mL

A

D. 400-600 mL

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23
Q

A patient of 6 weeks’ amenorrhea had a (+) pregnancy test but transvaginal ultrasound didn’t show an intrauterine pregnancy. A PUL is labeled

A. complete abortion
B. early intrauterine pregnancy
C. multifetal pregnancy
D. failing intrauterine pregnancy

A

D. failing intrauterine pregnancy

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24
Q

Which of the following clinical conditions is not part of the criteria in diagnosing an ovarian pregnancy?

A. Ipsilateral tube is intact and distinct from the ovary
B. Ectopic pregnancy occupies the ovary
C. The ectopic pregnancy disconnected by the infundibulopelvic ligament to the uterus
D. Ovarian tissue can be demonstrated histologically amid the placental tissue

A

C. The ectopic pregnancy disconnected by the infundibulopelvic ligament to the uterus

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25
Q

Antidote of methotrexate toxicity

A. Folic acid
B. Leucovorin
C. NSAIDs
D. Zinc

A

B. Leucovorin

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25
Q

A G3P2 (2002) came in due to severe abdominal pain and dizziness. By LMP she is 10 weeks AOG. Which of the following indicates an interstitial pregnancy?

A. ≥ 5 mm myometrial mantle surrounding the sac
B. Gestational sac
C. > 1 cm away from the most lateral edge of the uterine cavity

A

C. > 1 cm away from the most lateral edge of the uterine cavity

26
Q

CS scar pregnancy is diagnosed ultrasonographically with the following, except

A. Prominent vascular pattern on the scar
B. A thin myometrial mantle between the gestational sac and bladder
C. Placenta or gestational sac (asterisk) embedded in the hysterotomy scar
D. Full endocervical canal

A

D. Full endocervical canal

26
Q

A 25-year-old consulted for vaginal spotting and abdominal pain with a pain score of 9/10. History revealed 7 weeks amenorrhea. Pregnancy test was positive. BP was 80/50 mmHg, HR 125/min. On physical exam, abdomen was not fully assessed due to muscle guarding. IE revealed cervical motion tenderness. What should be done next on this patient?

A. Immediate exploratory laparotomy
B. Blood transfusion
C. Culdocentesis
D. TVS

A

A. Immediate exploratory laparotomy

26
Q

In cases of incomplete abortion, which is the most common complication resulting from overzealous dilatation and curettage?

A. Cervical injury
B. Infection
C. Perforation
D. Hemorrhage

A

A. Cervical injury

27
Q

What is the hallmark sign of gestational trophoblastic neoplasia?

A. Uterine bleeding
B. Seizure
C. Hemoptysis
D. Pelvic vein thrombosis

A

A. Uterine bleeding

27
Q

The most common site of metastasis for Gestational Trophoblastic Tumor.

A. Liver
B. Lungs
C. Brain
D. Vagina

A

B. Lungs

27
Q

Which of the following is characteristic of a partial molar pregnancy?

A. There is no evidence of fetal red blood cells.
B. It is androgenic in origin.
C. Almost all cases occur following a dispermic fertilization of an ovum.
D. Majority represents tetraploid or mosaic conceptions.

A

C. Almost all cases occur following a dispermic fertilization of an ovum.

28
Q

After molar evacuation, hCG disappears after how many weeks?

A. 8-10
B. 6-8
C. 4-6
D. 2-4

A

A. 8-10

29
Q

Metastatic disease is most commonly seen in which of the following?

A. Placental site trophoblastic tumor
B. Epithelioid trophoblastic tumor
C. Invasive mole
D. Choriocarcinoma

A

B. Epithelioid trophoblastic tumor

29
Q

By how many days following resection of an ectopic pregnancy does serum beta-hCG decreases to 10 percent of preoperative levels?

A. 8 days
B. 12 days
C. 4 days
D. 2 days

A

B. 12 days

30
Q

Which of the following can increase the incidence of cervical pregnancy?

A. Advancing maternal age
B. In vitro fertilization
C. High CS rates
D. Increased use of cervical loop excision

A

B. In vitro fertilization

30
Q

Most common complication of twin molar pregnancy.

A. Abortion
B. Abdominal pain
C. Preeclampsia
D. Intrauterine fetal demise

A

C. Preeclampsia

30
Q

This refers to 2 or more failed clinical pregnancies by the American Society for Reproductive Medicine.

A. Recurrent Pregnancy loss
B. Missed abortion
C. Complete abortion
D. Spontaneous abortion

A

A. Recurrent Pregnancy loss

30
Q

A G2P1 (1001) with 7 weeks missed period presents with a 3-day history of vaginal spotting and hypogastric pain. Positive pregnancy test. Vital signs are stable. On Bimanual exam, cervix is closed, no cervical motion tenderness, no adnexal mass palpated. What is the possible diagnosis?

A. Septic abortion
B. Induced abortion
C. Threatened abortion
D. Inevitable abortion

A

C. Threatened abortion

31
Q

Vaginal sonography can detect an intrauterine Gestational sac when the serum beta-hCG reaches what level?

A. 2500 mlU/mL
B. 2000 mlU/mL
C. 1500 mlU/mL
D. 1000 mlU/mL

A

C. 1500 mlU/mL

32
Q

A 30 y.o. G3P2 (1101) Pregnancy uterine 18 weeks AOG consulted at the ER because of watery vaginal discharge and hypogastric pain. Vital signs were normal. Uterus enlarged to 18 weeks AOG. Speculum exam revealed pooling of watery vaginal discharge. On IE, cervix open with palpable fetal parts at the os. What is the diagnosis?

A. Incomplete abortion
B. Recurrent abortion
C. Inevitable abortion
D. Threatened abortion

A

C. Inevitable abortion

32
Q

After an abortion and in normal spontaneous vaginal delivery, hCG is undetectable in how many weeks?

A. 10
B. 8
C. 2
D. 3-6

A

D. 3-6

32
Q

Classic histologic findings of molar pregnancy.

A. Abundant vesicular tissues
B. Trophoblast proliferation and villi with stromal edema
C. Abundance of cytotrophoblast
D. Absence of syncytiotrophoblast

A

B. Trophoblast proliferation and villi with stromal edema

32
Q

Which of the following statements is not a characteristic of human chorionic gonadotrophin?

A. hCG is released into the blood and some of it excreted in the urine.
B. Elevated hCG is seen in all cases of GTD.
C. Levels of hCG can determine if there are more tumor cells in the body.
D. This is used in monitoring if the treatment of a GTD is effective.

A

B. Elevated hCG is seen in all cases of GTD.

33
Q

Which of the following is the most common life-threatening complication associated with abdominal pregnancy?

A. Sepsis
B. Hemorrhage
C. Aspiration
D. Pre-eclampsia

A

B. Hemorrhage

33
Q

Which is the most common predisposing factor of tubal implantation?

A. Previous genital infection
B. Douching
C. Smoking
D. OCP

A

A. Previous genital infection

33
Q

Which of the following is utilized in the medical treatment of ectopic pregnancy?

A. Methotrexate
B. Vincristine
C. Dexamethasone
D. Bleomycin

A

A. Methotrexate

33
Q

Which of the following can affect the ciliary action and smooth muscle contraction of the fallopian tubes thereby predisposing the patient to ectopic pregnancy?

A. Amphetamine use
B. Alcoholic beverage drinking
C. Drinking coffee
D. Smoking

A

D. Smoking

34
Q

Antiphospholipid antibodies have been found in the circulation of women with this condition.

A. SLE only
B. Recurrent miscarriage
C. History of thrombocytopenia
D. False negative result of syphilis

A

B. Recurrent miscarriage

34
Q

A 40 years old G1PO was brought in by her husband for checkup last August 1, 2021, due to vaginal
spotting for 3 days. LMP: June 28, 2021. Pregnancy test was done a week prior to consult and claimed that the result was faintly positive. Vital signs were normal. Abdomen was soft and not tender. Bimanual pelvic exam findings revealed the following: Cervix - closed soft movable, non-tender. Uterus - movable, not enlarged, non-tender. Adnexa- no mass palpated, non-tender bilaterally. CBC result was normal. TVS result revealed a thickened endometrium, but no gestational sac seen. Ovaries were normal looking. A 1.5x1 cm complex mass was seen on the left adnexa. Right adnexa were negative. No fluid was seen at the post culde-sac. How will you manage this patient?

A. Start methotrexate
B. Request for beta hCG determination
C. Request for a repeat ultrasound
D. Schedule for salpingostomy

A

B. Request for beta hCG determination

35
Q

Which of the histological presentations is a characteristic of complete molar pregnancy?

A. Proliferation of trophoblastic epithelium with equal degree
B. Hydropic degeneration and swelling of the villous stroma
C. Presence of fetus and amnion
D. Presence of blood vessels in the swollen villi

A

B. Hydropic degeneration and swelling of the villous stroma

35
Q

A form of gestational trophoblastic disease characterized by excessive trophoblastic proliferation and edema of the villous stroma without excessive local invasion is:

A. Invasive mole
B. Choriocarcinoma
C. H. mole
D. Placental site trophoblastic tumor

A

C. H. mole

35
Q

A condition where the excessive beta hCG hormonal level oversaturate the assays thus giving a false negative result.

A. Hook effect
B. Mimic effect
C. Thyroid storm
D. Eclampsia

A

A. Hook effect

35
Q

The triad of symptoms of ectopic pregnancy are:

A. Syncope, abdominal rigidity, amenorrhea
B. Amenorrhea, syncope, vaginal bleeding
C. Amenorrhea, abdominal pain, vaginal bleeding
D. Abdominal pain, vomiting, vaginal bleeding

A

C. Amenorrhea, abdominal pain, vaginal bleeding

35
Q

What is the most common etiology of first trimester abortion/miscarriage?

A. Endocrine disorders
B. Iatrogenic
C. Early removal of corpus luteum
D. Chromosomal abnormalities

A

D. Chromosomal abnormalities

35
Q

Which of the following uterine abnormality has the greatest likelihood of spontaneous abortion?

A. Bicornuate uterus
B. Leiomyoma
C. Uterine septa
D. Uterine didelphys

A

A. Bicornuate uterus

36
Q

How many weeks after abortion does ovulation usually occurs?

A. 5-6 weeks
B. 4-5 weeks
C. 6-7 weeks
D. 2-3 weeks

A

D. 2-3 weeks

37
Q

What is the most serious complication in medical treatment of ectopic pregnancy?

A. Bleeding from retained trophoblast
B. Infertility
C. Hypovolemia
D. Toxicity of medication

A

C. Hypovolemia

37
Q

A 34 years old G3P2 (2002) consulted last August 1, 2021, for vaginal spotting for 3 weeks. This was associated with mild, tolerable hypogastric pain more on the right side. LMP: May 25, 2021. TVS result revealed a left adnexal mass measuring 3x3 cm. No fluid seen on the post-cul-de-sac. Vital signs were normal. What is the most likely site of the ectopic pregnancy?

A. Isthmus
B. Cornua
C. Ampulla
D. Cervical

A

C. Ampulla

37
Q

At what part of the fallopian tube does tubal rupture occur earliest?

A. Isthmic
B. Fimbria
C. Interstitial
D. Ampullary

A

A. Isthmic

38
Q

What is the conservative surgical treatment in ectopic pregnancy where the incision site is closed with delayed absorbable sutures?

A. Salpingotomy
B. Salpingostomy
C. Salpingectomy
D. Tubal end to end anastomosis

A

A. Salpingotomy

39
Q

Most common finding in Gestational Trophoblastic Neoplasia.

A. Irregular bleeding with abdominal pain
B. Irregular bleeding with uterine subinvolution
C. Uterine subinvolution with abdominal pain
D. Vaginal mass

A

B. Irregular bleeding with uterine subinvolution

39
Q

A woman with irregular menses consulted because of 8 weeks amenorrhea, vaginal spotting, and mild hypogastric discomfort. Pelvic exam reveals unremarkable findings. What is the initial step to be done?

A. Request for TVS.
B. Do an oral progesterone challenge test.
C. CBC and Blood typing
D. Pregnancy test

A

D. Pregnancy test

39
Q

A 25 years old G1P0 14 weeks AOG came in for consultation due to fetal demise based on her recent ultrasound. On IE, cervix was closed without bloody discharges. The patient was anxious as to when the fetus will pass out. Based on a study, what is the mean death to abortion interval?

A. 8 weeks
B. 6 weeks
C. 10 weeks
D. 4 weeks

A

B. 6 weeks

39
Q

A 48 years old G5P4 (4013) was diagnosed to have molar pregnancy by ultrasound. She was 18 weeks AOG based on LMP. Vital signs were normal. She is non hypertensive and non-diabetic. Initial laboratory results were within normal limits except for an elevated beta HCG. How will you best manage this patient?

A. Advise hysterectomy.
B. Advise bilateral tubal ligation after curettage.
C. Schedule suction curettage immediately.
D. Prescribe OCPs after curettage.

A

A. Advise hysterectomy.

39
Q

What causes vaginal bleeding in ectopic pregnancy?

A. Menstrual remnants
B. Decidualization
C. Trauma
D. Backflow of ruptured tubal pregnancy

A

D. Backflow of ruptured tubal pregnancy

39
Q

Choriocarcinoma is most likely to develop after a:

A. Partial mole
B. Ectopic pregnancy
C. Hydatidiform mole
D. Normal pregnancy

A

C. Hydatidiform mole

40
Q

The following are risk factors for ectopic pregnancy except?

A. Alcohol intake
B. Progestin only contraceptives
C. Multiple sexual partner
D. Smoking

A

A. Alcohol intake

40
Q

Serum Human Chorionic Gonadotropin is a Glycoproteins hormone which has similar alpha unit with

A. Luteinizing hormone
B. Progesterone
C.Human placental lactogen
D. Estrogen

A

A. Luteinizing hormone

40
Q

Patient S.M., 36 years old, G1 brought to OB ER on Sept 8 2020 for hypogastric pain associated with vaginal spotting 1 day PTC. Vital signs are as follows: BP: 100/60, HR 105, RR 20, Temp 36.7. Physical examination: Pinkish palpebral conjunctivae, abdomen-there was tenderness at hypogastrium with no palpable mass. Pelvic exam: cervix closed with motion tenderness, uterus was not enlarged with tenderness at right adnexa. Pregnancy test revealed positive result. On Ultrasound, the uterus was empty with endometrial thickness of 1 cm. There was a 4cm x 4cm echogenic mass at right adnexa. Minimal fluid collection was noted at posterior cul de sac. What is the best management for the patient?

A. Repeat the ultrasound the following day
B. Do medical management
C. Do pelvic laparotomy
D. Do expectant management

A

C. Do pelvic laparotomy

41
Q

What is the most common presentation of molar pregnancy?

A. Headache
B. Weakness
C. Vomiting
D. Vaginal bleeding

A

D. Vaginal bleeding

41
Q

What type of ectopic pregnancy is usually diagnosed later in pregnancy and results to severe hemorrhage when it ruptures?

A. Cornual pregnancy
B. Ovarian pregnancy
C. Ampullary pregnancy
D. Isthmus pregnancy

A

A. Cornual pregnancy

42
Q

Which of the following is true regarding euploid abortions

A. Occurrence peaks at 9 weeks
B. Incidence is increased in maternal age of >35 years old
C. It is not caused by medical disorders
D. Euploid abortions occur early

A

B. Incidence is increased in maternal age of >35 years old

42
Q

During monitoring of patients with ectopic pregnancy who received methotrexate, we can say that there is a good response to the drug when,

A. There is more than 15% decrease in the size of the ectopic mass
B. There is more than 25% decrease in the size of the ectopic mass
C. There is a fall of more than 25% from the baseline HCG
D. There is a fall of more than 15% from the baseline HCG

A

D. There is a fall of more than 15% from the baseline HCG

43
Q

A Patient with possible antiphospholipid antibody syndrome would be suspected in this case

A.4 unexplained spontaneous abortions before 10 weeks
B.2 unexplained deaths of a morphological normal fetus at 6 weeks
C. Low serum levels of IgG anticardiolipin antibodies
D. Severe preeclampsia is necessitating delivery before 40 weeks

A

A.4 unexplained spontaneous abortions before 10 weeks

43
Q

The following are conservative management for ectopic pregnancy except

A. Medical management with methotrexate
B. Salpingotomy
C. Salpingectomy
D. Salpingostomy

A

C. Salpingectomy

43
Q

Patient H.K., 46 years old, G9P7 (7017) came at OB ER on Sept 8 2020 due to vaginal bleeding 1 day PTC. Vital signs are as follows: BP 140/90 HR 105 RR 24 Temp 37.5 Physical findings: pale palpebral conjunctivae, clear breath sounds. Abdomen is flabby, soft and no tenderness. Speculum exam: there are grapelike tissues at vaginal canal, cervix was bluish with active bleeding. Bimanual pelvic exam: cervix 2 cm open, uterus is 16 weeks size. What is your working impression?

A. Invasive mole
B. GTD
C. GTN
D. Choriocarcinoma

A

B. GTD

44
Q

The pathognomonic sign of complete hydatidiform mole on ultrasound described as multiple anechoic cystic masses occupying the entire endometrial cavity

A. Sandstorm appearance
B. Snowstorm appearance
C. Hailstorm appearance
D. Spoke of wheel appearance

A

B. Snowstorm appearance

45
Q

Dead products of conception are retained for weeks in the uterus with a closed cervical os is

A. Complete abortion
B. Incomplete abortion
C. Missed abortion
D. Threatened abortion

A

C. Missed abortion

45
Q

Which of the following risk factors for ectopic pregnancy reduces the contractility of the Fallopian tube by decreasing its muscle tone?

A. Use of illicit drugs
B. Cigarette smoking
C. Use of combined oral contraceptive pills
D. Excessive alcoholic beverages intake

A

B. Cigarette smoking

45
Q

Which of the following indicate a diagnosis of early pregnancy loss?

A. Gestational sac without yolk sac and after 1 weak no embryo with heartbeat is seen
B. MSD of 22 mm and no embryo
C. CRL of 6 mm and no heartbeat
D. Gestational sac with yolk sac and after 12 days no embryo with a heartbeat is seen

A

D. Gestational sac with yolk sac and after 12 days no embryo with a heartbeat is seen

45
Q

What is the most common cause of early pregnancy losses?

A.Endocrine problem
B. Infections
C. Maternal age
D. Chromosomal abnormality

A

D. Chromosomal abnormality

46
Q

The following are criteria for medical management of ectopic pregnancy except:

A. Hemodynamically stable patient
B. Absence of fetal cardiac activity
C. BHCG of less than 5000 mIU/mL
D. Adnexal mass of more than 3.5 cm

A

D. Adnexal mass of more than 3.5 cm

46
Q

What immunostaining can be used to differentiate moles from hydropic degeneration?

A. Cytokeratin
B. hPL
C. ki-67
D. p57kip2

A

D. p57kip2

47
Q

What is responsible for the exuberant proliferation of trophoblastic growth in complete mole?

A. Excessive maternal and absence of paternal genome
B.Excessive paternal and excessive maternal genome
C.Excessive maternal and genome
D.Excessive paternal and absence maternal genome

A

D.Excessive paternal and absence maternal genome

47
Q

Proximal tubal segment within muscular uterine wall

A. Cervical pregnancy
B. Abdominal pregnancy
C. Interstitial pregnancy
D. Cesarean scar pregnancy

A

C. Interstitial pregnancy

47
Q

An amenorrheic patient came in for vaginal spotting. No abdominal tenderness was noted. A transvaginal ultrasound was done with findings of an empty uterus with endometrial thickness of 0.7 cm. There was 3 cm x 2 cm homogenous mass at right adnexa. What is the next best thing to do?

A. BHCG determination
B. Observe and do repeat ultrasound after 1 week
C. Pelvic laparotomy
D. Conservative management with methotrexate

A

A. BHCG determination

48
Q

Patient came in at the ER and claimed that she had passages of meaty tissues. Pelvic exam: uterus slightly enlarged, cervix is 2 cm open with palpable tissues at os with bloody discharge. What is your management this time?

A. Dilatation and curettage
B. Evacuation and curettage
C. Bed rest
D.None of the above

A

A. Dilatation and curettage

49
Q

Patient R.P., 33 years old, G3P2 (0020) brought to OB ER on Sept 8 2020 for vaginal spotting 1 day PTC. Vital signs are normal. Physical examination: pinkish palpebral conjunctivae, abdomen with mild tenderness at right lower quadrant with no palpable mass. Pelvic mass: cervix closed, uterus was not enlarged with tenderness at right adnexa. Patient’s LMP July 10 2020. Pregnancy test revealed positive result. What will be your working impression based on the given data?

A. GTD
B. Ectopic pregnancy
C. Incomplete miscarriage
D. Septic abortion

A

B. Ectopic pregnancy

49
Q

A uterine defect which causes mid trimester spontaneous pregnancy loss

A. Leiomyomas
B. Previa
C.Chorioamnionitis
D.Chromosomal fetal anomaly

A

A. Leiomyomas

50
Q

Single most frequent specific chromosomal abnormality in abortion

A. Tetraploidy
B. Trisomy
C. Monosomy X
D. Triploidy

A

C. Monosomy X

50
Q

Which of the ff is not contraindicated for methotrexate?

A. Breastfeeding
B. Ectopic Pregnancy
C. Peptic Ulcer disease
D. Tubal rupture

A

B. Ectopic Pregnancy

50
Q

What is the management for ovarian pregnancy?

A. Wedge resection
B. Oophorectomy
C. Salpingectomy
D. Salpingo-oophorectomy

A

A. Wedge resection
B. Oophorectomy

51
Q

Which of the following is a disadvantage of methotrexate?

A. Diminishes ovarian reserve
B. A folic acid antagonist
C. binding to dihydrofolate reductase
D. Excretion into breast milk and accumulation in neonatal tissues

A

D. Excretion into breast milk and accumulation in neonatal tissues

51
Q

The best management for a closed cervix in an amenorrheic patient of 8 weeks who complained of vaginal spotting with an ultrasound of an intrauterine live pregnancy?

A. bed rest
B. evacuation curettage
C. pelvic laparotomy
D. dilatation and curettage

A

A. bed rest

51
Q

Patient is treated with expectant management. What was the finding that merits this treatment?

A. Hemodynamically stable with TVS showing ectopic pregnancy
B. Hemodynamically stable with abnormal intrauterine pregnancy
C. Hemodynamically unstable with presumed ruptured ectopic pregnancy
D. Hemodynamically stable and normal intrauterine pregnancy

A

B. Hemodynamically stable with abnormal intrauterine pregnancy

52
Q

What is done first before evacuating pregnancy?

A. Dilation
B. Oxytocin IV infusion
C. Blood Transfusion
D. Sharp Curettage

A

A. Dilation

52
Q

Taken when serum B-hCG level exceeds set discriminatory level?

A. Treatment of ectopic pregnancy if chorionic villi is present
B. Surgical treatment for presumed ruptured ectopic pregnancy
C. Dilatation and curettage due to abnormal intrauterine pregnancy
D. Additional serum B-hCG level if complete abortion suspected

A

D. Additional serum B-hCG level if complete abortion suspected

52
Q

Complete hydatidiform mole may arise from

A. Fertilization of normal haploid ovum by 1 haploid sperm
B. Fertilization of an empty ovum by a diploid sperm
C. Fertilization of a normal haploid ovum by a triploid sperm
D. Fertilization of an empty ovum by 2 sperms

A

D. Fertilization of an empty ovum by 2 sperms

53
Q

Criteria for diagnosis of ovarian pregnancy

A. Cervical glands noted histologically opposite the placental attachment site
B. Implantation within myometrium of prior cesarean delivery scar
C. Ipsilateral tube is intact and distinct from the ovary
D. Conception in the rudimentary horn of the uterus with a Mullerian anomaly

A

C. Ipsilateral tube is intact and distinct from the ovary

53
Q

What is the best management for H mole in a patient with completed family size?

A. Hysterectomy with bilateral salpingo-oophorectomy
B. Hysterectomy
C. None of the above
D. Suction Curretage

A

B. Hysterectomy

53
Q

To confirm for a diagnosis of ovarian pregnancy, which of the following criteria is insignificant?

A. Ectopic pregnancy occupies the ovary
B. Distinct and intact ipsilateral tube
C. Ectopic pregnancy is connected to the uterus by the utero ovarian ligament
D. Products of conception are grossly identified

A

D. Products of conception are grossly identified

53
Q

Patient M.A., 21 years old G3P2 (2002) came to OB ER for vaginal spotting noted 1 week PTC. Patient LMP was June 12 2020. Vital signs: BP 120/80 PR 88 RR 19. Bimanual pelvic exam: cervix closed, soft, nontender; uterus 12 weeks size; negative adnexal findings; blood tinged. What is your working impression?

A. Complete miscarriage
B. Threatened miscarriage
C. Incomplete miscarriage
D. Inevitable miscarriage

A

B. Threatened miscarriage
- presumed when bloody vaginal discharge or bleeding appears through a closed cervical os during first 20 weeks

L3 (1ST BMEX) (18 decks)

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