Questions Flashcards
A 28-year-old woman, gravida 2 para 1, at 9 weeks’ gestation presents with severe nausea and vomiting. She is unable to keep any food or fluids down and has lost 5% of her body weight over the past two weeks. She looks dehydrated and has not been able to carry out her normal daily activities. Her blood tests are normal and an ultrasound scan confirms a viable intrauterine pregnancy
What is the most likely diagnosis?
Hyperemesis gravidarum
Acute pancreatitis
Gastroenteritis
Pyelonephritis
Molar pregnancy
A 28-year-old woman, gravida 2 para 1, at 9 weeks’ gestation presents with severe nausea and vomiting. She is unable to keep any food or fluids down and has lost 5% of her body weight over the past two weeks. She looks dehydrated and has not been able to carry out her normal daily activities. Her blood tests are normal and an ultrasound scan confirms a viable intrauterine pregnancy
What is the most likely diagnosis?
Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting leading to dehydration, weight loss, and electrolyte imbalances in early pregnancy. The other options are less likely because:
A 32-year-old woman, gravida 2 para 0, at 10 weeks’ gestation presents with vaginal bleeding and lower abdominal cramping. Ultrasound reveals an empty gestational sac without a fetal pole.
What is the most likely diagnosis?
Molar pregnancy
Threatened miscarriage
Missed miscarriage
Ectopic pregnancy
Inevitable miscarriage
A 32-year-old woman, gravida 2 para 0, at 10 weeks’ gestation presents with vaginal bleeding and lower abdominal cramping. Ultrasound reveals an empty gestational sac without a fetal pole.
What is the most likely diagnosis?
A missed miscarriage is characterized by an empty gestational sac or a non-viable fetus without bleeding or passage of tissue, usually confirmed by ultrasound. The other options are less likely because:
A) Threatened miscarriage involves bleeding with a closed cervix and a viable fetus.
B) Inevitable miscarriage would present with cervical dilation and active bleeding.
D) Ectopic pregnancy presents with pain and potentially a non-uterine location on ultrasound.
E) Molar pregnancy shows a “snowstorm” pattern on ultrasound, not an empty sac.
A 27-year-old woman, gravida 1 para 0, presents with severe lower abdominal pain and vaginal spotting at 7 weeks’ gestation. Her β-hCG levels are 2000 IU/L, and transvaginal ultrasound does not show an intrauterine pregnancy.
What is the most likely diagnosis?
Ovarian torsion.
Threatened miscarriage
Ectopic pregnancy
Missed miscarriage
Molar pregnancy
An ectopic pregnancy is highly suspected when there is a positive pregnancy test, pain, spotting, and no evidence of an intrauterine pregnancy on ultrasound (pregnancy of unknown location), especially with elevated β-hCG levels. The other options are less likely because:
B) Missed miscarriage would usually show an intrauterine sac on ultrasound.
C) Threatened miscarriage involves an intrauterine pregnancy with bleeding but a viable fetus.
D) Ovarian torsion presents with severe, acute lower abdominal pain but not associated with β-hCG levels or pregnancy.
E) Molar pregnancy would show a “snowstorm” appearance on ultrasoun
A 25-year-old woman, gravida 1 para 0, presents at 12 weeks’ gestation with excessive nausea, vomiting, and vaginal bleeding. Her uterus is larger than expected for gestational age, and her serum β-hCG levels are markedly elevated. Ultrasound shows a “snowstorm” appearance.
What is the most likely diagnosis?
.
Twin pregnancy
Hyperemesis gravidarum
Complete molar pregnancy
Ectopic pregnancy
Missed miscarriage
Explanation:
A complete molar pregnancy is characterized by excessive nausea and vomiting due to high β-hCG, vaginal bleeding, and a characteristic “snowstorm” pattern on ultrasound. The other options are less likely because:
A) Hyperemesis gravidarum does not cause a large-for-date uterus (unless it was an undiagnosed twin pregnancy) but certainly not or “snowstorm” appearance.
B) Missed miscarriage would not show this ultrasound pattern.
D) Ectopic pregnancy would not cause uterine enlargement or this ultrasound appearance.
E) Twin pregnancy could cause high β-hCG but would not show a “snowstorm” pattern on ultrasound.
A 30-year-old woman presents to the emergency department with sudden-onset severe lower abdominal pain and dizziness. She is 8 weeks pregnant. On examination, she is hypotensive, and her abdomen is tender with guarding and rebound tenderness.
What is the most likely diagnosis?
Answer
Ruptured ectopic pregnancy
Acute cholecystitis
Missed miscarriage
Appendicitis
Ovarian cyst rupture
Ruptured ectopic pregnancy presents with severe lower abdominal pain, hypotension, and signs of peritonitis in a woman with a positive pregnancy test. The other options are less likely because:
A) Ovarian cyst rupture can cause pain but is less likely to cause hypotension and is unrelated to pregnancy.
B) Appendicitis is a differential diagnosis and would cause right lower quadrant pain but is not typically hypotension.
D) Missed miscarriage does not cause severe pain or hypotension.
E) Acute cholecystitis causes right upper quadrant pain and does not relate to early pregnancy
A 32-year-old primigravida at 36 weeks’ gestation presents with a blood pressure of 150/95 mmHg, significant proteinuria on dipstick, and a persistent headache. On examination, she has pitting oedema up to her knees. Her blood pressure at booking was 120/65 mmHg.
What is the most likely diagnosis?
HELLP syndrome
Eclampsia
Pre-eclampsia
Gestational hypertension
Chronic hypertension
Pre-eclampsia is characterized by new-onset hypertension after 20 weeks of gestation with significant proteinuria and symptoms like headache and oedema. The other options are less likely because:
A) Chronic hypertension is diagnosed when high blood pressure is present before pregnancy or before 20 weeks’ gestation. The fact that her BP at booking was normal makes this diagnosis less likely.
B) Gestational hypertension involves high blood pressure after 20 weeks without proteinuria or other systemic symptoms.
D) Eclampsia would present with seizures, which this patient does not have.
E) HELLP syndrome involves haemolysis, elevated liver enzymes, and low platelets, typically with more severe systemic symptoms.
The first-line management of gestational diabetes typically involves dietary modifications and exercise to control blood glucose levels. The other options are considered if lifestyle modifications fail
A) Repeat OGTT in 2 weeks is not typically indicated after a positive test.
C) Start metformin is an option if dietary changes are insufficient.
D) Start insulin therapy is considered if blood sugar levels remain uncontrolled despite other interventions.
E) Immediate delivery is not indicated unless there is another obstetric complication.
Ursodeoxycholic acid is the treatment of choice for intrahepatic cholestasis of pregnancy to reduce bile acid levels and relieve symptoms. The other options are less appropriate:
A) Oral antihistamines may provide symptomatic relief but do not address the underlying condition.
B) Topical corticosteroids are not effective for the pruritus associated with cholestasis.
D) Immediate delivery is reserved for cases with severe disease or fetal compromise.
E) Antenatal corticosteroids are used to enhance fetal lung maturity but are not a primary treatment for cholestasis.
In well-controlled gestational diabetes, induction of labour at 38-39 weeks is often recommended to reduce the risk of stillbirth and macrosomia. The other options are less suitable because:
