Early pregnancy care EMQ- part2

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A 16-year-old student attends the early pregnancy unit with mild
abdominal pain and not being able to pass urine for the past12 hours

A recent ultra sound examination showed a viable intrauterine singleton
pregnancy. On examination hervitalsignsarefound to bestablewithlower
abdominal distension.

A) commencelow-doseaspirin

B) commencelow-molecular-weightheparinandlow-doseaspirin

C) immediate catheterisation and reassurance

D) inpatient HDU care with hydration, analgesia and observation

E) intramuscular 17 OH progesterone injections

F) intramuscular methotrexate followed by folinic acid

G) intravenous access and urgent pelvic ultrasonography

H) laparoscopic salpingectomy

I) MSU culture followed by intravenous antibiotic

J) offer detailed counselling about selective termination

K) oralprogesterone

L) prophylactic antibiotics

M) reassuranc

N) serial serum beta-hCG level

O) termination of pregnancy

A31-year-old woman presents with bleeding pervaginum.She is unsure
of the date of her lastmenstrualperiod.Onultrasoundthereisan
intrauterinegestationalsac17mminsizewithnocontents.

A) elective evacuation of retained products of conception

B) repeat ultrasound scan in 10–14days

C) reassurance and discharge

D) medical management with mifepristone/misoprostol

E) intravenous access, fluid replacement and urgent curettage

F) laparoscopy and salpingectom

G) laparotomy

H) repeat ultrasound in 4days

I) folic acid

J) serial beta human chorionic gonadotrophin(bhCG) measurement

K) culdocentesis

L) diagnostic curettage to look for chorionic villi

M) conservative management

N) referral to an appropriatecentre

O) transvaginal ultrasound

3) A 37-year-old woman presents to her GP with 6 weeks of amenorrhoea. She under goes an ultra sound examination in the early pregnancy unitand is found to have a heterotopic pregnancy without cardiac activity in the ectopicsac.She is completely a symptomatic with stable vital signs.

A) commencelow-doseaspirin

B) commencelow-molecular-weightheparinandlow-doseaspirin

C) immediate catheterisation and reassurance

D) inpatient HDU care with hydration, analgesia and observation

E) intramuscular 17 OH progesterone injections

F) intramuscular methotrexate followed by folinic acid

G) intravenous access and urgent pelvic ultrasonography

H) laparoscopic salpingectomy

I) MSU culture followed by intravenous antibiotic

J) offer detailed counselling about selective termination

K) oralprogesterone

L) prophylactic antibiotics

M) reassuranc

N) serial serum beta-hCG level

O) termination of pregnancy

4) The proportion of ectopic pregnancies that are cervical pregnancies

A) <1%

B) 10%

C) 25%

D) 33%

E) 40%

F) 50%

G) 66%

H) 75%

I) 80%

J) 90%

A28-year-old lady presents in her fourth pregnancy at 14weeks.Her
three miscarriages were in the middle trimester. On examination the cervix
is found to be 2 cm dilated with coning of the membrane son ultrasound

A) diabetes screening

B) thyroid function test

C) progestogen supplementation

D) glucose tolerance test and thyroid function test

E) parental karyotype, thrombophilia screening and pelvic ultrasound

F) aspirin and he parin during pregnancy

G) immunotherapy

H) TORCH(toxoplasmosis,rubella,cytomegalovirus,herpessimplexand humanimmunodeficiencyvirus)screen,karyotyping!APS (antiphospholipidsyndrome),ACL(anticardiolipinantibody)

I) treatment of bacterial vaginosis

J) reassurance

K) cervical cerclage

L) aspirin during pregnanc

6 w pregnant.βhCG1000IU/L. Intrauterine sac measuring 50mm
containing a fetal pole ofcrown-rumplength10mm.No fetal heart activity
is identified.

A) Complete miscarriage

B) Early fetal demise

C) Intruder in pregnancy of uncertain Vi ability

D) Inevitable miscarriag

E) Incomplete miscarriage

F) Late miscarriage

G) On going intrauterine pregnancy

H) Pregnancy of unknown location

I) Recurrent miscarriage

J) Ruptured tubal ectopic pregnancy

K) Stillbirth

L) Threatened miscarriag

M) Unruptured tubal ectopic pregnancy

7) A 33-year-oldprimigravidapresentstotheearlypregnancyunitat10-

week gestation with painful vaginal bleeding. On examination , her vital

signs are found to best able. Speculum examination reveals mild vaginal

bleeding with a closed cervix. Ultra sound examination shows viable

intrauterine pregnancy .Her urinalysis is normal.

A) commencelow-doseaspirin

B) commencelow-molecular-weightheparinandlow-doseaspirin

C) immediate catheterisation and reassurance

D) inpatient HDU care with hydration, analgesia and observation

E) intramuscular 17 OH progesterone injections

F) intramuscular methotrexate followed by folinic acid

G) intravenous access and urgent pelvic ultrasonography

H) laparoscopic salpingectomy

I) MSU culture followed by intravenous antibiotic

J) offer detailed counselling about selective termination

K) oralprogesterone

L) prophylactic antibiotics

M) reassuranc

N) serial serum beta-hCG level

O) termination of pregnancy

A22-year-old is diagnosed with a 1.5cm left tubal ectopic pregnancy
(described as gestational Sac-like structure)on ultra sound.Her βh CGIs
1500IU/Landhasincreasedto1600IU/Lin48h.Sheisasymptomatic(no
pain or bleeding)and has no evidence of pelvic hemoperitoneum
ultra sound

A) Admission to hospital ward for observation

B) Diagnostic laparoscopy and proceedas necessary according to pathology identified

C) Intramuscular methotrexate

D) Intravenous fl uid resuscitation

E) Intravenous anti bioti

F) Measure serum βhCG and serum progesterone

G) Measure FBC and determine blood group type

H) Oral mifepristone followed 24–48h later by vaginal misoprostol

I) Pelvic ultrasound

J) Speculum and vaginal /cervical infection screening swab test

K) Speculum and cervical smear test

L) Surgicale vacuation of the uterus

9) The proportion of partial moles that are triploidin origin

A) <1%

B) 10%

C) 25%

D) 33%

E) 40%

F) 50%

G) 66%

H) 75%

I) 80%

J) 90%

10)

A36-year-oldladywhoispara2presentsat10week’sgestationwith
excessive bleeding and feeling cold and clammy. She is tachycardic on
admissionwithaheartrateof120beats/ minute. On examination theosis
open.

A) elective evacuation of retained products of conception

B) repeat ultrasound scan in 10–14days

C) reassurance and discharge

D) medical management with mifepristone/misoprostol

E) intravenous access, fluid replacement and urgent curettage

F) laparoscopy and salpingectom

G) laparotomy

H) repeat ultrasound in 4days

I) folic acid

J) serial beta human chorionic gonadotrophin(bhCG) measurement

K) culdocentesis

L) diagnostic curettage to look for chorionic villi

M) conservative management

N) referral to an appropriatecentre

O) transvaginal ultrasound

11)

A27-year-old woman presents with history of bleeding at 8 weeks’
gestation.Ultrasound show saviable intrauterine pregnancy of 7weeks’
gestation.There is an18 ! 20 mmsub chorionichaematoma.O

A) elective evacuation of retained products of conception

B) repeat ultrasound scan in 10–14days

C) reassurance and discharge

D) medical management with mifepristone/misoprostol

E) intravenous access, fluid replacement and urgent curettage

F) laparoscopy and salpingectom

G) laparotomy

H) repeat ultrasound in 4days

I) folic acid

J) serial beta human chorionic gonadotrophin(bhCG) measurement

K) culdocentesis

L) diagnostic curettage to look for chorionic villi

M) conservative management

N) referral to an appropriatecentre

O) transvaginal ultrasound

12)

A 26-year-old woman presents to the A &E with fever, vomitingand
severe pain in her abdomen and flank.The last menstrual periodwas
6 weeks ago.Her urine pregnancy testis positive and urinalysis shows
multiple puscellsandepithelialcells.Onexamination,sheisfoundtobe
dehydratedwithapulseof98 beatsperminute(bpm),andherblood
pressure(BP)is80/40 mmHgwithrigidityandguardinginthepelvicregion

A) commencelow-doseaspirin

B) commencelow-molecular-weightheparinandlow-doseaspirin

C) immediate catheterisation and reassurance

D) inpatient HDU care with hydration, analgesia and observation

E) intramuscular 17 OH progesterone injections

F) intramuscular methotrexate followed by folinic acid

G) intravenous access and urgent pelvic ultrasonography

H) laparoscopic salpingectomy

I) MSU culture followed by intravenous antibiotic

J) offer detailed counselling about selective termination

K) oralprogesterone

L) prophylactic antibiotics

M) reassuranc

N) serial serum beta-hCG level

O) termination of pregnancy

13)

The risk of miscarriage in a recognized pregnancy in a woman aged
35–39years

A) <1%

B) 10%

C) 25%

D) 33%

E) 40%

F) 50%

G) 66%

H) 75%

I) 80%

J) 90%

A 36-year-old woman is referred from the radiology department after her
datingscanwithaspontaneous,viable7-weekquadrupletpregnancy.She
hasmilddysuriaandabdominalpain.ExaminationshowsPRof78 bpm
andBPof110/70mmHG withanormalabdominalexamination

14)

A) commencelow-doseaspirin

B) commencelow-molecular-weightheparinandlow-doseaspirin

C) immediate catheterisation and reassurance

D) inpatient HDU care with hydration, analgesia and observation

E) intramuscular 17 OH progesterone injections

F) intramuscular methotrexate followed by folinic acid

G) intravenous access and urgent pelvic ultrasonography

H) laparoscopic salpingectomy

I) MSU culture followed by intravenous antibiotic

J) offer detailed counselling about selective termination

K) oralprogesterone

L) prophylactic antibiotics

M) reassuranc

N) serial serum beta-hCG level

O) termination of pregnancy

15)

A28-year-old lady presents with her partner after two consecutive
miscarriages.Her last two miscarriages were in the middle trimester.She
complains of agrey is h discharge and her pregnancy testis positive

A) diabetes screening

B) thyroid function test

C) progestogen supplementation

D) glucose tolerance test and thyroid function test

E) parental karyotype, thrombophilia screening and pelvic ultrasound

F) aspirin and he parin during pregnancy

G) immunotherapy

H) TORCH(toxoplasmosis,rubella,cytomegalovirus,herpessimplexand humanimmunodeficiencyvirus)screen,karyotyping!APS (antiphospholipidsyndrome),ACL(anticardiolipinantibody)

I) treatment of bacterial vaginosis

J) reassurance

K) cervical cerclage

L) aspirin during pregnanc

16)

10wpregnant with cramping pelvic pain and vaginal bleeding.Ultra sound
shows fetus with CRL 25 mm and fetal heart activity. Speculum
examinationshows3–4cm di late dcervicaloswithevidenceofactive
bleeding.

A) Complete miscarriage

B) Early fetal demise

C) Intruder in pregnancy of uncertain Vi ability

D) Inevitable miscarriag

E) Incomplete miscarriage

F) Late miscarriage

G) On going intrauterine pregnancy

H) Pregnancy of unknown location

I) Recurrent miscarriage

J) Ruptured tubal ectopic pregnancy

K) Stillbirth

L) Threatened miscarriag

M) Unruptured tubal ectopic pregnancy

17)

9 w pregnant.βhCG2500IU/L. left pelvic tenderness. Ultra sound shows
an empty uterus, free fluid in the pelvis(40mmby60mm)and a left
adnexal mass containing sac-like structure measuring2.5cm

A) Complete miscarriage

B) Early fetal demise

C) Intruder in pregnancy of uncertain Vi ability

D) Inevitable miscarriag

E) Incomplete miscarriage

F) Late miscarriage

G) On going intrauterine pregnancy

H) Pregnancy of unknown location

I) Recurrent miscarriage

J) Ruptured tubal ectopic pregnancy

K) Stillbirth

L) Threatened miscarriag

M) Unruptured tubal ectopic pregnancy

18)

A17-year-old is bought in by ambulance after collap singina shop. Her
BPis100/70,HR115bpmandsats98%air.Shecomplainsofsevere
abdominal pain and shoulder pain and feels faint.

A) Admission to hospital ward for observation

B) Diagnostic laparoscopy and proceedas necessary according to pathology identified

C) Intramuscular methotrexate

D) Intravenous fl uid resuscitation

E) Intravenous anti bioti

F) Measure serum βhCG and serum progesterone

G) Measure FBC and determine blood group type

H) Oral mifepristone followed 24–48h later by vaginal misoprostol

I) Pelvic ultrasound

J) Speculum and vaginal /cervical infection screening swab test

K) Speculum and cervical smear test

L) Surgicale vacuation of the uterus

19)

Anulliparous 21-year-oldladypresentswithabdominalpainoccurringfor
the past 4 hours.She gives a history of fainting. She has apositive
pregnancy test. She has irregular periods and can not recall the date of her
last menstrual period.Ultrasounds how sat Hicken domatium with no fetal
polewithintheuterus.ThereisasmallamountoffreefluidinPOD(Pouch
ofDouglas).Shecomplainsofleftadnexalpainandhassignsofperitonism.
Sheistachycardicandhasanormalbloodpressure.SerumbhCG(beta
humanchorionicgonadotrophin)is2300IUandhaemoglobinlevelis95
g/dL.

A) elective evacuation of retained products of conception

B) repeat ultrasound scan in 10–14days

C) reassurance and discharge

D) medical management with mifepristone/misoprostol

E) intravenous access, fluid replacement and urgent curettage

F) laparoscopy and salpingectom

G) laparotomy

H) repeat ultrasound in 4days

I) folic acid

J) serial beta human chorionic gonadotrophin(bhCG) measurement

K) culdocentesis

L) diagnostic curettage to look for chorionic villi

M) conservative management

N) referral to an appropriatecentre

O) transvaginal ultrasound

20)

A28-year-old lady presents with a positive pregnancy test in her fourth
pregnancy at 7 weeks. She has had three consecutive miscarriages. blood
results have shown anti cardiolipin antibodies outwoo casions.

A) diabetes screening

B) thyroid function test

C) progestogen supplementation

D) glucose tolerance test and thyroid function test

E) parental karyotype, thrombophilia screening and pelvic ultrasound

F) aspirin and he parin during pregnancy

G) immunotherapy

H) TORCH(toxoplasmosis,rubella,cytomegalovirus,herpessimplexand humanimmunodeficiencyvirus)screen,karyotyping!APS (antiphospholipidsyndrome),ACL(anticardiolipinantibody)

I) treatment of bacterial vaginosis

J) reassurance

K) cervical cerclage

L) aspirin during pregnanc

21)

28-year-oldG1P0is12weekspregnant.ShecomplainsofPVbleeding
after inte rcourse. Her last cervicalsmear,6months ago, was reportedas
normal.

A) Admission to hospital ward for observation

B) Diagnostic laparoscopy and proceedas necessary according to pathology identified

C) Intramuscular methotrexate

D) Intravenous fl uid resuscitation

E) Intravenous anti bioti

F) Measure serum βhCG and serum progesterone

G) Measure FBC and determine blood group type

H) Oral mifepristone followed 24–48h later by vaginal misoprostol

I) Pelvic ultrasound

J) Speculum and vaginal /cervical infection screening swab test

K) Speculum and cervical smear test

L) Surgicale vacuation of the uterus

22)

A28 year-old-lady attends the gynaecology clinic after three consecutive
miscarriages.She and her partner are other wise well and anxioustostart
afamily.Whatisthemostappropriateadvice?

A) diabetes screening

B) thyroid function test

C) progestogen supplementation

D) glucose tolerance test and thyroid function test

E) parental karyotype, thrombophilia screening and pelvic ultrasound

F) aspirin and he parin during pregnancy

G) immunotherapy

H) TORCH(toxoplasmosis,rubella,cytomegalovirus,herpessimplexand humanimmunodeficiencyvirus)screen,karyotyping!APS (antiphospholipidsyndrome),ACL(anticardiolipinantibody)

I) treatment of bacterial vaginosis

J) reassurance

K) cervical cerclage

L) aspirin during pregnanc

23)

Acoupleareseeninthegynaecologyclinicaftertheirthirdmiscarriage.
Thekaryotypingisnormal.Thrombophiliascreeningisnegative.Pelvic
ultra sound is normal.

A) diabetes screening

B) thyroid function test

C) progestogen supplementation

D) glucose tolerance test and thyroid function test

E) parental karyotype, thrombophilia screening and pelvic ultrasound

F) aspirin and he parin during pregnancy

G) immunotherapy

H) TORCH(toxoplasmosis,rubella,cytomegalovirus,herpessimplexand humanimmunodeficiencyvirus)screen,karyotyping!APS (antiphospholipidsyndrome),ACL(anticardiolipinantibody)

I) treatment of bacterial vaginosis

J) reassurance

K) cervical cerclage

L) aspirin during pregnanc

24)

5w pregnant.βhCG600IU/Intrauterine gestation sac with mean
diametermeasuring20mm.Ayolksacwasidentifiedwithinthegestation
sac, but there is no evidence of a fetal pole

A) Complete miscarriage

B) Early fetal demise

C) Intruder in pregnancy of uncertain Vi ability

D) Inevitable miscarriag

E) Incomplete miscarriage

F) Late miscarriage

G) On going intrauterine pregnancy

H) Pregnancy of unknown location

I) Recurrent miscarriage

J) Ruptured tubal ectopic pregnancy

K) Stillbirth

L) Threatened miscarriag

M) Unruptured tubal ectopic pregnancy

25)

.A19-year-old has under gone a medical termination of pregnancy at 9
weeks. She presents 2 weeks later with heavy vaginal bleeding

A) Admission to hospital ward for observation

B) Diagnostic laparoscopy and proceedas necessary according to pathology identified

C) Intramuscular methotrexate

D) Intravenous fl uid resuscitation

E) Intravenous anti bioti

F) Measure serum βhCG and serum progesterone

G) Measure FBC and determine blood group type

H) Oral mifepristone followed 24–48h later by vaginal misoprostol

I) Pelvic ultrasound

J) Speculum and vaginal /cervical infection screening swab test

K) Speculum and cervical smear test

L) Surgicale vacuation of the uterus

26)

A31-year-old lady attends for a nuchal translucency scan at 11weeks’
gestation She is foundtohaveagestationalsacof23mmwithayolksac.
Nofetalpoleisrecognised

A) elective evacuation of retained products of conception

B) repeat ultrasound scan in 10–14days

C) reassurance and discharge

D) medical management with mifepristone/misoprostol

E) intravenous access, fluid replacement and urgent curettage

F) laparoscopy and salpingectom

G) laparotomy

H) repeat ultrasound in 4days

I) folic acid

J) serial beta human chorionic gonadotrophin(bhCG) measurement

K) culdocentesis

L) diagnostic curettage to look for chorionic villi

M) conservative management

N) referral to an appropriatecentre

O) transvaginal ultrasound

27)

.A recent immigrant to the U K presents with shortness of breath
haemoptys is and vaginal bleeding.She describesa‘miscarriage’afew
monthsearlier.Apregnancytestisstronglypositiveandanultrasound
scanshowsahaemorrhagiccysticmassintheuterus.AchestX-rayshows
multiplenodulesinbothlungs.Whatisthemostlikelykaryotypeofthe
tumour?

A) 23,X

B) 23,Y

C) 45,XO

D) 46,XX

E) 46,XY

F) 47,XXO

G) 47,XXX

H) 47,XXY

I) 47,XYY

J) 69,XXX

K) 69,XXY

L) 69,XYY

M) 69,YYY

28)

A34-year-old is diagnosed by ultra sound to have probable complete
molar pregnancy at 10weeks’gestation.

A) Admission to hospital ward for observation

B) Diagnostic laparoscopy and proceedas necessary according to pathology identified

C) Intramuscular methotrexate

D) Intravenous fl uid resuscitation

E) Intravenous anti bioti

F) Measure serum βhCG and serum progesterone

G) Measure FBC and determine blood group type

H) Oral mifepristone followed 24–48h later by vaginal misoprostol

I) Pelvic ultrasound

J) Speculum and vaginal /cervical infection screening swab test

K) Speculum and cervical smear test

L) Surgicale vacuation of the uterus

29)

415.A woman presents with hyperemesis and bleeding to the gynecology
assessment unit. An ultrasound scan suggests acompletemolar
pregnancyandthisisconfirmedfollowinghistopathologicalanalysisofthe
evacuatedproductsofconception.Whatisthekaryotypeofthespermthat
fertilisedtheoocyte

A) 23,X

B) 23,Y

C) 45,XO

D) 46,XX

E) 46,XY

F) 47,XXO

G) 47,XXX

H) 47,XXY

I) 47,XYY

J) 69,XXX

K) 69,XXY

L) 69,XYY

M) 69,YYY

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