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MCQ on bleenig in early pregnasncy for undergraduate

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Undergraduate course lectures in OBSTERICS&GYNECOLOGY ,Faculty of medicine,Zagazig University ,Prepared by DR Manal Behery

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MCQ on bleenig in early pregnasncy for undergraduate

  1. 1. MCQ on bleeding in early pregnancy DRManal Behery Zagazig University 2013 med-ed-online
  2. 2. Abortion med-ed-online
  3. 3. 1-What is wrong about recurrent abortion?A-HSG is the best method to R/O anatomical etiologiesB-HSG is recommended several weeks after operative hysteroscopyC-vaginal ultrasonography and MRI are the best techniques to detect anatomical defectsD-Septated uterus is the most common anatomical cause of recurrent abortionAns:A med-ed-online
  4. 4. 2- A 20yo, Rh -ve and unsensitised womanhas missed miscarriage of 10wks all aretrue exceptA- Anti-D immunoglobulin should be administered if surgical evacuation is performedB-Anti-D immunoglobulin is unnecessary after medical evacuationC- products of conception should be sent for histological examination to exclude molar tissueAns:B med-ed-online
  5. 5. Recurrent abortion tests• Karyotype• HSG• Luteal phase biopsy of endometrium• TSH and prolactin level• ACL antibodies• LAC (lupus anticoagulant)• CBC med-ed-online
  6. 6. Forcases of abortion withoutFor cases of abortion without fever:fever: Doxy 100 mg bidDoxy 100 mg bid oror tetracycline 250 mg qidtetracycline 250 mg qid for 5-7 daysfor 5-7 days med-ed-online
  7. 7. 3-What is wrong about postabortal or“redo” syndrome?A- It is a complication of suction curettageB- It is a painful cramp in the first 2 hours after curettageC-uterine bleeding is less than expectedD-treatment is D&C under anesthesiaAns:D med-ed-online
  8. 8. 4- During a sharp curettage of an incompleteabortion uterine is perforated. What is thefirst step of management?A- curettage should be completed and patient should remain under observationB-laparatomyC-curettage should be stopped and patient should remain under observationD- if there is no hemorrhage in the first 24 hours after operation, the patient can be dischargedAns:B med-ed-online
  9. 9. 5-The clinical findings of a woman with GA=8 wkswith the chief complaint of hemorrhage and clotpassing is an open int os Uterine size about 8 wksand no bleeding. What should be done ?A-No treatment is needed because abortion is completeB-it is a case of threatened abortionC-it is an inevitable abortionD-Abdominal sonographyAns:D med-ed-online
  10. 10. 6- A woman has undergone elective abortion oneweek ago. Now she comes to the clinic with thechief complaint of hemorrhage. In PE cervix isclosed, uterine is contracted with no tenderness.Her temperature is normal . What is the besttreatment?A-Doxy 100 mg bid for two weeksB-clinda +gentaC-observation and check of Hb and HctD-hormone therapyAns:D med-ed-online
  11. 11. 7- What is the most likely cause of abortion in a 27 year oldwoman with the past history of two abortions in 10 wks andone in 15 wks with normal Karyotype conceptus?A- endocrineB-immunologicalC-anatomicD-infectiousAns:BThe treatment of immunological recurrent abortion is low dose Heparin sc 5000 units bid+Aspirin 80 mg daily med-ed-online
  12. 12. 8-What should be done for a woman 22 years oldwho has undergone suction curettage and nowsuffers severe pelvic cramps , sweating andtachycardia. Her uterus is large and tender. Shealso has spotting.A-observation and oxytocinB-laparatomyCDilation and suction curettage without anesthesiaD- CT scanAns:C med-ed-online
  13. 13. 9-What is the best way of pregnancy termination ina bicornuate uterus with a 14 w fetal death?A-dilatation and curettage under USB-uterotonic drugsC-dilatation and curettage under laparascopyD-hysterotomyAns:B med-ed-online
  14. 14. EctopicPregnancy
  15. 15. 10-Where is the discriminatory zone?A-3000 IU/L HCG + abdominal USB-1000-1500 IU/L HCG + vaginal USC-a constant value of HCG for any type of USD-in multiple pregnancy it is lower than singleton pregnancyAns:B med-ed-online
  16. 16. Beta HCG below 2000+ no visible intrauterine sac+ mass in tube below 3.5 cm ______________________Repeat of beta HCG q 48 hA-If a dead IP is confirmed (beta HCG increase lessthan 50% or below 1000mIu/mL- P below 5 ng/mL +visible intrauterine sac) then curettage B-If EP is confirmed (beta HCG more than 2000 andmass >3.5 cm) then laparascopyC-If a dead IP and EP is confirmed (beta HCG morethan 2000 and mass < 3.5 cm) then MTXFETUS SHOULD BE VISIBLE ON DAY 45 OF med-ed-onlineGESTATION
  17. 17. Indication of MTX for EP• Hemodynamic stability• No intra uterine pregnancy• Max sac diameter not equal or more than 4 cm med-ed-online
  18. 18. 11-What is your management of a 36 year old woman whois pregnant after primary infertity. She is referring to you forspotting and hypogastric pain, beta HCG is 1500 mu/l andultrasound of uterus and ovaries are normal.A-laparatomyB-laparascopyC-repeat of vaginal sonography several days laterD-progesterone measurementAns:C med-ed-online
  19. 19. 12-A 30 year old woman has become pregnantafter 5 years of infertility with ovulation inductionand a history of EP in the right tube 2 years ago.She has undergone laparatomy for ruptured rightfallopian tube. What is the best technique for thissurgery?A-MilkingB-linear salpingectomyC-right tube salpingectomyD-segmantal excision and delayed anastomosisAns:C med-ed-online
  20. 20. 13- In a woman 31 years old who has undergonesalpingectomy two weeks ago for EP, HCG level isincreasing. What is your management?A-MTXB-transvaginal sonographyC-salpingectomyD-chest x-rayAns:B med-ed-online
  21. 21. 14-RU486 can not attach to:A-Progesterone receptorB-androgen receptorC-glucocorticosteroid receptorD-estrogen receptorAns: D med-ed-online
  22. 22. 15-What is your management for a woman with :HR=120 BP=80/60 mmHg T=37.5 c uterinesize=8 wks beta HCG=2500 mIU/mL and nointrauterine pregnancy in sonography?A-LaparatomyB- laparascopyC- D&CD-serum progesteroneAns:A med-ed-online
  23. 23. Adenexal mass< 3.5 cm MTX Adenexal mass=> 3.5 cm -> laparascopy>laparatomy Uncertain US + beta HCG increase less than 50% -> D&C Unstable conditions->laparatomy med-ed-online
  24. 24. 16- which is a predisposing factor for ovarian EP?A-PIDB-infertility historyC-DES exposureD-present IUDAns:D med-ed-online
  25. 25. 17-All are among indications for conservativemanagement of EP except::A-ovarian EPB-reduced HCG levelC-sac of less than 3 cmD-lack of noticeable intra abdominal hemorrhageAns:A med-ed-online
  26. 26. • Gestational trophoblastic disease Vesiculaer mole med-ed-online
  27. 27. CASE STUDY• A 21 year old woman comes in for first prenatal visit .Her LMP was 12 wks ago of which she was certain .• Upon examination you noted 20 wks uterus ,therefore an US is performed and revealed bilaterally enlarged adnexa and a snowstorm pattern in the uterus. You suspect a molar pregnancy what is your next step ? med-ed-online
  28. 28. You should order B-HCG in serum• The result comes back as 100,000 confirming your suspicion of a complete mole• Of course the definite diagnosis will not be made until a D&C is performed med-ed-online
  29. 29. 18-Clinical features that distinguish acomplete mole from a partiel mole areA-Gestational age between 8-16 wksB-B HCG level 100,000C-Uterine size that is larger for gestational ageD- Ultrasonographic featuresE- all of the aboveAns:D med-ed-online
  30. 30. 19-To optimally prepare for D&C youshould take the following steps exceptA-type and cross match for bloodB- full operating room settingC- suction cannulaD-General anathesiaE- A 22 gauge intravenous accessAns:E med-ed-online
  31. 31. 20-With respect to complete mole all aretrue except• A- Complete moles have 46XX karyotype• B-Maternal serum AFP levels are undetectable in complete moles as there no fetal parts• C-Medical evacuation using prostaglandins and oxytocin is the recommended treatment• D-During surgical evacuation, oxytocin infusion shouldn’t be commenced before the uterus is empty med-ed-online• ANS C
  32. 32. 21- All of the following are associatedwith an increased risk of malignantchange in a woman with vesicular molarPPREPREpregnancy except• A-maternal age > 39years HSG• B-woman with BG-A with a partner of BG-O TSH and prolactin level• C-Complete mole more than partial moles• D- smoking• Ans:D med-ed-online
  33. 33. Suction evacuation under general anathesia was performed How can you councel this case regarding contraceptive advice before the next pregnancy med-ed-online
  34. 34. 22-Which is true regarding contraception after molar evacuation ? A-Women should be advised not to conceive until HCG levels have been normal for 12 mthsB-Use of the COCP after HCG levels have returned to normal is associated with increased need for chemotherapyC-Use of IUDs in contraindicated until after HCG levels have returned to normalAns:C med-ed-online
  35. 35. 23-Which is true regarding molar pregnancy• A-women presenting with persistent vaginal bleeding following evacuation of a complete molar pregnancy should undergo further uterine evacuationB- women should be advised not to become pregnant until HCG levels have reverted to normal for 6/12 M C-mifepristone is recommended for termination of a partial molar pregnancy at 14wks gestation• ANS B med-ed-online
  36. 36. Thank you

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