Bleeding in early pregnancy

 Bleeding in early pregnancy:

Abortions:

1. Regarding missed abortion, all of the following are CORRECT, EXCEPT:

A. Patient may present with loss of the symptoms of pregnancy

B. Per vaginal bleeding may be one of the presenting symptom

C. Immediate evacuation should be done once the diagnosis is made

D. Disseminated intra-vascular coagulation may occur as a sequele of

missed abortion

E. Ultrasound should be done to confirm the diagnosis

2. 14 weeks pregnant woman had abortion and she was told that it is a complete

abortion. This is true regarding complete abortion:

A. Uterus is usually bigger than date

B. Cervical OS is opened with tissue inside the cervix

C. Need to have evacuation of the uterus

D. After complete abortion there is minimal or no pain and minimal or no

bleeding

E. Follow up with β-hCG for one year.

3. In patients with three consecutive spontaneous abortion in the second trimester

the most useful investigation is:

A. Chromosomal analysis

B. Hysterosalpingogram

C. Endometrial biopsy

D. Post coital test

E. Prolactin level

4. Regarding cervical incompetence, all of the following are true, EXCEPT:

A. Typically causes painful abortions

B. Typically causes mid-trimester abortions

C. Is treated by Shirodkar suture (cervical cerculage) which is best

preformed early in the second trimester

D. May lead to premature rupture of the membrane

E. Can occur in patient with history of cone biopsy

5. Causes of first trimester abortion

A. Chromosomal abnormalities

B. Cervical incompetence

C. Bicornuate uterus

D. Gestational hypertension

E. Pre-eclampsia

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6. Management of a patient with threatened abortion includes all of the following,

EXCEPT:

A. Ultrasound

B. Physical examination

C. CBC

D. Derailed menstrual history

E. Dilatation and curettage.

7. A 25-year-old primigravida with 8 weeks threatened abortion, ultrasound would

most likely reveal:

A. Thickened endometrium with no gestational sac

B. Feral heart motion in the adnexia

C. Empty gestational sac

D. Collapsed gestational sac

E. An intact gestational sac with fetal

8. Regarding incomplete abortion, all are true, EXCEPT:

A. There is a history of tissue passed per vagina

B. The cervix is open on vaginal examination

C. Ultrasound shows retained product of conception

D. Ultrasound shows intact gestational sac non- viable fetus

E. Management include evacuation

9. Most common cause of first trimester abortion

A. Chromosomal abnormalities

B. Syphilis

C. Rhesus isoimmunization

D. Cervical incompetence

E. Bifurcate uterus

10. Incompetent cervix

A. Is a cause for early pregnancy loss

B. Is best diagnosed by history

C. Is a cause for fetal congenital abnormalities

D. Is not encounted with uterine anomities

E. Can be treated with tocolytics

11. Of the proposed etiologies for recurrent pregnancy wastage, the least likely is:

A. Maternal trauma.

B. Maternal balanced translocation.

C. Paternal balanced translocation.

D. Luteal phase deficiency.

E. Autoimmune disease.

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12. The most common etiology for spontaneous abortion of a recognized first

trimester gestation:

A. Chromosomal anomaly in 50-60% of gestations.

B. Chromosomal anomaly in 20-30% of gestations.

C. Maternal hypothyroidism.

D. Maternal Diabetes.

E. Progesterone deficiency.

13. In threatened abortion, which one of the following items is TRUE?

A. The cervix is open

B. Evacuation is the best treatment

C. All patients should be admitted

D. In the majority of cases pregnancy will continue without any complication

E. Does not necessitate giving Anti-D for Rh-negative mother

14. In case of threatened abortion :

A. Fetal heart is present

B. Cervix is dilated

C. There is a history of passing tissue per vagina.

D. Patients needs immediate evacuation

E. No need to give anti-D for Rhesus negative mothers

15. Missed abortion may cause one of the following complication:

A. Bone marrow depression

B. Rupture uterus

C. High positive serum β-hCG

D. Skin allergies

E. Coagulopathy

16. Management of a patient with threatened abortion includes all the followings

EXCEPT:

A. Ultrasound.

B. Physical exam.

C. CBC.

D. Detailed menstrual history.

E. Immediate dilation and curettage.

17. In threatened abortion at 15 weeks gestation in a nulliparous patient:

A. Pain is characteristic.

B. The internal os is often opened.

C. Fainting is characteristic.

D. Vaginal bleeding is usually mild.

E. Absence of fetal movements suggest non viability.

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18. Regarding threatened abortion:

A. Anti-D should be given to Rh- positive mother.

B. All patients should be admitted to the hospital.

C. Ultrasound should be done to confirm the diagnosis.

D. Vaginal examination will reveal severe pain.

E. The patient has vaginal bleeding and tissue passage per vagina.

19. Therapy in threatened abortion should include:

A. Progesterone IM

B. D & C

C. Prolonged bed rest

D. Restricted activity

E. Prostaglandin suppositories

20. During the first & second trimester of pregnancy, the most common pathologic

cause of vaginal bleeding :

A. Hydatiform mole

B. Abruptio placenta

C. Ectopic pregnancy

D. Abortion

E. Uterine rupture

21. Which of the following items may be associated with a mid trimester abortion:

A. Recurrent pelvic infection

B. Maternal smoking

C. Uterine anomalies

D. Sickle cell disease

E. Hyperemesis gravidarum

22. Bleeding in early pregnancy could be causes by all of the following, EXCEPT :

A. An ectopic pregnancy

B. Trophoblastic disease

C. Carcinoma of the ovary

D. Invasive carcinoma of the cervix

E. Threatened abortion

23. Which of the following is correct in the treatment of a case of threatened

abortion :

A. Bed rest

B. Oral stillbosterol

C. Curettage

D. Urgent admission to hospital

E. I.M Tranexamic acid

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24. Abortion :

A. Has an incidence of 15% of all pregnancy

B. 18 weeks missed abortion is usually managed with suction curettage

C. In threatened abortion, the cervix is always open

D. 1st trimester abortion is usually causes by incompetent cervical os

E. Pregnancy usually continue to term in cases of inevitable abortion

25. Etiological factors in spontaneous abortion include :

A. Chromosomal abnormalities

B. Placental abnormalities

C. Maternal disease

D. Uterine abnormalities

E. All of the above

26. A major hazard of a late missed abortion :

A. A positive human chorionic gonadotropin (hCG) titer

B. Systemic allergies

C. Bone marrow depression

D. Coagulopathy

E. Toxemia

27. A missed abortion is :

A. Death of the fetus at 36 weeks of gestation

B. In which the products of conception are expelled completely

C. In which the products of conception are partially expelled

D. Bleeding and cramps but the fetus still viable

E. Death of the fetus before 24 weeks gestation

28. A 26- year- old married white whose LMP was 2 1⁄2 months ago developed bleeding,

uterine cramps, and passed some tissue per vagina. Two hours later she began to

bleed heavily

I. The most likely diagnosis is :

A. Twin pregnancy

B. Threatened abortion

C. Inevitable abortion

D. Premature labor

E. Incomplete abortion

II. Of the option listed, the bleeding is most likely due to :

A. Retained products of conception

B. Ruptured uterus

C. A systemic coagulopathy

D. Vaginal lacerations

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A. Bleeding hemorrhoids

III. The indicated procedure is :

A. Hysterectomy

B. Vaginal packing

C. Compression of the hemorrhoids

D. IV fibrinogen

E. Uterine curettage

29. Cervical cerculage:

A. Closure of incompetence cervix

B. Effective in prevention of all types of abortion

C. Should be removed at 32 weeks of pregnancy

D. Protect against exposure of the pregnant lady to infection

E. Should applied after 9 weeks of pregnancy

30. A 25 primigravida with 8 weeks threatened abortion. The US would most likely

reveal :

A. Thickened endometrium with no gestational sac.

B. Fetal heart motion in the adnexia.

C. Empty gestational sac.

D. An intact gestational sac with fetal heart motion.

E. Collapsed gestational sac.

31. 14 weeks pregnant woman had abortion and she was told that it is a complete

abortion. This is true regarding complete abortion:

A. Uterus is usually bigger than date

B. Cervical OS is opened with tissue inside the cervix

C. Need to have evacuation of the uterus

D. After complete abortion there is minimal or no pain and minimal or no

bleeding

E. Follow up with β-hCG for one year.

32. Regarding Cervical incompetence, one is true:

A. Cone biopsy is not a predisposing factor

B. Cerculage is contraindicated

C. In not encountered with uterine anomalies

D. Best diagnosed by Hx

E. Is a cause of early pregnancy abortion

33. In patients with three consecutive spontaneous abortion in the second trimester

the most useful investigation is:

A. Chromosomal analysis

B. Hysterosalpingogram

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C. Endometrial biopsy

D. Post coital test

E. Prolactin level

34. Therapy for threatened abortion should include:

A. Progesterone IM.

B. D & C.

C. Prolonged bed rest.

D. Restricted activity.

E. Prostaglandins suppository.

35. Approximately what percentage of spontaneous 1ST trimester abortions show

chromosomal abnormalities:

A. 1%.

B. 10%.

C. 25%.

D. 50%.

E. 75%.

36. Repeated 2ND trimester abortions, especially when associated with a lack of

painful uterine contractions, suggests most strongly:

A. Defective germ plasm.

B. Uterine myoma.

C. Maternal hyperthyroidism.

D. Folic acid deficiency.

E. Incompetent cervical os.

37. Inevitable abortion is usually associated with all of the following EXCEPT:

A. Pain.

B. Dilated cervix.

C. Bleeding.

D. Fever.

E. The pregnancy is almost doomed.

38. Threatened abortion is characterized by:

A. The presence of empty sac by ultrasound.

B. Disappearance of pregnancy symptoms.

C. Passage of vaginal vesicles.

D. The cervix is affected.

E. Vaginal bleeding.

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39. In spontaneous abortion:

A. Uncontrolled blood sugar increases the risk of abortion in diabetic

patients.

B. If the patient has mild bleeding with opened internal os this is considered

to be threatened abortion.

C. Cervical incompetence is the most common cause of abortion in the 1ST

trimester.

D. History of bleeding & passing of tissue per vagina indicates the need for

curettage without the need for US.

E. D & C should be done immediately once missed abortion is diagnosed.

40. Early bleeding in pregnancy may be caused by the following, EXCEPT:

A. Incomplete abortion

B. Cervical cancer

C. Threatened abortion

D. Ectopic pregnancy

E. Vasa praevia

Ectopic pregnancies:

41. Regarding ectopic pregnancy, all of the following are true, EXCEPT:

A. Is associated with uterine enlargement

B. Is situated in the ovary in about 0.5% of all cases

C. Is more dangerous when it is situated in the isthmus of the fallopian tube

D. Can only be diagnosed after it has ruptured

E. Is a complication of assisted conception

42. Acceptable management of ruptured ectopic pregnancy

A. Observation followed by Methotrexate

B. Diagnostic laparoscopy followed by observation

C. Repeat ultrasound next 24 hours to confirm the diagnosis

D. Exploratory laparotomy and salpingectomy

E. Dilatation and curettage

43. The following are factors affecting the choice of Methotrexate as a choice of

treatment for ectopic pregnancy, EXCEPT:

A. Size of the ectopic

B. Presence or absence of cardiac activity

C. Level of β-hCG

D. Parity of the patient

E. Integrity of the tube

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44. The most common cause of ectopic pregnancy is:

A. History of pelvic inflammatory disease

B. Congenital anomalies of the tube

C. Endometriosis

D. Tubal surgery

E. Previous sterilization

45. Following evacuation of a molar pregnancy, β-hCG titers will fall to untraceable

levels in about 90% of patients within:

A. 2 weeks.

B. 4 weeks.

C. 8 weeks.

D. 10 weeks

E. 12 weeks.

46. A 25 year-old G3 P1+1 presents to the emergency room complaining of lower

abdominal crampy pain 6 weeks form he last normal period. She had significant

vaginal bleeding but no passage of tissue & pregnancy test is Positive.

I) The patient's most likely diagnosis is:

A. Incomplete abortion.

B. Complete abortion.

C. Missed abortion.

D. Threatened abortion.

E. Ectopic pregnancy.

II) The most important step in this patient's evaluation should be:

A. Sonography.

B. Physical exam.

C. CBC.

D. Quantitative β-hCG.

E. Detailed menstrual history.

III) Transvaginal Ultrasonography would most likely reveal:

A. Fetal heart motion.

B. An intact gestational sac.

C. A discrete yolk sac motion.

D. A Thickened endometrium with gestational sac.

E. Fetal heart motion in the adnexia.

47. The most common symptom of ectopic pregnancy is :

A. Profuse vaginal bleeding.

B. Abdominal pain.

C. Syncope.

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D. Dyspareunia.

E. Decreased pregnancy associated symptoms.

48. Acceptable management of possible rupture ectopic pregnancy would include all

of the following EXCEPT:

A. Exploratory laparotomy.

B. Diagnostic laparoscopy.

C. Partial salpingectomy.

D. Total salpingectomy.

E. Observation followed by Methotrexate.

49. If the above described patient has had a previous term pregnancy prior to her

ectopic pregnancy, her chances of subsequent intrauterine pregnancy would be

about:

A. 80%

B. 60%

C. 40%

D. 20%

E. <10%

50. The commonest site of ectopic pregnancy is :

A. Peritoneal cavity

B. Mesosalpinx

C. Ovary

D. Ampulla of the fallopian tube

E. Isthmus portion of the fallopian tube

51. Etiological factor of ectopic pregnancy include all of the following EXCEPT:

A. Gonococcal Salpangitis

B. Tubal surgery

C. Combined OCP

D. TB salpingitis

E. Previous ectopic

52. In ectopic pregnancy :

A. Rarely diagnosed before 12 weeks of gestation

B. Usually present as obstetric emergency before 12 weeks gestation

C. IM progesterone is useful

D. 50% continued up to term

53. Patient with ectopic pregnancy:

A. Present with heavy per-vaginal bleeding

B. Methotrexate is the treatment of the choice in patient with ruptured one

C. May complain of shoulder pain.

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D. Present with cardio vascular collapse in all the cases

E. Never have fainting attacks.

54. In the management of ectopic pregnancy:

A. β-hCG titer has a role in the Dx & management of ectopic pregnancy.

B. D&C is the treatment of choice

C. Methotrexate should be used if the patient hemodynamically unstable

D. Shoulder pain is referred from bowel irritation

E. The presence of severe bleeding is an indication of conservative

management

55. Methotrexate Treatment in ectopic is contraindicated if:

A. β-hCG < 1500

B. No fetal heart.

C. Hemoperitonium

D. Gestational sac < 3 cm

56. Regarding ectopic pregnancy, all of the following are true, EXCEPT:

B. Is associated with uterine enlargement

C. Is situated in the ovary in about 0.5% of all cases

D. Is more dangerous when it is situated in the isthmus of the fallopian tube

E. Can only be diagnosed after it has ruptured

F. Is a complication of assisted conception.

57. The following are factors affecting the choice of Methotrexate as a choice of

treatment for ectopic pregnancy, EXCEPT:

A. Size of the ectopic

B. Presence or absence of cardiac activity

C. Level of β-hCG

D. Parity of the patient

E. Integrity of the tube

58. The most common cause of ectopic pregnancy is:

A. History of pelvic inflammatory disease

B. Congenital anomalies of the tube

C. Endometriosis

D. Tubal surgery

E. Previous sterilization

59. Lower abdominal pain and six weeks gestation:

A. Vaginal examination is contraindicated.

B. Right iliac fossa pain is diagnostic of appendicitis.

C. Placental abruption should be considered.

D. Could be gallstones.

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E. USS has reliable diagnostic information.

60. The endometrial change of ectopic pregnancy:

A. Glandular cystic hyperplasia

B. Decidual transformation

C. Secroteraty changes with chorial cell

D. Atypical hyperplasia

E. Proliferation endometrium

61. In ectopic pregnancy :

A. The ovarian ectopic pregnancy is the most common site

B. More than 90% of ectopic pregnancies occurs in the fallopian tube

C. The majority of tubal pregnancies occurs in the fimbria

D. The most common symptoms of ectopic pregnancy is vaginal bleeding

without abdominal pain

E. Pregnancy test is negative more than 90% of the cases

62. Which of the following is a contraindication to medical treatment in ectopic

pregnancy?

A. An intact tubal pregnancy.

B. The size is less than 3cm.

C. The presence of hemoperitonium.

D. The absence of fetal cardiac activity.

E. A serum β-hCG of 1500.

63. The quantitative β subunit of HCG in a serum of patient with ectopic pregnancy

will :

A. Rise in a rate greater than expected.

B. Rise at rate consistent with the normal curve.

C. Rise at a slower than expected.

D. Plateau.

E. Progressively fall.