MCQ on bleeding in
early pregnancy
DR
Manal Behery
Zagazig
University
2013
med-ed-online
Abortion
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1-What is wrong about recurrent abortion?
A-HSG is the best method to R/O anatomical
etiologies
B-HSG is recommended several weeks after
operative hysteroscopy
C-vaginal ultrasonography and MRI are the best
techniques to detect anatomical defects
D-Septated uterus is the most common
anatomical cause of recurrent abortion
Ans:A med-ed-online
2- A 20yo, Rh -ve and unsensitised woman
has missed miscarriage of 10wks all are
true except
A- Anti-D immunoglobulin should be
administered if surgical evacuation is
performed
B-Anti-D immunoglobulin is unnecessary
after medical evacuation
C- products of conception should be sent for
histological examination to exclude molar
tissue
Ans:B med-ed-online
Recurrent abortion tests
• Karyotype
• HSG
• Luteal phase biopsy of endometrium
• TSH and prolactin level
• ACL antibodies
• LAC (lupus anticoagulant)
• CBC
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For cases of abortion without
For cases of abortion without
fever:
fever:
Doxy 100 mg
Doxy 100 mg bid bid
or
or
tetracycline 250 mg
tetracycline 250 mg qidqid
for 5-7 days
for 5-7 days
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3-What is wrong about postabortal or
“redo” syndrome?
A- It is a complication of suction curettage
B- It is a painful cramp in the first 2 hours
after curettage
C-uterine bleeding is less than expected
D-treatment is D&C under anesthesia
Ans:D
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4- During a sharp curettage of an incomplete
abortion uterine is perforated. What is the
first step of management?
A- curettage should be completed and patient
should remain under observation
B-laparatomy
C-curettage should be stopped and patient should
remain under observation
D- if there is no hemorrhage in the first 24 hours
after operation, the patient can be discharged
Ans:B
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5-The clinical findings of a woman with GA=8 wks
with the chief complaint of hemorrhage and clot
passing is an open int os Uterine size about 8 wks
and no bleeding. What should be done ?
A-No treatment is needed because abortion
is complete
B-it is a case of threatened abortion
C-it is an inevitable abortion
D-Abdominal sonography
Ans:D
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6- A woman has undergone elective abortion one
week ago. Now she comes to the clinic with the
chief complaint of hemorrhage. In PE cervix is
closed, uterine is contracted with no tenderness.
Her temperature is normal . What is the best
treatment?
A-Doxy 100 mg bid for two weeks
B-clinda +genta
C-observation and check of Hb and Hct
D-hormone therapy
Ans:D med-ed-online
7- What is the most likely cause of abortion in a 27 year old
woman with the past history of two abortions in 10 wks and
one in 15 wks with normal Karyotype conceptus?
A- endocrine
B-immunological
C-anatomic
D-infectious
Ans:B
The treatment of immunological recurrent
abortion is low dose Heparin sc 5000 units
bid+Aspirin 80 mg daily
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8-What should be done for a woman 22 years old
who has undergone suction curettage and now
suffers severe pelvic cramps , sweating and
tachycardia. Her uterus is large and tender. She
also has spotting.
A-observation and oxytocin
B-laparatomy
CDilation and suction curettage without
anesthesia
D- CT scan
Ans:C
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9-What is the best way of pregnancy termination in
a bicornuate uterus with a 14 w fetal death?
A-dilatation and curettage under US
B-uterotonic drugs
C-dilatation and curettage under laparascopy
D-hysterotomy
Ans:B
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Ectopic
Pregnancy
10-Where is the discriminatory zone?
A-3000 IU/L HCG + abdominal US
B-1000-1500 IU/L HCG + vaginal US
C-a constant value of HCG for any type of
US
D-in multiple pregnancy it is lower than
singleton pregnancy
Ans:B
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Beta HCG below 2000+
no visible intrauterine sac+
mass in tube below 3.5 cm
______________________
Repeat of beta HCG q 48 h
A-If a dead IP is confirmed (beta HCG increase less
than 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 and
mass >3.5 cm) then laparascopy
C-If a dead IP and EP is confirmed (beta HCG more
than 2000 and mass < 3.5 cm) then MTX
FETUS SHOULD BE VISIBLE ON DAY 45 OF
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GESTATION
Indication of MTX for EP
• Hemodynamic stability
• No intra uterine pregnancy
• Max sac diameter not equal or more than
4 cm
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11-What is your management of a 36 year old woman who
is pregnant after primary infertity. She is referring to you for
spotting and hypogastric pain, beta HCG is 1500 mu/l and
ultrasound of uterus and ovaries are normal.
A-laparatomy
B-laparascopy
C-repeat of vaginal sonography several
days later
D-progesterone measurement
Ans:C
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12-A 30 year old woman has become pregnant
after 5 years of infertility with ovulation induction
and a history of EP in the right tube 2 years ago.
She has undergone laparatomy for ruptured right
fallopian tube. What is the best technique for this
surgery?
A-Milking
B-linear salpingectomy
C-right tube salpingectomy
D-segmantal excision and delayed
anastomosis
Ans:C med-ed-online
13- In a woman 31 years old who has undergone
salpingectomy two weeks ago for EP, HCG level is
increasing. What is your management?
A-MTX
B-transvaginal sonography
C-salpingectomy
D-chest x-ray
Ans:B
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14-RU486 can not attach to:
A-Progesterone receptor
B-androgen receptor
C-glucocorticosteroid receptor
D-estrogen receptor
Ans: D
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15-What is your management for a woman with :
HR=120 BP=80/60 mmHg T=37.5 c uterine
size=8 wks beta HCG=2500 mIU/mL and no
intrauterine pregnancy in sonography?
A-Laparatomy
B- laparascopy
C- D&C
D-serum progesterone
Ans:A
med-ed-online
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
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16- which is a predisposing factor for ovarian EP?
A-PID
B-infertility history
C-DES exposure
D-present IUD
Ans:D
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17-All are among indications for conservative
management of EP except::
A-ovarian EP
B-reduced HCG level
C-sac of less than 3 cm
D-lack of noticeable intra abdominal
hemorrhage
Ans:A
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• Gestational trophoblastic disease
Vesiculaer mole
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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 ?
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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
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18-Clinical features that distinguish a
complete mole from a partiel mole are
A-Gestational age between 8-16 wks
B-B HCG level 100,000
C-Uterine size that is larger for gestational
age
D- Ultrasonographic features
E- all of the above
Ans:D
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19-To optimally prepare for D&C you
should take the following steps except
A-type and cross match for blood
B- full operating room setting
C- suction cannula
D-General anathesia
E- A 22 gauge intravenous access
Ans:E
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20-With respect to complete mole all are
true 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
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• ANS C
21- All of the following are associated
with an increased risk of malignant
change in a woman with vesicular molar
PPREPRE pregnancy 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
Suction evacuation under general
anathesia was performed
How can you
councel this case
regarding
contraceptive
advice before the
next pregnancy
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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 mths
B-Use of the COCP after HCG levels have
returned to normal is associated with increased
need for chemotherapy
C-Use of IUDs in contraindicated until after HCG
levels have returned to normal
Ans:C
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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 evacuation
B- 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
Thank you
