first trimester

Question 1

What is the smallest fetal pole that a competent ultrasonologist would confidently diagnose as nonviable due to absence of cardiac activity?

a. 7 mm
b. 9 mm
c. 13mm
d. 17mm
e. 21mm

Answer 1

7mm

Question 2

What is the smallest gestational sac size that a competent ultrasonologist would confidently diagnose as a blighted ovum because of lack of fetal pole?

a. 11mm
b. 15mm
c. 19mm
d. 23mm
e. 27mm

Answer 2

25mm

Question 3

A woman presents with abdominal pain at 6 weeks amenorrhoea, BHCG is 6000, US empty uterus. O/E tender adnexae. Best next step:

1. serial BCHG
2. rpt US in 1 week
3. laparoscopy
4. laparotomy

Answer 3

3. laparoscopy

Question 4

Presents at 7 weeks after TOP 1 week ago. Still symptoms of pregnancy. O/E 7/40 size uterus, urinary BHCG positive. Op notes from TOP report minimal tissue, histopath: decidual tissue only. Next step:

1. TV U/S
2. Expoloratory laparotomy
3. Reassurance

Answer 4

1. TV USS

Question 5

What is the concern about a pregnancy after failed morning after contraception?

1. multiple pregnancy
2. abnormal fetus
3. increased risk of ectopic pregnancy
4. increased risk of miscarriage
5. higher risk of premature labour

Answer 5

3. increased risk of ectopic pregnancy

Question 6

A 21 yo woman has an US at 7/40 for lower abdominal pain. A viable 7/40 pregnancy is seen, and an 8cm single locular cystic structure is noted in the right adnexa. What management option do you choose?

1. Reassure and review regularly
2. RSO through a Pfannensteil incision
3. RSO through a midline incision
4. US guided drainage of the cyst
5. Rescan in 6/52

Answer 6

5. Rescan in 6/52

Question 7

The most common presenting symptom for molar pregnancy is:

1. abnormal bleeding
2. hyperemesis
3. fundus larger than dates
4. thryotoxicosis
5. pre-eclampsia

Answer 7

1. abnormal bleeding

Question 8

Concerning partial moles, which statement is incorrect?

1. the fetus may be alive
2. most are triploidic
3. more often progress to choriocarcinoma than complete moles
4. pre-eclampsia is more common with partial moles

Answer 8

3. more often progress to choriocarcinoma than complete moles

Question 9

Regarding hydatidiform mole, which statement is correct:

1. <3 % progress to chroiocarcinoma
2. choriocarcinoma can be associated with thyrotoxicosis
3. commonest karyotype is 45 XO
4. association between prognosis and rhesus blood group
5. less common in older women

Answer 9

2. choriocarcinoma can be associated with thyrotoxicosis
3. <3 % progress to chroiocarcinoma

“however persistence or change into malignant disease requiring chemotherapy occurs in 0.5 – 4 per cent of partial moles” - RANZCOG

Question 10

Concerning partial moles, all true except:

1. fetus may be alive
2. mostly triploidy
3. same follow up as complete moles – different now, follow up if negative within 8 weeks then 3/12
4. more often go on to choriocarcinoma than complete moles
5. preeclampsia occurs most commonly with partial moles

Answer 10

4. more often go on to choriocarcinoma than complete moles

Question 11

Least valuable predictor of missed abortion

1. 5mm sac with no heart beat
2. 15 mm sac with no fetal pole
3. 20 mm sac and no fetal heart beat

Answer 11

1. 5mm sac with no heart beat

Question 12

Spontaneous ab, correct option:

1. increased in women > 40
2. DES associated with many pregnancy problems but no spont ab
3. Most common chromosomal abnormality is triploidy
4. Genetic abnormality in aborted fetuses are similar to those occurring in term fetuses

Answer 12

1. increased in women > 40

Question 13

A woman with 4 previous 1st trimester miscarriages has been fully investigated, no cause found. Management for the next pregnancy is:

1. progesterone supplement empirically, or test serum progesterone
2. aspirin and heparin
3. serial BHCG
4. US at 6/40

Answer 13

4. US at 6/40

Question 14

In first trimester, a PG presents with N & V, tachycardia. TFT show slight increase in free T4, decrease in TSH, and normal RT3. This is associated with:

1. normal
2. hyperemesis gravidarum
3. Graves disease
4. Hashimoto’s thyroiditis
5. Non-toxic goitre

Answer 14

2. hyperemesis gravidarum

Question 15

A woman has three first miscarriages and presented to you at 6 weeks gestation. What is the next most appropriate step?

1. perform an U/S
2. serum bHCG
3. reassurance
4. lupus screen
5. commence on progesterone

Answer 15

1. perform an U/S

Question 16

Patient 16 days after expected period. PV spotting in casualty. BHCG is 140,000. Most likely diagnosis?

1. multiple pregnancy
2. intrauterine pregnancy
3. missed ab
4. ectopic pregnancy
5. intrauterine pregnancy and dysgerminoma of the ovary

Answer 16

2. intrauterine pregnancy

Question 17

After which procedure is the decay rate of BHCG the fastest?

1. vacuum curette for termination of pregnancy
2. vacuum curette for spontaneous abortion
3. resection of ectopic pregnancy
4. linear salpingotomy for ectopic pregnancy
5. BHCG decays at the same rate for all procedures

Answer 17

5. BHCG decays at the same rate for all procedures

Question 18

Which investigation delivers the greatest dose of radiation to an 8 weeks fetus?

1. IVP
2. CXR
3. Cholecystogram
4. Barium enema
5. Lumbar spine series

Answer 18

4. Barium enema

Question 19

In a woman who conceives with an IUD insitu, all of the following are associated EXCEPT:

1. miscarriage
2. prematurity
3. low birth weight
4. fetal abnormalities
5. chorioamnionitis

Answer 19

4. fetal abnormalities

Question 20

Suction curettage for missed abortion at 10/40. What size suction catheter should you use?

1. 6
2. 8
3. 10
4. 12
5. 14

Answer 20

4. 10

Question 21

The most likely place of damage if haemorrhage and suction D&C?

1. anterior laceration of corpus
2. posterior laceration of corpus
3. lateral laceration of corpus
4. cervical laceration

Answer 21

4. cervical laceration

(vs lateral laceration of corpus- uterines)

Question 22

At 7 weeks gestation, which of the following findings is most likely to be consistent with a tubal ectopic pregnancy?

1. abdo US empty uterus + BHCG <600
2. abdo US empty uterus + BHCG <1000
3. abdo US empty uterus + BHCG >7000
4. abdo pain and negative culdocentesis

Answer 22

3. abdo US empty uterus + BHCG >7000

Question 23

A woman had a termination of pregnancy at 8/40 gestation at a local clinic under LA. The cervix was difficult to dilate and the uterus appeared to be perforated during this dilation. There was no bleeding or pain. A TVS was performed and showed a viable 8/40 fetus with an intact sac. What is the most appropriate management?

1. continue with the termination
2. transfer to hospital and continue termination under GA
3. insert a cervagem vaginally and wait 4 hrs then attempt the suction termination
4. perform a laparotomy and repair the defect, continue with suction termination with hysterotomy and removal of POC if necessary
5. stop the procedure and wait 1-2 weeks then reconsider

Answer 23

5. stop the procedure and wait 1-2 weeks then reconsider

Question 24

3 recurrent abortions, no cause found after investigation. Now 6/40 in next pregnancy, next step:

1. aspirin
2. progesterone
3. quantitative HCG
4. transvaginal US

Answer 24

4. TV USS

Question 25

Regarding ectopics 1. Continuing US and BHCG delays intervention and leads to greater risk of rupture 2. Recurrence risk about 10% 3. Better chance of subsequent live birth with salpingostomy vs salpingectomy

Answer 25

3. Better chance of subsequent live birth with salpingostomy vs salpingectomy recurrence risk 15% RCOG : The three-year cumulative pregnancy rate was 62% after salpingotomy and 38% after salpingectomy

Question 26

37 yo has just had 4th 1st trimester miscarriage within her only marriage and no living children. Most likely cause 1. idiopathic 2. lupus 3. chromosomal 4. cervical incompetence

Answer 26

1. idiopathic

Question 27

What is of proven value as treatment for recurrent 2nd trimester miscarriages associated with uterine contractions? 1. erthromycin 2. transfusing wife with husbands WBC 3. Strassmann operations 4. McDonald cerclage

Answer 27

4. McDonald cerclage

Question 28

Recurrent abortion, no cause found. What do you do at 6-7/40 in next pregnancy? 1. pelvic US 2. cervical suture 3. BHCG 4. Progesterone injections

Answer 28

1. pelvic US

Question 29

A lady 12 weeks pregnant with a bicornuate uterus presents to A&E with pain and bleeding. US shows an empty uterus and 8 cm adnexal mass. Obs BP 90/60, PR 110: 1. get A&E to organise laparoscopy with probable salpingostomy 2. get A&E to organise laparoscopy with probable laparotomy 3. do nothing until you arrive in 30 mins 4. have a culdotomy tray ready for you

Answer 29

2. get A&E to organise laparoscopy with probable laparotomy

Question 30

At 12 weeks gestation the corpus luteum is removed for bleeding, the most appropriate pregnancy support with the least fetal risk is: 1. duphaston 2. depo provera 3. norethisterone 4. progesterone and oestrogen 5. no hormones

Answer 30

5. no hormones

Question 31

Commonest cause of first trimester miscarriage? 1. T21 2. XO 3. T16 4. T18 5. XXY

Answer 31

2. XO Altogether, the trisomies make up 50% of chromosomal causes, T16 being the most common and always lethal. On its own XO comprises 20% so is probably most common

Question 32

A woman you have been following with a bicornuate uterus had her LNMP 11/52 ago. A home pregnancy test was positive 2/52 ago. She has presented to ED with severe lower abdominal pain and bleeding O/E HR 110, BP 90/60, lower abdomen rigid and US 6 cm adnexal mass and empty uterus. Mx? 1. ask for stat LFT’s plt in preparation for MTX 2. ask for a culdocentesis tray to be organised 3. have them do nothing until you arrive in \< 30 mins 4. begin arranging theatre for laparoscopy/likely linear salpingostomy 5. begin arranging theatre for laparoscopy probably laparotomy

Answer 32

5. begin arranging theatre for laparoscopy probably laparotomy

Question 33

A 21 yo primigravida at 14 weeks is found to have a BP of 180/110. The BP was noted to be normal at her first visit and prior to pregnancy. Of the possible diagnoses, the most lethal is? 1. PIH 2. Acute glomerulonephritis 3. Essential HT 4. Hydatidiform mole 5. Phaeochromocytoma

Answer 33

5. Phaeochromocytoma

Question 34

In a woman who is 8 weeks pregnant with an IUD in situ the correct management is? 1. immediate removal of the IUD 2. advise termination of pregnancy 3. remove the IUD only if there is evidence of infection 4. if the strings are visible cut them as high up in the cervical canal as possible 5. immediate laparoscopy to exclude ectopic pregnancy

Answer 34

1. immediate removal of the IUD

Question 35

The most common emotional response after a termination is 1. severe depression 2. shame 3. relief 4. anxiety 5. psychosis

Answer 35

3. relief

Question 36

27 yo female at 7/40 pregnant with 8 cm unilocular cyst presents with LIF pain. Mx? 1. operative laparoscopy 2. cystectomy via pfannensteil 3. oopherectomy via midline incision and washings 4. laparoscopy and aspiration of cyst 5. repeat US in 6 weeks

Answer 36

5. repeat US in 6 weeks

Question 37

Ectopic pregnancvy 1. increased after legal TOP 2. increased on progesterone only pill more than without contraception 3. rate is higher with copper IUD’s than plastic ones 4. increased with IUD more than normal population 5. none of the above

Answer 37

5. none of the above

Question 38

TOP at 6/52. One week later, no bleeding or pain but BHCG remains positive. There is a 6-7 week size uterus. The path showed scanty decidual tissue, no fetal parts. Next ? 1. qualitative BHCG 2. ultrasound 3. repeat curette 4. laparotomy

Answer 38

2. ultrasound

Question 39

6/52 pregnant, 3 days of abdo pain and 2 days of PV bleeding. Bilateral adnexal tenderness. US – complex adnexal mass and free fluid in POD. Next? 1. culdocentesis 2. laparotomy 3. quantitative BHCG 4. laparoscopy

Answer 39

4. laparoscopy

Question 40

12 weeks pregnant. HCG positive at 6 weeks. No other antenatal care. Feels pregnant. One week history of PCB without cramping. Speculum reveals bright red 3 cm mass on the ectocervix. Which test will give a definite diagnosis? 1. real time US 2. tissue biopsy 3. colposcopy and biopsy 4. stain with Lugo’s iodine

Answer 40

1. real time US

Question 41

Risk of ectopic highest with? 1. COCP 2. Condoms 3. No contraception 4. POP 5. diaphragm

Answer 41

3. no contraception

Question 42

Threatened ab at 6 weeks shows cardiac activity and appropriate for dates. Risk of ab? 1. \<10% 2. 50% 3. 25% 4. 90%

Answer 42

1. \<10%

Question 43

Woman at 6/52 amenorrhoea with PV bleeding and lower abdo pain. HCG 3000 and US empty uterus. Options? 1. do nothing 2. serial HCG 3. laparoscopy

Answer 43

3. laparoscopy

Question 44

Pregnant lady in first trimester with the following GTT. Fasting BSL 6.8, 2 hrs post 100gm load 12.6. Mx? 1. admit for stabilisation 2. commence on oral hypoglycaemic agent 3. commence on insulin as an outpatient 4. repeat the test in the second trimester 5. counsel on dietary measures

Answer 44

3. commence on insulin as an outpatient vs admit for stabilisation