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25 Cards in this Set
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In early pregnancy:
a) the yolk sac is the first structure to be identified and disappears by 10weeks gestation b) About 70% of twin pregnancies identified at <10 weeks gestation result in an ongoing singleton pregnancy c) the doubling time for HCG is 72 hrs d) falling HCG concentrations indicate a non-viable pregnancy |
a) TRUE - the yolk sac is the 1st structure that can be accurately identified in the gestation sac; it is visualised at 5-6wks from LMP and disappears around 10wks. Max diameter is 5mm ~7wks
b) TRUE- 71% of viable twin pregnancies diagnosed by USS before 10wks result in an ongoing singleton pregnancy (vanishing twin) c) FALSE - A HCG doubling time of </= 2 days in early pregnancy is consistent with an intrauterine pregnancy d) TRUE - Falling HCG levels before 10-12wks gestation indicate a non-viable pregnancy |
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With respect to molar pregnancy:
a) Complete moles have 69XXY karyotype b) Maternal serum AFP levels are undetectable in complete moles c) Medical evacuation using prostaglandins and oxytocin is the recommended treatment d) During surgical evacuation, oxytocin infusion should be commenced before the uterus is empty |
a) FALSE- Complete moles have 46XX karyotype
b) TRUE- No fetal parts in complete mole therefore, no AFP is produced c) FALSE d) FALSE - Uterotonic agents should be avoided before the uterus is empty as they may increase the risk of embolisation of molar tissue |
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With regard to molar pregnancy:
a) Women should be advised not to conceive until HCG levels have been normal for 12 months b)Use of the COCP after HCG levels have returned to normal is associated with increased need for chemotherapy c) There is a recognised association with ovarian theca-leutin cysts d) Use of IUDs in contraindicated until after HCG levels have returned to normal |
a) FALSE - women should be advised not to fall pregnant until HCG levels have returned to normal
b) FALSE - Not associated with increased requirement for chemotherapy c) TRUE - High HCG levels result in ovarian theca-leutin cysts d) TRUE- IUDs are contraindicated until HCG levels have returned to normal |
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The following are associated with an increased risk of malignant change in a woman with a molar pregnancy:
a) maternal age > 39yo b) woman with BG-A with a partner of BG-O c) partial hydatidiform moles d) smoking |
a) TRUE - (9x) risk in women >40yo
b) TRUE - highest risk = woman BG-A/partner BG-O; lowest risk = woman BG-A/partner BG-A c) FALSE - There is malignant potential with complete mole with 7-16% requiring chemotherapy, compared with partial mole ~0.5% d) FALSE |
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Complete hydatidiform moles:
a) Secrete LH b) Have maternally derived chromosomes c) Usually have avascular trophoblastic villi d) May be complicated by hypothyroidism |
a) FALSE - Secrete large quantities of HCG
b) FALSE - Complete moles have a 46 XX karyotype - caused by a single sperm fertilising an anucleate oocyte, then duplicating its genetic material c)TRUE - characterised by hydropic avascular villi with a snow-storm appearance on USS d) FALSE - the alpha subunit of HCG is identical to the alpha subunit of TSH and high levels of HCG may cause symptomatic HYPERthyroidism |
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With respect to molar pregnancies:
a) women presenting with persistent vaginal bleeding following evacuation of a complete molar pregnancy should undergo further uterine evacuation b) women with placental site trophoblastic tumour do not need to be registered with a surveillance centre c) women should be advised not to become pregnant until HCG levels have reverted to normal for 6/12 d) mifepristone is recommended for termination of a partial molar pregnancy at 14wks gestation |
a) FALSE-if persistent vaginal bleeding occurs post evacuationof a molar pregnancy advice should be sought from the nearest screening centre before further surgical intervention is undertaken
b) FALSE- Women with molar pregnancies should be registered with one of the three national screening centres Criteria for registration include: complete or partial mole, twin pregnancy with complete or partial mole, choriocarcinoma, placental site trophoblastic tumour and microscopic change suggestive of molar pregnancy c) TRUE-women should be advised not to conceive until the HCG level has been normal for 6 months. COCP and HRT are safe to use after HCG levels have reverted to normal d) FALSE -use of mifepristone should be avoided |
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With respect to molar pregnancies:
a) termination of pregnancy should be recommended if a twin pregnancy is diagnosed with one complete molar pregnancy b) in a twin pregnancy, with one molar pregnancy, the chances of a viable fetus are ~10% c) USS is a highly sensitive tool in the diagnosis of molar pregnancy d) the presence of cystic spaces in the placenta with a viable fetus is suggestive of a partial molar pregnancy |
a) FALSE-in twin pregnancy with one viable fetus and the other molar, allow pregnancy to proceed if the woman wishes after appropriate counselling. (NOTE- increased risk of VTE and pre-eclampsia)
b) FALSE - chances of a viable fetus are ~40% c) FALSE - USS diagnosis of partial molar pregnancy is difficult - presence of cystic spaces in the placenta and a transverse AP diameter of gestation sac >1.5 are suggestive d) TRUE |
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In a woman with choriocarcinoma:
a) a rise in the level of urinary HCG after initial clinical response is diagnostic of recurrence b) there is usually a recent history of 1st trimester miscarriage c) with optimal Tx, the 5-yr survival rate is <70% d) successful chemotherapy is followed by a return of fertility in most young women |
a) FALSE - it could be a new pregnancy
b) FALSE -50%-will have had a preceeding molar pregnancy, 25% of cases follow a spontaneous or induced abortion, and 25% follow a normal or ectopic pregnancy c) FALSE - the overall 5-yr survival rate with optimum treatment is >95% d) TRUE - ~90% of patients who want to become pregnant follwoing chemotherapy have succeeded and there is no evidence of any increase in fetal abnormalities c) |
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With respect to gestational trophoblastic disease:
a) chorioadenoma destruens is typically associated with theca-leutin ovarian cysts b) HCG levels are invalidated by administration of the OCP c) 3% of women with complete molar pregnancy develop choriocarcinoma d) choriocarcinoma responds to treatment with folic acid antagonists |
a) TRUE
b) FALSE c) TRUE - about 2-3% of hydatidiform moles are complicated by the development of choriocarcinoma d) TRUE |
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A 20yo, Rh-Neg and unsensitised woman is foound to have a 10wks seize missed miscarriage:
a) Anti-D immunoglobulin should be administered if surgical evacuation is performed b) Anti-D immunoglobulin is unnecessary after medical evacuation c) Screening for chlamydia infection is recommended prior to evacuation d) histological examination of products of conception is recommended |
a) TRUE - Anti-D immunoglobulin should be administered if an intervention is undertaken to evacuate the uterus
b) FALSE c) TRUE - screening for genital tract infection with chlamydia is recommended in women <25yo or those at high risk prior to uterine instrumentation d) TRUE - products of conception should be sent for histological examination to exclude molar tissue |
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The following are recommended investigations in a woman who is otherwise fit and well with three successive miscarriages:
a) pelvic USS b) laparoscopy c) fasting BSL and TFTs d) hysteroscopy to exclude uterine anomalies |
a) TRUE
b) FALSE c) FALSE d) FALSE |
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Investigation of a woman with recurrent miscarriage...
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1. Karyotype of couple - refer to clinical geneticist if positive result
2. Karyotype of products of conception if next pregnancy fails 3. Pelvic USS - ovarian morphology/uterine anomalies 4. Screening for anti-phopholipid antibodies on 2x occasions at least 6wks apart - third test if discordant results; treat with low dose aspirin+heparin 5. Screening for inherited thrombophilias |
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The following are recognised features of septic miscarriage:
a) HTN b) DIC c) ARF d) Jaundice |
a) FALSE
b) TRUE c) TRUE d) TRUE |
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Complications of septic miscarriage...
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1. Endometritis- progressing to pelvic cellulitis/abscess and septicaemia
2. Endotoxic Shock- features include hypotension, tachycardia, tachypnoea, hypothermia(<35 deg) or pyrexia, hypoxaemia, oliguria, positive blood cultures 3. DIC - leading to jaundice 4. Crepitus - may occur following infection with gas-forming organisms, this usually complicates illegal abortions |
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Features of endotoxic shock... (7x key features)
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1. Hypotension
2. Tachycardia 3. Tachypnoea 4. Hypotehrmia (<35deg) or Pyrexia 5. Hypoxaemia 6. Oliguria 7. Positive Blood Cultures |
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The following are associated with an increased risk of 1st trimester miscarriage...
a) PCOS b) Treated hypothyroidism c) Well controlled insulin-dependant DM d) balanced translocation in the father |
a) TRUE - USS features of polycystic ovaries are more prevalent in women with recurrent miscarriage (50%) compared with general population (22%)
b) FALSE c) FALSE - well controlled IDDM and thyroid disease are not associated with recurrent miscarriage. Incidence of subclinical DM is not higher in recurrent miscarriage. Poorly controlled DM is associated with an increased risk of miscarriage d) TRUE - 3-5% of couples presenting with recureent miscarriage carry a chromosomal anomaly, most commonly a balanced translocation. The incicdence of balanced translocation in the general population is ~0.4%. The female is (x2) more likely to carry the translocation than the male to be a carrier of the translocation |
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In a woman with threatened miscarriage at 8wks gestation:
a) a VE should be avoided until after USS b) bed-rest is effective treatment c) progesterone supplementation has been shown to be effective treatment d) Anti-D immunoglobulin is recommended in Rh-NEg unsensitised women |
a) FALSE - Vaginal examination should be undertaken and there is no evidence that this adversely affects outcome
b) FALSE - bed rest does not improve pregnancy outcome and may be harmful c) FALSE - progesterone supplementation does not improve pregnancy outcome d) FALSE - Anti-D immunoglobulin is not recommended and should only be given if bleeding is heavy and associated with pain |
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In a woman with 3 x previous 2nd trimester miscarriages:
a) hysteroscopy should be performed to diagnose cervical incompetence b) a cervical suture should be inserted 10wks into her pregnancy c) transvaginal USS may be used to diagnose cervical incompetence d) randomised trials have shown a definite benefit for cervical cerclage |
a) FALSE - hysteroscopy is not useful in the diagnosis of cervical incompetence as it cannot be undertaken during pregnancy
b) FALSE c) TRUE - diagnosis of cervical incompetence is based on clinical obstetric history aided by physical examination and transvaginal USS d) FALSE - randomised trials have shown that cervical cerclage does not improve pregnancy outcome in women whom the diagnosis of cervical incompetence is uncertain or suggested by transvaginal scanning |
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With respect to cervical incompetence and preterm-labour:
a) the normal cervical length is 38-42mm on transvaginal scanning b) There is an increased risk of preterm delivery associated with cervical length <38mm c) cervical cerclage has been shown in randomised trials to be associated with a reduction in perinatal mortality d) cervical cerclage has been shown to be associated with increased risk of maternal infection |
a) TRUE
b) FALSE - Cervical length <25mm is associated with a 50% risk of preterm delivery c) FALSE - Cervical cerclage does not improve pregnancy outcome, even in women with shortened cervices on transvaginal scanning d) TRUE - cervical cerclage is associated with increased risk of maternal puerperal pyrexia and medical intervention, including the use of tocolytics, IOL and C/S |
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In the diagnosis of anti-phospholipid antibody syndrome, the following are considered as adverse pregnancy outcomes:
a) 2 x consecutive miscarriages before 10wks gestation b) 1 x morphologically normal fetal death > 10wks gestation c) 1 x delivery before 34wks gestation d) 1 x neonatal death of a term baby |
a) FALSE - 3 or more miscarriages before 10wks gestation
b) TRUE c) FALSE - one or more deliveries before 34wks gestation due to severe pre-eclampsia, eclampsia or IUGR d) FALSE |
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The following are associated with an increased risk of 1st trimester miscarriage...
a) PCOS b) Treated hypothyroidism c) Well controlled insulin-dependant DM d) balanced translocation in the father |
a) TRUE - USS features of polycystic ovaries are more prevalent in women with recurrent miscarriage (50%) compared with general population (22%)
b) FALSE c) FALSE - well controlled IDDM and thyroid disease are not associated with recurrent miscarriage. Incidence of subclinical DM is not higher in recurrent miscarriage. Poorly controlled DM is associated with an increased risk of miscarriage d) TRUE - 3-5% of couples presenting with recureent miscarriage carry a chromosomal anomaly, most commonly a balanced translocation. The incicdence of balanced translocation in the general population is ~0.4%. The female is (x2) more likely to carry the translocation than the male to be a carrier of the translocation |
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In a woman with threatened miscarriage at 8wks gestation:
a) a VE should be avoided until after USS b) bed-rest is effective treatment c) progesterone supplementation has been shown to be effective treatment d) Anti-D immunoglobulin is recommended in Rh-NEg unsensitised women |
a) FALSE - Vaginal examination should be undertaken and there is no evidence that this adversely affects outcome
b) FALSE - bed rest does not improve pregnancy outcome and may be harmful c) FALSE - progesterone supplementation does not improve pregnancy outcome d) FALSE - Anti-D immunoglobulin is not recommended and should only be given if bleeding is heavy and associated with pain |
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In a woman with 3 x previous 2nd trimester miscarriages:
a) hysteroscopy should be performed to diagnose cervical incompetence b) a cervical suture should be inserted 10wks into her pregnancy c) transvaginal USS may be used to diagnose cervical incompetence d) randomised trials have shown a definite benefit for cervical cerclage |
a) FALSE - hysteroscopy is not useful in the diagnosis of cervical incompetence as it cannot be undertaken during pregnancy
b) FALSE c) TRUE - diagnosis of cervical incompetence is based on clinical obstetric history aided by physical examination and transvaginal USS d) FALSE - randomised trials have shown that cervical cerclage does not improve pregnancy outcome in women whom the diagnosis of cervical incompetence is uncertain or suggested by transvaginal scanning |
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With respect to cervical incompetence and preterm-labour:
a) the normal cervical length is 38-42mm on transvaginal scanning b) There is an increased risk of preterm delivery associated with cervical length <38mm c) cervical cerclage has been shown in randomised trials to be associated with a reduction in perinatal mortality d) cervical cerclage has been shown to be associated with increased risk of maternal infection |
a) TRUE
b) FALSE - Cervical length <25mm is associated with a 50% risk of preterm delivery c) FALSE - Cervical cerclage does not improve pregnancy outcome, even in women with shortened cervices on transvaginal scanning d) TRUE - cervical cerclage is associated with increased risk of maternal puerperal pyrexia and medical intervention, including the use of tocolytics, IOL and C/S |
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In the diagnosis of anti-phospholipid antibody syndrome, the following are considered as adverse pregnancy outcomes:
a) 2 x consecutive miscarriages before 10wks gestation b) 1 x morphologically normal fetal death > 10wks gestation c) 1 x delivery before 34wks gestation d) 1 x neonatal death of a term baby |
a) FALSE - 3 or more miscarriages before 10wks gestation
b) TRUE c) FALSE - one or more deliveries before 34wks gestation due to severe pre-eclampsia, eclampsia or IUGR d) FALSE |
