EBCOG PART 1 – EARLY PREGNANCY (EMQ)

A.Dilute Russell viper venom test

B.Glucose tolerance test

C.Karyotyping of products of conception

D.No test required

E.Ovarian autoantibodies

F.Parental peripheral blood karyotyping

G.Pelvic ultrasound scan

H.Peripheral blood natural killer cell testing

I.Serum cytokine levels

J.Thrombophilia screen

K.Thyroid function tests

L Thyroid peroxidase antibodies

M.TORCH (toxoplasmosis, rubella virus, cytomegalovirus, herpes simplex virus and HIV) screen

N.Uterine natural killer cell testing

For each of the following clinical scenarios, choose the single next most appropriate test from the options listed. Each option may be used once, more than once or not at all.

1.A 32-year-old woman attends the miscarriage clinic for a follow- up appointment. She has previously been investigated for three recurrent first- trimester losses (all tests according to RCOG guidance), but now presents with a further pregnancy loss at 16 weeks of gestation.

2.A woman attends the miscarriage clinic after three consecutive miscarriages. All investigations are normal. She subsequently has a fourth miscarriage, which is managed surgically.

3.A 38-year-old woman is referred by her GP to the miscarriage clinic after two consecutive miscarriages.

A.Clinical examination

B.CT scan

C.Hysteroscopy

D.Laparoscopy

E.Laparotomy

F.MRI scan

G.No diagnostic test required

H.Serum α-fetoprotein (AFP)

I.Serum β-human chorionic gonadotropin (β-hCG)

J.Serum progesterone

K.Transabdominal ultrasound scan

L.Transperineal ultrasound

M.Transvaginal ultrasound scan

For each of the following scenarios, what is the most appropriate investigation from the options listed? Each option may be used once, more than once or not at all.

4.A 35-year-old woman who has had three previous caesarean sections presents with scar pain and vaginal bleeding at 7 weeks of gestation. What is the primary diagnostic modality for diagnosing caesarean scar pregnancies?

5.A 33-year-old woman in her fourth pregnancy is referred to an obstetric consultant following a late booking scan. It is 16 weeks since her last menstrual period. An ultrasound scan had shown an empty uterus but a gestation sac outside the uterus surrounded by loops of bowel. What diagnostic modality can be a useful adjunct in advanced abdominal pregnancy?

6.A 29-year-old woman attends the early pregnancy unit following in vitro fertilisation (IVF) treatment. She has mild abdominal tenderness and a small amount of vaginal bleeding. Her embryo transfer was 5 weeks previously and her pregnancy test is positive. The patient underwent IVF treatment due to tubal disease secondary to Chlamydia infection. What would be the diagnostic tool of choice for ectopic pregnancy in this situation?

A.Cornual resection

B.Dilation and curettage

C.Evacuation of retained products of conception

D.Expectant management

E.Hysteroscopic resection

F.Intramuscular methotrexate

G.Laparoscopic salpingectomy

H.Laparoscopic salpingotomy

I.Laparoscopy and proceed

J.Laparotomy and proceed

K.Manual vacuum aspiration

L.No treatment required

M.Potassium injected into the pregnancy under ultrasound guidance

N.Uterine artery embolization

For each of the following scenarios, what is the most appropriate management from the options listed? Each option may be used once, more than once or not at all.

7.A woman presents to the early pregnancy unit with pain and bleeding at 6 weeks of gestation. An ultrasound scan is performed, which shows an empty uterus with a barrel- shaped cervix. There is a gestation sac below the level of the internal os with blood flow around the sac visible using colour Doppler.

8.A woman with a history of left ectopic pregnancy managed by salpingotomy attends the early pregnancy unit with right- sided pain and vaginal bleeding. It is 7 weeks since her last menstrual period. A transvaginal ultrasound scan demonstrates a mass in the right adnexa, which is tender. Her serum β-hCG level is 7800 IU/l.

9.A woman with a previous history of ectopic pregnancy attends the early pregnancy unit for a reassurance scan at 7 weeks of gestation. She has no symptoms. A transvaginal scan shows an empty uterus but a 32 mm left adnexal cystic mass separate from the ovary. A yolk sac and fetal pole are seen, but there is no fetal heartbeat. There is no free fluid. Her serum β- hCG is 3500 IU/l. This is repeated 48 hours later and is 3800 IU/l.

A.23,X

B.23,Y

C.45,XO

D.46,XX

E.46,XY

F.47,XXO

G.47,XXX

H.47,XXY

I.47,XYY

J.69,XXX

K.69,XXY

L.69,XYY

M.69,YYY

For each of the following clinical scenarios, what is the most likely karyotype from the options listed? Each option may be used once, more than once or not at all.

10. A woman presents with hyperemesis and bleeding to the gynaecology assessment unit. An ultrasound scan suggests a complete molar pregnancy and this is confirmed following histopathological analysis of the evacuated products of conception.What is the karyotype of the sperm that fertilised the oocyte?

11.A woman attends for a routine dating scan at 12 weeks of gestation. This shows an enlarged placenta with cystic spaces and a small fetus. A surgical evacuation is performed, which confirms a partial molar pregnancy.What is the most likely karyotype?

12.A recent immigrant to the UK presents with shortness of breath, haemoptysis and vaginal bleeding. She describes a ‘miscarriage’ a few months earlier. A pregnancy test is strongly positive and an ultrasound scan shows a haemorrhagic cystic mass in the uterus. A chest X- ray shows multiple nodules in both lungs.What is the most likely karyotype of the tumour?

A <1%

B 10%

C 25%

D 33%

E 40%

F 50%

G 66%

H 75%

I 80%

J 90%

For each of the following clinical scenarios, what is the closest risk of each event occurring from the options listed? Each option may be used once, more than once or not at all.

13.The proportion of partial moles that are triploid in origin.

14.The proportion of ectopic pregnancies that are cervical pregnancies.

15.The risk of miscarriage in a recognised pregnancy in a woman aged 35–39 years.