EBCOG Part 1-Early Pregnancy-Day 1(SBA)

1. A 25-year-old woman presents to the A + E department with abdominal pain and a positive pregnancy test (8/40). USS is performed to rule out a miscarriage. USS shows an intrauterine gestational sac with the ratio of transverse to anteroposterior dimension, greater than 1.5 with cystic spaces in the placenta. What is the likely ultrasonographic diagnosis?

A. Complete molar pregnancy
B. Incomplete miscarriage
C. Missed miscarriage
D. Partial molar pregnancy
E. Pseudosac of an ectopic pregnancy

2.A 25-year-old woman diagnosed with a complete mole (16/40) is scheduled to undergo surgical evacuation in theatre. Which is the only acceptable management plan in her case?

A. Cervical priming using prostaglandins
B. Routine oxytocin infusion prior to commencement of evacuation
C. Oxytocin infusion in cases of life-threatening haemorrhage
D. Routine oxytocin infusion at the end of evacuation
E. IUCD for long-term contraception immediately post-procedure

3.The incidence of gestational trophoblastic disease in the UK is calculated as:

A. 1in 287 live births
B. 1 in 346 live births
C. 1 in 563 live births
D. 1in 714 live births
E. 1in 976 live births

4.Which of the following is not an example of gestational trophoblastic disease:

A. Chorioangioma
B. Choriocarcinoma
C. Complete mole
D. Partial mole
E. Placental site trophoblastic tumour

5.Which of the following statements is correct about molar pregnancy:

A. Complete moles usually (75–80 %) arise as a consequence of dispermic fertilisation of an ‘empty ovum’.
B. Complete moles show evidence of mature fetal red blood cells.
C. Partial moles occur rarely due to dispermic fertilisation of an ovum.
D. Some complete moles (20–25 %) arise after duplication of a single sperm following fertilisation of an ‘empty ovum’.
E. 10 % of partial moles represent tetraploid or mosaic conceptions

6.A 41-year-old patient has been diagnosed with gestational trophoblastic neoplasm 6 months after a complete hydatidiform mole. Her pretreatment beta human chorionic gonadotropin (hCG) was 15,000 IU, and a recent computed tomography scan has suggested a possible single lung metastasis. What is the best modality of treatment?

A. Intramuscular methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days until the hCG has returned to normal and then for a further 6 consecutive weeks.
B. Intramuscular methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days until the hCG has returned to normal, and then for a further 6 consecutive months.
C. Intravenous methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days until the hCG has returned to normal, and then for a further 6 months.
D. Intravenous multiagent chemotherapy, which includes combinations of methotrexate, dactinomycin, etoposide, cyclophosphamide and vincristine until hCG level has returned to normal.
E. Intravenous multiagent chemotherapy, which includes combinations of methotrexate, dactinomycin, etoposide, cyclophosphamide and vincristine until the hCG has returned to normal and then for a further 6 consecutive weeks.

7.A 29-year-old patient presents with abdominal distension and vaginal bleeding at 12 weeks’ gestation. A transvaginal ultrasound scan suggests a molar pregnancy with bilateral enlarged multicystic ovaries. T e cysts are thin walled and have clear contents. T ere is no obvious free fluid in the pelvis.What is the most likely diagnosis?

A. Mucinous cystadenoma.
B. Ovarian cystadeno carcinoma.
C. Serous cystadenoma.
D. Struma ovarri
E. Theca lutein cyst.

8.The general practitioner calls to ask about the immediate follow-up of a woman who had a suction evacuation of a complete molar pregnancy.What is your advice?

A Twice weekly urine &serum beta hcg TILL hcg is normalised
B. Do a urine pregnancy test every two weeks for 24 weeks.
C. Do a urine check test every week until it is negative for four successive tests.
D. Do a urine or blood test for hCG every week until it normalizes.
E. No need for any follow-up if the urine pregnancy test is negative after one month

9.A woman has an evacuation of a partial molar pregnancy. She was 11 weeks pregnant.What is your follow-up plan?

A. Chorionic gonadotropin (hCG) assessment until she starts a hormonal contraception after the tests have normalized.
B. Serum and urine hCG every two weeks until the levels are normal followed by one confirmatory normal urine sample after four weeks.
C. Serum hCG after four weeks.
D. Urine pregnancy test every two weeks.
E. Urine pregnancy test every four weeks.

10.Following appropriate treatment of complete and partial molar pregnancies, what percentage of women need additional chemotherapy in each case, respectively?

A. 10% and 0.3%.
B. 15% and 0.5%.
C. 20% and 1.0%
D. 25% and 2.0%.
E. 33% and 3.0%.

11. A 36-year-old woman has had a suction evacuation because of a complete molar pregnancy. Her chorionic gonadotropin (hCG) levels started to rise six months after treatment. Her FIGO 2000 score was assessed as 6.What is your management?

A. Intravenous multi-agent chemotherapy.
B. Needs treatment only if her score goes up to 7.
C. Single-agent intramuscular methotrexate.
D. Subtotal hysterectomy.
E. Total hysterectomy and bilateral salpingo-oophorectomy.

12.A 28-year-old woman who has received single-agent chemotherapy because of a persistent rise in her chorionic gonadotropin levels after evacuation of a complete molar pregnancy asks about her future fertility options.What will you tell her?

A. She cannot conceive because of the chemotherapy.
B. She can conceive but after one year of completion of her treatment and follow-up
C. She can conceive after two years of undetectable gonadotropin levels (hCG) levels
D. She can conceive after two years of a contraceptive.
E. She can conceive but only with oocyte donation

13.To improve the results of treatment of gestational trophoblastic disease (GTD), what audit topic would you recommend?

A. The proportion of women with GTD registered with the relevant screening centre.
B. The proportion of women with a histological diagnosis of molar pregnancy who were diagnosed by ultrasound before evacuation of the molar pregnancy.
C. The proportion of women who receive medical management for the evacuation of a molar pregnancy.
D. The proportion of women who had histological examination of the products of conception after an induced abortion.
E. The proportion of women who did not use contraception during the follow-up period

14.Regarding a molar pregnancy, which one of the following statements is incorrect?

A. Although an ultrasound is useful in diagnosing a molar pregnancy, the definite diagnosis is made from histopathology results
B. Anti-D prophylaxis should be given to all women with a molar pregnancy after surgical evacuation of the uterus
C. It is safe to prime the cervix with prostaglandins before surgical evacuation of the uterus
D. If the size of the pregnancy allows, a suction catheter is the choice of instrument to remove a partial molar pregnancy
E. One of the clinical presentations of a molar pregnancy is hypothyroidism

15.Ultrasound in a 38-year-old woman revealed a complete hydatidiform mole and she was managed by surgical evacuation of the uterus. Serial beta Hcg chorionic gonadotropin concentrations, used for monitoring, reverted to normal 4 weeks after the procedure. She would like to know how long she should wait before conceiving.What should your advice be for this patient?

A She may try to conceive now
B She should wait another 5 months before trying to conceive
C She should wait another 6 months before trying to conceive
D She should wait another 56 days before trying to conceive
E She should wait 1year before trying to conceive

16. What’s the detection rate of combined first trimester screening for Downs ?

A.60%
B.70%
C.80%
D.90%
E.95%

17. What’s the false positive rate for cell-free DNA testing in evaluation of Down syndrome?

A.0.1%
B.0.2%
C.0.3%
D.0.4%
E.0.5%

18. Current methods of cell-free DNA testing necessitate that the minimum fetal fraction should be

A.1%
 B.2%
C.3%
D.4%
E.5%

19. What effect does Down syndrome have on the quadruple test?

a) Decreased alphafetoprotein, decreased human chorionic gonadotrophin, decreased unconjugated estradiol and increased inhibin
b) Decreased alphafetoprotein, increased human chorionic gonadotrophin, decreased unconjugated estriol and decreased inhibin
c) Decreased alphafetoprotein, increased human chorionic gonadotrophin, decreased unconjugated estriol and increased inhibin
d) Decreased alphafetoprotein, increased human chorionic gonadotrophin, increased unconjugated estriol and increased inhibin
e) Increased alphafetoprotein, decreased human chorionic gonadotrophin, decreased unconjugated estradiol and increased inhibin

20. At the 11–13-week assessment, what is the relative prevalence of trisomy 18 and 13 to trisomy 21?

A.one to two and one to seven respectively EMQ
B.one to three and one to eight respectively
C.one to four and one to seven, respectively
D.one to three and one to seven, respectively
E.one to three and one to nine respectively

21. Mrs.Babitha , A 45-year-old women gravid 1 para 0 is referred to antenatal clinic for booking.She misses her dating scan. She is now 16 weeks’ pregnant and her booking bloods reveal normal haematological and biochemical tests. However, her quadruple test reveals

low levels of AFP (α-fetoprotein)

high levels of ß-hCG

Low levels of oestriol

High levels of inhibin A.

What is the probality of Karyotyping report following amniocentesis would be

A. 47XX +13
B.46XX Y
C.47 XX +18
D.47XX +21
E.45X0

22.Mrs. X had a combined test shows high risk for downs syndrome .Patient declined invasive prenatal tests because of her religious views .Scan shows cystic hygroma and short femur.What’s your diagnosis?

A. Turner syndrome
B. Edward syndrome
C. Patau syndrome
D. Down syndrome
E.None of the above .

23.In Uk , how many women in Uk offered choice of invasive prenatal diagnostic tests ?

A.1in 25
B.1in 10
C.1in 15
D.1in 20
E.1in 4

24. A 34 year old women is admitted to the labour ward via A&E. She has not had any contact with the health services during her antenatal period. Emergency C‐section is performed due to signs of fetal distress.A small female is born and is noted to have cleft lip and palate, prominent occiput, low set ears,omphalocele and clenched hands with over‐riding fingers. The baby is transferred to SCBU due to apnoeic episodes.What is the most likely diagnosis?

A) Trisomy 13
B) Trisomy 18
C) Trisomy 21
D) Turners Syndrome
E) Cri‐du‐chat

25. Mrs.X is 34 year old primigravida now 9 weeks pregnant, presented with spotting .Ultrasound shows good cardiac activity with bowel loops are seen outside of the belly through the umbilical cord .What would you counsel her ?

A.Chorionic villus sampling
B.non invasive prenatal diagnostic tests
C.Referral to fetal medicine unit
D.Reassurance
E.Termination

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EBCOG Part 1-Early Pregnancy-Day 1(SBA)

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