EBCOG Part 1-Early Pregnancy-Day 2(SBA)

1. A 29-year-old, who is at 6 weeks’ gestation, is diagnosed to have a right tubal ectopic pregnancy by transvaginal pelvic ultrasound. Which one of the following factors would enable systematic methotrexate to be offered as a medical treatment option for the ectopic pregnancy?

2. A 29-year-old, who is at 6 weeks’ gestation, presents with slight vaginal spotting. Transvaginal pelvic ultrasound shows no evidence of any intrauterine or extrauterine pregnancy. A serum βhCG is measured at initial presentation and repeated 48 h later. Which one of the following βhCG results is suspicious for a clinically significant ectopic pregnancy?

3. A 25-year-old woman presents to the A+E department with left iliac fossa pain, vaginal  bleeding and a positive pregnancy test. Which symptoms may be associated with an ectopic pregnancy?

4. Which of the following statements is appropriate in women presenting with early pregnancy with bleeding:

5. Medical management for an ectopic pregnancy can be considered if:  

6. A 28-year-old woman is admitted with severe right-sided lower abdominal pain. Her pulse is 90 bpm with a BP of 110/70 mm Hg and a transvaginal ultrasound scan shows a 2.5 cm complex right adnexal mass. T ere is colour flow on Doppler but no free fluid in the pouch of Douglas. A pregnancy test is positive with beta hCG of 1400 IU/L, and there is no evidence of an intrauterine pregnancy. T e serum progesterone is 24 nmol/L.What is the most appropriate next step in her management?

7.Which of the following statements regarding abdominal ectopic pregnancies is correct?  

8.What is the risk of dying from an ectopic pregnancy?  

9.As the on-call gynaecology registrar, you have been asked by the second-year specialist trainee to review a 23-year-old woman who has presented with lower abdominal pain and mildvaginal bleeding. She is 6 weeks pregnant and a urine pregnancy test is positive.

The ultrasound report reads:’Uterusanteverted and measures 10cm x 8cm x 5cm.MIxedechogenicmaterial seen within the uterine cavity with positive Doppler flow, measuring 20 mmx 15mm  x 15mm. Both ovaries are normal. Minimal free fluid, measuring 5 mm, seen in the recto-uterine pouch’. What is the most appropriate management?

10.The general practitioner calls you out of hours to ask what to do because she has an eight-week pregnant woman who is complaining of moderate right abdominal pain and slight vaginalbleeding. What is your advice?

11.  The midwife in the early pregnancy assessment unit asks you to review a woman who has seven weeks of amenorrhea but the previous and current ultrasound could not locate the pregnancy. The human chorionic gonadotropin (BhCG) increased from 800 IU/L to 1600 IU/L after 48 hours. The woman is fit and well with no signs or symptoms.What is your next plan?

12.The serum BhCG of a symptomless woman with a pregnancy of unknown location (PUL) has dropped by more than 50% after 48 hours.What is the next step you advise?

13. A woman who is eight weeks pregnant is offered laparoscopic surgical management of an ectopic pregnancy. She had a previous normal pregnancy and vaginal delivery.How will you justify laparoscopic salpingectomy as opposed to salpingostomy?

14. You are the specialist registrar on call for gynaecology. A nurse from the early pregnancy assessment unit asks you to review a set of ultrasounds and blood test results and give appropriate advice so she can call the patient, via the telephone clinic, with a management plan. The patient is 28 years old and 5 weeks pregnant by dates. A urine pregnancy test is positive. The results the nurse shows you are as follows:
`Uterus anteverted and normal.Gestation sac not seen in the uterine cavity. Both ovaries are normal with no adnexal masses. Minimal free fluid in the recto-uterine pouch. No cervical excitation or adnexal tenderness! The beta-hCG concentration was measured on the day of the scan and repeated 48 hours later. Concentrations were 500 IU/L and 300 !UM, respectively. What is the most appropriate management plan?

15. You are the on call gynaecology registrar and have been. asked to review a 28-year­ old nulliparrous woman with  a positive pregnancy test who has just undergone  ultrasound.The sonographer’ s report reads: “Uterus anteverted and normal- No gestational sac seen within the uterine cavity- Left ovary is normal and measures I2 mm. x 10 mm *8mm. Right ovary ls normal and measures 13 mm*9 mm*5 mm)There is a doughnut-shaped mass measuring 10 mm x 12 mm x 20 mm adjacent to the right ovary consistent with an ectopic pregnancy. No free fluid in the recto-uterine pouch. No adnexal tenderness or cervical excitation.The plasma beta-hCG concentration is 1300 IU/L.How should she be managed?

16. The incidence of clinically recognised miscarriage in pregnancy is about:  

17. The most common indication for women attending gynaecology emergency in the UK is:  

18. Which of the following routes of administration is inappropriate for the drug misoprostol:

19. A 20-year-old, who is at 12 weeks’ gestation, has a 2-day history of vaginal bleeding and  lower abdominal pain. Ultrasound shows a 25 mm fetal pole with absent fetal heart rate.  Pelvic examination reveals her cervix to be 4 cm dilated with bulging intact membranes.  Which one of the following is the most likely diagnosis?  

5.Which one of the following ultrasound descriptions is diagnostic of miscarriage (GS,  gestational sac; CRL, crown-rump length; FHR, fetal heart rate)?  

21. A patient with a positive pregnancy test, small amount of PV bleeding and no abdominal  pain present has a single transvaginal ultrasound scan, showing an intrauterine gestational  sac, with a crown-rump length (CRL) of 5 mm, with no fetal heart beat. Which of the  following would be the most appropriate management plan?  

22. Ms. XY is a primigravida who presents to the A + E department with dark-brown discharge  PV for 1 day and mild lower abdominal discomfort. She is 7/40 pregnant as per her LMP. Her TV scan shows the presence of a gestational sac and yolk sac with a fetal pole of 7.5  mm and no fetal heart activity. Which of the following treatment options are best suited to  her?  

23.Ms. XY is a primigravida who is 9/40 weeks’ pregnant and has confi rmed diagnosis of  missed miscarriage (she had 2 transvaginal scans a week apart). After discussion of the  various options, she opts for medical management for missed miscarriage. She is extremely  anxious about the discomfort associated with the procedure and has a low pain threshold.  Which of the following is appropriate for medical management of missed miscarriage?  

24. Ms. XY is 9/40 weeks’ pregnant. She presents to the early pregnancy clinic with a  history of a painful vaginal heavy bleed 96 h ago. Ultrasound reveals a live fetus at  9/40 weeks with a 5 × 5 cm subchorionic haematoma. Booking bloods reveal she is  A negative with no atypical antibodies.  Which of the following treatment options are best suited to her with regard to  administration of anti-D?  

25. A 28-year-old patient attends an early pregnancy unit for a reassurance scan at 8 weeks’  gestation. transvaginal views show a mean sac diameter of 3.5 cm and a CRL of 10 mm with  no visible heartbeat. T e internal os appears closed on scan and there is no vaginal bleeding.  What are the scan findings likely to suggest?  

26. A 20-year-old para 0 attends for an early pregnancy scan at 12 weeks. An embryo with a  CRL of 20 mm is identi ed with no fetal heart action seen. She opts for medical management.  What is the appropriate next step in management?  

 27. A primigravida who is 10 weeks pregnant is complaining of slight vaginal bleeding and the  occasional abdominal colic. Ultrasound showed a live singleton pregnancy corresponding to  her last menstrual period. She is worried about losing this pregnancy and asks for any  medication to help keep the pregnancy. She has read something about progesterone  treatment. How will you counsel her?  

28. A 20-year-old woman who was nine weeks into her first pregnancy has just had a complete miscarriage. She is distressed and very tearful. You have explained that miscarriage does not  affect her future fertility. Her partner is worried her anxiety may persist and be a possible cause of a delayed pregnancy. What else will you tell them?  

29. A woman who is 11+3 weeks pregnant complained of abdominal colic and an attack of  brisk vaginal bleeding. A repeat ultrasound confirmed fetal demise. You diagnosed inevitable  miscarriage. She is considering expectant management. How will you counsel her?  

30. A woman who is 11 weeks pregnant with confirmed miscarriage was very hesitant in deciding on medical or surgical management. She was still keen on avoiding the anaesthetic  and surgical risks, if possible. What will you tell her about her chances of not having surgery  .if she opts for medical management?