EBCOG PART 1 – HIGH YIELD QUESTIONS – EARLY PREGNANCY (SBA)

1. What is the diagnostic tool of choice for tubal ectopic pregnancy?

A. Laparoscopy
B. MRI of pelvis
C. Serial β-human chorionic gonadotropin (β-hCG) measurements
D. Transabdominal ultrasound
E. Transvaginal ultrasound

2. What proportion of ectopic pregnancies occur in the interstitial portion of the fallopian tube?

A. 1–6%
B. 7–10%
C. 11–16%
D. 17–20%
E. 21–26%

3. A woman attends the early pregnancy unit having experienced some discomfort and vaginal bleeding in early pregnancy. It is 6 weeks since her last menstrual period. She is actively trying to conceive. A transvaginal ultrasound scan is performed, but there is no evidence of an intrauterine gestation sac. Her serum β-hCG level is 1200 IU/l. The β- hCG is repeated after 48 hours and is 950 IU/l. What is the most appropriate management?

A. Diagnostic laparoscopy
B. Discharge the patient
C. Medical therapy with methotrexate
D. Perform a urinary pregnancy test in 2–3 weeks
E. Repeat a further β- hCG in 48 hours

4. A woman attends the early pregnancy unit with a small amount of per vaginam spotting. It is 7 weeks since her last menstrual period, but her cycle is irregular. A transvaginal scan is performed, which shows an intrauterine gestation sac measuring 15 mm in diameter. A follow- up scan is arranged 14 days later, which shows a gestation sac with a diameter of 24 mm. There is now a yolk sac visible with a fetal pole with a crown–rump length of 7 mm, but no fetal heartbeat is visible. What is the diagnosis?

A. Incomplete miscarriage
B. Missed miscarriage
C. Pregnancy of unknown location
D. Pregnancy of unknown viability
E. Viable intrauterine pregnancy

5. What proportion of miscarriages occur after the identification of fetal heart activity?

A. <5%
B. 5–8%
C. 9–12%
D. 13–17%
E. 18–24%

6. Which objective and validated index is typically used to classify the severity of nausea and vomiting in pregnancy (NVP)?

A. Morning sickness evaluation score
B. Korttila scale
C. Pregnancy-unique quantification of emesis (PUQE)
D. Rhodes index of nausea, vomiting and retching
E. Value of eMesis score (VOMS)

7. At what gestation do the symptoms of NVP typically peak?

A. 4 weeks
B. 7 weeks
C. 9 weeks
D. 12 weeks
E. 15 weeks

8. Which abnormality of acid–base balance is most commonly seen in women with NVP?

A. Metabolic acidosis
B. Metabolic acidosis with respiratory compensation
C. Metabolic alkalosis
D. Respiratory acidosis
E. Respiratory alkalosis

9. What is the most appropriate solution for intravenous rehydration in women with NVP?

A. 5% dextrose
B. Hartmann’s solution
C. Human albumin solution 4%
D. Normal saline 0.9%
E. Normal saline 0.9% with potassium chloride

10. What proportion of women with hyperemesis gravidarum have abnormal thyroid function tests?

A. 10%
B. 33%
C. 50%
D. 66%
E. 90%

11. A 25-year-old woman with no live births attends the recurrent miscarriage clinic. She has had three first-trimester miscarriages in the past. During consultation, she enquires about her chances of a successful pregnancy when she next becomes pregnant. Which figure should be quoted?

A. 20%
B. 40%
C. 60%
D. 80%
E. 100%

12. What proportion of parents with recurrent miscarriage will be found to have a balanced chromosomal translocation if peripheral blood karyotyping is performed?

A. 2%
B. 12%
C. 22%
D. 32%
E. 42%

13. What is the most common symptom in women who develop gestational trophoblastic disease after a miscarriage?

A. Breast engorgement
B. Nausea and vomiting
C. Passing tissue vaginally
D. Symptoms of hyperthyroidism
E. Vaginal bleeding

14. A woman who is rhesus negative is diagnosed with a molar pregnancy and undergoes surgical evacuation of the uterus. Histological analysis confirms this to be a complete molar pregnancy. In terms of anti- D prophylaxis, what is the most appropriate management?

A. Administer 250 IU anti-D
B. Administer 1500 IU anti-D
C. Anti-D is not required
D. Arrange paternal genetic testing
E. Perform a Kleihauer test

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

A. Less than1 %
B. 1–2 %
C. 5–10 %
D. 10–20 %
E. 20–30 %

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

A. Bleeding in early pregnancy
B. Missing IUCD
C. Pain in the lower abdomen
D. Pelvic organ prolapse
E. Urinary incontinence

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

A. Oral
B. Subdermal
C. Sublingual
D. Rectal
E. Vaginal

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

A. Mean GS diameter 25 mm, with no obvious yolk sac or fetal pole
B. Mean GS diameter 25 mm containing a fetal pole with CRL = 3 mm without evidence of FHR
C. Mean GS diameter 40 mm containing a fetal pole with CRL = 7 mm with evi- dence of FHR
D. No identiﬁable intrauterine or extrauterine GS with serum βhCG 200 IU/L
E. No identiﬁable intrauterine or extrauterine GS with serum βhCG 1500 IU/L

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?

A. Cervical incompetence
B. Incomplete miscarriage
C. Inevitable miscarriage
D. Pregnancy of uncertain viability
E. Threatened miscarriage

20. 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?

A. Ectopic adnexal mass is 5 × 4 cm in size.
B. Initial serum hCG 1000 IU/L.
C. Presence of fetal heart beat in ectopic pregnancy.
D. Ultrasound evidence of haemoperitoneum >50 mL.
E. The woman has had previous salpingectomy so further salpingectomy surgery is contraindicated.