Obstetrics & Gynecology 21

1. Question

Regarding ectopic pregnancy, all of the following are true, EXCEPT:

Is associated with uterine enlargement
Is situated in the ovary in about 0.5% of all cases
Is more dangerous when it is situated in the isthmus of the fallopian tube
Can only be diagnosed after it has ruptured
Is a complication of assisted conception

2. Question

Regarding ectopic pregnancy, all of the following are true, EXCEPT:

Is associated with uterine enlargement
Is situated in the ovary in about 0.5% of all cases
Is more dangerous when it is situated in the isthmus of the fallopian tube
Can only be diagnosed after it has ruptured
Is a complication of assisted conception.

3. Question

Abruptio placenta:

Is defined as premature separation of low lying placenta.
There is no increase risk of recurrence.
The etiology of placental abruption is usually known.
The diagnosis of placental abruption is frequently confirmed by ultrasound.
The most predisposing condition is chronic maternal Hypertension.

4. Question

Acceptable management of ruptured ectopic pregnancy

Observation followed by Methotrexate
Diagnostic laparoscopy followed by observation
Repeat ultrasound next 24 hours to confirm the diagnosis
Exploratory laparotomy and salpingectomy
Dilatation and curettage

5. Question

The following are factors affecting the choice of Methotrexate as a choice of treatment for ectopic pregnancy, EXCEPT:

Size of the ectopic
Presence or absence of cardiac activity
Level of β-hCG
Parity of the patient
Integrity of the tube

6. Question

Management of Placental Abruption includes all of the following EXCEPT:

Coagulation studies.
Expectant management in cases of IUFD.
Augmentation of labor.
Artificial rupture of Amniotic membrane.
Intensive I.V. fluid replacement.

7. Question

The following are factors affecting the choice of Methotrexate as a choice of treatment for ectopic pregnancy, EXCEPT:

Size of the ectopic
Presence or absence of cardiac activity
Level of β-hCG
Parity of the patient
Integrity of the tube

8. Question

The most common cause of ectopic pregnancy is:

History of pelvic inflammatory disease
Congenital anomalies of the tube
Endometriosis
Tubal surgery
Previous sterilization

9. Question

The most common risk factors for placental abruption:

Diabetes
Increased maternal age, Multiparity, hypertension & cigarette smoking.
Intrauterine growth retardation
Rh isoimmunization
Multiple pregnancy.

10. Question

The most common cause of ectopic pregnancy is:

History of pelvic inflammatory disease
Congenital anomalies of the tube
Endometriosis
Tubal surgery
Previous sterilization

11. Question

Lower abdominal pain and six weeks gestation:

Vaginal examination is contraindicated.
Right iliac fossa pain is diagnostic of appendicitis.
Placental abruption should be considered.
Could be gallstones.
USS has reliable diagnostic information.

12. Question

The following is a contraindication for the use of amnio-hook:

Plcenta previa
Abruptio placenta
Breech presentation
IUGR
Face presentation

13. Question

Following evacuation of a molar pregnancy, β-hCG titers will fall to untraceable levels in about 90% of patients within:

2 weeks.
4 weeks.
8 weeks.
10 weeks
12 weeks.

14. Question

The endometrial change of ectopic pregnancy:

Glandular cystic hyperplasia
Decidual transformation
Secroteraty changes with chorial cell
Atypical hyperplasia
Proliferation endometrium

15. Question

Regarding Abruptio placenta:

Is defined as premature separation of low lying placenta
There is no increase risk of recurrence
The etiology of placental abruption is usually known
The diagnosis of recent placental abruption is frequently confirmed by ultrasound
Chronic maternal hypertension is a known cause.

16. Question

A 25 year-old G3 P1+1 presents to the emergency room complaining of lower abdominal crampy pain 6 weeks form he last normal period. She had significant vaginal bleeding but no passage of tissue & pregnancy test is Positive. The patient’s most likely diagnosis is:

Incomplete abortion.
Complete abortion.
Missed abortion.
Threatened abortion.
Ectopic pregnancy.

17. Question

In ectopic pregnancy :

The ovarian ectopic pregnancy is the most common site
More than 90% of ectopic pregnancies occurs in the fallopian tube
The majority of tubal pregnancies occurs in the fimbria
The most common symptoms of ectopic pregnancy is vaginal bleeding without abdominal pain
Pregnancy test is negative more than 90% of the cases

18. Question

Management of placental abruption includes all of the following EXCEPT:

Coagulation studies
Tocolytic drugs if the baby is premature
Augmentation of labor
Artificial rupture of amniotic membrane
Intensive intravenous fluid replacement

19. Question

A 25 year-old G3 P1+1 presents to the emergency room complaining of lower abdominal crampy pain 6 weeks form he last normal period. She had significant vaginal bleeding but no passage of tissue & pregnancy test is Positive. The most important step in this patient’s evaluation should be:

Sonography.
Physical exam.
CBC.
Quantitative β-hCG.
Detailed menstrual history.

20. Question

Which of the following is a contraindication to medical treatment in ectopic pregnancy?

An intact tubal pregnancy.
The size is less than 3cm.
The presence of hemoperitonium.
The absence of fetal cardiac activity.
A serum β-hCG of 1500.

21. Question

The followings are causes of Antepartum hemorrhage EXCEPT:

Abruptio placenta
Placenta brevia
Cervical polyp
Vasa previa.
Rh isoimmunization.

22. Question

A 25 year-old G3 P1+1 presents to the emergency room complaining of lower abdominal crampy pain 6 weeks form he last normal period. She had significant vaginal bleeding but no passage of tissue & pregnancy test is Positive. Transvaginal Ultrasonography would most likely reveal:

Fetal heart motion.
An intact gestational sac.
A discrete yolk sac motion.
A Thickened endometrium with gestational sac.
Fetal heart motion in the adnexia.

23. Question

The quantitative β subunit of HCG in a serum of patient with ectopic pregnancy will :

Rise in a rate greater than expected.
Rise at rate consistent with the normal curve.
Rise at a slower than expected.
Plateau.
Progressively fall.

24. Question

Extensive bleeding into the myometrium & beneath the uterine serosa in severe cases of abruption placenta may result in :

A couvelaire uterus.
Active uterus
Placental perfusion
Normal fetal heart rate
Reactive CTG tracing

25. Question

The most common symptom of ectopic pregnancy is :

Profuse vaginal bleeding.
Abdominal pain.
Syncope.
Dyspareunia.
Decreased pregnancy associated symptoms.

26. Question

Antepartum haemorrhage may be caused by the following, EXCEPT:

Placenta previa
Cervical cancer
Abruptio placenta
Ectopicpregnancy
Vasa praevia

27. Question

Which of the following is NOT a complication of abruption placenta ?

Postpartum hemorrhage
Consumptive hemorrhage
Fetal demise
Acute renal failure
Subsequent ectopic

28. Question

Acceptable management of possible rupture ectopic pregnancy would include all of the following EXCEPT:

Exploratory laparotomy.
Diagnostic laparoscopy.
Partial salpingectomy.
Total salpingectomy.
Observation followed by Methotrexate.

29. Question

Each of the following typical feature of placenta previa, EXCEPT:

Painless bleeding
First episode of bleeding is usually self limited
May be associated with post coital bleeding
Commonly associated with coagulopathy
The uterus tends to be soft and non-tender

30. Question

One of the following contraindications for the use of amnio-hook :

Placental previa
Abruptio placenta
Breech presentation
IUGR
Face presentation

31. Question

The commonest site of ectopic pregnancy is :

Peritoneal cavity
Mesosalpinx
Ovary
Ampulla of the fallopian tube
Isthmus portion of the fallopian tube

32. Question

A 33 year old woman at 37 weeks gestation confirmed by early sonogram presents with moderate to sever vaginal bleeding, and is note by sonogram to have placenta previa, which of the following is the best management for her.

Induction of labor
Give tocolytic drugs
Caesarean section
Expectant management
Artificial rupture of the membrane

33. Question

Which of the following signs is most useful in predicting the absence of placental abruption following trauma :

Absence of uterine contraction
Absence of vaginal bleeding
Presence of normal fetal heart tones
Absence of tense , painful uterus
Absence of nausea and vomiting

34. Question

Repeated 2ND trimester abortions, especially when associated with a lack of painful uterine contractions, suggests most strongly:

Defective germ plasm.
Uterine myoma.
Maternal hyperthyroidism.
Folic acid deficiency.
Incompetent cervical os.

35. Question

Etiological factor of ectopic pregnancy include all of the following EXCEPT:

Gonococcal Salpangitis
Tubal surgery
Combined OCP
TB salpingitis
Previous ectopic

36. Question

Regarding Abruptio placenta:

Postpartum hemorrhage occurs only when there in hypofibrinogenemia
Maternal anemia is a major cause for abruptio placenta
Fetus is not usually affected
Associated with antecedent hypertension
On Examination the abdomen is usually soft and lax

37. Question

24 -year- old patient ( G2 P1 + 0 ). At 34 weeks of gestation presented to emergency with vaginal bleeding. Which one of the following is NOT TRUE ?

Admit the patient
Resuscitate the patient
Do digital examination immediately
Cross-match blood
Do ultrasound

38. Question

Inevitable abortion is usually associated with all of the following EXCEPT:

Pain.
Dilated cervix.
Bleeding.
Fever.
The pregnancy is almost doomed.

39. Question

In ectopic pregnancy :

Rarely diagnosed before 12 weeks of gestation
Usually present as obstetric emergency before 12 weeks gestation
IM progesterone is useful
50% continued up to term

40. Question

Regarding Placenta previa:

Is diagnosed when the placenta occupies the funds and start to bleed
Recognized to be complicated by postpartum hemorrhage
The fetal heart rate is usually abnormal.
Less common in patients with repeat caesarian section
Diagnosis is confirmed when bleeding starts at 13 weeks of gestation

41. Question

In the management of placenta previa centralis :

Once diagnosis is made, the treatment should urgent caesarean section
Patient may stay at home if she is living near the hospital
Vaginal examination should be done carefully to confirm diagnosis
If the pregnancy has advanced to 37 weeks, it is usually best to perform C/S
If the baby is premature liberal blood transfusion is the treatment of choice for severe hemorrhage

42. Question

Threatened abortion is characterized by:

The presence of empty sac by ultrasound.
Disappearance of pregnancy symptoms.
Passage of vaginal vesicles.
The cervix is affected.
Vaginal bleeding

43. Question

Patient with ectopic pregnancy:

Present with heavy per-vaginal bleeding
Methotrexate is the treatment of the choice in patient with ruptured one
May complain of shoulder pain.
Present with cardio vascular collapse in all the cases
Never have fainting attacks.

44. Question

In placenta previa: Which is true?

It is common primigravida
May cause abnormal lie
Causes recurrent painful bleeding
All patients should be induced with prostaglandin pessaries
Digital examination is mandatory to exclude local causes

45. Question

In spontaneous abortion:

Uncontrolled blood sugar increases the risk of abortion in diabetic patients.
If the patient has mild bleeding with opened internal os this is considered to be threatened abortion.
Cervical incompetence is the most common cause of abortion in the 1ST trimester.
History of bleeding & passing of tissue per vagina indicates the need for curettage without the need for US.
D & C should be done immediately once missed abortion is diagnosed.

46. Question

In the management of ectopic pregnancy:

β-hCG titer has a role in the Dx & management of ectopic pregnancy.
D&C is the treatment of choice
Methotrexate should be used if the patient hemodynamically unstable
Shoulder pain is referred from bowel irritation
The presence of severe bleeding is an indication of conservative management

47. Question

Antepartum hemorrhage: Which is true?

Is any bleeding from the genital tract during any stage of pregnancy
Requires assessment by vaginal examination
May be caused by cervical carcinoma
Is always painless
All patients should be delivered by Caesarian Section

48. Question

Early bleeding in pregnancy may be caused by the following, EXCEPT:

Incomplete abortion
Cervical cancer
Threatened abortion
Ectopic pregnancy
Vasa praevia

49. Question

Methotrexate Treatment in ectopic is contraindicated if:

β-hCG < 1500
No fetal heart.
Hemoperitonium
Gestational sac < 3 cm

50. Question

A pregnant woman presents with a placenta praevia of a major defect and fetus is malformed. Which of the following will be the best management?

Caesarian section
Oxytocin drip
Rupture of membranes
Induce with PG E2
Forceps delivery in the second stage to accelerate delivery.