Early Pregnancy – SBA

1.Mrs. Sweetie 45-year-old woman has a hydatidiform mole evacuated uneventfully.

Now she is presenting with recurrent bleeding suspicious of Gestational trophoblastic neoplasia. Her pre-treatment hCG 1000 0IU/L, uterine tumour measuring 2x3cm, diagnosis occurred with in 4months of evacuation, CT scan confirms metastatic to brain.

Which one of the following factors is most likely to significantly increase the FIGO prognostic risk factor scoring for histologically diagnosed choriocarcinoma?

2. Mrs. Tina is 20 year old primigravida has presented with excessive nausea and vomiting. On further evaluation ultrasound shows cystic spaces with a Fetal pole suggestive of partial molar pregnancy .Which one of the following factors is characteristically associated with partial hydatidiform mole?

3. Mrs. Tina , 22 year old has presented to accident and Emergency with excessive vomiting . She is 12weeks pregnant in her first pregnancy .
She has got her ultrasound done .
looking at the image ,

The genetic karyotyping of this pregnancy would be

4. Mrs. Rasheeda , is an immigrant from INDIA, she is primigravida presented with vaginal bleeding . Bed side ultrasound showed snow storm appearance suggestive of molar pregnancy . What’s the incidence of molar pregnancy ?

5. Mrs. sadiya , 26year old presented with hyperemesis gravidarum. She has been. Admitted to hospital for Intravenous hydration with antiemetics.Her Liver function tests show as sightly increased bilirubin , with elevated liver enzymes . She has no jaundice what is the Incidence of raised LFts in women with Hyperemesis Gravidarum ?

6. Mrs.Rachel , 30 year old woman presented with excessive vomiting .she also gove history of retching and hematemesis .she has been grated with Antacids, since she wasn’t better with that she underwent Gastroduodenoscopy . The endoscopy image is enclosed .what is your diagnosis ?

7. Mrs.Tina.  34 year-old woman is admitted with  recurrent hyperemesis .she is  into her 8 weeks pregnancy . Her thyroid function tests are abnormal with a raised Free T3&T4  and low TSH. Select the most likely cause of her deranged thyroid function:

8. Regarding Accupresure treatment in Hypermesis all are true except

9. 24 year old woman at 21 weeks 3days has come to you to discuss her anomaly scan result which shows  Unilateral  talipes of left leg .No other  anomalies .she is insisting for termination of pregnancy as she cannot think of having a handicapped child  even after counselling .your consultant has discussed  and agreed for termination .she wants to wait for 2 weeks for her husband to arrive 

What is the most  important information u have to give her if she wants to delay for 2 weeks ?

10. 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

11. Mrs.. Tina at 9 weeks gestation has been diagnosed with missed miscarriage she is here for Manual vaccum aspiration as outpatient procedure . While consenting she asks you what’s the possibility of her requiring additional treatment ?

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

13. Mrs.Babitha, A 45-year-old women gravid 1 para 0 is referred to antenatal clinic for booking. She is here for dating scan. She is now 11 weeks’ pregnant and her booking bloods reveal normal haematological and biochemical tests. However, her downs screening test reveals

NT is 3.8mm

low levels of PAPPA

high levels of ß-hCG .

She is counselled for Chorionic Villus sampling .

She asks about chances of severe sepsis ?

14. 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, she is offered quadruple test .whatos the detection rate and false positive rate of this test ?

15. Julie, 26 year old has been treated for Cesarean scar pregnancy in her pregnancy has been treated by current age with uterine artery embolisation .

At the time of discharge she is asking about possibility of Cesarean scar pregnancy recurring again .

16. Ms, Tina ,A 22year old women presented with 6 weeks gestation, complains of mild pain abdomen with moderate vaginal bleeding .

Hemodynamically stable ,

 Abdomen and vagina examination is insignificant

Urine pregnancy test positive .

TVs scan- no intrauterine sac , both tubes &ovaries -Normal

No free fluid

What’s appropriate management plan?

17. Mrs. Rosy , 22year old woman primiparous at 14 weeks requesting for medical termination of pregnancy .her blood group is A Positive ,she has undergone counselling as well and she is sure of her decision

The recommended regimen all are true except

18. Regarding antibiotic prophylaxis all are true except

19. Mrs. sweetie , A 20 -year-old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. She has been treated for pelvic inflammatory disease three times in past . She also gives history of multiple sexual partners ,At laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility.

Which is the single best management option?

20. What is the most common statutory ground for abortions (abortion act 1967)inUk

21. All are true regarding abdominal ectopic pregnancy are true except

22. he most reported location for abdominal pregnancy is

23. In early pregnancy scan The embryonic pole is first Visualized beside yolk sac on day

24.The diagnosis of pregnancy of unknown viability in transvaginal scan , irrespective of woman’s Last menstrual period can be done in all except

25. The optimal timing for viability of Pregnancy In Ultrasound is

26. Mrs.Rubaa , 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. No free fluid in pelvis .

Ultrasound image is enclosed .

What is the most likely diagnosis?

27. Mrs. Angelina , A 23-year-woman had an ultrasound scan that was suggestive of a missed miscarriage. She underwent evacuation of the uterus and products of conception were sent for histology. The histology report confirmed that this had been a partial molar pregnancy.whats immediate follow-up plan you will advise on her discharge .

28. A 35year old woman has a long history of infertility and is contemplating assisted conception treatment. She asks you what is the risk of having a baby with trisomy 21 at her age?

29. You are asked to conduct An audit as number of tubal ectopic pregnancies diagnosed is increasing .Tosent national standard of incidence of tubal ectopic pregnancy u choose

30. Mrs. Lovely , 4o year old, is in her first pregnancy now she is 12 weeks pregnant . She is recently diagnosed as HIV positive not any medications as her Downs syndrome risk is high 1in 100. She is advised to get invasive prenatal tests .what is the risk of transmission of HIV to baby

31. A healthy 28-year-old, P0+2, has a 7-hour history of sudden-onset severe right-sided lower abdominal pain; her LMP was 6 weeks ago; periods are normally infrequent and irregular: 3–4/35–56 days. She and her partner have a past history of subfertility and are currently receiving clomiphene citrate 100mg for ovulation induction for anovulatory oligomenorrhoea. Her first pregnancy was an early miscarriage; the second was a left tubal pregnancy.

On examination: she looks pale and distressed; the abdomen is very tender in the lower half on the right side with rebound peritonism; no masses. Vaginal examination: normal sized uterus, no masses and cervical excitation tenderness is elicited.

Observations are as follows:

Pulse rate (bpm) 110

Temperature (ºC) 36.0

Blood pressure (mmHg) 120/50

Urine analysis has not passed urine

Respiratory rate (breaths/min) 14

O2 saturation on air (%) 96

What is the most appropriate investigation. Of choice is

32. Mrs. Joly ,is primigravida now 6 weeks pregnancy diagnosed with Missed miscarriage underwent surgical termination.Histopathologysho was partial Molar pregnancy . What is the most common symptom Mrs. Jolly can present with in case of persistent trophoblastic disease.

33. Mrs.Tina is 32 year old lady who gives history of 3 miscarriages at 20 , 22 and 24 weeks of gestation. She gives history of painful contraction followed by miscarriages. What could be the possible cause of miscarriage ?

34. Mrs, Tina is 20 years old primigravida presented with continued nausea and vomiting associated with ketonuria . Her first visit body weight was 60kgs ,today she weighs 55kgs , despite oral antiemetics what is Appropriate management

35. What is the route of Misoprostol with the earliest onset, fastest & longest duration of action?

36. You are teaching your junior colleagues about  Safe investigations in early pregnancy.one of the colleagues asks you about which investigation causes highest radiation exposure to fetus ?

37. Mrs. X has twin gestation, in early pregnancy, her ultrasound image enclosed.

What is the best parameter to diagnose chorionicity?

38. Mrs. X had a combined test showing 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?

39. Ms.X, 17 years old girl underwent surgical evacuation of molar pregnancy at 8 weeks .Karyotyoe is 46XX.Her Risk of needing chemotherapy is

40.Ms.X, 17 years old girl underwent surgical termination of pregnancy, what is her risk of developing GTN?

41. Miss Sarah is a P0+3 who had 3 early pregnancy loss as part of her routine recurrent miscarriage investigation she was diagnosed to have Antiphospholipid syndrome. What percentage of women with recurrent miscarriage have antiphospholipid antibodies?

42. Mrs. X, 46 years old is 7 weeks pregnant.She is really anxious as she has read there is increased risk of miscarriage for her age.What are the chances of miscarriage for her?

43. Mrs. X, 30 years old is in her second pregnancy, previous baby delivered by cesarean section at full dilatation. She is at 6 weeks and presents with lower abdominal pain and spotting. Transvaginal ultrasound shows a gestation sac distal to a closed internal cervical os. Cervix is barrel shaped. Doppler shows increased vascularity around gestational sac. Sliding sign is absent. What is the probable diagnosis?

44. Mrs.Renet has a history of recurrent miscarriage. All the investigations done for her came back as normal. She is concerned regarding her risk for future pregnancy. What is the risk for her to have another miscarriage?

45. For the screening test for Down syndrome the following results were obtained. What is the sensitivity of this test?

46. A sample of 10 women seeking prenatal care at Boston Medical center agree to participate in a study to assess the quality of prenatal care. At the time of study enrolment, you the study coordinator, collected background characteristics on each of the moms including their age (in years).

The data is shown below:

24        18        28        32        26        21        22        43        27        29

What is the median value?

48. In female fetus, Mullerian duct appears by which week?

48. Mrs.Tamara, 24 years old in her 2nd pregnancy of 12weeks gestation, diagnosed to have cesarean scar pregnancy. She had elective cesarean section in her first pregnancy. What could be the probable indication of first Cesarean having increased her risk of scar pregnancy?

49. What percentage of women do not attend appointment of IUC insertions post abortion?

51. Mrs. Ruby  Has been admitted with  recurrent admission for hypermesis . During her antenatal care  she is noticed to have small for gestational age . What s the incidence of women developing this ?