Answer 5

5.  Answer A is the correct answer.  The fallopian tube is the most common area that an ectopic pregnancy is found.

Question 5

5.  Where does the majority of ectopic pregnancies occur?

1. Fallopian Tube
2. Cervix
3. Ovary
4. Abdominal Cavity

Answer 4

4.  D is the correct answer. Chlamydia causes a cervicitis.  Candida causes a vaginitis and can be treated with Diflucan in a non pregnant patient.  Gardnarella and Trichomonas can be treated with Flagyl.

Question 4

4.   Which of the following is not a cause of vaginitis?

1. Candidia
2. Gardnarella
3. Trichomonas
4. Chlamyidia

Answer 3

3.  Answer C is the correct answer.  There is an increase of gallstones in pregnancy because of the increased levels of estrogen.  There is an increase of kidney  stones and pyelonephritis because of the uterus putting pressure on the ureter causing decreased urinary flow.  Round ligament pain is caused by the uterus growing and the ligament that attaches the uterus to the abdominal wall and stretches as the uterus grows.  This usually presents after 17-18 weeks.  Diverticulitis does not usually cause right sided abdominal pain in the pregnant female. 

Question 3

3.  All of the following causes right sided abdominal pain are increased in pregnancy in except:

1. Cholelithiasis
2. Kidney stones
3. Diverticulitis
4. Round Ligament Pain

Answer 2

2.  Answer C is the correct answer.  The uterus ascends out of the pelvis between 12 and 16 weeks.  It is not advised to try to attempt to get them before this point without an ultrasound.  It can be upsetting to the mother. 

Question 2

2.  At what point can you reasonably expect to assess fetal heart tones trans-abdominally with a doppler???

1. 4-6 weeks
2. 8-10 weeks
3. 12-16 weeks
4. It is impossible to assess fetal hear tones until the third trimester.

Answer 1

1.  Answer D is the correct answer.  It is impossible to rule out or rule in an ectopic pregnancy at this point.  The standard of care is to follow the quantitative HCG in 48 hours to see if it doubles.  The differential diagnoses in this patient are early intrauterine pregnancy not seen, incomplete miscarriage, or early ectopic pregnancy not seen yet.  If the quantitative HCG is increasing, it advised to follow the ultrasound to see if a fetal pole is visible.  If the quantitative HCG is over 1000-2000 a fetal pole should be visible.  There is no way to tell at this point if a D and C is indicated.

Question 1

1. Your patient is a 25 year old female that had a positive pregnancy test at home.  She presents with pelvic pain and vaginal bleeding.  Her LMP was approximately 5 weeks ago but she is not sure.  Her quantitative HCG is 746 and her pelvic ultrasound shows no fetal pole seen on ultrasound.  The remainder of the ultrasound is negative.  Which of the follow is the most correct action?

1. She unfortunately has miscarried.  Advise pelvic rest and bed rest.  Have her follow up with her OB in 2 weeks.
2. This is an incomplete miscarriage.  There has to be fetal remnants if the quantitative HCG is still up.  She is going to need a D and C.  Refer to OB and try to get her in a week.
3. This is an ectopic pregnancy.  Call OB and recommend an immediate laparoscopy and salpingectomy
4. Recommend follow up quantitative HCG in 48 hours with possible repeat ultrasound.   It is impossible to rule out an ectopic pregnancy at this point.