Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 7
Ectopic Pregnancy

7–1. An ectopic or extrauterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity. Such pregnancies account for what percentage of reported pregnancies in the United States?

a. 2

b. 4

c. 5

d. 6

7–2. Most ectopic pregnancies implant in the fallopian tube. Where is the LEAST common fallopian tube implantation site?

a. Fimbria

b. Isthmus

c. Ampulla

d. None of the above

7–3. Which of the following carries the highest risk of subsequent ectopic pregnancy?

a. Smoking

b. Prior ectopic pregnancy

c. More than five lifelong sexual partners

d. Positive test result for cervical Chlamydia trachomatis

7–4. Smoking more than one pack of cigarettes daily increases the risk of ectopic pregnancy by what amount?

a. Twofold

b. Fourfold

c. Sixfold

d. Eightfold

7–5. The levonorgestrel-releasing intrauterine system (Mirena) has a 5-year cumulative pregnancy rate of 0.5 per 100 users. What percentage of these pregnancies are ectopic?

a. 20

b. 30

c. 50

d. 70

7–6. In a woman with known risk factors for an extrauterine pregnancy who presents with amenorrhea, which of the following symptoms may suggest an ectopic pregnancy?

a. Breast tenderness

b. Pain with defecation

c. Vaginal bleeding and abdominal pain

d. All of the above

7–7. Inappropriately rising serum β-human chorionic gonadotropin (hCG) levels only indicate a dying pregnancy, not its location. With a robust uterine pregnancy, serum β-hCG levels should increase by which of the following percentage ranges every 48 hours?

a. 23 to 46 percent

b. 53 to 66 percent

c. 63 to 76 percent

d. 73 to 86 percent

7–8. Using transvaginal sonography, this gestational structure is usually first visible between which of the following weeks of gestation?

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Reproduced, with permission, from Dashe J, Moschos, E, Hoffman BL: Sonographic findings of early intrauterine pregnancy (update). In Cunningham FG, Leveno KL, Bloom SL, et al (eds): Williams Obstetrics, 22nd ed. Online. Accessmedicine.com. New York, McGraw-Hill, 2007, Figure 3.

a. 4.5 and 5 weeks

b. 5 and 6 weeks

c. 5.5 and 6 weeks

d. After 6 weeks

7–9. A lower-limit serum β-human chorionic gonadotropin (β-hCG) concentration is selected to represent the discriminatory value at which transvaginal sonography can reliably visualize pregnancy? This value may vary by institution but is usually one of which number pairs listed below?

a. 1500 or 2000 IU/L

b. 2500 or 3000 IU/L

c. 4500 or 5000 IU/L

d. 5500 or 6000 IU/L

7–10. The absence of an uterine pregnancy by sonography and a serum β-hCG levels ABOVE the discriminatory value may signify which of the following?

a. An ectopic pregnancy

b. An incomplete abortion

c. A resolving completed abortion

d. All of the above

7–11. In this image, a yolk sac is seen within a gestational sac that is adjacent to an ovary. This image most likely represents which of the following?

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a. An intracervical pregnancy

b. A normal intrauterine pregnancy

c. A pregnancy within the fallopian tube

d. An intraligamentous pregnancy

7–12. In Question 7-11, the cystic mass seen within this ovary most likely represents which of the following?

a. Endometrioma

b. Theca lutein cyst

c. Serous cystadenoma

d. Corpus luteum cyst

7–13. A woman presents with a serum β-hCG level exceeding 2500 IU/L, vaginal bleeding, and abdominal pain. This laparoscopic photograph illustrates which of the following?

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Photograph contributed by Dr. Kevin Doody.

a. A right ovarian mass

b. An intrauterine pregnancy

c. A right interstitial pregnancy

d. A distended right tubal ampulla

7–14. In women presenting with a positive urine pregnancy test result plus abdominal pain with or without vaginal bleeding, use of which of the following strategies helps diagnose a pregnancy of unknown location?

a. Transvaginal sonography

b. Dilatation and curettage

c. Quantitative serum β-hCG measurement

d. All of the above

7–15. Without intervention, an ectopic tubal pregnancy can lead to which of the following?

a. Tubal rupture

b. Spontaneous resolution

c. Expulsion of products of conception through the tubal fimbria

d. All of the above

7–16. In the medical management of ectopic pregnancy, a predictor of success for the use of single-dose methotrexate includes which of the following?

a. Fetal cardiac activity

b. Concomitant use of folinic acid

c. An ectopic mass greater than 3.5 cm

d. An initial serum β-hCG value <5000 IU/L

7–17. Methotrexate is often used in the medical management of selected ectopic pregnancies. The agent methotrexate is which of the following?

a. A protease inhibitor

b. A monoclonal antibody

c. A folic acid antagonist

d. A vascular endothelial growth factor antagonist

7–18. The use of methotrexate to medically treat ectopic pregnancy is contraindicated in which of the following settings?

a. Renal dysfunction

b. Breastfeeding

c. Hemodynamic instability

d. All of the above

7–19. One of the most common side effects of methotrexate includes which of the following?

a. Myelosuppression

b. Pulmonary damage

c. Anaphylactoid reaction

d. Transient liver dysfunction

7–20. For carefully selected patients, medical management of ectopic pregnancy using methotrexate is associated with what overall resolution rate?

a. 30 percent

b. 50 percent

c. 80 percent

d. 90 percent

7–21. Close monitoring of the patient receiving single-dose intramuscular methotrexate for the management of an ectopic pregnancy includes the comparison of serum β-hCG levels on which of the following schedules?

a. Day 1, 2, and 3

b. Day 1, 4, and 7

c. Day 4, 7, and 10

d. None of the above

7–22. During the first few days following methotrexate administration for ectopic pregnancy, which of the following symptoms can be expected in up to half of all patients?

a. Syncope

b. Polyuria

c. Abdominal pain

d. Increased vaginal bleeding

7–23. Contraception is recommended after successful medical therapy with methotrexate, as this drug has been shown to persist in human tissue for up to how many months after a single intramuscular dose?

a. 2 months

b. 4 months

c. 8 months

d. 16 months

7–24. In a number of randomized trials, single-dose intramuscular methotrexate compared with laparoscopic salpingostomy found similar outcomes with regard to which of the following?

a. Treatment complication rates

b. Health-related quality of life

c. Tubal patency and subsequent uterine pregnancy

d. None of the above

7–25. One of the criteria that should be met to diagnose an ovarian ectopic pregnancy includes which of the following?

a. The ipsilateral tube is incorporated into the pregnancy mass.

b. The ectopic pregnancy is connected by the mesoteres to the uterus.

c. Histologically, ovarian tissue is identified in the gestational sac wall.

d. All of the above

7–26. Although this location for an ectopic pregnancy is rare, risk factors compared with other ectopic pregnancy sites are similar. Of the following, what is a specific risk factor for this type of ectopic pregnancy?

Image

Figure B: Photograph contributed by Dr. Jennifer Muller. Reproduced with permission from Hoffman BL, Horsager R, Roberts SW, et al: Williams Obstetrics 23rd Edition Study Guide. New York, McGraw-Hill, 2011, Figure 10-4.

a. Prior intrauterine device use

b. Prior medical abortion

c. Prior cesarean delivery

d. Prior ipsilateral salpingectomy

7–27. Sonographic criteria that support the diagnosis of a cervical ectopic pregnancy include all EXCEPT which of the following?

a. A comma-shaped uterine contour

b. Absent intrauterine gestational tissue

c. Gestational tissue at the level of the cervix

d. A portion of the endocervical canal seen interposed between the gestation and the endometrial canal

7–28. Cesarean scar pregnancy can often be sonographically diagnosed if four criteria are satisfied. These include all EXCEPT which of the following?

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a. An empty uterine cavity

b. An empty cervical canal

c. A gestational sac in the anterior part of the uterine isthmus

d. Normal myometrium between the bladder and gestational sac

Chapter 7 ANSWER KEY

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