Molar Pregnancy/Ectopic Pregnancy Test Questions

1. Which of the following, by itself, is NOT a risk factor of ectopic pregnancy?
a. history of salpingitis (6x more likely)
b. age (ages 35-44 3x more likely)
c. IUD use (by itself is not a risk factor - increased incidence of PID with IUD use is risk factor)
d. previous ectopic pregnancy (10 x more likely)

2. Which of the following is accurate?
a. Complete molar pregnancies are less likely than partial molar pregnancies to be malignant. (false – molar pregnancies have a 15-30 percent malignancy rate, partial is <5)
b. Partial molar pregnancies result from the fertilization of an empty ovum by one or two sperm. (false – partial pregnancies are the result of a normal ovum fertilized by two sperm)
c. It is highly unlikely that a woman that conceives after age of 50 will experience a molar pregnancy and even if conception results in a molar pregnancy, it rarely is malignant. (false – 1 out of 3 pregnancies after the age of 50 are molar and of those molar pregnancies, 50% are malignant)
d. Complete molar pregnancies are more common than partial molar pregnancies. (True – 90% of molar pregnancies are complete)

3. Which of the following symptoms should raise a clinician’s index of suspicion for a complete molar pregnancy?
a. markedly elevated hCG (>100,000), hyperemesis gravidarum, uterus large for gestational age, vaginal bleeding that resembles prune juice, pre-eclampsia in the first trimester. (true - all are s/s of a complete molar pregnancy)
b. moderately elevated hCG for gestational age, hyperemesis gravidarum, uterus small for gestational age, vaginal bleeding that resembles prune juice, hyperthyroidism. (false – moderately elevated hCG and small for gestational age uterus are more indicative of partial)
c. markedly elevated hCG, lower abdominal pain, adenexal mass and expulsion of tissue resembling grape clusters. (false - lower abdominal pain/adnexal mass are s/s of ectopic pregnancy not molar pregnancy).
d. moderately elevated hCG, mild nausea and vomiting, uterus small to normal for gestational age, vaginal bleeding resembling prune juice, and expulsion of tissue resembling grape clusters. (false – complete molar pregnancies typically will have hcg >100,000, hyperemesis gravidarum, and a large for gestational age uterus).

4. Which of the following is true regarding methotrexate treatment for ectopic pregnancy?
a. Ectopic gestations > 5 cm are most effectively treated with methotrexate. (false – methotrexate is used for pregnancies <3.5cm).
b. Methotrexate is the best options for treating AD service women while deployed. (false – methotrexate is not an option in the deployed setting).
c. Monitoring for regression of hCG due to persistant trophoblstic activity is not necessary following administration of methotrexate. (false – monitoring of hCG is necessary and may indicate need for further methotrexate administration or surgery).
d. Methotrexate is an appropriate choice when ectopic gestations show no signs of rupture, no cardiac activity, and are <3.5> (all are appropriate indications for use of methotrexate).

5. Which of the following symptoms is least likely to be associated with ectopic pregnancy?
a. lower abdominal pain (80-90% present with this)
b. acute pelvic pain (75-90%present with this)
c. vaginal bleeding (65-85% present with this)
d. acute nausea and vomiting (not typically a presenting symptom strongly indicative of ectopic pregnancy, nausea present in only 15% of patients)
e. amenorrhea (75-95 present with this)