Ectopic & GTD

Question 1

What’s the risk of recurrence with ectopic pregnancy?

Answer 1

12-18%

Question 2

What is the chance of an ectopic in the normal population?

Answer 2

1/8000

Question 3

What is the chance of an ectopic in the fertiligy patient population?

Answer 3

1/1800

Question 4

Where should you always look for an ectopic pregnancy?

Answer 4

morrison’s pouch

Question 5

What is the ‘ring of fire’ sign?

Answer 5

Color doppler signal surrounding the gestational sac

Question 6

What is the most common site for an ectopic implantation?

Answer 6

ampulla of the ovaduct

Question 7

Adnexal implantation includes the…

Answer 7

isthmus, ampulla, fimbria, and interstitial areas.

Question 8

Which is the most life-threatening of all ectopic gestations?

Answer 8

interstitial ectopic

Question 9

This exists when the conceptus implants on any site within the uterus that is outside the endometrial cavity.

Answer 9

‘uterine’ ectopic pregnancy

Question 10

‘Uterine’ ectopic pregnancy is suggested by a gestational sac that high in the fundus and NOT surrounded by at least ___ of myometrium in all planes.

Answer 10

5 mm

Question 11

Cervical ectopics carry high ___ rates and attempts to evacuate the conceptus can cause ___.

Answer 11

morbidity and mortality, massive hemorrhage

Question 12

Why might a woman with an ectopic pregnancy have pain in her shoulder?

Answer 12

because of intraperitoneal hemorrhage

Question 13

This is a concomitant intrauterine implantation AND an extrauterine implantation.

Answer 13

heterotopic gestation

Question 14

About when does an isthmus ectopic rupture?

Answer 14

6-8 weeks

Question 15

About when does an ampullary ectopic rupture?

Answer 15

8-12 weeks

Question 16

About when does an interstitial ectopic rupture?

Answer 16

12-16 weeks

Question 17

This folic acid antagonist has been shown to destroy proliferating trophoblast and may be effective in small unruptured ectopics.

Answer 17

Methotrexate (MTX)

Question 18

This physical sign is usually associated with intraperitoneal bleeding from hemorrhagic pancreatitis, ruptured abd aorta or ruptured ectopic.

Answer 18

Grey-Turner sign

Question 19

What constitutes a Grey-Turner sign?

Answer 19

ecchymosis on the side of the abdomen

Question 20

This is when the conceptus trophoblast layers proliferates and not the embryoblast; no embryo develops.

Answer 20

gestational trophoblastic disease

Question 21

This abnormal fertilization process is a complication of pregnancy that is increased in older and very young women.

Answer 21

molar gestation

Question 22

Name two clinical indicators of molar gestation.

Answer 22

1. vaginal bleeding in the first or early second trimester

2. serum levels of beta-hCG are DRAMATICALLY elevated

Question 23

T/F? Women with a molar pregnancy may experience hyperemesis, preeclampsia, and PIH.

Answer 23

true

Question 24

T/F? Women with a molar pregnancy have AFP levels that are very high.

Answer 24

FALSE, very low

Question 25

T/F? Women with a molar pregnancy have a fundal height that is higher than dates.

Answer 25

true

Question 26

GTD affects how many pregnancies in the US?

Answer 26

1/1500 or 2000

Question 27

What is the characteric sonographic appearance of GTD?

Answer 27

the 'snowstorm', an echogenic mass containing cystic spaces

Question 28

This is the most common form of GTD.

Answer 28

Complete hydatidform mole

Question 29

How often does a complete mole happen in the US?

Answer 29

1:1500

Question 30

This is the most common form of GTD, occuring in 1/1500 and 5% risk of recurrence.

Answer 30

complete hydatidifom mole

Question 31

T/F? In a complete mole no identifiable fetal tissue is present.

Answer 31

true

Question 32

A complete mole occurs when sperm fertilizes an ___ ovum.

Answer 32

empty.

Question 33

A complete mole is completely ___ in origin.

Answer 33

paternal

Question 34

What are the risk factors for a complete mole?

Answer 34

1. under 20 or over 40 2. low economic status 3. deficient in protein & folic acid

Question 35

T/F? In the 2nd trimester, a complete mole is hypervascular, with high velocity and low resistance.

Answer 35

FALSE, 1st trimester

Question 36

T/F? In the 1st trimester, a complete mole will present with unilateral theca lutein cysts.

Answer 36

FALSE, bilateral

Question 37

T/F? In the 2nd trimester, a complete mole has areas of necrosis.

Answer 37

true

Question 38

In complete moles, these are an ovarian response to excess hCG secretion by the GTN.

Answer 38

theca lutein cysts

Question 39

This form of GTD is commonly found to have 1 set of maternal chromosomes and 2 sets of paternal chromosomes.

Answer 39

Partial mole

Question 40

This GTD occurs when the mass contains a severely defective embryo and abnormal cells.

Answer 40

Partial mole

Question 41

What is a triploid karyotype?

Answer 41

Three sets of chromosomes

Question 42

A partial mole results when...

Answer 42

Two sperms fertilize a single ovum.

Question 43

Partial miles present with...

Answer 43

1. Deformed gest. sac 2. Growth restricted triploid fetus 3. Large cystic placenta 4. Similar to a missed abortion

Question 44

This GTD is similar to a partial mole but with a normal karyotype fetus.

Answer 44

Mole with coexisting normal fetus

Question 45

This condition most commonly follows GTD.

Answer 45

Persistent trophoblastic neoplasia (PTN)

Question 46

This is another phrase for PTN.

Answer 46

Recurrence of molar tissue

Question 47

This is the most common form of PTN.

Answer 47

Invasive mole

Question 48

This GTD penetrates the myometrium; may cause rupture and hemoperitoneum.

Answer 48

Invasive mole

Question 49

This is considered a malignant, non metastatic form of GTD.

Answer 49

Invasive mole

Question 50

What's another term for invasive mole?

Answer 50

Chorioadenoma destruens

Question 51

This GTD presents as echogenic material that may extend into the myometrium with irregular sonolucent areas; 'lights up like a Christmas tree'.

Answer 51

Invasive mole

Question 52

This form of GTD is considered malignant and metastatic.

Answer 52

Choriocarcinoma

Question 53

This form of GTD is very rare, 1:30,000 pregnancies.

Answer 53

Choriocarcinoma

Question 54

How many GTD pregnancies give rise to choriocarcinoma?

Answer 54

1:40

Question 55

The GTD that leads to vascular invasion, hemorrhage, and necrosis of the myometrium is...

Answer 55

Choriocarcinoma

Question 56

This GTD presents with an enlarged uterus with a vascular irregular complex mass.

Answer 56

Choriocarcinoma

Question 57

T/F? Choriocarcinoma presents in non pregnant patients with an elevated hCG.

Answer 57

True

Question 58

Patients with choriocarcinoma are often counseled to avoid pregnancy for at least ___ to minimize the risks.

Answer 58

One year