Ectopic Pregnancy and Gestational Trophoblastic Disease MCQs

Obstetrics & Gynaecology · 147 free questions with answers & explanations.

1. A 24-year-old woman presents to the emergency department with left lower abdominal pain and vaginal spotting. She is 7 weeks amenorrhoeic. Serum β-hCG is 2200 mIU/mL. Transvaginal ultrasound shows no intrauterine pregnancy and a small amount of free fluid in the pouch of Douglas. She is hemodynamically stable. What is the MOST appropriate next step?
2. A 27-year-old woman is confirmed to have a 3 cm left tubal ectopic pregnancy. She is hemodynamically stable, β-hCG is 1800 mIU/mL, no cardiac activity on ultrasound, and no contraindications to methotrexate. Single-dose methotrexate is administered. On day 4 post-treatment, the β-hCG is 1950 mIU/mL. What is the CORRECT interpretation and action?
3. A 22-year-old woman presents 3 months after suction evacuation of a molar pregnancy with vaginal bleeding. Serum β-hCG is 8500 mIU/mL (was undetectable 6 weeks ago). Chest X-ray shows 3 pulmonary nodules. Pelvic ultrasound reveals a heterogeneous intrauterine mass with increased vascularity. Which diagnosis is MOST likely?
4. A 19-year-old woman presents at 16 weeks with uterus size large for dates, hyperemesis gravidarum, and vaginal bleeding. Ultrasound shows a 'snowstorm' appearance without a fetal pole. β-hCG is 450,000 mIU/mL. Which of the following karyotypes is MOST likely for a complete hydatidiform mole?
5. A 26-year-old woman 6 weeks after hydatidiform mole evacuation has plateaued serum β-hCG levels (three consecutive weekly readings: 210, 218, 205 IU/L). Ultrasound shows no intrauterine mass. Chest X-ray is normal. According to FIGO 2000 GTD criteria, she has:
6. A haemodynamically stable woman with a 2.8 cm right tubal ectopic pregnancy and serum β-hCG of 1,800 IU/L desires future fertility. No cardiac activity is seen on transvaginal ultrasound. The MOST appropriate management is:
7. A patient with complete hydatidiform mole undergoes suction evacuation. Post-evacuation, her β-hCG falls from 85,000 IU/L to 420 IU/L over 8 weeks but then rises to 960 IU/L on week 10. CT thorax shows two 1.5 cm pulmonary nodules. WHO score is 4. The MOST appropriate treatment is:
8. A 30-year-old woman with a previous salpingectomy for left ectopic pregnancy presents with 6 weeks amenorrhea and beta-hCG of 2400 IU/L. Transvaginal ultrasound shows an empty uterus and no adnexal mass. What is the MOST appropriate next step?
9. A 27-year-old woman is diagnosed with gestational trophoblastic neoplasia (GTN) after molar evacuation. Beta-hCG plateau at 500 IU/L for 3 consecutive weekly measurements at 10 weeks post-evacuation. She is WHO scoring 4, FIGO Stage I. What is the APPROPRIATE management?
10. In WHO scoring of gestational trophoblastic neoplasia, which of the following INCREASES the prognostic score the MOST (2 points)?
11. A woman presents with 6 weeks of amenorrhea, beta-hCG 2400 mIU/mL, and transvaginal ultrasound showing no intrauterine pregnancy but a 2.5 cm adnexal mass with complex echogenicity and no fetal heartbeat. She is hemodynamically stable. What is the beta-hCG threshold (discriminatory zone) above which a normal intrauterine pregnancy should be visible on TVUS?
12. Following molar evacuation, a patient with complete hydatidiform mole shows the following beta-hCG pattern: Day 0 = 80,000, Day 14 = 10,000, Day 28 = 8,200, Day 42 = 7,900. According to FIGO 2000 criteria, this pattern indicates gestational trophoblastic neoplasia (GTN). Which FIGO criterion is met?
13. A 28-year-old woman is diagnosed with non-metastatic gestational trophoblastic neoplasia (FIGO Score 4) post-complete mole. She desires future fertility. Which is the FIRST-LINE chemotherapy regimen?
14. Placental site trophoblastic tumor (PSTT) differs from gestational choriocarcinoma in all of the following respects EXCEPT:
15. A 26-year-old presents with 7 weeks amenorrhoea, mild left pelvic pain, and a serum β-hCG of 2,200 mIU/mL with an empty uterus on transvaginal ultrasound. The adnexa are not visualised. She is haemodynamically stable. According to ACOG criteria, which best guides the decision to administer methotrexate?
16. A 32-year-old has serum β-hCG of 45,000 mIU/mL. Ultrasound shows a snowstorm appearance with no fetal parts. She undergoes suction evacuation for complete hydatidiform mole. Histology confirms diploid 46,XX chromosomal complement with diffuse trophoblastic proliferation, complete absence of fetal/embryonic tissue, and cisternae formation. Post-evacuation β-hCG plateaus at 2,400 mIU/mL for 3 consecutive weeks at 8 weeks post-evacuation. What is the diagnosis and next management step?
17. A woman 4 months post-complete hydatidiform mole evacuation develops haemoptysis. CXR shows multiple pulmonary nodules. β-hCG is 180,000 mIU/mL. She has no prior chemotherapy. WHO/FIGO prognostic scoring: antecedent pregnancy = mole (0), interval 4–6 months (1), pre-treatment hCG 100,000–999,999 mIU/mL (4), largest tumour size ≥ 5 cm (2), site of metastasis = lung (4), number of metastases 1–4 (1), prior chemotherapy = none (0). Total score is 12. What defines this as 'ultra-high risk' and what is the appropriate initial chemotherapy?
18. In gestational trophoblastic neoplasia (GTN), the WHO prognostic scoring system is used to guide treatment. A patient has a score of 5 based on: age >40, serum β-hCG 40,000 IU/L at 6 months after antecedent pregnancy, liver metastasis, and prior chemotherapy. The correct classification and initial treatment is:
19. Methotrexate treatment for unruptured ectopic pregnancy is MOST likely to fail (require surgical intervention) in which of the following clinical scenarios?
20. Complete hydatidiform mole (CHM) is distinguished from partial mole (PHM) in which of the following sets of features?
21. A 28-year-old woman is diagnosed with gestational trophoblastic neoplasia (GTN) post-molar pregnancy. She has beta-hCG of 12,000 mIU/mL at 6 weeks post-evacuation with a plateau (less than 10% rise or fall) over 3 weeks. FIGO anatomic staging shows disease confined to the uterus (Stage I). WHO scoring gives her a total of 3. What is the most appropriate first-line treatment?
22. Regarding the heterogeneity of gestational trophoblastic disease, a 40-year-old woman develops GTN 14 months after a term pregnancy (non-molar). Her WHO/FIGO score is calculated at 9 (high-risk). Which factor specifically differentiates the gestational origin of this trophoblastic tumor from a primary choriocarcinoma arising from ovarian germ cells?
23. A 31-year-old woman presents at 7 weeks gestation with vaginal bleeding and an adnexal mass. Beta-hCG is 3,200 mIU/mL. Transvaginal ultrasound shows an empty uterus and a 2.5 cm left adnexal mass with a yolk sac sign. She is hemodynamically stable. Methotrexate single-dose protocol (50 mg/m²) is administered. On day 4, she reports increased pain. Beta-hCG on day 4 is 3,600 mIU/mL (increase from baseline). What is the most appropriate interpretation?
24. Regarding methotrexate (MTX) treatment for ectopic pregnancy using the single-dose protocol, which criterion is correctly defined as a contraindication to medical management?
25. A 27-year-old woman has a complete hydatidiform mole evacuated. Post-evacuation beta-hCG plateau at week 4 (less than 10% decline over 3 consecutive weekly values). According to FIGO 2021 criteria for gestational trophoblastic neoplasia (GTN), what is the scoring system used to determine treatment intensity?
26. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in several key ways. Which characteristic is unique to PSTT?
27. In the management of interstitial (cornual) ectopic pregnancy, which intervention is preferred over salpingectomy and why?
28. A 27-year-old woman with a previous cesarean scar has 7 weeks amenorrhea, a positive pregnancy test, and ultrasound shows a gestational sac implanted in the lower anterior uterine segment at the scar site with no fetal heartbeat. β-hCG is 12,500 IU/L. This is a cesarean scar pregnancy (CSP). According to the Vial classification, this particular type where the sac is embedded deeply in the scar with risk of uterine rupture is:
29. In gestational trophoblastic neoplasia (GTN), the 2000 FIGO scoring system guides chemotherapy selection. A patient with a score of 7 following a term pregnancy (with score contribution from site) has 'intermediate risk' GTN. According to the FIGO 2000 scoring system, which factor contributes the MOST points in a high-score (≥7) situation?
30. A patient treated with single-agent methotrexate for low-risk GTN shows a rise in hCG of 10% over 3 consecutive weekly measurements. This is considered treatment failure. The next step in management is:
31. Placental site trophoblastic tumor (PSTT) differs from other gestational trophoblastic neoplasias in its sensitivity to chemotherapy. The key distinguishing biomarker that is characteristically normal or minimally elevated in PSTT is:
32. A woman treated with single-dose methotrexate (50 mg/m²) for an unruptured ectopic (beta-hCG 2,100 IU/L) has a 5% drop in hCG from day 1 to day 4, and a 10% drop from day 4 to day 7. The correct interpretation and management is:
33. According to FIGO 2000 scoring system for gestational trophoblastic neoplasia (GTN), a patient with choriocarcinoma, pre-treatment hCG of 150,000 IU/L, uterine disease only, largest tumor 5 cm, and no prior chemotherapy has a FIGO risk score most consistent with:
34. Interstitial ectopic pregnancy differs from ampullary ectopic pregnancy in which clinically important way?
35. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in which important characteristic affecting treatment?
36. A 26-year-old woman with a single-dose methotrexate treatment for ectopic pregnancy (initial hCG 1,850 IU/L) presents at Day 7 with hCG 1,920 IU/L (rose by 4% from Day 4 value of 1,850). She is hemodynamically stable with no increase in abdominal pain. What is the correct interpretation and next management?
37. A patient is diagnosed with FIGO Stage II low-risk gestational trophoblastic neoplasia (GTN) following a molar pregnancy. The FIGO/WHO risk score is 3. Which chemotherapy regimen is most appropriate?
38. A 32-year-old woman treated for complete hydatidiform mole 4 months ago develops a serum β-hCG plateau of 2,400 IU/L over 3 consecutive weekly measurements. Chest CT shows no pulmonary metastases. Pelvic MRI reveals a 2.5 cm uterine lesion. She is assigned FIGO Stage I, WHO risk score 4. Which feature, if additionally present, would reclassify her WHO risk score and mandate combination chemotherapy?
39. A woman with a rising β-hCG of 3200 mIU/mL and no intrauterine gestational sac on transvaginal ultrasound is found to have an adnexal mass of 2.5 cm. She is haemodynamically stable, has no contraindications, and is eligible for methotrexate treatment. According to the single-dose methotrexate protocol, what constitutes treatment success?
40. A patient is diagnosed with high-risk gestational trophoblastic neoplasia (GTN) with a WHO risk score of 13, metastases to brain and liver. According to FIGO 2000 scoring and BGCS/UKCTOCS guidelines, which chemotherapy regimen is the recommended first-line treatment?
41. In the FIGO 2000 WHO scoring system for GTN, which of the following factors contributes the MOST points (maximum 4) to the total risk score?
42. A 30-year-old with a previous right salpingectomy has a serum β-hCG of 3200 mIU/mL with no intrauterine pregnancy on transvaginal ultrasound. The diagnosis of ectopic pregnancy is suspected. According to current evidence, what is the most appropriate discriminatory zone threshold for transvaginal ultrasound in modern practice?
43. A 34-year-old is diagnosed with gestational choriocarcinoma post-molar evacuation. Her WHO prognostic scoring gives a total score of 11 (high-risk). According to FIGO/WHO guidelines, which is the appropriate first-line treatment?
44. A complete hydatidiform mole is evacuated. Histological analysis uses p57kip2 immunostaining for definitive diagnosis. What is the staining pattern seen in complete versus partial mole?
45. A 28-year-old woman has a serum beta-hCG of 2,400 mIU/mL with no intrauterine pregnancy on transvaginal ultrasound (discriminatory zone 1,500–2,000 mIU/mL). She is haemodynamically stable with mild left adnexal tenderness. She has no contraindications. After methotrexate 50 mg/m² IM is given, what is the expected pattern of beta-hCG before declaring treatment success?
46. A 32-year-old woman is diagnosed with high-risk gestational trophoblastic neoplasia (GTN) based on FIGO/WHO scoring. Her score is 14. She is started on EMA-CO chemotherapy. Which FIGO WHO risk score component adds the most points when present, and thus identifies the highest-risk group?
47. A woman previously treated for complete hydatidiform mole 8 months ago presents with irregular vaginal bleeding and serum beta-hCG of 3,200 mIU/mL. MRI brain reveals a single 1.5 cm ring-enhancing lesion. Chest CT is clear. She is FIGO WHO score 10. Which treatment is most appropriate?
48. A 24-year-old woman underwent laparoscopic salpingotomy for a right ampullary ectopic pregnancy 7 days ago. Post-operative serial βhCG levels show a 15% decline by day 4 but a subsequent 8% rise by day 7. What is the most appropriate next management step?
49. Using the FIGO/WHO prognostic scoring system for gestational trophoblastic neoplasia (GTN), a patient scores: age 30 (0), antecedent hydatidiform mole (0), interval from index pregnancy 6 months (1), pre-treatment βhCG 12,000 IU/L (2), largest tumour 3 cm (1), single lung metastasis (1), no prior chemotherapy (0). What is the total score and the recommended treatment?
50. In interstitial (cornual) ectopic pregnancy, which criterion on ultrasound differentiates it from an intrauterine pregnancy in the cornual region?
51. A 28-year-old woman has an intrauterine molar pregnancy removed by suction curettage. On histology the specimen shows hydropic villi with circumferential (360°) trophoblastic proliferation, no fetal parts, p57 (CDKN1C) immunostaining negative in villi and cytotrophoblasts. What is the diagnosis and chromosomal constitution?
52. A patient treated with single-agent methotrexate for an ectopic pregnancy has a 15% drop in beta-hCG on day 4 (day 1 injection). What is the appropriate action?
53. A woman is diagnosed with gestational trophoblastic neoplasia (GTN) following complete mole evacuation. beta-hCG is 28,000 mIU/mL at 8 weeks post-evacuation. The GTN score (WHO prognostic scoring system modified by FIGO 2000) is calculated at 6. What treatment is appropriate?
54. A woman treated with single-dose methotrexate for ectopic pregnancy has an hCG of 3200 IU/L on day 1. On day 4, hCG rises to 4100 IU/L. What is the most appropriate next step?
55. According to the FIGO 2000 scoring system for gestational trophoblastic neoplasia (GTN), a patient with a 9-month antecedent pregnancy interval, hCG of 80,000 IU/L, 4 metastases (including 2 liver metastases), and no prior chemotherapy has a score of:
56. Placental site trophoblastic tumour (PSTT) differs from other gestational trophoblastic neoplasias in its secretion and treatment. The unique characteristics are:
57. A woman is diagnosed with persistent gestational trophoblastic neoplasia (GTN) after a hydatidiform mole. FIGO score is calculated as follows: age 30 years (0), antecedent mole (0), interval from index pregnancy 5 months (1), pre-treatment hCG 12,000 IU/L (1), largest tumor including uterus 4 cm (1), site of metastases — lungs (0), number of metastases 2 (1), prior chemotherapy — none (0). What is the total FIGO prognostic score and its clinical implication?
58. A woman treated with methotrexate for an unruptured ectopic pregnancy (hCG 2800 IU/L, adnexal mass 2.8 cm, no fetal cardiac activity) presents on day 4 with worsening pelvic pain. hCG has risen to 3200 IU/L. What is the correct interpretation?
59. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in which key feature that affects treatment choice?
60. A 28-year-old woman with a uterine scar from prior myomectomy presents at 8 weeks with bleeding. MRI shows a pregnancy implanted within the anterior uterine wall scar with no clear myometrial layer between it and the bladder. This is BEST classified as a:
61. A 30-year-old woman undergoes uterine evacuation for a complete hydatidiform mole. Post-evacuation hCG levels are monitored. According to FIGO 2000 criteria for gestational trophoblastic neoplasia (GTN), which of the following ALONE constitutes an indication to initiate chemotherapy?
62. A 26-year-old woman has choriocarcinoma with FIGO score of 7 (high risk) — lung metastases, post-term gestational event, and hCG 55,000 IU/L. According to EMA-CO regimen, the 'CO' component consists of which drugs?
63. A 31-year-old woman presents 4 weeks after evacuation of a partial hydatidiform mole with serum hCG rising from 800 to 1,200 IU/L over 2 weeks. Pelvic ultrasound shows a 3 cm vascularized intrauterine lesion. Chest X-ray is normal. According to FIGO scoring for GTN, all of the following are scored ZERO points EXCEPT:
64. A 28-year-old presents with 7 weeks amenorrhoea, mild right iliac fossa pain, and vaginal spotting. Serum β-hCG is 2400 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac; an adnexal mass with a ring-of-fire appearance is seen. The most appropriate management is:
65. Following suction evacuation of a complete hydatidiform mole, serial β-hCG monitoring is performed. Which β-hCG pattern mandates treatment for gestational trophoblastic neoplasia (GTN)?
66. A 25-year-old develops choriocarcinoma 4 months after a term delivery. Pre-treatment β-hCG is 90,000 IU/L, the largest tumour is >5 cm, and there are 4 lung metastases; she has had no prior chemotherapy. Using the FIGO/WHO prognostic scoring system, how is she classified and managed?
67. An interstitial (cornual) ectopic pregnancy at 10 weeks is found incidentally on MRI in a haemodynamically stable patient. The distinguishing MRI feature of interstitial ectopic compared to intrauterine pregnancy is:
68. A 26-year-old woman presents with a 6-week amenorrhoea and mild left iliac fossa pain. Serum β-hCG is 2200 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac and a small left adnexal mass. She is haemodynamically stable. She is managed with single-dose methotrexate 50 mg/m². Follow-up serum β-hCG on Day 4 is 2400 mIU/mL and on Day 7 is 1900 mIU/mL. This result indicates:
69. A 30-year-old woman had an evacuation of a molar pregnancy 8 weeks ago. Serial serum β-hCG has plateaued at 800 mIU/mL for 3 consecutive weeks. Chest X-ray shows no lesions. She is diagnosed with gestational trophoblastic neoplasia (GTN). According to FIGO 2023 GTN scoring, which feature contributes the MOST points (score 4) in the WHO prognostic scoring system?
70. An interstitial ectopic pregnancy is identified at 10 weeks gestation on MRI. The patient is haemodynamically stable. Compared to a tubal ectopic, which feature of interstitial ectopic pregnancy makes it particularly dangerous?
71. According to FIGO 2000 scoring system for gestational trophoblastic neoplasia (GTN), a patient has a non-metastatic post-molar GTN at 8 weeks after antecedent pregnancy with β-hCG of 65,000 IU/L and no prior chemotherapy. What is her FIGO/WHO risk score?
72. Which of the following is the MOST sensitive investigation to diagnose a cornual (interstitial) ectopic pregnancy?
73. A woman with a complete hydatidiform mole underwent suction evacuation. Post-evacuation β-hCG was 45,000 IU/L. Surveillance β-hCG values over 3 weeks are: 40,000 → 38,500 → 39,200 IU/L. According to FIGO 2002 criteria, this pattern indicates need for treatment because of:
74. A 28-year-old woman presents 8 weeks after a molar evacuation with a serum beta-hCG of 2400 mIU/mL (plateau for 3 consecutive weeks). CT scan shows no metastases. WHO/FIGO prognostic scoring is performed. Age 28 = 0 points; antecedent pregnancy = hydatidiform mole = 0 points; interval from index pregnancy = 4 months = 1 point; pre-treatment hCG = 2400 = 1 point; largest tumor size = 3 cm = 1 point; site of metastases = none = 0 points; number of metastases = 0 = 0 points; prior failed chemotherapy = none = 0 points. Total score = 3. Management is:
75. A 24-year-old woman has an unruptured ectopic pregnancy at 6 weeks, confirmed by transvaginal ultrasound showing a 2.8 cm adnexal mass with cardiac activity. She is haemodynamically stable. Serum beta-hCG is 4,200 mIU/mL. She has no contraindications to methotrexate. Which of the following is a contraindication to medical management with methotrexate in this case?
76. A 30-year-old woman develops choriocarcinoma after a term delivery (not a molar pregnancy). She has metastases in the lungs and vagina. WHO/FIGO score: interval from index pregnancy (term delivery) = 5 months = 1 point; pre-treatment hCG = 85,000 mIU/mL = 4 points; number of metastases = 6 = 2 points; largest metastasis = 4 cm = 1 point; site = lung + vagina = 1 point (vagina = 1); antecedent pregnancy = term = 2 points; prior chemotherapy = none = 0. Total = 11. Management:
77. A woman undergoes suction evacuation for a complete hydatidiform mole. Histology confirms 46,XX diploid complete mole. Serial serum hCG monitoring shows the following: week 4 hCG 1200, week 8 hCG 980, week 12 hCG 820. This pattern is best described as:
78. A woman with GTN is scored on the WHO/FIGO prognostic system: antecedent complete mole (score 0), interval since index pregnancy 5 months (score 1), β-hCG 5,000 IU/L (score 1), tumour size 3 cm (score 1), no metastases (score 0), no prior chemotherapy (score 0). What is her total WHO score and classification?
79. A 32-year-old woman with GTN has the following WHO score: antecedent mole (0), interval >12 months (4), β-hCG >100,000 IU/L (4), largest tumour 5 cm (2), lung metastases (0), no prior chemotherapy (0). What is her total score and what is the recommended first-line treatment?
80. Placental site trophoblastic tumour (PSTT) differs from choriocarcinoma in all of the following ways EXCEPT:
81. A woman presents with an ectopic pregnancy at 6 weeks with β-hCG 2,200 IU/L, haemodynamically stable, no free fluid on ultrasound, adnexal mass 2.5 cm. She is treated with a single-dose intramuscular methotrexate protocol. On which day is the first follow-up β-hCG measured to assess treatment success?
82. Epithelioid trophoblastic tumour (ETT) is derived from which cell type and what is its characteristic immunohistochemical marker profile?
83. A 26-year-old woman with a previous salpingectomy for ectopic pregnancy presents at 7 weeks with a serum beta-hCG of 6,800 mIU/mL and ultrasound showing no intrauterine gestation sac but a 3.2 cm hyperechoic mass adjacent to the cervix below the uterine cavity. The diagnosis is:
84. A 34-year-old woman completed treatment for a hydatidiform mole 8 months ago with beta-hCG normalisation. She now presents with a lung nodule, serum beta-hCG of 4,600 mIU/mL, and no new intrauterine pregnancy. For WHO prognostic scoring (FIGO/WHO 2000 scoring system), the interval from index pregnancy is scored as 0 for <4 months, 1 for 4–6 months, 2 for 7–12 months, and 4 for >12 months. What score does the 8-month interval contribute?
85. A woman treated for high-risk gestational trophoblastic neoplasia with EMA-CO becomes resistant. Which salvage regimen is most commonly employed as second-line treatment?
86. A 28-year-old woman is diagnosed with FIGO Stage II gestational trophoblastic neoplasia (GTN). According to current FIGO classification, Stage II GTN refers to:
87. A 25-year-old woman presents with 7 weeks amenorrhoea and mild left iliac fossa pain. Serum β-hCG is 1800 IU/L. Transvaginal ultrasound shows an empty uterine cavity without decidual reaction. At 48 hours β-hCG rises to 2400 IU/L (33% rise). Most appropriate management is:
88. A 28-year-old woman receives single-dose methotrexate 50 mg/m² for an ectopic pregnancy with β-hCG 2200 IU/L. On day 4 post-injection her β-hCG is 2350 IU/L. This finding indicates:
89. A 30-year-old woman had a molar pregnancy evacuated 6 months ago. Serial β-hCG showed plateauing at 850 IU/L for 3 consecutive weeks. CT chest shows two pulmonary nodules each less than 2 cm. She received one prior course of single-agent methotrexate. WHO/FIGO prognostic scoring: age 30 (0), antecedent molar pregnancy (0), interval 6 months (1), pre-treatment hCG 850 IU/L (0), largest tumour less than 3 cm (0), lung metastases — 2 sites (1), prior single-agent chemotherapy (2). Total score = 4. Which treatment is indicated?
90. Which of the following histological features distinguishes choriocarcinoma from a complete hydatidiform mole?
91. A 41-year-old woman develops gestational trophoblastic neoplasia after a term delivery. Her interval from the index pregnancy is 5 months, pre-treatment β-hCG is 5,000 mIU/mL, the largest uterine tumour is 2 cm, and there are no metastases. She has not received prior chemotherapy. Using the FIGO/WHO prognostic scoring system, calculate her score and determine management.
92. A 35-year-old woman is diagnosed with placental site trophoblastic tumour (PSTT). Which feature distinguishes PSTT from other gestational trophoblastic neoplasias and influences its treatment?
93. A 24-year-old woman presents with vaginal bleeding 10 weeks after a term delivery. β-hCG is 85,000 mIU/mL. Ultrasound shows a heterogeneous intrauterine mass invading the myometrium with loss of uterine serosa intact. Chest X-ray shows two pulmonary nodules < 3 cm. Her WHO/FIGO score is calculated as 6. She is treated with single-agent methotrexate. At the third cycle, β-hCG plateau is detected. The next management step is:
94. A 26-year-old woman presents with persistent low beta-hCG after uterine evacuation for a complete hydatidiform mole. Her serum beta-hCG is 1200 IU/L at 6 weeks post-evacuation, having plateaued for 3 consecutive weekly measurements. She has no metastatic disease on staging. According to FIGO criteria, what is the diagnosis?
95. A patient with low-risk GTN (FIGO score 4) is started on single-agent methotrexate. After 3 cycles, beta-hCG levels have risen by 20% above the nadir. What is the MOST appropriate next step?
96. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in all of the following features EXCEPT:
97. A 30-year-old woman presents with a 4 cm ectopic pregnancy at the right cornu visible on laparoscopy; however, the trophoblastic tissue is within the uterine wall at the intramural portion. Her contralateral tube is absent. What is the MOST appropriate management?
98. Complete hydatidiform mole is distinguished from partial hydatidiform mole by which combination of histological and cytogenetic features?
99. A 26-year-old woman is diagnosed with a non-tubal cornual ectopic pregnancy at 8 weeks. Which is the preferred primary management approach for an unruptured cornual ectopic with a living embryo and no haemodynamic compromise?
100. According to FIGO 2000 criteria, gestational trophoblastic neoplasia (GTN) is diagnosed when a post-molar patient has a plateau in beta-hCG for how many consecutive measurements over at least how many weeks?
101. A 32-year-old woman with complete hydatidiform mole undergoes suction evacuation. Two months later, beta-hCG is 2,800 IU/L. Chest X-ray shows three pulmonary nodules, the largest measuring 1.8 cm. Pelvic ultrasound shows a 2 cm enhancing uterine lesion. Her FIGO/WHO prognostic score is calculated and found to be 7. The most appropriate first-line chemotherapy is:
102. Placental site trophoblastic tumour (PSTT) differs fundamentally from choriocarcinoma in which clinically important respect?
103. The recommended contraceptive method and follow-up period after a complete hydatidiform mole evacuation before attempting conception is:
104. A patient treated with single-dose methotrexate for ectopic pregnancy at day 0 (day-1 dose) has βhCG of 3200 mIU/mL on day 1 and 3800 mIU/mL on day 4. This finding indicates:
105. A patient develops GTN after a complete hydatidiform mole. She has a uterine lesion, βhCG of 12,000 mIU/mL, no metastases on imaging, and duration of disease less than 4 months. Her WHO/FIGO prognostic score is calculated and found to be 3. The appropriate treatment is:
106. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in that PSTT:
107. Which clinical scenario fulfills the FIGO 2000 criteria for diagnosis of post-molar gestational trophoblastic neoplasia without histological confirmation?
108. A woman is diagnosed with a 3.5 cm ampullary ectopic pregnancy (β-hCG 4,200 mIU/mL, hemodynamically stable, no free fluid on ultrasound). She wants future fertility. After counseling, she agrees to salpingostomy. Which statement is TRUE regarding subsequent reproductive outcomes?
109. A 26-year-old woman with a prior molar pregnancy presents 10 months later with vaginal bleeding and β-hCG 18,000 mIU/mL (uterine evacuation was 8 months ago). Ultrasound shows a 2.5 cm intrauterine lesion. Chest CT shows a single 1.8 cm left lower lobe nodule. Based on FIGO 2000 staging and scoring, she is Stage III. Which initial treatment is indicated?
110. Placental site trophoblastic tumor (PSTT) differs from gestational choriocarcinoma in which of the following ways?
111. The criteria for diagnosing post-molar gestational trophoblastic neoplasia (GTN) after complete hydatidiform mole include which of the following (FIGO 2000)?
112. Epithelioid trophoblastic tumor (ETT) is distinguished from placental site trophoblastic tumor (PSTT) by which histological and clinical feature?
113. In the methotrexate single-dose protocol for ectopic pregnancy, which β-hCG trend on day 4 vs day 7 indicates treatment success?
114. According to FIGO 2000 criteria, gestational trophoblastic neoplasia (GTN) is diagnosed after a molar evacuation when serum beta-hCG shows which pattern?
115. A 26-year-old woman develops GTN after a term delivery (non-molar). She is classified as low-risk by the FIGO/WHO prognostic scoring system. The FIRST-LINE chemotherapy is:
116. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in which important clinical and histological feature?
117. EMA-CO chemotherapy for high-risk GTN stands for which drug combination?
118. A 29-year-old woman is diagnosed with complete hydatidiform mole and undergoes suction evacuation. Which criterion alone is sufficient to diagnose GTN and initiate chemotherapy according to FIGO 2000 criteria?
119. A woman with low-risk GTN (FIGO score 4) is started on single-agent methotrexate and folinic acid rescue (8-day regimen). After 2 courses, her hCG plateau persists. What constitutes resistance requiring a change to multi-agent therapy?
120. Placental site trophoblastic tumour (PSTT) differs from choriocarcinoma in all of the following EXCEPT:
121. A 38-year-old woman presents with vaginal bleeding 8 months after a term delivery. Beta-hCG is 12,000 mIU/mL. CT shows a 3 cm uterine mass and a 1.5 cm lung nodule. There is no hepatic, splenic, or brain involvement. FIGO anatomical stage and prognostic score are calculated. Her FIGO 2000 score is 6 (one antecedent term pregnancy, interval > 12 months scores 4; lung metastasis < 3 cm scores 1; hCG < 100,000 scores 1 = total 6). This classifies her as:
122. According to the FIGO 2000 prognostic scoring system for gestational trophoblastic neoplasia, a score of ≥7 classifies the patient as high-risk requiring multi-agent chemotherapy. Which of the following factor combinations would score the MOST points?
123. A 28-year-old woman is treated with single-agent methotrexate for an ectopic pregnancy. She presents 4 days later with increased pelvic pain but is haemodynamically stable, with no free fluid on ultrasound, and serum hCG has decreased by 5% from day 1 to day 4. The most appropriate management is:
124. Complete hydatidiform mole (CHM) is differentiated from partial hydatidiform mole (PHM) by all of the following EXCEPT:
125. After suction evacuation of a complete hydatidiform mole, hCG plateau (less than 10% change over 3 consecutive weekly measurements) is noted at week 8. According to FIGO 2000, this necessitates treatment for:
126. A heterotopic pregnancy is MOST likely to occur in which clinical context?
127. A 28-year-old woman with previous PID presents with 7 weeks of amenorrhea, vaginal bleeding, and left iliac fossa pain. Serum β-hCG is 2800 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac and a 2.5 cm adnexal mass with a ring of fire sign on Doppler. She is hemodynamically stable. The MOST appropriate first-line management is:
128. A woman undergoes suction evacuation for a complete hydatidiform mole. Post-evacuation β-hCG is monitored. Which of the following findings indicates gestational trophoblastic neoplasia (GTN) requiring treatment?
129. A 32-year-old woman has an interstitial (cornual) ectopic pregnancy at 8 weeks. β-hCG is 12,000 mIU/mL and she is hemodynamically stable. The BEST initial management is:
130. Epithelioid trophoblastic tumor (ETT) is a rare form of GTN. Which of the following is a DISTINGUISHING feature of ETT from placental site trophoblastic tumor (PSTT)?
131. Complete hydatidiform mole (CHM) is genetically characterized as:
132. A woman is diagnosed with low-risk non-metastatic gestational trophoblastic neoplasia (GTN) following molar evacuation. First-line chemotherapy is single-agent methotrexate. The WHO PROGNOSTIC SCORE that defines low-risk disease (requiring single-agent treatment) is:
133. A woman with a previous right salpingectomy presents with a positive pregnancy test (hCG 3400 IU/L) and a 2.5 cm heterogeneous mass in the left adnexa on ultrasound. She is haemodynamically stable. Methotrexate (single-dose) is planned. Which finding would be a CONTRAINDICATION to medical management?
134. After successful treatment of a hydatidiform mole, hCG surveillance shows a plateau at 280 IU/L over 3 consecutive weekly measurements (weeks 6, 7, 8 post-evacuation). Chest X-ray is clear. What is the most appropriate next step?
135. Which feature of a complete hydatidiform mole on cytogenetics distinguishes it from a partial mole?
136. A 24-year-old woman presents 8 months after delivery of a normal baby with hemoptysis, irregular vaginal bleeding, and hCG of 95,000 IU/L. Chest CT shows multiple pulmonary nodules. Brain MRI is negative. What is the most likely diagnosis and WHO risk score category?
137. Placental site trophoblastic tumour (PSTT) differs from choriocarcinoma in which key characteristic?
138. A 28-year-old woman with a history of right salpingectomy presents at 7 weeks with pain and beta-hCG of 4,500 mIU/mL. Transvaginal ultrasound shows a heterogeneous mass in the cervix with peritrophoblastic vascularity and no intrauterine gestational sac. This presentation is MOST consistent with:
139. According to FIGO 2000 scoring for gestational trophoblastic neoplasia (GTN), a patient has: prior term delivery, 5-month interval since antecedent pregnancy, beta-hCG 45,000 mIU/mL, largest tumour 4 cm, lung metastases only (3 lesions), no prior chemotherapy. Her total FIGO prognostic score is:
140. In the FIGO 2000 prognostic scoring for GTN, a patient scores 9 total. The FIRST-LINE chemotherapy regimen for this high-risk category is:
141. A woman treated for GTN with chemotherapy is counselled about future pregnancy. After how long following complete remission (normalisation of beta-hCG) is pregnancy generally considered safe according to FIGO guidelines?
142. Placental site trophoblastic tumor (PSTT) differs from choriocarcinoma in which important clinical characteristic?
143. A 26-year-old woman with a history of left salpingectomy for ectopic pregnancy 2 years ago now presents with a positive pregnancy test. TVS shows a gestational sac with cardiac activity within the caesarean scar. This is a cesarean scar ectopic (CSE). The MOST appropriate primary management for a haemodynamically stable CSE at 7 weeks with cardiac activity is:
144. A woman is diagnosed with an unruptured ectopic pregnancy at 6 weeks: adnexal mass 3.2 cm, beta-hCG 1800 mIU/mL, no fetal cardiac activity on transvaginal ultrasound. She is hemodynamically stable. What criteria MUST be met for single-dose methotrexate (50 mg/m²) to be appropriate?
145. Which complete hydatidiform mole genetic characteristic distinguishes it from a partial mole?
146. For low-risk GTN (FIGO/WHO score ≤ 6) that is resistant to first-line single-agent chemotherapy (methotrexate or actinomycin-D), what is the standard second-line treatment?
147. A 30-year-old woman with a confirmed left ampullary ectopic pregnancy at 7 weeks has a β-hCG of 2200 mIU/mL. She is haemodynamically stable with no haemoperitoneum. She meets criteria for methotrexate (MTX) therapy. She receives single-dose MTX 50 mg/m². On day 7, her β-hCG has fallen from 2200 to 1800 mIU/mL (18% decline). What is the correct interpretation and next step?