KMU Past Paper Practice

Question:

A 25-year-old woman at 9 weeks of gestation develops cramping and vaginal bleeding and passes recognizable pregnancy tissue. Several hours later, her pain and bleeding markedly decrease. Examination shows a closed cervix, and ultrasound demonstrates an empty uterine cavity. Which diagnosis best fits the current findings?

Options:

Correct Answer: Complete miscarriage

Explanation: Expulsion of all products followed by reduction in bleeding, closure of the cervix and an empty uterus indicates a complete miscarriage.

Question:

A 28-year-old woman at 10 weeks of gestation presents with increasing vaginal bleeding and painful uterine cramps. Speculum examination shows that the cervical os is open, but no pregnancy tissue has yet been expelled. Which diagnosis is most appropriate?

Options:

Correct Answer: Inevitable miscarriage

Explanation: Bleeding and cramping with an open cervix indicate that pregnancy loss is in progress even though the products have not yet been expelled.

Question:

A woman presents three days after an early pregnancy loss with fever, lower abdominal pain and offensive vaginal discharge. She is tachycardic, the uterus is tender, and ultrasound suggests retained products. Which management principle is most appropriate after immediate stabilization?

Options:

Correct Answer: Intravenous antimicrobials followed by uterine evacuation

Explanation: Fever, uterine tenderness and offensive discharge indicate septic miscarriage; infection requires antimicrobial therapy and removal of infected retained tissue after stabilization.

Question:

A healthy 27-year-old woman experiences a spontaneous first-trimester pregnancy loss. She has no uterine abnormality, systemic illness or previous pregnancy complications. Which underlying abnormality is an important cause of an isolated early loss such as this?

Options:

Correct Answer: Chromosomal abnormality of the conceptus

Explanation: Abnormal embryonic chromosomes are an important cause of spontaneous early pregnancy loss, particularly when no specific maternal disorder is identified.

Question:

A 31-year-old woman with poorly controlled diabetes is planning another pregnancy after a previous miscarriage. Which intervention best addresses a modifiable maternal factor before conception?

Options:

Correct Answer: Optimize metabolic control before pregnancy

Explanation: Poorly controlled maternal metabolic disease can increase pregnancy risk; preconception optimization addresses a preventable contributor rather than treating all miscarriages nonspecifically.

Question:

A woman is medically stable after treatment of an uncomplicated pregnancy loss but appears distressed and reluctant to discuss the event because she fears being judged. Which response best reflects an appropriate post-abortion care principle?

Options:

Correct Answer: Provide confidential, respectful and nonjudgmental support

Explanation: Post-abortion care includes emotional support and clear communication delivered respectfully and confidentially, in addition to management of physical complications.

Question:

During laparoscopic treatment of a tubal ectopic pregnancy, the implantation is found in the widened segment of the fallopian tube lying between the infundibulum and the isthmus. Which anatomical site is involved?

Options:

Correct Answer: Ampullary segment

Explanation: The ampulla is the widened tubal segment between the infundibulum and isthmus and is the commonest site of tubal ectopic implantation.

Question:

A 30-year-old woman previously treated for a tubal ectopic pregnancy now has a new positive pregnancy test. She has no pain or bleeding. Which follow-up step is particularly important in this pregnancy?

Options:

Correct Answer: Early assessment to establish the pregnancy location

Explanation: Previous ectopic pregnancy increases recurrence risk, so a subsequent conception should be assessed early to confirm intrauterine implantation.

Question:

A clinically stable woman has a small unruptured ectopic pregnancy. She has minimal symptoms, serial β-hCG values are spontaneously declining, and she can return reliably for review. Which management approach may be appropriate?

Options:

Correct Answer: Carefully supervised expectant management

Explanation: Selected stable patients with evidence of spontaneous resolution and reliable follow-up may be managed expectantly rather than receiving immediate medical or surgical treatment.

Question:

A stable woman requires surgery for an unruptured tubal ectopic pregnancy. At laparoscopy, the affected tube is extensively damaged. Which factor should most directly guide whether the tube is conserved or removed?

Options:

Correct Answer: Tubal damage and future fertility considerations

Explanation: Surgical management is individualized according to the condition of the affected tube and the patient’s fertility considerations rather than unrelated pregnancy symptoms.

Question:

A woman with a molar pregnancy has severe persistent nausea and vomiting that is much greater than expected for gestational age. Which hormonal abnormality most directly explains this manifestation?

Options:

Correct Answer: Markedly elevated circulating hCG

Explanation: Excessive trophoblastic proliferation can produce very high hCG concentrations, contributing to the unusually severe nausea and vomiting associated with molar pregnancy.

Question:

A 23-year-old woman is diagnosed with a complete hydatidiform mole. She is hemodynamically stable and wishes to preserve fertility. Which treatment is the most appropriate definitive initial approach?

Options:

Correct Answer: Suction evacuation of the uterine contents

Explanation: Suction evacuation removes the molar tissue while preserving fertility and is the standard uterine evacuation principle for a stable patient with hydatidiform mole.

Question:

After successful evacuation of a hydatidiform mole, a woman is advised to use reliable contraception during the period of hCG surveillance. What is the main reason for this advice?

Options:

Correct Answer: A new pregnancy would make hCG interpretation difficult

Explanation: A new pregnancy also raises hCG, making it difficult to distinguish normal pregnancy-related hormone production from persistent trophoblastic disease.

Question:

A woman with a hydatidiform mole has experienced repeated episodes of uterine bleeding before diagnosis. She is pale and complains of fatigue. Which complication most directly results from this prolonged blood loss?

Options:

Correct Answer: Anemia due to uterine hemorrhage

Explanation: Repeated vaginal bleeding from abnormal molar tissue can produce clinically significant blood loss and anemia.

Question:

Two women undergo evacuation for molar pregnancies. Histology confirms a complete mole in one and a partial mole in the other. Why is the woman with the complete mole particularly important to monitor for persistent disease?

Options:

Correct Answer: Persistent trophoblastic neoplasia is more likely after a complete mole

Explanation: Complete moles carry a greater risk of persistent trophoblastic neoplasia than partial moles, making post-evacuation surveillance particularly important.

Question:

A woman being treated for gestational choriocarcinoma develops a sudden severe headache, vomiting and a focal neurological deficit. Imaging reveals metastatic disease in the brain. Which complication is particularly concerning because these metastases are highly vascular?

Options:

Correct Answer: Intracranial hemorrhage

Explanation: Choriocarcinoma metastases are highly vascular and may bleed; cerebral metastases can therefore cause neurological deterioration and intracranial hemorrhage.

Question:

Histological examination of a uterine tumor from a woman with persistent elevated hCG after pregnancy shows a highly hemorrhagic and necrotic malignant trophoblastic lesion. Which cellular pattern best supports gestational choriocarcinoma?

Options:

Correct Answer: Malignant cytotrophoblast and syncytiotrophoblast

Explanation: Gestational choriocarcinoma is composed of malignant cytotrophoblastic and syncytiotrophoblastic cells and characteristically shows marked hemorrhage and necrosis.

Question:

A pathology report describes persistent trophoblastic tissue that has locally invaded the uterine wall following a molar pregnancy. Which condition is classified as gestational trophoblastic neoplasia rather than as a hydatidiform mole?

Options:

Correct Answer: Invasive mole

Explanation: Invasive mole belongs to gestational trophoblastic neoplasia, whereas complete and partial moles are classified as hydatidiform moles.

Question:

A woman with a nonviable intrauterine pregnancy is being considered for treatment with mifepristone. Her history reveals long-term systemic corticosteroid therapy for a chronic disorder. Which pharmacological property of mifepristone is particularly relevant to this history?

Options:

Correct Answer: Antiglucocorticoid receptor activity

Explanation: In addition to progesterone antagonism, mifepristone has antiglucocorticoid activity, making significant adrenal disease or long-term systemic corticosteroid therapy clinically relevant.

Question:

A clinically stable woman has a confirmed nonviable intrauterine pregnancy and wishes to avoid surgical evacuation if medically appropriate. Which reproductive use of mifepristone best applies to this situation?

Options:

Correct Answer: Medical management of selected early pregnancy loss

Explanation: Mifepristone may be used in selected nonviable intrauterine pregnancies, generally with a prostaglandin to facilitate medical uterine evacuation.