Arian Jade T.

Atluna BSN-2A

1. The following is useful to diagnose ectopic pregnancy:

A. X- Ray- Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure

to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. This
means it is a special x-ray using dye to look at the womb and Fallopian tubes which will also help in
diagnosis of ectopic precnancy. Ectopic pregnancy is revealed by an early pregnancy ultrasound or MRI.

B. Laparascopy- can be used to visualize the fallopian tube if the symptoms alone do not reveal a clear
picture of the patient’s condition and ultrasound is inconclusive. Laparoscopy is the gold standard
method to diagnose ectopic pregnancy.

C. Qualitative hCG- this will determine if the patient is experiencing early pregnancy.

2. One of the following is an indication to treat ectopic pregnancy with methotrexate:

A. Mass < 3 cm- methotrexate is indicated if the the gestational sac is less than or equal to 3.5 cm and
if the cardiac activity is present.

Non tubal implantation- Non-tubal ectopic pregnancies are rare but can be a life-threatening condition
due to late diagnosis. Early diagnosis and treatment of patients are associated with decreased morbidity
and mortality in non-tubal pregnancy and, very importantly, preserve the uterus and subsequent
fertility. 

C. Mass > 5 cm - it is a contraindication for methotrexate.

3. Case: A patient who is gravida 8 present with missed period for 7 weeks. P.V. bleeding. cervical
excitation, lower abdominal pain, fainting 2 times yesterday. You diagnosis is:

A. Pancreatitis- Athe signs and symptomsof pancreatitis include; Upper abdominal pain, abdominal
pain that radiates the back, abdominal pain that feels worse after eating, fever, rapid pulse, nausea,
vomiting and tenderness when touching the abdomen.

B. Ectopic pregnancy- It is because ectopic pregnancy indicates dizziness or fainting, vaginal bleeding,

cervical excitation, lower abdominal pain.

C. Abortion- it is a procedure to end a pregnancy. It uses medicine or surgery to remove the
embryo or fetus and placenta from the uterus.

4. Ectopic pregnancy can be reliably diagnosed by:

A. Ultrasound scan- High-definition ultrasonography, particularly using the transvaginal route, has
revolutionised the assessment of patients with early pregnancy problems, allowing for clearer
visualisation of both normal and abnormal gestations. Early pregnancy scanning should generally be able
to tell the difference between a pseudosac and an empty early intrauterine sac. In the absence of an
intrauterine gestation sac, an ectopic pregnancy can be diagnosed by the presence of an adnexal mass,
often visible within the Fallopian tube.

B. Laporascopy- can be used to visualize the fallopian tube if the symptoms alone do not reveal a clear
picture of the patient’s condition and ultrasound is inconclusive.

C. Pregnancy test-this will determine if the patient is experiencing early pregnancy.

D. HSG- Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to

investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. This means
it is a special x-ray using dye to look at the womb and Fallopian tubes which will also help in diagnosis of
ectopic precnancy.

5. Which type of the following ectopic pregnancies would rupture earlier:

A. Isthmus- The isthmus of the fallopian tube is not able to expand to accommodate a growing ectopic
pregnancy and is more prone to rupture.

B. Interstitial - there is an ectopic gestation developing in the uterine part of fallopian tube.

C. Ampulla- it is the most common location in the fallopian tube for ectopic pregnancy to occur. The
ampullar portion of fallopian tube is more distendable than other areas.

D. Fimbria- if the ectopic pregnancy is at the fimbria, the fimbrial evacuation is feasible, in the absence
of indications for salpingectomy. The chance of rupture is low and the embryo can often dislodged out
leading to an ectoic pregnancy.

E. No difference - there’s a difference because the parts have different functions.

6. Regarding ectopic pregnancy which is true:

A. Bleeding precedes pain- The pain may be in the pelvis, abdomen, or even the shoulder and neck due
to blood from a ruptured ectopic pregnancy pooling under the diaphragm. IT is present in almost every
case and precedes vaginal bleeding. It may be aching due to tubal distension.

B. Shoulder tip pain is an important symptom- it is a sign of ectopic pregnancy wherein there is an
irritation of the diaphragm by blood in the peritoneal cavity . The irritation to the phrenic nerve causes
referred pain in the shoulder blade.

C. The isthmus of the tube is the commonest site of implantation- the isthmus sits next to the opening of
the fallopian tube into the uterus.

E. The incidence is higher in women fitted with intrauterine device- the irritation of the fallopian
tubes caused by the presence of the intrauterine device in the uterine cavity may
prevent the egg from going into the uterus.
F. Ultrasonic scan is of no help in the diagnosis- prompt ultrasound evaluation is key in diagnosing
ectopic pregnancy.

7. Which of the following is not a sign of ruptured ectopic pregnancy:

A. mFast thready pulse

C. Heavy vaginal bleeding- it is a result of decidual breakdown in the uterine cavity due to suboptimal
hcg levels.

D. Rebound tenderness of the abdomen

D. + cervical excitation

E. Cold and clammy extremities- it is not a sign and symptom of ectopic pregnancy because the signs
are dizziness or fainting, vaginal bleeding, cervical excitation, lower abdominal pain.

8 The most common cause of ectopic pregnancy:

A. Congenital anomalies of the tube

B. Inflammation of the tubes- sexually transmitted infections such as gonorrhea or chlamydia can cause
inflammatiion in the tube and other nearby organs and increase risk of ectopic pregnancy.

C. Uterine abnormalities
D. Using OCPs
E. Pelvic adhesions

9. Regarding interstitial ectopic pregnancy:

A. Bleeds heavily- if the fertilized egg continues to grow in the fallopian tube, it can cause the tube to
rupture resulting to heavy bleeding.

B. Less dangerous than ampullary

C. Salpingectomy is the surgery indicated
D. More common than ampullary

10. The commonest surgical procedure used to treat ruptures tubal pregnancy:

A. Total hysterectomy- A total hysterectomy removes the uterus, cervix, and one or both ovaries and
fallopian tubes.

B. Salpingostomy- Before the advent of laparoscopy, laparotomy with salpingectomy (removal of the
fallopian tube through an abdominal incision) was the standard therapy for managing ectopic
pregnancy. Laparoscopy with salpingostomy, without fallopian tube removal, has become the preferred
method of surgical treatment. Laparoscopy has similar tubal patency and future fertility rates as medical
treatment. So, to remove the ectopic pregnancy, a salpingostomy is performed. This procedure is also
performed on a woman to restore fertility after the fallopian tubes are damaged. This damage can be
caused by the adhesions used in the surgery. A salpingostomy can also be performed in this condition
named hydrosalpinx where the fallopian tubes get filled with fluid and become blocked. The procedure
will create a new tube opening named as tubal ostium.

C. Salpingectomy- Salpingectomy is the surgical removal of one (unilateral) or both (bilateral) fallopian
tubes. Fallopian tubes allow eggs to travel from the ovaries to the uterus. A partial salpingectomy is
when you have only part of a fallopian tube removed.

D. Salpingo-oophorectomy- Salpingo-oophorectomy is a procedure to remove the fallopian tube

(salpingectomy) and ovaries (oophorectomy), which are the female organs of reproduction. Since it
requires anesthesia, overnight hospital stay, and removal of body parts, it is classified as major surgery.
It requires 3-6 weeks to heal completely. Salpingo-oophorectomy is the surgery to remove the ovaries
and fallopian tubes. Removal of one ovary and fallopian tube is called a unilateral salpingo-
oophorectomy. When both are removed, it's called a bilateral salpingo-oophorectomy. This procedure is
used to treat a variety of conditions, including ovarian cancer.

E. Electrical cauterization- Electrocauterization (or electrocautery) is often used in surgery to remove

unwanted or harmful tissue. It can also be used to burn and seal blood vessels. This helps reduce or stop
bleeding during surgery or after an injury. It is a safe procedure.