Title OB Hmole JULY 2025 (for distribution).pdf ✅

20th OBGYN ORAL EXAM REVIEW July 2025 ORAL EXAM SIMULATION | 1 EXAMINER’S COPY Name of Examinee:_____________________________________________ Name of Examiner: _____________________________________________ *Give Page 1 A 22/G1P0, presents to the emergency department due to vaginal bleeding, vomiting and palpitations. Her LMP was 14 weeks ago, with a positive home pregnancy test. She had a BP of 130/80, HR of 128 bpm, RR of 22 and temperature of 38.3 C. Her abdomen was soft, nontender, with no fetal heart tones appreciated. On speculum exam, there were no vaginal masses but there was minimal bleeding per cervical os. On internal exam, the cervix is admits tip and the uterus was symmetrically enlarged, and boggy at 18 weeks AOG. SCORE 1. Give 3 differential diagnosis. ANSWERS: ◻ Hydatidiform mole with hyperthyroidism, in storm ◻ Threatened or Missed Abortion ◻ Multiple pregnancy ◻ Early pregnancy with a uterine/ovarian mass ◻ Early pregnancy with hyperemesis gravidarum (1.5 POINTS) 0.5 point per answer 2. Give 2 INITIAL tests that should be requested to help arrive in the diagnosis. ◻ Transvaginal/Pelvic ultrasound ◻ Serum DILUTED beta-hcg (0.5 POINT) 0.25 point per answer The patient’s serum diluted beta-hcg is 890,000 mIU/ml. Her transvaginal ultrasound showed the following findings:

20th OBGYN ORAL EXAM REVIEW July 2025 ORAL EXAM SIMULATION | 3 Serum beta-hcg 890,000 mIU/ml Burch Wartofsky Score: 45 4. What is the complete diagnosis? Give the basis for each diagnosis. ANSWER: ◻ Hydatidiform mole - Discrepancy in AOG and uterine size, snowstorm pattern, beta-hcg 890,000 mIU/ml, normal CXR ◻ Thyrotoxicosis from GTD, in storm - Palpitations, BWS 45, Thyroid function tests ◻ Anemia secondary to acute blood loss – vaginal bleeding, hemoglobin 89 ◻ G1P0 (2 POINTS) 0.5 point per answer 5. What is the management? ANSWER: ◻ Admit, Secure IV line ◻ Correct the anemia : transfuse and prepare blood for OR use ◻ Treat the thyroid storm: 🡪 PTU/Methimazole, Propanolol ◻ Refer to Endocrinology, Anesthesia ◻ Prompt suction curettage (2.5 POINTS) 0.5 point per answer 6. How will the patient be advised on serum bhCG monitoring following evacuation according to the latest CPG of the Philippine Society for the Study of Trophoblastic Diseases? ANSWER: ◻ Repeat bhCG 1 week after evacuation ◻ Every 2 weeks until normal ◻ Continue to monitor monthly for the next 6 months for complete HM or repeat after 1 month for partial HM then discontinue (0.75 POINT) [0.25 point per answer 7. What other advise should be given to the patient prior to discharge including future pregnancies? ANSWER: ◻ Offer chemoprophylaxis ◻ Advise diligent bhCG monitoring due to possible post-molar malignant degeneration / GTN ◻ Advise contraception during beta-hCG monitoring ◻ Consult immediately as soon as pregnancy is suspected due to increased risk of another hydatidiform mole in future pregnancies (0.75 POINT) 0.25 point per answer
20th OBGYN ORAL EXAM REVIEW July 2025 ORAL EXAM SIMULATION | 4 TOTAL 9 POINTS