NEWEST COMPLEX CARE FINAL EXAM 2024 COMPLETE
ACTUAL EXAM WITH REAL QUESTIONS AND CORRECT
DETAILED ANSWERS (CORRECT VERIFIED ANSWERS)
LATEST UPDATED VERSION |ALREADY GRADED A+
(REVISED EXAM)
miscarriage - ANSWER: -pregnancy loss that occurs before 20 weeks gestation
-occurs in at least 15% of pregnancies (1 in 6)
recurrent miscarriage - ANSWER: 3 or more consecutive miscarriages
multiple factors involved including:
-genetic causes
-immunological factors
-structural anamolies
-infections
aneuploidy - ANSWER: -abnormal number of chromosomes
-causes about 50% of fetal losses in first 8-15 weeks
Causes of miscarriage - ANSWER: -abnormality at time of conception including
placental malformations
-maternal illness eg viral infections, unstable diabetes
-uterine and cervical: 'weak' cervix, fibroids, congenital abnormality of the uterus
-exposure to teratogens
-drug use
-domestic violence
-genetic causes
-obesity, stress & excessive caffeine
-age > 36
-unknown causes
types of misscarriage - ANSWER: -threatened - there is some bleeding but pregnancy
may continue and 85% usually have normal pregnancy outcome
-inevitable (imminent) - pregnancy will not continue to will proceed to complete or
incomplete miscarriage
-complete - products of conception are completely expelled
-incomplete- products of conception are partially expelled
-anembryonic (blighted ovum) - fetus fails to develop but placental tissue continues
to function. may be no initial bleeding and may be retained for several weeks before
the placental tissue separates and bleeding starts
,-missed - fetus dies but womans Cx stays closed. no bleeding. pregnancy is non-
viable confirmed on USS
- recurrent - 3 or more consecutive MC
miscarriage care options - ANSWER: expectant management- wait and see approach.
50% of women who have PV bleeding in 1st trimester go on to have a viable
pregnancy. Bloods taken every few days to check serum HCG levels and USS
-medical management - 92% effective in pregnancies up to 7 weeks. Oral
mifepristone administered followed by a dose of misoprostol 36-48 hours later.
effects are seen within 4 hours of second dose. requires follow up examination
-surgical management - synto often started before surgery to reduce blood loss.
vacuum aspiration preferred over sharp curettage in cases of incomplete MC
Midwifery care of miscarriage - ANSWER: -reassurance, acknowledge loss, empathy
-family planning - encourage woman to wait until after first normal period
- obstetric specialist referral for recurrent pregnancy loss
-pre & post operative care - OT prep
-check maternal blood group, anti D if RH neg
- social work / counselling referral
-cultural considerations eg burial rites
-pregnancy momentos
-documentation
other causes of bleeding in pregnancy - ANSWER: -cervical carcinoma
-cervical pathology (ectropian, polyps)
-varicosities of the Cx, vagina or vulva
-bleeding from urinary tract
-haemorrhoids
-maternal infections
-'weakened' cx
gestational trophoblastic disease - ANSWER: -also known as molar pregnancy
-term that covers both benign hydatidiform mole and malignant choriocarcinoma
-malformation of trophoblast in which chorionic vili are abnormal - may be up to 3
cm in length
hydatidiform mole - ANSWER: -rare (more common in asian women)
-can lead to cancer so accurate diagnosis and treatment is essential
risk factors:
-more common in ages <20 and >40
- environment
-genetic constitution
-poor nutrition
,-previous molar pregnancy
diagnosis:
-elevated serum HCG levels
-'snowstorm' appearance on USS
2 types of hydatidiform mole - ANSWER: PARTIAL = Abnormal placenta + some fetus
COMPLETE = Abnormal placenta but NO FETUS - more likely to develop
choriocarcinoma
hydatidiform mole clinical features - ANSWER: symptoms:
-bleeding
-minor degree on intravascular coagulation
-reduced platelets
-hyperemesis due to elevated HCG levels
-pallor and shortness of breath
-anxiety & tremor
signs
-uterine enlargement
-absent FHR
-absent fetal parts
-early onset pre-ecplamsia
-unexplained anaemia
-signs of hyperthyroidism
-PV loss of vesicles
hydatidiform mole risks - ANSWER: before evacuation:
-haemorrhage
-trophoblastic invasion & perforation of myometrium
-dissemination of malignant cells
during evacuation:
-haemorrhage
-perforation by instruments
-dissemination of malignant cells
-emergency hysterectomy
hydatidiform mole management - ANSWER: - avoid hormonal contraceptive until
HCG levels back to normal limits
- don't conceive until HCG levels have been normal for 6 months
-persistent elevation of HCG levels indicated presence of choriocarcinoma, requires
tertiary centre care
-check serum HCG levels every 1-2 weeks until 3 consecutive tests show normal
levels
-then serum HCG levels should be checked every 3 months for 6 months after return
to normal
, -follow up every 8 weeks for 12 months with urine pregnancy tests due to risk of
choriocarcinoma (10% of cases)
-chemotherapy in cases of myometrial invasion or evidence of trophoblastic
metastases to brain liver or lungs
-chemotherapy required in 15% of cases following a complete mole and 0.5%
following a partial mole
ectopic pregnancy - ANSWER: -implantation occurs outside uterine cavity -
commonly in the fallopian tube (ampulla most common site for ectopic pregnancy)
incidence: 1-2% or pregnancies
mortality 10-15% of pregnancy related deaths are caused by ectopic pregnancy
ectopic pregnancy risk factors - ANSWER: -previous tubal or pelvic infection or
inflammation - eg chlamydia
-previous tubal or pelvic surgery
-women who conceive with an IUD in-situ
-assisted reproduction using ovulation stimulating drugs
-congenital tube abnormalities
-maternal cigarette smoking
-migration of ovum to fallopian tube opposite to follicle from which ovulation
occurred
signs & symptoms of ruptured & unruptured ectopic pregnancy - ANSWER:
unruptured
-symptoms of early pregnancy
ruptured
-collapse
-weakness
-fast weak pulse of 110 bpm or more
-hypotension
-dizziness
-hypovolemia
-acute abdominal and pelvic pain
-abdominal distension
-pallor
-shoulder pain
ectopic pregnancy medical management - ANSWER: -always suspect ectopic
pregnancy until proven otherwise
-determine gestation
-transvaginal USS to exclude intra-uterine pregnancy
Methotrexate - ANSWER: -folic acid antagonist that causes dissolution of ectopic
mass and resorption of the conceptus
ACTUAL EXAM WITH REAL QUESTIONS AND CORRECT
DETAILED ANSWERS (CORRECT VERIFIED ANSWERS)
LATEST UPDATED VERSION |ALREADY GRADED A+
(REVISED EXAM)
miscarriage - ANSWER: -pregnancy loss that occurs before 20 weeks gestation
-occurs in at least 15% of pregnancies (1 in 6)
recurrent miscarriage - ANSWER: 3 or more consecutive miscarriages
multiple factors involved including:
-genetic causes
-immunological factors
-structural anamolies
-infections
aneuploidy - ANSWER: -abnormal number of chromosomes
-causes about 50% of fetal losses in first 8-15 weeks
Causes of miscarriage - ANSWER: -abnormality at time of conception including
placental malformations
-maternal illness eg viral infections, unstable diabetes
-uterine and cervical: 'weak' cervix, fibroids, congenital abnormality of the uterus
-exposure to teratogens
-drug use
-domestic violence
-genetic causes
-obesity, stress & excessive caffeine
-age > 36
-unknown causes
types of misscarriage - ANSWER: -threatened - there is some bleeding but pregnancy
may continue and 85% usually have normal pregnancy outcome
-inevitable (imminent) - pregnancy will not continue to will proceed to complete or
incomplete miscarriage
-complete - products of conception are completely expelled
-incomplete- products of conception are partially expelled
-anembryonic (blighted ovum) - fetus fails to develop but placental tissue continues
to function. may be no initial bleeding and may be retained for several weeks before
the placental tissue separates and bleeding starts
,-missed - fetus dies but womans Cx stays closed. no bleeding. pregnancy is non-
viable confirmed on USS
- recurrent - 3 or more consecutive MC
miscarriage care options - ANSWER: expectant management- wait and see approach.
50% of women who have PV bleeding in 1st trimester go on to have a viable
pregnancy. Bloods taken every few days to check serum HCG levels and USS
-medical management - 92% effective in pregnancies up to 7 weeks. Oral
mifepristone administered followed by a dose of misoprostol 36-48 hours later.
effects are seen within 4 hours of second dose. requires follow up examination
-surgical management - synto often started before surgery to reduce blood loss.
vacuum aspiration preferred over sharp curettage in cases of incomplete MC
Midwifery care of miscarriage - ANSWER: -reassurance, acknowledge loss, empathy
-family planning - encourage woman to wait until after first normal period
- obstetric specialist referral for recurrent pregnancy loss
-pre & post operative care - OT prep
-check maternal blood group, anti D if RH neg
- social work / counselling referral
-cultural considerations eg burial rites
-pregnancy momentos
-documentation
other causes of bleeding in pregnancy - ANSWER: -cervical carcinoma
-cervical pathology (ectropian, polyps)
-varicosities of the Cx, vagina or vulva
-bleeding from urinary tract
-haemorrhoids
-maternal infections
-'weakened' cx
gestational trophoblastic disease - ANSWER: -also known as molar pregnancy
-term that covers both benign hydatidiform mole and malignant choriocarcinoma
-malformation of trophoblast in which chorionic vili are abnormal - may be up to 3
cm in length
hydatidiform mole - ANSWER: -rare (more common in asian women)
-can lead to cancer so accurate diagnosis and treatment is essential
risk factors:
-more common in ages <20 and >40
- environment
-genetic constitution
-poor nutrition
,-previous molar pregnancy
diagnosis:
-elevated serum HCG levels
-'snowstorm' appearance on USS
2 types of hydatidiform mole - ANSWER: PARTIAL = Abnormal placenta + some fetus
COMPLETE = Abnormal placenta but NO FETUS - more likely to develop
choriocarcinoma
hydatidiform mole clinical features - ANSWER: symptoms:
-bleeding
-minor degree on intravascular coagulation
-reduced platelets
-hyperemesis due to elevated HCG levels
-pallor and shortness of breath
-anxiety & tremor
signs
-uterine enlargement
-absent FHR
-absent fetal parts
-early onset pre-ecplamsia
-unexplained anaemia
-signs of hyperthyroidism
-PV loss of vesicles
hydatidiform mole risks - ANSWER: before evacuation:
-haemorrhage
-trophoblastic invasion & perforation of myometrium
-dissemination of malignant cells
during evacuation:
-haemorrhage
-perforation by instruments
-dissemination of malignant cells
-emergency hysterectomy
hydatidiform mole management - ANSWER: - avoid hormonal contraceptive until
HCG levels back to normal limits
- don't conceive until HCG levels have been normal for 6 months
-persistent elevation of HCG levels indicated presence of choriocarcinoma, requires
tertiary centre care
-check serum HCG levels every 1-2 weeks until 3 consecutive tests show normal
levels
-then serum HCG levels should be checked every 3 months for 6 months after return
to normal
, -follow up every 8 weeks for 12 months with urine pregnancy tests due to risk of
choriocarcinoma (10% of cases)
-chemotherapy in cases of myometrial invasion or evidence of trophoblastic
metastases to brain liver or lungs
-chemotherapy required in 15% of cases following a complete mole and 0.5%
following a partial mole
ectopic pregnancy - ANSWER: -implantation occurs outside uterine cavity -
commonly in the fallopian tube (ampulla most common site for ectopic pregnancy)
incidence: 1-2% or pregnancies
mortality 10-15% of pregnancy related deaths are caused by ectopic pregnancy
ectopic pregnancy risk factors - ANSWER: -previous tubal or pelvic infection or
inflammation - eg chlamydia
-previous tubal or pelvic surgery
-women who conceive with an IUD in-situ
-assisted reproduction using ovulation stimulating drugs
-congenital tube abnormalities
-maternal cigarette smoking
-migration of ovum to fallopian tube opposite to follicle from which ovulation
occurred
signs & symptoms of ruptured & unruptured ectopic pregnancy - ANSWER:
unruptured
-symptoms of early pregnancy
ruptured
-collapse
-weakness
-fast weak pulse of 110 bpm or more
-hypotension
-dizziness
-hypovolemia
-acute abdominal and pelvic pain
-abdominal distension
-pallor
-shoulder pain
ectopic pregnancy medical management - ANSWER: -always suspect ectopic
pregnancy until proven otherwise
-determine gestation
-transvaginal USS to exclude intra-uterine pregnancy
Methotrexate - ANSWER: -folic acid antagonist that causes dissolution of ectopic
mass and resorption of the conceptus
