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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5775_Библиотеки_им_академика_М_И_Перельмана
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Largelesionsizeisalsoanimportantfactor.Largermasses(>10cm)aremorelikelytobemalignant.
Presenceof papillaryexcrescences (not absence)and solid components will alsoincrease concernfor
malignancy.However,asmentionedabove,thepresenceofinternalbloodflowhasthegreatestchanceof
beingassociatedwithmalignancy.
Reference:HertzbergBS,MiddletonWD.Ultrasound:therequisites,3rded.Philadelphia,PA:Elsevier,2016:592–598.
7 FirstTrimesterPregnancy
Questions
1a. A 37-year-old woman presents to the ED with hyperemesis, vaginal passage of vesicles, and
bloating.LaboratoryworkshowsWBCcountof7,500.Atransvaginalultrasoundshowsthefollowing:
Basedonthehistoryandimages,whatisthemostappropriatenextstepinthemanagementofthispatient?
A.RecommendCTscanforstagingaspatientmostlikelyhasendometrialcarcinoma.
B.Treatpatientforpelvicinflammatorydisease.
C.Recommendhysteroscopyandtissuesamplingtoexcludemalignancy.
D.AskforserumbetahCGlevelasfindingsareconcerningformolarpregnancy.
1b.Thispatientisatincreasedriskforwhichofthefollowing?
A.Endometrialcarcinoma
B.Hypercoagulablestate
C.Persistenttrophoplasticneoplasia
D.Intractableascites
2a.A29yearsold hemodynamicallystablefemale presentswith rightpelvicpain. Serum betahCGis
3,520mIU/mL.Imagesfromtransvaginalpelvicultrasoundareshown.
Based on the Society of Radiologists in Ultrasound (SRU) Multispecialty Consensus Conference on
“Early first trimester diagnosis of Miscarriage and Exclusion of a Viable Intrauterine pregnancy”
publishedinOctober2012,whichofthefollowingisthemostappropriatenextstep?
A. Imaging findings are diagnostic of pregnancy of unknown location. The patient should be
referred for the management of presumed ectopic pregnancy by IM methotrexate or other
pharmacologicorsurgicalmethods.
B. A viable intrauterine pregnancy is likely; serial beta hCG measurements and pelvic
sonographyshouldbeperformed.
C.Aviableintrauterinepregnancyispossiblebutunlikely;however,atleastonefollow-uphCG
measurement and follow-up pelvic US should be performed before treatment for ectopic
pregnancy.
D. Findings are diagnostic of failed intrauterinepregnancy. Thepatient should be referredfor
dilatationandcurettage.
2b.Additionalimagesoftherightadnexaareshown.
The positive predictive value (PPV) of the findings shown in establishing the diagnosis of ectopic
pregnancyis:
A.75%
B.85%
C.95%
D.100%
3. What isthe earliestintragestational sac structure to be visualized atultrasound thatcanabsolutely
confirmanintrauterinepregnancy?
A.Amnion
B.Embryo
C.Yolksac
D.Placenta
4. A 31-year-old womanpresentsto theemergency departmentwith persistent vaginal bleeding after
undergoing medical termination of pregnancy 4 weeks ago. Laboratory values are as follows: WBC
7,418,Hgb6.1,Hct19.1,beta-hCG2,717.Whatisthemostlikelydiagnosis?
A.Endometrialhematoma
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