OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is hydatidiform mole. While this may seem a odd practice, it is useful to see multiple examples of how hydatidiform mole will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 20 year old primigravida woman comes to the emergency department because of a 1 week history of nausea and vomiting. Her last menstrual period was 15 weeks ago, however she reports having daily vaginal bleeding for the past month. She has not received any prenatal care. Her temperature is 98.5°F, pulse is 85/min, respirations are 19/min, and blood pressure is 140/90 mm Hg. Physical exam reveals the presence of pedal edema. Abdominal exam shows a fundal height that is consistent with 20 weeks gestation. There is no adnexal tenderness. A serum pregnancy test is conducted and is positive. Urine dipstick shows 1+ protein. Ultrasound shows mulitoculnar ovarian cysts bilaterally, as well as echogenic structures in the uterus. What is the most likely diagnosis?
Question # 2
A 40 year old woman comes to the clinic for a visit after she notices a positive home urine pregnancy test. Her last menstrual period was 11 weeks ago. For the past month the patient has been noticing increasing nausea. She vomits a few times a day, and has difficulty keeping her meals down. She has 3 children, all of which were born at term via C-section. During the visit an ultrasound demonstrates echogenic intrauterine tissue without an amniotic sac. There are also multiple bilateral ovarian cysts. Dilation and curettage is performed and hydronic villi are removed from eh uterus. What is the diagnosis in this patient?
Question # 3
A 21 year old nullgravid female presents to the emergency department with painless vaginal bleeding. Her last menstrual period was 15 weeks ago. On physical exam, her temperature is 98.4°F, heart rate is 120 beats/minute, and blood pressure 140/90 mm Hg. Abdominal and pelvic examination confirms an enlarged uterus that is consistent with a gestation that is 20-weeks. There is a small amount of blood present in the vagina. The patient’s serum beta-hCG is 69,000 mIU/mL. Fetal doppler tones are not auscultated. Pelvic ultrasound shows an echogenic “snowstorm” appearance in the uterus. What is the likely diagnosis?
Explanation: very high beta-hCG value + snowstorm appearance in the uterus on ultrasound = hydatidiform mole
Question # 4
A 28 year old G2P1 woman is early on in her pregnancy when she comes to the clinic with vaginal spotting. Her last normal menstrual period was three months ago, and she had a positive home pregnancy test three weeks ago. She explains that she has been experiencing severe morning sickness. She denies any pelvic cramping or abdominal pain and her past medical history is unremarkable. She has a palpable uterus just above the symphysis. Pelvic examination is remarkable for a 2 cm fleshy friable nodular lesion along the right lateral vaginal sidewall. There is a small amount of blood in the vaginal vault. Bimanual examination confirms a 11-week sized uterus. A pelvic ultrasound is conducted and confirms a snowstorm pattern. Serum beta-hCG is 55,000 mIU. What is the likely diagnosis in this patient?
Explanation: very high beta-hCG value + snowstorm appearance in the uterus on ultrasound = hydatidiform mole
Page Updated: 10.24.2016