MRCOG Part 2 Exam March 2016 GYNECOLOGY SBA 1. 82 years old lady who suffers from urgency, frequency and stress urinary incontinence. She has medical history of osteomalacia and chronic constipation. She has tried physiotherapy and bladder retraining but was ineffective. On examination; she has moderate vaginal atrophy. Which medication you will offer her: -Immediate release Oxybutinin -Transdermal Oxybutinin -Vaginal Estrogen -Trospium Hydrochloride -Duloxetine 2. In cases of lichen sclerosis, What percentage of patients will not respond to treatment with topical steroids: -15-22% -25-30% -35-40% 3. During evacuation of retained products of conception, what is the most common site of uterine perforation -Anterior uterine wall -Posterior uterine wall -Right lateral uterine wall -Left Lateral uterine wall -Uterine fundus 4. A 45 years old lady who had under gone a hysterectomy for abnormal uterine bleeding and dysmenorrhea. On histopathological examination was found to have Adenomyosis. What would be the most common co-existing uterine finding: -Endometrial cancer -Endometrial polyp -Uterine fibroid -Endometrial hyperplasia 5. In postmenopausal women what is the percentage of endometrial cancer in those who present with abnormal uterine bleeding -5% -10% -15% -20% -25%
6. A lady presents with missed miscarriage at 7 weeks gestation. She opted for surgical management. What is the most common complication she is at risk of: -Cervical trauma -Infection -Blood transfusion -Uterine perforation 7. A postmenopausal woman presented with slow onset of increasing facial acne and hirsutism that started initially 6 months back. On examination: she has male type baldness. What is the most likely diagnosis: -Androgen secreting tumour -Ovarian Hyperthicosis -Adrenal tumour -Polycystic ovaries 8. A couple presents to the infertility clinic for advice. The husband on investigation was found to have low FSH, LH and testosterone levels. What is the most likely cause: -Kalmann syndrome -Anabolic steroids -Kleinfilter Syndrome -Cystic fibrosis 9. A lady presents with vulvar irritation. On examination: wou found an annular lesion with scaling on the vulva with a similar one on the scalp. What is your management: -Refer to dermatology -Clobetasol -Immunomodulators 10. A lady presents with vulval irritation. On examination you found a small lesion <1cm in diameter on the labia majora. What is your management -Excisional biopsy -Clobetasol -Flurouracil -Vulvectomy 11. A lady presents with vulval irritation. On examination you found a 1cm growth on the clitoral hood. What is your management -Excisional biopsy -vulvectomy -Edge biopsy -biopsy from the center 12. A couple presented to the infertility clinic for advice. The lady has a normal hormonal profile with ovulatory cycles. HSG showed normal patent tubes bilaterally. The husband had semen analysis of 0.1 million sperm/ml, abnormal forms, small
testicles with high FSH and LH. Which treatment option you will offer the: -IUI with donor sperm -IVF with donor sperm -IVF with husband sperm -Surgical sperm retrieval -ICSI 13. A lady had hysteroscopic tubal sterilization she is currently on combined oral contraceptives. You advise her that the procedure will be effective: -After her first menstrual cycle -After finishing the current packs of COCPs -After having HSG confirmation after 3 months 14.
An Epileptic drug whose efficacy is reduced if used concomitantly with COCPs -Phenytoin -Valproic acid -Lamotrigine
15. A 17 years old girl presented with primary amenorrhea. She has well developed breast and sparse pubic and axillary hair. On examination was found to have a blind ending vagina. -MRKH -CAH -Androgen secreting tumour -Turner Syndrome -Androgen insensitivity 16. A 40 years old women, came to see you with her husband who mentioned that she lately developed acne and hoarseness of voice. She has grade 2-4 hirsutism. Testosetrone is 11, 17-Ketosteroids are normal. FSH, LH are normal. What is the most likely cause: -Androgen secreting tumour -Adrenal tumour -Cushings syndrome -PCOD 17. Patient had ovulation induction for IVF on day 9 she developed severe OHSS and was admitted to the hospital. She remained oliguric despite adequate fluid maintenance. What is your management: -Expectant -Diuretics -Paracentesis
18. A 35 years old lady with irregular periods has seen the GP who did some blood tests for her: FSH is 35 iu/l and LH is 45 iu/l. What investigation you will do for her first: -AMH -Repeat FSH and LH on day 2-3 of her periods -HSG 19. Patient presents with history of difficulty emptying the bladder. She has history of multiple sclerosis. On investigations was found to have high residual volume. What is your management: -Tamsulosin -Botulinium injection -Suprapubic catheterization -CISC 20. Patient presents with persistent urge incontinence after failed conservative management of bladder retraining and decreasing fluid and caffeine intake. What is your management: -Desmopressin -Imipramine -Trospium Hydrochloride -Venlafaxine 21. A 34 years old Aerobics instructor, complaining of stress incontinence. She has tried physiotherapy and pelvic floor exercise but no benefit. You advise her for surgical management, but she refused. She asks you if there is any medication available for her case. What is your management: -Duloxetine -Imipramine -Desmopressin -Oxybutinin -you tell her that there are no medications for her condition 22. You review a patient in the gynaecology ward. She had TVT with postop 48hrs catheterization. After removal of the catheter she had urinary retention. How long you would re-catheterize her for: -48 hrs with clamping -24 hrs free drain -Catheterization with antibiotic cover 23. Middle age Patient presents to the Gyn clinic with vulval irritation and progressively worsening dysparaunea even with using lubricants. It started initially 6 months back. On examination Labia are flushed. What is the most likely diagnosis: -Lichen sclerosis -Lichen planus
-VIN 24. Patient presents to the gyn clinic with multiple small painless erythematous red fleshy lesions on the vulva. What is the most likely diagnosis: -VIN -Vulval Cancer -HPV infection -HSV infection 25. Patient presents with irregular bleeding. An endometrial biopsy was collected. The pathology report showed: Irregular glands, packed together back to back but not invading the stroma. What is the most likely diagnosis: -Complex endometrial hyperplasia -Simple endometrial hyperplasia -Endometrial Adenocarcinoma 26. A patient presents in early pregnancy at 6 weeks of gestation. Pelvic scan showed a small fetal pole with no fetal heart. GS is 28 x 25 x 22 mm in size. What is your management: -Repeat scan in 7-10 days -Counsel Re-TOP -Medical management 27. Patient presents with pap smear that shows low grade changes. You did HPV triage testing and it was negative. What is your management: -Colposcopy -Routine recall in 3-5 years -LLETZ 28. Patient is 58 years old. She is on HRT. She is scheduled for TAH and BSO in 7 days. What would be your plan for postoperative thromboprophylaxis: -LMWH x 4 days -LMWH x 7 days -LMWH only during her inpatient stay -TEDS + mobilization 29. This is a study that was done to compare the effectiveness of Metformin and clomid in subfertile patients with PCOD. A sub analysis was done according to the
patient weight. The results show:
-Metformin is equally as effective as clomifene in the obese group (BMI > 30) -Metformin andclomifeneare equally affective in the non-obese group (BMI <30) -Metformin is less effective than clomifene in the non-obese group (BMI >30) -Metformin is more effective than clomifene in the non-obese group (BMI < 30) -The statistical difference is insignificant 30.
The risk of infraumbilical adhesions after a midline laparotomy is: -20% -30% -40% -50% -60%
31.
What is the initial management in a 25 years old patient with HMB: -COCPs -Tranexamic acid -Mirena
32. What is the management for a 47 years old patient with DUB with normal investigations: -Mirena -COCPS -NET -Progesterone injections
33. Patient who is postmenopausal was started on continuous combined HRT 3 months back. She presented with aacomplaint of abnormal uterine bleeding. What is your management: -USS -Change type of HRT -stop HRT -Increase the dose of HRT 34. A 38 year old woman who smokes 30 cigarettes a day comes for six week postnatal checkup after delivery of her third child. She is keen not to become pregnant again but does not wish to be sterilized. She does not wish to gain weight. What is the single most appropriate prescription treatment. -Medroxyprogesterone acetate(Depot Provera) -Mirena -IUCD -POPS -Postcoital oral contraception 35. The pathology shown in this HSG is most commonly associated with which anomaly:
-Pelvic kidney -Double ureter -renal agenesis -ectopic ureter 36. A patient was diagnosed with PMS after having symptom diary. What is the initial management: -Psychotherapy -COCPS -High dose SSRI 37. A 29 years old lady attends the Gyn clinic 6 months post difficult vaginal delivery. She is complaining of vulval pain and dysparaunea. On examination the perineum
looks normal with vaginismus. What is the appropriate initial management: -Lidocaine ointment to the perineum -Refer to physiotherapy -Refer for Psychosexual counseling -Amitriptyline 38. Misoprostol for medical management of miscarriage has the fastest onset of action and longest duration of action if administred through which route: -buccal -sublingual -vaginal -rectal -oral 39.
Risk of vaginal prolapse in women is: -20% -30% -50% -60%
40. Patient comes to see you in the clinic who is 14 years old and wants to TOP. You will proceed according to what: -Fraser competence -Gillick competence -Mental capacity -Parental consent 41. A couple married for 3 years with subfertility. On investigations all normal for both of them. What is the management that you will offer: -IVF -ICSI -IUI -Clomid 42. A 45 years old lady with history of HMB for which she is receiving medical management. In which of the following conditions ultrasound scan will be done as an initial investigation: -Prior to insertion of IUS -Heavy bleeding causing anemia -Failed medical treatment 43. You are doing Gyn clinic and a patient came to see you who had a cervical mass of 2 cm in size. She complains that 1 year ago she had a pap smear that showed sever dyskariosis and no one informed her. She mentioned that she has shifted her house during that time. What is the action that you will take:
-Clinical incident report -Governance patient safety report -Inform CMO -Inform GMC 44. 41 years old patient known to have PCOD, her BMI is 35. She has family history of heart attack. According to her risk factors, what is the most important risk factor that puts her at risk of metabolic syndrome: -Her age -Her BMI -Her family history -PCOS 45. A patient with estrogen positive breast cancer she has completed 5 years of Tamoxinfen. For how long you would advise her to wait before she gets pregnant: - 6months - 1 year - 2 year -immediately GYNECOLOGY EMQS What is most possible diagnosis in each of the following cases: Options: -Stress urinary incontinence -Mixed urinary incontinence -Overactive bladder -Overactive bladder + stress incontinence -Diabetic bladder -Urge incontinence -Vesicovaginal fistula 46. 58 years old woman suffering from urinary incontinence, urgency and dribbling of urine. Her urine culture is negative. Her UDS are as follows: Bladder capacity: 200 ml Residual volume: 25 ml Detruser pressure during the procedure: 30 flow rate : 30 mls/sec first desire to void at 90 ml Incontinence on provocative tests 47. 58 years old woman suffering from urinary incontinence, urgency and frequency. Her urine culture is negative. Her UDS are as follows:
Bladder capacity: 400 ml Residual volume: 50 ml Detruser pressure during the procedure stable throughout flow rate : 10 mls/sec Had continuous leakage from the vagina throughout the procedure 48. 58 years old woman suffering from urinary incontinence and urgency. Her urine culture is negative. Her UDS are as follows: Bladder capacity: 300 ml Residual volume: 50 ml Detruser pressure during the procedure: 30 flow rate : 50 mls/sec first desire to void at 90 ml no incontinence was demonstrated
What is most possible diagnosis in each of the following cases: Options: -MRKH -CAH -Androgen secreting tumour -Turner Syndrome -Sweyer syndrome -Androgen insenstivity 49. A 19 years old girl with primary amenorrhea, normal secondary sexual characters. She is sexually active. On examination found to have a blind ending vagina. 50. A 16 years old girl, presenting with primary amenorrhea. She has grade 2-4 hirsutism, acne and small non developed breast. She refused vaginal examination.
A postmenopausal woman presents with a single episode of vaginal spotting. On USS was found to have ET of 1.3 mm, with incidental diagnosis of left ovarian cyst of 4.5 cm in size. What is the most appropriate management in each of these cases: Options: -TAH + BSO -TAH +BSO + Omentectomy + Peritoneal cytology + lymphadenectomy -Left Oophorectomy
-Bilateral oophoprectoomy -Ovarian cystectomy -Cyst aspiration -Discharge with no Followup -USS in 4 months 51. The cyst is noted on the scan to have regular smooth surface with clear fluid content. CA125 is 10. 52.
The cyst is multilocular with solid component <1cm . CA125 is 30.
53. The cyst is simple, and it was noted that she had a scan 1 year back where that cyst with same measurements was noted. CA125 is 30.
What is the most relevant cause of this patient’s symptoms? Options: -Complicated Chlamydia infection -Gonorrhea -Trichomonasvaginalis -Herpes simplex 54. Patient in a monogamous relationship for 4 years. 2 years back she had Chlamydial infection that was treated but she did not follow up in GUM clinic. Now she presents with vaginal discharge, abdominal pain and mild dysuria. She also generalized joint pain, arthritis and conjunctivitis.
A patient presents to the early pregnancy unit with left iliac fossa pain. Pregnancy test is positive. What is the most appropriate management in each of these cases: Options: -Admit for observation -Discharge with no followup -Booking scan at 12 weeks -Do BHCG now and after 48 hrs -Laparoscopy -Serum progesterone now and in 48 hrs
55. On USS a viable foetus is seen with small subchorionic bleed. And a 3 cm haemorrhagic left ovarian cyst was noted too. 56.
No IUGS is seen on USS.
57.
IUGS is seen on USS, with a 3 cm left ovarian mass and moderate free fluid in POD.
What is the most appropriate management in each of these cases: Options: -Await menstruation/ check BHCG -IUCD -Mirena -Levonelle -UPA 58. A woman had an IUCD inserted 3 months back. She had her periods 3 weeks ago, it was heavy with clots. Then she went on a vacation for 2 weeks where she had regular sexual intercourse. Last SI was 4 days back. She came to see you as she could not feel the threads. And she is requesting emergency contraception. On USS there was no IUCD. 59. A lady had unprotected SI 3 days back. She has an abnormal shaped uterus. Requesting emergency contraception. 60. A lady had USI 3 days back. She is 35 years old, wants contraception that she can retain for a long time.
What is the most likely cause in each of these cases: Options: -Bowel obstruction -Intrabdominalhaematoma -Vaginal haematoma -Infected vault haematoma -UTI -Chest infection -Narcotic misuse -PE -Mismanagement of IV fluids
61. You went to review the patient 6 hrs post-operative who is postmenopausal , 60 years old.You found her with low respiratory rate, otherwise all was normal. 62. A patient post TAH on day 2 who is a cigarette smoker is having pyrexia, feeling unwell. Her observations are normal and abdomen is soft. She is obese with BMI of 39. 63. Day 1 post TAH, she is having oliguria. Urine output < 30 ml/hr. Abdomen soft, wound with signs of bruises but no bleeding or signs of infection. All observations are normal. What is the most appropriate management in each of these cases: Options: -Continue same management 64. 24 hrspost-operative the patient had a spike of temperature 37.8 and was started on antibiotics. All her observations are normal and she is stable since then.
OBSTETRICS SBA 65. A pregnant lady at 14 weeks gestation , she got Parvovirus infection. What is the risk of mother to fetus transmission intrauterine at this gestation: -5% -10% -15% -25% -35% 66. The risk of urinary incontinence after Elective cesarean section is decreased in comparison to normal vaginal delivery to what percentage: -4% -10% -8% -14%
67. A pregnant woman at 24 weeks gestation known to have pulmonary TB on Isoniazid, Rifampicin and Ethambutol. Which investigation you will do monthly: -Liver function test -Urea electrolytes -Drug levels -CRP -Full blood count 68. A patient who is known to have hyperthyroidism on Carbimazole. She presents at 26 weeks gestation with a complaint of sore throat. Which investigation you will do urgently: -FBC -CRP -Throat swab -Thyroid function tests 69. You received a call from the GP asking for your opinion as he has a patient who presented at 24 weeks of gestation with a 2 day history of chicken pox rash who came asking for advise. What would you advise him to do: -Refer her to hospital -Offer acyclovir -Reassure her -Topical emollients -Intravenous IG 70. Woman in the second trimester of pregnancy, presenting with erythematous rash over her face, neck, chest and extensor surface of arms. What is the most likely diagnosis: -PEP -Atopic eruptions of pregnancy -Prurigo -… (no infectious causes were in the choices) 71. A lady with MCDA twins presents antenatally. At what gestational age you should start screening for TTTS -14 weeks -16 weeks -18 weeks -20 weeks -24 weeks 72. Patient comes to see you in the clinic. She is 3 months post Forceps delivery with 2nd degree vaginal tear. She is complaining of flatus incontinence and fecal incontinence too especially when her stools are soft. What is the investigation that you will do:
-Manometry and endoanal scan -Pelvic floor exercise 73. Regarding the anatomy of the Inferior Epigastric artery. From which branch it originates? -External iliac artery -Internal Iliac artery -Femoral artery 74.
Patient presents with IUFD at 26 weeks gestation. What is your management: -Mifepristone 200 milligrams followed after 36-48 hrs with Misoprostol 100 micrograms x 6 doses. -Mifepristone 100 milligrams followed after 36-48 hrs with Misoprostol 25-50 micrograms x 6 doses. -Mifepristone 200 micrograms followed after 36-48 hrs with Misoprostol 100 micrograms x 6 doses. -Mifepristone 200 micrograms followed after 36-48 hrs with Misoprostol 25-50 micrograms x 6 doses. -Mifepristone 100 micrograms followed after 12-24 hrs with Misoprostol 25-50 micrograms x 6 doses.
75. Patient at 13+4 weeks gestation. She is 41 years old and wants screening for Down syndrome. What is the most appropriate test at this gestation: -Combined test ( NT + Pappa A + BHCG) -Quadrible test + Triple test -CVS -Amniocentesis -Gestational age not suitable for screen now 76. Patient weighing 120 Kgs, has just delivered by emergency cesarean section. What is the dose of Deltaparin that you will prescribe for her: -5000 IU -7500 IU -10,000 IU 77. Patient is seen by you in the antenatal clinic in the second trimester. She has history of admission to the psychiatric unit before pregnancy with major psychiatric disorder. She is on Fluxetine 40 mg OD for depression. She is worried about its effect on the baby and is asking you about what she should do. Your advise will be: -Stop medication -Reassure her -Decrease the dose to 20 mg Daily -Change to TCAs -Stop the medication and start CBT
78.
The most sensitive feature of acute myocardial infarction on ECG is: -ST segment elevation -ST segment Depression -Prolonged Q-T interval
79. Patient with h/o PPROM , with temperature of 35.7, BP 80/50 . What is your initial investigation: -CBC and CRP -Blood culture+ Lactic acid -HVS 80.
Threshold level of lactic acid for diagnosis of sepsis is: -1 mmol/l -2 mmol/l -3 mmol/l -4 mmol/l -5 mmol/l
81. Patient at 30 years old, who is p1 had normal vaginal delivery 6 hrs back. She has family history of thrombophilia. When she was investigated was found to be factor V leiden homozygous. What is your management: -LMWH x 7days -LMWH x 6 months -TEDS + mobilization 82. In your hospital it was decided to use FFN for all patients who present with risk of preterm labour. After 6 months only you realized that the stock that was ordered has all finished. You want to know whether you have underestimated the number of patients that present to your hospital or what. What is your management: -Clinical effectiveness -Arrange meeting with unit managers -Run an audit -Make a research 83. The RCOG exam has two componenets written and OSCE, Which choice best describes each: Written Formative Formative Summative Summative
OSCE Summative Formative Formative Summative
84. This is a study that was done in a hospital where the researcher recommends that according to his findings all preterm babies should be delivered by CS as it improves the survival rate. Number GA Survival
CS 150 26+5 high
SVD 450 26+5 low
P value 0.003
Why is that wrong: -The numbers on each arm are not even -The P-value is not significant -It was not done with intention to treat -wrong statistical analysis 85. This is a Patient 2 years post renal transplant. She is stable. Came to see you for preconceptional counseling. She is taking the following medications, which one you would advise her to stop prior to pregnancy: -Enalapril -Labetalol -chloroquine 86. A 36 years old, obese patient with BMI of 38 at 35 weeks gestation. She has frequent attacks of headache with diplopia and eye pain. CT was done which was negative. Which treatment you will offer: -Acetazolamide -Propranolol 87. A patient with high BP post-delivery. She is asthmatic. Which medication you will prescribe to her: -Labetalol -Nifedipine 88. Patient with HIV. Viral load is undetectable. She was on HAART antenatally. When should you stop HAART postnatally: -immediately -4 weeks -6 weeks -6 months -12 months 89.
Patient who has sepsis postnatally. What is the most common causative organism: -E-coli -GBS -Pseudomonas
-Streptococcus Agalactae 90. A pregnant patient who recently arrived to the UK, mentioned to you that she had genital cutting as a child. On examination: there is no clitoris, no labia minora, labia majora are sutured together in the midline was small opening admitting 1 finger at the fourchette. How do you classify that: -Grade 1 FGM -Grade 2 FGM -Grade 3 FGM -Grade 4 FGM -Female circumcision 91. A registrar is performing an elective CS,on opening the abdomen he found large vessels covering the lower uterine segment. At 19 wks. USS showed Placenta anterior low lying but not previa. what will be your management: -ask interventional radiologist to come and pass femoral line then proceed -stop and wait for consultant to come -give incision above the upper edge ofvessels and deliver the baby until the consultant arrives -ask for USS to check placental location than proceed 92. Patient who had slow progress of labour. She just had the head of the baby delivered 2 mins ago with +ve turtle sign. After call for help and the emergency bell what will be your management: -McRoberts -Suprapubic pressure -All Fours -Internal maneuvers 93.
Risk of congenital heart block in SLE where Anti Ro and Anti La are positive: -2% -5% -10%
94.
Recurrence risk of acute fatty liver of pregnancy is: -5% -10% -25% -35% -45%
95.
Risk of post dural puncture headache is: -0.1-0.4 % -0.5-2.5%
-3-4.5% 96.
Opiates receptors in the CNS are located in: -Basal ganglia + Spinal cord white matter -Hippocumpalgyrus + Spinal cord grey matter -Preaquiductal area of the brain
97. You performed an Audit. you set the criteria, collected the data, made an acyion plan, trained the team and did a re-audit after 6 months. What is the remaining step: -Setting the standard -Closing the loop -Implementation of the results -Sharing the results 98. Patient developed rashes over her body at 26 weeks gestation. Which of the following criteria of the rash would be reassuring: -Sparing the umbilicus -If abdominal striae are present -If rashes are on the trunk and the extensor surfaces 99. Patient had normal delivery with multiple tears: parauretheral , labial and a tear involving 50% of the EAS but intact mucosa and IAS. Which grade you will classify her tear: -2nd degree -3a 3rd degree -3b 3rd degree -3c 3rd degree -4th degree 100. Patient is having a psychiatric problem on Olanzapine. Which side effect is more common with this medication: -Hypocalcemia -Hypoglycemia -Congenital anomalies -Cardiac anomalies 101. The most common side effect of excessive use of oxytocin is: -Hypernatremia -Hypoglycemia -Hypokalemia -Hypomagnesaemia 102. During the 10 weeks scan the fetus was noted to have omphalocele with midline defect. What is the possible cause: -Physiological gut herniation
-Edward Syndrome -Patau syndrome 103. A pregnant patient in the first trimester. CRL is 90 on the scan. Which parameter would be most accurate for dating: -HC -BPD -AC -CRL 104. In case Face presentation what is the presenting diameter: -Submentopregmatic -suboccipitopregmatic -Mentoverical -mentobregmatic Pregnant lady with baby weight <10% and oligohydramnios, male fetus ,what is the most likey cause: - Uteroplacental insufficiency - Posterior uretheral valve - Decreased renal perfusion
105.
OBSTETRICS EMQS What is your initial management in each of the following Scenarios? Options: -Ergometrine -Oxytocin IV 5 IU -Oxytocin infusion -Hysterectomy -Bakri balloon -Brace suture -Uterine artery embolization -Manual removal of placenta in theatre under anaethesia -Examination in the room with good light 106. Patient had Cesarean section. During the procedure she sustained bladder injury that the urologist came in and repaired intraoperatively. After the procedure while the patient was still in the recovery with Syntocinon infusion running, you were called by the midwife that was worried as the patient is heavily bleeding. The dressing is dry with no ooze from the wound and the uterus is contracted. Her preoperative Hb was
11.8 g/dl. Now he Hb is 7.4 g/dl. 107. Patient with previous Cesarean section had a successful vaginal delivery. However placenta was not separated despite active management of third stage. The patient is heavily bleeding. 108. Para 4 patient, post normal vaginal delivery. She had completed active management of third stage with small second degree tear that was already sutured by the midwife. You were called as the patient while still in the labour room started bleeding.
What is your management in each of the following cases: Options: -Amniocentesis for detection of infection -Serial ultrasound scans -Counsel for termination of pregnancy -Reassure 109. Patient presents at 26 weeks gestation with rash. On blood investigations you found that she has got Rubella infection. 110. A school teacher presented with a rash after contact with a boy at school who had a similar rash that was thought initially to be Rubella. However on serology was found to be negative for rubella but infected with Parvo virus.
What is your management in each of the following cases: Options: -Admit for induction of labour -IOL at 37 weeks -IOL at 40 weeks -IOL within next week -Cesaarean section 111. Patient presented at 38 weeks, she complains that she can’t walk due to severe pain at the pubic symphysis that she has been taking codeine and paracetamol for. She is demanding delivery. 112. Patient presented at 39 weeks of gestation, she had history of spinal injury but was fine before pregnancy. By 31 weeks gestation she started using crutches at home too
for mobilization later she had to buy a wheel chair to use at home for movement. Now she even uses the wheelchair to go out as can’t walk anymore. She is demanding delivery.
Choose the most appropriate option: Options: -Late indirect maternal death -Indirect maternal death -direct maternal death -Coincidental death -Early indirect maternal death -Sudden death -Does not fulfill maternal mortality criteria 113. A lady was murdered by her husband at 22 weeks gestation. 114. A lady who was admitted at 14 weeks gestation and had surgical management for missed miscarriage. 2 days later she died and was discovered to have cardiac disease with Eisenmenger syndrome. 115. A lady who had IOL for preeclampsia. On day 4 postnatal her BP was 222/115. She developed intracranial haemorrhage and died at 5 weeks postnatal.
Choose the most relevant vessel in these cases: Options: -obturator artery -pudendal artery -deep circumflex iliac artery -Superficial circumflex iliac artery -Middle rectal artery -Superior gluteal artery -Inferior gluteal artery -External iliac artery 116. During doing sacrospinous fixation for a patient with vault prolapse she started bleeding heavily during tying a knot near the pyriformis muscle. Which vessel is most likely injured?
117. Patient had a forceps delivery after which she developed a heamatoma on the right vaginal wall. You took her to the OR for evacuation and found that blood was coming from a deep vessel. Which vessel is most likely injured? 118. Patient who sustained a 4th degree tear during delivery had severe bleeding from the anal area. What is the main vessel from which the injured vessel has arisen?
What is your management in each of the following cases: Options: -Inform community midwife -Arrange community midwife visit -Another ANC appt in 1 week - Another ANC appt in 4 weeks -Inform police -Inform safeguarding services 119. Patient who is known to take Cocaine and other elicit drugs. She was started on Methadone OD, but she is not complaint with the medications. She is known to the social services. She is also having reports of domestic abuse. She had a scheduled antenatal clinic follow up appointment with you today but she did not show up. 120. Patient who is known to take Cocaine. She was started on Methadone. She is taking her medication regularly. She had a scheduled antenatal clinic follow up appointment with you today but she only did her ultrasound scan and left without seeing you. The community midwife has already been informed.
What is your management in each of the following cases: Options: -Inform the police -Can’t proceed as consent requirements not complete -Defer the procedure -Take husband consent -Get another opinion -Respect patient’s rights -Proceed with the procedure -Take parental consent 121. 15 years old boy came to see you in the clinic with his girlfriend from school that is 15 years old too. She is pregnant and requesting TOP, and she does not want to
inform her family. 122. A patient in labour seems to have a sound mind. She is having a pathological CTG, you advised her for emergency cesarean section, but after understanding all the risks she refused to have the procedure done. However, the husband is asking you to proceed with CS.
What is your management in each of the following cases: Options: -Take biopsy from the mass -Abandon the procedure and arrange appointment for discussion -Can’t proceed as consent requirements not complete -Defer the procedure -Take husband consent -Take consent from next of kin -Get another opinion and proceed -Proceed with the procedure -Remove structure (x) from structure (y) -Remove structure (y) 123. Patient at 38 years old is consented for Laparoscopic hysterectomy with ovarian conservation +/- laparotomy +/- BSO for Abnormal uterine bleeding. During the surgery you found that the left ovary (y) has a cyst (x) and is adherent to the lateral pelvic wall. 124. A Patient, who is 28 years old with a positive HCG and empty uterus on scan with a 3 cm right adnexal mass, was consented for laparoscopy + salpingectomy. During the procedure you found both tubes normal and the right ovary (y) has a 3 cm mass attached to it (x). 125. You were called by you surgeon colleague who was doing a laparoscopic appendectomy on a patient who presented with pelvic pain for suspected appendicitis. During the procedure he found that the appendix was normal so he deferred the procedure. But he also found a 3 cm hemorrhagic ovarian cyst (x) attached to the right ovary (y) so he called you in for opinion. What is your initial management in each of the following cases: Options: -Cardiac MRI -Desferrioxamine chelation therapy
-LMWH -LMWH + LDA -LDA -Deferasirox chelation 126. Pregnant patient in second trimester with thalassemia major, did not come for preconceptualcunselling. On liver ferriscan was found to have high iron overload. 127. Pregnant patient with thalassemia major who had history of splenectomy. Her platelet count is 600x 10#3.
What is the most likely diagnosis in each of the following cases: Options: -Anaphylactic shock -Pulmonary embolism -VTE 128. A bus driver 42 years old, at 35 weeks gestation. She is para 4. At the end of her shift she collapsed. Resuscitation was attempted but she died after 30 mins. She also had severe peanut allergy. What is your management in each of the following cases: Options: -Allow home delivery -Allow VBAC but no IOL or augmentation -IOL -CS 129. Para 1 patient. Low risk. In her first pregnancy she did not have any problems antenatally. During the dlivery she had epidural and rotational forceps delivery. It was a very traumatic experience for her. She wants her delivery this time without intervention at all. 130. Patient with pervious 2 x CS. The first was for Breech and the second as for low lying placenta at 35 weeks gestation. In the index pregnancy, placenta is not low lying. And so far pregnancy has been uneventful. She wants to have vaginal delivery. What is the most appropriate management in each of the following cases: Options: -Refer to psychiatry unit urgent -Admit to psychiatric ward
-Admit to maternity ward -Start antipsychotoc medications -Arrange an urgent psychological assessment -Reassurance, family support -Isolation from the baby 131. Patient brought by her husband 4 days post-delivery she is tearful, but no harm ideations. 132. Patient is brought by her husband post-delivery; she is anxious and mentioned that she is hearing voices talking to her. She has no suicidal ideations or harm thoughts. What is the most appropriate management in each of the following cases: Options: -Repeat titre 4 weeks later -Refer to FMU for MCA Doppler -Measure cell free F DNA from maternal plasma using PCR -Measure cell free F DNA from maternal plasma using DNA hybridization -Umbilical artery Doppler -Ductusvenosusdoppler 133. Patient presents at 26 weeks gestation with anti D level of 1013 IU/l .Her husband is Heterozygous for RH-D. 134. Patient presents at 16 weeks gestation with Anti D level of 0.4 IU/L. Husband is homozygous for RH-D.
What is your management in each of the following cases: Options: -Immediate augmentation of labour -Acyclovir -CS -Await SVD but no intervention as FSE or FBS -Augmentation after 24 hrs if not in labour till then -Augmentation after 48 hrs if not in labour till then 135. Patient presents with recurrent episode of herpes simplex at term with prelabour rupture of membranes. 136. Patient with HIV who was on HAART natenatally. Her viral load is <50 copies/ml. She came at term with prelabour rupture of membranes.
What is your management in each of the following cases: Options: -Intapartum antibiotics -Treat now + intrapartum Abs -Treat now + screen at 37 weeks -Screen at 37 weeks -Routine care -Erythromycin 137. Patient with history of GBS in her previous pregnancy. Baby was not affected. Came asking about the management in this pregnancy. 138. Patient with GBS in urine antenatally. 139. Patient with PPROM unknown GBS status
Your are counseling a couple in the preconceptional clinic Regarding the risk of thalassemia to the offspring: Options: -50% affected -25% affected -50% carrier -25% affected -Refer to genetic counseling -CVS -Amniocentesis 140. A lady who is alpha thalassemia carrier, married a man who is beta thalassemia carrier. 141. A lady who is beta thalassemia major, married a man who is HbE 142. A lady who is beta thalassemia major, married a man who is alpha thalassemia carrier. Your are counseling a couple in the preconceptional clinic Regarding the risk of to the offspring:
Options: -50% affected -25% affected -50% carrier -25% affected -None affected -all females are carriers -all females are affected -all males are carriers -all males are affected -(many choices) 143. A woman who has a sister affected with cystic fibrosis is married to a man who is unaffected. 144. A woman who is known to be screen free is married to a man with Duchenne muscular dystrophy. 145. Congenital adrenal hyperplasia… What is your initial management in the following scenarios: Options: -CRP 100/min -Synchronized cardioversion shock -3 consecutive shocks -Adrenaline 1 mg -Adrenaline 5 mg -CPR 30/2 breaths /min -CPR 15/2 breaths / min -Oxygen mask 146. A pregnant patient was found pulseless on the floor in the antenatal ward. 147. A pregnant patient that collapsed, attended by the emergency team, intubated and the monitor showed ventricular tachycardia, a shock was given after which the patient recovered. 2 minutes later she collapsed again. She was still intubated and connected to the monitor which should ventricular fibrillation this time.
What is your management in the following scenarios: Options: -reassess in 30 mins
-CS category 1 -CS category 2 -Rotational forceps -Rotational ventouse -Forceps delivery in labour room -Forceps delivery in OR -await spontaneous labour 148. A primigravida, fully dilated with head just below the spines. Per abdomen the head is 0/5th palpable. CTG is non reassuring. FBS was done with a result of 7.23. 149. Patient is in labour with pathological CTG. Per abdomen head is 2/5th palpable. She is gully dilated and head is in ROT position. 150. Patient is in labour, on vaginal examination was found to be 6 cm dilated with cord prolapse. CTG is normal. What is the estimated risk to both the mother and the baby in the following scenarios: Options: Mother High (25%) High (25%) High (25%) Moderate (15%) Moderate (15%) Moderate (15%) Low (5-10%) Low(5-10%) Low(5-10%)
Baby High (25%) Moderate (15%) Low (5-10%) High (25%) Moderate (15%) Low (5-10%) High (25%) Moderate (15%) Low (5-10%)
151. A patient who has a single atrium and a single ventricle. She had Fontan operation a child. She is now pregnant. 152. A patient with ASD, asymptomatic. Was found to have a genetic syndrome. 153. Patient with cardiomyopathy. Had cardiac echo done which showed good stroke volume. What is your management in the following scenarios: Options: -Offer resuturing
-Conservative management -Augmentin 625 mg x 7 days -Flucloxacillin + metronidazole 400 mg BID x 14 days 154. Patient came for followup post SVD with 2nd degree tear. She is complaining that her strutures broke down, she is 4 days postnatal. On examination, the wound is completely gabbed, with clean base, and creamy vaginal discharge.
