MRCOG Part 2 - Free Grand Mock - Paper 1 - EMQ

1.Mrs, Rubina, 24 year old woman 7weeks of pregnancy presented with bleeding P/v and history of expulsion of product of conception at home.sonographer made diagnosis of incomplete miscarriage

Each of the following clinical scenarios below relate to of women choosing termination of pregnancy and appropriate regimen required. For each patient select the single most appropriate option from the list above. Each option may be used once, more than once or not at all.

A.200mg mifepristone
B.800mcg vaginal misoprostol followed by 400mcg every 3 hourly
C.400mcg misoprotol every 3hourly
D.200mcg Misorpostol every 4th hourly
E.200mcg Misorpostol every 6th hourly
F.100 mcg Misorpostol every 6th hourly
G.100 mcg Misorpostol every 4th hourly
G.400mcg Misorpostol
H.600 mcg Misorpostol
I.1000mcg misoprostol
J.1200mcg misoprostol

2.Mrs.Saksha ,40year old, is 13 weeks pregnant , confirmed by scan as well is for medical termination of pregnancy . She has taken 200mg of mifepristone 2days before what’s next Recommended regimen

3.Mrs.Lisa, 26year old, late booker , diagnosed with potter syndrome, on anomaly scan at 21weeks for medical termination of pregnancy , the first drug to be considered to start with

4.Mrs Radha , 36 year old diagnosed with Intaruterine feral death secondary to Severe IUGR at 29 weeks , she was counselled and she wanted to start of with termination, she is given 200mg of mifepristone , what’s next Recommended regimen

5.Ms.rachel ,26year old late booker baby diagnosed with complex congenital cardiac disease at 27weeks , for termination of pregnancy , started with mifepristone 36hrs, what’s next Recommended regimen

6. Messeh , 32 year old ,primigravida now 7weeks pregnant. She is a known case of pulmonary hypertension with recent 2D Echo done 10days back shows Ejection fraction of 45% .

A.Clause A of abortion act 1967
B.Clause C of abortion act 1967
C.Clause E of abortion act 1967
D.Clause D of abortion act 1967
E.Clause B of abortion act 1967
F.Clause F of abortion act 1967
G.Clause G of abortion act 1967
H.inappropriate for termination
I.None of the above

Instructions -

Each of the above Options describes Various clauses of abortion act 1967 .

For each patient select the single most appropriate clause for termination from the list above. Each option may be used once, more than once or not at all

7.Katie, 18 year old is at 7 weeks of pregnancy . She is here for termination of pregnancy as she and her boy friend are not yet ready for this pregnancy.

8.Hazel, 16 year old is now 9 weeks of pregnancy .This pregnancy was Result of sexual assault by her teacher. She is requesting for termination.

9. A 30 year old woman in her second pregnancy has had normal spontaneous vaginal delivery. She has no risk factor for PPH. She has consented for active management of the third stage of labour.

A. Oxytocin 10 IU by IM injection

B .Oxytocin 5 IU by slow IV injection

C. Misoprostol

D. Syntometrine intramuscular injection

E. Ergometrine intramuscular injection

F .Oxytocin low dose infusion

G. Oxytocin high dose infusion

H .Uterine artery embolisation

I. Uterine artery ligation

J .Caesarean hysterectomy

K. Ergometrine intravenous injection

L. Internal iliac artery ligation

Instruction: For each question posed below, choose the single most appropriate prophylactic oxytocic for management of the third stage of labour from the list above. The given option may be used once, more than once or not at all.

10. A 32 year old woman has had an emergency caesarean section for undiagnosed breech. She has had a previous delivery complicated by postpartum haemorrhage. She is very keen to have a prophylactic measure taken for the management of the third stage of labour.

11.A 20 year old primigravida has delivered at home. She is happy for prophylactic management of the third stage of labour but scared of an injection and keen to have alternative medication if possible. She has heard about other alternatives from her friend who has needle phobia.

12. A 26 year old woman has delivered normally but had prolonged first stage of labour. Her BMI is 34. She has collapsed soon after delivery after severe PPH and bled approximately 1.5 litres.

A A high concentration of oxygen (10-15 litres/minute)

B Urinary catheter

C Two 14-gauge IV cannula

D Commence crystalloid infusion

E Keep the woman wan

F Oxygen (10-15 litres/minute) and anaesthetic help

G Send investigations

H One 14-gauge IV cannula

I Recombinant factor Vila therapy

J Arrange blood

Instruction: For each question posed below, choose the single most appropriate initial management from the AsJ list above. The given option may be used once, more than once or not at all.

13. A 32 year old woman delivered normally with a prolonged second stage of labour, She had an epidural and had normal vaginal delivery. She bled approximately 700m1 soon after delivery and had no other risk factor for PPH.

14.A 30 year old multigravida woman delivered twins with a normal vaginal delivery. Soon after the third stage she started bleeding profusely. There is no perineal laceration and the uterus is very soft and not contracting properly.

15.A 32 year old woman in her first pregnancy has had normal vaginal delivery. Her second stage was prolonged. She had a small vaginal tear and required no suturing. Soon after delivery of the placenta, she started having profuse vaginal bleeding. Uterus was found to be relaxed and atonic. Pharmacological method and bimanual compression have failed to control bleeding. She wants to preserve her fertility.

16. A 27-year-old multiparous woman has a rapid delivery soon after arriving in the delivery suite. After delivery of the placenta she is noted to have heavy vaginal bleeding. Help has been summoned. What is the most appropriate next step?

A summon help

B methotrexate

C bimanual compression

D fresh frozen plasma

E B Lynch suturing

F laparotomy/hysterectomy

G 40 units of oxytocin in 500S of normal saline

H intramuscular carboprost

I repeat Syntinnetrine

J examination under anaesthesia

K examination of the placenta

L intravenous access

M internal iliac artery ligation

N broad-spectrum antibiotics

O uterine packing

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

17. A 38-year-old lady has had a forceps delivery for prolonged second stage. The pla-centa is noted to be complete on examination. She has a massive postpartum haemorrhage (PPH). Help has been summoned and intravenous access obtained. Syntometrine has been given. On examination the uterus is well contracted. What is the most appropriate next step?

18.A 32-year-old woman G2P1 at 30 weeks of gestation in an uncomplicated pregnancy attends the Day Assessment Unit complaining of losing a ‘gush’ of fluid through her vagina 2 hours ago followed by irregular, intermittent abdominal pains

A.Speculum examination
B.Obstetric ultrasound for liquor volume
C.Insulin‐like growth factor‐binding protein 1 (IGFBP‐1) test on vaginal fluid
D.Nitrazine test
E.Consider prophylactic vaginal progesterone
F.Consider prophylactic cervical cerclage
G.Consider both vaginal progesterone or cervical cercalage
H.Start tocolysis + corticosteroids
I.Arrange Trasvaginalscan
J.Arrange fetal fibronectin test

What would be the next step of the management in the provided cases, you can choose the option once, more then once or none of them

19.A 32-year-old woman G2P1 at 30 weeks of gestation in an uncomplicated pregnancy attends the Day Assessment Unit complaining of losing a ‘gush’ of fluid through her vagina 2 hours ago followed by irregular, intermittent abdominal pains, speculum examination does not revealed any fluid in vagina

20.A 26-year-old woman G1P0 at 28 weeks of gestation attends the labour ward complaining of regular painful contractions.There is no history of rupture of the fetal membranes.

21.A 35-year-old woman G3P2 at 10 weeks of gestation with history of cervical cone biopsy p1 year back due to CIN 2 , her pregnancy has been uncomplicated so far. She attends the Day Assessment unit, her TVS revealed cervical length of 3 cm.

22.A 22 years old low risk primigravida attended antenatal clinic for fetal anomaly scan at 20 weeks of gestation, the scan revealed cervical length of 22mm.

23.A 33 year old women at 38 weeks of gestation attended labour room with a complaint of Regular uterine contractions, her lab tests revealed platelet count 70 x 10 /L, regarding her pain relieve what would the best plan

A.No precautions required
B.Avoid use of mid-cavity or rotational forceps
C.use fetal scalp electrodes with caution
D.fetal scalp electrodes contraindicated
E.treat the woman as healthy for the purpose of considering regional analgesia
F.Before considering regional analgesia and anaesthesia, take into account clinical history,the woman's G.preferences and anaesthetic expertise
H.Avoid regional analgesia and anaesthesia under most circumstances
For the provided cases, you can choose the option once, more then once or none of them

24.A 28 year old women at 36 weeks of gestation attended labour room presented with pre-term labour , her lab tests revealed platelet count 85 x 10 /L, regarding her pain relieve what would the best plan

25.A 35 year old women at 38 weeks of gestation attended labour room with a complaint of PPROM and labour pains, her speculum examination revelaed 3 -4 cm dilatation , her lab tests revealed platelet count 40 x 10 /L, regarding her pain relieve what would the best plan

26.A 22 year old women presented with labour pains her recent platelet count revealed platelets 100x 10/L, there is no bleeding manifestation, you suspect gestational thrombocytopenia, what precaution you need to take for the fetus

27. A 52-year-old lady undergoes a laparotomy for suspected ovarianmalignancy. Her left ureter is inadvertently injured during ligation of theinfundibulopelvic ligament. A complete transection of the mid-ureter isnoted. What is the appropriate surgical management?

A.Suprapubic catheter
B.Uretero-neocystostomy
C.Renal ultrasound
D.Intraoperative cystoscopy
E.Suprapubic catheter and Foley catheter
F.Double-layered closure and continuous bladder drainage for 1 week
G.End-to-end anastomosis with a stent
H.End-to-end anastomosis
I.Boari flap
J.CT urogram
K.Expectant management
L.Uretero-ureterostomy
M.Cystoscopy
N.Percutaneous nephrostomy

For each description below, choose the single most appropriate answer fromthe above list of options. Each option may be used once, more than once, ornot at all.

28. 27-year-old lady undergoes a repeat elective caesarean sectionunder general anaesthetic for previous two lower-segmentcaesarean sections. At the end of the surgery urine is noted tobe heavily blood stained and a 2-cm rent in the bladder isnoted. What is the appropriate surgical management?

29. A 37-year-old lady undergoes a hysterectomy for multiplefibroids. The anatomy of the pelvis is distorted and the rightureter is inadvertently clamped while a blind bleeding spotis noted near the uterine vessels. It is immediatelyrecognised and the clamp released. What is the appropriatesurgical management?

30. A 40-yr old woman underwent a total abdominalhysterectomy and bilateral salpingo- oophrectomy forsevere endometriosis. On day 3 following the operation,she complains of weakness of hip flexion. On examination,the knee jerk reflex is absent and paraesthesia is present over the anterior and medial thigh.

For each of the following clinical scenarios, choose the mostappropriate response. Each option may be used once, more than once,or not at all.

A.Common perineal nerve
B.Femoral nerve
C.Genito-femoral nerve
D.Ileo-hypogastric nerve
E.Lateral cutaneous nerve
F.Obturator nerve
G.Pudendal nerve
H.Sciatic nerve
I.Tibial nerve

31. A 60-yr old woman with a BMI of 40 had a totalabdominal hysterectomy and bilateral salpingo-oophrectomy through a Pfannenstiel incision for apelvic mass. She is now complaining of sharp burning pain from the incision site to the labia and thigh

32. A 54 year old lady presents with postmenopausal bleeding. The pipelle biopsy shows endometrial hyperplasia without atypia. She declines to have a coil.

A .Insert Levonorgestrol – releasing intrauterine system (LNG – IUS)
B.LNG – IUS for 6 months
C.Continuous oral progesterone therapy
D.Weight loss

E.Cyclical oral progesterone therapy
F.Repeat endometrial biopsy in 3 months
G.Total abdominal hysterectomy + Bilateral salpingo-oophorectomy
H.Repeat endometrial biopsy in 6 months
I.Total laparoscopic hysterectomy + Bilateral salpingo-oophorectomy
J.Discharge
K.Total laparoscopic hysterectomy + conservation of ovaries
L.Endometrial ablation
M.Continuous progesterone for 6 months
N.Progesterone + endometrial surveillance in 3 months

For the following scenario, please choose the single most appropriate management plan from the above list of options. Each option may be used once, more than once, or not at all.

33. A 43 year old Para 2 lady has BMI of 46. She complains of menorrhagia and the pipelle biopsy shows endometrial hyperplasia without atypia. She had Mirena coil inserted 2 years ago, but the symptoms have recurred.

34. A 42 year old Para 3 woman is diagnosed with endometrial hyperplasia without atypia. She had oral progesterone therapy. Her follow up endometrial pipelle biopsy at 12 months shows endometrial hyperplasia without atypia.

35. A 49 year old lady complained of menorrhagia and was found to have endometrial hyperplasia without atypia 2 years ago. She had the Mirena coil at the time. She had 2 pipelle biopsies 6 months apart and they were normal.

36. A 39 year old nulliparous lady complains of menorrhagia. She is found to have endometrial hyperplasia with atypia. She wants to conceive soon.

37. A 56 year old lady is on tamoxifen and complains of postmenopausal bleeding. She is found to have multiple polyps on transvaginal scan and the endometrial biopsy shows endometrial hyperplasia without atypia.

38. A 28-year-old woman presents to clinic with symptoms suggestive of premenstrual syndrome (PMS). She subsequently returns for a review appointment after 2 months of completing a symptom diary, but the completed diary does not give a clear diagnosis. What treatment should be considered for 3 months to facilitate a definitive diagnosis?

A.Cognitive behavioural therapy (CBT)+ vit B
B.Continuous combined hormone replacement therapy (HRT)
C.Cyclical norethisterone
D.Danazol
E.Drospirenone-containing combined oral contraceptive pill (COCP)
F.Evening primrose oil
G.GnRH analogue
H.LNG-IUS
I.Micronised progesterone
J.Norethisterone
K.Norethisterone-containing COCP
L.Selective serotonin reuptake inhibitors (SSRIs)
M.Spironolactone
N.Tibolone
O.Transdermal oestradiol
P.Vitamin B6 only

For each of the following clinical scenarios, what would be the most appropriate treatment option from the list above? Each option may be used once, more than once or not at all.

39. An otherwise healthy 30-year-old woman with a BMI of 24 kg/m2 has completed a symptom diary that is strongly suggestive of a diagnosis of PMS. What would be considered the first-line pharmaceutical hormonal treatment option?

40.A 42-year-old woman with severe PMS opts to have a laparoscopic bilateral oophorectomy following failed medical management. She decided to retain her uterus and has commenced transdermal oestrogen therapy. What would be considered the optimal first-line therapy oral therapy for endometrial protection?

41. A 28-year-old woman presents to clinic with symptoms suggestive of premenstrual syndrome (PMS). She subsequently returns for a review appointment after 2 months of completing a symptom diary, but the completed diary does not give a clear diagnosis. She does not want any pharmacological treatment for her symptoms

42.A 50 year old lady with urgency, frequency and intractable nocturia

For each case described below, choose the single most likely drug management from the above list of options. Each option may be used once, more than once, or not at all.

A.Oxybutinin
B.Tolteratidine
C.Duloxetine
D.Imipramine
E.Desmopressin
F.Mirabegron
G.Transdermal oxybutinin
H.Vaginal oestrogen
I.Bethanecol
J.Oral HRT

43. A 65 year old lady who does not want surgery for Stress Urinary Incontinence (SUI)

44. A 60 year old lady with poor bladder contractility

45. An 85 year old frail lady with Overactive Bladder (OAB)

46. A 60 year old lady in whom Oxybutinin, Tolteradine or Darifenacin tablets are ineffective

47.A 28-year-old pregnant lady presents with bleeding per vaginum at 20 weeks of pregnancy. Ultrasound reveals an active appropriately grown fetus with a small area of retroplacental haematoma. The cervix appears normal on clinical examination. She has had no smear tests so far voluntarily. What is appropriate management?

A.Cervical screening

B.refer to colposcopy

C.large loop excision of the transformation zone

D.colposcopy-directed cervical biopsy

E.high vaginal swab and Chlamydia swab

F.reassurance

G.cone biopsy – knife

H.perform a first smear test

I.await the next smear test results

J.punch biopsy of the cervix on naked-eye examination

K.Pipelle endometrial sampling

L.hysteroscopy and endometrial biopsy

M.smear test after childbirth

N.refer to colposcopy within 2 weeks

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

48. A 25-year-old lady has a routine smear and is reported as having hrHPV positive and cytology has moderate dyskaryosis. What is appropriate management?

49. A 32-year-old lady has a routine smear and is noted to have hrHPV positive and cytology has borderline endocervical cell changes. What is appropriate management?

50. A 27-year-old woman is 14 weeks pregnant in her first pregnancy. She had been on routine three-yearly smears prior to her pregnancy when one had been found to show mild dyskaryosis, two months before she found herself to be pregnant.

A.Repeat smear in six months
B.Colposcopy in the second trimester to exclude high-grade pathology
C.Wedge biopsy
D.Repeat smear in three years
E.Repeat smear 3–4 months postnatally
F.Do not require colposcopy
G.Cone biopsy
H.Large loop excision of the transformation zone (LLETZ)
I.Repeat smear in 12 months
J.Refer for colposcopy

Match the most appropriate management plan to the following scenario:

MRCOG Part 2 – Free Grand Mock – Paper 1 – EMQ

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