EMQ MOCK EXAM – 200 PACK

104. A 25-year-old primigravida complains of headaches which started two weeks before when she attended her 20 week scan. There is no significant history of previous headache. The pain occurs behind her right eye and she describes it as severe and “stabbing” in nature. The pain is so severe that she cannot sit still and has to walk about. She has noticed that her right eye becomes reddened and “watery” during the attack and her nose is “runny”. The attacks have no obvious trigger and mostly occur a few hours after she has gone to sleep. The usually last about 20 minutes. She has no other symptoms. She smokes 20 cigarettes a day but does not take any other drugs, legal or otherwise. What is the most likely diagnosis?

120. Mrs. X is farmer by profession. She is now 26 weeks pregnant. She presented with fever, sore throat, headache, muscle aches and pains. She has swollen lymph nodes, especially in the neck. She says they have lots of pet animals, dogs, cats and poultry as well. On follow up ultrasound, baby has ascites and hepatosplenomegaly, chorioretinitis and hydrocephaly with intracerebral calcification

105. A woman with BMI of 35 attends for her combined Downs syndrome screening test. She complains of pain behind her eyes. The pain is worst last thing at night before she goes to sleep or if she has to get up in the night. She has noticed horizontal diplopia on several occasions. She has no other symptoms. Examination shows papilloedema.

121. A woman of 19 years books in your antenatal clinic. The previous year she delivered a live male infant at 27 weeks gestation. She is embarrassed to inform you of a pale vaginal discharge that has a fishy odour.

106. A Grandmultiparous of 40 years, experienced sudden-onset, severe headache, vomited several times and then collapsed, all within the space of 30 minutes. She is admitted urgently in a semi-comatose state. Examination shows neck-stiffness and left hemi-paresis.

Option list
A. Interstitial cystitis
B. Hunner ulcer
C. Bladder tuberculosis
D. Glomerulations
E. Cancer of bladder
F. Bladder painsyndrome
G. Nodular lesions

Each the following Options describe various clinical diagnosis in women presenting for cystoscopy.
For each patient select the single most appropriate diagnosis from the list above.
Each option may be used once, more than once or not at all

122.

Option list:
A. HBcAg +ve
B. HBcAb -ve
C. HBcAb +ve
D. HBeAg +ve
E. HbsAg +ve
F. HBsAg +ve; HBsAb –ve; HBcAb -ve
G. HBsAg +ve; HBsAb –ve on two tests six months apart
H. HBsAG –ve; HBsAb -ve on two tests six months apart
I. HBsAg –ve; HBsAb +ve; HBcAb –ve
J. HBsAg –ve; HBsAb +ve; HBcAb +ve
K. HBsAg –ve; HBsAb +ve
L. HBsAg +ve; HBcAg +ve

The above options are various antigen and antibody related to Hepatitis B infection. Each option may be used once, more than once or not at all.

107. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she has an acute infection?

123.

108. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing indicate that she is immune to the HBV as a result of natural infection?

124.

109. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?

110. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV infection 6 months ago. What results on routine blood testing would indicate that she is a chronic carrier of HBV infection?

Option List.
A. Direct death.
B. Indirect death.
C. Early maternal death.
D. Late maternal death.
E. Extra-late death.
F. Fortuitous death.
G. Coincidental death.
H. Accidental death.
I. Murder.
J. Not a maternal death.
K. None of the above.

The following scenarios relate to maternal mortality. Pick the option that best answers the task in each scenario from the option list. Each option can be used once, more than once or not at all.

111. A 23 years old woman presented to A&E diagnosis of a ruptured ectopic pregnancy with hypovolemic shock at 10 weeks’ gestation. Resuscitation was not successful .

112. An obese primigravida at 10 weeks was admitted with abdominal pain. No cause was found, and she was discharged. This happened several times. On her last re-admission, she was seen by a consultant and diagnosed of ruptured appendix, emergency appendicectomy was done but she died of ARDS and sepsis.

113. A 26 years old woman is a known case of bipolar disorder. She dies from suicide at 10 weeks’ gestation.

114. A 40 years old woman is 36 weeks’ pregnant. She has a history of coronary artery disease for last 8 years. She dies of a coronary thrombosis

115. A woman has gestational trophoblastic disease, develops choriocarcinomas and dies from it 24months after the GTD was diagnosed and the uterus evacuated. What kind of death is it?

116. A woman develops puerperal psychosis from which she makes a poor recovery. She kills herself, when the baby is 6 months old. What kind of death is it?

Option list:
A. Meningococcal meningitis
B. Analgesia overuse headache
C. Bacterial meningitis
D. Benign intracranial hypertension
E. Cerebral venous sinus thrombosis
F. Cluster headache
G. Impending eclampsia
H. Malaria
I. Abdominal migraine
J. Migraine
K. Pancreatitis
L. Sinusitis
M. Subdural haematoma
N. Subarachnoid haemorrhage
O. Tension headache
P. Intracranial Haemorrhage

The following cases indicate various diagnosis of headache. Each option may be used once, more than once or not at all.

101. A 40-year-old para 3 is admitted at 38 weeks by ambulance with severe headache of sudden onset. She describes it as “the worst I’ve ever had”. Which diagnosis needs to be excluded urgently?

Option list
A. Bacterial vaginosis
B. Candia albicans
C. Chalamydia trachomatis
D. Zika virus
E. Gonococcus
F. Group B streptococcus
G. Listeria monocytogenes
H. Rubella
I. Streptococcus faecalis
J. Toxoplasma gondii
K. CMV
L. Pravovirus
M. Chicken pox
N. Malaria

The following scenarios relate to pregnant woman with rash. Pick the option that best answers the causative organism in each scenario from the option list. Each option can be used once, more than once or not at all.

117. Ms. X, 25-year-old woman, 14 weeks pregnant, has presented with a 1 day history of a non-vesicular rash, consisting of red spots behind her ears, across her head, neck, trunk and legs. She also complains of painful swellings behind her ears. She is noted to have a temperature of 38°C.

102. A 32-year-old para 1 has recently experienced headaches. They are worse on exercise, even mild exercise such as walking up stairs. She experiences photophobia with the headaches. Which is the most likely diagnosis?

118. Mrs. S presented to you in clinic at 8 weeks, as she is exposed to child who has developed rash similar to slapped cheek. On follow up at 16 weeks shows Fetal Hydrops. Doppler indicates fetal anemia

103. A primigravida has had headaches on a regular basis for many years. They occur most days, are bilateral and are worse when she is stressed. What is the most likely diagnosis?

119. Mrs. X presented with fever, headache, generalised arthralgia myalgia with retro-orbital pain. She has a generalised rash with itching. She gives history of recent travel to Brazil, followed by which she started these symptoms. Treated symptomatically, on ultrasound – baby has Mircrocephaly, Cerebellar atrophy, IUGR.

Option List
A. Oxytocin 5units Iv
B. Oxytocin 10units IM
C. Ergometrine
D. Ergometrine-oxytocin
E. Carborpost -4th dose to be given
F. Carbetocin
G. Consider Shifting to OT
H. BLynch
I. Stepwise devascularisation
J. Hysterectomy
K. Tranexmic acid 1gm IV

Each of the following describes various scenarios of postpartum haemorrhage. For each patient select the single most appropriate management from the list above. Each option may be used once, more than once or not at all
1. 34 years old Rebecca, is into her second pregnancy – a low risk pregnancy. Which is best drug to prevent atonic PPH?

2. 30 years old Leslie is undergoing elective cesarean section for breech presentation. What is the best drug for prophylaxis of PPH

3. 34 years old Rachel in her third pregnancy , low risk pregnancy .she is fully dilated and pushing ,she has a history of atonic PPH in her previous delivery ,what is the appropriate prophylactic drug for her

4. 36year old Lisa is undergoing elective cesarean section for Twin pregnancy with transevrse lie of first baby along with oxytocin which other dug can be considered to reduce risk of PPH

5. Sherlye, 32 years old, primiparous had a normal vaginal delivery. With removal of placenta she has increased vaginal bleeding. Quantified blood loss is 1000ml. She has been started with all resuscitation measures and blood transfusion. She has received oxytocin, ergometrine, 3 doses of carboprost given 15minutes apart. She is continuing to bleed. What is next best step?

Option List
A. Consider operative vaginal delivery after a further 30 minutes, if no change
B. Ask the attendant midwife to perform a vaginal examination and artificial rupture of fetal membranes
C. Do amniotomy and reassess progress of the labour in 4hours
D. Do amniotomy, commence oxytocin infusion and reassess progress of the labour in 2 hours
E. Do amniotomy and reassess progress of the labour in 2 hours
F. Deliver by category 1 caesarean section
G. Deliver by category 2 caesarean section
H. Repeat FBS now
I. Consider operative vaginal delivery after a further 60 minutes, if no change
J. Commence intravenous oxytocin
K. Perform fetal blood sample for a pH estimation
L. Prepare for assisted/instrumental delivery in the labour room
M. Encourage directed pushing in lithotomy position
N. Reassess progress of the labour in 2 hours
O. Transfer to operating theatre for a reassessment with view to an instrumental delivery
P. Repeat FBS in 30 minutes
Q. Forceps delivery in labour room
R. Operative delivery in Operation theatre.

For the following clinical scenarios, chose the single most appropriate management option from the list. Each answer may be used once, more than once or not at all.

6. A 23-year-old has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation. The symptoms settled spontaneously, and all investigations and monitoring were normal; her blood group is AB Rh positive. Vaginal prostaglandin gel insertion established labour within 3 hours and the labour progressed such that 6 hours later the cervix was 8 cm dilated with meconium stained liquor with a satisfactory CTG, and epidural anaesthesia was instigated. Three hours later, the fetal head was zero -fifth palpable abdominally; the cervix was fully dilated; the position was direct occipito anterior, 3cm below spines; with minimal caput and moulding. A small amount of post-examination vaginal bleeding was noted. The present CTG is as follows

7. A 41-year-old woman, in her first pregnancy and with a BMI of 32, is admitted in spontaneous labour at 39 weeks of gestation after a straightforward normal pregnancy. She has had most of her antenatal care with her community midwife. She reports reduced fetal movements for the last 24 hours; there is no history of any vaginal bleeding. She is distressed and contracting four times every 10 minutes. On examination: symphysial fundal height (SFH) is 35 cm; longitudinal lie; presenting part is cephalic with one-fifth palpable. The fetal heart rate is 140 beats per minute and regular with one audible deceleration. A vaginal examination reveals the cervix is 8 cm dilated; presenting part vertex; occipto-anterior position with minimal caput and moulding; clear liquor is draining. The CTG shows same trace for last 55 minutes even after conservative measures

8. A 21yearold woman, P1 and with a BMI of 22, is admitted in spontaneous labour at 37 weeks of gestation after a straightforward normal pregnancy. She has had her antenatal care with her community midwife and had a normal birth of her first child, birthweight 3305 g. She reports reduced fetal movements for the last 24 hours; there is no history of any vaginal bleeding. On admission she was 4cm dilated
As CTG showed late decelerations ,fetal blood sampling was done. PH is 7.3
After 1hour CTG is as follows.

9. Ms. Rachel, is a primigravida, 38 weeks in spontaneous labour. She is known case of gestational diabetes and on diet control. She was assessed at 13:00 h and had progressed to 5 cms cervical dilatation. She was examined at 17:00 h and was found to be 6 cms dilated, 0.5 long, with intact membranes, vertex at 0 station. Her CTG is as follows .

10. Low-risk 27-year-old woman is induced at 41+ 5 weeks gestation in her second pregnancy, having had a previous ventouse delivery for fetal distress. She has epidural analgesia for pain relief in labour. Following confirmation of full cervical dilatation and an hour of passive second stage, she pushes with contractions for 90 minutes without signs of imminent birth. She feels well, her contractions are strong, 3-4 in 10 minutes and CTG trace is as follows

Option List
A. Morrison clamp
B. Gwilliams clamps
C. Babcocks forceps
D. Zeppelin clamps
E. Morris clamps
F. Ballantine clamp
G. Kocher’s clamp
H. Littlwood forceps
I. lahey’s forceps
J. Heaney clamps
K. Maingot forceps.

11. Instruments used to hold LineAlba during cesarean section

12. Instrument used to hold parametrium during werthimes Hysterectomy

13. The instrument used to dissect the ureteric tunnel during radical hysterectomy

14. The instrument used to stabilize cyst capsule during open cystectomy

Option List
A. Uterine
B. Ascending cervical branch of vaginal artery
C. Deep circumflex
D. Inferior epigastric
E. Internal iliac
F. Internal pudendal
G. Lateral sacral
H. Middle rectal
I. Obturator
J. Ovarian
K. Posterior division of the internal iliac
L. Superior gluteal
M. Umbilical
N. Anterior division of the internal iliac
O. Vaginal

Choose the Single most appropriate artery/vein for the scenarios given below. Each answer may be used once, more than once or not at all

15. Mrs. Maha, 34 years old Para3 Living 3 with previous caesarean section was for trial of scar. She progressed normally and had a forceps delivery due to fetal distress with pathological CTG, following which she had postpartum haemorrhage, measuring estimated blood loss of 1500ml. Shifted to operation theatre. Blynch sutures applied and uterine artery as well. Ligation of this vessel sometimes needed in this case.

16. You are reviewing Ms.Tessily,24 years old, who is in her second pregnancy. She is now at 20 weeks gestation. Her first delivery was induced as it was SGA baby, delivered normally baby girl weighing 2100gm. She has a BMI Of 26. She is fit and fine, non-smoker. Biophysical blood flow analyses (Doppler) may be used for her to assess possible perinatal outcomes.

17. Mrs. Saly, 30 years old has been pushing for last 2 hours. She is exhausted. Now CTG is abnormal. Forceps delivery was decided with her consent. She was not on any pain relief. Consultant decided for regional block after discussing with her. This artery can be damaged when injecting local anaesthetic

18. Ms. Tina, 24 years old has undergone laparoscopic cystectomy for endometriosis cyst. In post op ward, she developed hypotension with tachycardia suspecting of recurs sheath hematoma. She looks pale. During intra operative period, insertion of second port was difficult.

19. This artery to be secured when closing the anterior vagina during a total hysterectomy.

Option List
A. Coated Vicryl^® / Braided polyglactin / Half circle, round bodied / 3-0
B. Coated Vicryl^® / Braided polyglactin / J needle, round bodied, heavy/ 2-0
C. Coated vicryl^® / Braided polyglactin / Half circle, round bodied / 0
D. Dermabond^® / Topical skin adhesive / None
E. Endoloop^® ligature / Braided polyglactin / None / 0
F. Mersilene^® / Polyester fibre / Blunt point, half circle, double / 5 mm
G. Monocryl^® / Monofilament: polypropylene / Half circle, round bodied / 1
H. Nylon / Monofilament / Straight cutting / 0
I. PDS / Monofilament: polydioxanone / Half circle, round bodied / 3-0
J. PDS / Monofilament: polydioxanone, looped / Blunt, taperpoint, half circle, heavy / 0
K. Prolene^® / Monofilament: polypropylene / Curved double / 6-0
L. Prolene^® / Monofilament: polypropylene / Curved, reverse cutting / 4-0
M. Stainless steel wire / Multifilament / Tapercut, round bodied / 2 mm
N. Steristrips^® / Skin adhesive strips / None
O. VicrylRapide^® / Braided polyglactin / Tapercut, half circle / 2-0

Choose the single most appropriate suture material for the scenarios given below. Each answer may be used once, more than once or not at all.

20. An 18 years old girl had a normal birth of a healthy male infant with the right medio-lateral episiotomy performed. The third stage of labour is completed with minimal blood loss; the vagina and perineal muscle layer have been sutured; now the perineal skin needs to be closed.

21. A 29-year-old woman, P2L2 , has had a rotational forceps delivery of a healthy male infant at term with extensive perineal trauma. In theatre, a fourth-degree tear is diagnosed and the anorectal mucosa has been sutured and the external and internal anal sphincters now need to be sutured.

22. A 39-year-old woman in her first pregnancy has a rotational forceps delivery with an episiotomy in theatre with effective epidural analgesia after a prolonged labour. Inspection of the lower genital tract reveals damage above the episiotomy incision and a 2-cm ‘button-hole’ defect in the vagina that includes the anorectal mucosa is identified and now has to be sutured.

23. You are seeing Ms. Annabel /34 years old, at 18 weeks. She is an international banker by profession. She had preterm delivery at 30 weeks in previous delivery. Her previous delivery notes shows she had premature rupture of membranes. Transvaginal scan done today shows cervical length of 16mm. You counselled her for cervical encirclage.

Option List
A. Stress urinary incontinence
B. Detrusor overactivity
C. Overactive bladder
D. Overactive bladder + stress incontinence
E. Diabetic bladder
F. Urge incontinence
G. Vesicovaginal fistula
H. Bladder pain syndrome
I. Bladder outlier obstruction
J. Detrusor in activity

The following cases indicate various cases of urinary incontinence. Choose the most appropriate diagnosis from the above list. Each answer may be used once, more than once or not at all.

24. 58 years old woman suffering from urinary incontinence, urgency and dribbling of urine. Her urine culture is negative. Her urodynamic studies are as follows:

Bladder capacity: 450 ml
Residual volume: 25 ml
Detruser pressure during the procedure: 50cm of water with leak
Flow rate : 15 mls/sec
First desire to void at 120ml
Incontinence on provocative tests like coughing

25. 58 years old woman post hysterectomy suffering from urinary incontinence, urgency and frequency. Her urine culture is negative. Her urodynamic studies 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

26. 58 years old woman suffering from urinary incontinence and urgency. Her urine culture is negative. Her UDS are as follows:

Bladder capacity: 500 ml
Residual volume: 50 ml
Detruser pressure during the procedure: 30cm of water
Flow rate : 20 mls/sec
First desire to void at 90 ml
No incontinence was demonstrated

Option List
A. Un ruptured tubal ectopic pregnancy
B. Cervical pregnancy
C. Cornual pregnancy
D. Cesarean scar pregnancy
E. Intrauterine pregnancy
F. Ruptured tubal ectopic pregnancy
G. Missed miscarriage
H. Tubo ovarian abscess
I. Pregnancy of unknown location

Each of the following clinical scenarios below relate to women in early pregnancy.

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

27. A 22 years old, at 6 weeks gestation with beta Hch is 1500IU/L came with nausea and vomiting. Transvaginal scan reveals endometrial thickness of 20mm, adnexa is normal; no free fluid in POD

28. A 25 years old with 7 weeks pregnancy presents with abdominal pain and spotting. She has previous history of surgical termination of pregnancy complicated by infection in post op period. Her Beta Hcg is 1750IU /L. USG shows gestational measuring 25x24mm present below internal os, with absent sliding sign with vascularity around Gestational sac in Doppler

29. A 34 years old lady with 8weeks pregnancy with beta hcg of 1200IU /L with previous cesarean section. She came with spotting. TVS- Gestational sac located anteriorly at the level of the internal os embedded at the site of the previous lower uterine segment caesarean section scar. Doppler showing vascularity around sac. Empty uterine cavity.

30. A 24 years old, 7 weeks pregnant now in her first USG report shows -thin endometrium with no adnexal massBeta -HCG :900IU/L. USG report after 48 hours: right adnexal mass: doughnut mass measuring 30x20mm -, no free fluid in POD. Present Beta-HCG:1600 u/L

31. A 22 years old comes with nausea and vomiting, her beta hcg was 1000IU/L, scan showed thickened endometrium, no adnexal mass, no free fluid. Beta hcg after 48 hour is 1700IU, intrauterine gestational sac with ring of fire in right ovary.

Option List
A. 20%
B. 64.2%
C. 83.3%
D. 70%
E. 120%
F. 50%
G. 90%
H. 180%
I. 100%
J. 200%
K. 90%
L. 250%

Lead in:
New diagnostic study is being evaluated for its accuracy to diagnose Stroke. The sensitivity was 90% and specificity was 50%. In the study there were 200 patients who truly had stroke and 200 who truly did not.

32. How many false negatives in the study?

33. How many false positive in the study?

34. What is the PPV?

35. What is the NPV?

Option List
A. One sample t test
B. Multiple regression
C. Pearson correlation test
D. ANOVA
E. Chi squared test
F. Two sample unpaired t test
G. Wilcoxon sign rank test
H. Spearman correlation test
I. Mann Whitney U test
J. Mean difference
K. Percentage difference
L. Proportion
M. Coefficient of variation
N. Inter quartile range

Lead in:
A study was done to assess delivery time in forceps, ventouse and caeserian delivery in diabetic mothers. HbA1C, Birth weight, age, parity, and smoking were also recorded. Which inferential test would you select for the following:-

36. To compare the weight loss in pregnant women before and after attending the healthy eating program (normally distributed).

37. To determine whether forceps delivery increases chances of having pelvic floor surgery later in life.

38. To determine whether age, parity, smoking affects the birth weight

39. To assess whether HbA1c level is related to the birth weight in diabetic mothers

40. To compare the decision-delivery time interval in second stage for forceps, ventouse and Caesarean section

Option List
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
H. 400mcg Misorpostol
I. 600 mcg Misorpostol

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.

41. 24 years old  Jameelah at 7 weeks of pregnancy, presented with bleeding P/v and history of expulsion of product of conception at home. Sonographer made diagnosis of incomplete miscarriage

42. 30 years old, Sara, is 13 weeks pregnant , confirmed by scan as well is for medical termination of pregnancy. She has taken 200mg of mifepristone 2 days before. What’s next recommended regimen?

43. Lisa, 26 years old, late booker, diagnosed with potter syndrome, on anomaly scan at 21weeks for medical termination of pregnancy. The first drug to start with

44. 36 years old, Radha, diagnosed with Intrauterine fetal death secondary to severe IUGR at 29 weeks. She was counselled and wanted termination. She is given 200mg of mifepristone, what’s next recommended regimen?

45. 26 years old, Rachel, late booker, baby diagnosed with complex congenital cardiac disease at 27weeks. Proceeded for termination of pregnancy; started with mifepristone 36hrs, what’s next recommended regimen?

Option List
A. Acute renal failure
B. Allergic reaction
C. Bowel perforation
D. Pnuemonia
E. Cerebrovascular accident
F. Deep vein thrombosis
G. Delirium tremens
H. Intra-abdominal haemorrhage
I. Myocardial infarction
J. Paralytic ileus
K. Pulmonary atelectasis
L. Pulmonary embolism
M. Small bowel obstruction
N. Subcutaneous haematoma
O. Sub rectus haematoma
P. Septic shock
Q. Urinary tract infection
R. Vaginal vault haematoma

Choose the single most likely diagnosis in postoperative period from the option list above. Each answer may be used once, more than once or not at all.

46. A 75-year-old woman, with a BMI of 24 and who is a non-smoker, had a laparotomy through a mid-line surgical incision for an ovarian malignancy 3 days ago and the tumour was deemed to be inoperable. She has developed some central and right-sided chest pain and is feeling unwell and breathless and has become restless.

On examination: abdomen is soft and non-tender; wound satisfactory; chest dull to percussion both bases and poor air entry with some crepitations that clear with coughing.
On examination –
pulse rate is 96 bpm
BP is 110/60 mmHg
temperature is 38.7°C
respiratory rate is 21 breaths/min

47. A 25-year-old woman underwent an uncomplicated laparoscopy and dye test to investigate primary subfertility. There was some minimal stage endometriosis, which was diathermised, and the fallopian tubes were patent. Eight hours after the operation the woman is experiencing a lot of pain requiring opiate analgesia. The abdomen is very tender around the secondary port site in the left iliac fossa; is slightly distended; oozing blood-stain fluid, despite a pressure dressing.
Observations: pulse rate is 110 bpm
BP is 140/75 mmHg
temperature is 36.5°C
respiratory rate is 18 breaths/min .

48. A 42-year-old woman had undergone emergency cesarean section for fetal distress in the afternoon the day before and is seen on the Day 1 ward round. She looks pale and feels unwell and faint and complains of difficulty getting her breath and pains in her chest and shoulders. There is no vaginal bleeding and the urine catheter sample is clear, but she has passed only 100 ml overnight, despite receiving more than a litre of normal saline overnight. The abdomen is slightly distended and tender, bowel sounds are present.
Observations: pulse rate is 105 bpm
BP is 120/50 mmHg;
temperature is 36.7°C;
respiratory rate is 25 breaths/min

49. A 70-year-old woman, Para1Living 1 with a BMI of 34 and type 2 diabetes and who is a smoker (15 cigarettes a day) had an uncomplicated laparoscopic hysterectomy and bilateral salpingo-oophorectomy two days ago to treat endometrial cancer. She has developed some central and right-sided chest pain and is feeling unwell and breathless and has become restless.

On examination: she looks pale and moderately distressed; abdomen is soft and non-tender; wounds satisfactory; chest percussion and breath sounds are normal; lower limbs normal and mobile.
Observations: pulse rate is 102 bpm;
BP is 140/750 mmHg; temperature is 36.7°C;
respiratory rate is 22 breaths/min

50. A 48-year-old woman had an abdominal total hysterectomy and bilateral salpingo-oophorectomy to remove an ovarian tumour and is seen on the ward round on day 2. She had a poor night with abdominal pain and bloating and has just started vomiting.
On examination: she looks distressed with pain. the abdomen is distended with minimal bowel sounds and generalised tenderness; temperature is 36.8°C; pulse rate is 100 bpm; BP is 120/65 mmHg; respiratory rate is 14 breaths/min; BMI is 36

Option list
A. Copper bearing intrauterine device
B. Levonorgestrel intrauterine system
C. Norethisterone 5mg
D. Desogestrel 75 mcg
E. IM medroxyprogesterone acetate 150 mg
F. Levonorgestrel 150 mcg and ethinylestradiol 30 mcg
G. Desogestrel 150 mcg and ethinylestradiol 30 mcg
H. Cyproterone acetate 2mg and 35 mcg ethinylestradiol
I. Ulipristal acetate
J. Hysterectomy

For the following scenarios, choose the most appropriate contraceptive method from the above list. You can choose each option once, more than once or not at all.

51.  A 43 years old patient has 3 children with her ex-husband. She has been in a new relationship for the past 8 months and has been using condoms. She has no personal or family history of venous thromboembolism, cancer or heart disease. Her periods are regular occurring every 28-30 days. She complains although her periods are regular, they are heavy with clots. She & her partner are not keen to have babies. She is a non-smoker. On examination BP 120/80, HR 84, BMI 30.5 kg/m²

52. A 43 years old alcoholic has been admitted with decompensated liver cirrhosis. She is having regular unprotected sexual intercourse. She smokes 20 cigarettes per day. Her physician is referring her to you for contraception. Her BP is 100/60, HR 100 reg, BMI 19.5 kg/m²

53. A 36 years old is in a new relationship for 3 months. She has no personal or family history of VTE, cancer or heart disease. Periods are regular every 28-30 days. She reports these are very heavy, and she has used tranaxemic acid tablets without any improvements. She currently has no plans to conceive however wants to get pregnant in the future. She is a smoker, smokes 20 cigarettes per day. Obs: BP 130/70, HR 74, BMI 33.5 kg/m². Pelvic ultrasound shows multiple small fibroids measuring 1.0 cm – 1.5 cm and a bicornuate uterus. She doesn’t like tablets as she always forgets to take tablets.

Option list
A. Snowballing
B. Brainwashing
C. Delphi technique.
D. Demonstration & practice using clinical model.
E. Doughnut round.
F. Interactive lecture with EMQs.
G. Brainstorming
H. 1minute preceptor method.
I. Schema activation.
J. Schema refinement.
K. Small group discussion.
L. Lecture
M. Snowboarding.
N. Hands on training

For the following scenarios choose the most appropriate teaching method from the list above. You can choose each option once, more than once or not at all.

54. A diabetic woman admitted in labour had shoulder dystocia. Baby delivered with delivery of posterior arm. You wish to use the case to outline key aspects of diabetes and shoulder dystocia and management to the two junior colleagues who are in the labour ward with you. Which would be the most appropriate approach?

55. You have been asked to teach a new trainee in the department the use of forceps delivery. Which would be the most appropriate approach?

56. You have been asked to teach a group of medical students about management of eclampsia. When you checked their background knowledge, they have a good knowledge. Which method you will apply here?

57. You have been asked to discuss Postpartum Haemorrhage with your unit’s medical students. You are uncertain about the amount of basic physiology and anatomy they remember from basic science teaching. Which technique will you use?

58. Your consultant has asked you to allocate junior colleagues to prepare some questions about Antepartum Haemorrhage. These students will ask their colleagues the questions next time when they meet?

Option list
A. Late fetal loss
B. Early fetal loss
C. Antepartum stillbirth
D. Intrapartum stillbirth
E. Early neonatal death
F. Extended perinatal death
G. Perinatal death
H. Post-neonatal death
I. Stillbirth
J. Late neonatal death

From the following scenarios choose the most appropriate definition of various perinatal mortality rates from the list above. Choose each option. Once, more than once or none at all.

59. A baby delivered at 24+0 weeks gestational age showing no signs of life,

60. Baby delivered at 37 weeks gestation but died after 35 days after birth due to meningitis

61. Baby born at 34weeks of gestation, died after 8 days of birth due to respiratory failure

62. Baby delivered at 22 weeks 6 days with no signs of life.

Option List
A. Abandon operative procedure and reschedule
B. Defer the operative procedure
C. Fraser competence must be demonstrable before obtaining consent
D. Obtain legal advice on individuals who withhold consent for treatment 16
E. Obtain legal advice on interpretation on the Abortion Act 1967
F. Discuss with the consultant and proceed forclwprotmy
G. Obtain legal advice on interpretation as she doesn’t have the Mental Capacity
H. Parental consent must be obtained before proceeding
I. Parental consent need not be obtained before proceeding
J. Perform additional procedure without explicit consent to do so
K. Proceed without consent in order to save the fetus life
L. Proceed without consent in order to save the woman’s life
M. Respect the rights of the putative father of the fetus to withhold consent
N. Respect the rights of the unborn fetus and proceed to delivery
O. Respect the rights of the woman to withhold consent for treatment
P. Verbal consent of patient alone is acceptable
Q. Verbal consent with witness and case note documentation
R. Written consent must be obtained

For each of the scenarios described choose the single most appropriate statement concerning the obtaining of patient consent with respect to the law in England. Each option may be used once, more than once, or not at all

63. Ms.X, 35-year-old suffering from Down syndrome, is diagnosed to have sued ted borderline ovarian tumour. She lives in-home care, and she has no relatives. She has been accompanied by home care nurse .she needs laparotomy as per MDT S opinion.

64. You are about to start seeing Ms Briganza in urogynecology clinic who has been referred by GP for prolapse uterus. Your junior colleague wants to sit with you during the consultation of Ms Braganza

65. Mrs.Suzi is 34 years old is in the surgical unit for Laparoscopic sterilisation which she consented for a week before in the outpatient clinic. She now appears somewhat upset and anxious, and she is refusing to undergo the procedure.

66. Mrs Sara Ahmed, primigravida now 38 weeks admitted in active labour. When she is 6cm dilated, suddenly there is prolonged bradycardia lasting for 6minutes, when discussed options, Mrs, Sara Doesn’t want to undergo caesarean section even at the cost of baby’s life, as it’s her against views of delivery. She understands the pros and cons, and she has the capacity to make decision.

67. Ms Suzi 15year old has been brought by ambulance to A&E as she collapsed in the road. She has been brought by a stranger; she is tachycardic, g

Feeble pulse, hypotensive, and very pale. On bedside usg confirms ruptured ectopic pregnancy.

Option list:
A. 20%
B. 10%
C. 66.6%
D. 90%
E. 52.9%
F. 50%
G. 100%
H. 25%
I. 33%
J. 40%
K. 16%
L. 18%
M. 4%
N. 81%
Lead-in: A diagnostic accuracy study of a new test to diagnose UTI in women reveals the following data.

68. What is the sensitivity of the new test?

69. What is the specificity of a new test?

70. What is the NPV of the new test?

Option list
A. 1 in 2
B. 1 in 12
C. 1 in 3
D. 1 in 4
E. 1 in 8
F. 2 in 3
G. 2 in 7
H. 3 in 4
I. 100%
J. 0%

A woman has a brother affected by haemophilia A and comes to see you discuss the implications of this as she is planning a pregnancy. Which of the answers from the list is the most appropriate?
All the options can be chosen once or More than once

71. What is the chance of her having an unaffected son?

72. What is the chance of her having a daughter who is a carrier?

73. What is the chance of her being a carrier?

74. What is the chance of her brother having an affected son?

75. What is the chance of her having a son who is a carrier?

Option list:
A. Low vagina
B. Vulval swab
C. High vagina
D. Endocervical canal with gentle rotation
E. 1cm inside Endocervical canal with gentle rotation
F. Vigorous rotation inside Endocervical canal.
G. Both options D&E
H. Both options E&F

76. Mrs Katie, 36-year-old in her second pregnancy is 35 weeks pregnant. In her first pregnancy, GBs carriage was identified and treated. Her first delivery was uneventful. She delivered a baby boy at 39weeks. She is here for Bacteriological screening.

77. Ms Tina, 22-year-old presents with lower abdominal pain, Dyspareunia and vaginal discharge. On examination – strawberry cervix noted. She agrees to take a swab

78. Ms Lui, 18-year-old presents with Dyspareunia, vaginal discharge. She has 5 sexual partners in the last 6months. On examination – the uterus is normal size with bilateral forniceal tenderness notes. She agrees to take a swab

79. Ms.Shweta, 24year old Type 1 diabetes on insulin, presented with vulval itching and profuse vaginal discharge, on examination-satellite lesions with curdy white profuse discharge noted

Option list
A. 40%
B. 1.5%
C. 20%
D. 60%
E. 50%
F. 91%
G. 100%
H. 75%
I. 97%
J. 0.5%
K. 1 in 200
Each of the following Options describes various
Percentages on woman presenting with postpartum haemorrhage.

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

80. A 26 year old Tesisly has delivered 6weeks back. She underwent caesarean section for prolonged rupture of membranes with suspected chorioamnionitis,Now she has presented with heavy vaginal bleeding.Her ultrasound shows retained membranes -she has consented for the evacuation of the uterus

What is her chances of having uterine perforation?

81. A Sherlye, 32-year-old, primiparous and normal vaginal delivery.With removal of placenta, she has increased vaginal bleedingHer quantified blood loss is 1700ml.She was managed with balloon tamponadeWhat percentage of women, hysterectomy is avoided with tamponade

82. What percentage of the woman with massive PPH needs to be notified to the risk management team?

Option list
A. Un ruptured tubal ectopic pregnancy
B. Cervical pregnancy
C. Cornual pregnancy
D. Cesarean scar pregnancy
E. Intrauterine pregnancy
F. Ruotured tubal ectopic pregnancy
G. Missed miscarriage
H. Tubo ovarian abscess
I. Pregnancy of unknown location

Each of the following clinical scenarios below relates to women with the diagnosis of early pregnancy. For each patient, select the single most option from the list above. Each option may be used once, more than once or not at all.

83. A 22 year old , with 6 weeks gestation with beta Hch is 1500IU/L came with nausea and vomiting, Transvaginal scan reveals the endometrial thickness of 20mm, adnexa is normal no free fluid in POD

84. A 24 year old, 7 weeks pregnant now Her first Usg report Shows -thin endometrium with no adnexal mass Beta -HCG :900IU/L. Usg report after 48 hours: right adnexal mass: doughnut mass measuring 30x20mm -, no free fluid in POD. Present Beta-HCG: 1600 u/L

85. 22 year old coming with nausea and vomiting, her beta hcg was 1000IU/L, the scan showed thickened endometrium no adnexal mass no free fluidBeta hcg after 48 hour is 1700IUIntrauterine gestational sac with the ring of fire in right ovary

Option list
A. Infection
B. Haemorrhage
C. Death
D. Third and fourth degree perineal tear
E. Cephalhematoma
F. Uterine preforation
G. Postpartum Haemorrhage
H. Need for repeat evacuation
I. Bleeding for 2 weeks
J. Retinal haemorrhage
K. Neonatal jaundice

For each option provided below, choose the possible complication of different surgical procedures which you need to explain to obtain valid, informed consent. Each option may be used once, more than once, or not at all.

86. Mrs. Adams, 38 weeks pregnant is here for planning her delivery. This is her second pregnancy. First one was Emergency caesarean section done at full dilatation for fetal distress. She is asking what the commonest problem she can encounter if she chooses to have a repeat caesarean section is

87. Ms, Tina, 20 years old is suffering from chronic pelvic pain, not been benefited from any treatment, and she is posted diagnostic laparoscopy .What is a complication which is very rare that can happen during this procedure.

88. Ms. Rebecca / 24-year-old In her pregnancy  now 38 weeks admitted in active labour, she has been fully dilated for 3hours 30minutes under epidural analgesia, the station is +3 , left occipital anterior, absent membranes, when discussed for operative delivery she is keen on ventouse delivery, wants to know very common complication to her.

Option list:
A. If willing Offer bacteriological screening now
B. Offer Intrapartum Antibiotic Prophylaxis
C. No need for screening
D. If willing Offer bacteriological screening at 35-37 weeks
E. Treat now and offer Intrapartum Antibiotic Prophylaxis
F. No need of Intrapartum Antibiotic Prophylaxis
G. Treat now for GBs bacteriuria
H. Offer broad-spectrum antibiotics including to cover GBS
I. The polymerase chain reaction in labour
J. Near patient testing in Labour
K. Offer expectant management up to 24 hours
L. Wait for spontaneous onset of labour
M. Offer expectant management up to 48hours
N. Offer Intrapartum Antibiotic Prophylaxis and immediate induction of labour

Choose the most appropriate investigation for the following management options regarding Group B streptococcus .choose option once or more than once or not at all.

89. Mrs Katie, 36-year-old in her second pregnancy is 24 weeks pregnant. In her first pregnancy, GBs carriage was identified and treated. Her first delivery was uneventful. She delivered a baby boy at 39weeks.

90. Ms Susan is 24 years old in her first pregnancy, and she had a frequency of micturition and dysuria. Urine culture has grown GBS.

91. Mrs.Leslie is immigrant from Asia, and she was a here for a family get together. She is on her first pregnancy at 37 weeks 4days. She presented with leaking per vagina. On examination – the temperature is 36.5c, no uterine contractions on palpation. Sterile speculum confirmed premature rupture of membranes .her GBS carrier status is unknown.

92. Mrs Lovely, 34 years old, is in her second pregnancy. Now she is 34 weeks of pregnancy, and she is undergoing elective cesarean section due to vasa previa at 35 weeks. Her GBS status is unknown.

Option List:

A. TSH
B. Prolactin levels
C. Pregnancy test
D. FSH
E. Ultrasound
F. Karyotyping
G. MRI
H. CT scan
I. Serum DHEA -S level
J. Testosterone

93. Ms. Anne 15 year old, has presented with primary amenorrhoea, on examination, her BMI was 29 and was found to have absent secondary sexual characteristics. The investigation of choice is

94. Ms Mary, 15-year-old, has presented with failure of onset of puberty with a height of about 130and is weighing 54kgs. She was examined and found to have tanners stage 1 breast development with widely spaced nipples. She also has cubitus valgus

95. Ms.Mary 15-year-old has presented with primary amenorrhoea. She gives a history of weight gain, lethargy and tiredness. She has nausea and vomiting. There is no history of cyclical abdominal pain, visual disturbances. The appropriate investigation is

96. Ms Sweetie, A 16-year-old girl presents with recurrent abdominal pain and primary amenorrhea. On examination, both breast development and pubic hair distribution are noted to be Tanner Stage V. An abdominal mass is detected on palpation. Speculum examination showing a bluish colour at the end of the speculum

Option list:
A. Double dose of LNG
B. Single dose of LNG
C. Copper T
D. Condoms
E.LNG-IUS
F. DMPA
G. High dose combined contraceptive pill
H. Low dose combined contraceptive pill
I. Ulipristal Acetate
J. Sterilisation
K. Vasectomy
L. Implant
M. Do a pregnancy test

Choose the most appropriate method of emergency contraception for these following scenarios. Choose option once or more than once or not at all.

97. Ms X, an 18-year-old presents to you requesting emergency contraception. She has taken ulipristal acetate for emergency contraception 5 days before. Again she had multiple unprotected sexual intercourses last 4 days .Her last menstrual period was 12days back. Her gets periods every 28 days. She is currently on antibiotics for a recent episode of PID.

98. Mrs A. 20 year old she has taken LNG for emergency contraception 5 days before, yesterday night condom broke during sex. She has a regular cycle of 28days her last menstrual period was 13days back. Otherwise, she is generally healthy

99. Ms Sweetie 21 year old got raped by a stranger 4day back, and she has undergone forensic examination which confirms the same. After counselling She has been given Postexposure prophylaxis for HIV (tenofovir, emtricitabine and raltegravir ) and Hepatitis B vaccination. She is asking for emergency contraception. But she doesn’t want copperT as she still recovering from trauma .otherwise she is generally fit and fine.

100. Ms Angelina 17-year-old in her 2nd week of her cycle. She has taken ulipristal acetate for emergency contraception 4 days back for UPSI .her cycles are regular -30 days cycle and last period was 15days back.