MRCOG Part 2 – 4 Months – SBA Mock Exam

1. A 25-year-old woman with a history of chronic pelvic pain has recently had an USS of her pelvis, which has been reported as normal. She is sad and upset and has told the nurse that she feels like no one is taking her concerns seriously. You are meeting her in the gynaecology outpatient clinic today for the first time. The woman reports that the doctor who did ultrasound made a comment about her ovaries during the USS, and she is worried there is something seriously wrong.
What is the most appropriate approach during your consultation?

2. 30 year old woman presents with lower abdominal pain since 9 months. Pain typically worsens during the premenstrual period and associated with fatigue and exacerbated by standing, walking, and gardening. Pain worsens after intercourse resulting in throbbing ache afterwards. What is the definitive investigation to establish the diagnosis?

3. A 35-year-old female, who is a para 3, had firstly a vaginal delivery and two Caesarean sections – first was done in view of foetal distress and the second was elective caesarean. She has presented with chronic pelvic pain three months after her last lower uterine segment Caesarean section (LSCS).What is the incidence of nerve entrapment after LSCS?

4. A 38-year-old woman with Type 2 diabetes is admitted for induction of labour at 38 weeks gestation in her third pregnancy. She was on drugs for diabetes control but because of uncontrolled blood sugar insulin was started. She had two previous spontaneous normal births. She has epidural analgesia for pain relief and her labour is uncomplicated until shoulder dystocia is diagnosed after delivery of the foetal head. Additional help is summoned but the shoulders cannot be delivered with axial traction and with McRoberts’ position. What is the most appropriate next step?

5. There is panic in labour room as there is shoulder dystocia case where the delivery of baby was delayed than expected. With regard to Shoulder dystocia, permanent injury to the brain is more likely after :

6. With regard to shoulder dystocia, all of the following are false except

7. What is the recurrence rate of shoulder dystocia?

8. A first year trainee approaches you to learn how to perform the manoeuvres to manage shoulder dystocia. What is the most effective way of achieving this learning?

9. You are ST3 on call asked to attend an obstetric emergency call for the problem shown in figure. You and midwife successfully managed the problem and you then advise them to prepare for PPH.

What is approximate chance of PPH?

10. What is the incidence of concomitant endometrial cancer in %, in the uterus specimen if the hysterectomy had been done for atypical hyperplasia?

11. A 34 years nulliparous women is seen at menstrual disorders clinic for HMB. She is a known PCOS with BMI 34. A histological report received after office biopsy shows numerous glands packed back to back with stroma in between with increased mitotic figures and alteration in the nuclear cytoplasmic ratio. What is this suggestive of?

12. A 44-year-old white woman is referred to the rapid-access gynaecologic clinic with PMB. Speculum examination reveals a stenosed cervical os and two failed attempts at endometrial pipelle biopsy. A transvaginal ultrasound shows an endometrial thickness of 6 mm. She claims to be fit and well.

13. 45 years old Mrs. Lucy is diagnosed with endometrial hyperplasia with Atypia, but she is not willing to undergo hysterectomy. How should she be managed?

14. You are ST5 registrar on call. You are called to the postnatal ward to see a 37-year-old para 3 who, after a reasonably long induced labour, has had a vaginal delivery 3 hours previously. Developed the problem given picture below.

What would be the most reasonable course of action?

15. A 35 year old woman with severe pre-eclampsia has had an emergency caesarean section at 32 weeks gestation because of severe IUGR. She became hypotensive and tachycardic and was returned to theatre where 2l of blood was evacuated from the abdomen and hysterectomy was performed. One week later, she developed sudden onset of severe chest pain and breathlessness and dies despite resuscitation. What is the diagnosis?

16. A healthy 23 year old woman has been referred to the antenatal clinic at 10 weeks gestation in her second pregnancy. Her first pregnancy was complicated by intra-uterine foetal death at 41 weeks gestation and she developed DVT after delivery. Following full investigation, she was found to have APAS. Her mother and sister both suffer from essential hypertension. Her BMI is 27 kg/m2 and her BP is 120/85 mmHg. Urine analysis showed no abnormalities. How will you manage the patient in this pregnancy?

17. A 27-year-old para 1 comes to your clinic requesting contraception. She mentions that her maternal aunt had deep vein thrombosis (DVT) and is on warfarin. She is worried that if she takes hormonal contraception, she will also develop DVT. Which of the following advice regarding DVT is incorrect?

18. Which of the following is the primary diagnostic test for DVT in pregnancy?

19. A woman with an uncomplicated pregnancy of 26 weeks gestation is about to go on a long haul flight to visit relatives in America, from India. She has a BMI of 37, is a smoker and she will be returning to the UK at 30 weeks gestation. Select the best advice regarding thromboembolism prevention in her case.

20. All of the following about LMWH are true compared to UFH except:

21. What is the risk of VTE in pregnancy after IVF with OHSS?

22. You are going to take an ANC lecture in your hospital where your special focus will be on pregnancy with diabetes. A 32-year-old woman tells you she is diagnosed with gestational diabetes during this pregnancy, and her capillary blood glucose level is 4 mmol/L. What is her risk of developing type2 diabetes within 5 years of this birth?

23. Give your expert opinion to update your unit guidelines on antenatal aspirin. Which one of the following patients should have aspirin 75 mg daily from 12 weeks’ gestation?

24. A 37-year-old para1 attends the delivery suite with periodic abdominal pain at 34 weeks’ gestation. She has diabetes and is on insulin. On examination there is a closed cervix and a positive fetal fibronectin test. What is the most appropriate management plan?

25. A 30-year-old lady who had a stillbirth in her previous pregnancy has been found to have undiagnosed diabetes. She is currently on oral hypoglycaemic agents, with good glycaemic control, and attends for pre-pregnancy counselling. What is the appropriate next step?

26. A 20-year-old woman books into the antenatal clinic at 10 weeks of gestation. She is fit and well but is noted to have an increased body mass index (BMI) but no other risk factors for diabetes. What BMI and above should be offered screening for diabetes?

27. A 36 -year-old Pakistani lady has delivered her fourth baby normally. She is a known Type 2 diabetic for 5 years and was taking Metformin and isophane insulin in pregnancy for glycaemic control. The woman is planning to breast feed.
What advice should be given with regard to a hypoglycaemic agent in the postnatal period?

28. Ms Lily is 37 weeks pregnant. She has been diagnosed with gestational diabetes, which is well controlled by diet alone. Her 36-week growth scan shows a normally grown foetus with normal liquor and Doppler. She was screened for GDM in view of her ethnicity alone. Her pregnancy has been uneventful so far. Up to when can Ms Lily be offered elective birth if she remains undelivered?

29. A 29-year-old woman is 24 weeks pregnant. She has long-standing type 1 diabetes mellitus. Her 20-week foetal anatomy ultrasound showed no structural foetal abnormalities. However, she is concerned about whether her diabetes may cause congenital foetal anomalies in her unborn child.
Of the options listed below, which SINGLE action addresses her anxiety?

30. A para 1 who delivered 2 week ago, was diagnosed to have GDM (diet controlled), and her plasma glucose levels have now returned to normal. What follow-up should she have postpartum?

31. 70 years old Ms. W presents with complaints of frequency, urgency and urge incontinence for the past 9 months. She does not give history of nocturia, visible haematuria, mass descending per vaginum. On examination, there was no pelvic organ prolapse and no evidence of demonstrable stress incontinence. What is the most relevant investigation that should be done before starting the treatment?

32. A 47 years old Mrs. X. P2L2 has presented to the gynaecology OPD with complaints of passing urine on cough and also is complaining of urinary urgency, and is passing urine more than 7-8 times in the day and more than three times at night. She underwent urodynamic testing which is given below. What is the most likely diagnosis?

33. The normal flow rate in a female during a voiding cystometry should be more than?

34. 70 years old woman had presented with complaints of predominantly urinary urgency, frequency, and occasional stress urinary incontinence. She was diagnosed to have overactive bladder. She was initiated with lifestyle modifications and bladder training for 6 weeks following which she was referred with no improvement in symptoms. What is the next step of management?

35. Your junior college wants to know about the drug mirabegron. He is asking you about the classification of the drug. You would tell him that it belongs to the class of

36. 52 years old woman underwent Transvaginal tape procedure for stress urinary incontinence. The procedure was uneventful, and the postoperative recovery was also uneventful. Your consultant tells you to discharge her and give her a review appointment. When would you ask her to come for a follow up vaginal examination?

37. In the grid and the line diagram of the POP-Q classification, the diagnosis of the given picture is?

38. You are assisting your consultant for a vaginal hysterectomy being done for third degree UV prolapse. Following the vaginal hysterectomy, you see that the vaginal vault is at the level of the introitus. What additional procedure do you think your consultant would perform?

39. 30 years old Primigravida at 34+ weeks presented with severe itching including the palms and soles and is worse at night. Her liver function tests were normal, and emollients did not give her relief. Your consultant starts her on ursodeoxycholic acid(UDCA) and antihistamines. All the statements are false regarding obstetric cholestasis (OC) except,

40. 35 years old G2P1 has come for booking visit. She had a previous instrumental delivery and had sustained a third-degree perineal tear, following which it was repaired and she is asymptomatic. But she is anxious to know whether she will sustain the injury again. What is her risk of sustaining a third or fourth degree perineal tear in this pregnancy?

41. 30 years old Primi is in labour at term and is contracting 4 in 10 minutes and the head is less than 1/5^th palpable. Vaginal examination revealed a fully dilated cervix with no membranes and the fetus is in LOA and the vertex is at +1 to +2 station. She has been in active second stage for about 2 hrs and is exhausted. If you have decided for an instrumental delivery and the woman consents for a forceps delivery, which type of OVD will you be performing?

42. 29 years old primigravida, wishes to have a home birth. This is a low risk pregnancy. What is the risk of baby having a serious medical problem?

43. 37-year-old P2L2 has been posted for diagnostic laparoscopy for chronic pelvic pain. She has undergone a midline vertical laparotomy for ruptured ectopic pregnancy. The decision of doing a closed-entry technique at the palmer’s point has been made. Which of the following is the correct anatomical description of Palmer’s point?

44. Complications related to the use of devices and mesh should be reported to

45. During the insertion of the primary trocar, the intra-abdominal pressure following the veress needle insertion is maintained between 22-25 mm Hg. All are true regarding this, except

46. The incidence of periumbilical adhesion with previous laparoscopy is

47. Your consultant is doing a diagnostic laparoscopy for a 30 year old woman who has presented to you with chronic pelvic vein. Your consultant has asked you to identify the marked structure. Identify the structure.

48. The overall risk of serious complication during a diagnostic hysteroscopy is

49. During the postoperative period, all are true except

50. The first-choice anti-septic unless contraindicated for the surgical site that is next to the mucous membrane is

51. 35-year-old P1L1, is planned for a resection of a sub-mucous fibroid. Hysteroscopy reveals,

What is the ideal distension medium for the resection of the fibroid using a resectoscope?

52. 32-year-old primigravida has presented to the labour room with early labour and undiagnosed breech, she has been planned for a category 2 CS. All are true regarding this situation, except

53. The preferred transverse incision is Joel-Cohen incision because it has

54. 22 year old woman underwent elective repeat caesarean section at 39+ weeks and had received morphine as intrathecal opioid. She should be monitored hourly for RR, sedation, and pain scores for atleast __?

55. All are true regarding bipolar devices and the energy, except

56. The following are good practice points while using a monopolar device, except:

57. 38 year old multiparous woman is undergoing diagnostic laparoscopy for chronic pelvic pain. What is the chance that the bowel injury might be missed at the time of laparoscopy?

58. 30 year old primigravida at 33+ weeks is on epidural catheter, and has been fully dilated and vertex is at +2 to +3 station actively pushing for more than 3 hours. The CTG is reassuring. The most appropriate management is

59. All are true regarding vacuum extraction, except:

60. 34-year-old G2P1L1 has presented to the labour ward at 38+ weeks in active labour. She is being monitored with a continuous EFM. The most consistent finding in uterine rupture is

61. 17 year old woman from Eritrea has come to the Antenatal clinic at 24 weeks of gestation. She has migrated from her country to UK recently. On exploring sensitively, she said that she has undergone FGM. The most important action would be

62. 20 year old has presented to the labour room with complaints of reduced fetal movements at 39 weeks of gestation. She had a similar complaint a week back and after necessary investigations was reassured and sent home which is quite remote with difficulty in accessing health care. She is a smoker. Examination reveals an adequately grown fetus and CTG is reassuring. Ultrasound revealed appropriately grown fetus and adequate liquor with normal umbilical Doppler. What is the most appropriate action?

63. 36 year old woman Rh negative has presented to the labour room at 32 weeks with complaints of loss of fetal movements since two days. Ultrasound done revealed IUFD. All the statements regarding IUFD and Rh negative pregnancy are true except:

64. 39 year old G2P1L1 at 31 weeks and a known GDM on insulin is admitted in the ward for IUFD. She has had a previous normal vaginal delivery and is being planned for Induction of labour. What is the ideal dose of the medication that should be used?

65. A 34 year-old woman is 16 weeks pregnant in her third pregnancy. Her blood pressure is 155/105 mmHg; 4 weeks earlier, it was 160/102 mmHg. Her urine dipstick shows + protein. Her spot urinary protein/creatinine ratio is 40mg/mmol. Which one of the following is considered the most likely diagnosis?

66. 40 year old primigravida has just identified that she is pregnant at 34 days of amenorrhoea. She is a known chronic hypertensive on captopril. What is the most appropriate management?

67. 31 year old P1L1 was delivered 6 weeks before at 28 weeks of gestation due to severe pre-eclampsia and HELLP syndrome. During her postnatal review, her BP is found to be normal and she was on anti-hypertensives for 2 weeks following delivery. She is very anxious that she may develop pre-eclampsia again in the subsequent pregnancy. What is the risk of recurrence of pre-eclampsia in her subsequent pregnancy?

68. 34 year old Lisa, has been pushing at full dilatation for over 2 hours now with no obvious progress even with syntocinon infusion.
Vacuum delivery was decided. She delivered with third pull, two times vacuum pulled off. Baby cried only after resuscitation, born with low Apgar scores and was kept in NICU. This unstable neonate found to have scalp swelling with ill-defined edges, that crosses suture lines. What’s your diagnosis?

69. 27 year old woman conceived after an IUI, with uncomplicated antenatal period had a spontaneous onset of labour and she progressed well into the second stage of labour. She was not on epidural and she had been actively pushing for more than 2 hours and was exhausted. Outlet forceps delivery was done and on examination following forceps delivery found to have a button-hole tear with an intact EAS and IAS. How would you classify this tear as?

70. 32 year old woman has presented with obstetric cholestasis at 35 weeks of gestation. She was put on menandiol sodium phosphate of 10 mg daily in view of prolonged prothrombin time. Which of the following complications is likely to happen to the neonate in this scenario?

71. A woman who is Rhesus-negative undergoes a laparoscopic salpingectomy for an ectopic pregnancy at eight weeks gestation. What dose of anti-D immunoglobulin should she receive immediately after the operation?

72. You are asked to review the blood results of a 32-year-old woman at 28 weeks gestation in her second pregnancy. Which one of the following antibodies has significant risk of causing fetal anaemia?

73. Which of the following is true regarding anti-D prophylaxis in pregnancy?

74. You are discussing the complications associated with laparoscopic ovarian cystectomy.

Which of the following are associated with chemical peritonitis?

75. You perform a transvaginal ultrasound scan on a 46-year-old woman who has a unilateral ovarian cyst. Which of the following is a suspicious feature?

76. A 57-year-old multiparous woman presents after an episode of heavy vaginal bleeding. Ultrasound shows a regular endometrium, with a thickness of 6 mm. However, a 9 cm irregular ovarian mass is seen in the left adnexal area. What is the likely tumour type?

77. You review a 57-year-old woman with an 8 cm complex ovarian mass and ascites. You are about to place her on the operating list when your consultant asks you for her RMI. Which of the following features of the ultrasound scan contributes to the RMI?

78. A 46-year-old nulliparous woman is seen with bloating and weight loss. Ultrasound confirms the presence of an irregular vascular 7 cm solid lesion adjacent to the left ovary. Ascites is present. What is the most appropriate course of management?

79. A 24-year-old woman presents with sudden onset of itching, burning, and irritation of the vulva. She is fit and well, and had an episode of hay fever recently. She also suffers from eczema and has recently started a new relationship. Inspection reveals vesicles and weeping of the skin on both labial folds with oedema and crusting. What is your diagnosis?

80. You are following up a 22-week pregnant woman in the antenatal clinic. Her epileptic fits are well controlled on medications. What is the most common cause of maternal death secondary to epilepsy?

81.  A 35-year-old woman comes for a suitable family planning method. She is obese (BMI 35 kg/m2), with a family history of endometrial cancer. What are her options?

82. A 30-year-old woman with a previous history of caesarean section and multiple uterine fibroids had a repeat elective caesarean section due to breech presentation. She had massive postpartum haemorrhage (PPH) secondary to uterine atony with an estimated blood loss of 3 L. She is RhD-negative and had a transfusion of the group-specific packed red cells, reinfusion of the salvaged red cells from the cell saver and also fresh frozen plasma (FFP), cryoprecipitate and platelets. The cord blood group was confirmed as RhD-negative.

Anti-D prophylaxis should be administered in which one of the options if she had the following blood products transfused?

83. A 41-year-old woman presents with a long history of probable recurrent urinary tract infections and has been treated with presumptive antibiotics when she lived abroad. She has severe pain in the bladder area and also urinary urgency but no leaks. She also reports occasional haematuria that resolves spontaneously. Serial urine cultures have always been negative, including for fungus and atypical bacteria. Choose the most appropriate investigation to obtain diagnosis.

84. You see a woman in the gynaecology outpatient clinic. She has symptoms of frequency and urgency of micturition. You asked her to keep a bladder diary. Over what length of time should a bladder diary be undertaken?

85. Interstitial cystitis (IC) is a clinical syndrome characterised urinary frequency, urgency, and pelvic pain of unknown aetiology. Which of the following is correct about IC?

86. Bernard Soulier Syndrome is associated with significant risk of primary and secondary PPH, and wound haematoma. Which of the following statement is true?

87. DDAVP is a useful modality to manage many bleeding conditions and may be used by the intravenous, subcutaneous or intranasal route. It is not helpful in all of the following conditions except:

88. Fibrinogen deficiency may be associated with bleeding, but quantitative and qualitative deficiency can also be associated with thrombosis and pregnancy loss. In the neonate, afibrinogenaemia has been associated with ICH and umbilical bleeding. Which of the following statements is false:

89. There is evidence of better overall obstetric outcome after bariatric surgery compared with women with class III obesity who are managed conservatively. Pregnancy can exacerbate nutritional deficiencies that predate pregnancy. Which of the following deficiencies in women can occur post bariatric surgery:

90. What is the advisable minimum waiting period to conceive following bariatric surgery?

91. Pregnant women with epilepsy have the highest risk of breakthrough seizures during:

92. A 17-year-old female has recently been diagnosed with epilepsy. She currently takes the oral contraceptive microgynon. Which of the following anti-epileptic medications is likely to make her contraception less effective?

93. Which antiepileptic drug is least associated with the fetal anomaly shown below:

94. Which alternative AED may be considered as first-line to replace seizures responsive to sodium valproate therapy (women with generalized epilepsy syndromes) in pregnancy?

95. A 70-year-old Caucasian patient was referred with a 2-year history of vulval and vaginal soreness unrelieved by vaginal oestrogen. She also reports recent onset dyspareunia, both superficial and deep. On further questioning she describes constipation, dysuria and both oral inflammation and ulceration. The examination confirmed oral ulceration and a white lacy pattern on the vulva. The vagina was very erythematous with a narrowed introitus and thin filmy adhesions to the mid-third. The examination was extremely painful.

What is the most likely diagnosis?

96. A 36 year old lady presents with severe vulval itching. On examination vaginal muscosa is not involved, but the skin has pink smooth non-scaly lesions. On further examination she has similar lesions over her elbows and knees. What is your most likely diagnosis?

97. A 32-year-old primigravida woman books at 12 weeks gestation with a BMI of 55. What management would you advocate?

98. Regarding pregnancy outcome after bariatric surgery in obese reproductive-age women, which of the following is true?

99. You are reviewing a 27-year-old patient who is a known carrier for severe hemophilia and is due to undergo chorionic villous sampling. Which of the following should be checked pre-procedure?

100. A lady has hemophilia A, husband normal. She gave birth to a female baby, what are the chances of her offsprings being a carrier?