MRCOG Part 2 EMQ Mock Exam

Option List:

A. Methotrexate
B. Etoposide, methotrexate, actinomycin D and folinic acid plus vincristine and cyclophosphamide
C. Repeat evacuation of uterus
D. No treatment required
E. On follow up for 1 year after the treatment
F. Methotrexate/folinic acid
G. Hysterectomy
H. Methotrexate and Hysterectomy
I. Follow up every bi-weekly till Hcg becomes normal

Instructions –

Each of the above Options describes Various Treatment of gestational trophoblastic neoplasia.
For each patient select the single most appropriate management for each scenario.
Each option may be used once, more than once or not at all

1. A 41-year-old woman has bleeding for 10 months following her third-term vaginal delivery. Uterine evacuation identifies choriocarcinoma on histological diagnosis. Ultrasound shows a 5-cm lesion in the myometrium and chest x-ray shows multiple (more than eight) lung nodules.

2. A 45-year-old woman has a hydatidiform mole evacuated uneventfully. The hCG decreases from a pre-evacuation value of 80,000 to 1000 IU/l, 4 weeks after the evacuation but then persists at 1000 mIU/ml for 4 weeks. Clinical examination shows no abnormality or evidence of metastases. Ultrasound of the uterus shows a 2-cm lesion in the myometrium. Chest x-ray is negative.

3. Mrs. A, has been treated for complete molar pregnancy 8 months back. She is on follow up; her Beta Hcg is 20,000 – since last 2 times it is showing increasing trend.
On further evaluation – CT scan shows lung and GIT metastasis.

Option List:

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

Each of the following clinical scenarios below relate to 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.

4. Mrs. Rubina, 24 years old woman 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

5. Mrs. Saksha, 40 years old, is 13 weeks pregnant confirmed by scan as well. She wants medical termination of pregnancy. She has taken 200mg of mifepristone 2 days before? What is next recommended regimen?

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

7. Mrs Radha, 36 years old, is diagnosed with Intrauterine fetal death secondary to severe IUGR at 29 weeks. She was counselled and wanted termination. To start with she is given 200mg of mifepristone. What is next recommended regimen?

8. Ms. Rachel, 26 years old, is late booker. Baby is diagnosed with complex congenital cardiac disease at 27 weeks. For termination of pregnancy – started with mifepristone 36hrs. What’s next recommended regimen?

Option List:

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
J. Clause M of abortion act 1967
K. Clause N of abortion act 1967

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

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

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

11. Hazel, 16 years old is now at 9 weeks of pregnancy. This pregnancy was result of sexual assault by her teacher. She is requesting for termination.

12. Mrs. Rasheeda, is a late booker. Second trimester screening at 18 weeks reveals high risk of Down’s syndrome of 1 in 20. Detailed anomaly scan shows VSD, duodenal atresia, short femur and nuchal fold thickness of 9mm.

13. Mrs. Sona 32 years old, is known diabetic and on insulin. Her blood sugar is well controlled. This is third pregnancy – unplanned pregnancy. Her first two babies were diagnosed with Down’s syndrome. She is requesting for termination

14. Mrs. Rawia, is immigrant who has been diagnosed with severe mitral stenosis with diameter of 0.25cm. She is into 6 weeks of pregnancy.

From the following clinical scenarios below, choose the single most appropriate management option from the option list.
Where relevant, it can be assumed that in each case the woman has been registered with the nearest Trophoblastic Screening and Treatment Centre.
Each answer may be used once, more than once or not at all.

Option List :

A. Dilatation of the cervix and uterine curettage
B. Hysterectomy and bilateral salpingo-oophorectomy
C. Intramuscular methotrexate and folinic acid
D. Intravenous multiagent chemotherapy
E. Measure serum hCG 6–8 weeks after the pregnancy
F. Medical termination of pregnancy
G. Oxytocin infusion to stop uterine haemorrhage prior to suction evacuation of the uterus
H. Prenatal invasive testing for fetal karyotype
I. Prostaglandin cervical ripening prior to suction evacuation of the uterus
J. Second suction evacuation of the uterus
K. Suction evacuation of the uterus
L. Suction evacuation of the uterus and insertion of Mirena® intrauterine delivery system
M. Suction evacuation of the uterus and postoperative antiD prophylaxis
N. Suction evacuation of the uterus with antibiotic prophylaxis
O. Tests and treatment not required
P. Register with screening centres
Q. Write a letter back to GP.
R. Suction evacuation of the uterus and Register with screening centres .
S. Need to do Fetomaternal haemorrhage testing.

15. Mrs. Serena, 20 years old nulliparous woman presents with some vaginal bleeding at 12 weeks of gestation and a pelvic ultrasound scan indicates a diagnosis of a molar pregnancy. Complains of vaginal bleeding.
On examination
Per abdomen -16weeks gravid sized
Per vaginal examination – cervix -os admits 1 finger, fresh blood clots noted in vagina
Investigation results are as follows:
full blood count: haemoglobin 11. 2 g/l, otherwise normal
liver and renal function tests: normal
blood group: O Rh negative
serum hCG: 100000iu/l
TSH: 1.5 mU/l

16. Mrs. Sara Ben, 25 years old woman, Para1living1 presents with heavy vaginal bleeding and crampy period-like pains at 12 weeks of gestation.
On examination she looks pale;
BP: 100/60 mmHg
pulse rate: 104 bpm
Per abdomen – uterus is 16 week sized uterus
Per vaginal examination – cervix is open and there is a lot of fresh blood and clots in the vaginal together with copious vesicular placental tissue.
Investigation results are as follows:
full blood count – haemoglobin 9.9. g/l,
blood group: O Rh positive
Serum Hcg- 5000Iu/L

17. Mrs. Tina, 39 years old woman, P4, presents at 10 weeks of gestation with recurrent vomiting and dehydration. On examination the uterus is palpated at approximately 16-week sized.
A pelvic ultrasound scan indicates a twin pregnancy with a possible diagnosis of a partial molar pregnancy in one of the twins.
Investigation results are as follows:
full blood count: haemoglobin 10.2 g/l, otherwise normal
liver and renal function tests: normal .
blood group: AB Rh positive
serum hCG: 120000IU/l
thyroid function – free T4: 26 pmol/l free T3: 6.3 pmol/l TSH < 0.1 mU/l

18. Mrs. Sara, a 34-year-old woman, Para3 Living 3 presents with some vaginal bleeding at 16 weeks of gestation and a pelvic ultrasound scan indicates a diagnosis of a partial molar pregnancy.
On examination the uterus is palpated at the level of the umbilicus; the cervix looks normal and is closed; there is fresh blood and clots in the vagina. Investigation results are as follows:
Full blood count: haemoglobin 9.2 g/l, otherwise normal
Liver and renal function tests normal
Blood group – AB Rh positive
serum hCG: 148 457 IU/l
TSH: 3.1 mU/l

19. Mrs. Sabeera, 23-year-old nulliparous woman presents with 1 week of brown vaginal bleeding.
Her LMP was 14 weeks ago
She does not feel as if she is pregnant any more.
On examination -uterus is 6-8 weeks -sized
Cervix looks normal and is closed
There is old blood and brown discharge in the vagina.
A pelvic ultrasound scan shows a small fetus with no fetal heart action and a collapsed gestational sac.
Investigation results are as follows:
full blood count: haemoglobin 11.2 g/l
Blood group – AB Rh positive
serum hCG: 557 IU/l
thyroid function: normal.
After an evacuation of the uterus the histology confirms fetal parts and defective endovascular trophoblast invasion in decidual implantation site fragments from routine products of conception

Option List:

A. Vitamin B1
B. Vitamin B12
C. Proton pump inhibitors
D. Hydrocortisone
E. Normal saline with potassium chloride
F. Ginger
G. Pyridoxine
H. Metcalopramide
I. Phenothiazine
J. Procylcidine IV
K. Dextrose with potassium chloride
L. Termination of pregnancy

Each of the following clinical scenarios below relate to Management of women with Hyperemesis gravidarum.
For each patient select the single most appropriate management option from the list above. Each option may be used once, more than once or not at all.

20. Mrs. Sheeba, 32 years old primigravid woman is having inpatient management of hyperemesis gravidarum. She is having an oculogyric crisis, tardive dyskinesia after she received fast IV push of metaclopramide.

21. Mrs. Ruby, 24 years old referred from ambulatory care, as her PUQE index is 15. She is dehydrated, Ketonuria 2+, What is best rehydration regimen?

22. Mrs. Lovely, 19 years old, presenting with 2 episodes of nausea and vomiting. She is not dehydrated, able to tolerate orally, wishes to avoid anti-emetics.

23. Mrs. Rachel, 30 years old women, admitted for inpatient management of Hyperemesis, managed with rehydration, regimen, thiamine, Iv phenothiazine, Iv metaclopramide, diet according to dietician advise. She is still not responding to treatment.

24. This medication to be given before giving dextrose infusion

25. Mrs. Rita, 30 years old woman, presented with recurrent episodes of nausea and vomiting, she complains of recurrent heart burn suggestive of developing gastro-oesophageal reflux disease, additional medication along with antiemetics to be given.

Option List:

A. 45%
B. 90%
C. 75%
D. 14%
E. 8%
F. 7%
G. 80%
H. 65%
I. Less than 1%
J. 20%
K. 100%
L. 0%
M. 5%
N. 15%
O. 45%
P. 27%
Q. 6%

Each of the following clinical scenarios below relate to Management of women with Tubal ectopic pregnancy.

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

26. Mrs. Sweetie, 20 year sold nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. She has been treated for pelvic inflammatory disease three times in past. She also gives history of multiple sexual partners. During laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility. Salpingotomy with conservation of contralateral tube was done.
What is the further pregnancy rate for Mrs. Sweetie?

27. Mrs. Leslie, 32 -year-old primiparous woman presents to the early pregnancy clinic with Her last menstrual period was 7 weeks ago.
History of recurrent PID noted.
Vital signs on arrival are:
blood pressure = 100/60 mmHg & pulse = 75beats/min, temperature = 36.5°C, respiratory rate =16/min
Investigations : A urine pregnancy test is positive. , hCG level = 1400 iu/l.
On transvaginal scan – left adnexa was seen to contain an ectopic pregnancy measuring 22 mm x 18 mm x 15 mm with absent cardiac activity and no evidence of haemoperitoneum noted. After counselling she wants to take injection methotrexate.
What is the probability of her requiring surgery ?

28. Mrs. Sweetie, 20 years old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. She has been treated for pelvic inflammatory disease three times in past. She also gives history of multiple sexual partners. During laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility. Salpingotomy with conservation of contralateral tube was done.
What is the incidence of persistent trophoblast after this surgery ?

29. Mrs. X, 32 years old woman, primigravida now 6 weeks pregnant. Her transvaginal scan shows right adnexa mass of 36x25x30mm with fetal cardiac activity present. Her beta hcg is 1570IU/L. She is asymptomatic and hemodynamically stable. She underwent laparoscopy and because of healthy contralateral tube, salpingectomy is done. What is the incidence of persistent trophoblastic activity?

30. Mrs. Sweetie, 20 years old nulliparous woman, undergoes surgical management of a left tubal ectopic pregnancy. She has been treated for pelvic inflammatory disease three times in past . She also gives history of multiple sexual partners. During laparoscopy, the contralateral right tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility. Left Salpingotomy with conservation of right tube was done.
What is the incidence of repeated ectopic pregnancy in left tube for Mrs. Sweetie?

Option List:

Each of the following Options describes various women presenting with Antepartum Haemorrhage
For each patient select the single most appropriate management option from the list

A. Offer Magnesium sulphate infusion
B. Admission at 34 weeks, offer steroid and Cesarean at 36 weeks if asymptomatic
C. Offer steroids
D. Admission at 36 weeks for elective Cesarean if asymptomatic
E. Incision type doesn’t affect outcome of baby
F. Do a vaginal examination.
G. Admission at 32 weeks, offer course of steroids and deliver at 34-36 weeks if asymptomatic
H. Novasure endometrial ablation
I. Verticals skin incision and or curvilinear uterine incision
J. Consultant led care unit
K. Pfannesteil skin and curvilinear uterine incision
L. Wait and watch
M. Vertical skin and/or vertical uterine incision.

31. A 24 years old woman immigrant of Asian origin, in her second pregnancy. First delivery was by cesarean section. In this pregnancy she is diagnosed to have grade 2 Placenta Previa, planned for elective CS at 37 weeks as she was asymptomatic. Now she is 35 weeks 2 days and presented with spotting.

32. A 32 years old woman presented with heavy bleeding. She is now 27 weeks pregnant with transverse lie, she was resuscitated with 6 units of packed red blood cells and 4 units of FFP. She is immediately shifted to OT, what is the best surgical approach?

33. A 30 years old primigravida, conceived by IVF – anomaly scan shows vessel running between placenta and succenturiate lobe. What is the best plan for her delivery?

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. 1in 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

34. 26 years old Tesisly has delivered 6 weeks back. She underwent cesarean section for prolonged rupture of membranes with suspected chorioamnionitis. Now she has presented with heavy vaginal bleeding. Her ultrasound shows retained membranes -she is for evacuation of uterus. What are her chances of having uterine perforation?

35. Sherlye, 32 years old, primiparous and a normal vaginal delivery. With removal of placenta she has increased vaginal bleeding. Her quantified blood loss is 1700ml.
She was managed with balloon tamponade. In what percentage of women, hysterectomy is avoided with tamponade?

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

37. Sherlye, 32 years old, primiparous and a normal vaginal delivery. With removal of placenta she has increased vaginal bleeding. Her quantified blood loss is 1800ml.
Bleeding wasn’t controlled with oxytocin, balloon tamponade. She was shifted to operation theater for B lynch suture & bleeding controlled with that. What percentage of women, hysterectomy is avoided with B lynch suture?

38. Active management of third stage of Labour decreases PPH by what percentage.

Each of the following Options describes various tests for male factor infertility.
For each patient select the single most appropriate test from the list below. Each option may be used once, more than once or not at all

Option List:

A. Karyotyping.
B. Serum testing for cystic fibrosis
C. Repeat semen analysis immediately.
D. Repeat semen analysis after 3months
E. Repeat FSH, LH & testosterone.
F. Refer for urologist.
G. Measure prolactin level.
H. Urine for microscopy & culture.
I. US/doppler scrotum.
J. Test for smell.
K. Culture of semen.
L. Advanced sperm quality test
M. DNA fragmentation test of sperm.

39. Mr. Stuart, 24 years old Caucasian presents for evaluation of infertility. No problem in erection or ejaculation. Examination -showed bilateral absence of the vas. Semen analysis confirmed azoospermia.

40. Mr. Tom, 30 years old, tall healthy man presents for infertility evaluation. He has no problem in erection or ejaculation. Semen analysis showed count of 6 million/ml. Repeated twice.

41. Mr. Adam, 34 years old man, who was previously healthy & has fathered a child before, now complains of excessive fatigue and headache. He failed to produce semen for testing twice. His hormonal profile showed low FSH, LH & testosterone.

42. Mr. Lewis, 28 years old, healthy, has fathered 2 children before, but he noticed some urgency, dysuria & turbid/cloudy urine after sexual intercourse.

From the following statements, choose the single most appropriate artery/vein from the blood vessel options.

Option List:

A. Anterior division of the internal iliac
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. Uterine
O. Vaginal

43. May be divided when opening the peritoneum during a laparotomy and is also known as the urachus.

44. May become thrombosed in the puerperium and is a rare cause of acute localised abdominal pain.

45. Occasionally may need to be ligated in cases of acute pelvic or obstetric haemorrhage.

46. Biophysical blood flow analyses (Doppler) may be used in the second trimester of pregnancy to assess possible perinatal outcomes

47. May be damaged when injecting local anaesthetic during a regional block for instrumental deliveries.

48. Biophysical blood flow analyses (Doppler) may be used in the third trimester of pregnancy to assess possible perinatal outcomes

49. Initial suturing during a surgical repair of a right mediolateral episiotomy will prevent postpartum haemorrhage

50. You are reviewing a patient who delivered via ventouse 2 hours earlier. She complained of severe pain around episiotomy. Pain score is 8/10. You note a bulge developed around her vagina. You suspect it’s a vulval hematoma. The following main vessels is responsible for a vulval haematoma?

Option List:

A. Less than 1%
B. 1–10%
C. 11–20%
D. 21–40%
E. 41–59%
F. 60–70%
G. 71–85%
H. 86–95%
I. Greater than 95%

Instructions –
Each of the above Options describes various incidence and prevalence of chicken pox in pregnancy .
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

51. Mrs. Rachel , 32-year-old nulliparous woman is 12 weeks pregnant and is anxious to know the prevalence of chickenpox complicating pregnancy, because her father recently died of the disease in his early 50s, while receiving chemotherapy treatment for metastatic lung cancer.

52. Ms. Rebecca, 19-year-old nulliparous woman has contracted chickenpox at 23 weeks of gestation. She suffers mild to moderate asthma and is currently using Synbicort Inhaler (steroid and beta agonist ) and is under good symptomatic control without any oral steroids. She is anxious to know the chances of developing pneumonia as a complication.

53. Ms. Tina, 26 year-old woman, P2, has contracted chickenpox at 39 weeks of gestation during an otherwise uncomplicated pregnancy and she is worried about the risks for her baby and, in particular, the chance that her new-born will develop clinical chickenpox.

54. Ms. Rosy, 19 years old, P3, developed chickenpox early in her pregnancy at around 8 weeks gestation, while living abroad in Africa. She did not have access to zoster immunoglobulin at that time. She has arrived in the UK as an asylum seeker at 34 weeks of gestation. She now enquires about the risk of her baby being affected by chickenpox infection in the womb (foetal varicella syndrome)

55. Ms. Suzi, mother of a 15-year-old, enquires whether her daughter should be immunised against chickenpox because, in the past, the mother had a child severely affected by foetal varicella syndrome. After counselling, she wishes to know if her daughter were to have an immunity test for chickenpox, what would be the likelihood she will be seropositive.

Option List:

A. 0.1/10
B. 0.2/1000
C. 0.3/1000
D. 0.4/1000
E. 0.5/1000
F. 0.6/1000
G. 0.8/1000
H. 0.9/1000
I. 1/1000
J. 2/1000
K. 4/1000
L. 5.3/1000
M. 2.3/1000
N. 35%
O. 50%
P. 48%
Q. 58%
R. 1 in 400
S. 1 in 5000

The following scenarios relate to a 28 years old nulliparous woman concerned about GBS. Choose the most appropriate option from the above list for each scenario.

56. A 28 years old nulliparous woman at 22 weeks come to antenatal clinic . She is worried as her friend delivered recently and her newborn got GBS infection. She wants to know the risk of her newborn getting GBS disease ?

57. She also has heard that if she gets fever during labour then the risk of having GBS infection in newborn increases. How much is the risk?

58. She comes at 32 weeks with vaginal discharge and GBS present in Vaginal swab. What is the risk of having GBS in newborn in current situation?

59. She tells that her sister was diagnosed to be GBS carrier in her last pregnancy, and she is again pregnant. What is the chance that she is again carrier of GBS ?

60. Her sister underwent bacteriological test at 35 weeks which was positive. What is the risk of her sister’ baby being affected by GBS infection ?

Option List:

A. Ovarian hyperthecosis
B. Polycystic ovary syndrome
C. Premature ovarian failure
D. Turner’s syndrome
E. Androgen insensitivity syndrome
F. Prolactin secreting adenoma
G. Drug-induced hyperprolactinaemia
H. Post-pill amenorrhoea
I. Depo-medroxyprogesterone acetate induced amenorrhoea
J. Unexplained infertility
K. Late onset congenital adrenal hyperplasia
L. Rokitansky syndrome
M. Androgen secreting tumour
N. Cushing’s syndrome Asherman’s syndrome
O. Sheehan’s syndrome

For each scenario described below, choose the single most appropriate diagnosis from the above list.

61. A 32 years old woman presents with a 2 year h/o primary infertility. She was on depot for 3 years until 1 year ago. She has regular 28 days cycle, her BMI is 24 kg/m2. Investigation: Her transvaginal scan shows Normal pelvis & semen analysis, serum, prolactin are normal. Tubal patency test shows bilateral free spill .

62. A healthy 37 years old woman develops rapidly progressive hirsutism & male pattern baldness. She has her period every 22-65 days, her BMI is 34 kg/m2. Pelvic ultrasound: bilateral complex ovarian cysts of 5.6cm and 6.4cm. Follicular phase FSH = 5.5 IU/L, total serum testosterone = 6.5 nmol/L, prolactin = 15ng/ml

63. A 34 years old woman presents in infertility clinic with secondary infertility. She has 1 child  delivered by CS for placenta previa 3 years ago. She has period every 32– 50 days & has not used contraception for 3 years. Pelvic ultrasound and her partner’s semen analysis are normal. Follicular phase FSH = 28 IU/L, LH = 18 IU/L , prolactin = 15 ng/ml. FSH and LH were repeated twice, and showed the same values.

64. A healthy 32 years old presents with secondary amenorrhoea. She had been using depo-inj for contraception, last injection was 2 years ago. Her BMI is 24 kg/m2. Pelvic ultrasound shows increased ovarian volume. Serum prolactin = 50 ng/ml, testosterone = 3.6 nmol/L, FSH = 2.2 IU/L, LH = 2.0 IU/L, TSH = 1.5 mIU/L, SHBG = 12 nmol/L. All other investigations normal.

65. 17 years old girl presents with primary amenorrhoea. She is sexually active with normal breast, axillary, pubic hair development. Her height is 1.65m and BMI is 20 kg/m2. TVS shows that the uterus is absent. Serum testosterone = 18 nmol/L.

Option List:

A. IgG
B. IgM
C. VZIG
D. Oral Acyclovir 400 mg 3 times daily for 5 days
E. Intravenous Acyclovir
F. Oral Acyclovir 400 mg 3 times daily from 32 weeks
G. Oral Acyclovir 400 mg 3 times daily from 36 weeks
H. Oral Acyclovir 800 mg 5 times for 7 days
I. IgG avidity test
J. No treatment needed
K. Observation for 12 hours and discharge if well
L. Observation for 24 hours and discharge if well

Choose the most appropriate management from the options above for the below scenarios. Each option can be used once, more than once or none at all.

66. A 24 years old para 2 woman at 24 weeks comes to you. She is worried as her youngest son has developed chicken pox rash yesterday. She is sure she never had chicken pox earlier. What is your next step ?

67. The woman from the above scenario, comes after 10 days as her elder daughter has also developed chicken pox rash. What is your next step ?

68. 28 years nullipara at 27 weeks comes with chicken pox rash developed in morning, and now having severe itching.

69. A 26 years old woman with HIV develops primary HSV at 28 weeks. What will be your initial treatment?

70. A 28 years old woman, HIV positive presents with recurrent HSV at 30. What will be your management in regard to HSV?

71. What is the neonatal management of a baby doing fine and no signs of infection, delivered to a mother by Caesarean Section who developed primary Herpes at 34 weeks and took Acylovir since the lesion developed till delivery?

72. What is the neonatal management of a baby doing fine and no signs of infection, delivered to a mother vaginally at 38 weeks,  who developed primary Herpes at 34 weeks and took Acylovir since the lesion developed till delivery?

Option List:

A. Intravenous artesunate
B. Antiemetic plus repeat oral quinine
C. Antiemetic plus repeat oral quinine and clindamycin
D. Intravenous quinine
E. Intravenous clindamycin
F. Intravenous quinine plus oral clindamycin
G. Intravenous quinine plus intravenous clindamycin
H. Oral quinine
I. Oral clindamycin
J. Oral quinine plus oral clindamycin
K. Oral chloroquine for 3 days
L. Oral chloroquine 300 mg weekly until delivery
M. Pyrimethamine
N. Primaquine
O. Sulphadiazine

73. A 32-year-old Afro-Caribbean woman, nullipara women presents to the day assessment unit at 29 weeks of gestation with fever, chills, malaise and musculoskeletal pain. She gives a history of malaria 4 years ago during her visit to South Africa. A peripheral blood smear shows Plasmodium falciparum. Her FBC , LFT and RFT is WNL and there are no symptoms or signs of severe complications.

74. A 28-year-old Asian woman, primigravida presents to the antenatal clinic at 22 weeks of gestation with fever, malaise and muscle pain. She returned to the UK 2 weeks ago from India. A peripheral blood smear shows Plasmodium vivax. She receives anti-malarial treatment for 7 days and is cured. Four weeks later, she comes to see her general practitioner for advice on further management in pregnancy.

75. A 30 years old Afro-Caribbean woman, Gravida 2 para 1  presents to the day assessment unit at 37 weeks of gestation with fever, malaise and muscle pain. Her peripheral smear shows Plasmodium ovale.  Her FBC , LFT and RFT is WNL and there are no symptoms or signs of severe complications.

Option List:

A. Letrozole
B. Clomiphene
C. Hysterosalpingography
D. Diagnostic hysteroscopy
E. Diagnostic laparoscopy
F. Chromopertubation
G. Donor insemination
H. Unprotected intercourse limited to time of ovulation
I. Gonadotropin stimulation
J. GnRH agonist and step up protocol and minimal dose of HCG
K. GnRH antagonist protocol with GnRH agonist for ovulation induction
L. IUI

Choose the most appropriate option from the above list for the below scenarios. Each option may be used once, more than once or none at all.

76. A 22 years old nulliparous woman with primary amenorrhea was found to have hypogonadotrophic hypogonadism related amenorrhea. What will be treatment of choice for infertility management?

77. A 28 years old nulliparous woman is in same sex relation. What Method of conception?

78. A 28 years old woman being investigated for infertility for 3 years has dysmenorrhea, dyspareunia and dyschezia. What is the gold standard method for diagnosis of her condition?

79. A 32 years old couple with Husband HIV positive and compliant with HAART and viral load < 50 copies/ml.

80. A 28 years old woman known case of PCOS undergoing IVF treatment. Which protocol is best to avoid OHSS ?

Option List:

A. Dexamethasone 12 mg , 2 doses, 12 hrs apart
B. Lower segment CS – category I
C. Fetal fibronectin assay
D. Insulin like growth factor binding Protein I test
E. Commence Magnesium sulphate infusion
F. High vaginal Swab for culture
G. In uterotransfer
H. Intravenous atosiban 6.75 mg bolus followed by infusion with dexamethasone
I. Urine microscopy and MSU for culture
J. Oral erythromycin 250 mg QID with betamethasone
K. Betamethasone 12 mg 24hrs apart
L. Oral Nifedepine 20mg followed by 10-20mg with betamethasone
M. Oral erythromycin 250mg TID with betamethasone

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

81. 35 years old Primi gravida with an uneventful Antenatal period presents at 28 weeks of gestation with complaints of draining P/V with no pain or bleeding. On examination, uterus was relaxed with no contractions and pooling of fluid was observed on speculum examination. The best management plan is

82. 30 years old Primigravida deemed to have low risk pregnancy presented with complaints of draining P/v at 33 weeks of gestation. On examination, uterus was relaxed, and pooling of the liquor was not evident. The best management plan is

83. 35 years old second gravida presented with 33 weeks of gestation presented with leaking P/V. On examination, was found to have regular uterine contractions and pooling of vaginal fluid on speculum examination with a partially effaced cervix. The best management option is

84. 40 years old primigravida presented with complaints of pain abdomen at 31 weeks of gestation with complaints of leaking P/V with no pain or bleeding. She had been previously managed  for a threatened preterm labour 3 days back. On examination, was found to have regular uterine contractions and pooling of vaginal fluid on speculum examination and cervix was 3-4 cms dilated. The best management option is

Option List:

A. Syntometrine
B. Oxytocin intramuscular
C. Group specific blood transfusion
D. Carboprost i.m 0.25 mg
E. Rh negative blood transfusion
F. Oxytocin intravenous
G. EUA
H. Oxytocin infusion
I. FFP and cryprecipitate
J. HDU care
K. Misoprostol 1000mg sublingually
L. MOEWS chart
M. Involve the consultant
N. Ergometrine im or iv

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

85. 29 years old multiparous delivered male baby weighing 3.6 kg by spontaneous vaginal delivery with a good APGAR. Following delivery, placenta and membranes expelled.  She had atonic PPH following delivery which was managed with oxytocin. Her pulse is 98/min and her BP is 100/60 mmhg. The best management option is

86. 30 years old multiparous woman delivered vaginally at A&E following a precipitate labour with profuse vaginal bleeding.  On examination she was found to have atonic Uterus with a small perineal tear. IV access was secured, and immediate resuscitation measures started. The best management is

87. 36 years old woman delivered her first baby by outlet forceps delivery for fetal distress. Following the placental delivery, she had profuse vaginal bleeding and on examination was found to have well contracted uterus and the placental membranes were completely removed.  Immediate resuscitation measures initiated.  The management option is

88. A 24 years old primigravida undergoes induction of labour at 34 weeks of gestation for severe preeclampsia for which she was on magnesium sulphate infusion. Following vaginal delivery, she was found to have PPH for which oxytocin injection  and infusion was started. Resuscitative measures initiated. Bimanual uterine compression also is being performed. Bleeding persisted and the next management option is

Option List:

A. Repeat ECV with tocolysis
B. ECV
C. Repeat ECV in one week
D. Elective caesarean section
E. Emergency caesarean section
F. Breech extraction
G. Allow vaginal breech delivery
H. Conduct an assisted vaginal breech delivery
I. Offer ECV at 36 weeks
J. Offer ECV at 37 weeks
K. ECV contraindicated
L. Breech extraction
M. Routine AN care
N. Vaginal breech delivery contraindicated
O. Start syntocinon and then artificial rupture of membranes

Choose the most appropriate option for the scenario given. Each option may be used once or more than once or not at all

89. 30 years old G2P1 has presented to the labour ward at 39 weeks of gestation with labour pains. Her previous pregnancy and delivery was uneventful and had delivered a 3.8 kg male baby. On examination, there was 3 contractions occurring every 10 mins lasting for 20-30 secs, the lower pole seemed to be having the breech and the CTG was reassuring. On vaginal examination, she was 5 cms dilated and the foot was presenting. The most appropriate management option is

90. 30 years old nulliparous woman presented herself to the obstetric day assessment unit at 36+weeks of gestation with a mild to moderate vaginal bleeding. No further episodes of bleeding and clinically the woman was stable with breech presentation with adequate liquor and the EFW was 2.9kgs, with no evidence of placenta praevia or placental abruption. Following observation, she was discharged and she then presented herself to the labour ward for ECV because she was booked for ECV. The best management option is

91. 35-year-old G2P1 woman with previous uncomplicated vaginal delivery of 3.7 kgs presented to the labour room with twin pregnancy and both babies are in a cephalic presentation at 37 weeks of gestation. This pregnancy has been very uneventful and early trimester scan had revealed DCDA twin. The USG done at 36 weeks showed twins are above the 50th centile for growth with  no discordant  growth with adequate SDP of 5 and 6 respectively. She progressed well during the labour with CTG normal throughout labour. The first twin is delivered by vertex uneventfully. After the delivery of the first twin, the second twin is found to be transverse. What would be the best immediate action?

92. 28 years old primigravida was seen at the antenatal clinic at 36 weeks of gestation. Clinical examination revealed breech presentation. Ultrasound revealed an adequately grown fetus with extended breech, normal liquor with an EFW of 2.7 kgs. The appropriate management plan is

Option List:

A. Syntocinon im
B. Syntocinon 5IU intramuscularly
C. Syntocinon 10 IU intramuscularly
D. Syntocinon 5IU infusion
E. Syntocinon 10IU intravenously
F. Carbetocin
G. Carboprost
H. Syntometrine
I. Misoprostol

From the options given above, choose the most appropriate uterotonic agent for the scenario given. Each option may be used once or more than once or not at all

93. 25 years old primigravida with uneventful antenatal period, presented to the labour ward and delivered by spontaneous vaginal delivery. The most appropriate agent is?

94. 28 years old woman conceived with IUI and a known GDM on insulin with no other co-morbidities with twin gestation, had a spontaneous onset of labour and had a normal progression of labour. Twin 1 was delivered by forceps as there was a delay in the second stage of labour. Twin 2 delivered spontaneously with no problems. The most appropriate uterotonic is.

95. 34 years old woman was induced at 37 weeks of gestation for severe pre-eclampsia, but is undergoing emergency LSCS for fetal distress. The most appropriate uterotonic to prevent PPH is

Option List:

A. HDU care , IV fluids and supportive care
B. Stabilisation and Category I CS
C. Category 1 CS
D. Perimortem caesarean section
E. Two-wide bore cannula, CBC, coagulation profile ,U&E’s and cross match
F. Call the consultant
G. Check airway, breathing, oxygen supplementation and IV access
H. Coronary angiography
I. CT pulmonary angiogram
J. Intravenous heparin loading dose followed by infusion

For each of the following scenarios, choose the single most appropriate option from the list given above. Each option may be repeated once or more than once or not at all

96. 28 years old G3P2 was brought to the emergency in a collapsed state with 34 weeks of gestation. She is a smoker who smokes about 10 cigarettes per day. Otherwise she had an uncomplicated pregnancy. She now had complained of severe abdominal pain. At emergency, her pulse is 110/min, and BP is 90/50mm Hg. Her abdominal examination revealed a tender hard uterus and the fetal heart rate is less than 100/min. The initial resuscitative measures have been done. The appropriate management is

97. 39 years old primigravida was found to be high risk  on the combined test. She was advised Amniocentesis and was about to undergo amniocentesis. While undergoing the procedure, she suddenly had complaints of breathing difficulty, giddiness and became unconscious. The appropriate management is

98. 40 years old multiparous woman was brought to the emergency on the 10^th post natal day with history of chest pain, sweating, palpitations and sudden collapse and is a heavy smoker. She was resuscitated with initial measures and was stabilised. The most appropriate investigation option is

Option List:

A. Low dose Aspirin
B. Serial Cervical length ultrasound scan
C. Prednisolone
D. HCG
E. Low molecular weight Heparin
F. Metformin
G. Hysteroscopic resection
H. Intravenous immunoglobulin
I. Cervical cerclage
J. Reassurance
K. Progesterone pessary
L. Low dose Aspirin & LMW Heparin
M. Weight reduction

Choose the single most appropriate management plan for the following statements:

Each option may be used once, more than once, or not at all.

99 . A 28 years old lady presents at 10 weeks gestation with vaginal spotting. She gives history of one first trimester pregnancy loss and one second trimester pregnancy loss at 18 weeks suspected to be due to cervical weakness. Investigations were normal.

100. A 34 years old woman being investigated for recurrent 1st trimester Pregnancy losses. She is obese with a BMI of 33 and a family history of diabetes mellitus. She has been diagnosed to have PCOS. No other cause has been found.