MRCOG Part 2 Mock Exam

1. Mrs. Sweetie 45-year-old woman has a hydatidiform mole evacuated uneventfully. Now she is presenting with recurrent bleeding suspicious of Gestational trophoblastic neoplasia. Her pre-treatment hcg is 1000 0IU/L. Uterine tumour measuring 2x3cm. Diagnosis occurred within 4months of evacuation, CT scan confirms metastatic to brain.
Which one of the following factors is most likely to significantly increase the FIGO prognostic risk factor scoring for histologically diagnosed choriocarcinoma?

2. Mrs. Tina, 20 years old primigravida, has presented with excessive nausea and vomiting. On further evaluation ultrasound shows cystic spaces with a Fetal pole suggestive of partial molar pregnancy. Which one of the following factors is characteristically associated with partial hydatidiform mole?

3. Mrs. Tina, 22 years old, has presented to Accident and Emergency with excessive vomiting. She is 12weeks pregnant in her first pregnancy. She has got her ultrasound done.
Looking at the image, the genetic karyotyping of this pregnancy would be

4. Mrs. Rasheeda, is an immigrant from INDIA. She is primigravida, presenting with vaginal bleeding. Bed side ultrasound showed snowstorm appearance suggestive of molar pregnancy. What’s the incidence of molar pregnancy ?

5. Mrs. Sadiya, 26 years old, presented with hyperemesis gravidarum. She has been admitted to hospital for Intravenous hydration with antiemetics. Her Liver function tests show as slightly increased bilirubin, with elevated liver enzymes. She has no jaundice. What is the Incidence of raised LFTs in women with Hyperemesis Gravidarum ?

6. Mrs. Rachel, 30 years old woman, presented with excessive vomiting. She also gives history of retching and hematemesis. She has been treated with Antacids. Since she wasn’t better with that, she underwent Gastroduodenoscopy. The endoscopy image is enclosed. What is your diagnosis?

7. Mrs. Tina 34 years old woman is admitted with recurrent hyperemesis. She is into her 8th week of pregnancy. Her thyroid function tests are abnormal with a raised Free T3&T4 and low TSH. Select the most likely cause of her deranged thyroid function:

8. Regarding acupressure treatment in Hyperemesis all are true except

9. 24 years old woman at 21 weeks 3 days has come to you to discuss her anomaly scan result which shows Unilateral talipes of left leg. No other anomalies. She is insisting for termination of pregnancy as she cannot think of having a handicapped child even after counselling. Your consultant has discussed and agreed for termination. She wants to wait for 2 weeks for her husband to arrive. What is the most  important information you have to give her if she wants to delay for 2 weeks?

10. Mrs. Babitha, 45-year-old woman gravid 1 para 0 is referred to antenatal clinic for booking. She misses her dating scan. She is now 16 weeks pregnant and her booking bloods reveal normal haematological and biochemical tests. However, her quadruple test reveals
low levels of AFP (α-fetoprotein)
high levels of ß-hCG
Low levels of oestriol
High levels of inhibin A.
The probability of Karyotyping report following amniocentesis would be

11. Mrs. Tina at 9 weeks gestation has been diagnosed with missed miscarriage, she is here for Manual vacuum aspiration as outpatient procedure. While consenting she asks you what’s the possibility of her requiring additional treatment?

12. In UK, how many women are offered choice of invasive prenatal diagnostic tests?

13. Mrs. Babitha, 45-year-old woman gravid 1 para 0 is referred to antenatal clinic for booking. She is here for dating scan. She is now 11 weeks pregnant and her booking bloods reveal normal haematological and biochemical tests. However, her Downs screening test reveals
NT is 3.8mm
Low levels of PAPPA
High levels of ß-hCG .
She is counselled for Chorionic Villus sampling.
She asks about chances of severe sepsis.

14. Mrs. Babitha, 45-year-old woman gravid 1 para 0 is referred to antenatal clinic for booking. She misses her dating scan. She is now 16 weeks pregnant and her booking bloods reveal normal haematological and biochemical tests. She is offered quadruple test. What is the detection rate and false positive rate of this test?

15. Julie, 26 years old, has been treated for Cesarean scar pregnancy in her pregnancy has been treated by current age with uterine artery embolization. At the time of discharge, she is asking about possibility of Cesarean scar pregnancy recurring again?

16. Ms. Tina, 22 years old woman, presented with 6 weeks gestation, complains of mild pain in abdomen with moderate vaginal bleeding.
Hemodynamically stable.
Abdomen and vagina examination is insignificant.
Urine pregnancy test positive.
TVs scan- no intrauterine sac, both tubes &ovaries -Normal.
No free fluid.
What’s appropriate management plan?

17. Mrs. Rosy, 22 years old woman, primiparous at 14 weeks requesting for medical termination of pregnancy. Her blood group is A +, she has undergone counselling as well and she is sure of her decision. The recommended regimen all are true except

18. Regarding antibiotic prophylaxis all are true except

19. Mrs. Sweetie, 20 -year-old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. She has been treated for pelvic inflammatory disease three times in the past. She also gives history of multiple sexual partners ,At laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility.
Which is the single best management option?

20. What is the most common statutory ground for abortions (abortion act 1967)in UK

21. All are true regarding abdominal ectopic pregnancy except

22. The most reported location for abdominal pregnancy is

23. In early pregnancy scan the embryonic pole is first visualized beside yolk sac on day

24. The diagnosis of pregnancy of unknown viability in transvaginal scan, irrespective of woman’s last menstrual period can be done in all except

25. The optimal timing for viability of pregnancy in ultrasound is

26. Mrs. Rubaa, 29-year-old patient, presents with abdominal distension and vaginal bleeding at 12 weeks’ gestation. A transvaginal ultrasound scan suggests a molar pregnancy with bilateral enlarged multicystic ovaries. No free fluid in pelvis. Ultrasound image is enclosed.

What is the most likely diagnosis?

27. Mrs. Angelina, 23-year-woman had an ultrasound scan that was suggestive of a missed miscarriage. She underwent evacuation of the uterus and products of conception were sent for histology. The histology report confirmed that this had been a partial molar pregnancy. What is immediate follow-up plan you will advise on her discharge?

28. A 35 years old woman has a long history of infertility and is contemplating assisted conception treatment. She asks you what is the risk of having a baby with trisomy 21 at her age?

29. You are asked to conduct an audit as number of tubal ectopic pregnancies diagnosed is increasing. To set national standard of incidence of tubal ectopic pregnancy you choose

30. Mrs. Lovely, 40 years old, is in her first pregnancy. Now she is 12 weeks pregnant. She was recently diagnosed as HIV positive; she is not any medications as her Downs syndrome risk is high 1 in 100. She is advised to get invasive prenatal tests. What is the risk of transmission of HIV to baby?

31. You are reviewing a patient who delivered via ventouse 2 hours earlier. You note a bulge developed around her vagina. You suspect it’s a vulval hematoma. Which of the following vessels is responsible for a vulval haematoma?

32. The emergency buzzer went off in the postnatal ward & you are called to see a patient who delivered 4 hours earlier via ventouse. You note a bulging haematoma has developed and patient is hypotensive. With regard to vulval haematomas what structure limits its spread?

33. A healthy 28-year-old, P0+2, has a 7-hour history of sudden-onset severe right-sided lower abdominal pain; her LMP was 6 weeks ago; periods are normally infrequent and irregular: 3–4/35–56 days. She and her partner have a past history of subfertility and are currently receiving clomiphene citrate 100mg for ovulation induction for anovulatory oligomenorrhoea. Her first pregnancy was an early miscarriage; the second was a left tubal pregnancy.
On examination: she looks pale and distressed; the abdomen is very tender in the lower half on the right side with rebound peritonism; no masses. Vaginal examination: normal sized uterus, no masses and cervical excitation tenderness is elicited.

Observations are as follows:

Pulse rate (bpm) 110
Temperature (ºC) 36.0
Blood pressure (mmHg) 120/50
Urine analysis has not passed urine
Respiratory rate (breaths/min) 14
O2 saturation on air (%) 96
What is the most appropriate investigation of choice?

34. Mrs. Joly, primigravida, now 6 weeks pregnant is diagnosed with Missed miscarriage and underwent surgical termination. Histopathology shows as partial Molar pregnancy. What is the most common symptom Mrs. Jolly can present with, in case of persistent trophoblastic disease?

35. Ms. Briganza, 34 years old, multigravida had a forceps delivery followed by which she had massive PPH. She receives a transfusion of 18 units of both O negative and cross matches red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate. All are complications of massive blood transfusion except

36. Cryoprecipitate includes all except

37. Third stage active management of labour reduces postpartum Haemorrhage by

38. Mrs Sweetie, primigravida, now at 36 weeks of pregnancy with breech presentation. Recent scan shows Flexed breech with good cardiac activity. Estimated fetal weight is 2450 grams. What advice will you give for delivery?

39. Mrs. Tina is 32 years old lady who gives history of 3 miscarriages at 20, 22 and 24 weeks of gestation. She gives history of painful contraction followed by miscarriages. What could be the possible cause of miscarriage ?

40. Mrs. Rosy, primigravida, is at 36 weeks gestation with persistent breech presentation. She has been offered external cephalic version. She wants to know the risk of spontaneous re-version after successful External cephalic version.

41. Mrs. Tina, 30-year-old woman attends the Antenatal Assessment Unit at 18 weeks of gestation. She presents with a few days’ history of flu-like symptoms. She reveals that she returned to the UK last week from a two-week trip to Caribbean island. What is the most appropriate next step in her management?

42. A 22-year-old medical student presents with a request for contraception. Her menstrual cycle is irregular, and she complains of acne and hirsutism. Previous investigation has diagnosed polycystic ovary syndrome (PCOS). She wishes to have a combined oral contraceptive with the best risk profile and most impact on her androgenic symptoms. Which one of the following is the best available option to recommend for her?

43. Ms. Suzy, 14 years old girl presented with excessive facial hair, irregular cycle. In adolescent girls to diagnose PCOS all are considered except

44. A 25-year-old primigravida woman is admitted to the labour ward with regular contractions and draining clear liquor. She is a known carrier for Streptococcus B in this pregnancy. Shortly after being given a loading dose of benzylpenicillin, she becomes wheezy, develops a rash and has difficulty breathing.
What is the most appropriate initial dose of intramuscular adrenaline?

45. Mrs. Tina, 20 years old, primigravida, presented with continued nausea and vomiting associated with ketonuria. Her body weight has reduced from 60kgs to 55kgs, despite oral antiemetics. What is the most appropriate management?

46. Mrs. Susan is primigravida, relieved at 36 weeks. She had history of spontaneous rupture of membranes 22 hours prior to delivery, developed a temperature of 38°C in the last hour of the labour. Six hours after delivery Mrs. Susan notices that the baby is lethargic and not feeding well.
What is the most likely aetiology?

47. Ms. X, a 30-year-old pregnant woman who is at 28 weeks of gestation presents to the Day Assessment Unit complaining of flu-like symptoms, fever with chills. She tells you that she recently went on holiday to Kenya.
What is the most appropriate test for the diagnosis of malaria?

48. Mrs. X presented to you in clinic at 8 weeks, as she is exposed to child who has developed rash similar to slapped cheek appearance . On follow up at 16 weeks shows Fetal Hydrops. Doppler indicates fetal anemia. What is your diagnosis?

49. What is the route of Misoprostol with the earliest onset, fastest & longest duration of action?

50. Mrs. Sabina, 26 years old is into her 10 th week of pregnancy. This is her 4th pregnancy. Last 2 deliveries were complicated by abruption. She had to undergo Emergency cesarean section for same reason. Now she is asking about chances of recurrence in this pregnancy as well. What is the correct answer?

51. A 32 yr old Caucasian woman comes to fertility clinic with her 35 yr old husband. They had visited the GP, who advised the few investigations. The investigation has been provided. What will be your next advice?
Report :
Vol : 0.6ml , no spermatozoa detected
Seminal fructose absent Sr FSH 8.5 mIU/ml ( Normal 1-14 mIU/ ml )

52. A 27-year-old woman presents with secondary infertility and heavy and painful periods. She has been trying for a baby for the past 2 years without success. She experiences severe bloating of the abdomen just before and during menstruation. On examination, her BMI is 22 kg/m . The uterus is retroverted and slightly bulky. There is some induration of the uterosacral ligaments. Her hormone profile is as follows: prolactin 267 mIU/L, FSH 5.4 IU/L, LH  4.7 IU/L,  TSH  1.2 IU/L and  free T4 12 pmol/L. What is the probable diagnosis?

53. You are seeing a couple with history of infertility since 2 yrs. She presents with the following investigations as advised by her GP.

Day 2 FSH / LH – Normal
HSG – Normal
TSH – Normal
Serum Prolactin Normal
Semen analysis – Azoospermia
The semen analysis is repeated which still shows azoospermia.
The following can cause azoospermia except one condition. Which one is the exception?

54. All of the below are steps in Assisted Reproductive Technique except

55. All of the following are characteristics of a good quality embryo for embryo transfer in ART cycle except:

56. A 28-year-old nursery teacher was given varicella-zoster immunoglobulin G (VZIG) after a significant exposure to chickenpox at 24 weeks gestation, as she was found to be seronegative on her booking bloods. How long should she be considered potentially infectious after exposure to chickenpox?

57. A primigravida at 35 weeks gestation develops primary genital herpes. She is being referred by the midwife to discuss the mode of delivery. The consultant advises  elective caesarean section to reduce the risk of neonatal transmission of herpes simplex virus (HSV) at birth. She wants to know the risk of transmission of neonatal HSV at birth?

58. A 32-year-old gravida 2 para 1 woman at 32 weeks’ gestation with a small for gestation foetus is in the antenatal clinic. She had TORCH screening and her cytomegalovirus (CMV) result was suggestive of a recent maternal infection. Which one of the following is most appropriate in woman with a recent primary maternal CMV infection?

59. All of the following are correct about congenital infection with CMV except :

60. Which of the following is true with regard to CMV:

61. All are correct about Human parvovirus B19 except :

62. Clinical signs suggestive of sepsis include all of the following except:

63. All of the following pregnant women will be offered  intrapartum antibiotic prophylaxis for prevention of early onset group B streptococcal infection in newborn , except :

64. A woman has come to infertility clinic who is planned for IVF treatment. But she is scared of injections and also got to know that some friend of her sister got the injections and because of the injections she got some pain in abdomen and breathing difficulty, something called OHSS and was hospitalised. She wants to know the chance of her developing severe OHSS requiring hospitalisation?

65. What is the first line pharmacological treatment for anovulatory PCOS .

66. A 32 years old woman being investigated for infertility complained of discharge from breast and secondary amenorrhea. What is mechanism behind secondary amenorrhea being caused by hyperprolactinemia ?

67. An 18 years old girl comes to you to seek advice for contraception. But she is also worried that it may affect her fertility in future. Which form of contraception is most strongly associated with delay in return of fertility?

68. A 28 years old para 2 at 28 weeks comes to the antenatal clinic as her daughter developed slapped cheek disease. She wants to know the effect on fetus if she also gets the infection?

69. You receive a call from GP as a pregnant woman came to him at 26 weeks with reports showing CMV specific IgM positive ; CMV specific IgG negative. He knows that CMV causes congenital abnormalities, hence he wants to know the risk of vertical transmission of the fetus?

70. A 28 years old para 1 underwent normal vaginal delivery and is breastfeeding. One week postdelivery she visits her midwife who finds her temperature raised, and difficulty in breastfeeding as her right breast is tender, red and hot. What is the most appropriate antibiotic regime for her?

71. A 25 years old male being investigated for primary infertility was found to have azoospermia in 2 semen analysis. His reports are as :
Total Testosterone ;70/ n mol /L(normal range ;8.4 -35.7)
FSH ; 0.6IU/L normal range ;2.5-10.2 IU/L)
LH:0.5  IU/L (normal range ; 1.9-12.5 )
Which of the following is the most likely cause?

72. You are on rounds in postnatal ward. You review a woman who delivered vaginally 10 hours back. Her vitals are :PR 120/min , BP 90/60 mmol Hg , RR 30/ min , Temperature 38’F. What is the most likely causative organism?

73. A 33 years old woman being investigated for primary infertility has been found to have bilateral hydrosalpinges on USG . She has been advised to go for IVF. Which the following should be advised to do prior to IVF?

74. A 36 years old woman is undergoing IVF treatment. How many embryos can be transferred during embryo transfer in her first cycle ?

75. A couple is being investigated for primary infertility. The Male partner had adopted a child 2 years back. They want to get funding from NHS for fertility treatment. How will you counsel them ?

76.  The percentage of Pre-term births associated with PPROM is

77. The reduced risk particularly associated with planned caesarean section for a baby presenting by breech is due to

78. 30 years old primigravida at 39 weeks of gestation with the baby presenting by breech. She had undergone ECV at 37 weeks of gestation which was unsuccessful. She is here to discuss about the plan of delivery. She wishes to know the risk of perinatal mortality provided she undergoes a planned elective caesarean section

79. 29 years old second gravida with previous normal vaginal delivery with the baby weighing 4 kgs, is now 39 weeks with baby presenting with breech. At 36-37 weeks, she underwent ECV which was unsuccessful. On examination, was found to have a flexed breech with adequate liquor and the estimated fetal weight was 3.9kgs. Your unit has consultant and trained personal to conduct assisted vaginal breech delivery. The best management option is

80. 25 years old primi gravida attends the obstetric day assessment unit after a growth scan at 31 weeks. At 28 weeks of gestation she was diagnosed to have an SGA fetus with normal umbilical artery Doppler. The ultrasound done today revealed EFW <3^rd percentile with normal single deepest vertical pocket and intermittent absent end diastolic flow. The MCA doppler and the Ductus venosus Doppler is normal. Also at 30 weeks she had presented with a mild APH which was managed conservatively and antenatal steroid prophylaxis given. CTG done today was normal. What is the most appropriate recommended mode of delivery?

81. The recurrence rate of breech after one breech presentation is

82. A 32 year-old woman primi at 30 weeks of gestation in an uncomplicated pregnancy attends the Day Assessment Unit complaining of leaking per vaginum for the past 1 hour followed by irregular, intermittent abdominal pains and with good Fetal movements and a reassuring fetal heart rate pattern. The uterus is soft and non-tender with no palpable contractions. A sterile speculum examination has revealed clear liquor pooling in the vagina. The cervix is closed. The woman has no past medical history or drug sensitivities. What is the single most appropriate combination of therapies?

83. A 32-year-old woman presented to the postnatal clinic for a postnatal appointment 6 weeks following spontaneous vaginal delivery. She had an SVD at 32 weeks of gestation and delivered a male baby weighing around 1.6kgs doing well now. She has also had two previous preterm deliveries (at 28 and 29 weeks of gestation) resulting in neonatal deaths. She underwent cervical length surveillance in this last pregnancy and her cervix was found to be 10 mm in length at 24 weeks of gestation and cervical cerclage was performed electively soon afterwards. Subsequently she spontaneously ruptured membranes at 31+4 weeks and started having contractions for which the cervical  suture was removed, and she subsequently delivered at 32+0. What  is the most appropriate management option in the next pregnancy?

84. 30 years old woman presented with 30+0 weeks of gestation with complaints of pain abdomen since 4 hrs and with no history of leaking or bleeding P/V and no history of dysuria and frequency of urine. On examination, she was found to have occasional tightening of the abdomen. The next immediate management option is?

85. The value of fetal fibronectin that would signify that the woman is likely to go into labour in the next 48 hrs is

86. 30 years old Primigravida with uneventful antenatal period had a spontaneous onset of labour and delivered an alive female baby of 3.9kg. She had massive PPH, and while being managed, the fibrinogen levels was found to be 1.5 g/L. The most appropriate blood component that would increase the levels is?

87. 35 years old primigravida was induced for a severe pre-eclampsia at 34 weeks of gestation, she progressed well and delivered spontaneously following which, she had excessive vaginal bleeding. She started to have oozing from the iv canula site. Her investigations are pending, and her blood group is O negative. She does not have any reservations to blood. Pending the results, haematologist was contacted for the transfusion of blood component. What would be the blood component likely to be suggested to correct this problem?

88. A nervous 42-year-old woman presents to your antenatal clinic. She is anxious that she has missed the right time to have her combined test for Down syndrome screening. She is now 17 weeks pregnant and is very concerned about her age. What assays would she be tested for at this gestation?

89. A 34-year-old primigravida woman with a BMI of 24, books with her midwife at 7 weeks of gestation following IVF treatment. She is delighted to be pregnant and has stopped her 5-a-day smoking habit. Indicate the most appropriate antenatal care.

90. You are reviewing a 36-year old woman in the antenatal clinic at 17 weeks of gestation. She has been referred for discussion of mode of delivery. She is G2P1 with one previous LSCS at term 8 years ago, delivering an appropriately grown neonate. Her BMI is 27. What is the best management?

91. A 27-year-old woman with a history of a previous SGA fetus and smokes about 3-4 cigarettes, underwent screening at 26 weeks of gestation. Screening revealed a customised EFW less than 10th centile with umbilical artery PI >2 SDs. What is the most appropriate management?

92. A 24-year-old athlete who is training herself for the upcoming Olympics rigorously is  booked at 6 weeks of gestation. She is fit and healthy, has no medical problems, is a non-smoker and has a BMI of 22. What does her antenatal management plan include?

93. A 40year-old primigravida conceived following IVF, presents with a history of painless bleeding at 31+6 weeks of gestation. This is the first episode of bleeding during this pregnancy. At home, the bleeding soaked her clothes and ran down her legs and also soaked two sanitary towels. When she presented to the hospital, the bleeding settled. At 20 weeks scan,  the placenta was found to be covering the os and she has another ultrasound appointment in the coming week. On examination: her Pulse was 110/min with BP of 100/72 mmHg and RR of 18/min with saturation of 100% at room air. The FHR tracing is reassuring. The most appropriate option would be?

94. 36 years old G3P2 with three previous CS has now presented with bleeding P/V, and on ultrasound was found to have placenta previa. The ultrasound image is given below

The chance of Placenta accreta in this woman is

95. The most predictive risk factor for placental abruption

96. 32 years old woman delivered half an hour back, had a major PPH and lost around 1500 ml. Resuscitative measures done but there is still minimal bleeding. Haematologist opinion sought and advised transfusion. What are the blood/ blood components that needs to be given to her?

97. Mrs. Rebecca is 34 years old,  primigravida at 36 weeks with flexed breech presentation in active labour. As she is fully dilated, she progressed quickly and Fetal head was entrapped during vaginal breech delivery. What is the next step?

98. A 35-year-old primi presented at 33+2 days with minimal bleeding antepartum haemorrhage and tightening. Clinically she is stable, and the bleeding has reduced significantly. Ultrasound examination at 32 weeks of gestation showed a low-lying placenta. Examination revealed  regular uterine activity. What would be the next step in her management?

99. A 37 years old primi with no significant history was admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks of gestation. While she was in the hospital, she is found collapsed and unresponsive in the corridor. The midwife who found her has called for the emergency team. You are the next person to arrive on the scene. What is the first most appropriate step in her care?

100. Mrs. Rebecca is 34 years old,  primigravida at 36 weeks with flexed breech presentation in active labour. While counselling, she agreed for ECV, by then she is fully dilated.
When performing vaginal breech delivery you –