MRCPI Part 2 Mock

1. Mrs. Tina, 19 years old, is presenting with 7 weeks amenorrhea and pain in abdomen. Transvaginal ultrasound shows absent fetal cardiac activity suggestive of missed miscarriage. She wants to have medical management.
What is the advice for her ?

2. Sarah, 24 years old, P1L1 is about to be discharged. She delivered male baby weighing 3.2kg 48 hrs ago. She had a forceps delivery for maternal exhaustion.
She has sustained a perineal tear in which 50% of the EAS was involved.
In perineal tear proforma, what degree of tear you have to document?

3. Ms. Rachel, 34 years old, has come at 16 weeks. Her BMI is 34kg/m2. Regarding measurement of her blood pressure

4. A 47-year-old woman seeks advice about continuing the combined oral contraceptive pill (COCP). She is normotensive and a non-smoker with a BMI of 25. She has no other medical history and no significant family history. She is concerned that the COCP may give her additional health risks. Which of the following malignancies would you advise she may have a small additional risk of developing due to taking the COCP?

5. Mrs. Tina, is in her early pregnancy clinic at 6weeks of pregnancy. She had 3 miscarriages at 6, 8 & 9weeks of pregnancy previously. What is the advice you would offer her?

6. Mrs. Angelina Robert, has come to meet you. She is sister of Mrs. Mayflower, who delivered her first baby, 7 days ago. She is not sleeping well, and is agitated with some odd behaviour. She is hearing voices on TV and radio that someone is coming to harm her baby. She has been in low mood for 24 hrs making it difficult to take care of the baby. She has no specific past history. What is the likely diagnosis?

7. Mrs. A, multiparous lady is in postpartum clinic. She has delivered 8 months back with history of major postpartum hemorrhage ( 4500ml). Now she complains of amenorrhoea. She stopped breastfeeding, also complains of difficulty in lactation. She complains of weight loss, dry skin and breast atrophy. What is the probable cause of diagnosis?

8. Mrs. Briganza, 56 years old postmenopausal lady has been treated with bisphosphonates for osteoporosis. What is the important side defect you would alert her?

9. Systemic Methotrexate is a safe and effective treatment for Ectopic pregnancy. What is the mechanism of action of Methotrexate?

10. Drug contraindicated in breastfeeding

11. Mrs. Rebecca 32 years old presents with secondary amenorrhoea who intentionally lost 12kgs.
BMI:26
FHS:56Iu/L
LH: 43 IU/L
Estradiol ;25mmol
What is the likely cause of amenorrhea?

12. Mrs. Ashley, 32 years lady presented with chronic pelvic pain and dysmenorrhoea. Ultrasound showed endometrioma of 5cm in right ovary. What is the appropriate management for her?

13. 22 years old Rachel has come for booking visit. Her ultrasound at 10 wks showed herniation of gut with umbilical cord on top of sac. What is the probable diagnosis?

14. Rebecca, 46 years is in the gynaecology ward. She has undergone total abdominal hysterectomy 12 hrs back and is on morphine for pain relief. Her respiratory rate is suppressed; she is drowsy and has pinpoint pupils. What medication would you give to reverse this potential morphine overdose?

15. Ms. Rachel 26 years old lady is going to work abroad for three months. She is currently 12 weeks pregnant and is enquiring about vaccination. Which of these vaccinations is contraindicated in pregnancy?

16. Ms. Ruby, 32 years old primiparous delivered few days before. She is exclusively breast feeding her baby, while lactating complains of sharp shooting bilateral breast pain. She is on Co- Amoxiclav for 5 days with no relief. What is the possible cause?

17. Mrs. X, 32 years old primigravida is now at 26 weeks of pregnancy she has been referred to A&E as she is feeling unwell. On examination pulse is 108bpm. Her blood pressure is 100/70mm Of Hg. Her temperature is 37.6 c. Respiratory rate is 24 per min. Per abdomen -soft, 26 weeks with active fetus. What is your management?

18. Mrs. Suzi, is 32 weeks pregnant. She is pure vegetarian. She is on folic acid, iron and vitamin D supplements. She is more prone to develop deficiency of:

19. Mrs. Adams, 45 years old, has presented with stress incontinence. It is affecting her quality of life. She wants to try conservative measures. On examination she has poor levator ani tone. What advice will you give her?

20. Bladder training is the first-line treatment for women with urgency or mixed urinary incontinence. What is the minimum duration it should be offered?

21. Mrs. Leslie, 32 -year-old primiparous woman presents to the emergency department with sudden onset of lower abdominal pain, mainly localised in the left iliac fossa. The pain is sharp in nature and is radiating to the left flank.
Her last menstrual period was 7 weeks ago.
History of recurrent PID noted.
Vital signs on arrival are:
blood pressure = 90/60 mmHg & pulse = 100 beats/min, temperature = 36.5°C, respiratory rate = 16/min
Vaginal examination is positive for cervical excitation.
Investigations : A urine pregnancy test is positive, hCG level = 5000 iu/l.
On transvaginal scan – left adnexa was seen to contain an ectopic pregnancy measuring 22 mm x 18 mm x 15 mm with noted cardiac activity and presence of haemoperitoneum noted.
What is the treatment of choice for this woman?

22. Ms. Tina 16 years old girl presented with absence of periods. She has a BMI of 19. Secondary sexual characteristics shows normal development. Her karyotype is 46XX. Ultrasound -absence of uterus, presence of ovaries.
Cause is

23. Mrs. X had a combined test which shows high risk for Downs Syndrome. Patient declined invasive prenatal tests because of her religious views. Scan shows cystic hygroma and short femur. What’s your diagnosis?

24. Ms. Babitha, primigravida, now 38 weeks pregnant, has come to labour room with history of leaking in active labour. She has a history of multiple fibroids in lower segment. On examination she is 4 cm dilated, baby’s nose, mouth and malar process are felt.
What is the length of engaging diameter in this presentation ?

25. Ms. Briganza, 58 years old post-menopausal woman has a ovarian cyst. Transvaginal ultrasound shows unilocular right ovarian cyst measuring 6cm x4x3cm, with no solid components. Left ovary normal. Her CA125 is 50. What is the most appropriate management?

26. 40 years old woman presents with nausea and vomiting, and heavy vaginal bleeding. She had undergone dilatation and evacuation for complete molar pregnancy 8 weeks back. She gives history of weight loss. She has been sent for scan and scan suggestive of mass in uterus.
Which tumour marker is appropriate, which helps diagnose this particular tumour?

27. 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?

28. Mrs. X is multiparous lady in a new relationship, she is requesting for effective contraception. She is hypertensive and adequately controlled. She has a history of Venous thromboembolism 5years back when she had a major car accident. She has regular periods with normal duration. She has no allergies
Her BMI is 35kg/m2. She smokes 10 cigarettes per day
What would you offer her?

29. A 24 years old with 7 weeks pregnancy presented 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

30. Mrs. Rachel, 30 weeks pregnant patient with bronchial asthma received steroid 800mcg inhalation and short acting beta 2 agonists which did not settle her condition. What medicine should be added next?

31. Mrs. X, 19  years old, presenting with 2 episode of nausea and vomiting, she is not dehydrated, able to tolerate orally, requesting for antiemetics. Which one of the following is most appropriate?

32. Ms. Rachel, 34 years old has come at 16 weeks. Her BMI is 32kg/m2. This is her first pregnancy. Which one of the following is true regarding her blood sugar monitoring?

33. 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 anaemia. What is your diagnosis?

34. A 30-year old woman presents at 12 weeks of gestation to the antenatal clinic for review. She has had one previous pregnancy. In the last pregnancy she had a placental abruption at 32 weeks of gestation requiring an emergency caesarean section; in the immediate postnatal period she developed fulminating pre-eclampsia requiring IV infusion of labetalol and magnesium sulfate.
She is otherwise well and her BMI today in clinic is 28. Her BP is 120/70 mmHg and her urine dipstick shows no abnormality.
What is the most appropriate antenatal management option?

35. Ms.Tina, 20 years old presents with irritability, mood swings before periods, which is affecting her relationships. It is affecting her quality of life and putting strain on her relationship with her boyfriend.
What is the best management?

36. Mrs. Suzi, 34 years old has been diagnosed with Endometriosis. She is really anxious about serious complications of endometriosis.
Which carcinoma is associated with endometriosis?

37. Ms. X, 44 years old, chronic smoker, complains of shortness of breath. On examination respiratory rate is 26, spo2-85% , abdomen examination shows mass corresponding to 14weeks gestation. Pelvic ultrasound shows unilateral mass -solid mass with ascites. CA-125is 60mIu/m. X Ray shows pleural effusion
What is the probable diagnosis?

38. Rachel is a 15-year-old girl who presents with a history of painful periods since menarche. She is now missing at least a day of school a month. Her mother is concerned that she may have endometriosis as she was diagnosed with mild endometriosis in her 20s whilst trying to conceive Rachel, although her periods were never painful. During the consultation Rachel becomes tearful and reveals that she is very anxious about her exams.
MOST appropriate management for her

39. Mrs. Tina, 30 years old, IVF pregnancy, with Diamniotic dichorionic pregnancy cephalic to cephalic presentation came in active labour. First twin delivered. 2nd twin is with high head and membranes intact. No contractions.
What is your next management?

40. What type of electrolyte disturbance is often seen in association with severe cases of OHSS?

41. Mrs. Lucy , 36 years old, with a severe case of OHSS initially presented with tense ascites, oliguria and a haematocrit of 46%. She was treated with appropriate fluid replacement and the haematocrit is now in the normal range. However, she remains markedly oliguric. What is the appropriate management?

42. Mrs. X, 55 years old presented with foul smelling vaginal discharge. Also complains of postcoital bleeding. On examination -exophytic growth present on cervix. Ultrasound shows bilateral hydronephrosis. You are suspecting cancer of cervix. Which stage of cancer of cervix is this ?

43. A 23 years old woman with Type 1 diabetes presents at 32 weeks gestation in her first pregnancy with regular painful contractions, a closed cervix and a positive fetal fibronectin test. What is the most appropriate management plan?

44. A 24 years old woman presents at 32 weeks gestation with threatened preterm labour. She is being given corticosteroids for foetal lung maturity. Tocolysis is therefore being considered.
The most effective tocolytic is

45. Ms. Julies, 18 years old with history of Amenorrhoea for 6 months, gives history of tough exercise routine. She has lost suddenly 5kgs. What is the likely cause of Amenorrhoea?

46. Patient the on tamoxifen due to cancer breast came for follow up ET. What next step of management?

47. Ms. X, a 32 years old woman is in labour in her second pregnancy. Her previous delivery was by caesarean section. What is the most consistent indicator of uterine rupture for this woman?

48. 34 years old Maricon, primigravida, is admitted in active labour. She has persistent occipito posterior. Second stage of labour was prolonged, at the time of pushing, prolonged Bradycardia with abnormal CTG. You decided for forceps and delivered baby quickly. Baby was born floppy which needed advance resuscitation. Baby developed seizures, and suspected to have Hypoxic Ischemic Encephalopathy. How long CTG and paired Ford blood samples of the baby needs to be preserved as this case can for claim anytime?

49. Mrs. B is primigravida now at 36 weeks of pregnancy with breech presentation. Recent scan shows flexed breech with good cardiac activity. Estimated fetal weight is 2450grams. What is advise you will give for delivery ?

50. 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?

51. Which infection is reported to be risk factor for second trimester miscarriage?

52. Mrs. Lucy is known case of type 1 diabetes and she is on insulin. She is known case of hypertension and on captopril. She is taking folic acid 5mg and she is here for pre conceptional counselling, what advice would you give her regarding her care?

53. Mrs. X is at 31 weeks Preterm labour with evidence of cervical dilatation. So she was offered magnesium sulphate infusion of 4gm of bolus and 1gm/hr maintenance dose, midwife suddenly calls you as Mrs. X’s respiratory rate is 10 breaths per minute, she has absent knee reflex as well as her urine out is only 50ml for last 4 hours. What is the best recommendation for her?

54. Mrs. X is 32 years old primigravida at 7 weeks pregnant. She is here for dating scan. Trans abdominal scan shows gestational sac pole measuring 26 mm and no cardiac activity noted. The sonographer is sure of findings.

What advice you would give her ?

55. Mrs. Tara, is 30 weeks pregnant and is being counselled for illicit drug use. Which one is amongst most dangerous?

56. Mrs. Tina, primigravida at 34 weeks, is in ANC clinic with partner for antenatal care. She makes very little eye contact, and on asking history, partner answers most questions. What is the most appropriate next step?

57. Mrs. Tina is 26 years old woman and here for your advice. She is 12 weeks pregnant and is concerned as she went to a children’s party where one of the children had ‘slapped cheek’. After consulting the local microbiology department, you organised for Parvovirus B19-specific IgG and IgM to be checked.The results show the following:
Parvovirus IgG negative
Parvovirus IgM positive
What does this suggest regarding the patient’s Parvovirus status?

58. Mrs. Lilly, 34 years old, primigravida, at 32 weeks gestation presented with flulike symptoms and fever with PPROM. On examination pulse 104bpmm, blood pressure is 110/70 mm of Hg. Temperature is 38.4c. The liquor is meconium stained. Most likely organism causing this is

59. Mrs.Teresa, 28 years old woman had a primary PPH 2 hours previously after delivery of a 4.1 kg boy. You are asked to review as she is confused and agitated. There is no sign of ongoing bleeding. Her pulse is 143 beats/min. Her Bp is 89/45 mm Hg and her booking weight was 71 kg. Approximately how much blood did this woman lose?

60. Mrs. Rosa, is 34 years old primigravida who presented with dysuria at 34 weeks pregnancy. Urine culture shows GBS POSITIVE bacteruria. She is allergic to penicillin. She had severe bronchospasm and angioedema after taking penicillin. What is the most appropriate management for this patient ?

61. 24 years old primigravida at 30 weeks presented with continuous pain in abdomen with vaginal bleeding of around 250ml.

She smokes 20 cigarettes per day.
She has repeated episodes of spotting in this pregnancy
On examination-
She is quiet and scared
BMI is19kg/M2
Pulse -84Bpm
Bp-100/70mm of Hg
Bruises present over back and legs and, on her abdomen, as well. She has a black left eye.
P/A- uterus, 30 weeks, tense and hard
Cephalic presentation
Speculum examination – os-2cm dilated dark brownish bleeding +
What is the most important cause of abruption you suspect in this woman?

62. Mrs. Sara, mother of 13 years old Tina, is here to see you. You have prescribed Tina oral contraceptive pill. Mrs. Sara is here to discuss regarding treatment you have given to her. What is the correct management option?

63. Mrs. Nabila, 34 years old, is primigravida from India at 24 weeks has done OGTT. She is diagnosed to have Gestational diabetes mellitus when

64. Mrs. Razanza, 60 years old presented with mass per vagina. On examination she has Grade 3 prolapse on POPQ. After counselling she has decided for vaginal hysterectomy. At the end of hysterectomy, vault descends to introitus. What measure will you take to prevent vault prolapse?

65. 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.
It is classified as

66. Mrs. X primigravida is in her 13 weeks of pregnancy. She has conceived by IVF.
Sonographer did dating scan -Twin gestation with T sign. She is anxious and worried asking regrading follow up of her pregnancy.
What is the frequency of hospital visits you would advise her?

67. Mrs. X primigravida in her 13 weeks of pregnancy. She conceived by IVF.
Sonographer confirmed Monochorionic diamniotic twin gestation. She was advised to have antenatal hospital visits should be every 2-3 weeks from 16 weeks’ gestation until delivery. The main reason for close follow up surveillance is to

68. Mrs. X is 37 weeks pregnant with twin gestation presented in active labour. She is 6cm dilated. Its DADC. Twin pregnancy cephalic to transverse lie presentation. Her first delivery was a normal delivery . She wants a normal delivery. She opted for Epidural analgesia & she delivered first baby uneventfully.
After delivery of her first baby, second twin is Transverse lie. What would you do now?

69. Mrs. Rosy, 65 yrs old, presents with Postmenopausal bleeding. Transvaginal scan showed 10 mm Endometrial thickness. She is on aspirin. Most likely cause of her bleeding is

70. In which of the following scenarios umbilical cord prolapse is the most common?

71. Mrs. Tina in to 38 weeks of pregnancy presents with labour pain. She complains of body aches, malaise and burning in vulva. On examination painful vesicles on labia majora. She gives history of similar episodes 6 months back.

What is the advice you will give regarding mode of delivery ?

72. Mrs. X. underwent laparoscopic hysterectomy for multiple fibroid uterus. After a week she developed flank pain, abdominal distention and peritonism. On examination abdomen is distended, bowel sounds are present. What is the cause of injury ?

73. An epileptic drug whose efficacy is reduced if used concomitantly with combined oral contraceptive pills

74. A 65-year-old woman has been assessed and offered botulinum toxin for the treatment of her refractory overactive bladder. What must she be trained to do before this treatment can be started?

75. Mrs. X has undergone total abdominal hysterectomy for abnormal uterine bleeding. All her previous smear reports are normal. No CIN noted in specimen. What is the follow up advice?

76. Mrs. X, 54 years old lady, is on renal dialysis for last 3 months. Her smear results show ASCUS, Hr-Hpv is negative. Previous results are normal. What is the follow up advice?

77. Which sort of injury is more common in laparoscopic hysterectomy compared to an open procedure?

78. Mrs. X is in her 32 weeks of pregnancy. This is her third pregnancy, she delivered her children by cesarean section. She is on etanercept for sero negative spondylising arthritis. She is asymptomatic now. When would you ask her to stop etanercept?

79. Ms.Tina,16 years old presented with delayed onset of her first periods. On examination she has normal breast development, she has sparse pelvic & pubic hair. She only gives history of Bilateral Inguinal hernia repair as a child. Her cause of amenorrhea could be 

80. Mrs. Rachel, primigravida at 16 weeks gestation presents with dysuria, urgency. Midstream urine shows plenty of Pus cells. Allergic to penicillin. UTI treatment of choice

81. A 25-year-old woman has been trying to conceive for 2 years. She has painful periods and occasional dyspareunia. On examination, the GP felt that the uterus was retroverted with reduced mobility and there were palpable nodules in the rectovaginal septum. The GP has done the following investigations:

• Full blood count – normal
• Thyroid function – normal
• Day 21 progesterone – confirms ovulation
• FSH and LH level – normal
• Rubella serology – immune
• Chlamydia swab – negative
• Pelvic ultrasound – normal
• Partner’s semen analysis –

She is now referred to the gynaecology outpatient clinic. What is your most appropriate management?

82. A 25-year-old presents with lower abdominal pain of 12 months duration. The pain is worse around her menses, which are also heavy. Sexual intercourse is painful. She has altered bowel habits especially around menstruation. You suspect that she may have either irritable bowel syndrome or endometriosis or both.

What approach will you take to differentiate between the two conditions?

83. Mrs. Maha, 34 years old, went for emergency cesarean section. She developed massive postpartum haemorrhage, which ended in cesarean hysterectomy. Total duration of surgery was 4hours. During surgery, her arm abducted more than 90degrees. Post op she developed ERB’S palsy. Which part of the brachial plexus got damaged?

84. Mrs. X , 30 years old is in her second pregnancy. Previous baby delivered by cesarean section at full dilatation. Now she is 6weeks pregnant presented with lower abdominal pain and spotting. Transvaginal Ultrasound shows a gestation sac distal to a closed internal cervical os. Cervix is barrel shaped. Doppler shows increased vascularity around gestational sac. Sliding sign is absent, what is the probable diagnosis?

85. In all of the following scenarios, offer magnesium sulphate infusion except

86. You are going to see the son of a gynaecology patient, Helen Hamilton, who came to your Gynaecology Clinic last week following an episode of post-menopausal bleeding.  You were completely unable to communicate with Hamilton, because she suffers from severe Alzheimer’s disease. She was unable to tolerate any form of clinical examination, nor a trans-vaginal ultrasound scan. She did have a limited trans-abdominal scan, and you have the report from this. Ms. Hamilton is unable to speak, does not seem to understand speech, nor to respond to non-verbal communication. She was brought to your Clinic last week by a Care Assistant from the residential care home where she lives. Her limited scan shows endometrial thickness of 10mm, you advise to undergo Hysteroscopy guided biopsy. Tom Hamilton, her son and legal power of attorney (LPA), is refusing to let her undergo this procedure. What is the appropriate management for this patient ?

87. A 32-year-old lady who is 25 weeks pregnant in her second pregnancy comes in contact with a child who has developed chicken pox. She is not immune to chicken pox.
Which one of the following statements is true?

88. A 30 years old woman presents at 38 weeks of gestation with fever, myalgia, arthralgia, cough and dyspnoea which began yesterday evening. She also has symptoms of vomiting. She was previously fit and well. On examination, she has a respiratory rate of 28, oxygen saturations of 90% on air, and a pulse of 110 bpm. Blood pressure is 120/70 mm HG. Her chest has widespread wheeze and reduced air entry. A chest Xray shows patchy consolidation throughout both lungs.
What is the most appropriate initial treatment?

89. You are seeing a pregnant woman with trichorionic triplet pregnancy during her routine antenatal visit at 16 weeks. You are coordinating with a core team of midwives and sonographers for her care. You are also planning an enhanced team for referrals. You will routinely include all of the following in that team except:

90. Elective caesarean section is best recommended to prevent morbidity from shoulder dystocia in which of the following clinical situations

91. Which one of the following correctly states how much energy is provided by human milk through breastfeeding?

92. Medical management for an ectopic pregnancy can be considered if:

93. Mrs. X 29-year-old woman,  P2L2,  had a rotational forceps delivery of a healthy male infant at term with  suspected extended perineal tear in theatre; third-degree tear (3b) is diagnosed. What suture material you would use to suture the tear?

94. Lichen sclerosus commonly presents in the following age group:

95. Flat-topped violaceous purpuric plaques on the vulva are characteristic of:

96. A 26-year-old woman has been admitted with late onset severe ovarian hyperstimulation syndrome (OHSS) 10 days after embryo transfer in an IVF cycle. She reports generalised abdominal pain and sickness for 2 days. Abdominal examination revealed significant ascites, whilst abdominal ultrasound showed bilateral enlarged ovaries with a maximal diameter of 10 cm. Which of the following combination of blood results is commonly observed on admission?

97. A 15-year-old girl attends sexual health clinic requesting termination of pregnancy. She is 7 weeks pregnant. Her boyfriend is also 15-years-old and studies in the same school. She has not informed anyone of this pregnancy. What is your most likely immediate action?

98. A 37-year-old woman is undergoing a diagnostic laparoscopy for investigation of pelvic pain. Following insertion of the laparoscope through the umbilical port you find bowel adherent to the anterior abdominal wall in the midline. You are worried that bowel may be adherent under the umbilicus. What is the recommended course of action?

99. Mrs. A, has been treated for complete molar pregnancy 8 months back; she is on follow up. Her Beta Hcg is 20000, since last 2 times it is showing increasing trend.
On further evaluation scan shows Lung and GIT metastasis.
What is the best treatment for her?

100. Sexual assault victim has been brought to your clinic by the police. You refer her to sexual assault centre. Assault happened 4 hours back. What is the first step?