SBA MOCK EXAM – 200 PACK

1. Mrs. Pandey, is para1 Living 1 with 38 weeks in spontaneous labour. She was assessed at 23:00 hrs and had progressed to 5 cms cervical dilatation. She was examined at 03:00 h and was found to be 6 cms dilated, 0.5 long, with intact membranes, vertex at spines.
What is the next appropriate step in managing her labour?

2. Mrs. Rashida Khan, 24 year old pregnant woman with metallic aortic valve is now at 32 weeks of pregnancy. She is on Tab warfarin 7mg once a day with well controlled INR. Her baby is small for gestation, recent Doppler is normal. Consultant has taken decision to deliver her by 35 weeks 0 days.
What is the ideal time to shift her to LMWH ?

3. Rebecca, primipara, low risk pregnancy, delivered yesterday, is up for discharge. Her labour was complicated by shoulder dystocia. Her baby had fracture clavicle-managed conservatively, otherwise baby is doing good. She is asking you recurrence of shoulder dystocia in furtive pregnancies.

4. Sara, low risk multiparous lady is in her third pregnancy. She has been low risk, EFW was 2800gms. She planned home delivery with her midwife, Ms. Angel.
Sara had spontaneous onset of labour, progressed well, delivered baby head but Ms. Angel noticed difficulty with delivery of the face & chin, and head started retracting. Midwife positioned sars thighs on her abdomen and tried with axial traction but it wasn’t successful. What’s the best manoeuvre Angel should try in this Situation?

5. Rachel, 38 weeks pregnancy has been induced because of Diabetes mellitus. Because of pathological CTG, forceps was applied, delivered baby’s head but shoulders not delivered with routine axial traction. With flexion and abduction of Rachel’s hips, positioning thighs on her abdomen. Shoulders got released. What is the success rate of this manoeuvre?

6. What is the incidence of EOGBS in UK without implementing the screening program?

7. What is the risk of adverse outcome to the baby if a low risk primigravida opted for home delivery?

8. What is the risk of spontaneous reversion after successful ECV at 36 wks in a Primigravida?

9. 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 ?

10. 26-year-old Margarita is primigravida with 39 weeks with Right occipito posterior in labour. What is the presenting diameter?

11. 45 years old Lisa presented to you with Heavy menstrual bleeding. It is affecting her quality of life. She is requesting for conservative mangement. After counseling, she chooses Tranexamic acid. What is the mechanism of action of Tranexamic acid ?

12. Mrs. X, 46 years old is 7 weeks pregnant. She is really anxious as she has read there is increased risk of miscarriage for her age. What are the chances of miscarriage for her?

13. What is the rate of infra-umbilical adhesions after midline laparotomy?

14. Mrs. X, 30 years old is in her second pregnancy, previous baby delivered by cesarean section at full dilatation. She is at 6 weeks and presents 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?

15. Ms. Dalia, 26 years old, posted for appendicectomy. Intra op findings- appendix is healthy but right simple ovarian cyst measuring 5x4cm is found. Gynecologist called for opinion. What is appropriate management?

16. 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?

17. The FY1, in labour ward called you to review a patient who gave birth a few days earlier and seems confused and delusional. They worried that she may have postpartum psychosis. Upon reviewing the patients notes, you realize that patient does not have risk factors for postpartum psychosis. What percentage of patients who develop postpartum psychosis will have no history to class them at high risk?

18. Mrs. Sweetie, 30 years old presents with severe abdominal pain and do’s tension. She has taken treatment for Infertility, with ovulation induction and Ovum pick up done 2 days back. On examination -ascites present. Ultrasound shows -ovarian size of 12 cm2, she develops oliguria after admission, despite fluid replacement. What is next appropriate management?

19. An 18-year-old nulliparous girl presents as a gynaecological emergency with left-sided pelvic pain, tachycardia and vomiting. A pregnancy test is negative. An ultrasound scan is performed in the emergency department, which appears to demonstrate a left adnexal cyst. In theatre, a laparoscopy is performed which shows an ovarian torsion that has twisted three times on its pedicle. The left tube and ovary appear purple and congested. What is the most appropriate surgical management?

20. Mrs. X had vacuum delivery previous day. She had blood loss of 500 ml. At what level of haemoglobin, she is said to be anaemic?

21. Mrs. Renet has a history of recurrent miscarriage. All the investigations done for her came back as normal. She is concerned regarding her risk for future pregnancy. What is the risk for her to have another miscarriage?

22. An elderly primigravida presents to you with confusion and delusion post-partum. You suspect she might be having postpartum psychosis. When is the typical presentation of postpartum psychosis?

23. You are reviewing a G2P1 @ 34weeks POA who come to you to discuss mode of delivery. You noticed in her previous pregnancy she sustained a third-degree tear. What percentage of women who sustain a third or fourth degree tear at their first birth will choose for elective Caesarean section for the birth of their second child?

24. A 24 years old patient was found unconscious by her partner following vaginal delivery 2 days earlier. She had been complaining of feeling very unwell with lower abdominal pain and had complained of offensive smelling vaginal discharge. She had vomited several times in the past 2 hours earlier. Her observations on arrival were:
Temperature 39.8ºC
Heart rate 140
Respiratory rate 25
BP 66/40
The patient is transferred to ITU following initial resuscitation in A&E but remains critically unwell. You speak to the family regarding the diagnosis of puerperal sepsis and the risk of death. Which organism is responsible for the majority of deaths from maternal infection in the UK?

25. 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?

26. You are reviewing a patient in her third pregnancy who is taking lithium for bipolar disorder but stopped when she found out she was pregnant. She has no history of postpartum psychosis. She is concerned regarding her risk of developing postpartum psychosis. What is the minimum recommended time this patient should remain under regular review postpartum?

27. A 28 years old woman is concerned her sister sustained OASIS. During her antenatal follow up she is concerned about her risk of sustaining a significant perineal tear during childbirth. You note her only previous pregnancy was delivered by term vaginal delivery and there was no third or fourth degree tear. What is the approximate incidence of 3rd and 4th degree perineal tears in multiparous women?

28. Ms. Rebecca, para2 Living 2. Her 1st delivery was forceps delivery & 2nd was cesarean section for Fetal distress. In her current pregnancy, what is the most likely measure to reduce the chance of forceps delivery?

29. A woman presents reporting that she is using phenytoin for epilepsy. She wishes to continue to use IM DMPA. What is the single most appropriate advice to offer her from the list below?

30. Ms. Dolly , para3Living 3 is here for follow up of Intrauterine device. As threads were not visible, X Ray and ultrasound was performed, which showed device in abdominal cavity. Elective laparoscopy was arranged to remove copper T. She is requesting for reinsertion of copper T. What is the minimum time she has to wait before reinsertion ?

31. The RCOG exam has two components written and OSCE. Which choice best describes each:

32. 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 ready for evacuation of uterus. What are her chances of having uterine perforation?

33. A 25-year-old woman with a bicornuate uterus attends the emergency gynaecology unit requesting emergency contraception (EC). She has been on holiday and had a condom breakage 4 days back. Today is 11th day of her periods. Her cycles are regular and 28 days cycle. She is in good health. Which of the following is the recommended EC?

34. The target range for blood sugars during labour for a pregnancy complicated by pre-existing diabetes is:

35. Ms. Angel is here to meet you at the clinic, she is very anxious. She is trying for pregnancy, and one of her friends recently had an episode of thromboembolism during pregnancy. She has heard that pregnancy and childbirth increase the risk of thromboembolism. What is the incidence of VTE in pregnancy and puerperium?

36. 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 90 degrees. Post op she developed ERB’S palsy. Which part of the brachial plexus was damaged?

37. Mr. Briganza, 58 years old post-menopausal woman has an 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?

38. What is the incidence of acute appendicitis in pregnancy?

39. You are seeing 56 year old postmenopusal Amy, at the clinic, who has been referred for uncontrollable vulval itch & soreness, which is worse at night. She has visited her GP and he has given her some lubricants which was of no benefit. On examination thinning of skin, labial adhesions seen. Skin looks like cigarette paper, vulval biopsy showed thinned epidermis with sub-epidermal hyalinization and deeper inflammatory infiltrate.
Choose correct diagnosis

40. Anna 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 Anna, although her periods were never painful. During the consultation Anna becomes tearful and reveals that she is very anxious about her exams. MOST appropriate management for her is.

41. What is the most frequently encountered complication of suction evacuation of the uterus for first trimester miscarriage?

42. A 51 years old woman underwent a vaginal hysterectomy and pelvic floor repair. She had an uneventful recovery and was discharged on day 3. She returns as an admission 15 days later with pelvic pain, spiking temperatures and on examination -hypotensive, the pouch of Douglas feels probably full and tender. What is the initial management?

43. According to MBBRACE UK the most common indirect cause of maternal death in UK in 2015-2017 is

44. What is true about case control and cohort studies?

45. The hypothetical pilot study on pesticide exposure and breast cancer: What is the odds ratio?

46. For the screening test for Down syndrome the following results were obtained. What is the sensitivity of this test?

47. A sample of 10 women seeking prenatal care at Boston Medical center agree to participate in a study to assess the quality of prenatal care. At the time of study enrolment, you the study coordinator, collected background characteristics on each of the moms including their age (in years).
The data are shown below:
24        18        28        32        26        21        22        43        27        29
What is the median value?

48. Which of the following statement is not correct

49. A woman has a brother affected by haemophilia A and comes to see you to discuss the implications of this as she is planning a pregnancy. During the discussion she asks what is the chance of her brother having a son who is a carrier?

50. 24 years old Primigravida at 30 weeks presented with continuous pain in abdomen with vaginal bleeding, around 250ml. She smokes 20 cigarettes per day. She has repeated episodes of spotting in this pregnancy. During examination she is quiet and scared.
On examination-
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, 30weeks, 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 ?

51. Mrs. X 28 years old sexually active presented with chronic abdominal pain, bloating which aggravated during menstrual cycles. She passes stool several times per day usually just after the meal. Pain always get relieved with passage of stool; she is currently on combined pill for contraception which was prescribed by her GP. Her cervical smear is up to date. No past history of STI. On examination -uterus is normal sized, fornices are free. Which of the following toll will be helpful for its diagnosis?

52. Mrs. X has twin gestation, in early pregnancy, her ultrasound image enclosed.

What is the best parameter to diagnose chorionicity?

53. Mrs. X, grand multiparous, received massive blood transfusion, for atonic postpartum Haemorrhage. What is the recommended dose of fresh frozen plasma to be administered to prevent coagulation problems?

54. Ms. X, a 32-year-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?

55. Mrs. X, a 30-year-old woman books in the antenatal clinic at 12 weeks of gestation with a BMI of 42. This is her first baby and she is normally fit and well with no significant family history. With regard to her BMI, which complication of pregnancy is the highest risk compared to women with a normal BMI?

56. Mrs. X, a 25-year-old woman is referred by midwife as she is found to have a platelet count of 90 x 10*9/l at a routine check-up at 28 weeks of gestation. Her platelet count at 12 weeks of gestation was 400 x 10*9/l. She has no history of travel, fever or any chronic conditions. What is the most likely diagnosis from the list below?

57.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?

58. Mrs. X, a 35-year-old woman presents to the antenatal clinic in her first pregnancy at 28 weeks of gestation with daily headaches. Her BMI was noted to be 38. The pain is mainly at the back of her eyes, and gets worse on eye movements. She describes her headaches as throbbing in nature. She also notices transient visual disturbances. Ophthalmological examination revealed papilledema. Neurological examination was normal. Which of the following is the most appropriate intervention?

59. Mrs. X, a 32- year-old primigravid woman attends the antenatal clinic complaining of persistent mild pruritus due to atopic eruption of pregnancy. Which is the first line treatment in reducing pruritus and providing relief of her symptoms?

60. A junior colleague wants to give vitamin K to baby born for epileptic mother, but is not sure how it works. Vitamin K is responsible for manufacturing which of the following coagulation factors?

61. Ms. X, from Ghana, 19-year-old woman is 28 weeks into her first pregnancy. On routine blood tests, her haemoglobin is 95 g/l. What is the best test to diagnose iron deficiency anaemia?

62. 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?

63. Ms. X is 32 weeks pregnant with uncomplicated triplet pregnancy. She is asking when she can be delivered. The recommended gestational age to offer delivery to an uncomplicated triplet pregnancy is:

64. Mrs. X had a combined test showing 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?

65. Which is correct regarding entry technique in laparoscopic surgery?

66. Most common laparoscopic injury reported to National pt insurance Association.

67. Mrs. X is 30 years old at 36 weeks pregnancy in her third pregnancy. Her first pregnancy was low risk normal delivery with midwife, second pregnancy was emergency cesarean section for fetal distress. Now opted for VBAC, what is the success rate VBAC for her ?

18. Causes of sterile pyuria include all except

69. Ms.X, 17 years old girl underwent surgical evacuation of molar pregnancy at 8 weeks . Karyotyoe is 46XX.Her Risk of needing chemotherapy is

70. Mr. and MRS. Alexander are here for preconceptional counselling. Both of them are carriers of most common mutation, ΔF508. They want to know chances of them having normal child

71. Ms. X, 17 years old girl underwent surgical termination of pregnancy, what is her risk of developing GTN?

72. Pregnant patient with bronchial asthma received steroid 800mcg inhalation and short acting beta 2 agonists. Not settled what next to add

73. Patient present in labour nulliparous, was low risk following with consultant, serial scan baby in 70th centile. How to follow her in labour:

74. Which condition puts pregnant lady in high risk of stroke

75. What is the most common type of ureteric injury during laparoscopic surgery?

76. Mr & Mrs. X, have been investigated for infertility. They have been evaluated and case of unknown infertility. This is second IVF cycle failure. What is the most common cause of implantation failure in couples like this undergoing IVF?

77. Miss Sarah is a P0+3  who had 3 early pregnancy loss as part of her routine recurrent miscarriage investigation she was diagnosed to have Antiphospholipid syndrome. What percentage of women with recurrent miscarriage have antiphospholipid antibodies?

78. You are seeing a patient in your gynae clinic who was been referred by the GP for vulval abcess. She also complained that she has been having on and off diarrhoea with bloody and mucousy discharge. On examination the vulva is swollen and oedematous with visible granulomas and abscess formation with a sinus tract. What could be the possible diagnosis?

79. Mrs. X is 51-year-old woman with hot flushes. She has no significant past medical or family history. You prescribe hormone replacement therapy (HRT). During her appointment you counsel her regarding the risks of estrogen and progestogen HRT. How many estimated additional cases of breast cancer are there per 1000 women using HRT for five years?

80. The FY1 who is in charge of the labour ward called you to review a patient who gave birth a few days earlier seems confused and delusional. They are worried that she may have postpartum psychosis. Upon reviewing the patients notes you become aware that patient does not have risk factors for postpartum psychosis. What percentage of patients who develop postpartum psychosis will have no history to class them at high risk?

81. What are the recommended and safe methods of analgesia in labour for WWE?

82. Pain is scored from 0 to 10 via visual analogue scale. What kind of data is this?

33. Ms. X , 22 years old is 36 weeks pregnant, she has concerns about baby’s movements. She works as nursery schoolteacher and gives history of fever with rash. Her CTG is as follows.

What viral infection you suspect in her ?

84. Ms. X, 30 years old woman undergoes laparoscopic resection of deep infiltrating endometriosis x Grade 4. If she does receive a thermal injury, due to diathermy when would you expect her to present?

85. A 16-year-old girl presents to the gynaecology outpatient clinic with primary amenorrhea. She is 152 cm tall and weighs 50Kg. Breast development is assessed as Tanner stage 3 and her pubic hair is noted to be sparse. Further examination identifies she has inguinal swelling and short blind ending vagina. She has no other dysmorphic features.
What is the most likely diagnosis?

86. Mrs. X a 48-year-old woman presents 1 week after a difficult , prolonged total abdominal hysterectomy. Her BMI is 32 Kg/m2 , she has persistent weakness of hip flexion and paraesthesia over the anterior and medial aspects of her left thigh. Damage to which nerve is the most likely cause?

87. A 30-year-old multiparous woman with a suspected borderline left ovarian tumour is awaiting laparotomy, frozen section and conservative or complete staging surgery. She wants to know the accuracy of frozen section. How many cases diagnosed as borderline ovarian tumours on frozen section would be later reclassified as invasive tumours?

88. Ms. X 50 years old woman is here to discuss consent for Abdominal hysterectomy due to abnormal uterine bleeding, she tried all conservative measures(Mirena, tranexamic acid, ablation ) She is on clopidogrel. If the benefits of stopping clopidogrel outweigh the risks, how long should clopidogrel be stopped prior to surgery?

89. You see a 30 years old pregnant women a for elective repeat cesarean section. While obtaining her consent for the operation you explain to her that persistent wound and abdominal discomfort in the first few months after surgery, is common risk.
What is the numerical ratio for a complication when it is quoted as ‘common’?

90. Mrs. X, 28 years old woman who is 36 weeks pregnant in her second pregnancy comes to the labour ward because of upper abdominal pain and slight vaginal bleeding. Her first pregnancy ended in Caesarean section because of placental abruption. She has a normal blood pressure (BP) and a reactive non-stress test. What are her chances of having another placental abruption?

91. Ms. X a 59-year-old woman, P2, is referred with urinary leakage when coughing, sneezing, lifting, bending and changing position and she has had to wear incontinence pads. On examination her BMI is 30 and there is evidence of lower genital tract atrophy; there is no demonstrable stress incontinence. Filling cystometry shows: an early first desire to void at 75 ml; urgency at 140 ml associated with high pressure detrusor contraction, which reached 40 cm/H2 0 and resulted in completed bladder emptying. What is the probable diagnosis?

92. Ms. X had a difficult forceps delivery with multiple tears, plabial and a tear involving 50% of the EAS but intact mucosa and IAS. Which grade you will classify her tear?

93. Ms. X, 28 years old woman had an open spina bifida lesion closed in the early neonatal period and subsequently she relies on a wheelchair for mobility and intermittent self-catheterisation. She is seeking your advice about the chance of her having a baby similarly affected by a neural tube defect.

94.This instrument is used commonly in cesarean section. What is the name of this instrument ?

95. Mrs. X a 44 years old type 1diabetic on insulin presents with Acute onset pruritus with pain and curdy white discharge. On examination -vulvar erythema & fissuring. KoH solution shows psuedohyphae & budding yeast cells.

96. The most common side effect of excessive use of oxytocin is

97. You are asked to repair a vaginal tear following a normal delivery. The mother’s weight is 50 kg. She is otherwise well with no allergies. What is the maximum dose of lidocaine 1% without epinephrine that you can use for perineal infiltration?

98. The obstetric team are conducting a study to evaluate whether there has been any effect on patient satisfaction following the establishment of enhanced recovery programme. Women who were not in this programme and women in this programme were asked to rate their overall satisfaction with the process using a visual analogue scale from 1 (least satisfied) to 10 (most satisfied).
What is the most appropriate statistical test to assess whether there is a significant difference in satisfaction between the two groups?

99. Mrs. X suffering from Ulcerative Colitis on Mesalazine, planning for pregnancy and came for pre-pregnancy counselling. What advice will you give regarding Mesalazine on pregnancy?

100.In MCDA twin pregnancy monitoring to detect TTTS starts at which week.

101. 22 years old Tina, has come with painful sex, difficulty having sex. She has history of childhood abuse, after examination you conclude this is a case of primary vaginismus. You advise her vaginal dilators. Vaginal dilators help in relieving this reflex.

102. Both Mr and Mrs. Adams are cystic fibrosis carriers. Mrs Adams has In-vitro fertilization and preimplantation genetic diagnosis 12 embryos were formed. How many embryos will be affected?

103. All are true regarding verrucous carcinoma of vulva, except

104. Following intraoperative cell salvage for a cesarean section in D negative women who is previously non-sensitised, all are true except,

105. An Epileptic drug whose efficacy is reduced if used concomitantly with combined oral contraceptive pills

106. A patient with estrogen positive breast cancer has completed 5 years of Tamoxifen. For how long you would advise her to wait before she gets pregnant.

107.The commonest site for perforation of uterus is

8. All the following are autosomal dominant diseases except

109.Women with APH resulting from placental abruption or placenta praevia should be strongly recommended to receive active management of the third stage of labour. According to green top guidelines this is Recommendation A.
This Grade of recommendations is obtained from

110.Malaria in pregnancy is detrimental to the woman and her fetus. The majority of these infections are caused by

111. Mrs. Sara, 34 years old, known Epileptic, para1Living1, just delivered by forceps. She was on carbamazepine, dose and frequency was increased during pregnancy. To avoid postpartum toxicity, of antiepileptics, when she should be reviewed ?

112.Mrs. Sara, is now 14 weeks pregnant in her second pregnancy. She is a known case of epilepsy. Her first delivery was normal Vaughan delivery, first child is 8 years old and diagnosed to have epilepsy. What is risk of this baby having epilepsy?

113. Mrs. Angel, has been diagnosed with chronic kidney disease. She is now here for her booking visit. Her creatinine level now I 175 μmol/ L. During counselling, she wants to know risk of her having preterm delivery.

114. Mrs. Fathima, 34 years old, is here for pre conceptional counselling. She is known case of renal transplant. She is on Mycophenolate Mofetil. How long should she be advised to wait before conceiving?

115.Pregnant women with liver disease are associated with increased morbidity and mortality. Pregnancy with liver diseases carrying male baby is most common in which of the following conditions?

116.In female fetus, Mullerian duct appears by which week?

117. Mrs. Lucy has brought her 8 year child with premature sexual hair development. On X-ray she has advanced bone age and rapid growth velocity. On further evaluation her 17 hydroxy progesterone levels are increased with normal DHEAs.
What is the probable diagnosis?

118. Mrs. Ruby is 32 weeks pregnant. She has been diagnosed with syphillis a week back. She has been prescribed Benzathine benzylpenicillin G, 2.4 mu intramuscularly day 0 and 7. What is the incidence of Jarisch –Herxheimer reaction during treatment?

119. Which Bisphosphonate used in treatment for osteoporosis reduces both hip and vertebral fractures?

20. Mrs. Adams, 56 years old lady presented with hirsutism and features of virilisation. Her testosterone levels are 8.7 n mol/L with normal DHEAS and normal urinary 17- keto steroids. The probable reason for her hirsutism is

121.Which selective estrogen receptor modulators is effective and licensed for use in vulvovaginal atrophy ?

122.Mrs. Lisa primigravida has presented with rash on abdomen that’s progressing to trunk and extremities sparing hands and face and umbilicus. What is the probable cause ?

123. A 55 years old woman has presented with hot flushes. She has been treated for breast cancer and on tamoxifen, she is looking for non-hormonal alternative treatment, which one of the following drugs she can take

124. Mrs. Georgia Adams, is primigravida who is now 39 weeks 4 days low risk pregnancy. She is requesting for induction of labour as her husband is posted abroad; he is in the armed forces. He has to leave in 10 days. What would you advise her?

25. Post-vasectomy semen analysis ( PVSA). What does special clearance mean?

126. What’s the best time to do post-vasectomy semen analysis?

27. Mrs. X is in her 32 weeks of pregnancy. This is her third pregnancy, she delivered her previous 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?

28. Mrs. Sweetie, now at 32 weeks, presented with neck pain, she has pre-existing hypertension with bicuspid aortic valve. Her pain is sharp and radiating to back and chest as well. History of syncope in the morning. On examination there is a pulse deficit. What is the test for definitive diagnosis?

129. 42 years old woman presented with menorrhagia. Ultrasound showed endometrial polyp with increase vascularity. On further evaluation with hysteroscopy, showed surface irregularity with necrotic areas which is suspicious of malignancy. What is the prevalence of malignancy in polyps?

130. According to Causes of cardiovascular deaths, UK and Ireland 2015-17, which is the commonest cause ?

131. CIN 3 refers to

132. A 30 years old patient comes to your clinic complaining of stabbing pain to the right lower abdomen in the suprapubic region that is worse on hip extension. She had a ceaserean section 3 months ago right around which the pain started. What is the best management ?

133. A 65 years old patient BMI 35 kg/m² has an outpatient endometrial pipelle biopsy due to post- menopausal bleeding. The biopsy was reported as insufficient tissue for diagnosis. What would be the best next step in her management?

34. What is risk of major congenital anomalies with IVF compared with natural conception?

135. Mrs. Juby, of Indian origin, is now 33 weeks pregnant. She complains of itching on the palmar aspect of the hands and plantar aspect of the feet, with the symptoms worsening at night, leading to disturbed sleep. No rashes noted. Her liver functions- normal bile acids and normal AST &ALT .
How frequently her liver functions tests need to be monitored if pruritus persists ?

136. When doing ultrasound for monochorionic twin gestation, there is discordance in amniotic volume. Bladder of twin 1 is not visible as well as reversed flow in ductus venous. Which Quintero staging of Twin to Twin transfusion syndrome is this ?

137. Leslie, 42 years old is at 21 weeks of gestation and here for anomaly scan. She missed her first trimester and second trimester down syndrome screening as she was not in UK, and was on vacation. According to NICE what’s the cut off for nuchal fold thickness beyond which referral to fetal medicine specialist for further tests should be done?

138. What proportion of patients having a surgical procedure will develop a surgical site infection?

39. At what pressure should the pneumoperitoneum be maintained during the insertion of secondary ports for a laparoscopic procedure?

140. Among those receiving gynaecological treatment, what is the reported incidence of domestic violence in the United Kingdom?

141. Definition – Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. There are five principal steps, commonly referred to as the audit cycle. What is the first step of audit ?

142. A 29-year-old woman in her first pregnancy presents at the antenatal clinic complaining of recurrent attacks of migraine. She is now 32 weeks pregnant and is concerned as she has these attacks once every 3 days. She is enquiring if there is any medication that she can safely use during the pregnancy to stop these attacks. Which of the following medications would you consider most appropriate?

143. You have been asked by your consultant to write a patient information leaflet on caesarean section for placenta praevia. What is the incidence of ureteric injury at the time of surgery?

144. You see a 28-year-old woman with a 2-year history of primary subfertility in your preoperative assessment clinic. She is booked for hysteroscopic resection of a type 1 submucous fibroid, and you obtain her consent for the procedure. What is the risk of fluid overload associated with operative hysteroscopy?

45. A 25-year-old primigravida develops severe preeclampsia at 37 weeks’ 3 days gestation and is delivered by emergency caesarean section. She is concerned about her future pregnancies. What is the chance of her developing preeclampsia in her next pregnancy?

46. How much time uterus (tissue) takes to heal?

47. A new-born baby develops sticky eyes 5 days after a vaginal delivery. His mother did not have any vaginal discharge although she had experienced dysuria and frequency a few months before pregnancy. She was having regular sexual intercourse during pregnancy with her partner of 2 years’ duration. On examination, both the baby’s eyes are sticky and have a yellowish discharge. The conjunctiva is inflamed. What is the probable cause?

148. Mrs. Tamara, 24 years old in her 2nd pregnancy of 12 weeks gestation, diagnosed to have cesarean scar pregnancy. She had elective cesarean section in her first pregnancy. What could be the probable indication of first Cesarean having increased her risk of scar pregnancy?

149. What percentage of women do not attend appointment of IUC insertions post abortion?

150. A 55-year-old woman is due to come in for total abdominal hysterectomy and bilateral salpingo-oophorectomy for a large mucinous ovarian cyst. She takes sequential HRT for menopausal symptoms. What is the approximate overall risk of serious complications from abdominal hysterectomy?

151. 22 year old Rachel has come for booking visit. Her ultrasound at 10 weeks showed herniation of gut with umbilical cord on top of sac. What is the probable diagnosis?

152. 30 year old Tina has come for Early Booking scan. She is not sure of her dates. Her ultrasound measures were as follows: CRL: 90mm HC:111mm BPD:29mm FL: 15 mmAC: 89mm. Which diameter should be used to determine her gestational age?

153. Hospital wants to benchmark still birth rate which is consistent with UK stillbirth rate

154. 34 year old Lisa, has been pushing at full dilatation for over 2 hours now with no obvious progress even with syntocinon infusion.

Decided for vacuum delivery. She delivered with third pull, two times vacuum pulled off. Baby cried only after resuscitation; born with low Apgar scores, baby kept in NICU. This unstable neonate found to have scalp swelling with ill defined edges, that crosses suture lines. What is your diagnosis?

155. Sarah / 24 year old P1L1, is about to be discharged. She delivered 48hrs ago, male baby weighing 3.2kg. She had a forceps delivery for maternal exhaustion. She suffered a perineal tear. 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 ?

156. 17 year old girl who is sexually active, presents with pain-less fleshy lesion at vulva. What is the most common diagnosis?

157. A 25-year-old school teacher has come to see you in antenatal clinic. She is in her first pregnancy at 11weeks of gestation. Her partner is known to have glucose 6-phosphatase deficiency. She is otherwise fit and healthy. She has been tested negative for the condition. The overall risk of her children being carriers of this condition is

158. 26 year old is into her 10th 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

159. 32 year old presented with vulval itching and soreness. It’s aggravated during her periods. It’s relieved during summer. On examination

Pitted nails noted
Skin lesions on scratching shows minute Haemorrhages
Thick red plaques with silvery scales seen over vulva
Same lesions seen under breast

Choose correct diagnosis

160. All are true regarding Endocrinology in PCOS except

161. 36year-old,Katie, multiparous woman in her fourth pregnancy attends antenatal clinic at 42+ 0 weeks of gestation. This is low risk pregnancy. She had three previous normal vaginal deliveries, all of which were induced. This time she is adamant that she does not want induction of labour. But she is willing for membrane sweeping now. What is the most appropriate form of monitoring for her?

162. The risk of malignancy of an asymptomatic polyp is low particularly if it is less than ———-in diameter

163. A 30-year-old woman attends at 12 weeks for a nuchal translucency measurement as part screening for aneuploidy. What approximate detection rate for trisomy 21 using nuchal translucency alone will you quote to this woman?

164. A 33-year-old primigravida is seen for booking at 10 weeks of gestation. Following counselling she opts for the integrated test for aneuploidy. What is the main advantage of this test over the first-trimester screening test?

165. A couple are anxious about the risk of their baby being born with an inherited autosomal recessive condition. Their anxiety stems from the fact that their relative recently had a baby with an autosomal recessive condition. They want to know what the most common autosomal recessive condition worldwide is. What do you tell them?

166. Endometrial preparation required for this first generation technique of Endometrial ablation

167. In early pregnancy scan, the embryonic pole is first Visualized beside yolk sac on day

168. 25 year old Susie, has been treated with Methotrexate for unruptured tubal ectopic pregnancy. How long she should use effective contraception?

169. A 23-year-old primigravid woman presents at the emergency department at 6 weeks of gestation with threatened miscarriage. On examination, her vital signs were normal and her abdomen was soft with minimal tenderness on deep palpation. On speculum examination, there was a small amount of brown (old) blood in the vagina. A transvaginal ultrasound scan showed an intrauterine gestation sac measuring 18 mm x 15 mm x 12 mm. No yolk sac or fetal pole was visible. What would be the best management plan for her?

170. 17-year-old girl presents with a 12 hour history of lower abdominal pain. She had unprotected intercourse a week ago, which was 6 days after her last period. Her pulse is 110 beats per minute, her blood pressure is 110/70 mmHg, her temperature 37.8°C and she is tender over her lower abdomen, especially in the right iliac fossa where there is rebound tenderness. There is cervical excitation. Her Hb is 137g/l (normal 115–165) and her white cell count 17.6 x 10*9/l (normal 4–11).
What is the most likely diagnosis?

171. A 46-year-old nulliparous woman has been referred by her GP having been treated for heavy regular menstrual bleeding with cyclical progestogens for a period of 6 months. The treatment has failed to improve her symptoms. What is the most appropriate next line of management?

172. A 24-year-old woman in her first pregnancy attends the antenatal clinic. Her community midwife has referred her to a Consultant clinic as she disclosed having had female genital mutilation (FGM) at 8 years of age. Which one of the following countries is this woman LEAST likely to originate from?

173. A 36-year-old parous woman was diagnosed with stage 3 endometriosis. She was on GnRH analogue for 12 months. Subsequently she had laparoscopic excision of recto-vaginal endometriosis. She continues to be in pain despite medical and surgical management. What is the next most appropriate management option for her?

174. 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?