MRCOG Part 1 – Data Interpretation

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Question 1 of 27

1. Question

You are the on call SHO for Labour Ward and you are called to review a 26 year old primigravid woman in early labour at term who is noted to be hypertensive. On examination, her blood pressure is 170/118 and urinanalyis shows 4+ proteinuria. Urgent biochemistry shows the following results:

*Investigation*	*Result*	*Normal Range*
Haemoglobin	96	110 – 140 g/L
White cell count	10 x 10⁹/L	6 – 16 x 10⁹/L
Platelets	120 x 10⁹/L	150-400 x 10⁹/L
Sodium	140 mmol/L	130 – 140 mmol/L
Potassium	4.1 mmol/L	3.3 – 5.1 mmol/L
Urea	3.8 mmol/L	2.2 – 4.3 mmol/L
Creatinine	95 mmol/L	34 – 82 mmol/L
ALT	280 IU/L	6 – 32 IU/L
ALP	380 IU/L	30 – 300 IU/L
Bilirubin	14 mmol/L	3 – 14 mmol/L
Albumin	21 g/L	28 – 37 g/L
Uric acid	0.51 mmol/L	0.14 – 0.38 mmol/L

What is the likely diagnosis?

Eclampsia

Correct Incorrect Correct answer

HELLP syndrome

Correct Incorrect Correct answer

Mild pre-eclampsia

Correct Incorrect Correct answer

Pregnancy induced hypertension

Correct Incorrect Correct answer

Severe pre-eclampsia

Correct Incorrect Correct answer

Correct

Incorrect

Question 2 of 27

2. Question

A 36 year old primiparous woman is seen in antenatal clinic at 28 weeks gestation. She is known to have essential hypertension and is taking methyldopa 250mg BD. Her blood pressure is 128/76 and her urine dip is negative. She has routine antenatal blood tests and is found to be anaemic.

*Investigation*	*Result*	*Normal Range*
Haemoglobin	90	110 – 140 g/L
White cell count	10 x 10⁹/L	6 – 16 x 10⁹/L
Platelets	376 x 10⁹/L	150-400 x 10⁹/L
MCV	94 fL	83-101 fL
Reticulocytes	6%	0.5-2.5%
Serum Iron	28	11-32 mol/L
Ferritin	150	12-200mg/L
TIBC	60	42-80mol/L
Vitamin B12	190	>150mg/L
Folate	6	>2mg/L
Sodium	140 mmol/L	130 – 140 mmol/L
Potassium	4.1 mmol/L	3.3 – 5.1 mmol/L
Urea	3.8 mmol/L	2.2 – 4.3 mmol/L
Creatinine	50 mmol/L	34 – 82 mmol/L
ALT	8 IU/L	6 – 32 IU/L
ALP	380 IU/L	30 – 300 IU/L
Bilirubin	45 mmol/L	3 – 14 mmol/L
Albumin	31 g/L	28 – 37 g/L
Uric acid	0.24 mmol/L	0.14 – 0.38 mmol/L

What is the likely diagnosis?

Aplastic anaemia

Correct Incorrect Correct answer

Haemolytic anaemia

Correct Incorrect Correct answer

HELLP syndrome

Correct Incorrect Correct answer

Iron deficiency anaemia

Correct Incorrect Correct answer

Thalassaemia trait

Correct Incorrect Correct answer

Correct

Incorrect

Question 3 of 27

3. Question

A 26 year old primiparous woman is seen in antenatal clinic at 28 weeks gestation. Her blood pressure is 128/76 and her urine dip is negative. She has routine antenatal blood tests and is found to be anaemic.

*Investigation*	*Result*	*Normal Range*
Haemoglobin	87	110 – 140 g/L
White cell count	10 x 10⁹/L	6 – 16 x 10⁹/L
Platelets	376 x 10⁹/L	150-400 x 10⁹/L
MCV	64 fL	83-101 fL
Reticulocytes	1%	0.5-2.5%
Serum Iron	5	11-32 mol/L
Ferritin	8	12-200mg/L
TIBC	90	42-80mol/L
Vitamin B12	190	>150mg/L
Folate	6	>2mg/L
Sodium	140 mmol/L	130 – 140 mmol/L
Potassium	4.1 mmol/L	3.3 – 5.1 mmol/L
Urea	3.8 mmol/L	2.2 – 4.3 mmol/L
Creatinine	50 mmol/L	34 – 82 mmol/L
ALT	8 IU/L	6 – 32 IU/L
ALP	380 IU/L	30 – 300 IU/L
Bilirubin	45 mmol/L	3 – 14 mmol/L
Albumin	31 g/L	28 – 37 g/L
Uric acid	0.24 mmol/L	0.14 – 0.38 mmol/L

What is the likely diagnosis?

Aplastic anaemia

Correct Incorrect Correct answer

Haemolytic anaemia

Correct Incorrect Correct answer

HELLP syndrome

Correct Incorrect Correct answer

Iron deficiency anaemia

Correct Incorrect Correct answer

Thalassaemia trait

Correct Incorrect Correct answer

Correct

Incorrect

Question 4 of 27

4. Question

*Investigation*	*Result*	*Normal Range*
Haemoglobin	90	110 – 140 g/L
White cell count	10 x 10⁹/L	6 – 16 x 10⁹/L
Platelets	376 x 10⁹/L	150-400 x 10⁹/L
MCV	94 fL	83-101 fL
Reticulocytes	6%	0.5-2.5%
Serum Iron	28	11-32 mol/L
Ferritin	150	12-200mg/L
TIBC	60	42-80mol/L
Vitamin B12	190	>150mg/L
Folate	6	>2mg/L
Sodium	140 mmol/L	130 – 140 mmol/L
Potassium	4.1 mmol/L	3.3 – 5.1 mmol/L
Urea	3.8 mmol/L	2.2 – 4.3 mmol/L
Creatinine	50 mmol/L	34 – 82 mmol/L
ALT	8 IU/L	6 – 32 IU/L
ALP	380 IU/L	30 – 300 IU/L
Bilirubin	45 mmol/L	3 – 14 mmol/L
Albumin	31 g/L	28 – 37 g/L
Uric acid	0.24 mmol/L	0.14 – 0.38 mmol/L

What is the most appropriate next diagnostic test?

Blood film

Correct Incorrect Correct answer

Direct anti-globulin test

Correct Incorrect Correct answer

Erythocyte sedimentation rate (ESR)

Correct Incorrect Correct answer

Erythopoetin level

Correct Incorrect Correct answer

Schilling test

Correct Incorrect Correct answer

Correct

Incorrect

Question 5 of 27

5. Question

A 25 year old primiparous woman attends in labour at term and is noted to have frank heavy vaginal bleeding on admission. She has an emergency Caesarean section for presumed fetal compromise and a retroplacental clot is found at the time of surgery, suggestive of a placental abruption. She has a significant postpartum haemorrhage of 3.5L requiring insertion of an intra-uterine balloon. A coagulation screen is sent:

*Investigation*	*Result*	*Normal Range*
Haemoglobin	60	110 – 140 g/L
White cell count	19 x 10⁹/L	6 – 16 x 10⁹/L
Platelets	90 x 10⁹/L	150-400 x 10⁹/L
PT	30s	12-16s
APTT	60s	35-45s
Fibrinogen	0.25g/L	2-4g/L

What is the likely diagnosis?

Disseminated intravascular coagulation (DIC)

Correct Incorrect Correct answer

HELLP syndrome

Correct Incorrect Correct answer

Haemolytic anaemia

Correct Incorrect Correct answer

Haemophilia

Correct Incorrect Correct answer

Von Willebrand’s disease

Correct Incorrect Correct answer

Correct

Incorrect

Question 6 of 27

6. Question

A 65 year old woman presents with symptoms of lower abdominal pain, fatigue and persistent bloating. She is worried that she has developed irritable bowel syndrome. Abdominal and pelvic examination is unremarkable. She has some blood tests including a CA-125. The results are shown below:

	Result	Normal Range
Hb	117	115 – 165 g/L
WCC	5.6	3.6 – 11.0 x 10⁹/L
Plts	299	140 – 400 x 10⁹/L
MCV	95.0	80 – 100 fL
MCH	0.40	0.37 – 0.47L/L
Na	140	133 – 146 mmol/L
K	4.3	3.5 – 5.3 mmol/L
Ur	3.8	2.5 – 7.8 mmol/L
Cr	76	45 – 84 mmol/L
CA-125	250	0 – 35 IU/ml
TSH	1.6	0.4 – 4.0 mU/L
Free T4	14	9 – 24 pmol/L

What is the most appropriate next management?

Abdominal and pelvic CT scan

Correct Incorrect Correct answer

Abdominal and pelvic MRI scan

Correct Incorrect Correct answer

Abdominal ultrasound scan

Correct Incorrect Correct answer

Abdominal and pelvic ultrasound scan

Correct Incorrect Correct answer

Pelvic ultrasound scan

Correct Incorrect Correct answer

Correct

Incorrect

Question 7 of 27

7. Question

	Result	Normal Range
Hb	80	115 – 165 g/L
WCC	5.6	3.6 – 11.0 x 10⁹/L
Plts	299	140 – 400 x 10⁹/L
MCV	69.0	80 – 100 fL
MCH	0.40	0.37 – 0.47L/L
Na	140	133 – 146 mmol/L
K	4.3	3.5 – 5.3 mmol/L
Ur	3.8	2.5 – 7.8 mmol/L
Cr	76	45 – 84 mmol/L
CA-125	2	0 – 35 IU/ml
TSH	1.6	0.4 – 4.0 mU/L
Free T4	14	9 – 24 pmol/L

What is the most appropriate next management?

Reassure patient that there is no evidence of malignancy

Correct Incorrect Correct answer

Routine referral to gastroenterologist

Correct Incorrect Correct answer

Routine referral to gynaecologist

Correct Incorrect Correct answer

Urgent “2-week-wait” referral to gastroenterologist

Correct Incorrect Correct answer

Urgent “2-week-wait” referral to gynaecologist

Correct Incorrect Correct answer

Correct

Incorrect

Question 8 of 27

8. Question

A 23 year old presents with secondary amenorrhoea for 6 months. She is nulliparous with a BMI of 36 and her periods have always been irregular with 55-60 day cycles on average. A urinary pregnancy test is negative but she reports alopecia, worsening acne and recently a deepening of her voice. Her blood test results are shown below with normal ranges shown in brackets:

FSH – 10.5                   (1.0-11.0 IU/L)

LH – 8.5                       (0.5-14.5 IU/L)

Testosterone – 7.8      (0.8-3.1 nmol/L)

Prolactin – 401            (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?

Abdominal ultrasound scan
Correct Incorrect Correct answer

CT Abdo/Pelvis
Correct Incorrect Correct answer

MRI Pelvis
Correct Incorrect Correct answer

Pelvic and abdominal ultrasound scan
Correct Incorrect Correct answer

Pelvic ultrasound scan
Correct Incorrect Correct answer

Correct

Incorrect
Question 9 of 27

9. Question

A 28 year old attends with secondary amenorrhoea for 6 months. She is nulliparous with a BMI of 24 and her periods have always been regular previously. A urinary pregnancy test is negative but she reports that she has been experiencing some hot flushes in the last few months. Her blood test results are shown below:

FSH – 45                      (1.0-11.0 IU/L)

LH – 30                        (0.5-14.5 IU/L)

Oestradiol – 80           (70-510 pmol/L)

Testosterone – 1.8      (0.8-3.1 nmol/L)

Prolactin – 401            (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?

Bone scan
Correct Incorrect Correct answer

Karyotype
Correct Incorrect Correct answer

Pelvic ultrasound
Correct Incorrect Correct answer

Progestogen withdrawal test
Correct Incorrect Correct answer

Repeat FSH
Correct Incorrect Correct answer

Correct

Incorrect
Question 10 of 27

10. Question

A 23 year old attends with secondary amenorrhoea for 6 months. She is nulliparous with a BMI of 31 and her periods have always been irregular with 55-60 day cycles on average. A urinary pregnancy test is negative but she reports that she has been experiencing significant headaches for the last few months and has noticed galactorrhoea. Her blood test results are shown below:

FSH – 10.5                   (1.0-11.0 IU/L)

LH – 8.5                       (0.5-14.5 IU/L)

Testosterone – 1.8      (0.8-3.1 nmol/L)

Prolactin – 3069          (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?

CT Head
Correct Incorrect Correct answer

MRI Head
Correct Incorrect Correct answer

MRI Pituitary
Correct Incorrect Correct answer

Pituitary hormone profile
Correct Incorrect Correct answer

Repeat prolactin levels
Correct Incorrect Correct answer

Correct

Incorrect
Question 11 of 27

11. Question

A 23 year old attends with secondary amenorrhoea for 6 months. She is nulliparous with a BMI of 31 and her periods have been irregular for the last three years with cycles varying between 2 and 4 months apart. A urinary pregnancy test is negative. Her past medical history includes irritable bowel syndrome for which she takes regular antispamodics and metoclopramide. Her blood test results are shown below:

FSH – 10.5                   (1.0-11.0 IU/L)

LH – 8.5                       (0.5-14.5 IU/L)

Testosterone – 1.8      (0.8-3.1 nmol/L)

Prolactin – 996            (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?

CT Head
Correct Incorrect Correct answer

MRI Head
Correct Incorrect Correct answer

MRI Pituitary
Correct Incorrect Correct answer

Pituitary hormone profile
Correct Incorrect Correct answer

Repeat prolactin levels
Correct Incorrect Correct answer

Correct

Incorrect
Question 12 of 27

12. Question

A 19 year old attends with secondary amenorrhoea for 6 months. She is nulliparous with a BMI of 15.1 and her periods started at the age of 12 years old and were previously regular. She is currently in her first year at university studying medicine and is not sexually active. She reports that she has become very health conscious in the past year, eating a vegan diet and has lost 10kg of weight. Her blood test results are shown below:

FSH – 1.1                     (1.0-11.0 IU/L)

LH – 0.6                       (0.5-14.5 IU/L)

Oestradiol – 49           (70-600 pmol/L)

Testosterone – 1.3      (0.8-3.1 nmol/L)

Prolactin – 600            (90-520 mu/L)

TSH – 1.5                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the likely diagnosis?

Anorexia nervosa
Correct Incorrect Correct answer

Excessive exercise
Correct Incorrect Correct answer

Iron deficiency anaemia
Correct Incorrect Correct answer

Pregnancy
Correct Incorrect Correct answer

Stress
Correct Incorrect Correct answer

Correct

Incorrect
Question 13 of 27

13. Question

A 30-year-old pregnant woman at 32 weeks of gestation presents with shortness of breath. Her ABG results are as follows: pH 7.47, pCO₂ 30 mmHg, pO₂ 85 mmHg, HCO₃⁻ 21 mmol/L.

What is the most likely interpretation of these results?

Compensated metabolic acidosis
Correct Incorrect Correct answer

Metabolic alkalosis
Correct Incorrect Correct answer

Normal pregnancy
Correct Incorrect Correct answer

Respiratory acidosis
Correct Incorrect Correct answer

Respiratory alkalosis
Correct Incorrect Correct answer

Correct

Incorrect
Question 14 of 27

14. Question

A 25-year-old woman presents to the emergency department with vomiting for the past 3 days at 11 weeks gestation in her first pregnancy. Her ABG is: pH 7.50, pCO₂ 45 mmHg, HCO₃⁻ 34 mmol/L.

What is the most likely interpretation of these results?

Compensated respiratory acidosis
Correct Incorrect Correct answer

Compensated respiratory alkalosis
Correct Incorrect Correct answer

Metabolic acidosis
Correct Incorrect Correct answer

Metabolic alkalosis
Correct Incorrect Correct answer

Respiratory acidosis
Correct Incorrect Correct answer

Correct

Incorrect
Question 15 of 27

15. Question

A 40-year-old woman presents with acute asthma exacerbation. ABG shows: pH 7.30, pCO₂ 55 mmHg, HCO₃⁻ 25 mmol/L, pO₂ 60 mmHg.

What is the most appropriate interpretation of these ABG results?

Compensated metabolic acidosis
Correct Incorrect Correct answer

Metabolic acidosis with respiratory compensation
Correct Incorrect Correct answer

Normal ABG
Correct Incorrect Correct answer

Respiratory acidosis
Correct Incorrect Correct answer

Respiratory alkalosis
Correct Incorrect Correct answer

Correct

Incorrect
Question 16 of 27

16. Question

A 28-year-old woman with severe postpartum sepsis has the following ABG: pH 7.25, pCO₂ 25 mmHg, HCO₃⁻ 15 mmol/L.

Which acid-base disturbance is present?

Compensated metabolic acidosis
Correct Incorrect Correct answer

Compensated metabolic alkalosis
Correct Incorrect Correct answer

Metabolic acidosis
Correct Incorrect Correct answer

Metabolic alkalosis
Correct Incorrect Correct answer

Respiratory acidosis
Correct Incorrect Correct answer

Correct

Incorrect
Question 17 of 27

17. Question

A 50-year-old woman is noted post-operatively to have new onset confusion. Her blood tests show sodium 122 mmol/L, potassium 4.2 mmol/L, urea 4.0 mmol/L, glucose 5.6 mmol/L. What is the most appropriate next step in her management?

Administer IV dextrose
Correct Incorrect Correct answer

Administer IV potassium chloride
Correct Incorrect Correct answer

Administer IV sodium chloride
Correct Incorrect Correct answer

Restrict fluid intake
Correct Incorrect Correct answer

Start oral sodium bicarbonate
Correct Incorrect Correct answer

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Question 18 of 27

18. Question

A 45-year-old woman is assessed pre-operatively and reports a history of generalized weakness. Her lab results are as follows: sodium 136 mmol/L, potassium 7.1 mmol/L, bicarbonate 16 mmol/L. What is the most likely cause of her hyperkalaemia?

Addison’s disease
Correct Incorrect Correct answer

Conn’s syndrome
Correct Incorrect Correct answer

Cushing's syndrome
Correct Incorrect Correct answer

Hypoaldosteronism
Correct Incorrect Correct answer

Thiazide diuretic use
Correct Incorrect Correct answer

Correct

Incorrect
Question 19 of 27

19. Question

A 32-year-old pregnant woman at her first antenatal visit tests positive for a Rapid Plasma Reagin (RPR) of 1:64 and a positive Treponema pallidum particle agglutination assay (TPPA).

What is the most likely diagnosis?

Biological false-positive result
Correct Incorrect Correct answer

Early latent syphilis
Correct Incorrect Correct answer

Neurosyphilis
Correct Incorrect Correct answer

Primary syphilis
Correct Incorrect Correct answer

Treated syphilis with residual antibody response
Correct Incorrect Correct answer

Correct

Incorrect
Question 20 of 27

20. Question

A 25-year-old woman has a positive Enzyme Immunoassay (EIA) for syphilis but a negative Rapid Plasma Reagin (RPR). What is the most appropriate next step?

Consider treatment for syphilis
Correct Incorrect Correct answer

Order a confirmatory Treponemal test
Correct Incorrect Correct answer

Reassure and no further testing
Correct Incorrect Correct answer

Start empiric antibiotic therapy
Correct Incorrect Correct answer

Test for HIV and other STIs
Correct Incorrect Correct answer

Correct

Incorrect
Question 21 of 27

21. Question

A 29-year-old woman who was treated for syphilis two years ago has a current Rapid Plasma Reagin (RPR) titre of 1:8. Her previous titre after treatment was 1:64. How would you interpret this result?

Adequate treatment response
Correct Incorrect Correct answer

Reinfection with syphilis
Correct Incorrect Correct answer

Serofast reaction
Correct Incorrect Correct answer

Treatment failure
Correct Incorrect Correct answer

Untreated syphilis in latent phase
Correct Incorrect Correct answer

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Question 22 of 27

22. Question

A 30-year-old primigravida presents at 34 weeks gestation with new-onset hypertension of 160/105 mmHg and proteinuria of 2+ on dipstick. Blood tests reveal platelets 160 × 10⁹/L (reference: 150-400 × 10⁹/L) and ALT 150 U/L (reference: 7-56 U/L). What is the most likely diagnosis?

Acute fatty liver of pregnancy
Correct Incorrect Correct answer

Chronic hypertension
Correct Incorrect Correct answer

HELLP syndrome
Correct Incorrect Correct answer

Normal pregnancy
Correct Incorrect Correct answer

Severe pre-eclampsia
Correct Incorrect Correct answer

Correct

Incorrect
Question 23 of 27

23. Question

A 27-year-old woman presents at 30 weeks gestation with a blood pressure of 145/95 mmHg. Urine PCR (protein/creatinine ratio) is 75 mg/mmol (reference: <30 mg/mmol). There is no evidence of haemolysis or liver dysfunction. What is the most appropriate classification of her condition?

Chronic hypertension
Correct Incorrect Correct answer

Gestational hypertension
Correct Incorrect Correct answer

HELLP syndrome
Correct Incorrect Correct answer

Mild pre-eclampsia
Correct Incorrect Correct answer

Severe pre-eclampsia
Correct Incorrect Correct answer

Correct

Incorrect
Question 24 of 27

24. Question

A 55-year-old woman presents with urinary urgency and incontinence. Urodynamic studies reveal involuntary detrusor contractions during the filling phase, with a maximum pressure of 60 cmH₂O. What is the most likely diagnosis?

Detrusor underactivity
Correct Incorrect Correct answer

Detrusor overactivity
Correct Incorrect Correct answer

Functional urinary incontinence
Correct Incorrect Correct answer

Stress urinary incontinence
Correct Incorrect Correct answer

Urethral hypermobility
Correct Incorrect Correct answer

Correct

Incorrect
Question 25 of 27

25. Question

A 48-year-old woman complains of urine leakage when sneezing or coughing. Urodynamic studies show no detrusor contractions during the filling phase, but leakage occurs with increased abdominal pressure, with a normal post-void residual volume.

What is the most likely diagnosis?

Detrusor sphincter dyssynergia
Correct Incorrect Correct answer

Mixed urinary incontinence
Correct Incorrect Correct answer

Overflow incontinence
Correct Incorrect Correct answer

Stress urinary incontinence
Correct Incorrect Correct answer

Urge urinary incontinence
Correct Incorrect Correct answer

Correct

Incorrect
Question 26 of 27

26. Question

A 60-year-old woman undergoes urodynamic testing. During the voiding phase, there is a weak and prolonged flow, with a maximum flow rate (Qmax) of 5 mL/sec and elevated detrusor pressure. The post-void residual volume is 150 mL. What is the most likely diagnosis?

Bladder outlet obstruction
Correct Incorrect Correct answer

Detrusor overactivity
Correct Incorrect Correct answer

Functional incontinence
Correct Incorrect Correct answer

Neurogenic bladder
Correct Incorrect Correct answer

Stress urinary incontinence
Correct Incorrect Correct answer

Correct

Incorrect
Question 27 of 27

27. Question

A 32-year-old woman with a history of infertility undergoes a pelvic ultrasound, which reveals a 4 cm cyst in the left ovary with homogenous, low-level internal echoes and increased posterior acoustic enhancement. What is the most likely diagnosis?

Corpus luteum cyst
Correct Incorrect Correct answer

Dermoid cyst
Correct Incorrect Correct answer

Endometrioma
Correct Incorrect Correct answer

Functional cyst
Correct Incorrect Correct answer

Ovarian malignancy
Correct Incorrect Correct answer

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Incorrect

MRCOG Part 1 – Data Interpretation

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