MRCOG Part 2 - FREE Trial Questions

A 39 year old woman has a total laparoscopic hysterectomy and bilateral salping-oophorectomy for Stage IV endometriosis.The procedure is complicated by significant adhesions requiring extensive adhesiolysis of the pelvic side wall. Postoperatively, she reports significant abdominal pain and distension and a CT Urogram confirms transection of the lower third of the right ureter. What is the most appropriate procedure for repair?

Boari flap

Correct Incorrect Correct answer

Psoas hitch

Correct Incorrect Correct answer

Trans–uretero-ureterostomy

Correct Incorrect Correct answer

Uretero-neocystostomy

Correct Incorrect Correct answer

Uretero-ureterostomy

Correct Incorrect Correct answer

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 6mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18. What is the next most appropriate investigation?

Amniocentesis

Correct Incorrect Correct answer

Chorionic villous sampling

Correct Incorrect Correct answer

Non-invasive prenatal testing

Correct Incorrect Correct answer

Fetal anatomy scan at 16 weeks

Correct Incorrect Correct answer

Fetal echocardiography at 16 weeks

Correct Incorrect Correct answer

A 34 year old woman with a metallic mitral valve replacement contacts the maternal medicine antenatal clinic with a positive pregnancy test at approximately 6 weeks gestation by LMP. Pre-pregnancy, she was taking 6mg of warfarin once daily. What is the most appropriate management?

Change to therapeutic low molecular weight heparin between week 6 and 12 then restart warfarin in second trimester

Correct Incorrect Correct answer

Change to therapeutic low molecular weight heparin between week 6 and 28 then restart warfarin in third trimester

Correct Incorrect Correct answer

Change to therapeutic low molecular weight heparin from week 6 onwards

Correct Incorrect Correct answer

Continue warfarin at current dosage

Correct Incorrect Correct answer

Continue warfarin at lower dosage

Correct Incorrect Correct answer

A 30 year old woman is booked for a planned Caesarean birth at 37 weeks gestation in her first pregnancy due to her medical history of Marfan’s syndrome with aortic root dilation of 48mm. What is the most appropriate first line uterotonic?

Carboprost

Correct Incorrect Correct answer

Ergometrine

Correct Incorrect Correct answer

Misoprostol

Correct Incorrect Correct answer

Oxytocin bolus

Correct Incorrect Correct answer

Oxytocin infusion

Correct Incorrect Correct answer

Which of the following assisted vaginal births should be conducted in theatre?

Para 0, induction of labour for gestational diabetes, maternal BMI 29, estimated fetal weight 3.8kg, effective epidural analgesia, cervix fully dilated, prolonged second stage >2 hours, 0/5ths fetal head palpable per abdomen, station at +1, LOA position <45 degrees

Correct Incorrect Correct answer

Para 0, induction of labour for gestational diabetes, maternal BMI 29, estimated fetal weight 3.8kg, no regional analgesia, cervix fully dilated, prolonged second stage >2 hours, 0/5ths fetal head palpable per abdomen, station at +2, LOA position <45 degrees

Correct Incorrect Correct answer

Para 0, induction of labour for post-dates, effective epidural analgesia, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +2, LOT position

Correct Incorrect Correct answer

Para 1, induction of labour for post-dates, effective epidural analgesia, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +2, LOT position

Correct Incorrect Correct answer

Para 1, induction of labour for gestational diabetes, estimated fetal weight 4.4kg, fetal heart rate 70bpm for 8 minutes with no recovery to baseline, effective epidural analgesia, cervix fully dilated, 0/5ths fetal head palpable per abdomen, station at +1, LOT position

Correct Incorrect Correct answer

A primiparous woman presents in spontaneous labout at 31 weeks gestation and rapidly has a spontaneous vaginal delivery. The baby is born in poor condition with no respiratory effort and a heart rate of 90 beats per minute. What is the most appropriate next step in neonatal resuscitation?

Give five inflation breaths with 30% oxygen at 25cm H2O pressure

Correct Incorrect Correct answer

Give five inflation breaths with 30% oxygen at 30cm H2O pressure

Correct Incorrect Correct answer

Give five inflation breaths with 25% oxygen at 25cm H2O pressure

Correct Incorrect Correct answer

Give five inflation breaths with air at 25cm H2O pressure

Correct Incorrect Correct answer

Give five inflation breaths with air at 30cm H2O pressure

Correct Incorrect Correct answer

A 23 year old presents 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 in 4-6 weeks

Correct Incorrect Correct answer

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She uses the combined hormonal transdermal patch and has just noticed that the patch she applied yesterday has become detached. She is unsure when the patch came off and has had unprotected sexual intercourse in the last 24 hours. What is the most appropriate advice?

Apply a new patch and no additional precautions are required

Correct Incorrect Correct answer

Apply a new patch and use condoms for seven days

Correct Incorrect Correct answer

Apply a new patch and use emergency contraception

Correct Incorrect Correct answer

Apply a new patch, use emergency contraception and use condoms for seven days

Correct Incorrect Correct answer

Use emergency contraception and change to a different contraceptive method

Correct Incorrect Correct answer

A 31 year old nulliparous woman presents with abdominal pain, irregular periods and bloating. Pelvic ultrasound shows a 5cm solid complex ovarian mass and laboratory testing confirms high alpha-fetoprotein (aFP) levels. Staging CT scan is suggestive of regional lymph node involvement. She wishes to conserve her fertility. What is the most appropriate management?

Neoadjuvant BEP (bleomycin, etoposide, cisplatin) chemotherapy

Correct Incorrect Correct answer

Neoadjuvant BEP (bleomycin, etoposide, cisplatin) chemotherapy with subsequent surgical resection

Correct Incorrect Correct answer

Neoadjuvant carboplatin chemotherapy with subsequent surgical resection

Correct Incorrect Correct answer

Surgical resection with adjuvant BEP (bleomycin, etoposide, cisplatin) chemotherapy

Correct Incorrect Correct answer

Surgical resection with adjuvant carboplatin chemotherapy

Correct Incorrect Correct answer

A 70-year-old woman presents with urinary frequency, urgency, nocturia and incontinence. She has reduced her caffeine intake, restricts her fluids in the evening and has had bladder retraining as well as supervised pelvic floor exercises. Whilst there has been some improvement of her symptoms, she still finds them quite troublesome, and they are affecting her quality of live. Her medical history includes glaucoma and hypertension for which she takes latanoprost and amlodipine. What treatment should now be considered?

Darifenacin

Correct Incorrect Correct answer

Duloxetine

Correct Incorrect Correct answer

Mirabegron

Correct Incorrect Correct answer

Oxybutinin

Correct Incorrect Correct answer

Trospium

Correct Incorrect Correct answer

A 34 year old woman is referred to her local early pregnancy unit at 8 weeks gestation following symptoms of vaginal bleeding with mild cramping pain having had one previous Caesarean section. The ultrasound findings are of an empty uterine cavity and closed empty cervical canal with a gestational sac in the niche of the previous Caesarean section scar that extrudes towards the bladder with absent overlying myometrium with negative sliding sign and evidence of trophoblastic circulation on Colour Doppler flow. Within the gestational sac, a viable embryo with fetal cardiac activity is seen. What is the most likely diagnosis?

Cervical pregnancy

Correct Incorrect Correct answer

Interstitial pregnancy

Correct Incorrect Correct answer

Type 1 Caesarean scar pregnancy

Correct Incorrect Correct answer

Type 2 Caesarean scar pregnancy

Correct Incorrect Correct answer

Viable intra-uterine pregnancy

Correct Incorrect Correct answer

A 30 year old woman woman contacts the Maternity Assessment unit at 28 weeks gestation as she is concerned because her nephew has developed chicken pox yesterday and she was looking after him when the rash appeared. Her community midwife has requested urgent serum serology for Varicella Zoster IgG from her antenatal booking bloods and the laboratory calls to report that the patient is non-immune. What is the most appropriate management?

Offer prophylactic Varicella-Zoster immunoglobulin (VZIG) immediately

Correct Incorrect Correct answer

Offer prophylactic Varicella-Zoster immunoglobulin (VZIG) after 10 days

Correct Incorrect Correct answer

Offer prophylactic Varicella-Zoster immunoglobulin (VZIG) if the patient develops chickenpox

Correct Incorrect Correct answer

Repeat serum serology immediately for varicella-zoster immunoglobulins

Correct Incorrect Correct answer

Repeat serum serology in 48 hours for varicella-zoster immunoglobulins

Correct Incorrect Correct answer

A 38 year old black African woman has an induction of labour at 37 weeks for Type 2 diabetes and gestational hypertension medicated with oral nifedipine 10mg BD. She has a spontaneous vaginal birth and her blood pressure on Day 1 and Day 2 postnatally is normal. She is reviewed in the community on Day 5 and noted to have a blood pressure of 155/98 mmHg. She is otherwise clinically well and is asymptomatic. She is not breastfeeding and does not plan to start. What is the most appropriate treatment option?

Repeat blood pressure measurement in 24 hours

Correct Incorrect Correct answer

Restart treatment with nifedipine

Correct Incorrect Correct answer

Start treatment with amlodipine

Correct Incorrect Correct answer

Start treatment with enalapril

Correct Incorrect Correct answer

Start treatment with losartan

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

An 18 year old nulliparous woman presents with lower abdominal pain and vaginal spotting. Her last menstrual period was 6 weeks ago and she has a positive urinary pregnancy test. Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity. A small gestational sac measuring 21mm in diameter is seen below the internal cervical os but there is no evidence of a yolk sac or fetal pole. There is blood flow seen on Colour Doppler around the gestational sac and sliding sign is absent. The ovaries appear normal with a corpus luteum seen on the left ovary and there is no free fluid in the Pouch of Douglas.

Conservative Management

Correct Incorrect Correct answer

CT scan

Correct Incorrect Correct answer

Laparoscopy +/- proceed

Correct Incorrect Correct answer

Laparotomy +/- proceed

Correct Incorrect Correct answer

Medical management with prostaglandins

Correct Incorrect Correct answer

Medical management with methotrexate

Correct Incorrect Correct answer

MRI scan

Correct Incorrect Correct answer

No action

Correct Incorrect Correct answer

Urine pregnancy test in two weeks

Correct Incorrect Correct answer

Serum beta human chorionic gonadotrophin levels in 48 hours

Correct Incorrect Correct answer

Serum beta human chorionic gonadotrophin levels in 7 days

Correct Incorrect Correct answer

Serum progesterone levels

Correct Incorrect Correct answer

Surgical Evacuation of Uterus

Correct Incorrect Correct answer

Transabdominal ultrasound scan in 14 days

Correct Incorrect Correct answer

Transvaginal ultrasound scan in 7-10 days

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A 50 year old women presents with a sensation of a vaginal lump on coughing. She is Para 3, having had three previous vaginal births. She has no other significant medical or surgical history. She has tried pelvic floor muscle training without significant benefit and wishes to have definitive treatment. On examination, her BMI is 24 and POP-Q assessment showed:

Abdominal sacrocolpopexy

Correct Incorrect Correct answer

Anterior colporrhaphy

Correct Incorrect Correct answer

Autologous rectus fascial sling

Correct Incorrect Correct answer

Colpocleisis

Correct Incorrect Correct answer

Colposuspension

Correct Incorrect Correct answer

High uterosacral ligament suspension

Correct Incorrect Correct answer

Laparoscopic sacrocolpopexy

Correct Incorrect Correct answer

Manchester repair

Correct Incorrect Correct answer

McCall culdoplasty

Correct Incorrect Correct answer

Pelvic floor muscle training

Correct Incorrect Correct answer

Posterior colporrhaphy

Correct Incorrect Correct answer

Sacrospinous fixation

Correct Incorrect Correct answer

Vaginal ring pessary

Correct Incorrect Correct answer

Vaginal shelf pessary

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A 62-year-old woman presents with a bleeding ulcerated anterior right vulval lesion. On examination, there is a 1.5 cm vulval tumour confined to the vulva and wedge biopsy confirms a histological diagnosis of vulval squamous cell carcinoma with stromal invasion of 0.8 mm. There is no evidence of lymph node involvement or distant metastasis on MRI.

Adjuvant chemoradiotherapy

Correct Incorrect Correct answer

Anterior vulvectomy

Correct Incorrect Correct answer

Bilateral inguinofemoral lymphadenectomy

Correct Incorrect Correct answer

Ipsilateral inguinofemoral lymphadenectomy

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy

Correct Incorrect Correct answer

Palliative care

Correct Incorrect Correct answer

Pelvic exenteration

Correct Incorrect Correct answer

Posterior vulvectomy

Correct Incorrect Correct answer

Primary chemoradiotherapy

Correct Incorrect Correct answer

Radical local excision with sentinel lymph node biopsy

Correct Incorrect Correct answer

Radical vulvectomy

Correct Incorrect Correct answer

Sentinel lymph node biopsy

Correct Incorrect Correct answer

Wide local excision without lymphadenectomy

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate diagnostic test from the above list. Each option may be used once, more than once or not at all.

A 20 year old woman presents to her local sexual health clinic with symptoms of profuse vaginal discharge which she describes as offensive. On examination, there is profuse frothy yellow offensive vaginal discharge and there is a strawberry cervix appearance with small punctate haemorrhages with ulceration.

Endocervical swab + culture

Correct Incorrect Correct answer

Endocervical swab + microscopy

Correct Incorrect Correct answer

Endocervical swab + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

First catch urine + culture

Correct Incorrect Correct answer

First catch urine + microscopy

Correct Incorrect Correct answer

First catch urine + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

High vaginal swab + culture

Correct Incorrect Correct answer

High vaginal swab + microscopy

Correct Incorrect Correct answer

High vaginal swab + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

Urethral swab + culture

Correct Incorrect Correct answer

Urethral swab + microscopy

Correct Incorrect Correct answer

Urethral swab + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

Vulvo-vaginal swab + culture

Correct Incorrect Correct answer

Vulvo-vaginal swab + microscopy

Correct Incorrect Correct answer

Vulvo-vaginal swab + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

Rectal swab + culture

Correct Incorrect Correct answer

Rectal swab + microscopy

Correct Incorrect Correct answer

Rectal swab + nucleic acid amplification test (NAAT)

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A 69-year-old woman presents with postmenopausal bleeding. Transvaginal ultrasound reveals an endometrial thickness of 14 mm. A biopsy confirms endometrial hyperplasia without atypia. She has no significant medical history and has a BMI of 24.

Annual endometrial surveillance

Correct Incorrect Correct answer

Conservative management

Correct Incorrect Correct answer

Continuous progestogen medroxyprogesterone acetate 5 mg daily

Correct Incorrect Correct answer

Continuous progestogen medroxyprogesterone acetate 10 mg daily

Correct Incorrect Correct answer

Continuous progestogen norethisterone 5 mg daily

Correct Incorrect Correct answer

Continuous progestogen norethisterone 10 mg daily

Correct Incorrect Correct answer

Endometrial ablation

Correct Incorrect Correct answer

Hysteroscopy and Endometrial biopsy

Correct Incorrect Correct answer

Levonorgestrel Intrauterine System + Endometrial biopsy in 3 months

Correct Incorrect Correct answer

Levonorgestrel Intrauterine System + Endometrial biopsy in 6 months

Correct Incorrect Correct answer

Levonorgestrel Intrauterine System

Correct Incorrect Correct answer

Subtotal hysterectomy

Correct Incorrect Correct answer

Total abdominal hysterectomy

Correct Incorrect Correct answer

Total abdominal hysterectomy and bilateral salpingo-oophorectomy

Correct Incorrect Correct answer

Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy

Correct Incorrect Correct answer

Ultrasound scan

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A woman in her second pregnancy opts to have a planned Caesarean birth. Her first child was born by forceps complicated by shoulder dystocia and the baby sustained a brachial plexus injury which required surgery and extensive physiotherapy. She has a booking BMI of 39 and develops gestational diabetes during pregnancy which requires insulin treatment. She is readmitted on Day 6 postpartum with extensive erythema around the Caesarean section wound which spreads rapidly. She has excruciating pain over the wound requiring intravenous morphine and the pain is elicited beyond the margins of the superficial erythema. She is treated with intravenous flucloxacillin but continues to deteriorate.

Co-amoxiclav

Correct Incorrect Correct answer

Ceftriaxone

Correct Incorrect Correct answer

Clarithromycin

Correct Incorrect Correct answer

Clindamycin

Correct Incorrect Correct answer

Erythromycin

Correct Incorrect Correct answer

Flucloxacillin

Correct Incorrect Correct answer

Gentamicin

Correct Incorrect Correct answer

Intravenous immunoglobulin (IVIG)

Correct Incorrect Correct answer

Meropenem

Correct Incorrect Correct answer

Metronidazole

Correct Incorrect Correct answer

No antibiotics required

Correct Incorrect Correct answer

Phenoxymethylpenicillin

Correct Incorrect Correct answer

Piperacillin-tazobactam

Correct Incorrect Correct answer

Suction evacuation of uterus

Correct Incorrect Correct answer

Surgical debridement

Correct Incorrect Correct answer

Teicoplanin

Correct Incorrect Correct answer

Vancomycin

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A woman in her first pregnancy attends in spontaneous labour at 30 weeks gestation and requests epidural analgesia which is sited and is effective. During the second stage of labour, the CTG is abnormal with repetitive late decelerations. On vaginal examination, the presenting part is at station 0 with occipito-posterior fetal position.

Category 1 emergency Caesarean section

Correct Incorrect Correct answer

Category 2 emergency Caesarean section

Correct Incorrect Correct answer

Category 3 emergency Caesarean section

Correct Incorrect Correct answer

Category 4 emergency Caesarean section

Correct Incorrect Correct answer

Direct traction forceps

Correct Incorrect Correct answer

External cephalic version

Correct Incorrect Correct answer

Internal podalic version

Correct Incorrect Correct answer

Rotational forceps

Correct Incorrect Correct answer

Spontaneous vaginal delivery

Correct Incorrect Correct answer

Vaginal breech delivery

Correct Incorrect Correct answer

Ventouse

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate analgesia option from the above list. Each option may be used once, more than once or not at all.

A woman in spontaneous labour at 40 weeks gestation requests rapid onset effective pharmacological analgesia for the duration of her labour. She has a history of immune thrombocytopenia and her platelets on admission are 70.

Acupuncture

Correct Incorrect Correct answer

Aromatherapy

Correct Incorrect Correct answer

Biofeedback

Correct Incorrect Correct answer

Birthing ball

Correct Incorrect Correct answer

Combined spinal-epidural

Correct Incorrect Correct answer

Continuous one-to-one support

Correct Incorrect Correct answer

Epidural

Correct Incorrect Correct answer

General anaesthesia

Correct Incorrect Correct answer

Hypnosis

Correct Incorrect Correct answer

Music

Correct Incorrect Correct answer

Nitrous oxide

Correct Incorrect Correct answer

Non-opioid analgesics

Correct Incorrect Correct answer

Opioids

Correct Incorrect Correct answer

Remifentanil patient-controlled analgesia

Correct Incorrect Correct answer

Spinal

Correct Incorrect Correct answer

Sterile water injections

Correct Incorrect Correct answer

Transcutaneous electrical nerve stimulation

Correct Incorrect Correct answer

Water immersion

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate investigation from the above list. Each option may be used once, more than once or not at all.

A 36 year old woman is referred to maternal medicine clinic at 23 weeks gestation in her second pregnancy with persistent hyperkalaemia and hyponatraemia. She previously had an uncomplicated first pregnancy and vaginal birth at term. In this current pregnancy, she has had hyperemesis gravidarum throughout pregnancy and has struggled with symptomatic low blood pressure and occasional episodes of hypoglycaemia.

Adrenal autoantibodies

Correct Incorrect Correct answer

Home blood pressure monitoring

Correct Incorrect Correct answer

Low-dose dexamethasone suppression test

Correct Incorrect Correct answer

Morning serum cortisol and plasma ACTH levels

Correct Incorrect Correct answer

Morning serum 17α-hydroxyprogesterone levels

Correct Incorrect Correct answer

Night serum cortisol level

Correct Incorrect Correct answer

Night salivary cortisol level

Correct Incorrect Correct answer

Oral glucose tolerance test

Correct Incorrect Correct answer

Serum aldosterone-to-renin ratio

Correct Incorrect Correct answer

Serum free androgen index

Correct Incorrect Correct answer

Serum plasma free metanephrines

Correct Incorrect Correct answer

Serum renin level

Correct Incorrect Correct answer

Short Synacthen stimulation test

Correct Incorrect Correct answer

Soluble fLt / PLGF ratio

Correct Incorrect Correct answer

Urinary free cortisol (UFC)

Correct Incorrect Correct answer

Urinary protein creatininine ratio

Correct Incorrect Correct answer

24-hour urine collection for plasma free metanephrines

Correct Incorrect Correct answer

For each clinical scenario described below, choose the single most appropriate management option from the above list. Each option may be used once, more than once or not at all.

A new screening test for gestational diabetes has been evaluated in a population of 1000 women. The test correctly identifies 120 of 150 women with gestational diabetes (true positives) and incorrectly labels 50 women without the disease as having gestational diabetes (false positives). What is the positive predictive value (PPV) of this test?

Approximately 20%

Correct Incorrect Correct answer

Approximately 25%

Correct Incorrect Correct answer

Approximately 30%

Correct Incorrect Correct answer

Approximately 35%

Correct Incorrect Correct answer

Approximately 40%

Correct Incorrect Correct answer

Approximately 45%

Correct Incorrect Correct answer

Approximately 50%

Correct Incorrect Correct answer

Approximately 55%

Correct Incorrect Correct answer

Approximately 60%

Correct Incorrect Correct answer

Approximately 65%

Correct Incorrect Correct answer

Approximately 70%

Correct Incorrect Correct answer

Approximately 75%

Correct Incorrect Correct answer

Approximately 80%

Correct Incorrect Correct answer

Approximately 85%

Correct Incorrect Correct answer

Approximately 90%

Correct Incorrect Correct answer

A 28 year old woman and her 32 year old partner are seen in fertility clinic with a three year history of primary subfertility. The results of their infertility investigations are shown below:

Female Investigations

BMI: 23
Menstrual cycle: regular, 28 days
Day-21 Serum Progesterone:
FSH: 6.5 mIU/ml
LH 7.4 IU/L
Pelvic ultrasound: normal appearances of uterus and ovaries
Hysterosalpingogram: both tubes appear patent

Male Investigations

BMI: 25
Semen analysis on two occasions 3 months apart: azoospermia
FSH: 0.2 IU/L
LH: 0.1 IU/L
Testosterone: 8 nmol/L

What is the most appropriate management option?

Corticosteroids for 3 months followed by repeat semen analysis

Correct Incorrect Correct answer

Gonadotrophins for 3 months followed by repeat semen analysis

Correct Incorrect Correct answer

Letrozole for 3 months followed by repeat semen analysis

Correct Incorrect Correct answer

No treatment

Correct Incorrect Correct answer

Testosterone injections for 3 months followed by repeat semen analysis

Correct Incorrect Correct answer

For each scenario described below, choose the single most appropriate management option. Each option may be used once, more than once or not at all.

A 52-year-old woman presents with severe hot flushes and night sweats affecting her quality of life. She has a BMI of 34 kg/m² and she has a medical history of previous ER positive breast cancer for which she takes ongoing adjuvant tamoxifen treatment.

Clonidine

Correct Incorrect Correct answer

Continuous combined oral HRT containing 1 mg of estradiol

Correct Incorrect Correct answer

Continuous combined oral HRT containing 2 mg of estradiol

Correct Incorrect Correct answer

Continuous combined HRT with transdermal estradiol

Correct Incorrect Correct answer

Combined sequential oral HRT containing 1 mg of estradiol

Correct Incorrect Correct answer

Combined sequential oral HRT containing 2 mg of estradiol

Correct Incorrect Correct answer

Estrogen only 1 mg oral HRT, without progestogen

Correct Incorrect Correct answer

Estrogen only 2 mg oral HRT, without progestogen

Correct Incorrect Correct answer

Menopause-specific cognitive behavioural therapy (CBT)

Correct Incorrect Correct answer

Oral ospemifene

Correct Incorrect Correct answer

Selective serotonin reuptake inhibitors (SSRIs)

Correct Incorrect Correct answer

Sequential HRT with transdermal estradiol

Correct Incorrect Correct answer

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Correct Incorrect Correct answer

Tibolone

Correct Incorrect Correct answer

Transdermal estradiol only HRT, without progestogen

Correct Incorrect Correct answer

Vaginal prasterone

Correct Incorrect Correct answer

Vaginal oestrogen

Correct Incorrect Correct answer

Vaginal laser treatment

Correct Incorrect Correct answer

Vaginal moisturiser and lubricant

Correct Incorrect Correct answer

For each scenario described below, choose the single most appropriate management option:

A 28-year-old woman with polycystic ovary syndrome (PCOS) is undergoing IVF with a GnRH antagonist fixed protocol. Her AMH is 40 pmol/L, and ultrasound reveals 25 antral follicles per ovary. Serum oestradiol is rising rapidly.

Clomiphene citrate cycle

Correct Incorrect Correct answer

Double embryo transfer

Correct Incorrect Correct answer

Freeze-all strategy

Correct Incorrect Correct answer

GnRH agonist long protocol

Correct Incorrect Correct answer

GnRH agonist short protocol

Correct Incorrect Correct answer

GnRH agonist trigger

Correct Incorrect Correct answer

GnRH antagonist protocol

Correct Incorrect Correct answer

hCG trigger

Correct Incorrect Correct answer

Letrozole stimulation

Correct Incorrect Correct answer

Mild stimulation protocol

Correct Incorrect Correct answer

Natural cycle IVF

Correct Incorrect Correct answer

Progesterone-primed protocol

Correct Incorrect Correct answer

Single embryo transfer

Correct Incorrect Correct answer

For each scenario described below, choose the single most appropriate management option:

A 19-year-old woman presents with a second episode of sudden-onset left iliac fossa pain and vomiting within six months. She previously underwent laparoscopic detorsion for left ovarian torsion with a normal-appearing ovary and no cysts. This time, transvaginal ultrasound again shows an enlarged left ovary with peripheral follicles, and Doppler flow is reduced. She is haemodynamically stable and not pregnant.

CT Abdomen / Pelvis

Correct Incorrect Correct answer

Diagnostic laparoscopy

Correct Incorrect Correct answer

Laparoscopic detorsion

Correct Incorrect Correct answer

Laparoscopic detorsion with oophorectomy

Correct Incorrect Correct answer

Laparoscopic detorsion with oophoropexy

Correct Incorrect Correct answer

Laparoscopic detorsion with ovarian cystectomy

Correct Incorrect Correct answer

Laparoscopic unilateral salpingo-oophorectomy

Correct Incorrect Correct answer

MRI Abdomen / Pelvis

Correct Incorrect Correct answer

Percutaneous cyst drainage

Correct Incorrect Correct answer

Staging laparotomy and unilateral salpingo-oophorectomy

Correct Incorrect Correct answer

Transvaginal cyst drainage

Correct Incorrect Correct answer

MRCOG Part 2 – FREE Trial Questions

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