MRCOG Part 2 - Practice Exam D

Question 1 of 100

1. Question

A new curriculum is being developed for trainees in obstetrics and gynaecology. To cater to different learning styles effectively, which approach should be prioritized in designing the curriculum?

Auditory teaching techniques

Correct Incorrect Correct answer

Kolb’s experiential learning model

Correct Incorrect Correct answer

Problem-based learning

Correct Incorrect Correct answer

Self-directed study modules

Correct Incorrect Correct answer

Visual aids and resources

Correct Incorrect Correct answer

Question 2 of 100

2. Question

To prepare for a session on clinical risk management, a trainee is asked to identify gaps in their knowledge and set specific goals. Which of the following learning methodologies does this exercise encourage?

Experiential learning

Correct Incorrect Correct answer

Goal-based learning

Correct Incorrect Correct answer

Problem-based learning

Correct Incorrect Correct answer

Reflective learning

Correct Incorrect Correct answer

Self-directed learning

Correct Incorrect Correct answer

Question 3 of 100

3. Question

For each of the following scenarios, select the most appropriate option:

In a study of 200 patients, a new test for diagnosing pre-eclampsia correctly identifies 80 of 100 patients with the disease (true positives) and correctly identifies 90 of 100 patients without the disease (true negatives). What is the sensitivity of the 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

Approximately 95%

Correct Incorrect Correct answer

Question 4 of 100

4. Question

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

A maternity department is reviewing its patient discharge process and identifies unnecessary steps, such as duplicative documentation, that delay discharge times. They implement changes to streamline the process. Which quality improvement methodology is being applied?

Clinical Audit

Correct Incorrect Correct answer

Communication Tool

Correct Incorrect Correct answer

Decision Tree

Correct Incorrect Correct answer

Fishbone diagram

Correct Incorrect Correct answer

Lean Six Sigma

Correct Incorrect Correct answer

Model for improvement

Correct Incorrect Correct answer

Performance benchmarking

Correct Incorrect Correct answer

Plan Do Study Act

Correct Incorrect Correct answer

Process mapping

Correct Incorrect Correct answer

Root cause analysis

Correct Incorrect Correct answer

Statistical Process Control

Correct Incorrect Correct answer

Technological innovation

Correct Incorrect Correct answer

Question 5 of 100

5. Question

For each of the following scenarios, select the most appropriate option:

A study is conducted into the safety and efficacy of uterine artery embolization (UAE) versus surgery for symptomatic uterine fibroids. A total of seven randomised controlled trials involving 859 patients were included. The results showed a shorter hospital stay and recovery time for UAE as compared to surgery.

Case control study

Correct Incorrect Correct answer

Case report

Correct Incorrect Correct answer

Cohort study

Correct Incorrect Correct answer

Cross-over study

Correct Incorrect Correct answer

Experimental study

Correct Incorrect Correct answer

Longitudinal study

Correct Incorrect Correct answer

Meta-analysis

Correct Incorrect Correct answer

Observational study

Correct Incorrect Correct answer

Prospective study

Correct Incorrect Correct answer

Randomised study

Correct Incorrect Correct answer

Randomised controlled study

Correct Incorrect Correct answer

Retrospective study

Correct Incorrect Correct answer

Systematic review

Correct Incorrect Correct answer

Question 6 of 100

6. Question

When considering sutures, there are three main types: non-absorbable, slowly absorbable, and rapidly absorbable. Which suture has the greatest tensile strength?

Polydioxanone

Correct Incorrect Correct answer

Polyglecaprone

Correct Incorrect Correct answer

Polyglactic 910

Correct Incorrect Correct answer

Polyglactin

Correct Incorrect Correct answer

Polyglycolic acid

Correct Incorrect Correct answer

Question 7 of 100

7. Question

Which vessel is in close relation to the ureter at the level of the internal cervical os?

Abdominal Aorta

Correct Incorrect Correct answer

Common Iliac Artery

Correct Incorrect Correct answer

External Iliac Artery

Correct Incorrect Correct answer

External Pudendal Artery

Correct Incorrect Correct answer

Femoral Artery

Correct Incorrect Correct answer

Inferior Epigastric Artery

Correct Incorrect Correct answer

Internal Iliac Artery

Correct Incorrect Correct answer

Internal Pudendal Artery

Correct Incorrect Correct answer

Obturator artery

Correct Incorrect Correct answer

Ovarian Artery

Correct Incorrect Correct answer

Superior Gluteal Artery

Correct Incorrect Correct answer

Uterine Artery

Correct Incorrect Correct answer

Question 8 of 100

8. Question

When carrying out a caesarean section a surgeon should avoid extending their incision out beyond the lateral margins of the rectus muscles to avoid which nerve injury?

Brachial plexus

Correct Incorrect Correct answer

Common Peroneal nerve

Correct Incorrect Correct answer

Dorsal Clitoral Nerve

Correct Incorrect Correct answer

Femoral Nerve

Correct Incorrect Correct answer

Genitofemoral Nerve

Correct Incorrect Correct answer

Ilioinguinal and iliohypogastric nerves

Correct Incorrect Correct answer

Lateral Cutaneous nerve

Correct Incorrect Correct answer

Obturator nerve

Correct Incorrect Correct answer

Phrenic nerve

Correct Incorrect Correct answer

Pudendal nerve

Correct Incorrect Correct answer

Sciatic Nerve

Correct Incorrect Correct answer

Tibial Nerve

Correct Incorrect Correct answer

Question 9 of 100

9. Question

On transvaginal scan in the transverse plane, the ovaries are located lateral to the uterus and anterior and medial to which vessel?

Abdominal Aorta

Correct Incorrect Correct answer

Common Iliac Artery

Correct Incorrect Correct answer

External Iliac Artery

Correct Incorrect Correct answer

External Pudendal Artery

Correct Incorrect Correct answer

Femoral Artery

Correct Incorrect Correct answer

Inferior Epigastric Artery

Correct Incorrect Correct answer

Internal Iliac Artery

Correct Incorrect Correct answer

Internal Pudendal Artery

Correct Incorrect Correct answer

Obturator artery

Correct Incorrect Correct answer

Ovarian Artery

Correct Incorrect Correct answer

Superior Gluteal Artery

Correct Incorrect Correct answer

Uterine Artery

Correct Incorrect Correct answer

Question 10 of 100

10. Question

You are asked to review a 70 year old patient on the Gynaecology Ward who had a vaginal hysterectomy two days ago with an estimated blood loss of 250ml. Her pre-operative haemoglobin was 109. The woman is complaining of feeling generally unwell and short of breath. There is no abdominal tenderness but there is reduced air entry at the right lung base. Her pulse is 120, her blood pressure is 80/50, her temperature is 39.5°C, her respiratory rate is 25 and her oxygen saturations are 94% on 10L of oxygen. What is the next most appropriate investigation?

Chest X-ray

Correct Incorrect Correct answer

CT Abdomen Pelvis

Correct Incorrect Correct answer

CT Pulmonary Angiogram

Correct Incorrect Correct answer

Repeat full blood count

Correct Incorrect Correct answer

Serum lactate

Correct Incorrect Correct answer

Question 11 of 100

11. Question

A 70 year old woman attends the pre-operative assessment clinic for a planned hysterectomy for a diagnosis of endometrial cancer.She is taking warfarin for atrial fibrillation following a stroke 2 months ago. What is the most appropriate pre-operative management for her anticoagulation?

Change to low-molecular weight heparin and omit dose on the day of surgery

Correct Incorrect Correct answer

Omit warfarin for five days before and after surgery

Correct Incorrect Correct answer

Omit warfarin for three days before surgery and check INR

Correct Incorrect Correct answer

Omit warfarin on the day of surgery and check INR

Correct Incorrect Correct answer

Postpone surgery until anticoagulation is no longer required

Correct Incorrect Correct answer

Question 12 of 100

12. Question

A 30 year old woman is referred from screening with a higher chance combined screening result at 12 weeks gestation. The nuchal translucency is 1.7mm with a combined screening result of 1 in 5 for Trisomy 21 and 1 in 140 for Trisomy 13/18. She opts to have NIPT as she wants to avoid any increased risk of miscarriage. The NIPT result is reported as ‘no result’. What is the next most appropriate investigation?

Amniocentesis

Correct Incorrect Correct answer

Chorionic villous sampling

Correct Incorrect Correct answer

Fetal anatomy and cardiac scan at 16 weeks

Correct Incorrect Correct answer

No further testing

Correct Incorrect Correct answer

Repeat non-invasive prenatal testing

Correct Incorrect Correct answer

Question 13 of 100

13. Question

A 22 year woman books for antenatal care at 8 weeks gestation. She and her partner are both sickle cell trait carriers and her booking bloods show HbsAG +ve, AntiHBc +ve, HBsAb -ve with viral load of 9log₁₀. She wishes to have prenatal diagnosis to ascertain the sickle cell status of her pregnancy. What is the most appropriate option?

Amniocentesis at 14+0

Correct Incorrect Correct answer

Amniocentesis at 15+0

Correct Incorrect Correct answer

Chorionic villous sampling at 9+6

Correct Incorrect Correct answer

Chorionic villous sampling at 10+6

Correct Incorrect Correct answer

Chorionic villous sampling at 11+6

Correct Incorrect Correct answer

Question 14 of 100

14. Question

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

Question 15 of 100

15. Question

A 35 year old woman has an uncomplicated spontaneous vaginal birth following induction of labour at 37 weeks for severe intrahepatic cholestasis of pregnancy. When should her liver function be rechecked postnatally?

1 week

Correct Incorrect Correct answer

2 weeks

Correct Incorrect Correct answer

4 weeks

Correct Incorrect Correct answer

6 weeks

Correct Incorrect Correct answer

8 weeks

Correct Incorrect Correct answer

Question 16 of 100

16. Question

A 22 year old woman attends a booking antenatal appointment with her community midwife at 8 weeks gestation. She tells her midwife that she thinks she may have been ‘circumcised’ as a child and on examination, there is evidence of Type 1 FGM. Which of the following countries has a very high prevalence of FGM?

Ghana

Correct Incorrect Correct answer

Kenya

Correct Incorrect Correct answer

Nigeria

Correct Incorrect Correct answer

Somalia

Correct Incorrect Correct answer

Uganda

Correct Incorrect Correct answer

Question 17 of 100

17. Question

For each of the following scenarios, select the most appropriate management option:

A 31 year old primiparous woman with an ultrasound indicated cervical cerclage due to previous LLETZ treatment presents with confirmed preterm prelabour rupture of membranes at 25+0 weeks gestation to her local district general hospital which has Level 2 neonatal facilities. Her blood results show a WCC of 6 and CRP of 5. Maternal observations show HR:80, BP 120/80, RR 14, T36.2, Sats 100% RA. There are no contractions and on speculum examination, the cervix appears closed with cerclage visible in situ.

Amniocentesis prior to rescue cervical cerclage

Correct Incorrect Correct answer

History indicated cervical cerclage

Correct Incorrect Correct answer

Laparoscopic abdominal cervical cerclage

Correct Incorrect Correct answer

Leave cerclage in situ then expectant management

Correct Incorrect Correct answer

Leave cerclage in situ and transfer to maternity unit with Level 3 neonatal facilities

Correct Incorrect Correct answer

Leave cerclage in situ then deliver by Caesarean section

Correct Incorrect Correct answer

Open abdominal cervical cerclage

Correct Incorrect Correct answer

Remove cerclage immediately then expectant management

Correct Incorrect Correct answer

Remove cerclage immediately and transfer to maternity unit with Level 3 neonatal facilities

Correct Incorrect Correct answer

Remove cerclage immediately then commence induction of labour

Correct Incorrect Correct answer

Remove cerclage immediately then deliver by Caesarean section

Correct Incorrect Correct answer

Rescue cervical cerclage

Correct Incorrect Correct answer

Ultrasound indicated cervical cerclage

Correct Incorrect Correct answer

Ultrasound surveillance of cervical length

Correct Incorrect Correct answer

Vaginal cervical cerclage

Correct Incorrect Correct answer

Question 18 of 100

18. Question

For each of the following ultrasound features, select the most appropriate diagnosis:

Absent cranial vault and cerebral hemispheres.

Anencephaly

Correct Incorrect Correct answer

Diaphragmatic hernia

Correct Incorrect Correct answer

Duodenal atresia

Correct Incorrect Correct answer

Encephalocele

Correct Incorrect Correct answer

Exomphalos

Correct Incorrect Correct answer

Gastroschisis

Correct Incorrect Correct answer

Holoprosencephaly

Correct Incorrect Correct answer

Hydranecephaly

Correct Incorrect Correct answer

Microcephaly

Correct Incorrect Correct answer

Oesophageal atresia

Correct Incorrect Correct answer

Ovarian cyst

Correct Incorrect Correct answer

Polycystic kidneys

Correct Incorrect Correct answer

Renal agenesis

Correct Incorrect Correct answer

Skeletal dysplasia

Correct Incorrect Correct answer

Spina bifida

Correct Incorrect Correct answer

Question 19 of 100

19. Question

For each of the following ultrasound features, select the most appropriate diagnosis:

A woman is referred from her dating scan with abnormal appearance of the fetal brain showing fusion of the cerebral hemispheres with a single ventricle.

Anencephaly

Correct Incorrect Correct answer

Diaphragmatic hernia

Correct Incorrect Correct answer

Duodenal atresia

Correct Incorrect Correct answer

Encephalocele

Correct Incorrect Correct answer

Exomphalos

Correct Incorrect Correct answer

Gastroschisis

Correct Incorrect Correct answer

Holoprosencephaly

Correct Incorrect Correct answer

Hydranecephaly

Correct Incorrect Correct answer

Microcephaly

Correct Incorrect Correct answer

Oesophageal atresia

Correct Incorrect Correct answer

Ovarian cyst

Correct Incorrect Correct answer

Polycystic kidneys

Correct Incorrect Correct answer

Renal agenesis

Correct Incorrect Correct answer

Skeletal dysplasia

Correct Incorrect Correct answer

Spina bifida

Correct Incorrect Correct answer

Question 20 of 100

20. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her second pregnancy. She has a history of gestational diabetes mellitus in her first pregnancy and a previous Caesarean section complicated by postpartum haemorrhage requiring multiple blood transfusions. She reports drinking up to 3L of water per day and has no other significant past medical history. Serum osmolality is 270 mOsmol/kg with serum sodium of 135, serum calcium of 2.4 mmol/L, random blood glucose of 4.8 and urine osmolality of 600 mOsmol/kg. What is the most likely diagnosis?

Gestational diabetes insipidus

Correct Incorrect Correct answer

Gestational diabetes mellitus

Correct Incorrect Correct answer

Nephrogenic diabetes insipidus

Correct Incorrect Correct answer

Neurogenic diabetes insipidus

Correct Incorrect Correct answer

Psychogenic diabetes insipidus

Correct Incorrect Correct answer

Question 21 of 100

21. Question

Which of the following anti-epileptic drugs are associated with an increased risk of haemorrhagic disease of the newborn?

Carbamazepine

Correct Incorrect Correct answer

Lamotrigine

Correct Incorrect Correct answer

Leviracetam

Correct Incorrect Correct answer

Valproate

Correct Incorrect Correct answer

Zonisamide

Correct Incorrect Correct answer

Question 22 of 100

22. Question

A 34 year old woman is seen for pre-pregnancy counselling in the maternal medicine clinic. She has a history of mitral valve prolapse with an ECHO that shows no other structural cardiac anomaly and LVEF >55%. What is her modified World Health Organization classification of maternal cardiovascular risk?

mWHO I

Correct Incorrect Correct answer

mWHO II

Correct Incorrect Correct answer

mWHO II-III

Correct Incorrect Correct answer

mWHO III

Correct Incorrect Correct answer

mWHO IV

Correct Incorrect Correct answer

Question 23 of 100

23. Question

A 28 year old woman is referred to the maternal medicine clinic at 14 weeks gestation in her first pregnancy with a history of ulcerative colitis. She currently opens her bowels once a day and has no rectal bleeding, urgency or frequency. Her weight is stable and she has not been on medication for the past two years. What is her risk of relapse in pregnancy?

10%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

40%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

Question 24 of 100

24. Question

A 30 year old woman with relapsing and remitting multiple sclerosis is referred to the maternal medicine pre-pregnancy counselling clinic. Which of the following obstetric complications are women with multiple sclerosis at increased risk of?

Congenital abnormalities

Correct Incorrect Correct answer

Fetal growth restriction

Correct Incorrect Correct answer

Miscarriage

Correct Incorrect Correct answer

Subfertility

Correct Incorrect Correct answer

Stillbirth

Correct Incorrect Correct answer

Question 25 of 100

25. Question

For each of the following scenarios, select the most appropriate diagnosis:

A 30 year old woman presents with headache at 22 weeks gestation in her first pregnancy. The headache is sudden onset, very severe and localized mainly to the occipital region.

Arteriovenous malformation

Correct Incorrect Correct answer

Caffeine withdrawal

Correct Incorrect Correct answer

Cerebral venous sinous thrombosis

Correct Incorrect Correct answer

Drug-related

Correct Incorrect Correct answer

Enlargement of pituitary tumour

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

Idiopathic intracranial hypertension

Correct Incorrect Correct answer

Migraine

Correct Incorrect Correct answer

Postdural puncture headache

Correct Incorrect Correct answer

Posterior reversible encephalopathy syndrome

Correct Incorrect Correct answer

Reversible cerebral vasoconstriction syndrome

Correct Incorrect Correct answer

Subarachnoid haemorrhage

Correct Incorrect Correct answer

Stroke

Correct Incorrect Correct answer

Tension headaches

Correct Incorrect Correct answer

Question 26 of 100

26. Question

For each of the following scenarios, select the most appropriate diagnosis:

A 38 year old woman develops itching with a new onset rash at 33 weeks gestation in her second pregnancy. On examination, there are widespread urticarial papules over the abdomen in a linear pattern matching the areas of excoriation.

Atopic eruption of pregnancy

Correct Incorrect Correct answer

Allergic contact dermatitis

Correct Incorrect Correct answer

Drug-induced pruritus

Correct Incorrect Correct answer

Demographic urticaria

Correct Incorrect Correct answer

Eczema

Correct Incorrect Correct answer

Intrahepatic cholestasis of pregnancy

Correct Incorrect Correct answer

Pemighoid gestationis

Correct Incorrect Correct answer

Polymorphic eruption of pregnancy

Correct Incorrect Correct answer

Psoriasis

Correct Incorrect Correct answer

Striae gravidarum

Correct Incorrect Correct answer

Telogen effluvium

Correct Incorrect Correct answer

Question 27 of 100

27. Question

For each of the following scenarios, select the most appropriate management:

A woman with known Type 1 Von Willebrand disease is booked for a planned Caesarean section for breech presentation at 39 weeks gestation. Her VWF activity level is 0.7 iu/ml.

Desmopressin

Correct Incorrect Correct answer

Fibrinogen concentrate

Correct Incorrect Correct answer

Fresh frozen plasma transfusion

Correct Incorrect Correct answer

Recombinant factor VII

Correct Incorrect Correct answer

Recombinant factor VIII

Correct Incorrect Correct answer

Recombinant factor IX

Correct Incorrect Correct answer

Recombinant factor XI

Correct Incorrect Correct answer

Recombinant factor XIII

Correct Incorrect Correct answer

Platelet transfusion

Correct Incorrect Correct answer

Packed red cell transfusion

Correct Incorrect Correct answer

Prothrombin complex concentrate

Correct Incorrect Correct answer

Tranexamic acid

Correct Incorrect Correct answer

Von Willebrand factor concentrate

Correct Incorrect Correct answer

Question 28 of 100

28. Question

For each of the following scenarios, select the most appropriate initial investigation:

A 29 year old woman is referred to maternal medicine clinic at 14 weeks gestation with severe refractory hypertension. Her booking BP was 200/110 and baseline blood tests show Hb 120, Plts 380, Na 132, K 3.2, Ur 4.1, Cr 68, ALT 19. Urine dipstick testing is normal.

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 renin level

Correct Incorrect Correct answer

Serum aldosterone-to-renin ratio

Correct Incorrect Correct answer

Serum plasma free metanephrines

Correct Incorrect Correct answer

Serum free androgen index

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

Question 29 of 100

29. Question

Answer Option	Risk of maternal cardiac event	Risk of fetus affected by congenital heart disease
A	2.5-5%	1%
B	2.5-5%	3%
C	2.5-5%	25%
D	2.5-5%	50%
E	5-10%	1%
F	5-10%	3%
G	5-10%	25%
H	5-10%	50%
I	10-20%	1%
J	10-20%	3%
K	10-20%	25%
L	10-20%	50%
M	20-30%	1%
N	20-30%	3%
O	20-30%	25%
P	20-30%	50%
Q	40-100%	1%
R	40-100%	3%
S	40-100%	25%
T	40-100%	50%

For each of the following scenarios, select the most appropriate risk profile:

A 24 year old woman is referred to pre-pregnancy counselling. She has a history of a large ventricular septal defect which was repaired as a child and she is otherwise fit and well. Her ECHO shows a LVEF of >55%.

A

Correct Incorrect Correct answer

B

Correct Incorrect Correct answer

C

Correct Incorrect Correct answer

D

Correct Incorrect Correct answer

E

Correct Incorrect Correct answer

F

Correct Incorrect Correct answer

G

Correct Incorrect Correct answer

H

Correct Incorrect Correct answer

I

Correct Incorrect Correct answer

J

Correct Incorrect Correct answer

K

Correct Incorrect Correct answer

L

Correct Incorrect Correct answer

M

Correct Incorrect Correct answer

N

Correct Incorrect Correct answer

O

Correct Incorrect Correct answer

P

Correct Incorrect Correct answer

Q

Correct Incorrect Correct answer

R

Correct Incorrect Correct answer

S

Correct Incorrect Correct answer

T

Correct Incorrect Correct answer

Question 30 of 100

30. Question

A multiparous woman had an induction of labour for dichorionic twins at 37 weeks gestation. The first twin was born cephalic by spontaneous vaginal delivery but the second twin was delivered by vaginal breech birth which was complicated by nuchal arms and required breech extraction. After birth, the second twin is noted to have weakness of the right arm, with the forearm extended and internally rotated. Grasp reflex is intact. What is the most likely diagnosis?

Clavicular fracture

Correct Incorrect Correct answer

Erb-Duchenne palsy

Correct Incorrect Correct answer

Fracture of the humerus

Correct Incorrect Correct answer

Klumpke’s palsy

Correct Incorrect Correct answer

Radial nerve injury

Correct Incorrect Correct answer

Question 31 of 100

31. Question

Which of the following interventions has the most evidence for reducing the risk of intraventricular haemorrhage (IVH) in preterm neonates?

Antenatal corticosteroids

Correct Incorrect Correct answer

Delayed cord clamping

Correct Incorrect Correct answer

High-frequency oscillatory ventilation

Correct Incorrect Correct answer

Magnesium sulphate for neuroprotection

Correct Incorrect Correct answer

Therapeutic hypothermia

Correct Incorrect Correct answer

Question 32 of 100

32. Question

What is the overall survival rate for infants born at 25 weeks gestation, according to the EPICURE 2 study?

20%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

40%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

60%

Correct Incorrect Correct answer

Question 33 of 100

33. Question

A primiparous woman presents in spontaneous labout at 27 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

Question 34 of 100

34. Question

For each of the following scenarios, select the most appropriate option for postpartum thromboprophylaxis. Each option may be used once, more than once or not at all.

A 36 year old multiparous woman has an induction of labour for dichorionic twin pregnancy at 38 weeks, having had two previous vaginal births. She has two spontaneous vaginal deliveries without regional anaesthesia and the estimated blood loss after birth is 500ml. She is a smoker and has a BMI of 28. She is prescribed low molecular weight heparin (LMWH) for 6 weeks postnatally. When should the first dose of LMWH be given?

After 4 hours

Correct Incorrect Correct answer

After 12 hours

Correct Incorrect Correct answer

After 24 hours

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

As soon as possible

Correct Incorrect Correct answer

Early mobilization and avoidance of dehydration

Correct Incorrect Correct answer

Not required

Correct Incorrect Correct answer

Warfarin with bridging dalteparin until INR therapeutic

Correct Incorrect Correct answer

Warfarin

Correct Incorrect Correct answer

2500 units dalteparin for 10 days

Correct Incorrect Correct answer

2500 units dalteparin for 6 weeks

Correct Incorrect Correct answer

5000 units dalteparin for 10 days

Correct Incorrect Correct answer

5000 units dalteparin for 6 weeks

Correct Incorrect Correct answer

60mg of enoxaparin for 10 days

Correct Incorrect Correct answer

60mg of enoxaparin for 6 weeks

Correct Incorrect Correct answer

9000 units tinzaparin for 10 days

Correct Incorrect Correct answer

9000 units tinzaparin for 6 weeks

Correct Incorrect Correct answer

Question 35 of 100

35. Question

For each clinical scenario described below, choose the most likely causative organism:

A woman presents on Day 4 postpartum feeling unwell with a productive cough. She had an emergency Caesarean section under general anaesthetic for placental abruption at 35 weeks gestation. Her booking BMI was 43 and she was known to have gestational diabetes which required treatment with insulin during the pregnancy. On examination, crepitations are auscultated at the right lung base. She has a normal blood pressure and temperature of 38.8°C, a respiratory rate of 24 breaths per minute and a pulse rate of 95 beats per minute.

Clostridium difficile

Correct Incorrect Correct answer

Clostridium perfringens

Correct Incorrect Correct answer

Clostridium sordellii

Correct Incorrect Correct answer

Clostridium septicum

Correct Incorrect Correct answer

Escherichia coli

Correct Incorrect Correct answer

Group A Streptococcus

Correct Incorrect Correct answer

Group B Streptococcus

Correct Incorrect Correct answer

Klebsiella pneumoniae

Correct Incorrect Correct answer

Methicillin-resistant Staphylococcus aureus (MRSA)

Correct Incorrect Correct answer

Morganella morganii

Correct Incorrect Correct answer

Neisseria gonorrhoeae

Correct Incorrect Correct answer

Proteus mirabilis

Correct Incorrect Correct answer

Pseudomonas aeruginosa

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Streptococcus pneumoniae

Correct Incorrect Correct answer

Question 36 of 100

36. Question

For each of the following scenarios, select the most appropriate option for postpartum thromboprophylaxis. Each option may be used once, more than once or not at all.

A 35 year old woman with known triple positive antiphospholipid syndrome has an intrauterine fetal death of a severely growth restricted baby at 24 weeks gestation complicated by severe pre-eclampsia. She has previously had multiple pulmonary emboli and a central venous sinus thrombosis. She has an induction of labour and a vaginal delivery.

After 4 hours

Correct Incorrect Correct answer

After 12 hours

Correct Incorrect Correct answer

After 24 hours

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

As soon as possible

Correct Incorrect Correct answer

Early mobilization and avoidance of dehydration

Correct Incorrect Correct answer

Not required

Correct Incorrect Correct answer

Warfarin with bridging dalteparin until INR therapeutic

Correct Incorrect Correct answer

Warfarin

Correct Incorrect Correct answer

2500 units dalteparin for 10 days

Correct Incorrect Correct answer

2500 units dalteparin for 6 weeks

Correct Incorrect Correct answer

5000 units dalteparin for 10 days

Correct Incorrect Correct answer

5000 units dalteparin for 6 weeks

Correct Incorrect Correct answer

60mg of enoxaparin for 10 days

Correct Incorrect Correct answer

60mg of enoxaparin for 6 weeks

Correct Incorrect Correct answer

9000 units tinzaparin for 10 days

Correct Incorrect Correct answer

9000 units tinzaparin for 6 weeks

Correct Incorrect Correct answer

Question 37 of 100

37. Question

For each clinical scenario described below, choose the single most appropriate treatment:

A 32-year-old primigravida presents 10 days postpartum with a painful, swollen left breast. She reports fever and malaise for 4 days and has been on oral flucloxacillin for 48 hours without improvement. On examination, the left breast is erythematous, warm, and tender and she has pyrexia of 38.9C with maternal heart rate of 110bpm.

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

Phenoxymethylpenicillin

Correct Incorrect Correct answer

Piperacillin-tazobactam

Correct Incorrect Correct answer

Teicoplanin

Correct Incorrect Correct answer

Vancomycin

Correct Incorrect Correct answer

No antibiotics required

Correct Incorrect Correct answer

Surgical debridement

Correct Incorrect Correct answer

Suction evacuation of uterus

Correct Incorrect Correct answer

Question 38 of 100

38. Question

A 21 year old woman presents as she is concerned that her periods are abnormally long. She reports that she bleeds for 12-14 days and that her cycle occurs every 35 days. What is the normal average duration of menstruation?

1 to 2 days

Correct Incorrect Correct answer

2 to 4 days

Correct Incorrect Correct answer

4 to 8 days

Correct Incorrect Correct answer

8 to 10 days

Correct Incorrect Correct answer

Up to 14 days

Correct Incorrect Correct answer

Question 39 of 100

39. Question

A 43 year old woman presents with increasingly heavy periods.She has tried tranexamic acid without any obvious benefit and she is requesting to have her Mirena removed due to persistent spotting. Her family is complete and she is extremely fed up with her symptoms and asks for definitive treatment. What is the most appropriate treatment?

Change of Mirena LNG-IUS

Correct Incorrect Correct answer

Dilatation and curettage

Correct Incorrect Correct answer

Endometrial ablation

Correct Incorrect Correct answer

Hysterectomy

Correct Incorrect Correct answer

Injectable long acting progestogens

Correct Incorrect Correct answer

Question 40 of 100

40. Question

A 27 year old presents with a painful left vulval swelling for the past two days. On examination, there is an erythematous fluctuant vulval lump at the left introitus, measuring approximately 3cm in diameter. Her GP refers her as an emergency to gynaecology and she has an incision and drainage with marsupialisation. She represents on three occasions subsequently with recurrence of her symptoms. What is the next appropriate management?

Admit to hospital and commence intravenous antibiotics

Correct Incorrect Correct answer

Advise conservative management

Correct Incorrect Correct answer

Commence oral antibiotics

Correct Incorrect Correct answer

Outpatient incision and drainage

Correct Incorrect Correct answer

Routine referral to gynaecology

Correct Incorrect Correct answer

Question 41 of 100

41. Question

A 71 year old woman is being investigated for a recent change in bowel habit and undergoes a CT Colon with contrast. The CT is reported as showing no obvious bowel pathology but comments that there is 8mm homogenous endometrium. The patient reports that she has not had any post-menopausal bleeding and is otherwise asymptomatic. What is the next appropriate management?

Endometrial biopsy

Correct Incorrect Correct answer

Reassure patient

Correct Incorrect Correct answer

Routine referral to gynaecologist

Correct Incorrect Correct answer

Transvaginal pelvic ultrasound

Correct Incorrect Correct answer

Urgent “2-week-wait” referral to gynaecologist

Correct Incorrect Correct answer

Question 42 of 100

42. Question

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

A 6-year-old girl presents with vaginal bleeding and breast development (Tanner stage III). Examination reveals no pubic hair development. Pelvic ultrasound shows a unilateral ovarian mass. Oestradiol levels are elevated, and gonadotropins are suppressed.

Adrenal tumour

Correct Incorrect Correct answer

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Familial precious puberty

Correct Incorrect Correct answer

Functional ovarian cyst

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

Hypothalamic hamartoma

Correct Incorrect Correct answer

Idiopathic precocious puberty

Correct Incorrect Correct answer

Leydig cell tumour

Correct Incorrect Correct answer

McCune-Albright syndrome

Correct Incorrect Correct answer

Neurofibromatosis Type 1

Correct Incorrect Correct answer

Ovarian granulosa cell tumour

Correct Incorrect Correct answer

Premature adrenarche

Correct Incorrect Correct answer

Premature menarche

Correct Incorrect Correct answer

Premature thelarche

Correct Incorrect Correct answer

Question 43 of 100

43. Question

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 60 year old woman presents with vulvovaginal irritation and pain on urination. She underwent menopause four years ago and her symptoms have worsened since then and are significantly affecting her quality of life. She does not have significant vasomotor symptoms or mood disturbance. Her BMI is 31 kg/m² and she has a medical history of hypertension for which she takes amlodipine. She has tried vaginal oestrogen treatment without significant benefit.

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

Question 44 of 100

44. Question

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

A 46-year-old woman presents with irregular heavy menstrual bleeding and perimenopausal symptoms of hot flushes and night sweats. 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. She is Para 2, having had two previous Caesarean sections and her family is complete. She is treated with a Levonorgestrel Intrauterine System and repeat endometrial biopsy at 6 and 12 months shows persistent hyperplasia without atypia.

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

Total abdominal hysterectomy

Correct Incorrect Correct answer

Total laparoscopic 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

Subtotal hysterectomy

Correct Incorrect Correct answer

Question 45 of 100

45. Question

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

A 17-year-old girl presents with primary amenorrhoea. She has normal breast development (Tanner stage V) and pubic hair (Tanner stage IV). Physical examination reveals a short blind ending vagina. Ultrasound confirms the absence of the uterus and normal ovaries.

Androgen Insensitivity Syndrome

Correct Incorrect Correct answer

Anorexia nervosa

Correct Incorrect Correct answer

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Fragile X Syndrome

Correct Incorrect Correct answer

Functional hypothalamic amenorrhoea

Correct Incorrect Correct answer

Hyperprolactinaemia

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

Kallmann Syndrome

Correct Incorrect Correct answer

Mayer-Rokitansky-Kuster-Hauser Syndrome

Correct Incorrect Correct answer

Polycystic Ovarian Syndrome (PCOS)

Correct Incorrect Correct answer

Prolactinoma

Correct Incorrect Correct answer

Swyer Syndrome

Correct Incorrect Correct answer

Turner Syndrome

Correct Incorrect Correct answer

Turner Mosaic

Correct Incorrect Correct answer

Question 46 of 100

46. Question

A 25 year old woman presents as she and her partner have being trying to conceive for two years without success. What is the incidence of male factor subfertility?

10%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

Question 47 of 100

47. Question

A 31 year old woman attends fertility clinic with her partner. They have been trying to conceive for two years without success and have no children and have never had a pregnancy. Her investigations have not shown any abnormality and the partner’s semen analysis is as follows:

Parameter	Value
Semen Volume (ml)	1.8
pH	7.35
Total Sperm number (10⁶per ejaculate)	0.2
Sperm Concentration (10⁶per ml)	0.1
Total motility (PR+NP [%])	3
Sperm morphology (normal forms [%])	0.2

What is the most appropriate next management?

Observation and lifestyle changes

Correct Incorrect Correct answer

Repeat semen analysis as soon as possible

Correct Incorrect Correct answer

Repeat semen analysis at 3 months

Correct Incorrect Correct answer

Refer for IVF with donor sperm

Correct Incorrect Correct answer

Refer for IVF with ICSI

Correct Incorrect Correct answer

Question 48 of 100

48. Question

A 25 year old woman presents as she and her partner have being trying to conceive for two years without success. What is the incidence of ovulation disorder subfertility?

10%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

30%

Correct Incorrect Correct answer

Question 49 of 100

49. Question

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

A 30 year old man is seen in fertility clinic with primary infertility of two years duration. His partner is a 28 year old woman who has a four year old child with a previous partner and all female fertility investigations have been normal. His semen analysis is as follows:

Parameter Value

Semen Volume (ml) 4.5

Total Sperm number (10⁶per ejaculate) 6

Sperm Concentration (10⁶per ml) 5

Total motility (PR+NP [%]) 14

Sperm morphology (normal forms [%]) 5

His hormone profile shows normal FSH and LH levels, normal testosterone and normal prolactin levels.

Bromocriptine

Correct Incorrect Correct answer

Donor sperm insemination

Correct Incorrect Correct answer

Gonadotrophin treatment

Correct Incorrect Correct answer

Gonadotrophin Releasing Hormone (GnRH) agonist

Correct Incorrect Correct answer

Gonadotrophin Releasing Hormone (GnRH) antagonist

Correct Incorrect Correct answer

In vitro fertilisation (IVF)

Correct Incorrect Correct answer

In vitro fertilisation with intracytoplasmic sperm injection (IVF-ICSI)

Correct Incorrect Correct answer

Intrauterine insemination (IUI)

Correct Incorrect Correct answer

Microsurgical testicular sperm extraction (micro-TESE)

Correct Incorrect Correct answer

No treatment

Correct Incorrect Correct answer

Percutaneous epididymal sperm aspiration

Correct Incorrect Correct answer

Testicular sperm aspiration (TESA)

Correct Incorrect Correct answer

Testicular sperm extraction (TESE)

Correct Incorrect Correct answer

Varicocele repair

Correct Incorrect Correct answer

Vasectomy reversal

Correct Incorrect Correct answer

Question 50 of 100

50. Question

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

A 28-year-old woman with polycystic ovary syndrome (PCOS) is planned for her first cycle of IVF. Her AMH is 40 pmol/L, and baseline ultrasound reveals 25 antral follicles per ovary.

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 antagonist protocol

Correct Incorrect Correct answer

GnRH agonist trigger

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

Question 51 of 100

51. Question

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

A 22 year old nulliparous woman is seen in gynaecology clinic following recent surgery six months ago for Stage III endometriosis. Her symptoms of pelvic pain have greatly improved and she and her partner wish to start a family. She has been trying to conceive for four months and is anxious that she may need assisted conception due to her diagnosis of endometriosis. Pelvic ultrasound shows normal appearance of the uterus and ovaries and HSG confirms patent Fallopian tubes. She has regular periods every 28 days and mid-luteal progesterone confirms ovulation. FSH and LH levels are normal and her AMH level is 14.3 ng/mL. Her partner’s semen analysis is within normal limits.

Bilateral salpingectomy

Correct Incorrect Correct answer

Bilateral salpingectomy with in vitro fertilisation

Correct Incorrect Correct answer

Excision/ablation of endometriosis

Correct Incorrect Correct answer

Expectant management

Correct Incorrect Correct answer

GnRH agonist therapy

Correct Incorrect Correct answer

GnRH antagonist therapy

Correct Incorrect Correct answer

Intrauterine insemination (IUI)

Correct Incorrect Correct answer

Intracytoplasmic sperm injection (ICSI)

Correct Incorrect Correct answer

In vitro fertilisation (IVF)

Correct Incorrect Correct answer

In vitro fertilisation (IVF) with donor eggs

Correct Incorrect Correct answer

In vitro fertilisation (IVF) with donor sperm

Correct Incorrect Correct answer

Laparoscopic ovarian drilling

Correct Incorrect Correct answer

Ovarian cystectomy

Correct Incorrect Correct answer

Ovulation induction with letrozole

Correct Incorrect Correct answer

Ovulation induction with clomifene citrate

Correct Incorrect Correct answer

Salpingostomy

Correct Incorrect Correct answer

Unilateral salpingectomy

Correct Incorrect Correct answer

Unilateral salpingectomy with in vitro fertilisation

Correct Incorrect Correct answer

Question 52 of 100

52. Question

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

Question 53 of 100

53. Question

Which of the following statements regarding use of the progestogen-only pill (POP) is incorrect?

The POP can be safely used in breastfeeding women

Correct Incorrect Correct answer

The POP is a less effective contraceptive than the combined oral contraceptive pill

Correct Incorrect Correct answer

The POP is not as effective at preventing pregnancies as long acting reversible contraceptives

Correct Incorrect Correct answer

With perfect use, the failure rate of the POP is less than 1%

Correct Incorrect Correct answer

With typical use, the failure rate of the COCP is 8%

Correct Incorrect Correct answer

Question 54 of 100

54. Question

A 34 year old woman attends gynaecology clinic with persistent break through bleeding midcycle having started Depo-Provera for contraception 6 months ago. What is the most appropriate management?

Cervical smear test and triple swabs

Correct Incorrect Correct answer

Change to the progesterone only implant as an alternative contraceptive method

Correct Incorrect Correct answer

Pelvic ultrasound

Correct Incorrect Correct answer

Start the combined oral contraceptive pill for breakthrough bleeding

Correct Incorrect Correct answer

Start mefenamic acid for breakthrough bleeding

Correct Incorrect Correct answer

Question 55 of 100

55. Question

A 45 year old woman attends for a routine change of her copper intra-uterine device (Cu-IUD). The Cu-IUD is successfully inserted without complications. When should it be changed next?

1 year

Correct Incorrect Correct answer

3 years

Correct Incorrect Correct answer

5 years

Correct Incorrect Correct answer

10 years

Correct Incorrect Correct answer

Remove when contraception is no longer required

Correct Incorrect Correct answer

Question 56 of 100

56. Question

Which of the following statements about vasectomy is incorrect?

Both vasectomy and tubal occlusion should be discussed with all men and women requesting sterilisation

Correct Incorrect Correct answer

Non-motile sperm persist in up to 2.5% of men after vasectomy

Correct Incorrect Correct answer

There is less risk associated with vasectomy than female sterilisation carried out by laparoscopy or laparotomy

Correct Incorrect Correct answer

Vasectomy is not immediately effective but can be easily reversed

Correct Incorrect Correct answer

Vasectomy has a lower failure rate than sterilization at 1 in 2000

Correct Incorrect Correct answer

Question 57 of 100

57. Question

For each of the following scenarios, select the most appropriate management:

A 24 year old attends her local sexual health clinic requesting termination of an unplanned pregnancy at 6 weeks gestation. She has a history of severe asthma requiring multiple intensive care admissions with poorly controlled symptoms on montelukast

Concurrent oral mifepristone 200mg with 800mcg misoprostol

Correct Incorrect Correct answer

Concurrent oral mifepristone 200mg with 400mcg misoprostol

Correct Incorrect Correct answer

Fetocide with potassium chloride, concurrent oral mifepristone 200mg with 800mcg misoprostol

Correct Incorrect Correct answer

Fetocide with potassium chloride, concurrent oral mifepristone 200mg with 400mcg misoprostol

Correct Incorrect Correct answer

Fetocide with potassium chloride, oral mifepristone 200mg with 800mcg misoprostol after 24-48 hours

Correct Incorrect Correct answer

Fetocide with potassium chloride, oral mifepristone 200mg with 400mcg misoprostol after 24-48 hours

Correct Incorrect Correct answer

Hysterectomy

Correct Incorrect Correct answer

Hysterotomy

Correct Incorrect Correct answer

Misoprostol 400mcg

Correct Incorrect Correct answer

Misoprostol 800mcg

Correct Incorrect Correct answer

Oral mifepristone 200mg

Correct Incorrect Correct answer

Oral mifepristone 200mg then 400mcg misoprostol after 24-48 hours

Correct Incorrect Correct answer

Oral mifepristone 200mg then 800mcg misoprostol after 24-48 hours

Correct Incorrect Correct answer

Oxytocin infusion

Correct Incorrect Correct answer

Surgical abortion by vacuum aspiration

Correct Incorrect Correct answer

Surgical abortion by dilation and evacuation

Correct Incorrect Correct answer

Question 58 of 100

58. Question

For each of the following complications, select the most appropriate estimate of risk:

Severe bleeding requiring blood transfusion after medical abortion at 22 weeks gestation

1 in 10

Correct Incorrect Correct answer

1 in 20

Correct Incorrect Correct answer

1 in 50

Correct Incorrect Correct answer

1 in 100

Correct Incorrect Correct answer

Less than 1 in 100

Correct Incorrect Correct answer

Higher than 1 in 100

Correct Incorrect Correct answer

1 in 250

Correct Incorrect Correct answer

1 in 1000

Correct Incorrect Correct answer

Less than 1 in 1000

Correct Incorrect Correct answer

Higher than 1 in 1000

Correct Incorrect Correct answer

1 in 10000

Correct Incorrect Correct answer

Less than 1 in 10000

Correct Incorrect Correct answer

Higher than 1 in 10000

Correct Incorrect Correct answer

Question 59 of 100

59. Question

For each of the following scenarios, select the most appropriate diagnostic test:

A 20 year old woman presents to her local sexual health clinic with symptoms of vulval itching, superficial dyspareunia and vaginal discharge. On examination, there is vulval erythema with excoriations and thick white curd-like vaginal discharge. She has experienced these symptoms before and been treated on a number of occasions.

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

Question 60 of 100

60. Question

For each of the following scenarios, select the likely causative organism:

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 malodorous grey vaginal discharge but the cervix appears normal.

Candida albicans

Correct Incorrect Correct answer

Chlamydia trachomatis

Correct Incorrect Correct answer

Gardnerella vaginalis

Correct Incorrect Correct answer

Haemophilus ducreyi

Correct Incorrect Correct answer

Herpes simplex virus 1

Correct Incorrect Correct answer

Herpes simplex virus 2

Correct Incorrect Correct answer

Human papillomavirus Type 1

Correct Incorrect Correct answer

Human papillomavirus Type 11

Correct Incorrect Correct answer

Human papillomavirus Type 16

Correct Incorrect Correct answer

Klebsiella granulomatis

Correct Incorrect Correct answer

Molluscum contagiosum virus

Correct Incorrect Correct answer

Mycoplasma genitalium

Correct Incorrect Correct answer

Neisseria gonorrhoea

Correct Incorrect Correct answer

Treponema pallidum

Correct Incorrect Correct answer

Trichomonas vaginalis

Correct Incorrect Correct answer

Ureaplasma urealyticum

Correct Incorrect Correct answer

Question 61 of 100

61. Question

For each of the following scenarios, select the most appropriate antibiotic treatment:

A 20 year old attends her local sexual health clinic requesting termination of an unplanned pregnancy at 6 weeks gestation. She opts to have a surgical abortion by manual vaccum aspiration.

Intravenous ceftriaxone 2g OD

Correct Incorrect Correct answer

Intravenous ceftriaxone 2g OD and intravenous metronidazole 500mg TDS

Correct Incorrect Correct answer

Intravenous ceftriaxone, metronidazole 500mg TDS and gentamicin 3mg/kg

Correct Incorrect Correct answer

Intravenous doxycycline 100mg BD

Correct Incorrect Correct answer

Intravenous doxycycline 100mg BD and oral metronidazole 400mg TDS

Correct Incorrect Correct answer

Intravenous doxycycline 100mg BD and intravenous metronidazole 500mg TDS

Correct Incorrect Correct answer

Intravenous doxycycline 100mg BD, intravenous metronidazole 500mg TDS and gentamicin 3mg/kg

Correct Incorrect Correct answer

Oral doxycycline 100mg BD

Correct Incorrect Correct answer

Oral doxycycline 100mg BD and oral metronidazole 400mg TDS

Correct Incorrect Correct answer

Oral doxycycline 100mg BD and intravenous metronidazole 500mg TDS

Correct Incorrect Correct answer

Oral doxycycline 100mg BD, intravenous metronidazole 500mg TDS and gentamicin 3mg/kg

Correct Incorrect Correct answer

Oral metronidazole 400mg TDS

Correct Incorrect Correct answer

Oral mifepristone 200mg then 800mcg misoprostol after 24-48 hours

Correct Incorrect Correct answer

Oxytocin infusion

Correct Incorrect Correct answer

Surgical abortion by vacuum aspiration

Correct Incorrect Correct answer

Surgical abortion by dilation and evacuation

Correct Incorrect Correct answer

Question 62 of 100

62. Question

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain, vomiting and loose stools. She is usually fit and well but is known to have uterine fibroids. Her last menstrual period was 8 weeks ago. On examination, her abdomen is soft but she has a bulky enlarged uterus of approximately 14 week size with palpable fibroids. Her urinary pregnancy test is positive and her GP refers her urgently to the local Early Pregnancy Unit. What is the next most appropriate investigation?

Serum bHCG

Correct Incorrect Correct answer

Serum progesterone

Correct Incorrect Correct answer

Transabdominal ultrasound scan of pelvis

Correct Incorrect Correct answer

Transvaginal ultrasound of pelvis

Correct Incorrect Correct answer

Urine dip

Correct Incorrect Correct answer

Question 63 of 100

63. Question

Which of the following inherited thrombophilias have not been shown to have an association with recurrent miscarriage?

Factor V Leiden

Correct Incorrect Correct answer

Methylentatrahydrofolate reductase (MTHFR) mutation

Correct Incorrect Correct answer

Prothrombin gene mutation

Correct Incorrect Correct answer

Protein C deficiency

Correct Incorrect Correct answer

Protein S deficiency

Correct Incorrect Correct answer

Question 64 of 100

64. Question

Which of the following factors is associated with an increased risk of recurrence of Caesarean scar pregnancy after treatment?

Irregular vaginal bleeding outside of pregnancy

Correct Incorrect Correct answer

Multiple previous Caesarean sections

Correct Incorrect Correct answer

Previous classical Caesarean section

Correct Incorrect Correct answer

Uterine artery embolization for previous Caesarean scar pregnancy

Correct Incorrect Correct answer

Uterine segment thickness measuring less than 5mm

Correct Incorrect Correct answer

Question 65 of 100

65. Question

A 31 year old woman presents with vaginal bleeding and lower abdominal pain in her first pregnancy. She is approximately 8 weeks pregnant by last menstrual period. Transvaginal ultrasound scan of her pelvis shows a gestational sac measuring 26x28x28mm with fetal pole with CRL of 11mm and fetal cardiac activity present. Both ovaries appear morphologically normal with a corpus luteum being seen on the right ovary. What is the most appropriate next management?

Perform a second scan a minimum of 7 days after the first scan

Correct Incorrect Correct answer

Perform a second scan a minimum of 14 days after the first scan

Correct Incorrect Correct answer

Reassure and discharge for routine antenatal care if bleeding stops

Correct Incorrect Correct answer

Start vaginal micronised progesterone 400 mg twice daily until 12 weeks of gestation

Correct Incorrect Correct answer

Start vaginal micronised progesterone 400 mg twice daily until 16 weeks of gestation

Correct Incorrect Correct answer

Question 66 of 100

66. Question

For each 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 28-year-old woman presents with a positive urine pregnancy test and mild vaginal spotting. Transvaginal ultrasound shows no evidence of intrauterine or ectopic pregnancy. Her serum β-hCG level is 700 IU/L. She is haemodynamically stable with no significant pain.

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

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

Correct Incorrect Correct answer

Transvaginal ultrasound scan

Correct Incorrect Correct answer

Urine pregnancy test in two weeks

Correct Incorrect Correct answer

Tubal ectopic pregnancy

Correct Incorrect Correct answer

Question 67 of 100

67. Question

For each 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 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage. This is an IVF donor egg pregnancy and she is currently 7 weeks pregnant based following the transfer of two blastocysts. Transvaginal scan shows an anteverted uterus with a closed cervix. A gestational sac is seen within the uterine cavity, medial to the interstitial portion of the fallopian tubes measuring 28 x 21 x 29mm. Within the gestational sac is a yolk sac and a fetal pole with a CRL measuring 6 mm with fetal cardiac activity seen. Both ovaries appear morphologically normal. Adjacent to the right ovary is an echogenic ring measuring 18x24x19 mm. There is moderate free fluid in the pouch of Douglas. Maternal observations show a maternal tachycardia of 120bpm.

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

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

Urine pregnancy test in two weeks

Correct Incorrect Correct answer

Tubal ectopic pregnancy

Correct Incorrect Correct answer

Question 68 of 100

68. Question

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

An 28 year old nulliparous woman presents with severe lower abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks ago and she has a positive urinary pregnancy test. She has a history of severe endometriosis for which she has had three previous laparoscopies requiring excision and adhesiolysis. Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity. The right ovary could not be visualised but the left adnexa shows a complex left adnexal mass with mixed echogenicity arising from the left ovary which is tender during scanning. There is a large amount of free fluid in the Pouch of Douglas.

Abdominal pregnancy

Correct Incorrect Correct answer

Anembryonic pregnancy

Correct Incorrect Correct answer

Caesarean scar pregnancy

Correct Incorrect Correct answer

Cervical pregnancy

Correct Incorrect Correct answer

Complete hydatidiform mole

Correct Incorrect Correct answer

Cornual pregnancy

Correct Incorrect Correct answer

Heterotopic pregnancy

Correct Incorrect Correct answer

Incomplete miscarriage

Correct Incorrect Correct answer

Inevitable miscarriage

Correct Incorrect Correct answer

Interstitial pregnancy

Correct Incorrect Correct answer

Intrauterine pregnancy

Correct Incorrect Correct answer

Missed miscarriage

Correct Incorrect Correct answer

Ovarian ectopic pregnancy

Correct Incorrect Correct answer

Partial hydatidiform mole

Correct Incorrect Correct answer

Pregnancy of unknown location

Correct Incorrect Correct answer

Tubal ectopic pregnancy

Correct Incorrect Correct answer

Question 69 of 100

69. Question

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

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage. She is Para 2 having had two previous emergency Caesarean sections at full dilation. She is currently approximately 7 weeks pregnant based on her last menstrual period and is asymptomatic. Transvaginal scan shows an anteverted uterus with empty cavity and a closed cervix. A gestational sac is seen anteriorly at the level of the internal cervical os and there is prominent blood flow seen on Colour Doppler around the gestational sac. There is a very thin layer of myometrium between the gestational sac and bladder.

Abdominal pregnancy

Correct Incorrect Correct answer

Anembryonic pregnancy

Correct Incorrect Correct answer

Caesarean scar pregnancy

Correct Incorrect Correct answer

Cervical pregnancy

Correct Incorrect Correct answer

Complete hydatidiform mole

Correct Incorrect Correct answer

Cornual pregnancy

Correct Incorrect Correct answer

Heterotopic pregnancy

Correct Incorrect Correct answer

Incomplete miscarriage

Correct Incorrect Correct answer

Inevitable miscarriage

Correct Incorrect Correct answer

Interstitial pregnancy

Correct Incorrect Correct answer

Intrauterine pregnancy

Correct Incorrect Correct answer

Missed miscarriage

Correct Incorrect Correct answer

Ovarian ectopic pregnancy

Correct Incorrect Correct answer

Partial hydatidiform mole

Correct Incorrect Correct answer

Pregnancy of unknown location

Correct Incorrect Correct answer

Tubal ectopic pregnancy

Correct Incorrect Correct answer

Question 70 of 100

70. Question

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a two-week wait referral for transvaginal pelvic ultrasound and Gynaecology review. What endometrial thickness cut-off should be used for further investigation?

3mm

Correct Incorrect Correct answer

4mm

Correct Incorrect Correct answer

5mm

Correct Incorrect Correct answer

6mm

Correct Incorrect Correct answer

7mm

Correct Incorrect Correct answer

Question 71 of 100

71. Question

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating. Abdominal and pelvic examination is unremarkable. What is the most appropriate next investigation?

CA-125

Correct Incorrect Correct answer

Full blood count

Correct Incorrect Correct answer

Hormone profile, including FSH and LH

Correct Incorrect Correct answer

Thyroid function tests

Correct Incorrect Correct answer

Urea and electrolytes

Correct Incorrect Correct answer

Question 72 of 100

72. Question

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Type 2 endometrial cancer and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

Avoid HRT

Correct Incorrect Correct answer

Continuous combined HRT

Correct Incorrect Correct answer

Estrogen only HRT

Correct Incorrect Correct answer

Topical vaginal oestrogen

Correct Incorrect Correct answer

Use HRT cautiously

Correct Incorrect Correct answer

Question 73 of 100

73. Question

What is the inheritance pattern for BRCA1 and BRCA2 germline mutations?

Sporadic

Correct Incorrect Correct answer

Autosomal dominant

Correct Incorrect Correct answer

Autosomal recessive

Correct Incorrect Correct answer

X-linked

Correct Incorrect Correct answer

Variable penetrance

Correct Incorrect Correct answer

Question 74 of 100

74. Question

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

A 70-year-old woman is diagnosed with endometrial cancer invading the serosa of the uterus. There is no evidence of nodal or distant metastases.

Preinvasive disease

Correct Incorrect Correct answer

Stage IA1

Correct Incorrect Correct answer

Stage IA2

Correct Incorrect Correct answer

Stage IA3

Correct Incorrect Correct answer

Stage IB

Correct Incorrect Correct answer

Stage IC

Correct Incorrect Correct answer

Stage IIA

Correct Incorrect Correct answer

Stage IIB

Correct Incorrect Correct answer

Stage IIIA

Correct Incorrect Correct answer

Stage IIIB1

Correct Incorrect Correct answer

Stage IIIB2

Correct Incorrect Correct answer

Stage IIIC1

Correct Incorrect Correct answer

Stage IIIC1i

Correct Incorrect Correct answer

Stage IIIC1ii

Correct Incorrect Correct answer

Stage IIIC2

Correct Incorrect Correct answer

Stage IIIC2i

Correct Incorrect Correct answer

Stage IIIC2ii

Correct Incorrect Correct answer

Stage IVA

Correct Incorrect Correct answer

Stage IVB

Correct Incorrect Correct answer

Stage IVC

Correct Incorrect Correct answer

Question 75 of 100

75. Question

What is the lifetime risk of breast cancer with BRCA2 mutation?

5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

45%

Correct Incorrect Correct answer

55%

Correct Incorrect Correct answer

60%

Correct Incorrect Correct answer

65%

Correct Incorrect Correct answer

Question 76 of 100

76. Question

For each of the following conditions, select the most appropriate underlying genetic mutation:

Muir-Torre Syndrome

BRCA1

Correct Incorrect Correct answer

BRCA2

Correct Incorrect Correct answer

BRIP1

Correct Incorrect Correct answer

MLH1

Correct Incorrect Correct answer

MLH2

Correct Incorrect Correct answer

MSH2

Correct Incorrect Correct answer

PTEN

Correct Incorrect Correct answer

RAD51C

Correct Incorrect Correct answer

STK11

Correct Incorrect Correct answer

SMARCA4

Correct Incorrect Correct answer

Question 77 of 100

77. Question

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

A 48-year-old woman presents with a vulval lesion confirmed as high-grade vulval intraepithelial neoplasia (VIN III) without stromal invasion on histology.

Preinvasive disease

Correct Incorrect Correct answer

Stage IA

Correct Incorrect Correct answer

Stage IB

Correct Incorrect Correct answer

Stage II

Correct Incorrect Correct answer

Stage IIIA

Correct Incorrect Correct answer

Stage IIIB

Correct Incorrect Correct answer

Stage IIIC

Correct Incorrect Correct answer

Stage IVA

Correct Incorrect Correct answer

Stage IVB

Correct Incorrect Correct answer

Question 78 of 100

78. Question

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

A 60-year-old woman has a 4cm cervical tumour invading the upper two-thirds of the vagina. Imaging shows no parametrial involvement or distant metastases.

Preinvasive disease

Correct Incorrect Correct answer

Stage IA1

Correct Incorrect Correct answer

Stage IA2

Correct Incorrect Correct answer

Stage IB1

Correct Incorrect Correct answer

Stage IB2

Correct Incorrect Correct answer

Stage IB3

Correct Incorrect Correct answer

Stage IIA1

Correct Incorrect Correct answer

Stage IIA2

Correct Incorrect Correct answer

Stage IIB

Correct Incorrect Correct answer

Stage IIIA

Correct Incorrect Correct answer

Stage IIIB

Correct Incorrect Correct answer

Stage IIIC1

Correct Incorrect Correct answer

Stage IIIC2

Correct Incorrect Correct answer

Stage IVA

Correct Incorrect Correct answer

Stage IVB

Correct Incorrect Correct answer

Question 79 of 100

79. Question

A 45 year old woman presents with urinary incontinence. She describes leaking on coughing and sneezing, associated with urgency and nocturia where she has to get up 4-5 times per night. This is affecting her ability to work as a telephone customer service assistant as she finds the urgency very troublesome during her job, despite reducing her caffeine and fluid intake. On examination, she has a normal BMI of 20 and urinanalysis is normal. What is the most appropriate treatment?

Bladder retraining

Correct Incorrect Correct answer

Botulinum toxin bladder injections

Correct Incorrect Correct answer

Pelvic floor muscle training

Correct Incorrect Correct answer

Sacral nerve stimulation

Correct Incorrect Correct answer

Vaginal oestrogen

Correct Incorrect Correct answer

Question 80 of 100

80. Question

In the POP-Q system, what does the point “C” represent?

A point located in the midline of the anterior vaginal wall 3 cm proximal to the external urethral meatus

Correct Incorrect Correct answer

A point on the posterior vaginal wall 3 cm proximal to the hymen

Correct Incorrect Correct answer

A point on the posterior vaginal wall 3 cm distal to the hymen

Correct Incorrect Correct answer

A point that represents either the most distal (i.e., most dependent) edge of the cervix or the leading edge of the vaginal cuff

Correct Incorrect Correct answer

A point that represents the location of the posterior fornix

Correct Incorrect Correct answer

Question 81 of 100

81. Question

Which of the following is not a symptom of overactive bladder?

Dysuria

Correct Incorrect Correct answer

Nocturia

Correct Incorrect Correct answer

Urge incontinence

Correct Incorrect Correct answer

Urinary urgency

Correct Incorrect Correct answer

Urinary frequency

Correct Incorrect Correct answer

Question 82 of 100

82. Question

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

A 31 year old woman has a planned Caesarean section at 39 weeks for placenta praevia in her first pregnancy. Post-operatively the urinary catheter is removed 8 hours after delivery. She passes 120ml of urine at first void but reports a sensation of incomplete bladder emptying following this. Bladder scan suggests that there is 200ml of residual urine in the bladder. In and out catheter assessment confirms a residual volume of 200ml.

Bladder scan

Correct Incorrect Correct answer

In and out catheter residual assessment

Correct Incorrect Correct answer

Insertion of urinary catheter

Correct Incorrect Correct answer

Insertion of urinary catheter and re-try trial without catheter (TWOC) in 24 hours

Correct Incorrect Correct answer

Insertion of urinary catheter and re-try trial without catheter in 48 hours

Correct Incorrect Correct answer

Indwelling urinary catheter for 24 hours

Correct Incorrect Correct answer

Indwelling urinary catheter for 48 hours

Correct Incorrect Correct answer

Indwelling urinary catheter for one week

Correct Incorrect Correct answer

Indwelling urinary catheter for two weeks

Correct Incorrect Correct answer

Measure volume of urine voided at 6 hours

Correct Incorrect Correct answer

Measure volume of urine voided at 6 hours post catheter removal

Correct Incorrect Correct answer

Removal of urinary catheter

Correct Incorrect Correct answer

Teach intermittent clean self-catheterisation

Correct Incorrect Correct answer

Question 83 of 100

83. Question

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

A 47 year old woman has a laparoscopic hysteropexy with mesh placement. Postoperatively, she becomes unwell with abdominal pain, vomiting and abdominal distension.

CT Abdomen/Pelvis

Correct Incorrect Correct answer

Cystometry

Correct Incorrect Correct answer

Cystourethroscopy

Correct Incorrect Correct answer

Examination under anaesthesia

Correct Incorrect Correct answer

Fluoroscopic studies

Correct Incorrect Correct answer

Laparoscopy

Correct Incorrect Correct answer

MRI Pelvis

Correct Incorrect Correct answer

Neuro-physiology studies

Correct Incorrect Correct answer

Post-void residual volume assessment

Correct Incorrect Correct answer

Sigmoidoscopy

Correct Incorrect Correct answer

Translabial ultrasound

Correct Incorrect Correct answer

Transvaginal ultrasound

Correct Incorrect Correct answer

Urinary flow studies

Correct Incorrect Correct answer

Question 84 of 100

84. Question

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

A 42-year-old woman presents with leakage of urine during coughing, sneezing, and exercise. Urodynamic testing reveals urine leakage with increased intra-abdominal pressure and no detrusor activity during leakage episodes.

Acontractile detrusor

Correct Incorrect Correct answer

Bladder outlet obstruction

Correct Incorrect Correct answer

Detrusor overactivity

Correct Incorrect Correct answer

Detrusor sphincter dyssynergia

Correct Incorrect Correct answer

Functional incontinence

Correct Incorrect Correct answer

Mixed urinary incontinence

Correct Incorrect Correct answer

Normal urodynamic study

Correct Incorrect Correct answer

Stress urinary incontinence

Correct Incorrect Correct answer

Urethral hypermobility

Correct Incorrect Correct answer

Urinary retention

Correct Incorrect Correct answer

Question 85 of 100

85. Question

For each scenario, choose the most likely prolapse stage based on the following POP-Q assessment:

Anterior – Stage 1

Correct Incorrect Correct answer

Anterior – Stage 2

Correct Incorrect Correct answer

Anterior – Stage 3

Correct Incorrect Correct answer

Posterior – Stage 1

Correct Incorrect Correct answer

Posterior – Stage 2

Correct Incorrect Correct answer

Posterior – Stage 3

Correct Incorrect Correct answer

Uterine – Stage 1

Correct Incorrect Correct answer

Uterine – Stage 2

Correct Incorrect Correct answer

Uterine – Stage 3

Correct Incorrect Correct answer

Uterine – Stage 4

Correct Incorrect Correct answer

Vaginal Vault – Stage 1

Correct Incorrect Correct answer

Vaginal Vault – Stage 2

Correct Incorrect Correct answer

Vaginal Vault – Stage 3

Correct Incorrect Correct answer

Vaginal Vault – Stage 4

Correct Incorrect Correct answer

Question 86 of 100

86. Question

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

A 47 year old woman presents with a sensation of a bulging lump at the vaginal introitus. She previously had a total abdominal hysterectomy for large fibroids with significant pressure symptoms. She has tried pelvic floor muscle training but has not had significant benefit. She is keen to avoid further surgery at present. On examination, POP-Q assessment showed:

Abdominal sacrocolpopexy

Correct Incorrect Correct answer

Anterior colporrhaphy

Correct Incorrect Correct answer

Autologous rectus fascial sling

Correct Incorrect Correct answer

Burch colposuspension

Correct Incorrect Correct answer

Colpocleisis

Correct Incorrect Correct answer

High uterosacral ligament suspension

Correct Incorrect Correct answer

Laparoscopic sacrocolpopexy

Correct Incorrect Correct answer

McCall culdoplasty

Correct Incorrect Correct answer

Manchester repair

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 hysterectomy

Correct Incorrect Correct answer

Vaginal sacrospinous hysteropexy with sutures

Correct Incorrect Correct answer

Vaginal ring pessary

Correct Incorrect Correct answer

Vaginal shelf pessary

Correct Incorrect Correct answer

Question 87 of 100

87. Question

A 30 year old woman attends antenatal clinic at 32 weeks gestation in her second pregnancy which is a dichorionic twin pregnancy. Her first pregnancy was a singleton pregnancy where she was induced for postdates at 41 weeks and received intrapartum antibiotic prophylaxis due to a history of GBS bacteriuria. What is the likelihood of maternal GBS carriage in this current pregnancy?

30%

Correct Incorrect Correct answer

40%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

60%

Correct Incorrect Correct answer

70%

Correct Incorrect Correct answer

Question 88 of 100

88. Question

What is the chance of transfer to an obstetric unit for low-risk multiparous women opting for planned home birth?

4%

Correct Incorrect Correct answer

7%

Correct Incorrect Correct answer

9%

Correct Incorrect Correct answer

12%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

Question 89 of 100

89. Question

Which of the following cardiac conditions is not an indication for planned Caesarean birth?

Dilated cardiomyopathy with LVEF 30%

Correct Incorrect Correct answer

Fontan circulation

Correct Incorrect Correct answer

Marfan’s syndrome with aortic root dimension 48mm

Correct Incorrect Correct answer

Pulmonary arterial hypertension

Correct Incorrect Correct answer

Turner Syndrome with aortic root dimension 30mm

Correct Incorrect Correct answer

Question 90 of 100

90. Question

A 20 year old woman presents in spontaneous labour at 38 weeks gestation in her first pregnancy. She has a history of epilepsy for which she has been on long term leviracetam and is requesting pain relief. Which of the following should be avoided?

Bupivacaine

Correct Incorrect Correct answer

Diamorphine

Correct Incorrect Correct answer

Meptazinol

Correct Incorrect Correct answer

Nitrous oxide

Correct Incorrect Correct answer

Pethidine

Correct Incorrect Correct answer

Question 91 of 100

91. Question

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

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 anaesthesia

Correct Incorrect Correct answer

Continuous one-to-one support

Correct Incorrect Correct answer

Epidural anaesthesia

Correct Incorrect Correct answer

General anaesthesia

Correct Incorrect Correct answer

Hypnosis

Correct Incorrect Correct answer

Nitrous oxide

Correct Incorrect Correct answer

Music

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 anaesthesia

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

Question 92 of 100

92. Question

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

A woman is admitted in spontaneous labour at term and is found to be 8cm dilated with intact membranes on vaginal examination. She is known to be Group B Streptococcus positive from a previous vaginal swab in the current pregnancy. She has no known drug allergies.

Artificial rupture of membranes (ARM)

Correct Incorrect Correct answer

Artificial rupture of membranes (ARM) and oxytocin

Correct Incorrect Correct answer

Benzylpenicillin

Correct Incorrect Correct answer

Clindamycin

Correct Incorrect Correct answer

Cefuroxime & metronidazole

Correct Incorrect Correct answer

Coamoxiclav

Correct Incorrect Correct answer

Erythromycin

Correct Incorrect Correct answer

Oxytocin

Correct Incorrect Correct answer

Vaginal examination in four hours

Correct Incorrect Correct answer

Vaginal examination in two hours

Correct Incorrect Correct answer

Question 93 of 100

93. Question

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

A woman presents with spontaneous rupture of membranes at term and is known to be a carrier of Group B Streptococcus.She is offered intrapartum antiobiotic prophylaxis and immediate induction of labour. Shortly after commencing her first dose of intravenous benzylpenicillin, she collapses with severe hypotension, obvious facial oedema and stridor.

Amniotic fluid embolism

Correct Incorrect Correct answer

Anaphylaxis

Correct Incorrect Correct answer

Cord prolapse

Correct Incorrect Correct answer

Drug overdose

Correct Incorrect Correct answer

Epileptic seizure

Correct Incorrect Correct answer

Eclamptic seizure

Correct Incorrect Correct answer

Fetal bradycardia

Correct Incorrect Correct answer

Obstetric haemorrhage

Correct Incorrect Correct answer

Shoulder dystocia

Correct Incorrect Correct answer

Uterine inversion

Correct Incorrect Correct answer

Venous thromboembolism

Correct Incorrect Correct answer

Question 94 of 100

94. Question

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

A woman in her first pregnancy has a third trimester ultrasound at 36 weeks gestation which shows estimated fetal weight on the 4th centile with abnormal umbilical artery Dopplers showing intermittently absent end diastolic flow and cephalic presentation.

Induction of labour at 36 weeks

Correct Incorrect Correct answer

Induction of labour at 37 weeks

Correct Incorrect Correct answer

Induction of labour at 38 weeks

Correct Incorrect Correct answer

Induction of labour at 39 weeks

Correct Incorrect Correct answer

Induction of labour at 40 weeks

Correct Incorrect Correct answer

Induction of labour at 41 weeks

Correct Incorrect Correct answer

Induction of labour at 42 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 36 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 37 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 38 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 39 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 40 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 41 weeks

Correct Incorrect Correct answer

Elective Caesarean section at 42 weeks

Correct Incorrect Correct answer

Question 95 of 100

95. Question

Which of the following factors is associated with the highest risk of shoulder dystocia?

Diabetes mellitus

Correct Incorrect Correct answer

Induction of labour

Correct Incorrect Correct answer

Macrosomia >4.5kg

Correct Incorrect Correct answer

Maternal BMI >30

Correct Incorrect Correct answer

Previous shoulder dystocia

Correct Incorrect Correct answer

Question 96 of 100

96. Question

A woman is diagnosed with preterm prelabour rupture of membranes at 34 weeks gestation in her first pregnancy. Ultrasound scan confirms normal fetal growth with extended breech presentation. She is given antenatal corticosteroids for fetal lung maturation and started on oral erythromycin. After 48 hours as an inpatient, there is no evidence of infection and she is not contracting. What is the next most appropriate management?

Immediate Caesarean section

Correct Incorrect Correct answer

Inpatient expectant management with elective Caesarean at 37 weeks

Correct Incorrect Correct answer

Inpatient expectant management with external cephalic version at 36 weeks

Correct Incorrect Correct answer

Outpatient expectant management with elective Caesarean at 37 weeks

Correct Incorrect Correct answer

Outpatient expectant management with external cephalic version at 36 weeks

Correct Incorrect Correct answer

Question 97 of 100

97. Question

Which of the following factors is most likely to increase the chance of assisted vaginal birth?

Continuation of epidural analgesia in second stage of labour

Correct Incorrect Correct answer

Epidural analgesia

Correct Incorrect Correct answer

Epidural analgesia in the latent phase of labour

Correct Incorrect Correct answer

Supine position in second stage of labour

Correct Incorrect Correct answer

Use of oxytocin in first stage of labour

Correct Incorrect Correct answer

Question 98 of 100

98. Question

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

Question 99 of 100

99. Question

For each of the following scenarios, select the most appropriate management option:

- A woman in her first pregnancy is found to have a baby in breech presentation at 36 weeks gestation. She has had an uncomplicated pregnancy thus far and has been under midwifery led care. Fetal growth is normal. She opts to have external cephalic version but this is unsuccessful.

Category 1 Caesarean section

Correct Incorrect Correct answer

Category 2 Caesarean section

Correct Incorrect Correct answer

Category 3 Caesarean section

Correct Incorrect Correct answer

Category 4 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

Ventouse

Correct Incorrect Correct answer

Vaginal breech delivery

Correct Incorrect Correct answer

Question 100 of 100

100. Question

For each of the following scenarios, select the most appropriate management option:

A woman in her first pregnancy has an induction of labour at 37 weeks for suspected small for gestational age fetus with estimated fetal weight on the 10th centile. She receives vaginal prostaglandin and makes good progress to full dilatation without further intervention. Due to slow progress in the second stage of labour, artificial rupture of membranes is performed and the umbilical cord is felt prolapsing through the cervix. The CTG is shows a fetal bradycardia. Vaginal examination shows the presenting part is at +2 station with occipital-anterior position.

Category 1 Caesarean section

Correct Incorrect Correct answer

Category 2 Caesarean section

Correct Incorrect Correct answer

Category 3 Caesarean section

Correct Incorrect Correct answer

Category 4 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

Ventouse

Correct Incorrect Correct answer

Vaginal breech delivery

Correct Incorrect Correct answer

MRCOG Part 2 – Practice Exam D

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