MRCOG Part 2 – Sexual & Reproductive Health SBAs

A 36 year old woman presents to her GP for a check of her intrauterine contraceptive device (IUCD) following insertion six weeks ago. On examination, the GP is unable to see the threads of the IUCD and refers her to the on call gynaecology team.  What is the most next appropriate management?

Which of the following statements regarding starting the combined oral contraceptive pill (COCP) is incorrect?

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She is taking the combined oral contraceptive pill and has forgotten to take her last two pills.  She is currently on Day 5 of her pill packet and has had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She is taking the combined oral contraceptive pill and has been vomiting for the last 24 hours and is concerned that she has vomited her last pill.  She is currently on Day 5 of her pill packet and has had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

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?

Which of the following medications affects the metabolism and efficacy of the combined oral contraceptive pill?

Which of the following medications does not affect the metabolism and efficacy of the combined oral contraceptive pill?

A 24 year old woman attends her local sexual health clinic to discuss contraception. She moved to the UK last year and has recently been diagnosed with latent tuberculosis for which she is taking combination therapy with rifampicin and isoniazid for three months.  At present, she is taking the combined oral contraceptive pill (COCP) and has been experiencing breakthrough bleeding.  What is the most appropriate management?

A 24 year old woman uses the combined oral contraceptive pill (COCP) but misses two pills in the first week and has unprotected sexual intercourse. She takes ‘Ella’ ulipristal acetate as emergency contraception.  What advice should she receive regarding use of the COCP after this?

What is the mechanism of action of the progestogen-only pill?

Which of the following is a traditional progestogen-only pill?

A 40 year old woman requests laparoscopic sterilization. Which of the following statements is not correct regarding laparoscopic sterilization?

Which of the following is a new generation progestogen-only pill?

Which of the following is a side effect of the progestogen-only pill?

Which of the following is an absolute contraindication to the progestogen-only pill?

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

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

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She is taking a progestogen-only pill containing levonorgestrel and has forgotten to take her last pill.  She has not had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She is taking the progestogen-only pill and has had vomiting with severe diarrhea for the last 24 hours and is concerned that she has vomited her last pill which she took 4 hours ago.  She has had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

Which of the following is not a long-acting reversible contraceptive?

What is the mechanism of action of the progestogen-only injectable contraceptive?

Which of the following is not a side effect of the progestogen-only injectable contraceptive?

What is the mechanism of action of the combined oral contraceptive pill?

Which of the following statements about the progestogen-only injectable (POI) contraceptive is incorrect?

Which of the following statements about starting progestogen-only injectable (POI) contraceptives is incorrect?

A 34 year old woman contacts the sexual health clinic for contraceptive advice. She has been using Depo-Provera injectable contraception but had forgotten to arrange her latest injection which was due one week ago.  She has had unprotected sexual intercourse in the last 48 hours.  What is the most appropriate management?

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?

What is the mechanism of action of the progestogen-only injectable implant?

Which of the following statements about the progestogen-only implant contraceptive is incorrect?

A 34 year old woman attends her local sexual health clinic for removal and change of her progestogen-only implant. On examination, the implant is not palpable and cannot be located.  What is the next appropriate management?

What is the mechanism of action of the copper intra-uterine device?

Which of the following statements about copper intra-uterine devices (CU-IUDs) is incorrect?

Which of the following is the most common risk of the use of copper intra-uterine devices (Cu-IUDs)?

Which of the following is not a side effect of the combined oral contraceptive pill?

Which of the following statements about insertion of copper intra-uterine devices (Cu-IUDs) is incorrect?

You are reviewing a recent cervical smear test result which shows the presence of Actinomyces-like organisms. On reviewing the woman’s medical records, you note that she had a copper intra-uterine contraceptive device (Cu-IUD) inserted six months ago.  What is the most appropriate management?

A 24 year old woman is referred to the on call Gynaecology team by her GP with a positive pregnancy test. Her last menstrual period was six weeks ago and she has a copper intra-uterine device in situ for contraception.  She is otherwise asymptomatic and has no abdominal pain or bleeding.  She expresses a wish to continue with the pregnancy.  What is the next most appropriate management?

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?

What is the mechanism of action of the levonorgestrel-releasing intra-uterine system (LNG-IUS)?

Which of the following statements about levonorgestrel-releasing intra-uterine systems (LNG-IUS) is incorrect?

Which of the following indications is the Mirena levonorgestrel-releasing intra-uterine system (LNG-IUS) not licensed for?

What is the efficacy of male condoms with typical use?

When can an intrauterine contraceptive device be inserted safely in the postpartum period?

Which of the following statements about lactational amenorrhoea method (LAM) is incorrect?

Which of the following is not an absolute contraindication to the combined oral contraceptive pill?

A 28 year old woman attends her local sexual health clinic to request emergency contraception as she has had unprotected sexual intercourse with her long-term partner 96 hours ago. She has been taking the progesterone-only Pill but often forgets to take this and is unsure if she has taken her last few pills. What is the most appropriate treatment?

A 28 year old woman attends her local sexual health clinic to request emergency contraception as she has had unprotected sexual intercourse with her long-term partner 48 hours ago. She has previously used EllaOne emergency contraception two weeks ago and is not taking any regular contraception.  What is the most appropriate treatment?

A 28 year old woman attends her local sexual health clinic to request emergency contraception as she has had unprotected sexual intercourse with her long-term partner 96 hours ago. She is a known epileptic and is taking carbamazepine and requests the ‘morning after pill’.  What is the most appropriate treatment?

Which of the following statements about vasectomy is incorrect?

Which of the following statements about female sterilization is incorrect?

Which of the following factors is not associated with regret after female sterilization?

A 25 year old woman has a medical termination of pregnancy at 14 weeks, following a chorionic villous sampling (CVS) that confirmed that the fetus had Trisomy 13. What clause of the Abortion Act is this performed under?

Which of the following statements about medical termination of pregnancy is incorrect?

Which of the following is not a risk of surgical termination of pregnancy?

A 16 year old girl attends her GP with her partner to request contraception.Her partner is 17 and has mild learning difficulties.  What is the most appropriate management?

Which of the following is a relative contraindication to combined oral contraceptive pill?

A 16 year old woman with mild learning difficulties attends her GP with her partner to request contraception. Her partner is 17 and also has mild learning difficulties.  She mentions that her periods are heavy and distressing but she is otherwise fit and well with no significant medical history and normal BMI.  What is the most appropriate management?

Which of the following should not be recommended for contraception in a patient with epilepsy taking lamotrigine?

Which of the following should be recommended for contraception in a patient with pulmonary arterial hypertension?

A 42 year old woman requests termination of pregnancy at 13 weeks gestation after a diagnosis of pregnancy affected by Trisomy 21 confirmed by chorionic villous sampling and opts to have a surgical abortion by vaccum aspiration under general anaesthesia. What is the most appropriate pre-operative investigation?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault. What percentage of victims of serious sexual assault tell police about the incident?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault. What percentage of victims of sexual assault knew the perpetrator?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault. What is the risk of pregnancy after vaginal rape?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault three days ago. She does not wish to report the incident to the police at present but asks if she can have forensic samples taken in case she changes her mind later.  What is the most appropriate management?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault. Which of the following is not routinely screened for after sexual assault?

An 18 year old girl attends the emergency department of her local hospital reporting a serious sexual assault. Which of the following should be offered immediately?

Use of the combined oral contraceptive pill affects the risk of certain cancers. Which of the following is incorrect regarding use of the combined oral contraceptive pill?

A 48 year old has had a copper IUD (Cu-IUD) in situ for contraception for the last ten years and is due to have it changed. She has been amenorrhoeic for 18 months but has no other menopausal symptoms.  What is the most appropriate management?

A 20 year old woman attends Gynaecology clinic with symptoms of profuse vaginal discharge which she describes as offensive. A high vaginal swab is taken and sent for analysis. Which of the following meets the diagnostic criteria for diagnosis of bacterial vaginosis?

A 25 year old woman presents to her local sexual health clinic with a generalised maculopapular rash, lymphadenopathy and condylomata lata and is found to be positive for Treponema Pallidum. What is the diagnosis?

A 25 year old woman has an uncomplicated vaginal birth of a health baby at term but the baby is admitted to the neonatal unit on day 3 of life with failure to thrive, a blistering bullous rash around the mouth, generalised lymphadenopathy and hepatosplenomegaly. The baby subsequently tests positive for Treponema Pallidum on two consecutive IgM EIA tests. What is the likely diagnosis?

Which of the following statements regarding use of the combined oral contraceptive pill (COCP) and venous thromboembolism (VTE) is incorrect?

Which of the following statements regarding use of the combined oral contraceptive pill (COCP) is incorrect?

A 34 year old woman books for antenatal at 6 weeks gestation.  Her booking bloods tests reveal a new diagnosis of HIV and she commences on a standard regimen antiretroviral therapy of tenofovir DX, emtricitabine and dolutegravir. How often should viral load be monitored if she remains virologically suppressed?

A 34 year old woman books for antenatal at 6 weeks gestation.  She is known to have a diagnosis of HIV and is on a standard regimen antiretroviral therapy of tenofovir DX, emtricitabine and dolutegravir with an undetectable viral load. How often should viral load be monitored if she remains virologically suppressed?

A 34 year old primiparous woman is found to be HIV positive on screening at booking at 8 weeks gestation. She was not known to have HIV prior to this and has never received treatment for this. Her initial viral load is 70,000 copies/mL and her CD4 count is 180 cells/mm3. When should antiretroviral therapy be commenced?

Which of the following is not an indication for repeat HIV testing to be offered in pregnancy?

Which of the following is not a contributing factor in vertical HIV transmission from women undiagnosed before or during labour?

What percentages of births in the UK to women with HIV have an undetectable viral load at delivery?

What is the current rate of vertical HIV transmission in the UK?