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What artery supplies the distal third of the transverse colon?
Celiac trunk artery

Inferior mesenteric artery
Left renal artery
Right renal artery
Superior mesenteric artery
What nerve supplies to the anterior one-third of the labium majus?
Dorsal branch of the pudendal nerve

Inferior rectal nerve
Ilioinguinal nerve
Obturator nerve
Pudendal nerve
What part of the spermatozoa has the highest concentration of mitochondria?
Acrosome
Flagellate tail
Middle piece
Principle piece
True head
Which testicular cells are located outside the blood/testis barrier?
Leydig
Primary spermocytes
Sertoli
Spermatids
Spermatogonia
What type of cells are sertoli cells as defined by shape?
Circular cells
Cubodial cells
Epithelia with gap junctions
Flat columnar
Tall columnar
What is the layer between the theca cells and the mural granulosa?
Basal lamina
Basement membrane
Podocysts
VEGF unregulated capillary bed
Zona pellucida
With regard to ovulation, what is the fluid filled space in a follicle called?
Antrum
Basal lamina
Blastocyst
Lacuna
Uniblastocyst
What size is a resting follicle?
0.02 mm
2 mm
10 mm
15 mm
20 mm
What size is a follicle that is ready to ovulate?
2 mm
4 mm
10 mm
15 mm
20 mm
Regarding the urinary bladder, which of the following is correct?
A glycosaminoglycan layer coats the luminal surface of the bladder mucosa

At the trigone, the epithelium is loosely adherent to the underlying muscle
The bladder wall consists of two layers of detrusor muscle
The uterovesical fold creates the Pouch of Douglas
The urinary bladder is covered entirely by peritoneum
The internal pudendal artery leaves the pelvis via what structure?
Greater sciatic foramen

Lesser sciatic foramen
Obturator foramen
Pudendal canal
Sacral canal
A direct inguinal hernia that develops from the weakness of the conjoint
tendon can cause damage to what nerve?
Genitofemoral nerve
Iliohypogastric nerve
Ilioinguinal nerve
Pudendal nerve
Subcostal nerve
Lymphatic drainage of the uterus is primarily to:
Common iliac nodes

External iliac nodes
Internal iliac nodes
Para-aortic nodes
Superficial inguinal nodes
From which embryological structure does the round ligament of the uterus
originate?
Cloaca
Gubernaculum
Mullerian duct
Urachus
Wolffian duct
Which of the following is NOT a branch of the anterior division of the internal
iliac artery?
Ilieolumbar artery
Internal pudendal artery
Obturator artery
Uterine artery
Vaginal artery
This is the last question of this quiz. Press finish to submit your choice(s) and
reveal the answer(s).
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The median umbilical ligament is the embryological remnant of what fetal
structure?
Your answer:
Urachus
Correct answer:
Urachus
The answer is urachus. The urachus forms the median umbilical ligament. Be
careful not to confuse it with the medial umbilical ligament, which represents
the remnants of fetal umbilical arteries. Note there is an umbilical vein, not
veins, and this forms the ligamentum teres hepatis.
The superficial inguinal ring is strengthened posteriorly by what structure?
Your answer:
Falx inguinalis
Correct answer:
Falx inguinalis
The answer is the falx inguinalis. The falx inguinalis is also called the conjoint
tendon and strengthens this anatomical area of weakness of the abdominal
wall. Note that although the superficial inguinal tendon sounds plausible, it
actually does not exist.
The inguinal canal transmits the round ligament and which important nerve?
Your answer:
Ilioinguinal nerve
Correct answer:
Ilioinguinal nerve
The answer is the ilioinguinal nerve. It orginates from the anterior rami of L1
and supplies the skin on the mons pubis and labia majora. It also has motor
supply to the internal oblique and transversus abdominis so it strengthens the
conjoint tendon.
A urinary catheter is vigorously inflated in the urethra at the time of caesarean

section. Urine leaks from the rupture into which anatomical space?
Your answer:
Into the anterior abdominal wall and mons pubis
Correct answer:
Into the anterior abdominal wall and mons pubis
The answer is into the anterior abdominal wall and mons pubis. This is the only
route possible due to the anatomy of the urethra.
Which group of nerves all constitute branches of the pudendal nerve?
Your answer:
Perineal nerve, dorsal clitoral nerve, inferior rectal nerve
Correct answer:
Perineal nerve, dorsal clitoral nerve, inferior rectal nerve
The answer is the perineal nerve, dorsal clitoral nerve and inferior rectal nerve.
These are the three important branches of the pudendal nerve.
The inferior hypogastric plexus is an important plexus supplying the hind gut.
What are its nerve root origins?
Your answer:
T10–12 and L1–L2
Correct answer:
T10–12 and L1–L2
The answer is T10–12 and L1–L2. The inferior hypogastric plexus is a
continuation of both hypogastric nerves. It is derived from the lower three
thoracic and upper two lumbar segments. The parasympathetic and
sympathetic supply of this plexus effects uterine contractions and
vasoconstriction.
What three muscles form the superficial group of muscles of the perineum?
Your answer:
Bulbospongiosus, superficial transverse perineal muscle, and ischiocavernous
Correct answer:
Bulbospongiosus, superficial transverse perineal muscle, and ischiocavernous
The answer is bulbospongiosus, superficial transverse perineal muscle and
ischiocavernous. These three muscles make up the superficial group of
perineal muscles. The bulbospongiosus is superficial to the Bartholin's glands.
Sympathetic supply to the bladder is derived from which lumbar segments?
Your answer:
T10 and L2
Correct answer:
T10 and L2
The answer is T10 and L2. Nerve root supply for pelvic organs is a common
single best answer examination question. It is worth drawing a table for each
of the main pelvic organs and writing down the artery, venous, lymphatic and
nerve supply. Note that the parasympathetic supply for the bladder comes
from S2, S3 and S4 but the sympathetic is as above. Sensory nerves are found
in both supplies.
The lower third of the vagina has lymphatic drainage to which lymphatic
nodes?
Your answer:
Correct answer:
The answer is the superficial inguinal nodes. Remember the embryological
difference between the lower one-third of the vagina and the
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What artery supplies the distal third of the transverse colon?
Your answer:
Correct answer:
The correct answer is the inferior mesenteric artery.
What nerve supplies to the anterior one-third of the labium majus?

Your answer:
Pudendal nerve
View correct answer
Correct answer:
Ilioinguinal nerve
The correct answer is ilioinguinal nerve. Posterior two-thirds of the perineal

branch of the pudendal nerve.
What part of the spermatozoa has the highest concentration of mitochondria?
Your answer:
Acrosome
View correct answer
Correct answer:
Middle piece
The correct answer is the middle piece.
Which testicular cells are located outside the blood/testis barrier?
Your answer:
Leydig
Correct answer:
Leydig
The correct answer is leydig cells.
What type of cells are sertoli cells as defined by shape?
Your answer:
Epithelia with gap junctions
View correct answer

Correct answer:
Tall columnar
The correct answer is tall columnar.
What is the layer between the theca cells and the mural granulosa?
Your answer:
Zona pellucida
View correct answer
Correct answer:
Basal lamina
The correct answer is basal lamina.
With regard to ovulation, what is the fluid filled space in a follicle called?
Your answer:
Antrum
Correct answer:
Antrum
The correct answer is antrum.
What size is a resting follicle?
Your answer:
10 mm
View correct answer
Correct answer:
0.02 mm
The correct answer is 0.02 mm.

What size is a follicle that is ready to ovulate?
Your answer:
20 mm
Correct answer:
20 mm
The correct answer is 20 mm.
Regarding the urinary bladder, which of the following is correct?
Your answer:
The bladder wall consists of two layers of detrusor muscle
View correct answer
Correct answer:
A glycosaminoglycan layer coats the luminal surface of the bladder mucosa
The correct answer is a glycosaminoglycan layer coats the luminal surface of

the bladder mucosa. The bladder mucosa is transitional epithelium and is
loosely connected to the muscular bladder wall by the lamina propria that
serves as a connective-tissue layer. The bladder submucosa or lamina propria is
rich in microvasculature and overlies the detrusor muscle. At the trigone, the
epithelium is more densely adherent to the underlying muscle. A layer of fatty
connective tissue covers most of the anterior and lateral bladder in the
retropubic space and can be viewed cystoscopically in the case of a bladder
perforation. The peritoneum covers the bladder posteriorly and separates it
from the anterior cul-de-sac or vesicouterine pouch and abdominal cavity
contents.
The internal pudendal artery leaves the pelvis via what structure?
Your answer:
Correct answer:
The correct answer is the greater sciatic foramen. The internal pudendal artery
is an artery that branches off the internal iliac artery, providing blood to the
external genitalia. The internal pudendal artery is the terminal branch of the
anterior trunk of the internal iliac artery. It is smaller in the female than in the
male. It exits the pelvic cavity through the greater sciatic foramen, inferior to
the piriformis muscle, to enter the gluteal region. It then curves around the
sacrospinous ligament to enter the perineum through the lesser sciatic
foramen. It travels through the pudendal canal with the internal pudendal
veins and the pudendal nerve.
A direct inguinal hernia that develops from the weakness of the conjoint
tendon can cause damage to what nerve?
Your answer:
Ilioinguinal nerve
Correct answer:
Ilioinguinal nerve
The correct answer is ilioinguinal nerve.
Lymphatic drainage of the uterus is primarily to:
Your answer:
Correct answer:
The correct answer is internal iliac nodes.
From which embryological structure does the round ligament of the uterus
originate?
Your answer:
Gubernaculum
Correct answer:
Gubernaculum
The correct answer is gubernaculum.
Which of the following is NOT a branch of the anterior division of the internal
iliac artery?
Your answer:
Ilieolumbar artery
Correct answer:
Ilieolumbar artery
The correct answer is the ilieolumbar artery.
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Which of the following amino acid bases is not contained in RNA?
Your answer:
Thymine
Correct answer:
Thymine
The answer is Thymine. In RNA the thymine is replaced by uracil. The other
bases (adenine, cystosine and guanine) remain the same.
Which of the following blood clotting factors activates fibrinogen in the

common pathway?
Your answer:
Prothrombin
Correct answer:
Prothrombin
The answer is Prothrombin. Accelerin (V) stimulates activation of prothrombin
(II) to thrombin (II), which activates fibrinogen (I) to form fibrin clot. This is
stabilised by cross linking with the aid of fibrin-stabilising factor (XIII).
Remember heparin increases the rate of complex formation of antithrombin
III, which inactivates thrombin.
Which part of the cell cycle is noted for sister chromatids separating and
moving to opposite sides of the cell?
Your answer:
Anaphase
Correct answer:
Anaphase
The answer is Anaphase. Within the cell cycle DNA replication occurs in the
synthesis phase before entering the Gap 2 phase. Mitosis starts with
chromosomes condensing (prophase) follow by chromatids aligning
(metaphase), following by sister chromatids separating and moving
(anaphase). Finally the cell membrane divides in telophase.
Which biochemical technique is used to detect the presence and the amount
of a protein?
Your answer:
Western blotting
Correct answer:
Western blotting
The answer is Western blotting. Southern blotting (named after Edwin
Southern) is used to detect particular sequences to DNA. Northern blotting is
used for the same reason but for RNA. Polymerase chain reaction is used to
amplify very small amounts of DNA (although it can be used for RNA if
converted to DNA). X-ray crystallography is used to reveal the structure of
nucleic acids such as DNA and RNA.
What molecules generate weak forces that can attract neutrophils to cell
walls?
Your answer:
Selectins
Correct answer:
Selectins
The answer is selectins. Selectins are molecules that are expressed in
endometrial cell walls and also leucocytes. They generate weak attraction
forces. Inflammatory processes via interleukins increase the amount of
selectins present and hence, attract more leucocytes.
Ribosomes are located in which part of the cell?
Your answer:
Rough endoplasmic reticulum
Correct answer:
The answer is Rough endoplasmic reticulum. Ribosomes 'read' the messenger
RNA created from the nuclear DNA and translate it to create proteins via
transfer RNA. There are free ribosomes in the cytoplasm of cells but they are in
abundance in the rough endoplasmic reticulum.
Which ketone bodies can be used as an energy supply for the brain in
starvation?
Your answer:
Acetoacetate
Correct answer:
Acetoacetate
The answer is acetoacetate. Acetone is also a ketone body but is not used for
energy. It is excreted in urine and is also exhaled in the breath.
You have been asked to review an asymptomatic patient in the early

pregnancy unit. Ultrasound scan is negative for pregnancy. βhCG levels over 48
hours are 550 and 350, and serum progesterone levels are 17 nmol. What is
the most likely outcome?
Your answer:
Non-viable pregnancy with the possibility of spontaneous resolution
Correct answer:
The correct answer is non-viable pregnancy with the possibility of spontaneous
resolution. Serum progesterone levels are useful adjuncts in the diagnosis of
pregnancy of unknown location. Levels below 15-25 are indicative of non-
viable pregnancy. Results below 20 nmol/l are associated with spontaneous
resolution with sensitivity of 93% and specificity of 94%. Levels above 60
strongly indicate development into normal pregnancy in the future. Serum hCG
levels are us
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Which of the following amino acid bases is not contained in RNA?
Adenine
Cytosine
Guanine
Thymine
Uracil
Which of the following blood clotting factors activates fibrinogen in the
common pathway?
Factor VIII
Factor XIII
Kallikrein
Kinin
Prothrombin
Which part of the cell cycle is noted for sister chromatids separating and
moving to opposite sides of the cell?
Anaphase
Metaphase
Prophase
Synthesis phase
Telophase
Which biochemical technique is used to detect the presence and the amount
of a protein?
Northern blotting
Polymerase chain reaction
Southern blotting
Western blotting
X-ray crystalography
What molecules generate weak forces that can attract neutrophils to cell
walls?
Cadhedins
Eicosanoids
Hemidesmosomes
Integrins
Selectins
Ribosomes are located in which part of the cell?
Golgi complex
Lysosomes
Mitochondria
Smooth endoplasmic reticulum
Which ketone bodies can be used as an energy supply for the brain in
starvation?
Acetyl CoA
Acetone
Acetoacetate
Choline
Succinate
You have been asked to review an asymptomatic patient in the early
pregnancy unit. Ultrasound scan is negative for pregnancy. βhCG levels over 48
hours are 550 and 350, and serum progesterone levels are 17 nmol. What is
the most likely outcome?
Ectopic pregnancy
Failing pregnancy
High risk of ectopic pregnancy needing intervention for treatment
Viable pregnancy
Your consultant has asked you to send a urea and electrolytes test (U&E) for a
postoperative woman who has undergone a prolonged and difficult
transcervical resection of fibroids. What electrolyte disturbance can occur after
this operation?
Hypernatremia
Hypokalaemia
Hyponatraemia
Hypovolaemia
Increased serum osmolality
In a pregnant woman with diabetes mellitus, target levels of HbA1C should be
below what level?
4.5%
6.5%
8.5%
10.5%
12.5%
A 14-year-old child presents to the adolescent gynaecology clinic. She has a
history of virilisation after undergoing pubertal changes. The karyotype reveals
46XY. An ultrasound scan does not show the presence of a uterus and ovaries.
Which enzyme deficiency may be associated with these clinical features?
5-alpha-reductase deficiency
Complete androgen insensitivity syndrome
Kallmann syndrome
Polycystic ovary syndrome
Turner syndrome
Where is a fetus is alpha-fetoprotein synthesised?
Gut
Kidney
Pancreas
Placenta
Spleen
Which body fat has a major role in gene transcription?
Eicosanoids
Fatty acids
Membrane phospholipids
Phospholipids
Triglycerides
What electrolyte has a role in maintaining intracellular fluids, helping the
regulation of pH and establishing resting membrane potential of the cells?
Bicarbonates
Calcium
Chloride
Potassium
Sodium
Which biochemical process creates pyruvate as an energy supply?
Beta oxidation
Glycolysis
Gluconeogenesis
Oxidative deamination
The citric acid cycle
Chronic renal failure can produce what effect on the parathyroid system?
Hypoparathyroidism
Primary hyperparathyroidism
Pseuohypoparathyroidism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
An active 70-year-old woman is admitted to the gynaecology clinic for a sling
procedure with a known history of Paget’s disease of the bone. Which
biochemical findings are most likely?
Elevated calcium, elevated phosphate and elevated alkaline phosphatise

Elevated calcium, reduced phosphate and reduced alkaline phosphatise
Normal calcium, normal phosphate and elevated alkaline phosphatase
Reduced calcium, elevated phosphate and elevated alkaline phosphatise
Reduced calcium, reduced phosphate and elevated alkaline phosphatase
Glycated haemoglobin (HbA1C) is a marker of diabetic control over what time
period?
48 hours
Up to 1 week
4–8 w
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What is the primary source of negatively charged ions in the blood?
Ammonium and chloride

Bicarbonate and ammonium
Bicarbonate and chloride
Phosphate and bicarbonate
Phosphate and chloride
What is the coagulation factor number for fibrinogen?
Factor I
Factor II
Factor IV
Factor V
Factor X
What is the average haemoglobin concentration in a newborn at term?
10 g/dl
12 g/dl
15 g/dl
17 g/dl
25 g/dl
What factor shifts the O2 dissociation curve to the right (i.e., reduces Hb
affinity for 02)?
Decreased CO2 concentration

Decreased hydrogen ion concentration
Increased 2,3 DPG
Increased sodium concentration
Reduced temperature
What coagulation factors are reduced in pregnancy?
III, IV
IX, X
V, VII
XI, XII
XI, XIII
Where is the chloride shift phenomenon seen?
Distal convoluted tubules

Glomerulus
Platelets
Red blood cells
White blood cells
What is the major hydrogen ion buffer in blood?
Albumin
Bicarbonate
Haemoglobin
Phosphate
Uric acid
What is the major production mechanism of 2,3 DPG?
Anaerobic metabolism in smooth muscle

Gluconeogenesis
Glycolysis
Only in the liver
Suprarenal glands
With regard to plasma calcium, what proportion is carried in an ionised form?
1%
5%
45%
75%
78%
With regard to bound plasma calcium, what is the major carrier?
Calciprotein transfer molecule 1 (CTM 1)

Haemoglobin
Neutrophils
Plasma proteins
SHBG
Where in the body is the major production of 1,25 (OH) D3 (calcitriol)?
Bone
Kidneys
Liver
Lung
Parathyroids
With regards to vitamin D metabolism, what food is particularly high in D2?
Bananas
Beef
Oily fish
Soya milk
Wheat
Which of the following best describes the complement system?
It consists of a series of approximately 60 serum glycoproteins

The major function of the complement system is to remove and destroy
antigens
The most abundant complement is C4
The alternative pathway is initiated by binding of antibody to antigen
The classic pathway does not require any antibody
Which coagulation factor decreases in pregnancy?
Factor I
Factor VII
Factor VIII
Factor X
Factor XI
With regard to oral iron absorption, reduction of Fe3+ to Fe2+ is inhibited by
what substance?
Gastric acid
Tea
Vitamin B1
Vitamin C
Vitamin E
A 54-year-old woman presents to her GP with malaise, a history of recent
weight loss and bloating. On examination the GP notes a large pelvic mass. He
sends her for an urgent abdominal ultrasound scan. What tumour marker
would be most useful to aid the diagnosis in this case?
a-FP
CA 15-3
CA 19-9
CA-125
HCG
Finish
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What is the primary source of negatively charged ions in the blood?
Your answer:
Phosphate and bicarbonate
View correct answer
Correct answer:
Bicarbonate and chloride
The correct answer is bicarbonate and chloride.
What is the coagulation factor number for fibrinogen?
Your answer:
Factor I
Correct answer:
Factor I
The correct answer is factor I.
What is the average haemoglobin concentration in a newborn at term?
Your answer:
12 g/dl
View correct answer
Correct answer:
17 g/dl
The correct answer is 17 g/dl.
What factor shifts the O2 dissociation curve to the right (i.e., reduces Hb
affinity for 02)?
Your answer:
Increased 2,3 DPG
Correct answer:
Increased 2,3 DPG
The correct answer is increased 2,3 DPG.
What coagulation factors are reduced in pregnancy?
Your answer:
XI, XIII
Correct answer:
XI, XIII
The correct answers are XI and XIII. the main changes in haemostasis factors
during pregnancy are:
Platelet count ↓
II, V =
Fibrinogen,VII,VIII,von Willebrand factor,IX,X,XII ↑
XI =/↓
XIII ↑/↓
Antithrombin =
Protein C =/↑
Protein S ↓
Heparin cofactor II ↑
F1+2,TAT,d-dimer ↑
t-PA ↓
ELT,PAI, TAFI ↑
Where is the chloride shift phenomenon seen?
Your answer:
Red blood cells
Correct answer:
Red blood cells
The correct answer is red blood cells.
What is the major hydrogen ion buffer in blood?
Your answer:
Haemoglobin
Correct answer:
Haemoglobin
The correct answer is haemoglobin.
What is the major production mechanism of 2,3 DPG?
Your answer:
Only in the liver
View correct answer
Correct answer:
Glycolysis
The correct answer is glycolysis.
With regard to plasma calcium, what proportion is carried in an ionised form?
Your answer:
5%
View correct answer
Correct answer:
45%
The correct answer is 45%.
With regard to bound plasma calcium, what is the major carrier?
Your answer:
Calciprotein transfer molecule 1 (CTM 1)
View correct answer
Correct answer:
Plasma proteins
The correct answer is plasma proteins.
Where in the body is the major production of 1,25 (OH) D3 (calcitriol)?

Your answer:
Kidneys
Correct answer:
Kidneys
The correct answer is the kidneys, specifically the proximal tubes of the
nephrons.
With regards to vitamin D metabolism, what food is particularly high in D2?
Your answer:
Soya milk
View correct answer
Correct answer:
Oily fish
The correct answer is oily fish.
Which of the following best describes the complement system?
Your answer:
antigens
Correct answer:
antigens
The correct answer is the major function of the complement system is to
remove and destroy antigens.
Which coagulation factor decreases in pregnancy?
Your answer:
Factor XI
Correct answer:
Factor XI
The correct answer is Factor XI.
With regard to oral iron absorption, reduction of Fe3+ to Fe2+ is inhibited by

what substance?
Your answer:
Gastric acid
View correct answer
Correct answer:
Tea
The correct answer is tea.
sends her for an urgent abdominal ultrasound scan. What tumour marker
would be most useful to aid the diagnosis in this case?
Your answer:
CA-125
Correct answer:
CA-125
The best answer is CA-125.

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What is the action of cytochrome P450 enzymes?
Always acts an isomerase

Always acts as a transferase
Always adds an alcohol group
Always adds a terminal electron
Always catalyses hydroxylations
Which cells in the body are dependent upon anaerobic respiration?
Cardiac muscle
Hepatocytes
Nephrons
Red blood cells
White blood cells
What is the product of aerobic glycolysis?
Free fatty acids

Glycogen
Lactate
Pyruvate
Urea
Where in the body is ATP found?
Both intracellular and extracellular

Only extracellular
Only intracellular
Only within high energy output cells
Only within mitochondria
With regard to Conns syndrome, what are the likely changes in pH, potassium
and sodium concentration?
Hypernatraemia, hyperkalaemia, alkalosis

Hypernatraemia, hypokalaemia, acidosis
Hypernatraemia, hypokalaemia, alkalosis
Hyponatraemia, hyperkalaemia acidosis
Hyponatraemia, hypokalaemia, acidosis
What type of acid base disturbance is indicated by the following?
pH: 7.2 (7.35–7.45)

PaCO2: 4.2 kPa (4.5–6.0)
BE: -18 (–2 to +2).
Bicarbonate renal excess
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
What is the most important buffer in the interstitial space?
Ammonia
Bicarbonate
Chloride
Phosphate
Plasma proteins
Ammonia is made from what amino acid in the kidney?
Arginine
Glutamine
Histidine
Lysine
Serine
What is the main buffer in urine?
Ammonia
Bicarbonate
Chloride
Haemoglobin
Phosphate
Bicarbonate is reabsorbed in what part of the kidney?
Collecting ducts
Distal convoluted tubules
Glomerulus
Loop of Henle
Proximal convoluted tubules
With regard to transport in the red blood cells, what ion enters the cell to
maintain electrical neutrality with the outward movement of bicarbonate?
Ammonia
Ammonium
Chloride
Potassium
Sodium
Finish
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Your result73%
What is the action of cytochrome P450 enzymes?
Your answer:
Correct answer:
The correct answer is always catalyse hydroxylations.
Which cells in the body are dependent upon anaerobic respiration?
Your answer:
Cardiac muscle
View correct answer
Correct answer:
Red blood cells
The correct answer is red blood cells.
What is the product of aerobic glycolysis?
Your answer:
Pyruvate
Correct answer:
Pyruvate
The correct answer is pyruvate.
Where in the body is ATP found?
Your answer:
Only intracellular
Correct answer:
Only intracellular
The correct answer is only intracellular.
With regard to Conns syndrome, what are the likely changes in pH, potassium
and sodium concentration?
Your answer:
Correct answer:
The correct answer is hypernatraemia, hypokalaemia, alkalosis.
What type of acid base disturbance is indicated by the following?
pH: 7.2 (7.35–7.45)

PaCO2: 4.2 kPa (4.5–6.0)
BE: -18 (–2 to +2).
Your answer:
Metabolic acidosis
Correct answer:
Metabolic acidosis
The correct answer is partially compensated metabolic acidosis.
What is the most important buffer in the interstitial space?
Your answer:
Plasma proteins
View correct answer
Correct answer:
Bicarbonate
The correct answer is bicarbonate.
Ammonia is made from what amino acid in the kidney?
Your answer:
Glutamine
Correct answer:
Glutamine
The correct answer is glutamine. Remember glutaminase!
What is the main buffer in urine?
Your answer:
Phosphate
Correct answer:
Phosphate
The correct answer is phosphate.
Bicarbonate is reabsorbed in what part of the kidney?
Your answer:
Correct answer:
The correct answer is the proximal convoluted tubules.
With regard to transport in the red blood cells, what ion enters the cell to
maintain electrical neutrality with the outward movement of bicarbonate?
Your answer:
Sodium
View correct answer
Correct answer:
Chloride
The correct answer is chloride.

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resourceEmbryology
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Embryology
Assessment History
Total Attempts: 6
View last results
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Retake quiz
Your result89%
How many oocytes are available at the time of puberty?
Your answer:
400 000
Correct answer:
400 000
The answer is 400 000. There are 1-2 million primordial follicles present at
birth but through the atretic process only 400 000 oocytes are available at
puberty.
A cystic structure is noted lateral to the vagina. This is believed to be a

Gartners duct. What is the embryological origin of this structure?
Your answer:
Mesonephric duct
Correct answer:
Mesonephric duct
The answer is Mesonephric duct. The mesonephric duct forms the ureter and
collecting system and in the female can form the epoophoron, appendix
vesiculosa and Gartner's duct.
Which sperm cell type undergoes the second meiotic division?
Your answer:
Secondary spermatocytes
Correct answer:
The answer is Secondary spermatocytes. Spermatogoniun are diploid and
divide by mitosis to produce diploid primary spermatocytes. These divide by
the first stage of meiosis to create haploid secondary spermatocytes.
Secondary spermatocytes complete the second stage of meiosis to become
spermatids. The conversion from spermatids to sperm is known as
spermiogenesis.
The intraembryonic coelom forms within which structure?
Your answer:
Lateral plate mesoderm
Correct answer:
Lateral plate mesoderm
The answer is Lateral plate mesoderm. In the second week of development the
lateral plate mesoderm splits to create this cavity. It will form the space for the
thoracic and abdominal cavity.
What is the best indicator of gestational age on a dating scan in the first
trimester?
Your answer:
Crown rump length
Correct answer:
Crown rump length
The answer is Crown rump length. Biparietal diameter is appropriate after 14
weeks. Gestational sac measurements help in early pregnancy diagnosis.
A 40-year-old woman is noted to have an elevation of alphafetoprotein. Which

is the most likely pathology diagnosed by ultrasound scan?
Your answer:
Spina bifida
Correct answer:
Spina bifida
The answer is Spina bifida. Alphafetoprotein is a glycoprotein synthesised by
three fetal structures: the gut, liver and yolk sac. It is may be elevated in a
defect of the anterior abdominal wall and the neural tube. As these defects are
not covered by skin, AFP freely enters the amniotic fluid from the fetal
circulation, leading to elevation of levels.
The canal of Nuck is associated with what?

Your answer:
Round ligament
Correct answer:
Round ligament
The answer is round ligament. The round ligament arises from the body of the
uterus antero inferior to the cornue. It passes through the layers of broad
ligaments across the psoas and external iliac vessels. It then passes through the
deep inguinal ring and the inguinal canal to the labium majus. In the fetus, the
round ligament is surrounded by a peritoneum, processus vaginalis, which is
obliterated at birth but may remain patent as the canal of Nuck.
In the development of the oocyte, when does the second meiotic division
occur?
Your answer:
At fertilisation
Correct answer:
At fertilisation
The answer is at fertilisation. The primary oocyte resumes meiotic maturation
in response to a surge in luteinising hormone. This results in a polar body and
the secondary oocyte. The oocyte is then ovulated and enters the second
meiotic cycle. It is arrested in metaphase II and only completes meiosis after
the entry of the spermatozoa at fertilisation.
Implantation of the embryo occurs at which stage?
Your answer:
Blastocyst
Correct answer:
Blastocyst
The answer is Blastocyst. Within 24 hours of fertilisation, the zygote undergoes
cleavage. It then further subdivides into blastomeres. By the third day, the
embryo contains 12 cells. By the fourth day, it is comprised of 16-32 cells and is
called a morula. On day 5, the blastocyst hat
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What inhibits glucagon releases?
Adrenaline
Exercise
Hypoglycaemia
Increased amino acids

Increased free fatty acids
What is the ratio of testosterone bound to sex hormone-binding globulin

(SHBG) and albumin respectively?
1% free, 19% albumin-bound and 80% SHBG-bound
What is the most common cause of hyperprolactinaemia?
Macroprolactinoma
Microprolactinoma
Primary hypothyroidism
Renal failure
Pituitary stalk interruption syndrome (PSIS)

Which part of the ovary is responsible for androgen production?
Granulosa cells
Leydig cells
Organ of Zuckerkandl cells
Sertoli cells
Theca cells
What is an appropriate endocrine response to low, detected serum calcium

levels?
Decreased parathyroid syndrome (PTH), increased phosphate excretion,

increased calcitriol and increased calcitonin
Decreased PTH, reduced phosphate excretion, increased calcitriol and

increased calcitonin
Increased PTH, increased phosphate excretion, increased calcitriol and reduced

calcitonin
Increased PTH phosphate excretion, reduced calcitriol and reduced calcitonin
Increased PTH, reduced phosphate excretion, increased calcitriol and reduced

calcitonin
Where in the body is aldosterone synthesized?
Distal tubules
Lung
Zona fasciculata
Zona reticularis
Zone glomerulosa
With regard to the renin-angiotensin system, where are the juxtaglomerular

cells located?
Afferent arteriole in the kidney
Afferent arteriole in the liver
Afferent arteriole in the lung
Efferent arteriole in the kidney
Efferent arteriole in the lung
What are the common features of Cushing syndrome?

Exophthalmos, renal calculi
Headache and proximal myopathy
Moon face and weight gain
Poor wound healing and polycythaemia
Renal calculi and changes in mental health
Which hormone has a structure similar to growth hormone?
Anti-müllerian hormone
Cortisol
Follicle-stimulating hormone
Insulin
Prolactin
Which of the following is the most reliable test for the diagnosis of Cushing
syndrome?
24-hour urine sample detecting cortisol level

Cortisol measurement taken at 0600 hours
Dexamethasone suppression test
Random cortisol measurement
Short adrenocorticotrophic hormone suppression test
What are the classical blood test results in Addison’s disease?
Hyperkalaemia, hyponatraemia, uraemia, hypercalcaemia and basophila
Hyperkalaemia, hyponatraemia, uraemia, hypercalcaemia and eosinophila
Hyperkalaemia, hyponatraemia, uraemia, hypocalcaemia and basophila
Hyperkalaemia, hyponatraemia, uraemia, hypocalcaemia and eosinophila
Hypokalaemia, hypernatraemia, uraemia, hypercalcaemia and eosinophila
Which hypothalamic hormone stimulates the release of prolactin?
Dopamine
Growth hormone releasing hormone

Gonadotrophin-releasing hormone
Somatostatin
Thyrotrophin-releasing hormone
Adrenomedullary hypersecretion is caused by which condition?
Addison’s disease
Conn syndrome
Cushing syndrome
Diabetes insipidus
Phaeochromocytoma
Leptin is a protein hormone secreted by adipose tissue. What stimulates its

release?
Catecholamines
High body mass index
Hypoinsulinaemia
Mineralocorticoids
Stress
Which hormone is responsible for the ovulation and initiation of luteinisation

of the follicle?
Estrogen
Luteinising hormone
Progesterone
The blood test of a 36-year-old fertility patient shows elevated luteinising

hormone (LH) levels and high estradiol levels. What is the most likely cause of
this?
Hypogonadotrophic hypogonadism
Midcycle LH surge
Ovarian failure
Weight-related amenorrhoea
Which hormone is made in the ovarian granulosa cells before ovulation

occurs?
Aldosterone
Alphafetoprotein
Antimüllerian hormone
Progesterone
Testosterone
Finish

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Tutorial history
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Assessment History
Total Attempts:5
Highest Score:100 %
Adrenaline
Exercise
Hypoglycaemia
Increased amino acids


Macroprolactinoma
Microprolactinoma
Renal failure
Pituitary stalk interruption syndrome (PSIS)
Granulosa cells
Leydig cells
Organ of Zuckerkandl cells
Sertoli cells
Theca cells

levels?
Decreased parathyroid syndrome (PTH), increased phosphate excretion,

increased calcitriol and increased calcitonin
Decreased PTH, reduced phosphate excretion, increased calcitriol and

increased calcitonin

calcitonin
Increased PTH phosphate excretion, reduced calcitriol and reduced calcitonin
Increased PTH, reduced phosphate excretion, increased calcitriol and reduced

calcitonin
Distal tubules
Lung
Zona fasciculata
Zona reticularis
Zone glomerulosa

cells located?
Afferent arteriole in the liver
Afferent arteriole in the lung
Efferent arteriole in the kidney
Efferent arteriole in the lung
Exophthalmos, renal calculi
Headache and proximal myopathy
Poor wound healing and polycythaemia

Renal calculi and changes in mental health
Anti-müllerian hormone
Cortisol
Insulin
Prolactin
syndrome?
24-hour urine sample detecting cortisol level
Cortisol measurement taken at 0600 hours
Random cortisol measurement
Short adrenocorticotrophic hormone suppression test

Hyperkalaemia, hyponatraemia, uraemia, hypercalcaemia and eosinophila
Hyperkalaemia, hyponatraemia, uraemia, hypocalcaemia and basophila
Hyperkalaemia, hyponatraemia, uraemia, hypocalcaemia and eosinophila
Hypokalaemia, hypernatraemia, uraemia, hypercalcaemia and eosinophila
Dopamine
Growth hormone releasing hormone
Somatostatin

Addison’s disease
Conn syndrome
Cushing syndrome
Diabetes insipidus
Phaeochromocytoma

release?
Catecholamines
Hypoinsulinaemia
Mineralocorticoids
Stress

of the follicle?
Estrogen
Luteinising hormone
Progesterone

this?
Hypogonadotrophic hypogonadism
Midcycle LH surge
Ovarian failure
Weight-related amenorrhoea

occurs?
Aldosterone
Alphafetoprotein
Progesterone
Testosterone
Finish
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Tutorial history
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Assessment History
Total Attempts:5
Highest Score:100 %
What enzyme converts androstenedione to estradiol?
5-alpha reductase
Catalyse
CYP19 aromatase
Transcriptase
What is the primary treatment of hyperthyroidism in pregnancy?
Carbimazole
Labetalol
Propylthiouracil
Radioactive iodine
Surgery
What is the most common cause of hyperthyroidism in the non-pregnant

woman?
Adenoma
Graves disease
Iodine excess
Subacute thyroiditis
Toxic multinodular goitre
What is the definition of premature menopause?
Menopause before 30 years of age
What is the most common cause of delayed puberty?
Constitutional delay
Low BMI
Ovarian failure
Pituitary failure
Turner syndrome
What is the definition of puberty in women?
Demonstration of stage 4 breast development
Demonstration of stage 5 breast development
Maturation of the HPO axis where by FSH secretion is greater than 10 IU
Physical maturation whereby the women becomes capable of sexual

reproduction
Physical maturation whereby the women first menstruates
Which three hormones consist of almost identical alpha chains?
ADH, oxytocin, FSH
FSH, LH, growth hormone
HCG, FSH, LH
HCG, ADH and FSH
TSH, growth hormone, HCG

What hormone is secreted by acidophil cells in the anterior pituitary?
Oxytocin
Growth hormone
FSH
LH
TSH
What hormone is significantly increased on day 0 of the menstrual cycle?
Estradiol
FSH
Inhibin
LH
Progesterone
With regard to the ovary, what cells produce testosterone?

Basal lamina
Cumulus granulosa
Leydig
Mural granulosa
Theca
What is the finite life span of the corpus luteum?
8 days
10 days
12 days
14 days
16 days
How many hours after the LH surge does ovulation occur?
3–6 hours
12–18 hours
24–36 hours
48–72 hours
Where in the body is calcidiol produced?
Kidneys
Liver
Parathyroids
Skin
Spleen
A 16-year-old primiparous woman presents to the Early Pregnancy Unit with a

two-day history of PV bleeding. She is approximately 7 weeks in to a
spontaneous unplanned pregnancy. She is otherwise fit and well. Her serum
βhCG is 94 000 iu/l. During pregnancy, from what structure is βhCG produced?
Cytotrophoblast
Decidua
Wharton’s jelly of umbilical cord
Secretory glands in endometrium
Syncytiotrophoblast
Finish
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Total Attempts:6
Highest Score:100 %
Your result88%
Your answer:
Correct answer:
The answer is increased free fatty acids. Glucagon is secreted by the alpha cells
of the pancreas. It increases hepatic glycogenolysis and also glyconeogenesis.
Adrenaline stimulates glucagon release in times of stress .This stimulates liver
glycogenolysis to ensure maximum glucose output to prepare for ‘flight or
fight' reaction. Hyperglycaemia inhibits glucagon release.

Your answer:
Correct answer:
The answer is 1% free, 19% albumin-bound and 80% SHBG-bound. Only 1% is

free but it is the albumin-bound fraction that is hormonally active.

Your answer:
Correct answer:
The answer is Primary hypothyroidism. Other common causes include

neuroleptic medication and dopamine D2 receptor anti-emetics.
Your answer:
Theca cells
Correct answer:
Theca cells
The answer is Theca cells. Luteneising hormone drives the conversion of

cholesterol into androgens in the theca cells. These androgens are then
transferred to the granulosa cells for conversion (aromatisation) into estrogen
(estradiol) under the influence of follicle-stimulating hormones.
levels?
Your answer:

calcitonin
Correct answer:

calcitonin
The answer is increased PTH, increased phosphate excretion, increased

calcitriol and reduced calcitonin. Low calcium levels are detected by the
parathyroid glands and PTH is secreted. PTH acts on the kidneys to increase
calcium absorption and also increase phosphate excretion. PTH also increases
the activity of 25-hydroxycholecalciferol, which converts calcidiol to calcitriol.
Your answer:
Zona reticularis
View correct answer

cells located?
Your answer:
Correct answer:
The answer is afferent arteriole in the kidney. Juxtaglomerular apparatus is

made up of the juxtaglomerular cells, lacis cells and macula densa. Renin is
secreted from the juxtaglomerular cells in response to a decrease in arterial
blood pressure (detected by the baroreceptors), a decrease in sodium chloride
(detected by the macula densa) and the sympathetic nervous system.
Your answer:
Correct answer:
The answer is moon face and weight gain. Although all of the above are
features of Cushing syndrome, only the following are common: moon face,
weight increase and central weight increase, changes in mental health,
impaired glucose tolerance, acne, bruising and proximal myopathy.
Your answer:
Prolactin
Correct answer:
Prolactin
The answer is Prolactin. Growth hormone is structurally similar to prolactin

and human placental lactogen.
syndrome?
Your answer:
Correct answer:

The answer is Dexamethasone suppression test. A 24-hour urine sample to
detect cortisol can be used for outpatients; however, a suppression test is
more reliable.
Your answer:
View correct answer
Your answer:
Correct answer:
The answer is Thyrotropin-releasing hormone. Thyrotrophin-releasing

hormone stimulates the release of TSH and prolactin from the anterior
pituitary. Dopamine also released from the hypothalamus inhibits prolactin
release.

Your answer:
Phaeochromocytoma
Correct answer:
Phaeochromocytoma
The answer is Phaeochromocytoma. Adrenomedullary hypersecretion is

caused by catecholamine-secreting tumours. It is characterised by
hypertension, pallor, headache and sweating and glucose intolerance. Conn
syndrome is associated with hypersecretion of aldosterone and is caused by an
adrenal adenoma. Diabetes insipidus is associated with the abscence of
antidiuretic hormone.

release?
Your answer:
Correct answer:

The answer is High body mass index. Leptin is a 167-amino acid product
derived from fat cells. Leptin receptors are found in the ovaries, the uterus, the
heart and skeletal tissue. Leptin provides a signal, reflecting the energy states
of the body, and may be involved in the control of appetite and reproduction.
It is a probable link between weight loss and menstruation. It is stimulated by
glucocorticoids, high body mass index, long-term hyperinsulinaemia and
excessive food ingestion.

of the follicle?
Your answer:
Luteinising hormone
Correct answer:
Luteinising hormone
The answer is Luteinising hormone (LH). Circulating estrogen levels rise in the
follicular phase and are responsible for the preovulatory surge of LH. This then
triggers the ovulation and initiates the luteinisation. Progesterone may have
some role in the LH surge, but the main factor is LH, which is responsible for
the above actions.

this?
Your answer:
Midcycle LH surge
Correct answer:
Midcycle LH surge
The answer is Midcycle LH surge. Polycystic ovary syndrome (PCOS) is

associated with high LH levels and usually normal estradiol levels. Ovarian
failure will result in high LH levels but low estradiol levels. Hypogonadotrophic
hypogonadism and weight-related amenorrhoea are associated with low LH
levels and low estradiol levels. PCOS results in a ratio of LH/Follicle-stimulating
hormone (FSH) > 1. The blood test may have been taken midcycle. In this case
we are not able to diagnose PCOS because we do not have a value for FSH.
Generally, women with PCOS have normal estradiol levels.

occurs?
Your answer:
Correct answer:
The answer is Antimüllerian hormone. The granulosa cells also convert
androgens produced by the theca cells into estrogen, and after ovulation, they
produce progesterone in the granulosa lutein cells.
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Assessment History
Total Attempts:6
Highest Score:100 %
Your result71%
Your answer:
5-alpha reductase
View correct answer
Correct answer:
CYP19 aromatase
The correct answer is CYP19 aromatase.
Your answer:
Propylthiouracil
Correct answer:
Propylthiouracil
The correct answer is propylthiouracil.

woman?
Your answer:
Graves disease
Correct answer:
Graves disease
The correct answer is Graves disease.
Your answer:
Correct answer:
The correct answer is menopause before 40 years of age.
Your answer:
Correct answer:
The correct answer is constitutional delay.
Your answer:

reproduction
Correct answer:

reproduction
The correct answer is physical maturation whereby the women becomes

capable of sexual reproduction.
Your answer:
HCG, FSH, LH
Correct answer:
HCG, FSH, LH
The correct answer is HCG, FSH and LH.
Your answer:
Growth hormone
Correct answer:
Growth hormone
The answer is growth hormone.

Your answer:
FSH
Correct answer:
FSH
The correct answer is FSH.
Your answer:
Leydig
View correct answer
Correct answer:
Theca
The correct answer is theca cells.

Your answer:
8 days
View correct answer
Correct answer:
14 days
The correct answer is 14 days.
Your answer:
24–36 hours
Correct answer:
24–36 hours
The correct answer is 24–36 hours.
Your answer:
Kidneys
View correct answer
Correct answer:
Liver
The correct answer is the liver.

Your answer:
Syncytiotrophoblast
Correct answer:
Syncytiotrophoblast
The best answer is syncytiotrophoblast.
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Exam preparation
Part 1 MRCOG
Tutorial history
Progress
100% complete
Submit
Assessment History
Total Attempts:6
Highest Score:100 %
Your result71%
Your answer:
5-alpha reductase
View correct answer
Correct answer:
CYP19 aromatase
The correct answer is CYP19 aromatase.
Your answer:
Propylthiouracil
Correct answer:
Propylthiouracil
The correct answer is propylthiouracil.

woman?
Your answer:
Graves disease
Correct answer:
Graves disease
The correct answer is Graves disease.
Your answer:
Correct answer:
The correct answer is menopause before 40 years of age.

Your answer:
Correct answer:
The correct answer is constitutional delay.
Your answer:

reproduction
Correct answer:

reproduction
The correct answer is physical maturation whereby the women becomes
capable of sexual reproduction.
Your answer:
HCG, FSH, LH
Correct answer:
HCG, FSH, LH
The correct answer is HCG, FSH and LH.
Your answer:
Growth hormone
Correct answer:
Growth hormone
The answer is growth hormone.
Your answer:
FSH
Correct answer:
FSH
The correct answer is FSH.
Your answer:
Leydig
View correct answer

Correct answer:
Theca
The correct answer is theca cells.
Your answer:
8 days
View correct answer
Correct answer:
14 days
The correct answer is 14 days.

Your answer:
24–36 hours
Correct answer:
24–36 hours
The correct answer is 24–36 hours.
Your answer:
Kidneys
View correct answer
Correct answer:
Liver
The correct answer is the liver.

Your answer:
Syncytiotrophoblast
Correct answer:
Syncytiotrophoblast
The best answer is syncytiotrophoblast.
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Epidemiology / Statistics
Tutorial history
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Epidemiology / Statistics
Assessment History
Total Attempts:4
Highest Score:100 %
25 pregnant women were sampled during the antenatal period, looking at the
number of episodes of urinary incontinence. This sample was from a
population of 3500. The number of episodes of incontinence per patient was
30, with a standard deviation of 10. What is the standard error of the mean?
10
If the mean booking weight of an antenatal population of 125 women was 80

kg and the standard error of the mean was 5 kg, what is the 95% confidence
interval?
40-120 kg
60-100 kg
65-95 kg
70-90 kg
75-85 kg
Diagnostic studies frequently use a receiver operating characteristic curve.
What do the two axes of the curve represent?
Accuracy versus 1/sensitivity
Positive likelihood ratio versus negative likelihood ratio
Positive predictive value versus negative predictive value
Sensitivity versus 1 – specificity
Sensitivity versus positive predictive value
If TP = true positive and FP = false positive, what is represented by the

equation TP / (TP + FP)?
Likelihood ratio
Negative predictive value
Positive predictive value
Sensitivity
Specificity
You wish to investigate the time it takes to perform a caesarean section on
women with and without pre-eclampsia. At the end of the study you have two
groups of women with the duration of caesarean sections recorded for each. It
can't be assumed that these are normally distributed. Which non-parametric
statistic test would you use?
Chi-squared test
Linear regression analysis
Mann-Whitney U test
Pearson’s R test
Student’s t-test
In appraising a study, it is important to assess the suitability of the research,

design and methods used in the context of a clinical condition. Which study
will provide the best evidence for a diagnostic test?
Case reports
Cohort study
Cost-benefit study
Cross-sectional study
Randomised controlled trial
Using the data in the table below, what is the likelihood ratio for an ultrasound
Doppler test for deep vein thrombosis (DVT)?
Number of DVT casesNumber of non-DVT casesPositive90 (a)5 (b)Negative10

(c)95 (d)
0.9
10
13.5
18
20
Which statistical test requires a normal population distribution?
Analysis of variance
Chi-squared test
Mann-Whitney U test
Spearman’s rank correlation

Wilcoxon rank-sum test
In a proposed clinical trial of a new uterine relaxant drug, what would be

associated with an increase in the sample size?
A decrease in the specified power of study
A decrease in the standard deviation of blood pressure measurements
A decrease in the type II error rate
An increase in the difference in the outcomes to be detected
An increase in the significant level from 1–5%
Squamous cell carcinoma accounts for approximately how many cases of vulval
cancer?
10%
30%
50%
70%
90%
A woman with a previous caesarean section arrives at term to your unit in

spontaneous labour. The midwife reports the cervix is 6 cm dilated, there is a
longitudinal lie and the vertex is well applied to the cervix. The woman is
contracting three times in 10 minutes. What would you tell this woman her risk
of scar rupture was?
1 in 50
1 in 100
1 in 1000
2 in 1000
2 in 10 000
Finish

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Part 1 MRCOG
Physiology page 1
Tutorial history
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Physiology page 1
Assessment History
Total Attempts:4
Highest Score:100 %
In the process of fertilisation, what is the correct sequence for sperm

penetration into the oocyte?
Corona radiata, zona pellucida, perivitelline space, plasma membrane
Corona radiata, zona pellucida, plasma membrane, perivitelline space
Zona pellucida, corona radiata, plasma membrane, perivitelline space
Zona pellucida, perivitelline space, corona radiata, perivitelline space
Zona pellucida, perivitelline space, plasma membrane, corona radiata
With regard to cardiovascular changes in pregnancy, what are the physiological

changes by the third trimester?
20% increase in blood volume, 35% increase in plasma volume and 10–20%
increase in red blood cell volume
increase red blood cell volume
There are different types of fetal haemoglobin produced throughout the

gestational period. What is the primary haemoglobin type at 32 weeks of
gestation?
Hb A
Hb F
Hb Gower 1
Hb Gower 2
Hb Portland
Fetal urine is an important contributor to the amniotic fluid volume. At what

gestation does fetal urine become the major contributor to amniotic fluid
volume?
10 weeks
12 weeks
14 weeks
16 weeks
18 weeks
The required daily intake of which vitamins and minerals is not increased in
pregnancy or lactation?
Folic acid
Iron
Vitamin A
Vitamin C
Vitamin D
At what gestational age does the formation of the definitive alveoli take place?
28 weeks
30 weeks
32 weeks
34 weeks
36 weeks
Which lung volume is decreased in pregnancy?
Forced expiratory volume
Functional residual capacity
Peak flow rate
Tidal volume
Vital capacity
Which test is used to diagnose haemolytic anaemia in a newborn?
Cord haemoglobin levels
Cord serum bilirubin levels
Direct Coombs test

Indirect Coombs test
Infection screening test
Signs of hypoglycaemia and hypocalcaemia are often similar. Which sign will
help differentiate the two in a newborn?
Cyanosis
High-pitched cry
Increased muscle tone
Jitteriness
Seizures
The physiological changes in pregnancy are associated with a change in serum

concentration of various hormones. Which test is most appropriate in
diagnosing the thyroid dysfunction in pregnancy?
Free thyroxine (T4) levels
Serum iodine levels
Serum triiodothyronine levels

Thyroid-binding globulin levels
Thyroid-stimulating hormone
A woman presents to the antenatal clinic at 30 weeks of gestation with vulval

varicosities. What is the most likely cause?
Decreased vascular resistance
Increased plasma volume
Increased cardiac output
Infection
Pressure effect of the gravid uterus on the inferior vena cava
What is the normal circulatory life span on a red blood cell?
20 days
40 days
80 days
120 days
160 days
What is the average lifespan of platelets?
5–10 days
10–20 days
40–80 days
80–120 days
120–160 days
What is the physiological mechanism for bile salts in pregnancy?
Aids the absorption of essential amino acids
Aids the absorption of fats
Helps to conjugate bilirubin
Helps to conjugate biliverdin
No known physiological function

Finish
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Exam preparation
Part 1 MRCOG
Physiology page 1
Tutorial history
Progress
100% complete
Submit
Physiology page 1
Assessment History
Total Attempts:4
Highest Score:100 %
In the process of fertilisation, what is the correct sequence for sperm

penetration into the oocyte?
Corona radiata, zona pellucida, perivitelline space, plasma membrane
Corona radiata, zona pellucida, plasma membrane, perivitelline space
Zona pellucida, corona radiata, plasma membrane, perivitelline space
Zona pellucida, perivitelline space, corona radiata, perivitelline space

Zona pellucida, perivitelline space, plasma membrane, corona radiata
With regard to cardiovascular changes in pregnancy, what are the physiological

changes by the third trimester?
increase in red blood cell volume
There are different types of fetal haemoglobin produced throughout the

gestational period. What is the primary haemoglobin type at 32 weeks of
gestation?
Hb A
Hb F
Hb Gower 1
Hb Gower 2
Hb Portland
Fetal urine is an important contributor to the amniotic fluid volume. At what

gestation does fetal urine become the major contributor to amniotic fluid
volume?
10 weeks
12 weeks
14 weeks
16 weeks
18 weeks
The required daily intake of which vitamins and minerals is not increased in
pregnancy or lactation?
Folic acid
Iron
Vitamin A
Vitamin C
Vitamin D
At what gestational age does the formation of the definitive alveoli take place?
28 weeks
30 weeks
32 weeks
34 weeks
36 weeks
Which lung volume is decreased in pregnancy?
Forced expiratory volume
Functional residual capacity
Peak flow rate
Tidal volume
Vital capacity
Which test is used to diagnose haemolytic anaemia in a newborn?
Cord haemoglobin levels
Cord serum bilirubin levels
Direct Coombs test
Indirect Coombs test
Infection screening test
Signs of hypoglycaemia and hypocalcaemia are often similar. Which sign will
help differentiate the two in a newborn?
Cyanosis
High-pitched cry
Increased muscle tone
Jitteriness
Seizures
The physiological changes in pregnancy are associated with a change in serum
concentration of various hormones. Which test is most appropriate in
diagnosing the thyroid dysfunction in pregnancy?
Free thyroxine (T4) levels
Serum iodine levels
Serum triiodothyronine levels
Thyroid-binding globulin levels
Thyroid-stimulating hormone
A woman presents to the antenatal clinic at 30 weeks of gestation with vulval

varicosities. What is the most likely cause?
Decreased vascular resistance
Increased plasma volume
Increased cardiac output
Infection
Pressure effect of the gravid uterus on the inferior vena cava

What is the normal circulatory life span on a red blood cell?
20 days
40 days
80 days
120 days
160 days
What is the average lifespan of platelets?
5–10 days
10–20 days
40–80 days
80–120 days
120–160 days
What is the physiological mechanism for bile salts in pregnancy?

Aids the absorption of essential amino acids
Aids the absorption of fats
Helps to conjugate bilirubin
Helps to conjugate biliverdin
No known physiological function
Finish
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Part 1 MRCOG
Physiology page 2
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Physiology page 2
Assessment History
Total Attempts:5
Highest Score:100 %
With regard to gestational diabetes, what is the likely change in plasma free
fatty acids (FFA) and plasma ketone bodies?
Decreased FFA and decreased ketone bodies
Increased FFA and decreased ketone bodies
Increased FFA and increased ketone bodies
Increased FFA and no change in ketone bodies
No change in FFA and increased ketone bodies
What cells are transformed by spermeogenesis?
Primary spermatocytes
Spermatids
Spermatogonia
Tertiary spermatocysts
How many times the normal range is alkaline phosphatase increased in

pregnancy?
x2
x3
x5
x10
x12
At what gestation is the physiological dilution of anaemia the greatest?
12 weeks of gestation
What is the increase in oxygen consumption in pregnancy?
10 ml/min
20 ml/min
30 ml/min
40 ml/min
50 ml/min
What lung function test volume is increased in pregnancy?
Expiratory reserve volume
Inspiratory reserve volume
Respiratory dead volume
Tidal volume
Total lung capacity
What is the change in FEV1 in pregnancy?
–20%
–10%
No change
+10%
+20%
What is the change in total lung capacity in pregnancy?
Decreased by 100 ml
Decreased by 200 ml
Increased by 100 ml
Increased by 200 ml
No change
What proportion of body calcium is stored in the skeletal system?
5%
10%
80%
90%
99%
What is the WHO definition of osteoporosis?
A spinal fracture or fracture of the hip with low calcium
T score < –1.0
T score < –2.5
Z score < –1.0
Z score < –2.5
What happens to gallbladder motility and bile composition in pregnancy?
Decreases gallbladder motility and decreases the lithogenicity of bile
Decreases gallbladder motility and increases the lithogenicity of bile
Has no effect on gallbladder motility and the lithogenicity of bile
Increases gallbladder motility and decreases the lithogenicity of bile
Increases gallbladder motility and increases the lithogenicity of bile

Regarding rheumatoid arthritis in pregnancy, which of the following is correct?
Epidural analgesia is relatively contraindicated
Exacerbation tends to occur in puerperium
Folic acid in high dose is beneficial
Methotrexate is safe to use in the second and third trimester
Usually exacerbates around 28–32 weeks of gestation
A primiparous 18-year-old woman presents to the maternity assessment unit

at 39 weeks of gestation. Urinalysis reveals a proteinuria value of 3+. The
woman has a blood pressure of 170/110 mmHg and she is suffering from a
headache. What underlying pathology would brisk reflexes indicate?
A stroke
Alcohol intoxication
Cerebral irritation
Hypothyroid disease
Lower motor neurone disease

A primiparous woman with a BMI of 40 from South East Asia is seen by you in
antenatal clinic. The woman is at 24 weeks of gestation and has a fundal height
of 30 cm. (Same scenario as above.) What vitamin would you prescribe for this
woman?
Vitamin A
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D
of 30 cm. What initial investigation do you organise?
24-hour urine collection
Glucose tolerance test.
Liver function tests
Referral to the dietician

Serum cholesterol
Finish
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Part 1 MRCOG
Physiology page 2
Tutorial history
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Physiology page 2
Assessment History
Total Attempts:6
Highest Score:100 %
Your result40%
With regard to gestational diabetes, what is the likely change in plasma free
fatty acids (FFA) and plasma ketone bodies?
Your answer:
Correct answer:
The correct answer is increased FFA and increased ketone bodies.
What cells are transformed by spermeogenesis?
Your answer:
Spermatids
Correct answer:
Spermatids
The correct answer is spermatids.
How many times the normal range is alkaline phosphatase increased in

pregnancy?
Your answer:
x2
View correct answer
At what gestation is the physiological dilution of anaemia the greatest?
Your answer:
View correct answer
What is the increase in oxygen consumption in pregnancy?
Your answer:
20 ml/min
View correct answer
What lung function test volume is increased in pregnancy?
Your answer:
Inspiratory reserve volume
View correct answer

What is the change in FEV1 in pregnancy?
Your answer:
No change
Correct answer:
No change
The correct answer is no change.
What is the change in total lung capacity in pregnancy?
Your answer:
No change
View correct answer
What proportion of body calcium is stored in the skeletal system?
Your answer:
10%
View correct answer
What is the WHO definition of osteoporosis?
Your answer:
T score < –2.5
Correct answer:
T score < –2.5
The correct answer is a T score < –2.5 .
CategoryT-score range% young womenNormalT-score ≥ –1.085%OsteopeniaT-

score between –2.5 and –1.014%OsteoperosisT-score ≤ –2.50.6%Severe
osteoperosisT-score ≤ –2.5 wth fragility fracture
What happens to gallbladder motility and bile composition in pregnancy?
Your answer:
Increases gallbladder motility and decreases the lithogenicity of bile

View correct answer
Regarding rheumatoid arthritis in pregnancy, which of the following is correct?
Your answer:
Correct answer:
The correct answer is exacerbation tends to occur in puerperium.
A primiparous 18-year-old woman presents to the maternity assessment unit

at 39 weeks of gestation. Urinalysis reveals a proteinuria value of 3+. The
woman has a blood pressure of 170/110 mmHg and she is suffering from a
headache. What underlying pathology would brisk reflexes indicate?
Your answer:
A stroke
View correct answer

of 30 cm. (Same scenario as above.) What vitamin would you prescribe for this
woman?
Your answer:
Vitamin B6
View correct answer
of 30 cm. What initial investigation do you organise?
Your answer:
Correct answer:
The best answer is glucose tolerance test.

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Part 1 MRCOG
Biophysics
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Biophysics
Assessment History
Total Attempts:5
Highest Score:100 %
Your result94%
What is the normal axis of the heart?
Your answer:
–30 to +90 degrees
Correct answer:
The answer is Minus 30 to plus 90 degrees. In cases of right ventricular

hypertrophy the axis shifts to the right and there is left shift with left
ventricular hypertrophy.
What is the frequency of a transvaginal ultrasound scan?

Your answer:
6 MHz
Correct answer:
6 MHz
The answer is 6 MHz. The higher the frequency the greater the axial resolution
of ultrasound meaning you can distinguish between structures based on their
distance from the ultrasound beam). Unfortunately, increasing the frequency
reduces the penetration of the beam. Transabdominal ultrasound therefore
requires a lower frequency and has a lower resolution. Lateral resolution
(distinguishing two structures that are the same distance away from the
ultrasound beam but are side by side) is not improved by increasing the
frequency and can only be increased by improving the focus of the beam.
In a Dexa bone mineral density scan the results are reported which two ways?
Your answer:
T score (compares the individual to a young adult where normal is greater than
–1) and
Z score (compares the individual to another individual of the same age and
gender)
Correct answer:
–1) and
gender)
The answer is T score (compares the individual to a young adult where normal
is greater than –1) and Z score (compares the individual to another individual
of the same age and gender).
A T score between +1 and –1 indicates a normal bone (since it is compared to a

younger population it is likely to be a negative cut off). A patient with a score
between –1 and –2.5 is osteopenic. A score of less then –2.5 is osteoporotic. A
Z score of less than -1 is suggestive of factors other than aging such as thyroid
problems, malnutrition, medications etc contributing to the osteoporosis.
You wish to achieve a cutting and simultaneous coagulation effect from the
diathermy machine. How is this best achieved?
Your answer:
Use monopolar diathermy with blended waveform
Correct answer:
The answer is Use monopolar diathermy with blended waveform. Bipolar can
only coagulate; it cannot cut and coagulate effectively.
In monopolar diathermy which feature prevents electrocution occurring?
Your answer:
High frequency
Correct answer:
High frequency
The answer is High frequency. The high frequency prevents depolarisation of

the cell. The voltage and current would certainly be enough for electrocution
to occur.
With regard to ultrasound with colour Doppler, how can the blue coloured
flow pattern be described?
Your answer:
Flow away from the colour box
Correct answer:
The answer is Flow away from the colour box. The colour only describes the
flow of the fluid towards (red) or away (blue) from the colour box. It does not
correlate to venous or arterial flow.
Which laser can be used in gynaecological surgery, is invisible without an aim
beam and cannot be transmitted down a fibre optic cable?
Your answer:
Carbon dioxide
Correct answer:
Carbon dioxide
The answer is Carbon dioxide. The CO2 laser generates an invisible light and
requires an aiming beam, usually helium–neon. It cannot be transmitted down
a fibre optic cable and is absorbed by water. It is used in cervical treatment but
is limited by the fact that it does not work in the presence of blood.
At the end of surgery you notice an area of burn near the attached diathermy
plate. The diathermy plate seems to be partially detached. Which of the
following would be the most likely aetiology?
Your answer:
Due to the plate not being secured properly, the current density was
concentrated in the smaller area where the plate was attached
Correct answer:
The answer is Due to the plate not being secured properly, the current density
was concentrated in the smaller area where the plate was attached. The
amount of thermal damage is dependent upon the current density and the size
of the current. The current density in the tip of the needle will be very high as
the current is concentrated in the small point. The plate used for the return
electrode in monopolar diathermy has a larger surface area of contact,
resulting in a much lower current density. Any thermal effect is therefore
widely dissipated. This highlights the need for the whole surface of the plate to
be securely attached to the body.
What would be the frequency of the electric current used in electrosurgery?
Your answer:
10 000 Hz
View correct answer
Correct answer:
500 Hz
The answer is 500 Hz. When an electric current of 50 Hz (household frequency)

passes through the body it causes an irreversible depolarisation of the cell
membrane. It may also cause depolarisation of cardiac muscles, resulting into
death. If the current frequency is increased above 200 Hz depolarisation does
not occur. Instead ions are excited to produce thermal effect. A frequency of
100 Hz may cause neuromuscular stimulation. The AM radio band utilises the
frequency of 10,000 Hz.
With regard to electrosurgery, if carbon is seen on the tip of an electrode the

surgeon can assume that, at some stage in the operation, what temperature
has been reached?
Your answer:
200°C
Correct answer:
200°C
The answer is 200°C. Necrosis occurs at 44°C. Coagulation occurs at 70°C.

Desiccation occurs at 90°C. Carbonisation occurs at 200°C.
Optimum intra-abdominal pressure should be achieved to insert the primary

trocar safely at laparoscopy. What is the optimum pressure range?
Your answer:
20–25 mmHg
Correct answer:
20–25 mmHg
The answer is 20–25 mmHg. An intra-abdominal pressure of 20–25 mmHg
results in increasing splinting. This allows the trocar to move more easily
through the abdominal layers. No adverse effect on respiratory function is
reported using such a pressure range. Once the primary trocar is inserted, the
secondary trocar can be visually introduced and the pressure can be lowered.
You have been asked to review an early pregnancy ultrasound scan that shows
a mean gestational sac of less than 25 mm and a crown rump length less than 6
mm with no visible fetal heart. What is the likely diagnosis?
Your answer:
Pregnancy of uncertain viability
Correct answer:
The answer is Pregnancy of uncertain viability. This woman should be

reassessed in 7 to 10 days time to assess viability, according to RCOG criteria. If
the gestational sac is larger than 25 mm with no fetal pole, it is suggestive of
silent miscarriage. Individual hospital guidelines vary. Pregnancy of unknown
location is a condition where serum beta-hCG is above the discriminatory zone
for ultrasound detection, but no intra or extrauterine pregnancy is detected on
the scan.
In the case of hypocalcaemia, what electrocardiography (ECG) changes

typically occur?
Your answer:
Long QT interval
Correct answer:
Long QT interval
The answer is Long QT interval. This is clinically important because it can result
in a cardiac arrest. Long QT syndrome can have a genetic basis, both with
recessive and dominant modes of transmission. There are several drugs that
can cause a long QT interval including haloperidol, erythromycin and
terfenadine.
With regard to the jugular venous pressure (JVP) waveform, what can cause an
elevated JVP reading with a normal waveform?
Your answer:
Right-sided heart failure
Correct answer:
The answer is Right-sided heart failure. Although tricuspid valve disorders can
cause an elevated JVP, there will not be a normal wave form.
A 53-year-old woman presents with chronic renal failure and a potassium
concentration of 5.8 mmol/l. An electrocardiography (ECG) has been
requested. What ECG feature can occur with this potassium concentration?
Your answer:
Tall T waves, wide QRS complex
Correct answer:
The answer is Tall T waves, wide QRS complex. These are important to note
because sudden cardiac arrest can occur if corrective action is not taken.

HCG is 94 000 iu/l. An ultrasound scan is performed on this patient which
shows no evidence of a fetal pole, but does show a placental mass in the
uterus, containing multiple echoes with a 'bunch of grapes' appearance. These
ultrasound findings are characteristic of which condition?
Your answer:
Complete hydatidiform mole
Correct answer:
The best answer is complete hydatidiform mole.
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Part 1 MRCOG
Biophysics
Tutorial history
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Biophysics
Assessment History
Total Attempts:4
Highest Score:100 %
What is the normal axis of the heart?
–0 to +90 degrees

Zero to +90 degrees
What is the frequency of a transvaginal ultrasound scan?
2 MHz
6 MHz
18 MHz
23 MHz
32 MHz
In a Dexa bone mineral density scan the results are reported which two ways?
–1) and
gender)
0) and
gender)
Z score (compares the individual to a young adult where normal is greater than
-1) and
T score (compares the individual to another individual of the same age and
gender)
0) and
gender)
–2.5) and
gender)
You wish to achieve a cutting and simultaneous coagulation effect from the
diathermy machine. How is this best achieved?
Use bipolar diathermy with blended waveform
Use bipolar diathermy with yellow (cutting pedal)
Use fulguration
Use monopolar diathermy with yellow (cutting) and blue (coagulation) pedal
simultaneously
In monopolar diathermy which feature prevents electrocution occurring?

Direct current (DC) not alternative current (AC)
High frequency
Low current
Low voltage
The patient is earthed
With regard to ultrasound with colour Doppler, how can the blue coloured
flow pattern be described?
Deoxygenated blood flow
Flow towards the colour box
Low volume of flow per unit area
Venous flow pattern
Which laser can be used in gynaecological surgery, is invisible without an aim

beam and cannot be transmitted down a fibre optic cable?
Argon
Carbon dioxide
Helium–neon
Neodymium:YAG
Potassium titanyl phosphate
At the end of surgery you notice an area of burn near the attached diathermy
plate. The diathermy plate seems to be partially detached. Which of the
following would be the most likely aetiology?
High voltage was used
The injury may have resulted from insulation failure
The power output was accidentally turned up
The surgeon may have accidently touched the instrument to the patient’s thigh
What would be the frequency of the electric current used in electrosurgery?

35 Hz
50 Hz
100 Hz
500 Hz
10 000 Hz
With regard to electrosurgery, if carbon is seen on the tip of an electrode the

surgeon can assume that, at some stage in the operation, what temperature
has been reached?
44°C
70°C
90°C
150°C
200°C
Optimum intra-abdominal pressure should be achieved to insert the primary

trocar safely at laparoscopy. What is the optimum pressure range?
10–15 mmHg
10–15 mm water
15–18 mmHg
20–25 mmHg
20–25 mm water
You have been asked to review an early pregnancy ultrasound scan that shows
a mean gestational sac of less than 25 mm and a crown rump length less than 6
mm with no visible fetal heart. What is the likely diagnosis?
Inevitable miscarriage
Missed miscarriage
Pregnancy of unknown location
Threatened miscarriage
In the case of hypocalcaemia, what electrocardiography (ECG) changes

typically occur?
Long QT interval
Short QT interval
ST depression
ST elevation
The presence of Q waves
With regard to the jugular venous pressure (JVP) waveform, what can cause an
elevated JVP reading with a normal waveform?
Atrial fibrillation
Left-sided heart failure
Tricuspid regurgitation
Tricuspid stenosis
A 53-year-old woman presents with chronic renal failure and a potassium

concentration of 5.8 mmol/l. An electrocardiography (ECG) has been
requested. What ECG feature can occur with this potassium concentration?
Flattened T Waves, ST depression
Flattened T waves, ST elevation
Tall T waves, ST depression
Tall U waves, ST depression

HCG is 94 000 iu/l. An ultrasound scan is performed on this patient which
shows no evidence of a fetal pole, but does show a placental mass in the
uterus, containing multiple echoes with a 'bunch of grapes' appearance. These
ultrasound findings are characteristic of which condition?
Endometrioma
Live intrauterine pregnancy
Missed miscarriage
Partial hydatidiform mole

Finish
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Part 1 MRCOG
Clinical management
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Clinical management
Assessment History
Total Attempts:4
Highest Score:100 %
A 16-year-old woman presents with secondary amenorrhoea. She is healthy,

with no past medical history. Her BMI is 17. What is the most appropriate
initial investigation?
Bone mineral density scan
Dehydroepiandrosterone sulphate (DHEAS) measurement
Follicle-stimulating hormone measurement
Karyotype
Thyroid function test

A 55-year-old woman presents to the clinic enquiring about the use of
hormone replacement therapy (HRT). She had a hysterectomy 8 years ago for
fibroids. She has no contraindications or other past medical history, except a
strong family history of osteoporosis. Her main symptoms are hot flushes and
vaginal dryness. What would be your first treatment option?
A selective estrogen receptor modulator
Combined sequential HRT
Estrogen-only HRT
Oral calcium therapy only
Selective serotonin reuptake inhibitor
An 18-year-old woman presents to an early pregnancy unit with light vaginal

bleeding after 10 weeks of amenorrhea. She had taken a pregnancy test 4
weeks ago that had tested positive. A transvaginal ultrasound scan showed an
irregular gestation sac with no fetal pole. What is the likely diagnosis?
Anembryonic pregnancy
Complete miscarriage
Hydatidiform mole
Incomplete miscarriage
Threatened miscarriage
A primigravid woman presents in spontaneous labour at 39 weeks of gestation.

At 18:00h, her cervical dilatation is 6 cm. A further vaginal examination at
22:00h reveals that cervical dilatation is still at 6 cm. At 02:10h, the fetus is in
the occipitoposterior position and uterine activity is present. What is the most
appropriate action?
Amniotomy
Commence intravenous oxytocin
Membrane sweep
Repeat vaginal examination after 2 hours
A 17-year-old woman presents to the sexual health clinic with vulval ulceration
and difficulty in passing urine. She is sexually active and has had unprotected
intercourse with her new boyfriend. She takes the combined oral
contraceptive pill. What is the most likely diagnosis?
Candida albicans
Herpes simplex virus

Herpes varicella virus
Human papillomavirus
Syphilis
Whilst you are attending to a woman in the antenatal ward, the

woman collapses and becomes unresponsive. You open their airway but they
are not breathing. What should you do next?
Commence artificial ventilation
Commence cardiac compressions
Get help
Give a precordial thump
Left lateral tilt
You answer an emergency call for a postpartum haemorrhage. The midwife

estimates that the woman has lost approximately 1 l of blood. What should
you be your first action?
Assess the woman’s airway, breathing and circulation and administer oxygen
at a rate of 15 l/min
Bimanual compression of the uterus
Catheterise the bladder
Obtain blood for cross match of 4 units
Site two large bore intravenous cannulae

estimates that the woman has lost approximately 500 ml of blood. What is the
most likely cause of the bleeding?
Cervical trauma
Coagulopathy
Retained placenta tissue
Uterine atony
Vaginal tear
A cardiotocograph shows type 1 variable decelerations. What is the cause of

this feature?
Fetal head compression

Fetal hypoxia
Fetal movements
Placental insufficiency
Umbilical cord compression
You are asked to assess a woman who is receiving magnesium sulphate

infusions for severe pre-eclampsia. They have passed only 5 ml urine in the last
2 hours. Tests demonstrate that their deep tendon reflexes are absent. What
other observation should you take?
Blood pressure
Glasgow coma score
Pulse rate
Respiratory rate
Temperature
Polyglactin sutures are used extensively in surgical procedures, particularly to

ligate vessels. What are the key features of polyglactin sutures?
Braided, absorbable and synthetic

Braided, non-absorbable and synthetic
Non-braided, absorbable and natural
Non-braided, absorbable and synthetic
Non-braided, non-absorbable and natural
A nulliparous woman presents with spontaneous rupture of membranes at 41

weeks of gestation. At 18:00h, her cervical dilatation is 3 cm. A further vaginal
examination at 22:00h reveals that her cervical dilatation is still 3 cm. At
02:10h, the fetus is in the occipitoposterior position and uterine activity is
present. What is the most appropriate action?
Administer prostaglandin per vaginam
Caesarean section
Membrane sweep
A 68-year-old woman presents with two episodes of postmenopausal bleeding.

She has a BMI of 23 and is otherwise healthy. An ultrasound shows that her
endometrial cavity is 4 mm thick, and an endometrial pipelle sample is taken
that yields a small volume of tissue. The pathology report suggests a neoplasm.
What is the most likely diagnosis?
Leiomyoma
Endometrial hyperplasia
Endometrial polyp
Endometrioid adenocarcinoma
Serous carcinoma
A 75-year-old woman presents with increased weight, loss of hair and a dislike
of cold weather. She was noted to have a high prolactin and normal
electrolytes. She is otherwise fit and well. What is the likely cause of the high
prolactin?
Antiemetic use
Hypothyroidism
Neuroleptic use
Prolactinoma
Renal failure
The midwife has asked you to review a 34-year-old multigravida who is 7 cm
dilated and progressing well. The CTG shows a variability of <5. She was given
pethidine when she was 6 cm dilated. A fetal blood sampling is done and
reveals a pH of 7.23. What will be your next line of management?
Delivery is indicated
Reassure the woman
Repeat FBS after 1 hour
Repeat FBS if fetal heart rate abnormality persists
Repeat FBS within 30 minutes
A 30-year-old primigravida who is pregnant after IVF attends the Early

Pregnancy Unit with severe right sided abdominal pain. An ultrasound scan
shows an empty uterus. β-hCG levels are 5,500 iu/L. What is the appropriate
course of action?
Expectant management, evaluate after 48 hours with repeat hCG levels
Laparoscopy and salpingectomy if there is an ectopic pregnancy
Laparoscopy and salpingotomy if there is an ectopic pregnancy
Methotrexate injection
Repeat scan in 7 days

sends her for an urgent abdominal ultrasound scan and initiates a 2-week-wait
referral. This woman is discussed at an MDT meeting and it is decided to
proceed with a laparatomy. During the laparotomy, a full examination is
performed to look for possible metastatic spread. If this cancer is presumed to
be ovarian, which lymph nodes would you expect the disease to drain to first?
External iliac lymph nodes
Hypogastric lymph nodes
Inguinal lymph nodes
Internal iliac lymph nodes
Para-aortic lymph nodes
A 28-year-old primiparous woman is induced at 39+2 due to a raised blood

pressure and significant proteinuria. She progresses well to full dilatation but
after pushing for 2 hours there is no vertex visible. A decision is made for an
instrumental delivery, and the baby is delivered via an assisted vaginal delivery
in theatre. The episiotomy extends and the tear involves approximately 60% of
the external anal sphincter. The internal anal sphincter and anal mucosa are
intact. How would you classify this perineal trauma?
Second degree tear

3a degree tear
3b degree tear
3c degree tear
Fourth degree tear

after pushing for 2 hours there is no vertex visible. On examination, the head is
felt to be in an occiput anterior position at +1 station. A decision is made for an
instrumental delivery, and the baby is delivered via assisted vaginal delivery in
theatre. For a ventouse delivery to be successful, the ventouse cup needs to be
applied to the flexion point of the fetal head. Where on the fetal head is the
flexion point located?
Approximately 3 cm anterior (in front) of the anterior fontanelle
Directly over the anterior fontanelle
Directly over the posterior fontanelle
On the sagittal suture line, approximately 2 cm posterior (behind) the posterior

fontanelle
On the sagittal suture line, approximately 3 cm anterior (in front) of the

posterior fontanelle
contracting three times in 10 minutes. The contractions stop and there is a
fetal bradycardia. What is the most likely diagnosis?
Placental abruption
Scar dehiscence
Scar rupture
Tetanic uterine contractions
Uterine atony

contracting three times in 10 minutes. You are asked to assess the woman by
the registrar on call as he is in theatre. What initial management would you
suggest?
You immediately perform a fetal blood sample
You suggest continuous fetal monitoring (CFM) and syntocinon infusion

You suggest continuous fetal monitoring (CFM) and vaginal assessment 2 hours
following the last VE
You suggest intermittent monitoring and 1 hourly vaginal assessments
You suggest mobilisation
A 15-year-old girl visits her GP requesting a method of contraception. When

taking her history, you discover a personal history of thromboembolic events.
She has had three sexual partners in 5 months. She also complains of
dysmenorrhea. You advise on contraception being mindful of which medical
law?
Abortion Act 1967
Bolam
Bolitho
Fraser
Gillick
Finish
© 2018
27 Sussex Place
Regent's Park
London NW1 4RG
UK
Tel +44 20 7772 6200
Fax +44 20 7723 0575
Contact Us
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Exam preparation
Part 1 MRCOG
Clinical management
Tutorial history
Progress
100% complete
Submit
Clinical management
Assessment History
Total Attempts:5
Highest Score:100 %
Your result86%

Your answer:
Correct answer:
The answer is follicle-stimulating hormone measurement. The likely diagnosis

is amenorrhoea caused by weight loss, so follicle-stimulating hormone
measurements would be appropriate. Since she is clinically euthyroid, thyroid
function tests would be of limited value.
Your answer:
Estrogen-only HRT
Correct answer:
Estrogen-only HRT
The answer is estrogen-only HRT. HRT provides the most effective method of
treating climacteric hot flushes and vaginal dryness, as well as postmenopausal
osteoporosis. Estrogen-only HRT is appropriate following a hysterectomy, as
the risk of endometrial carcinoma is not present.

Your answer:
Correct answer:
The answer is anembryonic pregnancy. Threatened miscarriage refers to

vaginal bleeding in the presence of a viable pregnancy; however, this
pregnancy is not viable. There are products of conception (gestation sac) that
are visible on the scan so this is an incomplete miscarriage, which is usually
associated with heavy vaginal bleeding. In this case, the woman is considered
to be pregnant, although no embryonic tissue is present. Therefore, the most
likely diagnosis is anembryonic pregnancy.

appropriate action?
Your answer:
Amniotomy
Correct answer:
Amniotomy
The answer is amniotomy. This case demonstrates slow/no progression during

the first stage of labour and malpositioning of the fetus. The most appropriate
initial intervention would be an amniotomy (artificial rupture of the
membranes).
Your answer:
Correct answer:
The answer is herpes simplex virus. A painful genital ulcer has developed in a
sexually active patient who has not used barrier contraception. Syphilis is
usually associated with the presence of a painless ulcer. Candida is not a
sexually transmitted disease and rarely presents with ulceration. Human
papillomavirus causes warts, and herpes varicella zoster causes chicken pox
and shingles.

Your answer:
Get help
Correct answer:
Get help
The answer is get help. Basic and Advanced Life Support guidelines highlight
the need to get help if a patient has collapsed and is unresponsive. You should
then place the patient in left lateral tilt and commence cardiac compressions at
a rate of 30:2. Artificial ventilation is not mandatory in the ALS guidelines.

Your answer:
Correct answer:
The answer is assess the woman’s airway, breathing and circulation and
administer oxygen at a rate of 15 l/min. In an acute emergency, one should
always assess the airway, breathing and circulation before addressing the
secondary treatment. In practice, this may be talking to the woman and to see
if they respond.
Your answer:
Uterine atony
Correct answer:
Uterine atony
The answer is uterine atony. Approximately 70% of all postpartum

haemorrhages are due to uterine atony.

this feature?
Your answer:
Correct answer:
The answer is umbilical cord compression. Variable decelerations are due to

umbilical cord compression. Early decelerations are caused by compression of
the fetal head, and late decelerations are caused by fetal hypoxia that is
secondary to placental insufficiency. Fetal movements are related to
accelerations.

Your answer:
Respiratory rate
Correct answer:
Respiratory rate
The answer is respiratory rate. This woman has signs of magnesium toxicity
(absent deep tendon reflexes), which is probably secondary to renal
impairment. Respiratory depression is a sign of increasing magnesium toxicity
is; therefore, the most appropriate follow-up would be to investigate the
woman's respiratory rate.

Your answer:

Correct answer:
The answer is braided, absorbable and synthetic. Polyglactin sutures are used
to ligate pedicles and close the uterus during a caesarean section. To achieve
this, the sutures are braided to prevent the knots from slipping.

Your answer:
Correct answer:
The answer is commence intravenous oxytocin. The membranes have ruptured

already so amniotomy is not required. No progression has been made during
the first stage of labour. Therefore, the woman should be administered
intravenous oxytocin.
Your answer:
Serous carcinoma
Correct answer:
Serous carcinoma
The answer is serous carcinoma. Serous carcinomas are typically seen in

postmenopausal women. The development of these carcinomas is not
associated with a raised BMI, diabetes or hypertension. The uterine tumour
can be very small (even in the presence of extra uterine spread), and therefore,
results from an ultrasound and even hysteroscopy can appear normal.
prolactin?
Your answer:
Hypothyroidism
Correct answer:
Hypothyroidism
The correct answer is hypothyroidism.

Your answer:
Reassure the woman
View correct answer
Correct answer:
The correct answer is repeat FBS within 30 minutes.

course of action?
Your answer:
View correct answer
Correct answer:
The correct answer is laparoscopy and salpingectomy if there is an ectopic

pregnancy.

Your answer:
Correct answer:
The best answer is para-aortic lymph nodes.

Your answer:
3b degree tear
Correct answer:
3b degree tear
The best answer is a 3b degree tear. Note that the risk of perineal tearing after
instrumental delivery is 7% for forceps and 4% for ventouse.

Your answer:

Correct answer:

The best answer is on the sagittal suture line, approximately 3 cm anterior (in
front) of the posterior fontanelle.
Your answer:
Scar rupture
Correct answer:
Scar rupture
The best answer is scar rupture as the fetus is compromised.

suggest?
Your answer:

View correct answer
Correct answer:
The best answer is CFM and vaginal assessment 2 hours following the last VE.

law?
Your answer:
Fraser
Correct answer:
Fraser
The correct answer is Fraser. This law refers specifically to contraception.

© 2018
27 Sussex Place
Regent's Park
London NW1 4RG
UK
Tel +44 20 7772 6200
Fax +44 20 7723 0575
Contact Us
Accessibility

Terms & conditions
facebook
twitter
linkedin
google
youtube
vimeo

Toggle navigation
Search StratOG
Home
Exam preparation
Part 1 MRCOG
Clinical management
Tutorial history
Progress
100% complete
Submit
Clinical management
Assessment History
Total Attempts:5
Highest Score:100 %
Your result86%

Your answer:
Correct answer:

The answer is follicle-stimulating hormone measurement. The likely diagnosis
is amenorrhoea caused by weight loss, so follicle-stimulating hormone
measurements would be appropriate. Since she is clinically euthyroid, thyroid
function tests would be of limited value.

Your answer:
Estrogen-only HRT
Correct answer:
Estrogen-only HRT
The answer is estrogen-only HRT. HRT provides the most effective method of
treating climacteric hot flushes and vaginal dryness, as well as postmenopausal
osteoporosis. Estrogen-only HRT is appropriate following a hysterectomy, as
the risk of endometrial carcinoma is not present.

Your answer:
Correct answer:
The answer is anembryonic pregnancy. Threatened miscarriage refers to

vaginal bleeding in the presence of a viable pregnancy; however, this
pregnancy is not viable. There are products of conception (gestation sac) that
are visible on the scan so this is an incomplete miscarriage, which is usually
associated with heavy vaginal bleeding. In this case, the woman is considered
to be pregnant, although no embryonic tissue is present. Therefore, the most
likely diagnosis is anembryonic pregnancy.

appropriate action?
Your answer:
Amniotomy
Correct answer:
Amniotomy
The answer is amniotomy. This case demonstrates slow/no progression during
the first stage of labour and malpositioning of the fetus. The most appropriate
initial intervention would be an amniotomy (artificial rupture of the
membranes).
Your answer:
Correct answer:
The answer is herpes simplex virus. A painful genital ulcer has developed in a
sexually active patient who has not used barrier contraception. Syphilis is
usually associated with the presence of a painless ulcer. Candida is not a
sexually transmitted disease and rarely presents with ulceration. Human
papillomavirus causes warts, and herpes varicella zoster causes chicken pox
and shingles.

Your answer:
Get help
Correct answer:
Get help
The answer is get help. Basic and Advanced Life Support guidelines highlight
the need to get help if a patient has collapsed and is unresponsive. You should
then place the patient in left lateral tilt and commence cardiac compressions at
a rate of 30:2. Artificial ventilation is not mandatory in the ALS guidelines.

Your answer:
Correct answer:
The answer is assess the woman’s airway, breathing and circulation and
administer oxygen at a rate of 15 l/min. In an acute emergency, one should
always assess the airway, breathing and circulation before addressing the
secondary treatment. In practice, this may be talking to the woman and to see
if they respond.

Your answer:
Uterine atony
Correct answer:
Uterine atony
The answer is uterine atony. Approximately 70% of all postpartum

haemorrhages are due to uterine atony.

this feature?
Your answer:
Correct answer:

The answer is umbilical cord compression. Variable decelerations are due to
umbilical cord compression. Early decelerations are caused by compression of
the fetal head, and late decelerations are caused by fetal hypoxia that is
secondary to placental insufficiency. Fetal movements are related to
accelerations.

Your answer:
Respiratory rate
Correct answer:
Respiratory rate
The answer is respiratory rate. This woman has signs of magnesium toxicity
(absent deep tendon reflexes), which is probably secondary to renal
impairment. Respiratory depression is a sign of increasing magnesium toxicity
is; therefore, the most appropriate follow-up would be to investigate the
woman's respiratory rate.

Your answer:
Correct answer:
The answer is braided, absorbable and synthetic. Polyglactin sutures are used
to ligate pedicles and close the uterus during a caesarean section. To achieve
this, the sutures are braided to prevent the knots from slipping.

Your answer:
Correct answer:
The answer is commence intravenous oxytocin. The membranes have ruptured

already so amniotomy is not required. No progression has been made during
the first stage of labour. Therefore, the woman should be administered
intravenous oxytocin.
Your answer:
Serous carcinoma
Correct answer:
Serous carcinoma
The answer is serous carcinoma. Serous carcinomas are typically seen in

postmenopausal women. The development of these carcinomas is not
associated with a raised BMI, diabetes or hypertension. The uterine tumour
can be very small (even in the presence of extra uterine spread), and therefore,
results from an ultrasound and even hysteroscopy can appear normal.
prolactin?
Your answer:
Hypothyroidism
Correct answer:
Hypothyroidism
The correct answer is hypothyroidism.

Your answer:
Reassure the woman
View correct answer
Correct answer:
The correct answer is repeat FBS within 30 minutes.

course of action?
Your answer:
View correct answer
Correct answer:
The correct answer is laparoscopy and salpingectomy if there is an ectopic

pregnancy.

Your answer:
Correct answer:
The best answer is para-aortic lymph nodes.

Your answer:
3b degree tear
Correct answer:
3b degree tear
The best answer is a 3b degree tear. Note that the risk of perineal tearing after
instrumental delivery is 7% for forceps and 4% for ventouse.

Your answer:

Correct answer:

The best answer is on the sagittal suture line, approximately 3 cm anterior (in
front) of the posterior fontanelle.
Your answer:
Scar rupture
Correct answer:
Scar rupture
The best answer is scar rupture as the fetus is compromised.

suggest?
Your answer:

View correct answer
Correct answer:
The best answer is CFM and vaginal assessment 2 hours following the last VE.

law?
Your answer:
Fraser
Correct answer:
Fraser
The correct answer is Fraser. This law refers specifically to contraception.

© 2018
27 Sussex Place
Regent's Park
London NW1 4RG
UK
Tel +44 20 7772 6200
Fax +44 20 7723 0575
Contact Us
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linkedin
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youtube
vimeo

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Celiac trunk artery

Dorsal branch of the pudendal nerve

A glycosaminoglycan layer coats the luminal surface of the bladder mucosa

Greater sciatic foramen

Common iliac nodes

Tel +44 20 7772 6200

The superficial inguinal ring is strengthened posteriorly by what structure?

A urinary catheter is vigorously inflated in the urethra at the time of caesarean

Sympathetic supply to the bladder is derived from which lumbar segments?

SBAs for Part 1 MRCOG online resource

View last resultsView highest resultRetake quiz

What artery supplies the distal third of the transverse colon?

Inferior mesenteric artery

Inferior mesenteric artery

The correct answer is the inferior mesenteric artery.

What nerve supplies to the anterior one-third of the labium majus?

View correct answer

The correct answer is ilioinguinal nerve. Posterior two-thirds of the perineal

What part of the spermatozoa has the highest concentration of mitochondria?

View correct answer

Which testicular cells are located outside the blood/testis barrier?

The correct answer is leydig cells.

What type of cells are sertoli cells as defined by shape?

Epithelia with gap junctions

View correct answer

The correct answer is tall columnar.

View correct answer

The correct answer is basal lamina.

The correct answer is antrum.

What size is a resting follicle?

View correct answer

The correct answer is 0.02 mm.

The correct answer is 20 mm.

Regarding the urinary bladder, which of the following is correct?

The bladder wall consists of two layers of detrusor muscle

View correct answer

The correct answer is a glycosaminoglycan layer coats the luminal surface of

Greater sciatic foramen

Greater sciatic foramen

The correct answer is ilioinguinal nerve.

Lymphatic drainage of the uterus is primarily to:

Internal iliac nodes

The correct answer is internal iliac nodes.

The correct answer is gubernaculum.

The correct answer is the ilieolumbar artery.

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Which of the following blood clotting factors activates fibrinogen in the

Ribosomes are located in which part of the cell?

You have been asked to review an asymptomatic patient in the early

Complete androgen insensitivity syndrome

Polycystic ovary syndrome

Where is a fetus is alpha-fetoprotein synthesised?

Elevated calcium, elevated phosphate and elevated alkaline phosphatise

Ammonium and chloride

Decreased CO2 concentration

Distal convoluted tubules