MRCOG Part 2 – March 2015 recalls.

 These are recalls. Some may be poorly recalled, but at least we tried.
 None of the answers are guarernteed true, in fact they were nothing but “common thoughts”.
Actually; for some questions; we couln’t even remember the given answers.
 Thanks to all who participated.
 If any one can recall more questions, more details, please post so we can modify.
 On top of all that, thanks alot for our leader, D. Mustafa.

GYNE
 statistics: [some of them came in obs]
• EMQ :What type of test should be used:
Options: Almost all types of tests were given
Questions:
1. We want to find the relationship between Um.A doppler & pre-eclamsia, after other
factors like age, parity, BMI are taken into consideration.
2. To find the relationship between maternal BMI & fetal birth wt.
3. To look for the different outcomes of pregnancy in relation to BMI.
• Name of the study:
4. To measure the outcome of breech delivery. Women were assigned into 2 groups:
vaginal & c/s ; & followed up.
Options:

 oncology:
• EMQ: Counselling about 5 rys survival rate
Options : Different figures
Qeustions: (May be changed next exams)
5. Stage 2b cx
6. 1a ovary (i think it was specifically mucinous).
7. 1b endometrium
• SBA:
8. An old woman with ?1cm mass in clitoris. What should be the enxt step to reac ha
diagnosis?
Options included exisional biopsy/incisional from centre surface/incisional from
margin/wide local exision + LND
9. A woman undergone evac of delayed miscarrige. Histopath. --> Complete mole. What is
the risk of developing chorio carcinoma?
Options: 1:20, 1:40 , 1:60 , 1:80 , 1:100. [15% was NOT there]
10. what is the % of bilaterality of dermoid.
Options: I think started with 10%, then bigger figures; 15% up to 40%.
11. Management option after treatment[LLETZ] for CIN 3 with biopsy showing unclear
margins?
[? test of cure + smear after 6 m]
12. Management option after treatment[LLETZ], age 52, biopsy showed CIN1+cGIN reaching
excitional margins.
 Options: cone biopsy, TAH, Radical hysterectomy,& others i can’t remember.

 Ethics/clinical goverannce
• EMQ: Options were many. We recalled these:
 Woman wtitten consent
 Woman to sign consent & assessing that she understands what she's consenting to
 Girl or woman verbal consent
 Can’t proceed as the consent requirements not complete
 Encourage girl to tell parents (Gillick/frasers’s were not in the options)
Questions:
13. Emergency c/s, mother refuse to sign consent. Father insist for c/s
14. A 15 yr girl came with boy friend (15 yrs) for TOP [GA ?17 wks] & they look
aware/understanding.
15. A 14 yrs girl came for ERPOC.
• EMQ:
Options: Too many. Unfortunately can’t recall most of them.
Questions:
16. I think a patient died & the coroner request the pt medical records. Option list included
full access, restricted access & ?deny access were in the option list.
17. A woman who underwent TVT 3 yrs ago now have symptoms recurred & she asks for her
medical records. [full or restricted access to patient records??]
18. A woman diagnosed with severe diskaryosis, colposcopy recommended. She moved
house & no lettre reached her to come back to follow up ( can't remember options). I
think later on she came with cancer.
19. A doctor carrying a study has took the study papers home [papers with private patient
info]. The study papers were stolen. (what should the hospital do?)
There were options like “report never event”, “report to information handling commitee”
20. A study carried out to compare suture material used &seniority of surgeon in suturing
3rd 4th degree perineum tear & compare it against rcog guideline.
• EMQ: Unexpected pathology during surgery.
Options:
 Abandon procedure.
 Take biopsy from X & abandon procedure
 Remove X from from Y
 Otehr options like -i think- Remove X, Remove X &Y, Contact enxt of kin........
21. A young girl who was entered as acute appendicitis. Appendix was found normal but a
dermoid cyst[X] was found on Rt ovary[Y]. Can’t remember size .
22. A 40 yrs woman during TAH FOR HMB was found to have a dermoid cyst[X] on Rt
ovary[Y], both attached to pelvic side wall by adhesions .
• EMQ
23. A woman caem at 41 wks GA. You offered her IOL but she denied.
[?give her patient inforamtion leaflet]

 firtility/andrology
24. Couples, 1ry infirtility for 30 months i think, all tests normal. This Q came as SBA & EMQ
 Options: CC, IVF, advise to try naturally for another 6 m,.......
25.
26. Male previously fertile. Now azoospermic. Low FSH & testosteron
options : klienfilter, anabolic steroids, Kallman’s
27. A woman with infertility, workup showed blooked tubes with hydrosalpings.
[?Salpingectomy followed by IVF. Also came as SBA & as a part of an EMQ].
28.
29. From the followin figures, what hormonal profile is consistent with WHO class 3
ov.disorders?
[High FSH, high LH , low E, normal PRL]
30. A 19-year-old woman was seen in the gynaecology clinic with a history of excessive
growth of facial hair, needing to wax every 2-3 weeks. Her menstrual periods last 3-4
days every 3-4 months. There is no change in her voice. Her BMI is 28 kg/m2.
Examination shows Ferriman-Gallwey grade 2-3 hirsutism over chest and abdomen. A
pelvic ultrasound showed no abnormality. Her day two hormone tests showed LH level
7.4IU/L, FSH level 5.2IU/L, serum testosterone level 2.3nmol/l, SHBG 24 nmol/L.
What is the most likely diagnosis?
PCO, Idiopathic, Cushing, Androgen producing tumour

*This is a repeat question, but in the previous exam they put a cycle pattern of 7-8 days
every 24-35 days. (idiopathic).
31. A woman came with hirsutism + virilization. Testesteron 7. No DHEA OR OTHER INVEST
were given, but mentioned to have central obesity
[?cushing]
32. A woamn came with hirsutism, irregular periods, LH was higher than FSH. Testosteron
was ? 6.5 . They asked about next test to help reach a diagnosis.
[Options included U/S , TFT, DHEA, 17(OH)P, ? dexameth. Supression test ]
• EMQ: Choose the most likely diagnosis.
Options: can’t remember well but include
 OHSS. (or manage OHSS according to unit protocol)
 Ectopic / Heterotropic [each as a seperate option]
 Acute appendicitis
 Tortion/ Ruptured cyst [each as a seperate option]
 Bowel perforation
 Laparotomylaparoscopy (?or lap for detortion)/, Expectant mng,.....
33. Surrogate woman, came from spain [or somewhere] after replacing 2 embryos , came
withe severe LIF pain. I think Ultrasound showed single gestational sac
[?hetero]
34. A woman 2 days after egg collection(larg number collected,? 25), came with severe LIF
pain, vomiting, lightheadedness. U/S showed ?“spider web”.
[? OHSS/ some said Torsion]
35. Iam not sure but i think there was another acute presentation, with U/S showing
?daughnut sign or something
• EMQ or SBA[not sure] : Male factor infirtility: investigations?
36. A scenario was given where semen analysis was normal [lower normal], the only
abnoramlity mentioned was dysuria or turbid urine after coitus.
 37. Another scenario, the man has fatiguability & errection problems.(i think the options
included something about “electric wave analysis fo eaculate”. Deeply sorry for the poor
recall.)
38. A third scenario, i think with oligospermia. He has mild gyencomastia.

 NERVE /vascular .INJ

• EMQ: Identify the most likely injured nerve
39. After forceps, woman came later with urinary & fecal inc
[?pudendal neuropathy]
40. After VD, woman can't flex knee or extend hip+ absent knee jerk
[? Femoral]
41. After surgery in lithotomy, a woman has foot drop & sensory loss in lateral surface of leg.
[Common peroneal wasn't in the options, but Lumbar-peroneal neuropathy was there.]
• SBA
42. During TVT, the surgeon accedently hit the inferior epigastric artery ( &NOT
OBTURATOR). From wich artery does it arise?
[ext. iliac ]

 urodynamics:
• EMQ: Coose the appropriate Mng:
Can't remember much but options inclded:
 PFMT
 Bladder retraing
 PFMT & Bladder retraing
 Bladder diary
 Clean intermittent self cath.
 Many options including specific drugs & surgeries. I don’t remember if urodynamics
were there or not.
43. A woman presents with urgency, freq, nocturia & STRES Inc.
[?diary]
44. Another woman who i think her symptoms were pure stress UI.
[PFMT]
45. A woman with multiple sclerosis + voiding diff
[?CISC]
• EMQ: urodynamic interpretation: what is the likely diagnosis
Options included DO, USI, Interstitial cystis, &-i think- chronic cystitis
46. Residual 70. 1st & max desire both reduced. Normal voiding velocity. I think pressure rise
during void was ? Normal.
47. There was another Q. Can’t remember
• SBA
48. woman with recurrent UTI + Pain : cystoscopy: --> multiple small hemorrhagic areas
Options: Interstitial cystitis, transitional cell ca, superficial cystitis or something.
49. Of women with OAB, what % will also have urge incontinence?

 Infections
 • EMQ: What is the diagnosis
Options: Primary syphilis, 2ndry syphilis, Chancroid, Vulval candidiasis, Lichen planus/sclerosis,
Vulval cancer, Melanoma, others.
50. A young lady, came from trip to china. C/O vulval lesion. O/E : 2 symmetrical painless
ulcers with raised edges on labia majora.
[we argued about chancroid-kissing ulcers. But painless?]
51. An elderly 82 yrs woman at nursery home c/o blood staining of underwares. NO
SYMPTOMS. O/E small pigmented lesion with rolled edge on Lt labium majus, with small
satellite lesions around.
[?candidiasis,? cancer]
52. A young lady came from somewhere, c/o mass, o/e: sessile growth on perineum ,
painless, no itching.
[wart]
 Others
53. Young lady with PMS mainly psychlogical (& her partner prosecutig her for assaulting
him). Her GP advised exercise or something.
Options included all steps of managing PMS, & also referal to social worker
54. what is the % of U perforation after evac (?of missed ab?)
[? 5:1000]
55. what is the absolute C/I to UAE from the following?
This Q came twice. & the only option came twice was adenomyosis....HINT OR
DISTRACTOR? Other options wrere age below 35 , IUCD in situ, active pelvic infection,
Asymptomatic fibroid. [Pregnany was NOT there].
56. A woman on stable relationship for past 23 years & on IUCD for last 12 years now she had
abd. Pain.U/S showed a mass beside right ovary.
[?Actinomycetoma?, can’t remember the other options]
57. What is the 1 st line managment of menorrhagia?
This Q came twice. The difference was in age &-in the first Q, they specifically referred to
NICE.
[We didn’t think of a difference: both IUS?]
58. A long history but at the end: ovarian tumour + pathology report of Call hexener bodies.
[granulosa cell tumour]
• EMQ: What sign do you expect to find. Options:
 bilteral adnexal masses
 Longitudenal vagianl septum.
 Retroverted uterus
 Thickinings in POD [?or tuero sacral lig]
 Uretrhal caurencle
 Other optiosn i can’t remember
59. A young girl with recurrent UTI. Now also has dsyparunia
[Most said urethral caruncle. Why not long.septum?]
60. A PCO woman taking clomifine .
[?adnexal masses]
61. One with a diagnosis of endometriosis
[? R/V uterus, thickinings]
• SBA
 62. A 36 yrs old lady with previous term healthy baby, now had 3 recurrent miscarriages at
6,7,8 wks. What invest. are you going to do?
Options : APLa, thrombopillia screen, pelvic U/S for anatomy, other 2 options i can’t
remember but did’t include karyo as far as i remember.
nd
63. A woman with PH of two 2 TM miscarriages, presented at 18 wks,no contractions but
o/e you find membranes bulging into vagina
[? Admission + cierclage]
64. EMQ: sexaully active, C/O frothy-greenish V.discahrge [?TV]
65. EMQ: sexaully active, C/O malodorous fishy discahrge. [?Gardnella]
66. What is the recurrence rate of bacterial vaginosis?
67. There was a question, where an obese diabetic lady on metformin undergoen TAH for
HMB. After....hrs post surgery, you were called by the conerend nurse. The patient’s
MOEWS chart was given. We were asked about the underlying pathology. Options
icnluded sepsis, DKA, Hypovolemia, Hypoxia.
68. There was a question about a woman who did an HSG, can’t remember details but i think
came later with features of PID. There was an option of “Manage PID according to
protocol” .
69. An 18 yrs girl came with 1ry A. Normal 2ndry sexaul development. Very shrot vagina{?the
ygave the length}. Ovaries presetn on scan.
[?MRKH]
70. A 16 yrs girl came with 1ry A. Heavy excersise. BMI 18. FSH 34.
[Options included: Wt related A, primary POF, wait for another 2 yrs]
71. What is the emergency CC option for an epileptic lady who denied IUCD?
[?levoenlle 3g]
72. The concentration/efficacy of the following drug is reduced by taking COCs
Options included the common AEDs
[?lamotrigine]
73. What is the commoenst type of ureteric inj in laparoscopic surgery?
[?transection]
• EMQ : Antibiotics prophylaxis choice: ALL CASES HAS SOME SORT OF CARDIAC DISEASE
Options included many endocarditis prophylaxix, Erythromycin/doxycyclin pre & post surgery.
NO cefuroxime or Augmentin as single doses , but there was cefazolin single dose
74. TAH + Ant[?or may be post] repair.
75. Diagnostic Hysteroscopy + cystoscopy.
76. There was a question about a lady who came 5 wks post IVF conception with mild
bleeding. U/S showed intrauterine empty GS of 21 mm. I thik they asked about the
diagnosis ratehr than next step.
OBS
• EMQ: for the following scenarios, what is the risk of maternal morbidity/ mortality
(low/significant/ high) & the risk of the baby having cong.heart disease(<10%, 15-25% , 50 %: )
77. mother with minor anomaly, with previous baby with CHD.
78. mother with pul.HTN
79. mother with PH of PPCM. In this pregnancy the echo shows structurally normal heart
with mild systolic dysfunction.
• EMQ: PPH: Options were many but included:
 Bimanual compress
 Carpoprost
 Ergometrin[one option was I/M, other was slow I/V]
 Synto [one option was bolus, other as infusion]
 Explore lower egnital tract under good light
 Explore in theatre. + many otehr options
80. Heavy bleeding, HD compromise, placenta complete, catheter in. Rescusitate WAS NOT
AN OPTION.
81. Moderate bleeding after delivering 4.1 kg baby .placenta complete. Uterus well
contracted.
82. Heavy bleeding. Placenta complete.catheter+ bimanual +oxytocin already given.
Patient has mild asthma.
• EMQ: what is the single most imp. Paremeter you want to know:
Options were BP, CBC, RBG,Coag profile, GCS, O2 sat.
83. You are about to undertake hysterectomy for massive I.O bleeding. The anesthetic team
are managing to keep stable BP.
84. After delivery, a lady developed a grand mal fit.
85. After c/s , pt became hypotensive. No v.bleeding but ooze from wond.
• EMQ: Most propable underlying cause:
Options inclded: anaphylaxix, Amnitic fluid embolism, Air& Fat embolism, Maligannt
hypertehrmia, tension pneumo thorax.
86. During c/s, pt developed generalized rash, hypotension.
87. During c/s , pt became short of breath, hypotensive, low O2 sat( & also CO2)
• EMQ: What is underlying cause:
88. before emergency c/s, pt complained of headache + visual disturb. BP ?160/110 i think.
Smooth section & viable fetus but pt didn't awake from anesthesia & died. Autopsy: IVH
+ conation of ? Cerebellar vermis. In the options, there was "acute hydrocephalus due to
herniation of medulla" or something like that.
89. An obese bus driver suddenly collapsed & died
• EMQ: 2nd stage & heart dis. The classification given was not NYHA ,but that mentioned in the
FSRH GL (CC & cardiac dis).
Options: Aim for VD, give oxytocin, deliver with forceps, deliver with ventose, C.section
90. Class 2, symptomless, in 2nd stage but pushing well, head +3.
91. 2nd woman was class 3 ,in 2nd stage, head + 2. I think she has some symptoms.
 DERMA:
 92. Woman with purpuric rash. Cant' remember GA. rash disappeared but woman still itchy.
LFT:( normal bilirubin, normal AST, high ALP , slightly low albumin[32 instead of 35]. What
further testing?
Options: serum bile acids, virology screen, caog.profile, repeat LFT, no further test
needed.
93. Mother with purpuric rash involving abd straie. What feature is a/w good prognosis?
(?Sparing umblicus,....)
94. Mother with purpuric rash. Biopsy showed immune complex deposition. What’s the likely
diagnossis?
Options: they gave the D/D of purpuric rash in pregnancy.
 INFECTIONS:
95. A pregnant lady developed chickenbox rash. Phoned on same day.
[? Acyclovir].
96. A pregnant lady developed chickenbox rash, phoned 3 days later .
[? avoid contact with preg ladies OR no further actions? OR U/S after 5 wks?].
97. A pregnant lady came with rash + joint pain. RETESTING( that how it was written) showd
her infected with parvo- not ruballa. GA was 2nd TM . What action?
[? U/S follow up]
98. There was a question about congenital malaria. A woman has malaria in pregnancy. What
should you do?
Options after delivery: 1)Blood film for baby at birth then wkly for 4 wks 2) plasental
films; if neg for malaria, no further action.
 Labour
• EMQ: IPC
Options: Re-assess after 15m/30m/1h/2h/4h [each as a seperate option], Forceps delivery,
Ventouse [2 cup types given]delivery, C/S, Reassess in theatre for forceps or c/s,...
nd
99. PG,effective epidural, good progress, 1h passive 2 stage & then actively pushing for
90m. head at spines & CTG noraml.
nd
100.Parous lady, in 2 stage for 90m, now pushing for 30m. Head ? OL at spines.
nd
101.A woman after 20 m in 2 stage tells you taht she can’t push more & demadns c/s. She
allows you to examine her. Head? OP at spines.
 Headache
102.What is the most common finding in CVT?
[? headache]
103.Preconeption counselling of pt with migrane. The optiosn were combiantions of ↑,
↓,unchanged migrane attacks & ↓, ↑ or uncahnged risk of pre-eclampsia.
[PE ↑. Attacks ?unchanged]
104.A question about headache where the lady described it as the worst ever.
[?SAH].
105.Headache developing post partum + focal neurological signs. MRI showed filling defect
[?CVT, others said Posterior reversible encephalopathy syndrome]

 OTHERS:
106.what is the chance of survival without disability for a baby born at 24 wks.
107.what is the most abnormal karyo to a/w trunkus arteriosus? [Options: trisomy 13 /21/
deletion of q22, others ].
 108.Mother with type 1 DM came with PPROM. What is the more common cause of death for
this baby
[ prematurity or lung hypoplasia?].
109.in what country is obstetric cholestasis most common?
[?Cheli]
110. A woman with PH of recurrent DVT, now on thromboprophylaxis with Rivaroxaban -
when to stop pre op? 24 hrs , 5 days , 7 days , 4 weeks .
After we did some search, it appeared to be an oral heparin, given daily. Needs to be
stopped 24 hrs prior to surgery. This was a web search. Please check again
111. What is the length of the presenting diaemter in Face presentation [9.5 cm]
112. A midwife ot sure abotu presentation called you. You palpate malar eminence + ?
alveolar margin. [?Face]
st
113. A pregnant women with breast lump. 1 invest will be: (options were u/s- mamograme-
chest x ray).
114. A woman found to have asymptomatic GBS bacteruria. Management plan?
[?treat now and IPAP in labour].
115. Waht is the rate of spont. Reversion to breech after ECV in PG
[? 5%]
116. A woman & her partenr both are CF carriers. What is the cahcne of an affected baby?
[1:4]
117. From the following, what is NOT a risk factor for twins?
Options: advanced age, PH of monozigotic twins, IVF, others.
118. What is the chance of success of Mc’robert with suprapubic pressrue to effect delivery?
[? 90%]
119. From the following, what is a major risk factor for SGA? [can’t remember options]
120. What is the best measure of GA at 84 mm diameter ?GS. [ options: CRL, HC, BPD].
• EMQ: HSV:can’t remember options
121. A woman came in labour, tells you that her partenr was recently treated for HSV.
122. A woman came in labour. Was treated 2 wks ago for recurrent HSV.
123. A woman came in labour, was treated ? 2 wks ago for 1ry HSV. After counselling; she’s
willing for VD.
• EMQ : Management
Options: Augment with oxytocin, IPAP, Erythromycin, I/M steroids, Expectant.Mng,....
124. GA 22wks, Known GBS carrier, now PPROM ,? Features of ch.amnitis
125. GA 28 wks. Threatened PTL. Speculum  cx 3 cm with intact membranes. Already given
full dose I/M steroids 2 wks ago.
126. What of the following conditions has more association with amle fetus
Options included AFLP, obstetric cholestasis,.......
• EMQ : The causative organism. (GAS, GBS, HSV, CT, Staph,... )
127. A neoante developd eye infection(stick eyes) after 1 wk from delivery.
[?CT]
128. A mother who had a vulval soreness, gave birth to a neonate who latter developed signs
of sepsis & he had vesicles on his back.
[?HSV]
129. What is the anti-D level above which there should be referral for fetal medicine unit?
[was it “above which” or “at which”?]
 130. Waht drug you choose for an asthamtic lady with post partum HTN?
[? Nifidipine. There was an ACEi in the options but not enalapril/captopril]
131. What is the definition of perinatal mortality rate?
[? After 24wks GA, up to 7days/1000 or 10.000?]
132. There was an EMQ with 3 scenarios of APH.
133. There was a question about the mode of delivery in HIV mother on HAART whose last VL
was 150
[?? The 2011 NICE c/s guideline says don’t offer c/s if VL <400. 2014 BHIVA said
“consider” c/s].

MHD