PASS‐MRCOG | Epidemiology

Question 1

The World Health Organisation define the maternal mortality ratio as

A) Maternal deaths per 10,000 live births & still births

B) Maternal deaths per 100,000 live births & still births
C) Maternal deaths per 10,000 live births
D) Maternal deaths per 100,000 live births
E) Ratio of maternal deaths to live births

Correct Answer:
Maternal deaths per 100,000 live births

Explanation: The maternal mortality ratio is the number of maternal deaths per 100,000 live
births.

Maternal deathis defined by the WHO as the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from
any cause related to or aggravated by the pregnancy or its management but not from
accidental or incidental causes

Live birthis defined by the WHO as the complete expulsion or extraction from its mother of a
product of conception, irrespective of the duration of the pregnancy, which, after such
separation, breathes or shows any other evidence of life ‐ e.g. beating of the heart, pulsation of
the umbilical cord or definite movement of voluntary muscles ‐ whether or not the umbilical
cord has been cut or the placenta is attached. Each product of such a birth is considered live
born

Question 2

Regarding uterine fibroids (leiomyoma) which of the following statements is TRUE regarding
their prevalence?

A) The prevalence is highest amongst asian women

B) The prevalence is highest amongst black women
C) The prevalence is highest amongst european women
D) The prevalence is highest amongst white women
E) There is no statistical difference in fibroid prevalence between ethnic groups

Correct Answer:
The prevalence is highest amongst black women
PASS‐MRCOG | Epidemiology

Explanation: Most studies into fibroid prevalence have occurred in the US. It has been shown
in a number of studies that African‐American women have a 2‐3 times more likely to develop
fibroids when compared to caucasian women.

Black women are also more likely to develop fibroids at a younger age. In most populations
fibroids are unusual below the age of 30 but this is not uncommon in black women for these to
develop in the 20's.

Question 3

The World Health Organisation (WHO) define maternal death as

A) The death of a woman whilst pregnant or within 48 hours of termination of

pregnancy
B) The death of a woman whilst pregnant or within 7 days of termination of pregnancy
C) The death of a women whilst pregnant or within 14 days of termination of pregnancy
D) The death of a women whilst pregnant or within 42 days of termination of pregnancy
E) The death of a women whilst pregnant or during labour

Correct Answer:
The death of a women whilst pregnant or within 42 days of termination of pregnancy

Explanation: WHO and CMACE consider maternal death to have occurred during pregnancy or
within 42 days of termination of pregnancy.

Maternal death is the death of a woman while pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not from accidental or incidental causes.
To facilitate the identification of maternal deaths in circumstances in which cause of death
attribution is inadequate, a new category has been introduced: Pregnancy‐related death is
defined as the death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the cause of death
PASS‐MRCOG | Epidemiology

Question 4

Following a single episode of reduced fetal movements what percentage of pregnancies will be
uncomplicated?

A) 98%
B) 90%
C) 70%
D) 50%
E) 25%

Correct Answer:
70%

Explanation: 70% of pregnancies with a single episode of RFM are uncomplicated

Question 5

A study looks at the average systolic blood pressure of patients in antenatal clinic. Out of 200
women the average SBP was 110mmHg and the standard error of the mean was 8mmHg. What
is the 95% confidence interval

A) 104.5 to 115.5
B) 94.3 to 125.6
C) 102 to 118
D) 100 to 120
E) none of the above

Correct Answer:
94.3 to 125.6

Explanation: Assuming a normal distribution, we can state that 95% of the sample mean would
lie within 1.96 SDs above or below the population mean.

For simplicity or to calculate a quick estimate you can use 2 rather than 1.96

Calculation of 95% CI for mean = (mean ‐ 1.96xSEM) to (mean +1.96xSEM)

Upper CI limit = mean + (1.96 x SEM)
Lower CI limit = mean ‐ (1.96 x SEM)

SEM = 8
PASS‐MRCOG | Epidemiology

SEM x 1.96 = 15.68

95% CI = (110‐15.68) to (110+15.68)
95% CI = 94.32 ‐ 125.68

Question 6

Which of the following reduces the risk of fibroids?

A) Black ethnicity
B) Obesity
C) Taking the Combined Oral Contraceptive Pill
D) Early Puberty
E) Pregnancy

Correct Answer:
Pregnancy

Explanation: Pregnancy reduces the risk of fibroids

COCPs are not thought to have a significant effect on prevalence but evidence is conflicting

Obesity, Black ethnicity and early puberty all increase the risk of fibroids

Question 7

Sensitivity is calculated by

A) A/A+B
B) A/A+C
C) B/A+B
D) B/B+D
E) D/B+D

Correct Answer:
A/A+C

Explanation: The answer is B

In the exam its often useful to draw the table above
PASS‐MRCOG | Epidemiology

Question 8

A new test for Group B strep has been designed and the results are shown above. Which of the
below is the Sensitivity?

A) 0.86
B) 0.93
C) 0.95
D) 0.97
E) 18.6

Correct Answer:
0.93

Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPR = 84/84 +2 = 0.97
NPR = 40/40+6 = 0.86
LR+ = Sensitivity/ (1‐Specificty) = 18.6
LR‐ = (1‐Sensitivity) / Specificity = 0.07

Question 9

Which of the following tests require the population to be of normal distribution

A) Chi‐squared
B) Mann Whitney U
C) Analysis of Variance
D) Kruskal Wallis
E) Spearman Correlation

Correct Answer:
Analysis of Variance

Explanation: The question is asking which test is parametric

PASS‐MRCOG | Epidemiology

Question 10

A 34 year old patient sustains a 3b perineal tear following delivery of her 3rd child. What is the
UK incidence of OASIS (obstetric anal sphincter injury) in multiparous women?

A) 1.7%
B) 2.9%
C) 6.1%
D) 11.3%
E) 15.5%

Correct Answer:
1.7%

Explanation: UK Incidence OASIS:

 Primiparous 6.1%
 Multiparous 1.7%
 Overall 2.9%

Question 11

Which of the following studies is most appropriate to assess the efficacy of a new medication to
reduce pain caused by endometriosis?

A) Randomised Control Trial

B) Longitudinal Study
C) Cohort Study
D) Cross Sectional Analysis
E) Cross Sectional Study

Correct Answer:
Randomised Control Trial

Explanation: When assessing treatment or intervention a randomised control trial is the gold
standard. Note if assessing prognosis or diagnostic tests Cohort and Cross Sectional Analysis
(AKA cross sectional study) respectively are optimal
PASS‐MRCOG | Epidemiology

Question 12

Regarding Pulmonary Embolism in Pregnancy which of the following statements is true?

A) PE is the most common cause of maternal death in the UK

B) PE accounts for approximately 25% of maternal deaths in the UK
C) PE mortality is 0.79/100,000 pregnancies in the UK
D) Being overweight (BMI 25‐30) does not increase VTE risk
E) Age >30 is a positive risk factor for VTE when considering thromboprophylaxis

Correct Answer:
PE mortality is 0.79/100,000 pregnancies in the UK

Explanation: Sepsis is now the most common cause of maternal death in the UK based on
recent figures. Prior to that Thrombosis was the most common cause. Eclampsia is the other
main source of mortality.

Being overweight (BMI 25‐30) has been shown to be increase risk of VTE. It is a weak risk factor
however and in terms of risk stratification of pregnant women for thromboprophylaxis a BMI of
>30 is considered a positive risk factor for PE by both the RCOG and SIGN (see the table)

Question 13

A study looked at 40,000 women at a maternity unit in an area with a population of 520,000.
The number of identified VTE episodes was 60 with a standard deviation of 20. Using the figures
what is the standard error of the mean (SEM)?

A) 0.23
B) 0.076
C) 4.6
D) 0.1
E) 3

Correct Answer:
0.1

Explanation: Standard Error of the Mean = Standard Deviation / square root of sample size
SEM = SD/ square root of n
SEM = 20/200 (200 is the square root of 40,000)
SEM = 0.1
PASS‐MRCOG | Epidemiology

Question 14

Regarding Venous Thomboembolism (VTE) in pregnancy which of the following statements is

TRUE?

A) Relative risk of VTE in pregnancy is 4 to 6 fold

B) Relative risk of VTE in pregnancy is 2 to 3 fold
C) Incidence of antenatal PE in the UK is 10/10,000 maternities
D) Incidence of antenatal PE in the UK is 3/10,000 maternities
E) Absolute risk of VTE in pregnancy and puerperium is 4‐5/1000

Correct Answer:
Relative risk of VTE in pregnancy is 4 to 6 fold

Explanation: Relative risk of VTE in pregnancy is increased 4 to 6 fold in pregnancy according to

the 2009 Greentop guidelines. The risk is increased further in the postpartum period and some
sources quote relative risk increased up to 10 fold.

Absolute risk of VTE in pregnancy and the puerperium is low at 1‐2/1000 pregnancies

Incidence of Pulmonary Embolism in the UK is 1.3/10,000 maternities

Question 15

Which of the following is the least common cause of maternal mortality

A) VTE
B) Eclampsia
C) Pre‐eclampsia
D) Sepsis
E) Haemorrhage

Correct Answer:
Haemorrhage

Explanation: It would be a little unfair of the RCOG to ask the leading cause of mortality as this
changes and the top 3 causes swap places. The most recent data state Sepsis is the most
common cause whereas the most recent Green Top Guideline (published in 2009) have VTE as

the most common cause (using data from 2003‐2005). Of the options listed haemorrhage is
least common
PASS‐MRCOG | Epidemiology

Question 16

A patient arrives on labour ward she is 37 weeks pregnant. Her last pregnancy ended with
delivery via uncomplicated lower segment C‐Section 4 years ago. Contractions are 5 minutes
apart and on examination and the cervix is 5cm dilated. She wants to know the risk to the baby
of proceeding with vaginal delivery. What is the risk of the infant developing hypoxic ischaemic
encephalopathy with VBAC?

A) 2 in 10,000
B) 8 in 10,000
C) 2 in 1,000
D) 8 in 1,000
E) 28 in 10,000

Correct Answer:
8 in 10,000

Explanation: The Green-top guidelines regarding Vaginal Birth After C-section (VBAC) state
the following risks with VBAC:

 2-3/10,000 additional risk of birth-related perinatal death

 8 in 10,000 infant developing hypoxic ischaemic encephalopathy
 22-74 in 10,000 Risk of uterine rupture (previous lower segment c-section)
 1% additional risk of either blood transfusion or endometritis

VBAC reduces the risk of:

 Reduces risk the baby will have respiratory problems after birth: rates are 2-3% with
planned VBAC and 3-4% with ERCS

Question 17

A new test for Group B strep has been designed and the results are shown above. Which of the
below is the Negative Predictive Value?

A) 0.87
B) 0.93
C) 0.95
D) 0.97
E) 18.6

Correct Answer:
0.87
PASS‐MRCOG | Epidemiology

Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPR = 84/84 +2 = 0.97
NPR = 40/40+6 = 0.87
LR+ = Sensitivity/ (1‐Specificty) = 18.6
LR‐ = (1‐Sensitivity) / Specificity = 0.07

Question 18

Specificity is calculated by

A/ A+C
A/ A+B
B/ A+B
B/ B+D
D/ B+D

Correct Answer:
B+D

Explanation: The answer is E

Question 19

A 26 year old patient sustains a 3b perineal tear following delivery of her 1st baby. What is the
UK incidence of OASIS (obstetric anal sphincter injury) in primiparous women?

A) 0.5%
A) 1.7&
B) 2.9%
B) 6.1%
D) 11.%

Correct Answer:
6.1%

Explanation: UK Incidence OASIS:

 Primiparous 6.1%
 Multiparous 1.7%
 Overall 2.9%
PASS‐MRCOG | Epidemiology

Question 20

Regarding the table above which of the below formulas would you use to calculate the positive
likelihood ratio?

A) A ÷ (A+C)
B) D ÷ (B+D)
C) (A/A+C) ÷ (1 ‐ (D/B+D))
D) (1 ‐ (A/A+C)) ÷ (D/B+D)
E) A ÷ (A+B)

Correct Answer:
(A/A+C) ÷ (1 ‐ (D/B+D))

Explanation: Two types of likelihood ratios exist ‐ positive (LR+) and negative (LR‐).
Positive likelihood ratios tell us how likely a disease is if the test is positive, while the negative
likelihood ratio tells us how unlikely a disease is if the test is negative.

They are calculated as:

LR+ = Sensitivity / (1 ‐ Specificity)

LR‐ = (1‐ Sensitivity) / Specificity
A ÷ (A+C) is the calculation for sensitivity
D ÷ (B+D) is the calculation for specificity
A ÷ (A+B) is the calculation for positive predictive value

NOTE It has been noted the RCOG may ask you for the likelihood ratio and doesn't specify
positive or negative. They have simply used sensitivity/specificity to calculate this. I can't find
any statistical resources that support using this calculation method

Question 21

Which of the following factors as shown to decrease ovarian cancer risk?

A) High Coffee consumption

B) Older age at menarche
C) Polycystic Ovarian Syndrome
D) Taking statins
E) Low Vitamin D levels

Correct Answer:
Taking statins
PASS‐MRCOG | Epidemiology

Explanation: Factors shown to decrease risk of ovarian cancer are:

 Oral contraceptive use

 Higher Parity
 Breast feeding
 Hysterectomy
 Tubal Ligation
 Statins
 SLE

Question 22

Which of the following is known to increase the risk of endometrial cancer?

A) Aspirin use
B) Mirena coil insertion
C) Coffee consumption
D) SLE
E) PCOS

Correct Answer:
PCOS

Explanation: Apart from PCOS all of the above have some evidence (some of it limited) that
they decrease the risk of endometrial cancer.

Risk Factors for Endometrial Cancer:

 PCOS (2.8 ties higher in PCOS patients)

 Obesity (BMI >30 increases risk by 2.5 times)
 Late menopause
 Early Menarche
 HRT
 Nulliparous
 Diabetes (60% higher incidence in diabetics v non-diabetics)
 Parkinsons
 Tamoxifen use
 Diethylstilbestrol use


Question 23

A new test for Group B strep has been designed and the results are shown above. Which of the
below represents the Specificity?
PASS‐MRCOG | Epidemiology

A) 0.93
B) 0.95
C) 0.97
D) 15.5
E) 18.6

Correct Answer:
0.95

Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPR = 84/84 +2 = 0.97
NPR = 40/40+6 = 0.86
LR+ = Sensitivity/ (1‐Specificty) = 18.6
LR‐ = (1‐Sensitivity) / Specificity = 0.07

Question 24

Negative Predictive Value is

A) A/A+B
B) A/A+C
C) B/B+D
D) D/C+D
E) D/B+D

Correct Answer:
D/C+D

Explanation: The answer is D

Question 25

WHO defines the perinatal mortality rate as

A) The number of stillbirths and deaths in the first week of life per 100,000 live births
B) The number of stillbirths per year
C) The number of stillbirths and deaths in the first week of life per 1000 live births
D) The number of stillbirths per 1000 births
E) The number of still births and deaths within 24 hours of delivery per year

Correct Answer:
PASS‐MRCOG | Epidemiology

The number of stillbirths and deaths in the first week of life per 1000 live births

Explanation: t is: The number of stillbirths and deaths in the first week of life per 1000 live
births

According to WHO the perinatal period commences at 22 completed weeks (154 days) of
gestation and ends seven completed days after birth

The UK national figure is about 8 per 1,000 and varies markedly by social class with the highest
rates seen in Asian women

Question 26

Which of the following is a parametric test used to test correlation?

A) Spearman
B) Pearson
C) Mann Whitney
D) Chi‐squred
E) t‐test

Correct Answer:
Pearson

Explanation: Spearman and Pearson are correlation tests.

Pearson is Parametric. Spearman is non‐parametric

Question 27

What is the incidence of placenta accreta (including increta and percreta) in the UK?

A) 1.0 per 1000 deliveries

B) 2.3 per 1000 deliveries
C) 7 per 1000 deliveries
D) 1.7 per 10,000 deliveries
E) 17 per 10,000 deliveries

Correct Answer:
1.7 per 10,000 deliveries
PASS‐MRCOG | Epidemiology

Explanation: The incidence is 1.7 per 10,000 deliveries in the UK.

The USA reports incidence as high as 3 per 1000

Question 28

A small study shows the lifetime incidence of breast cancer in smokers to be 20 in 100. In non
smokers the incidence is 10 in 100. Which of the following represents the absolute risk of
breast cancer in smokers?

A) 10%
B) 20%
C) 2
D) 100%
E) 0.1

Correct Answer:
20%

Explanation: Don't get absolute and relative risk confused. Absolute risk is the actual risk. In
this case 20 in 100 or 20%.

Relative risk is a ratio of risk comparing risk in the exposed and control groups, in this case
relative risk would be 2

Question 29

What is the prevalence of antiphospholipid syndrome in patients with recurrent miscarriage?

A) <0.5%
B) 2.5%
C) 7.5%
D) 15%
E) 30%

Correct Answer:
15%

Explanation: Anti‐phospholipid syndrome is an autoimmune diseases where antibodies bind to

phospholipid proteins on the plasma membrane.

Proteins that are bound include anticoagulants Protein C, Protein S and Factor V leading to a
hyper‐coagulable state.
PASS‐MRCOG | Epidemiology

Lupus anticoagulant (prothrombotic antibody. Most people with Lupus don't have it. Is primary
association is with antiphospholipid syndrome) binds prothrombin and cleaves it into the
coagulant thrombin

Antiphospholipid syndrome prevalence in the obstetric population is around 3%. In patients

with recurrent miscarriage it is 15%.

Question 30

What is the incidence of molar pregnancy in the UK?

A) 1 in 100 pregnancies
B) 1 in 1,000 pregnancies
C) 1 in 10,000 pregnancies
D) 1 in 100,000 pregnancies
E) 5 in 100,000 pregnancies

Correct Answer:
1 in 1,000 pregnancies

Explanation: Figures quoted vary from 1 in 600 to 1 in 2000

Question 31

Study Z gets funding to increase the population size from 1000 to 2000 patients. What effect is
this likely to have on the results?

A) Decrease type 1 errors

B) Decrease type 2 errors
C) Increase confidence intervals
D) Increase sensitivity of testing
E) Increase specificity of testing

Correct Answer:
Decrease type 2 errors

Explanation: Increasing sample size decreases type 2 errors and increases power of the results.
Sensitivity and specificity of the test should remain constant regardless of sample size.
Confidence intervals are applied by a statistician and are dependent on the mean.

Question 32

Which of the following studies is most appropriate to assess a prognosis of a disease?

PASS‐MRCOG | Epidemiology

A) Randomised Control Study

B) Case Control Studies
C) Cross Sectional Analysis
D) Cohort Study
E) Longitudinal study

Correct Answer:
Cohort Study

Explanation: Medics often think that RCT's are the gold standard of all studies. In terms of
evaluating a therapy or intervention RCTs are the gold standard and top the hierarchy of
evidence. This is not the case when evaluating prognostic tests which are best assessed by
cohort studies

Question 33

What is the incidence rate of ovarian cancer per 100,000 females in the UK?

A) 2
B) 7
C) 15
D) 22
E) 37

Correct Answer:
22

Explanation: Ovarian cancer is the 5th most common cancer among women in the Uk with an
incidence of 22 cases per 100,000 in the UK.

It should be noted that ovarian tumours are very common. According to the RCOG greentop guidelines
(No 62) up to 10% of women in the UK will have surgery for an ovarian mass. In premenopausal women
almost all ovarian tumours are benign

Question 34

What is the incidence of obstetric cholestasis in England?

A) 0.7%
B) 2.2%
C) 4.5%
PASS‐MRCOG | Epidemiology

D) 6.7%
E) 23%

Correct Answer:
0.7%

Explanation: OC Affects 0.7% pregnancies in England Itching in general affects 23% of

pregnancies

Question 35

Which of the following studies is most appropriate to assess a diagnostic test?

A) Randomised Control Trial

B) Case Control Studies
C) Regression Analytics
D) Cohort Study
E) Cross Sectional Analysis

Correct Answer:
Cross Sectional Analysis

Explanation: Medics often think that RCT's are the gold standard of all studies. In terms of
evaluating a therapy or intervention RCTs are the gold standard and top the hierarchy of
evidence. This is not the case when evaluating diagnostic tests or assessing prognosis.

Question 36

According to the HSCIC what is the incidence of postpartum haemorrhage in the UK?

A) >1%
B) 2%
C) 5%
D) 6.8%
E) 13.8%

Correct Answer:
13.8%

Explanation: The statistics published by HSCIC show postpartum haemorrhage effects 13.8% of
deliveries in the UK
PASS‐MRCOG | Epidemiology

Question 37

A new test for Group B strep has been designed and the results are shown above. Which of the
below represents the Positive Likelihood ratio?

A) 0.93
B) 0.97
C) 0.07
D) 15.5
E) 18.6

Correct Answer:
18.6

Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPR = 84/84 +2 = 0.97
NPR = 40/40+6 = 0.86
LR+ = Sensitivity/ (1‐Specificty) = 18.6
LR‐ = (1‐Sensitivity) / Specificity = 0.07

Question 38

A new test for Group B strep has been designed and the results are shown above. Which of the
below represents the Negative Likelihood ratio?

A) 0.05
B) 0.07
C) 0.93
D) 0.95
E) 18.6

Correct Answer:
0.07

Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPV = 84/84 +2 = 0.97
NPV = 40/40+6 = 0.86
PASS‐MRCOG | Epidemiology

LR+ = Sensitivity/ (1‐Specificty) = 18.6

LR‐ = (1‐Sensitivity) / Specificity = 0.07

Question 39

A patient arrives on labour ward she is 38 weeks pregnant. Her last and only pregnancy ended
with delivery via uncomplicated lower segment C‐Section 3 years ago. Contractions are 6
minutes apart and on examination and the cervix is 6cm dilated. She wants to know the
chances of a successful vaginal delivery if she proceeds with a vaginal delivery after c‐
section(VBAC). What is the chance of successful delivery with VBAC?

A) 95%
B) 90%
C) 75%
D) 50%
E) <25%

Correct Answer:
75%

Explanation: The RCOG Green-top guidelines state successful VBAC after a single c-section is
72-76%.

If a patient has had a previous successful VBAC the figure is 87-90%

The success rate is lower if any of the following are present:

 Induced labour
 No previous vaginal birth
 Obesity (BMI >30)
 Previous C-section for dystocia

Question 40

A patient arrives on labour ward she is 37 weeks pregnant. Her last pregnancy ended with
delivery via uncomplicated lower segment C‐Section 4 years ago. Contractions are 5 minutes
apart and on examination and the cervix is 5cm dilated. She wants to know the risk to the baby
of proceeding with vaginal delivery (VBAC). What is the additional risk the baby will have
respiratory problems after VBAC compared to elective repeat C‐section (ERCS)?

A) No difference
B) Risk 1 to 2% greater with VBAC
PASS‐MRCOG | Epidemiology

C) Risk 1 to 2% greater with ERCS

D) Risk 4 to 5% greater with VBAC
E) Risk 4 to 5% greater with ERCS

Correct Answer:
Risk 1 to 2% greater with ERCS

Explanation: The Green-top guidelines regarding Vaginal Birth After C-section (VBAC) state
the following risks with VBAC:

 2-3/10,000 additional risk of birth-related perinatal death

 8 in 10,000 infant developing hypoxic ischaemic encephalopathy
 22-74 in 10,000 Risk of uterine rupture (previous lower segment c-section)
 1% additional risk of either blood transfusion or endometritis

VBAC reduces the risk of:

 Reduces risk the baby will have respiratory problems after birth: rates are 2 to 3% with
planned VBAC and 3 to 4% with ERCS

Question 41

Regarding uterine fibroids (leiomyoma) which of the following statements is TRUE regarding
their prevalence?apart and on examination and the cervix is 5cm dilated. She wants to know
the risk

A) By age 49 prevalence is approximately 5%

B) By age 49 prevalence is approximately 15%
C) By age 49 prevalence is approximately 50%
D) By age 49 prevalence is approximately 75%
E) Non of the above

Correct Answer:
By age 49 prevalence is approximately 75%

Explanation: Uterine fibroids are the most common non‐cancerous tumours in women of
childbearing age. Although studies are limited studies have shown

Approximately 60% of black women had detectable fibroids by 35 years of age; this increased
to approximately 80% by 49 years of age.

Approximately 40% of white women had detectable fibroids by 35 years of age; this increased
to 70% by 49 years of age.
PASS‐MRCOG | Epidemiology

Question 42

Hypemesis gravidarum occurs in what percentage of pregnancies?

A) <0.5%
B) 1.5%
C) 5%
D) 15%
E) 80%

Correct Answer:
1.5%

Explanation: HG occurs in approximately 1.5% of pregnancies (range is 0.5‐3.0%)

Question 43

A small study looks at medical records of deceased women to see how many smoked and how
many were diagnosed with breast cancer. The results are below
A) <0.5%
B) 1.5%
C) 5%
D) 15%
E) 80%

Correct Answer:
1.5%

Explanation: First calculate the prevalence in the control and exposed groups
In smokers: 15/ (15+65) = 0.1875
In Non‐smokers 11/ (77+11) = 0.125

Then divide the prevalence in the exposed by the control group

0.1875/0.125 = 1.5

Question 44

What is the incidence of choriocarcinoma in the UK?

A) 1 in 1,000
PASS‐MRCOG | Epidemiology

B) 1 in 5,000 pregnancies
C) 1 in 50,000 pregnancies
D) 11 in 500,000 pregnancies
E) 1 in 1,000,000 pregnancies

Correct Answer:
1 in 50,000 pregnancies

Explanation: Figures quoted vary from 1 in 40,000 to 1 in 50,000 pregnancies.

Cure rates are 98‐100% in the UK.

Question 45

What is the most common site of ectopic pregnancy implantation?

A) Infundibular tubal
B) Interstitial
C) Abdominal
D) Ampullar tubal
E) Ovarian

Correct Answer:
Ampullar tubal

Explanation: here are about 11,800 ectopic pregnancies in the UK each year, with an ectopic
pregnancy occurring in about 11 in 1000 pregnancies.

Mortality rates for ectopic pregnancy in the UK are 2 per 1000.

The majority of ectopics are tubal with non‐tubal ectopics accounting for only 3‐5% of ectopic
pregnancies. The typical distribution is shown below

Question 46

A patient arrives on labour ward she is 37 weeks pregnant. Her last pregnancy ended with
delivery via uncomplicated lower segment C‐Section 4 years ago. Contractions are 5 minutes
apart and on examination the cervix is 5cm dilated. What is the risk of uterine rupture with
vaginal delivery?

A) 1 per 10,000
B) 5 per 10,000
C) 25 per 10,000
D) 170 per 10,000
PASS‐MRCOG | Epidemiology

E) 35 per 1,000

Correct Answer:
Ampullar tubal

Explanation: According to the Green‐top guideline No 45 the risk of uterine rupture with
Vaginal Birth After C‐section (VBAC) is 22‐74 per 10,000.

Remember if asked this in the exam the RCOG may ask the most appropriate risk figure from a
list and may use different units e.g. as risk per 1000 or as a percentage. The correct answer may
be written as 2 ‐ 8 in 1000 or 0.2 ‐ 0.8%.

Question 47

Positive Predictive Value is

A) A/A+B
B) A/A+C
C) A/A+D
D) D/C+D
E) D/B+D

Correct Answer:
A/A+B

Explanation: The answer is A

Question 48

Which of the following has been shown to increase ovarian cancer risk?

A) Polycystic ovarian syndrome

B) Systemic Lupus Erythematous
C) Hormone replacement therapy (oestrogen only)
D) Oral contraceptive pill use
E) Higher Parity

Correct Answer:
Hormone replacement therapy (oestrogen only)

Explanation: Of the factors listed above only HRT has been shown to increase ovarian cancer
risk.
PASS‐MRCOG | Epidemiology

Factors shown to decrease risk of ovarian cancer are:

 Oral contraceptive use

 Higher Parity
 Breast feeding
 Hysterectomy
 Tubal Ligation
 Statins
 SLE

Question 49

Regarding uterine cancer in the UK. What is the average age at diagnosis?

A) 51
B) 60
C) 65
D) 70
E) 78

Correct Answer:
60

Explanation: The average age at diagnosis reflects which age group which is responsible for the
most cases of uterine cancer. The average age at diagnosis is around 60 in the UK and the most
cases of uterine cancer is seen in the 60‐64 age group (see the graph).

It should be noted the incidence rate (cases per 100,000) is highest in the 70‐74 age group.

Question 50

Which of the following statements regarding fibroids is FALSE?

A) Fibroids do not generally occur in pre‐pubescent girls

B) After puberty, the prevalence of fibroids increases progressively until the menopause.
C) The risk of fibroids is increased by pregnancy
D) Approximately 40% of white women had detectable fibroids by 35 years of age
E) The prevalence of fibroids is higher in black women than white women

Correct Answer:
The risk of fibroids is increased by pregnancy
PASS‐MRCOG | Epidemiology

Explanation: The risk of fibroids is actually reduced by pregnancy and decreases with an
increasing number of pregnancies.

Fibroids are not seen before puberty. Prevalence increases from puberty until menopause

Question 51

A 61 year old patient undergoes laparotomy for a suspicious left sided ovarian mass. Following
histology the patient is diagnosed with a stage 1A ovarian epithelial cancer. What is the 5 year
survival for stage 1 ovarian cancers?

A) 12%
B) 25%
C) 39%
D) 70%
E) 90%

Correct Answer:
90%

Explanation: As can be seen below stage I has a good prognosis with 90% 5 year survival.
PASS‐MRCOG | Epidemiology

Question 52

What is the maternal mortality rate associated with ectopic pregnancy in the UK?
A) 0.2%
B) 1.0%
C) 2.0%
D) 5.0%
E) 10%

Correct Answer:
0.2%

Explanation:There are about 11,800 ectopic pregnancies in the UK each year, with an ectopic
pregnancy occurring in about 11 in 1000 pregnancies.
PASS‐MRCOG | Epidemiology

Mortality rates for ectopic pregnancy in the UK are 2 per 1000.

The majority of ectopics are tubal with non‐tubal ectopics accounting for only 3‐5% of ectopic
pregnancies. The typical distribution is shown below

Question 53

What is the maternal mortality rate associated with ectopic pregnancy in the UK?

A) <1%
B) 10‐15%
C) 25‐30%
D) 60‐70%
E) 95%

Correct Answer:
0.2%

Explanation: Despite the good post‐natal prognosis. Figures quoted state 95‐99% of Turner
syndrome conceptions will end in spontaneous abortion or stillbirth.

It is though Turner Syndrome is responsible for around 10‐15% of all first trimester
miscarriages.

Trisomies are thought to be responsible for 68% of first trimester miscarriages

Question 54

Which of the following statements regarding vulval cancer is true?

A) Most common in the 40‐49 age group

B) Crude incidence is 1.3/100,000 women
C) 85% are squamous cell carcinoma
D) Vulval cytology is appropriate for diagnosis of suspicious lesions
E) It is staged using ZIDAN staging system

Correct Answer:
85% are squamous cell carcinoma

Explanation: Vulval cancer is rare with approximately 1100 new cases per year in the UK. Its
crude incidence rate is 3.7/100,000 with crude mortality rate of 1.3/100,000. Although the
incidence has risen in the 40-49 age group it is uncommon below age 50. Median age at
presentation is 74
PASS‐MRCOG | Epidemiology

Key Points:

 Most common in the elderly, rare below age 50

 85% are SCC. The remainder are comprised of melanoma, Pagets disease, Bartholin
gland tumours, adenocarcinoma and BCCs.
 Vulval cytology is not a substitute for biopsy.
 The FIGO Staging system is used

Question 55

The peak incidence rate (per 100,000 women) of ovarian cancer in the UK is in which age
group?

A) 40‐49
B) 50‐59
C) 60‐69
D) 70‐79
E) 80+

Correct Answer:
80+

Explanation: As can be seen from the graph the peak incidence rate is in the 80‐84 age group.
Note the difference between incidence rate and number of cases. The 60‐69 age group
comprises the majority of cases in the UK.

Question 56

Study Y involves a trial of 72 patients. It finds improved outcomes in the treatment group (being
treated with Drug B) than those taking placebo. The null hypothesis (that Drug B makes no
difference to outcomes) is rejected.

Several larger studies involving several thousand patients clearly demonstrate Drug B makes no
statically significant difference to outcomes. What type of error has occurred in Study Y?

A) Type 1 error
B) Type 2 error
C) Selection bias
D) p‐value error
E) None of the above

Correct Answer:
Type 1 error
PASS‐MRCOG | Epidemiology

Explanation: This is an example of a Type 1 error

Question 57

Which of the following statements regarding miscarriage rate is correct?

A) In women aged 35‐39 miscarriage rate is approximately 40%

B) In women aged 20‐30 miscarriage rate is approximately 20%
C) In women over 45 years of age miscarriage rate approximately 40%
D) In women over 45 years of age miscarriage rate approximately 75%
E) None of the above are correct

Correct Answer:
women over 45 years of age miscarriage rate approximately 75%

Explanation: Diagram illustrating miscarriage rates by age

Question 58

Which of the following statements regarding miscarriage rate is correct?

A) A
B) B
C) C
D) D
E) A+D

Correct Answer:
B

Explanation: False positives are type 1 errors

Question 59
PASS‐MRCOG | Epidemiology

Which of these tests is most appropriate to use on study data where the population distribution
is unknown?

A) Pearson test
B) f‐test
C) t‐test
D) z‐test
E) Wilcoxon Signed Rank Test

Correct Answer:
Wilcoxon Signed Rank Test

Explanation: If the population distribution is unknown then a non‐parametric test is

appropriate. The Wilcoxon Signed Rank or Wilcoxon Rank Sum test is the only non‐parametric
test listed

Question 60

According to Greentop guideline No 52 the use of prophylactic oxytocics in the 3rd stage of
labour reduce the risk of postpartum haemorrhage by how much?

A) 5%
B) 15%
C) 25%
D) 35%
E) 60%
Correct Answer:
60%

Explanation: Prophylactic oxytocics should be offered routinely in the management of the third
stage of labour in all women as they reduce the risk of PPH by about 60%.

Question 61

All of the following factors increase the risk of endometrial cancer except which one?

A) Early menarche
B) Late menopause
C) High Coffee Consumption
D) Diabetes
E) PCOS

Correct Answer:
PASS‐MRCOG | Epidemiology

High Coffee Consumption

Explanation: Some studies show coffee consumption reduce the risk of endometrial cancer.

Risk Factors for Endometrial Cancer:

 Obesity (BMI >30 increases risk by 2.5 times)

 Late menopause
 Early Menarche
 HRT
 Nulliparous
 Diabetes (60% higher incidence in diabetics v non-diabetics)
 PCOS (2.8 ties higher in PCOS patients)
 Parkinsons
 Tamoxifen use
 Diethylstilbestrol use

Question 61

With regard to cervical screening what is the incidence of mild dyskaryosis?

A) 1%
B) 2.5%
C) 5%
D) 10%
E) 20%

Correct Answer:
10%

Explanation:  ncidence of mild dyskaryosis 10%

 Incidence of moderate and sever dyskaryosis 1-2%

 Inadequate smears 10%