Part 1 and Part 2 MRCOG

Examination
RCOG Visit to China
April 2018

© Royal College of Obstetricians and Gynaecologists

Dr S John Duthie FRCOG

China Advisor to RCOG China

Programme Board
RCOG Core Curriculum
SINGLE BEST ANSWER QUESTIONS (SBAa)

Author Mr S J Duthie
Theme Reproductive medicine
DomainHormones 1

Item 1
In human pregnancy, maternal growth levels begin to increase at around 10 weeks, plateau at approximately 28 weeks and can remain
elevated postpartum. What is the source of the majority of maternal growth hormone?

Option
A Anterior lobe of the pituitary / fetal
B Anterior lobe of the pituitary / maternal
C Maternal lover
D Maternal thyroid
E Placenta

Answer
E

Item 2
Human growth hormone is released in a pulsatile fashion. During which time period do most of the pulses occur?

Option
A Coitus
B Early morning
C Exercise
D Food ingestion
E Sleeping at night

Answer
E
 SINGLE BEST ANSWER QUESTIONS (SBAa)
Author Mr S J Duthie
Theme Oncology
DomainRT 1

Item 1
The Sievert is a unit of radiation. What is the single best definition of the Sievert?

Options
A Atomic mass number
B Equivalent dose to the target tissue
C Linear energy transfer
D Radiation absorbed by the target tissue
E Radiation emitted by the target tissue

Answer
B

Item 2
What is the single most likely effect of a dose of 6 Sieverts to an adult human?

Options
A Alopecia - reversible
B Lethal
C Mild nausea
D Self-limiting bleeding from the stomach
E Self-limiting diarrhoea

Answer
B
Item 3
Which type of radiation in the list of options has the highest linear energy transfer?

Options
A Alpha radiation
B Beta radiation
C Cosmic radiation
D Neutron radiation
E Obstetric ultrasound

Answer
A
 SINGLE BEST ANSWER QUESTIONS (SBAa)

Author Mr S J Duthie
Theme Understanding illness
DomainBacterial pathogens A
Item 1

Select from the list of options, the single best basis for the Lancefield classification of Streptococci.

Option
A Antibiotic susceptibility
B Appearance on dark ground illumination
C Carbohydrate composition of cell wall antigens
D Size of haemolysis following culture on blood agar plate
E Size of haemolysis following culture on enriched blood agar plate

Answer
C
 SINGLE BEST ANSWER QUESTIONS (SBAa)

Author Mr S J Duthie
Theme Embryology
DomainGenital tracts
Item 1

In the human genetic male, what is the site of biosynthesis of anti-Mullerian hormone(AMH)?

Option
A Granulocyte stem cells
B Hepatocytes
C Leydig cells
D Sertoli cells
E Spermatozoa

Answer
D

Item 2
In the absence of anti-Mullerian hormone (AMH), the paramesonephric ducts give rise to which structure?

Option
A Appendix testes
B Ovarian ligament
C Ovarian
D Round ligament
E Uterus

Answer
E
 SINGLE BEST ANSWER QUESTIONS (SBAa)

Author Mr S J Duthie
Theme Gynaecological problems
DomainSepsis 1

Item 1

Following coitus, there was a significant increase in the numbers of a certain microbe in the vagina with a concomitant increase in the
numbers of obligate anaerobes. The vaginal pH rose to 5.0. The women noticed that she had developed a malodorous vaginal discharge
with a fishy amine like smell. Material from a high vaginal swab taken from the woman was cultured in human blood agar in a moist
atmosphere enriched with carbon dioxide. Microscopic examination with Gram staining of the colonies showed the presence of Gram
negative coccobacilli. Which microbe is the most likely causative organism?

Option
A Bacterial vaginosis
B Chancroid
C Chlamydial infection
D Gonorrhoea
E Trichomoniasis
Answer
A

Item 2

Following coitus with a contact in Africa, a woman developed painful non-indurated genital ulcers and inguinal lymphadenitis. The ulcers
had a ragged appearance and microscopic examination of the exudate from the ulcer showed the presence of a large number of Gram
negative rods and chains. The organisms appeared both within and outside polymorphs in a “school of fish” appearance. What is the
single most likely diagnosis?
Option
A Bacterial vaginosis
B Chancroid
C Chlamydial infection
D Gonorrhoea
E Syphilis
Answer
B
Specialist Training & Education Programme

MRCOG
Full registration
Part 2 course

Basic Intermediate Advanced

Foundation Training Training Training Modules
CCT
Specialist Register
1 2 1 2 3 4 5 6 7 Independent Practice
Core Log Book
ARCP
Women’s Health Subspecialty
Module PART 2 MRCOG 2-3yr

PART 1 MRCOG PART 3 MRCOG

July 2014
Part 2 MRCOG

Paper 1 50 SBAs + 50 EMQs

Paper 2 50 SBAs + 50 EMQs

Part 2 MRCOG

• ST3 or above

• Exit ST5
Part 1 and Part 2 (written)

Max, 6 attempts

Stand alone tests

EMQ

Increases validity and coverage of the

syllabus without sacrificing reliability
What is the standard?
Part 2 MRCOG

A year 4 specialist trainee in Obstetrics

and Gynaecology of average intelligence
who has done the work and who would
pass the test on a good day.
STRUCTURE of an EMQ
Author
Theme
Domain
Functional
List of options +
Lead in statement
Distractors
/paragraph
Items
 LIST OF OPTIONS
Apples
✔

Oranges
✔

✘
EXTENDED MATCHING QUESTIONS(EMQs)
Author Mr S J Duthie
Theme Maternal mortality
Domain Definitions 1

A Accidental H Indirect
B Circumstantial I Late
C Coincidental J Late coincidental
D Direct K Late perinatal
E Early L Perinatal
F Early perinatal M Unclassified
G Incidental N Unknown

The items below describe the salient clinical facts in different cases of maternal death. Select the appropriate classification of each
maternal death from the list of options. Each option may be used once , more than once or not at all.

Item 1
A 24 year old woman was 28 weeks into her second pregnancy and she had a 2 year old child who had been delivered by
emergency lower segment Caesarean section for fetal distress. During the course of the second pregnancy a diagnosis of grade
4 placenta praevia was established. At 28 weeks gestation the woman developed significant antepartum haemorrhage and
emergency Caesarean section was carried out by an inexperienced obstetrician. Following the birth of a live infant catastrophic
haemorrhage occurred and the woman died one hour after delivery.

Answer
D Direct
Item 2
A 39 year old with a body mass index of 40kg/m 2 and a previous history of mild hypertension (prior to pregnancy) and who had a
family history of ischaemic heart disease underwent normal delivery of a live infant at 40 weeks gestation. Thirty five minutes
after delivery the woman collapsed and died. Post-mortem examination showed the presence of left ventricular hypertrophy and
sever coronary atheroma.

Answer
H Indirect

Item 3
A 28 year old woman with one living child had been undergoing treatment for a psychotic illness for the previous 10 years. The
woman was receiving olanzapine and appeared to be well controlled. No other medications were necessary or being taken. The
woman became pregnant, the antenatal course appeared uneventful from a clinical perspective and the woman underwent
normal delivery of a live infant at 40 weeks. Eight weeks after delivery the woman committed suicide by taking an overdose.
Post-mortem examination showed that the blood level of olanzapine was six times higher than the toxic level.

Answer
I Late
 Option
A 10% H 87%
B 15% I 90%
C 20% J 91%
D 45.5% K 94%
E 50% L 97.5%
F 65% M 99%
G 72% N 100%

The table below provides unpublished data on a new screening test for alpha-thalassaemia trait in an ante-natal population.

Alpha-thalassaemia trait

Present absent

Screen positive 1300 500

Screen negative 200 8000

Choose the appropriate match to the question given below from the list of options. Each option may be used once, more than
once or not at all.

Item 1
What is the sensitivity of the screening test?

Answer
H 87%
 EXTENDED MATCHING QUESTIONS(EMQs)
Author Mr S J Duthie
Theme Gynaecology
Domain Fibroids, UAE 1

Option
A Abdominal aorta → common iliac artery → external iliac artery → uterine artery
B Abdominal aorta → common iliac artery → internal pudendal artery → uterine artery
C Abdominal aorta → common iliac artery → internal iliac artery → uterine artery
D Anterior circumflex humeral → axillary artery → subclavian artery → aorta → common iliac artery → internal iliac artery →
uterine artery
E Femoral artery → external iliac artery → common iliac artery → aortic bifurcation → contralateral common iliac artery →
external iliac artery → uterine artery
F Femoral artery → external iliac artery → common iliac artery → aortic bifurcation → contralateral common iliac artery →
internal iliac artery → uterine artery
G Femoral artery → external iliac artery → common iliac artery → internal iliac artery → uterine artery
H Internal pudendal artery → internal iliac artery → uterine artery

Item 1
In the technique of uterine artery embolisation as a treatment for uterine fibroids, the uterine arteries are
occluded with polyvinyl micro-particles which are introduced using a catheter. Select the single most correct
route of the catheter from the list of options.

Answer
F Femoral artery → external iliac artery → common iliac artery → aortic bifurcation → contralateral common
iliac artery → internal iliac artery → uterine artery
It is important to observe consumer

spending over the next quarter.

It is important to observe summer

spending over the next quarter.

 Part 2 EMQ
Options:
A. Brainstorming
B. Delphi technique
C. Goldfish bowl
D. Lecture
E. Portfolio
F. Problem-based learning
G. Schema activation
H. Schema refinement
I. Simplified procedural hierarchy
J. Snowballing

39.You have been asked to organise a multiprofessional teaching session for a small group of
midwives and medical students on the subject of termination of pregnancy. Over a two
week period, these students have three one-hour sessions and also some private study
time. What is the single most appropriate teaching method from the list above?

40.You have been asked to teach some final year medical students in a tutorial on the
management for prolapse. You plan to initially revise pelvic floor anatomy, which has been
taught in first year. What is the single most appropriate teaching method from the list
above?
Part 2 EMQ

Actual performance:
Examining the Items

Item Difficulty Index

Item Discrimination Index

 EXTENDED MATCHING QUESTIONS (EMQs)
Author Mr S J Duthie
Theme Ectopic pregnancy
Domain Methotrexate 1

Options
  Symptom Clinical Signs Serum β – Ultrasound Findings   Symptom Clinical Signs Serum β – Ultrasound Findings
s HCG s HCG
A Abdomin Some 4,000 mIU/l Right adnexal mass F Minima Clinically well 4,000 IU/l Right adnexal mass
al pain, abdominal
quite tenderness, l with fetal heart
severe normal vitals sympto pulsations in mass
ms
B Abdomin Some 2,000 mIU/l Bilateral adnexal G Minima Clinically well 3,000 IU/l Right adnexal mass
al pain, abdominal masses l
quite tenderness, sympto
severe normal vitals ms
C Abdomin Rebound 4,000 IU/l Right adnexal mass, H No Clinically well 4,000 IU/l Right adnexal mass
al pain tenderness, free fluid in pelvis sympto with fetal heart
BP 90/40 ms pulsations in mass
mm Hg, I No Clinically well 3,000 mIU/l Right adnexal mass
pulse rate
112/min sympto
ms
D Abdomin Rebound 1,000 IU/l Right adnexal mass, J No Clinically well 1,000 mIU/l Bilateral adnexal
al pain tenderness, free fluid in pelvis sympto masses
BP 90/40 ms
mm Hg,
pulse rate
112/min

E Abdomin Rebound 200 IU/l Right adnexal mass,

al pain tenderness, free fluid in pelvis
BP 90/40
mm Hg,
pulse rate
112/min
ITEM 1
You are called to attend a woman in the Early Pregnancy Assessment Unit with a
suspected ectopic pregnancy. The Duty Sister informs you by telephone that the woman
is pregnant and wishes to avoid surgery if at all possible. The woman is aged 39 years, has
one living child and has previously been in good health. As you walk over to the EPAU you
consider the role of methotrexate in the management of women with an ectopic
pregnancy. Methotrexate is available and would be dispensed by the Pharmacy as long as
your Department’s protocol is followed. Which one of the options most closely defines a
suitable case for methotrexate?

ANSWER
G