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MRCOG part 2 September 2017 Recalls

Teaching, ethics & statistics


1. Forest plot …metformin in obese and non obese …..CI was 1 in both studies but one
study with touches the line [Compare to Q.87 march 2016].

2. Scenario with table of 2 x2 and to calculate PPV [Q.88 Sept 2016]

3. Pt 2cm ….fetal distress….Pt refusing surgery at any cost ,…… what next

[Counseling by another consultant …..legal court order urgent,,, next of kin……. Accept
women wishes…..]

4. Pain score …what type of data. [Q.89 Sept 2016]

5. Every year a hospital accept 12 new trainee as a part of the training program. What is
the best method to evaluate the new trainee before they engage into the hospital? [Q.99 Sep
2016].

6. Rude trainee …difficult to work with ..college supervisor informed …what type of
assesement tool/method to deal with the situation.

[Multi sources feedback, Case based discussions,……...]

7. What is the definition of Perinatal mortality rate.

8. Severe HMB resistant to medical Rtt in a 32 yrs with learning disabilities, brought by
relatives enquiring about hysterectomy

[legal order, proceed in best interest, take parental consent, proceed without consent as
gestures enough].

9. Which of these is formative & which represent summative assessment:

[Clinical case task , Mini cex, OSCE, OSAT, Ability to BBN, to assess skills,…]

10. Responsibility of the Caldicott

11. Definition [?or calculation] of PPV

EMQ: Options: failure to inform, Battery, implied consent, wriitten consent, Bolam……
12. Obese lady with bmi 39 have neccrtizing facitis ..was sueing that why not informed
about this complication before hysterectomy [& was not on consent] …was told that any
doctor of reasonale responsitiliry will not told such arisk as it is rare.
13. Pt obese with 3.9 kg baby 2with gdm had forceps delivery with shoulder dystocia
+erb’s. and the erbs palsy not corrected by physiotherapy ..was sueing that why was not
told abt risk of erbs palsy ..was not mention in the written consent foe instrumental delivery

14. Consent for sterilization ..mention about risk of ectopic and risk of failure ….what type
of legal act [Or: Consented for tubal sterilization, special hospital concent signed including
failure Rate 2/ 200]

EMQ: Type of study.


15. Midwife wanna see how many women who opted for water birth needed analgesia in
labour

16. Pt with PMB was referred to either quick one stop or general gynae clinic. Time was
compared from referral to ?investigation.

17. 15 year study to see the effect of carboplatin in the cancer pt

EMQ: Consent [options: remove this from that, leave, cancel, call, take biopsy,…]
Compare to Q21-22 March 2015, Q42-44 March 2016, Q 145-146 march 2017

18. Consented for laparotomy+ removal of appendix. You were called as a 6cm ov cyst
was found instead.

19. Age???, Consented for TAH [for HMB?]± laparotomy. A Rt ovarian cyst suggestive for
dermoid was found imbedded in dense adhesions to pelvic sidewall. ? PH of removed Lt ovary
for dermoid.

20. Incidental finding of an adnexal mass during cholecystectomy [consented for


cholecystectomy only].

Core surgical skills & post-op care

21. Type of Stitch for anorectal mucosa after 4th degree tear.

22. Risk of ovarian failure in UAE. [?age].

23. Lidocaine time to peak if not accidentally injected.

24. Nerve blocked during episiotomy (? Or pudendal block)

[antior labial branch of ilioinguinal nerve.. ant labial of pudendal, lateral cutansous n of
thigh.....lateral branch of femoral ilio hypogastric,post cutaneous of the thigh, ant cervical….].

25. Wound [surgical site] Infection rate after Em LSCS [?2nd stage]: [5, 10, 15, 20%,….]
26. Site of lidocaine inj for paracervical block [at what o’clock?]

Pictures with different combinations like (1 , 3 & 9) (2, 6 o'clock & 1) (2 3 5 o'clock & 7) (4
11 o'clock & 1) (4 o’clock & 8) (2 & 10).

27. Which incision best CS for a 55 BMI?

[pfannestiel, joil cohein, transverse bove panniculous, midline,……]

28. Question about support to prevent prolapse after surgery & another one asking for
definitive Rtt for PHVP [Q.27-28 Sept 2016]

29. EMQ: The most major consequence to notify about if pt refused Rtt. [same Q53-54
sept 2016]

30. Asking for most relevant investigation for a scenario suggestive of bladder [?ureter]
injury: complicated CS with extension to broad lig,….

[options included CT urogram, cystography MRI & some other urology invests].

31. Uretreic injury: what is the most common type requiring theraputic treatment.

32. Missed aborion , CRL 35 mm , has intramural fibroid 3 cm (+ other risk cant
remember), opted for MVA , what risk factor in her hx make this procedure unacceptable.

33. Trainee atend c/s with consultant and found consultant doing blunt disection what is
one advantage of this procedure

[hemostasis, quick recovery, lesser time, reduce post operative fever,..]

EMQ: Next step [TAH for fibroid uterus, you are assisted by ST2]
34. Next step skin incision. [ relevant options include: packing bowel, visualization of
adnexa , uterus and pouch of doughlas,…]

35. Before [? Or after] clamping of pedicles [dissect away ureters,….]

36. You found bladder adherent to uterus [?or ant vaginal wall]. Next step? [dissect away
or call consultant/urologist,…]

EMQ: Different scenarios asking about diagnosis


[options included different types of visceral injuries, opiate toxicity, PPCM, ACS, diff types of
shock, AFE, PE,……] ?Or may be immediate next step in mng

37. previous history of tah with left salphingooophorectomy 5 years before …..now right
complex mass need right oophorectomy ….post op laparoscopy 7 day ,,,pain localized right
side than generalized pain …bowel sound present …rigidity..guarding ….high grade fever.
38. Typical description of AFE,,,,fast delivery …..DIC, cardiac arrest

39. Typical description of opoid toxicity [Rr was 8/min].

40. Afrocaribbean sickler with chest pain not responsive to anti-acids & antibiotics, now
severe, O2 89%.

41. 36h post VD, offensive VD, low BP & T.

Early pregnancy, ANC & Maternal Medicine


42. Tow Pictures of GS sac one with fetal pole intrautine [?reassure] Second was GS big
without pole [?US after 1w]

43. Pt with hyperemesis in early preg and her TFT , high T4 , undetectable TSH

[give carbamizole, PTU, PTU then carbimazol, propranolol, potassium iodide, iv fluids with
oral iodine, do nothing,..]

44. Patient with hyperemesis TSH upper normal limit and t4 lower normal limit given,
cause was asked

[ graves disease, hashimotos, subclinical hypothyroidism, hypothyroidism,..]

45. MCMA twins. Timing & mode of delivery.

46. Anomaly scan showing truncus arteriosus. What is the most likely associated
chromosomal defect?

47. Screening results: NT 0.23 ?PAPPA low HCG normal. What advice?

[ serial growth scan, Kario, Amniosen at 16w , Scan at 22w ,….. ]

48. RH-D neg Pt undergoing medical TOP at 8 wks, asking for the need of anti-D.

49. Clotting factor normally decreased during pregnancy

[Factor 8, Protein c, Protein s , VWF, Factor 5]

50. Asthmatic on enalapril, what drug antenatally on exchange of enalapril.

51. A woman with H/O hodgkins lymphoma, was given bleomycin+ neck/mediastinum
radiotherapy 4 yrs back.. What test In future pregnancy?.

[resp FT, TFT,both,..…..]

52. Risk of postpartum psychosis for a pregnant woman with bipolar disorders.

53. HAART started at 22week to prevent vertical transmission. At delivery; zero viral load
,healthy. When to stop it post delivery.
54. Husband infected with ZIKV. Mother should use effective & barrier CC for how long
before trying for a pregnancy ?

[6,8,12,16,24 weeks]

55. Previous LSCS. Low lying placenta at ?29wks. What next step to rule out Accreta?

56. Migraine is A/w higher risk of what combination:

(stroke , PE , SAH) (stroke , PE , MI), …..

57. What is the most relevant ECG finding in MI during pregnancy?

58. Rate of reversion to breech after successful ECV.

59. Incidence of EOGBS in general poplation in uk without screening.

60. Which one is considered a major risk factor for SGA in this scenario?

[donor insemination .iui, natural conception , age was ok .....may be have fibroid . compare to
Q131 sept 2016].

61. Risk of breast feeding in a mother taking desferoxamine

[low risk, negligible risk, no risk,….]

62. Which of the following is more associated with a male fetus? [Q.137 Sept.2016]

63. Which of the following drugs increases the risk for GD?

64. The most useful dignositic tool for accreta in 2cs with anterior low placenta

65. Twins MCDA , twin 1 liqour 1 cm i think , twin2 liqour 9 cm. Bladder visible for both.
what is the diagnosis

[SGR, TTT, TAPs, TRAP,..]

66. Mother with chicken box st 39 wks what is the complication to the neonate?

[RDS, TTN, Jaundice, Something like haumorragic fulminant?,…]

67. Factor v heterozygous mutatio in 36 lady with BMIi32..for LMW heparin:

[Since pregnancy, From28wks, 6 week post, 10 days..post..partum,..]

68. Treatment [?initial live saving Rtt] for TTP at 24 wks wit Plt count of 45,000

[platlets, FFP, pridnisolone, plasma exchange transfusion]

69. SBA about CMV: pt was at 20week with CMV signs of infection [echogenic
bowel,..].....her booking blood and 20week blood were taken , asking how it will be
confirmed that it is first trimester infection [fourfolds rise IgM/IgG seoarate or both as
options, low avidity, high avidity,…..]

EMQ: NVP [tretment in community sitting with thiamine & vitamins, treatment in
community sitting e cyclazine, Inpatient treatment e iv Ns, inpatient treatment with e
dextrose & thiamin, oral prednisilon, parenteral feeding….]

70. refractory vomitting tried Community medecines but all failed

71. severe vomiting & ketonuria tried all

72. EMQ: Genetic counselling: thallasemia, Duchene, marfan,…… [Q.160-165 March 2016]

EMQ: RBC antibodies: What to expect on neonate


[early anemia, late anemia, early jaundice, late jaundice, polythycemia…]

73. Second pregnancy, anti d was normal but rose to 20 at 36week, delivered at 37 week.

74. Anti c antibodies 16 at 38 wks, NVD, BF started after 3h.

EMQ: Abortion act:


[dont comply with abortion act ……not relevant to abortion act, Clause A-E……..]

75. Top on fifth baby boy..

76. Wanna TOP on social reason

77. 24 week exact. TOP for severe pre eclampsia with coagulopathy not responding to
medical Rtt.

EMQ: Cause of headache


78. For 60 min…tightening type with photophobia..not associated with exertion

79. first episode ….throbbing severe headache with photo auditory

80. lasts 6 hours and worse on climbing stair, A/W photophobia and phonophobia

81. worst headache ever with neckstiffness ..postpartum 2 week

EMQ: Choice of antibiotics/drugs:


82. Asylum seeker, hiv positive allergic to metro positive for vdrl and typhae .

83. Gbs positive swab 36 week in labour..no allergy

84. Tender breast with cracked nipples.


85. Severe falciparum malaria.

EMQ: Genetic counselling: Risk to offspring


86. Cystic fibrosis carrier both …

87. Mother with Duchesne muscular dystrophy

88. Husband with Duchesne dystrophy

89. Marfan syndrome mother ….

90. EMQ: High blood pressure: Same as Q.161-162 Sept 2016

EMQ: AED [Low ris of congenital anomalies , High risk , limited evidence, Risk of CA similar to
back ground risk , Neurodevelopmental delay , Slight increase risk of developmental dely,
NTD, clefts, hypospadias,…]

91. Pt on lamtorigin, stabe on this drug ask about effect if the baby

92. pt was on lamotrigine not stable , change to topiremate ask about risk

Labour, delivery & postpartum

93. patient came in latent phase of labour was on paracetamol. She requested for more
analgesia.. she does not want effect of vomiting [? Vomiting phobia] . What is your choice of
drug

[epidural, diamorphine, pethidine, water birth, mobilizing, gas & air]

94. Similar to above but phobic from needles/ injections

95. Facial diameter direct deflexed occipito posterior?

[Mentovertical, occipitofrontal, occipito bregmatic, submentobregmatic, submentofrontal ]

96. Tightinings at 33 wks. Previous pregnancy ended in PTL at ?33 wks. What are the
chance of PTL in this pregnancy with +ve [or -ve] FFN test

97. Cut-edge of lactate level in septic shock.

98. EMQ FGM in labour [compare to Sept 2016 Q.55-56] .

99. FGM: Severely depressed (on Rtt) due to irregular labia (asymmetry), asked for
labioplasty. Age?? [agree surgery, psychsexual counselling, deny, report,….]

100. What is the term baby blood supply per kg.

101. Low risk pregnancy contracting every 15 min for the past 12 hours . Os is 2 cm dilated
and well effaced. What is your next step
[advice to go home and come back, come back nxt morning for IOL, rupture membrane,….]

102. 30year p1 with SROM, a case of preclampsia + placental abruption at 24 week… now
presented with bleeding heavily 500ml clots removed vaginally .…..cervix 5 cm with bulging
membranes ……vitals and labs not mentioned. what next

[synto reassement 30 min 2hours 4 hours,Cat 1 CS,..….No option of hysterotomy].

103. Another scenario/version of above question: 24 wks woman referred d/t BP 150/110
proteinurea +, labetalol started after admission.she has h/o abnormal combined test multiple
anomalies diagnosed on amniocentesis ,TOP advised by consultant but pt refused . Now next
day after admission to control BP , she develop no >160/110 , protein ++++, pain abdomen &
o/e :tender abdomen .shifted to labour room PV os 5m, cx effaced and she was also
multiparous . And fhs 100 what to do

104. PG with fast progress ..now 9 cm…before early deceleration ..now ctg with deep
variable deceleration some early with shouldering some late …..variability good ..last fbs was
7.23 1 hours before , asking for next step.….no option of conservative ..it was like start synto
fbs….caesarean no fbs option.

105. CTG trace picture showing tachycardia with occasional deceleration. Mother pulse
high but temperature normal what initial action u will do

106. Spinal cord injury at t4 140/90 maternal Brady ….now anxious tremors …dx [Q.100
Sept 2016]

107. what factor known to decrease the instrumental delivery risk

[continous support during labour...use of synto .....use of epidural anlgesia .....lithotomy


position ..upright position]

108. Pt on epidural received top up in 30 min before ..now fully, no urge…Head +3 DOA,
persistent brady 90. Next step?

109. Post partum with S&S of pulmonary embolism. No sign of DVT. CXR showed features
of atelectasis. Next step?

110. Pt with heptatis B sAg + , core antibody + , refused to come for follow up what to do to
minmize vertical transmission during labour?

[ immungluni to mother, immunglu to baby vaccin , oral lamu? To mother and imun to
baby,…]

111. Twins , Ist delivered , 2nd breech , os remain fully for ?30m , breech engaged

[breech vaginal delivery, assess after 30 min, c/s,……]

112. Medication used to increase breast milk in special cases


[Metochlorpramide, Chlorpomazin, Domperidone,…..]

113. A baby was delivered with one eye in the center of the head, holonecephaly +
omphacole, asking about most likely syndrome.

114. Flu vaccine protective for how many months for the baby as passive immunity?

115. Hepatitis b virus vaccine immunity last for how many days for baby after birth

116. What Ketonemia level of to diagnose DKA?

[0.3, 0.6, 0.9, 1.2, 1.6]

117. From the following, which one is an indication for Routine testing of blood sugar of
the neonate? [Q.130 Sept 2016].

118. 30 h PROM, stable vitals & CTG. Next step

119. EMQ: refer letter from a GP with results of HIV & 1 st TM screening: [Q.32 Sept 2015]
EMQ: Breech [IOL at 39 wks, ECV, CS,…..]
120. Para3, all VD, now breech at 38wks, presented with 3rd episode of RFM. US & CTG are
normal. She is keen for VD.

121. Breech second twin ..engaged ,,membrane intact ,,,,ctg normal ,,multi ..wat next.

EMQ: PTL scenarios [steroids with doses …mgso4….antibiotics …tocolysis, combinations of


above, rescue cerclage…..]

122. 28plus 3 days admitted three days before and received steroid …now 3cm dilated
bulging membranes …..irregular mild contraction a..Para 3

123. 31week threatened preterm labor ……tvs done 1cm long cervix…… what next

124. 29 [?24]week with 4 cm dilated

EMQ: Cord presentation


125. 9 cm cord presentation in a multigravida …ctg normal ….intact membranes …what
next.

126. Breech 6 cm …..cord presentation …..theatre busy a..good contraction

Gynecological Problems & Subfertility


127. 14 yrs old girl with history of Heavy bleeding every 6-7 weeks , mother concerned of
fatigue & lethargy. haemoglobin 111g, mcv 26, mchc 26 [decreased markedly]. what you will
do next
[reassure, routine refer to gyne clinic,…..]

128. 50 yrs old, Complaining of virilizing symptoms that were rapidly progressing over the
last 6m. [Q.74 Sept 2016].

129. 56 year + hot flushes…..what will be advise on starting HRT [ that it will not increase
the risk of : unsheduled bleeding at 6 month…. Bleeding for 1 month………????????????

130. Patient on continuous combined HRT in which situation u will do endometrial


sampling

131. PMB, on scan ET 2mm with small amount of fluid ,,what next ???

[reassure, biopsy different types……

132. PM have hysteroscopy and polyps removed… histology polyp showed simple
endometrial hyperplasia. Next step?

133. Primary amenorrhea with uterus not found ,…..external genitals and secondary
normal..karyotyping xx…..vagina short 1 cm ….what dx

134. 19 year BMI 26 secondary amenorrhea 8 month… took cop before …stopped already
…us and physical findings normal……. Mildly increase total and free testosterone. increased
lh/fsh ratio. Dx?

135. EMQ male factor subfertility, same as Q.82-85 sept 2016


136. PCO…took clomit 50/50/100 for 3 cycles. No ovulation ..wat next.

[LOD, IVF, HIgh dose gonadotropin, 3 more cycle of clomiphene, increase dose of metformin]

137. First line by NICE for HMB , most effective with good profile. [What is best for quailtly
of life for HMB: merena or progesteron ?]

138. PM with flushes, asking for HRT, she is a smoker & obese. Best option?

[coc , Coc estradiol , Pop, Esrogen patch, Estrogen with mirena]

139. a pt had two episodes of PMB ....on ultrasound the endometrial thickness was 3mm.
Next step?

140. What is most common complication of IVF with ovum donation

[pre-eclampsia, PTL, FGR,…

141. IVF , with donor egg , late risk to the baby?

[Miscarriage, Still birth, SGA,…]


142. 38 years old undergo IVF .Before IVF her FSH and LH Were ? 13 & 14 approximately.
Which complications is imp in this case different from general population?

[PE, PTL, GD,…]

EMQ: what next step [Hystrescopy and biobsy, Out pt biobsy , Out biobsy after 6 months ,
Out pt biobsy after 3 months, TVS, do nothing….]

143. Women had CT scan for renal calculi , ET found 10 mm ,

144. women 45 ? , irregular cycle out pt biobsy revealed proliferative ? Endometrium

Sexual & reproductive health

145. Question about incidence of neonatal herpes if VD after 1ry herpes. [GA:?]

EMQ: What infection: Syphilis, BV, chancroid, HPV,….


146. Stable relationship for 15 years …..have painless growth on Vulva….solid papupalar
growth increased in size.

147. Foul odorous discharge with itching excoriation …….description of bacterial


vaginosis..she had history of three first trimester miscarriages.

148. Suitable contraception for a woman who also has patent foramen ovale & heavy
periods.

149. Pt in depo inj came with breakthrough bleeding. Wht to offer [COC, northisterone
luteal phace, change inj time,….]

150. What type of contraception is suitable for epileptics on enzyme inducer? [Q.70 Sept
2016].

151. Hsv primary infection at 33 w. Next steps

152. Recurrent herpes, last episode 1wk ago, now asymptomatic, GA?, worried about risk
to baby. What advice.

EMQ: What likely finding to be expected on exam [ compare to Q.172-173 march 2016].
Options included multiple tender nodules in posterior forcheete …..multiple punched out
lesion, pinful blisters/?vesicles, vaginal hyperemia with whitish plaques on Vulva,….

153. 47 year old Vulval soreness and itching……. Initial sexual intercourse panfl despite of
lubricants …some occasional post coital bleeding no vagina discharge was noticed.

154. Pt with prodromal symptoms… acute urinary retention……dysuria


Oncology
155. A woman came for genetic counselling. From the following, what puts her at the
highest risk for Ca breast? [BRCA, FH one member,….] Compare to Q.114 sept 2016

EMQ: Ovarian cyst in PM. Options: Follow up in…month, refer to cancer center, cystectomy,
oophorectomy, TAH,…..

156. Cyst found 4.5cm simple with complain of lower abdominal pain many days ….other
ovary can’t visualize due to gas intestine CA-125 was 16. What next .?

157. Another cyst was 10mm …ca 125 35…..follow up ….other ovary was not visualized

158. Another cyst was also simple..ca 125 was not mentioned.

159. Another cystic septated mass with no ovarian tissue around 6.5 cm ..ca 125 was 35

EMQ: CIN management: Next step


160. Post hysterectomy, was on regular follow-up .completely excised CIN1 on histo.

161. 52 year old lady Cin 3 removed completely. Histo CGIN seen extending in deeply
excised tissue. After 6 month both smear and hpv negative.

162. Pt 25 year first smear low grade dyskaryosis….hpv inadequate…..wat next

163. Treated cin 1….test of cure still low grade ..hpv negative

164. Pt diagnosed with moderate diskaryosis but she didn't came follow up , after 1 yrs
smear showed severe diskaryosis , sent for colopscopy which show acetowhite change.
treated by LLETZ [see & treat], next step

165. Mild dyskaryosis treated , in adequate HPV, age 49

Urogynecology
166. A scenario was given with a picture [bladder tumor on cystoscopey], asking for next
step [? Refer to urology].

167. Another scenario with symptoms like recurrent UTI but neg cultures, on cystoscope
glomerulation. Diagnosis? [? BPS]

168. First line treatment for OAB with failed conservative Rtt.

169. Mixed sypltoms…..what first line investigation [?diary].


170. Asking for next step: Failed conservative for SUI. PH of ant repair, now has 1st degree
cysto & rectocele. She denied sling operation.

[options were marshal, paravginal repair, colposuspension,..]

EMQ: BPS [many options including diet, drugs, MDT, botox, UD studies, neuromodulation,
essentially all options in algorithm]

171. failed oral treatment with analgesics, next step,

172. failed complementary and conservatives ..next step.

173. failed drug treatment ..referred to MDT, had instillation therapy ,presented with OAB
symptoms……what next .

Thanks a lot to all who had shared

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