‫بسم هللا الرحمن الرحيم‬

MRCOG PART2 RECALLS MARCH 2015

( recalls telegram group )
MQ :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
Answer : multible regression

2 - To find the relationship between maternal BMI & fetal birth w

Answer : Pearson correlation

3 - To look for the different outcomes of pregnancy in relation to BMI.

For multiple factors wt one dependent variable logistic regression

4. To measure the outcome of breech delivery. Women were assigned into 2 groups:
vaginal & c/s ; & followed up.
 Two groups RCT intention to treat analysis (busy spr)

EMQ: Counselling about 5 rys survival rate (Options : Different figures)

Qeustions: (May be changed next exams)

Answer : 47%
5 - Stage 2b cx

6 - 1a ovary (i think it was specifically Mucinous) Answer : 90%

7 - 1b endometrium Answer : 72%

8 - An old woman with ?1cm mass in clitoris. What should be the next step to
reach a diagnosis Options included exisional biopsy/incisional from centre

surface/incisional from margin/wide local exision + LND , keye punch biopsy

Answer : exisional biopsy
Diagnosis is made by biopsy of a suspicious lesion. If the lesion is small and well circumscribed it may be possible to
perform a wide local excisional biopsy. It is preferable to use clinical photography to have a precise record of the site
of the lesion prior to performing the excision. A clearance margin of at least 1 cm, including depth, is required. If
there is no wide margin of normal tissue then the lesion should be biopsied rather than excised. Caution must be
exercised when performing excision biopsies. If further surgery is necessary, wide local excision can be extremely
challenging when the initial lesion is no longer present. For most lesions, it will be more appropriate to take one or
multiple biopsies. The procedure can be performed with local anaesthetic using a Keye’s biopsy blade ( TOG 2013 )
9 - A woman undergone evac of delayed miscarrige. Histopath. —> Complete mole. What
is the risk of developing chorio carcinoma? Answer : 1: 40
Options: 1:20, 1:40 , 1:60 , 1:80 , 1:100, 1:200[15% is invasive mole but he is asking
chorioca]
2-3 % written in epidemiology and stats = 1/40…. Recurrence of molar pregnancy is 1 in 80(Same
like twin in general population and red cell antibodies) …… Complete 15% ned chemo……partial
0.5% need chem.( rate to change to chorio. 0.5% ?

10. what is the % of bilaterality of dermoid Answer: 15%

15 %past papers and green top?) always choose (

upper one as books give 10-15% so choose 15%

11 - Management option after treatment[LLETZ] for CIN 3 with biopsy

showing unclear margins
Answer : Repeat LLETZ

Either re exsciton or TOC……… Depend on the age

* Less than 50 years test of cure
* more than 50 re excision
TOC ( test of cure ) Cervical smear and hpv test 6m
If +ve colposcopy………. If -ve 3 yrs recall………what
ever age

12 - Management option after treatment[LLETZ], age 52, biopsy showed

CIN1+cGIN reaching excitional margins Answer :cone biopsy

* Repeat excision to see if margins clear or not(Because LLETZ has diathermic injuries to the margin
and you can not know the margin safety)
* To be sure you removed all disease before hystrectomy bec if not you may need more invasive .
surgry than simple hysterectomy
* If she is above 50 and he start excision so go for repeat excision then hysterectomy
* if CIN choose LLETZ ……………..if CGin choose cone
** 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
Mother’s consent is more important .Woman to sign consent & Answer : can not proceed…
assessing that she understands what she's consenting to

14 - A 15 yr girl came with boy friend (15 yrs) for TOP [GA ?17 wks] & they
look aware/understanding Answer : Encourage girl to..
tell parents
Her consent is important as 15 and fraser competent, no evidence of abuse as boy just 17
first step is to encourage to tell her parents, if she refuses go to next option take patients
consent

15 - A 14 yrs girl came with partner for ERPOC.from whom will you take
consent Answer : take concent from girl

:EMQ •

Options: Too many. Unfortunately can’t recall most of them

Questions:

16 - I think a patient died & the coroner request the copy pt medical records.
Option list included:

full access, restricted access & ?deny access , advice from legal advisor of your hospital ,
were in the option list.

Government legal investigator for case of death is coroner…… you will give notes u cannot
refuse, u don’t have the right. U chose u will give copy of file no need to give unrestricted
Answer : coroner restricted
access
 access to notes as he only asked for copy of notes. If in case of a death we call coroner first
to see scene and if he allows then we can remove tubings etc

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, ask legal advisor of
hospital for help??] Answer : full acsess

= you give copy to patient as its pts right. (according to patient ‘s right act) ( check patient information
) you have to provide copy after 40 days if 40 days have passed since procedure so you need time to
find records and make a copy but if recent can be given earlier

= Its mention in tog as i remmber 10 y for medical disorder…….., ctg normal keep for 25 y ..........for
abnormal ctg indefentily

18 - A woman diagnosed with severe dyskaryosis, colposcopy recommended. She moved

house & no letter reached her to come back to follow up ( can't remember options). I
think later on she came with cancer

Options were : incident report review , report in national governance, pt safety events, to
inform responsibility disclaimer, root cause analysis
Answer: incident report

failure of pt to recall for colposcopy is serious and requires an incident report review and the person is
responsibility is of GP and is a clinical governance issue so has to be informed to clinical governance…. Next step is
to carry out root cause analysis , I the question mentions that incident review was done then we will do root
analysis…. If question didn’t mention review then we will do report to governance …….) read safe actions in
cervical screening program document GP is responsible and root analysis will be done to prevent this in future by
clinical governance

Regarding 18 one of the professors answerd it incident report becoz he said that the question is directed to us (
doctors) who are doing the incident report but root cause can be done but by other professions not the doctors

19 - doctor was carrying a study has took the study papers home [papers with private
patient info]. The study papers were stolen. (what you are going to do)

the options was inform police - inform governer- incidental report -inform medical director-
“report never event”, “report to information handling committee” risk management
committee , inform GMC Answer: report to risk management committee

Or Inform hospital legal authority

Staff should prepare an incident report to document
unusual and/or significant events or
emergencies involving individuals who receive services
and/or support. Examples of
such events include but are not limited to the following:
1 - Injury to individuaSVVl or caused to others
2 - Aggressive behavior directed at others
3 - Self abusive behavior
4 - Endangering or threatening others
5 - Serious illness and/or hospitalization
6 - Imminent death or death
7 - Property destruction
8 - Serious disruptive situation while in the community
9 - Illegal or unusual problematic behavior
10 - Being victimized by another individual who receives
services
11 - Any incident involving the police, fire department,
.ambulance etc
12 - Any time someone has physically intervened with an
individual when such intervention
is not in accordance with an approved behavioral
treatment plan
13 - Any time an individual is involved in an automobile
accident while receiving services
14 - Being a victim of a crime reported to a law
enforcement agency
15 - Being incarcerated (in jail or prison for at least one
overnight stay)
Significant accomplishments or other positive changes 16 -
which should be noted by others
breach of confidentiality of patient…… police needs
to be involved but the hospital will do that you will
not contact police. You cannot remove patient’s
notes from hospital even for an audit you do in
hospital u can’t remove notes from hospital at all. U
cannot even access computer without password u
can’t even put USB … u will inform clinical director
of hospital ….. who will tell legal advisor and then
they will inform police ……it’s a clinical governess
issue so root cause analysis done to make sure it
. doesn’t happen again
Root cause analysis b done by risk
management team
Audit setting the standard and comparing it to our
ideas then implementing then reaudit ( audit cucle)
‫ " التحليل التلوي‬This is the Meta-Analysis
Definition: A way of combining data from many
different research studies. A meta-analysis is a
statistical process that combines the findings from
.individual studies
Example: For example, researchers wanted to know
about the risk of stomach bleeding in people taking
aspirin. They did a meta-analysis of data from 24
clinical trials with nearly 66,000 participants and
found that the risk of stomach bleeding was 2.47
percent with aspirin compared to 1.42 percent with
.placebo (inactive substance)

20 - A study carried out to compare suture material used &seniority of surgeon in

suturing • Answer : aduit
EMQ: Unexpected pathology during surgery Options:
= Abandon procedure
= Take biopsy from X & abandon procedure
= Remove X from from Y
= Other options like -i think- Remove X, Remove X &Y, Contact next of kin
21 - A young girl who was entered as acute appendicitis. Appendix was found normal but
a 3 cm dermoid cyst[X] was found on Rt ovary[Y]. pt signed for appendicectomy and
laparotomy. Do as concented do not more exept: Answer : abandon the
1 – life saving …..ectopic procedure
2 – minimal int. to relieve symptoms …de torsion
= If haemodynamically unstable that the hge will
affect her life to remove as in case of ECTOPIC but if
.stable leave it for another appointment
 22 - A 40 yrs woman during lap assisted vag hysterectomy and had a previous history of
left ovary removed was found to have a dermoid cyst[X] on Rt ovary[Y], both attached to
pelvic side wall by adhesion Answer :As Consented Only planned procedure

Only vaginal hyst.

.23 - A woman came at 41 wks GA. You offered her IOL but she denied
ANSWER : [give her patient inforamtion leaflet]

at 42 ws ask for ( twice weekly ctg and amniotic

fluid assessment)
repect her wish & explain about risk & bene
as induction will be 41+3
by way this remember me the recall q about the
woman who asked iol becz her husband trave
with army for militry purpose

fertility/andrology

24 - Couples, 1ry infertility 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 Answer : ivf

26 - Male previously fertile. Now azoospermic. Low FSH & testosterone options :
klienfilter, anabolic steroids, Kallman Answer : anabolic steroid

.27 - A woman with infertility, workup showed blocked tubes with hydrosalpings

Women with hydrosalpinges should be Answer : Salpingectomy followed by IVF

offered salpingectomy, preferably by

laparoscopy, before IVF treatment because
this improves the chance of a live birth

29 - From the following figures, what hormonal

profile is consistent with WHO class 3 ovarian

disorders?

]High FSH, high LH , low E, normal PRL[

Answer : hight fsh and lh and low oest. ( premature ov.failure)
)
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 as 2 Rotterdam criteria biochemical and clinical
hyperandrogenism,and oligomennorhea. LH: FSH ratio
Answer : pco reversed, test.( total testosterone) <5nmol/l
PCO, Idiopathic, Cushing, Androgen producing tumour
androgen index This is a repeat question, but in the previous exam they put
TOTAL AND./ SHBG X 100 a cycle pattern of 7-8 days every 24-35 days. means he
canceled oligomenorrhea so not PCO so idiopathic
hirsutism (idiopathic)

31 - A woman came with hirsutism + virilization. Testosterone 7. No DHEA OR OTHER

INVEST were given, but mentioned to have central obesity ANSWER : cushing syndrome
in this case virilization, and testosterone level more than 5 favour androgen secreting tumour. In pco
testosterone is less than 5
If testosterone level is between 5-7 think of androgen secreting tumour
If equal to or more than 8 strongly suggestive of androgen secreting tumour

Cushing’s syndrome results from increased circulating concentrations of cortisol and can present
insidiously with centripetal weight gain, facial plethora, supraclavicular fat pads, abdominal striae and
signs of hyperandrogenism, such as hirsutism, acne and male pattern baldness. Cushing’s syndrome
can be secondary to an ACTH secreting pituitary tumour (Cushing’s disease) ( CENTRAL OBESITY )
32 - A woman came with hirsutism, irregular periods, LH was higher than FSH.
Testosterone was ? 6.5 . They asked about next test to help reach a diagnosis.
] Options included U/S , TFT, DHEA, 17(OH)P, dexameth. Suppression test ]
Answer : , 17(OH)P
• 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 separate option
* Acute appendicitis
* Torsion / Ruptured cyst [each as a separate option
* Bowel perforation
* Incomplete miscarriage
Answer : heteroectopic
* Laparotomy laparoscopy (?or lap for detorsion)/, Expectant mng
33 - Surrogate woman, came from Spain [or somewhere] after replacing 2 embryos , came
with severe right iliac Fossa pain. Mild pv bleeding. Tachycardia and hypotension. I think
Ultrasound showed single gestational sac
34 - A woman 2 days after egg collection (large number collected,? 25), came with severe
LIF pain, vomiting, lightheadedness. Egg collection done after two days travelled to UK
and woke up in morning with severe iliac fossa pain and felt lighted and abdominal pain
ANSWER : OHSS ( IF COMPLETE Q)

If sudden oncet ………….tortion

 35 - I am not sure but i think there was another acute presentation, with U/S showing
doughnut sign or something? Answer : ectopic

This paper describes a doughnut-like ultrasound (US)

finding in pediatric intestinal Burkitt's lymphoma

And ectopic also

) Yeah , bagel sign is in ectopic .. and ( bagel is doughnut)

The corpus luteum seen as a “ring of fire” on colour Doppler will be on the ipsilateral side in 70–85% of
cases of tubal EP and when present is a useful marker. Approximately 60% are seen as an
inhomogeneous mass or “blob sign” adjacent to the ovary and moving separately to it (Fig. 1); 20%
appear as a hyper‐echoic ring or bagel sign (Fig. 2); and 13% have an obvious gestational sac with a fetal
pole, with or without fetal cardiac activit

?36 - EMQ or SBA[not sure] : Male factor infertility: investigations

36 - A healthy male with slightly smaller testes scenario was given where semen analysis .
was normal [lower normal], the only abnormality mentioned was dysuria or turbid urine
after coitus.what will be invg?small to avg testes, mild gynecomastia
Answer : urine culture&microscpice

Turbid urine following coitus is not an infection.

think of DM &retrograde ejaculation & arrange fbg or so if there's
option like that Otherwise refer to urology if there's option

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.)
Answer : s prolactin

Fatiguability goes with thyroid hypofunction & tumors like

prolactinoma if there's clue
38. A third scenario, i think with oligospermia. He has mild
.gyencomastia Answer :klinefelter
breast Cancer in those people 7%
karyotyping
primary testicular dysfunction is Klinefelter syndrome. About 10–15% of
infertile men with absent (azoospermia) or low sperm concentrations
have Klinefelter syndrome
EMQ: Identify the most likely injured nerve (TOG article nerve injuries)

39 - After forceps, woman came later with urinary & fecal incontinence
Answer : Pudendal n

40 - After VD, woman can't flex hip or extend knee+ absent knee jerk
Answer : femoral n 11%
More common in abd. Hysterectomy by the retractor
41 - After surgery in lithotomy, a woman has foot drop & sensory loss in lateral surface of
leg. [Common peroneal wasn't in the options] Answer : sciatic n
( or its br. Common peroneal)
 42 - During TVT, the surgeon accedently hit the inferior epigastric artery ( &NOT
?OBTURATOR). From wich artery does it arise
Answer : external iliac a

Pfmt : in stress or mixed ui …..at least 3 month

8 cont. /3times /day/3month
urodynamics
Bbladder training : in oab or urgency mixed
EMQ: Choose the appropriate Mng
uifor at least 6 weeks
Can't remember much but options included If freq. is aproplem oab drugs + bladder
* PFMT training
* Bladder training
* PFMT & Bladder retraining
* 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 .
Answer : c bladder retraining

.44 - Another woman who i think her symptoms were pure stress UI
Answer : pfmt

45 - A woman with multiple sclerosis + voiding diff Answer : 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. Answer : oab

* If pressure ↑ during void and flow ↓ obstructive problem voiding difficulty,…….if another Q if rise in
pressure on filling….for non compliance

* in pbs pain increase with filling And ttt is cystodistention with haylauranic pain relieved at voiding

48 - woman with recurrent UTI + Pain : cystoscopy: —> multiple small hemorrhagic areas
Answer : Interstitial cystitis

Peticheal hges is the keyword

49 - Of women with OAB, what % will also have urge incontinence

50% stress Answer : > 30 %( 1/3)
36% mixed
In adult females aged 18 years and over, the prevalence of OAB ranges
from 13% (EPIC study, Irwin et al 2006) to 16%
.Approximately a third of women with OAB also have urge leakage
* 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 Answer Kissing ulcer
painful chancroid
Explanation Chancroid is caused by a type of bacteria called Haemophilus painless syphilis
ducreyi . The infection is found mainly in developing and third-world countries. Within 1 day–2 weeks
-after getting chancroid, the infected person develops a pain
ful ulcer, with sharply defined borders and a grey base which bleeds easily when scraped. About half of
infected men have only a single ulcer. Women often have four or more ulcers. In women the most
common location for ulcers is the labia majora. ‘Kissing ulcers’ may develop. Other areas, such as the
labia minora, perineum and the inner thighs, may also be involved. The most common symptoms in
- women are pain with urination and intercourse. The ulcer may look like a chancre
, the typical sore of primary syphilis. About half of the people who are infected
with a chancroid will develop enlarged inguinal lymph nodes. These nodes may l break through the
.skin and cause draining abscesses, also called buboes

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 Answer :candidiasisin young and canser old age

( Key : small satellite lesions around)…….if young age candida if old age cancer

Although vulvar or vaginal abnormalities (acetowhite epithelium, squamous

papillomatosis, filaments, satellite lesions, fissure, papules, or exophytic condylomas)
were more commonly seen in the cases than in the controls, the difference was
significant only for exophytic condylomas. In conclusion, colposcopy is not a good
predictor of HPV infection and should not be used as an HPV screening test. HPV DNA
hybrodization did not help more than the histopathologic findings in the diagnosis,
but allowed the recognition of high-risk patients. The role of an accurate colposcopic
.examination with target biopsies remains essential
 52 - A young lady came from somewhere, c/o mass, o/e: sessile growth on perineum ,
painless, no itching
Answer : wart( hpv)

Genital warts (condyloma acuminata) — Genital

warts, caused by human papillomavirus infection,
may be of flat, filiform, verrucous, pedunculated, or
giant morphology. They may be flesh colored or
pigmented (picture 8). Lesions of secondary syphilis
may have a wart-like appearance, but are not true
warts

1st step is to diagnose PMS……. By over 2 cycles

using a symptom diary, as Daily Record of Severity of
Problems (DRSP) if management asked

53 Young lady with PMS mainly psychlogical (& her partner prosecutig her for assaulting
him). Her GP advised exercise or something Answer : CBT
54 - what is the % of U perforation after evac (?of missed ab?)
Answer : 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,uterine anamolies. [Pregnany was NOT there
Answer : active pelvic inf
Wts the risk of perforation on
2nd trimester evacuation

5 % old one new guide line ppH

1.5% take care

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. Sulphur granules intraop
Answer : Sulphur granules is Actinomycetes

57 - What is the 1 st line managment of menorrhagia? 30 yrs old doesn’t want to prevent
pregnancy Answer : tranexmic

58 - A long history but at the end: ovarian tumour + pathology report of Call hexener
bodies Answer : [granulosa cell tumour]
EMQ: What sign do you expect to find. Options
* bilateral adnexal masses
* Longitudenal vaginal septum
* Retroverted uterus
* Thickenings in POD [?or utero sacral lig
* Urethral caurencle
* Other options i can’t remember
Answer : Ureheral DIVERT.
59 - A young girl with recurrent UTI. Now also has dsyparunia

Answer : bilateral ad. masses

60 - A PCO woman taking clomifine

62 - Thickening of uterosacral ligament Answer : Thickenings in POD [?or utero sacral lig

63 - A woman with PH of two 2nd TM miscarriages, presented at 18 wks,no contractions

but o/e you find membranes bulging into vagina Answer :EXPECTANT OR Rescue circlage
if ask about investigation apls( thromboplia screening
 Answer : Trichmonous vaginalis
64 - EMQ: sexually active, C/O frothy-greenish V. discharge

65 - EMQ: sexually active, C/O malodorous fishy discharge Answer : BV [Gardnella]

66 - What is the recurrence rate of bacterial vaginosis Answer :58%

67 -There was a question, where an obese

diabetic lady on metformin undergone TAH for
HMB. After...6.hrs post surgery,c/o abd pain
and increasing dysnea you were called by the
concerned nurse. The patient’s MOEWS chart
was given. We were asked about the underlying
pathology.drain had 750 ml blood and in urine
analysis no ketones. Options icnluded sepsis,
DKA, Hypovolemia, Hypoxia. Blood press
160/100.Options were pul embolism ,
sepsis,overdose morphine) pulse 120 (morphine

normal+6.hrs post surgery= exclude sepsis , sat

100%(pul embolism unlikely), ↑BP so excludes
hypovolemia, no ketones In urine = exclude
,.…… DKA Answer : morvine t.?
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
Answer : Mange pid according to hospital protocol
not gtg

69 - An 18 yrs girl came with 1ry A. Normal 2ndry sexual development. Very short
.vagina{the gaven the length?}. Ovaries present on scan
]Answer : Mayer Rokitanasky Syndrom - MRKH
 Answer :
70 - A 16 yrs girl came with 1ry A. Heavy exercise. BMI 18. FSH 34. If ask about dig. Pof / if
A diagnosis of POf should be considered in patients presenting with Repeat fsh in option
amenorrhea or irregular menses and high serum follicle-stimulating choose it
hormone (FSH) levels before age 40 year

71 - What is the emergency CC option for an epileptic lady who denied IUCD
Answer : levonella 3mg
In epileptic on inducing drugs for cc 3 iii( iucd / ius /injection )

Implanon ……….nooooooo

72 - The concentration/efficacy of the following drug is reduced by taking COCs

Answer : lamotrogin 70%
Options included the common AEDs

* Lamotrigin also affected by pregnancy

That is why you have to increase lamotrigin dose during pregnancy

73 - What is the commonest type of ureteric inj in laparoscopic surgery

Answer : transection

EMQ : Antibiotics prophylaxis choice: ALL CASES HAS SOME SORT OF CARDIAC DISEASE
Options included many endocarditis prophylaxis, Erythromycin/doxycycline pre & post
surgery. NO cefuroxime or Augmentin as single doses , but there was cefazolin single dose
74 - TAH + Ant[?or may be post] repair Answer : cefazolin

* after bolus we can give maintainance dose but in stat u cant

And Stat = Single dose , Bolus = Not as Infusion.. or COT iV
* Drug Name Reviews
Rocephin (Pro, More...) generic name: ceftriaxone 72 reviews
Claforan (Pro, More...) generic name: cefotaxime 0 reviews
Vantin (Pro, More...) generic name: cefpodoxime 6 reviews
Omnicef (Pro, More...) generic name: cefdinir
75 – Hysteroscopy……….laparoscopy also Answer no need antibiotics

Cystoscopy…….gentamycin( bladder )
Termination( surgicals ) of preg …… azithromycin + metronidazole
Low risk evacuation …….no need iucd …….no need
Ovd………….no need ……If risk of sti for any procedure give azithro stat
Perineal inj……….give antibiotcs ( metronidazole)
Gentamycin 2 – 4 mg /kg iv stat ( 7mg /kg in pid ) monitoring …..check renal f
Termination of pregnancy, highly recommended
,metronidazole 2 g PR/PO at first stage plus when chlamydia infection is likely
azithromycin 1 g 24–48 hours preoperative or doxycycline 100 mg twice daily for 7 days
miscarriage A Antibiotic prophylaxis is not recommended 1++122
Intrauterine contraceptive
device (IUCD) insertion A Antibiotic prophylaxis is not recommended

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 think they asked about the
diagnosis rather than next step
Answer : Pregnancy of uncertain viability

* OBS
EMQ: for the following scenarios, what is the risk of maternal morbidity/ mortality
(low/significant/ high) & the risk of the baby having congenital heart disease(<10%, 15-
% 25% , 50
Maternal risk (mortality) Fetal risk of CHD
a) mild 5-10% <10%
b) mild 5-10% 10 -20%
c) mild 5-10% 50%
d) significant 20% <10%
e) significant 20% 10 -20%
f) significant 20% 50%
g) High 40% <10%
h) High 40% 10 -20%
i) High 40% 50%
77 - mother with corrected minor anomaly, normal activity,had TOP before for a baby
.diagnosed with hypoplastic heart at 20 weeks anomaly scan Answer : low……..low
You have to condsider :
* Risk to baby when mother had chd depend on type of chd & if parent or
other sibling is also affected
* Risk to mother also depend on her underlying problem & severity
* some maternal conditions are autosomal dominant or so & so baby at
greatest risk
78 - mother with pul.HTN in early pregnancy Answer : g high …..low
** High risk mum less than 10% baby
79 - mother with Past History of PPCM. In this pregnancy the echo shows structurally
normal heart with mild systolic dysfunction. She is fit and can climb 2 floors without
dyspnea Answer hight …low in case of ppcm minimal left
vent. Function present and classified stage 4 hd
* Any PHT Eisemmenger……. Marfan
dilated aortic ……….Is high for mother
* PPCM risk high to mother reaching 50%
* If mother Marfan baby high 50% as its
aut dominant(AD )
* if mother has HCM baby risk is high 50%
bec its aut dominant ( AD)
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 genital tract under good light
* Explore in theatre. + many other options
80 - Heavy bleeding, hemodynamic compromise, placenta complete, catheter
in. Resuscitate WAS NOT AN OPTION Answer : synto?

81 - Moderate bleeding after delivering 4.1 kg baby .placenta complete.

Uterus well contracted Answer :first explore under good light

82 - Heavy bleeding. Placenta complete. catheter+ bimanual +oxytocin

already given. Patient has mild asthma Answer : ballon

* Exert caution in asthmatic patients as carboprost may cause bronchospasm

* There have since been a few case reports of bronchospasm associated with the use of
Carboprost in both Asthmatic and non-Asthmatic patients (2,3). With this added
information, and given that there are other readily available pharmaceutical options for the
treatment of postpartum hemorrhage including Oxytocin, Misoprostol, and Methergine, the
general consensus is that use of Carboprost in the asthmatic patient should be avoided
when at all possible
 EMQ: what is the single most imp. Parameter you want to know
Options were[ BP, CBC, RBG,Coag profile, GCS, O2 sat]
83 - You are about to undertake hysterectomy for massive intraoperative
bleeding. The anesthetic team are managing to keep stable BP
Answer :coagulation profile

84 - After delivery, a lady developed a grand mal fit

Answer : O2 saturation ( secure ptatant air way)

85 - After c/s , pt became hypotensive. No vaginal bleeding but ooze from

wound Answer : coagulation profle

EMQ: Most probable underlying cause

Options included: anaphylaxis, Amniotic fluid embolism, Air& Fat embolism,

.Malignant hyperthermia, tension pneumo thorax

86 - During c/s, pt developed generalized rash, hypotension .

Answer : anaphylaxis

87 - During c/s , pt became short of breath, hypotensive, low O2 sat( & alsoP
CO2) Answer : amniotic fluid embolism

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 Answer : ICH

89 - An obese bus driver suddenly

collapsed & died

ANSWER : PE
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 ventouse, C.
section]

90 - Class 2, symptomless, in 2nd stage but pushing well, head +3

Answer : aim for vd
91 - 2nd woman was class 3 ,in 2nd stage, head + 2. I think she has some symptoms

class 3&4 are indications of OVD, deliver with forceps Answer : forceps

in cardiac is more better as need

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] Answer : no further tests

No rash with Ob. Cholystasis & Viral

hepatit not with normal lft

93 -Mother with purpuric rash

involving abd. straie. What feature

is with good prognosis

Answer : sparing of umblicus
94 - Mother with purpuric rash. Biopsy showed immune complex deposition. What’s the
likely diagnosis Answer : Pemphigoid Gestations
95 - A pregnant lady developed chickenpox rash. Phoned on same day
within 24 hrs and more than 24 ws oral acyclovir Answer : acyclovir
* In chicken pox 800 5 times fr 7 days /* In herpes 400mg 3 times 5days

96 - A pregnant lady developed chickenpox rash, phoned 3 days later

Answer : Avoid contact with pregnant & USS After 5 weeks

Avoid contact( infectious )with the others for 21 days

If received the VZIG for 28 days

97 - A pregnant lady came with rash + joint pain. RETESTING( that how it was written)
showed her infected with parvo- not rubella. GA was 2nd TM . What action
Answer First after 4wk then every 2wk till 30wk if normal
reasure:
Fetal
* Fetal complications may occur over 8 weeks after maternal infection, when maternal IgM may be
undetectable
* Investigation required only if maternal infection is confirmed or when investigating non-immune
hydrops
* Serial ultrasound scans for the early detection of hydrops - follow-up scans for up to 12 weeks after
confirmed maternal infection
* In non-immune hydrops, fetal Parvovirus B19 IgM and DNA by PCR are required

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) placental films; if neg
for malaria, no further action.
Answer : 1)Blood film for baby at birth then wkly for
4 wks 2) placental films; if neg for malaria, no
further action
EMQ:

Options: Re-assess after 15m/30m/1h/2h/4h [each as a separate option], Forceps

delivery, Ventouse [2 cup types given]delivery, C/S, Reassess in theatre for forceps or
...,c/s

99 - PG, effective epidural, good progress, 1h passive 2nd stage & then actively
pushing for 90m. head at spines & CTG normal answer : reasses after 1h

100 - Parous lady, in 2nd stage for 90m, now pushing for 45m. Head station +2, OA,
CTG normal
Answer : reassess after 15 min
He do not told thing about epidural so If epidural extend the 2nd stage up to 4 hs for pg & mg
In this q100 they told any thing about epidural
1 –prim. 2nd stage 3hs ( 1h passive+ 2hs pushing)
In q 100 he told pushing for 45min when ex. 15 min
2 – multi 2nd stage 2hs ( 1h passive + 1h pushing) To complete 1h examination

Once your cervix is fully dilated, your baby's head will start moving down through your vagina. This is called
the second stage of labour. Even when your cervix is fully dilated, you may not have an urge to push with
.your contractions straight away – this is called the passive second stage

The active second stage is when you have an urge to push with most contractions, and ends when your baby
is born. The birth is expected to take place within 3 hours of the start of active pushing in most women
having their first baby, and within 2 hours for most women who have had a baby before
 101 - A woman after 20 m in 2nd stage tells you that she can’t push more & demadns c/s.
She allows you to examine her. Head? OP at spines, CTG normal
Answer : Reassess in theatre for forceps or c/s

102 -What is the most common finding in CVT?

Answer : headache

Headache is the most frequently (80–90%) occurring symptom in cerebral venous thrombosis and often
the first symptom reported by patients. The International Classification of Headache Disorders describes
the headache

as having no specific characteristics2 but one study found the headache was usually acute or subacute in
onset, localised, continuous and moderate to severe. Cases have been reported where headache is the
only neurological symptom or sign but this is very rare. More often other clinical manifestations present
at onset or develop during the course of the disease. These include papilloedema, focal deficits, altered
consciousness, seizures and cranial nerve signs, in particular diplopia caused by sixth nerve palsy.
Psychosis, in conjunction with focal neurological signs, has also been reported. The development of
.symptoms may occur over hours, days or even weeks

103 - Preconeption counseling of pt with migraine. The options were( combinations of ↑,

.↓,unchanged migraine attacks & ↓, ↑ or unchanged risk of pre-eclampsia)
Attacks in general decrease in pregnancy
Migraine without aura decrease ↑estrogen. , aura increase
)Migraine without aura improve (60%)
15% risk of PE -==……. MI , Stroke
Tog : 2fold inc in PE , 17 fold inc in stroke , 4fold inc in acute MI
Pregnancy can alter migraine aura and trigger attacks of aura

104 - A question about headache where the lady described it as the worst ever

the worst ever in sheerleta was CVT but in new tog SAH Answer : SAH
* The central feature of classic SAH is sudden onset of severe headache (thunderclap headache), often
described as the "worst headache of my life." Less severe hemorrhages may cause headache of
moderate intensity, neck pain, and nonspecific symptoms. Absence of headache in the setting of a
ruptured intracranial aneurysm is rare and proba

* chief complaint of headache was elicited in 455 patients, and 107 of these had "worst headache"
and were enrolled in the study. CT-confirmed SAH was found in 18 of the 107 (17%). Only 2 patients
(2.5%, 95% confidence interval, .3% to 8.8%) had SAH detected by CSF analysis among those with
negative CT imaging result. CSF spectrophotometric detection

105 - Headache developing post partum + focal neurological signs. MRI showed filling
defect DIAGNOSIS BY MRV Answer: CVT
Fever and leukocytosis may present

106 - what is the chance of survival without disability for a baby born at 24 wks

Answer : 28

107 - what is the most abnormal karyotyping

to a/w truncus arteriosus[williams syndrome]

DiGeorge syndrome, also known as 22q11.2 deletion

syndrome, is a syndrome caused by the deletion of a
small segment ofchromosome 22.[7] While the
symptoms can be variable they often include
congenital heart problems, specific facial features,
frequent infections, developmental delay, learning
problems, and cleft palate.[7] Associated condition
include kidney problems, hearing loss, and
autoimmune disorders such as rheumatoid arthritis or
]Graves disease. 7]

Array Comparative genomic hybridization ( ACGH )

test to diagnose it

* Digoerge i mean with one eye is holoprosenc

108 - Mother with type 1 DM came with PPROM. What is the more common cause of
death for this baby
Answer : prematurity
]prematurity , sepsis, lung hypoplasia [
?109 - in what country is obstetric cholestasis most common
5%Arcacanian indian group Answer : Cheli-2.4%
More common in winter
Oral heparin given daily

110 - A woman with PH of recurrent DVT, now on TP with Rivaroxaban - when to stop pre
op? [24 hrs , 5 days , 7 days , 4 weeks] Answer : 24 hs
111 - What is the length of the presenting diameter in Face presentation

Answer : 9.5cm

112 - A midwife not sure about presentation called you. You palpate malar eminence + ?
alveolar margin Answer : face pr.
:113 - A pregnant women with breast lump. 1st invest will be

)options were u/s- mammogram- chest x ray( Answer : u/s

114 - A woman found to have asymptomatic GBS bacteruria. Management plan?

 Answer :ttt now and iap

Recent history ( new gtg )

Carrier of GBS in Term with ROM……..> immediate induction + IAP
In preterm labour 34 wks or more ……..>immediate induction + IAP (risk of EOGB is 2.3/1000)
In preterm labour less than 34 wks ………>same management as in PPROM + IAP
The proportion of women giving birth preterm in the UK is 8.2%
Neonates born preterm with GBS infection represent 22% of All cases
Mortality rate at 33 wks is 27% (20-30%) and at 37 wks is 2.7% (2-3%)
Elective C.S. with ROM or in labour……> IAP
Carrier of GBS full term in labour………..> IAP (The women at term with previous GBS 0.08%)
Intrapartum pyrexia 38 or more……..>IAP (risk of EOGB is 5.3/1000)
Bacteriuria in current preg. …….>treat now + IAP
+ve cervical swap in current prg. ……….> IAP
previous infected baby……> IAP
chorioaminotis ttt with atibiotic cover gbs

In sever allergy give vancomycin ……not clindamycin which develop resisstnt

115 - What is the rate of spont. Reversion to breech after ECV in PG

After Success ecv 3% Answer : < 5%

Unsuccessful ecv 3-7% Success rate
Spontaneous version 8%
50% in generl
primi breech to ceph after 36 8%
Emergency cs within 34 hrs of ecv : 5/1000 40% for primi

Undetected breech at term : 20-32% 60% for multi

Recurrence: 9.9%

116 - A woman & her partner both are CF carriers. What is the chance of an
affected baby Answer : 1: 4

THE KEY OF THE ANS.

117 - From the following, what is NOT a risk factor for twins

]PH of monozygotic twins, advanced age, IVF, family hx = R. of dizygotic twin]

Answer : ph of monozygotic twins

118 - What is the chance of success of Mc robert with suprapubic pressure to

effect delivery Answer : 90 %

119 - From the following, what is a major risk factor for SGA
a. Age > 35

b. BMI > 35 Answer : e

c. Smoking 1-10 sig/day

d. Excersise

e. Maternal SGA

120 - What is the best measure of GA at 84 mm diameter ?

>84 ml hc Answer : crl ( 45ml – 84ml
• EMQ: HSV: can’t remember options Answer : VD + test for women

121 - A woman came in labour, tells you that her partner was recently treated
for HSV

122 - A woman came in labour. Was treated 2 wks ago for recurrent HSV.
Reassure+VD. R of neon.HSV 0-3%

risk for primary is 41%

123 - A woman came in labour, was treated ? 2 wks ago for 1ry HSV. After
counseling; she’s willing for VD Allaw vd + iv acyclovir+ avoid invasive manu.

Intravenous aciclovir given intrapartum to the mother (5 mg/kg every 8

hours) and subsequently to the neonate (intravenous aciclovir 20 mg/kg every 8
.hours) may be considered for those mothers opting for vaginal delivery

• EMQ : Management

Options: Augment with oxytocin, IPAP, Erythromycin, I/M steroids, Expectant

....,Mng

124 - GA 22wks, Known GBS carrier, now PPROM ,? Features of chorioamnitis

Answer : augmentin + oxytocin

Feticide first if in the option from ( 21w +6d)

125 - GA 28 wks. Threatened PTL. Speculum -cx 3 cm with intact membranes.

Already given full dose I/M steroids 2 wks ago Answer : mgso4

Expectant Mng, IV magnesium salfate offer from 24 to 30 wks, consider from 30 to 34 wks

126 - What of the following conditions has more association with a male fetus

Options included AFLP , obstetric cholestasis,....... pre-eclampsia

Others increase with male
1 - Abruptio placenta
2 - Vasa praevia
3 – AFLP
I have no ref.
 Herpes simplex ulcerations

) ...,EMQ : The causative organism. (GAS, GBS, HSV, CT, Staph

127 - A neonate developed eye infection(stick eyes) after 1 wk from delivery

chlamydia trachomatis need 5 - 12 days Answer : Chlamydia trachomatis
gonorrhoea need 2 – 4 days
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 Answer : HSV

:The most common types of neonatal conjunctivitis include the following

Inclusion (chlamydial) conjunctivitis

Chlamydia trachomatis can cause inclusion conjunctivitis and genital infections (chlamydia). Women with
untreated chlamydia can pass the bacteria to her baby during childbirth. Symptoms of inclusion conjunctivitis
include redness of the eye(s), swelling of the eyelids, and discharge of pus. Symptoms are likely to appear 5 to
12 days after birth. About half of newborns with chlamydial conjunctivitis also have the infection in other parts
of their bodies. The bacteria can infect the lungs and nasopharynx (where the back of the nose connects to the
.)mouth
Gonococcal conjunctivitis
Neisseria gonorrhoeae cause gonococcal conjunctivitis, as well as the sexually transmitted infection called
gonorrhea. Women with untreated gonorrhea can pass the bacteria to her baby during childbirth. Symptoms
usually include red eyes, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually
begins about 2 to 4 days after birth. It can be associated with serious infections of the bloodstream
.(bacteremia) and lining of the brain and spinal cord (meningitis) in newborns
Chemical conjunctivitis
When eye drops are given to newborns to help prevent a bacterial infection, the newborn’s eye(s) may become
irritated. This may be diagnosed as chemical conjunctivitis. Symptoms of chemical conjunctivitis usually include
.mildly red eye(s) and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours
Sorry it is not the place but imp.

Katrin nelson
129 - What is the anti-D level above which there should be referral for fetal
ANSWER: > 4
medicine unit?
= Anti-D level of > 4 but <15 iu
= Anti-
= Anti-
= Anti-c level of >7.5 but <20 iu/ml = Moderate risk of HDFN
= Anti-
= Anti-c l
= Once Detected Antibody Levels Be Monitored During Pregnancy
= Anti-D and anti-c levels should be measured every 4 weeks up to 28 weeks then every 2 weeks
until delivery
=Although anti-K titres do not correlate well with either the development or severity of fetal
anaemia, titres should nevertheless be measured every 4 weeks up to 28 weeks, then every 2
weeks until delivery
 130 -Blood level of which antiepileptic drug may particularly decrease in
pregnancy ( plus phenytoin may need monitoring) Answer : lamotrigine

Carbamazepine, Lamotrigine , Valproate sodium Olanzapine….hyperglycemia

131 - Patient on carbamazepine comes for emergency contraception

Answer : lng 3mg
Levonorgestrel 1.5 mg, Levonorgestrel 3 mg
ulipristal stop breast feeding one week but levon breast feeding safe

132 - 32 years presents with flat reddish brown lesion on the vulva with
satellite lesions Young , mean candidia, old lady vulval Answer : V.candidiasis
cancer ( malignant melanoma)

Melanoma
VIN : mostly elevated lesions, multiple but flat, variable colour as white, red, black, grey or brown
hyperpigmented, and this pigmentation indicate Biopsy, + blood staining of underwares + NO
SYMPTOMS + small pigmented lesion with rolled edge on Lt labium majus
Candidiasis: irritation and soreness+ hx. Of RF as DM, obesity, antibiotic use, vulva is red in colour,
slightly oedematous and small, red papules scattered randomly soreness and irritation under the breasts
[intertrigo= under fold of skin as axilla, thigh breast]
Lichen sclerosis: (any age but usually >40) + irritation + labial fusion+ skin atrophy + Thin white skin +
common cause of vulval itching, not cause erythema and scaling = steroid

133 - 15 years old girl accompanied with her 15 years old boy friend 17 weeks
pregnant asking for termination
Answer : encourage her to tell her parents
Encourage her to tell her parents

Take written consent

Discuss with child protection lead

134 - At 24 weeks delivery what is the percentage

of babies that survive:[30-50%]

20% ,30 % , 40% ,60%

,43% ,22% ,8% ,0.4% 22weeks…….16……..0.4%

and 59% at 22 wks, 23 wks, 24 wks, 25 wks and 26 wks

[SIP 41] Answer : 46

135 - Cancer endometrium with parametruim (Stage III B) involved in surgery
5 year survival rate is Answer : 30%
136 - Both partners carrier of cystic fibrosis offer Answer : pgd

[PGD, Amniocentesis, Advice against pregnancy]

If required, antenatal diagnosis can be performed by chorionic villus biopsy
in T1. Alternatively, IVF with preimplantation genetic diagnosis is an option

* To see homozygocity or complete heterozygocity

After preg. Acoording to gestation age 10 w free fetal Dna 11 w cvs after 14
aminoce

137 - Obstetric cholestasis which vitamin to be given

Answer : vit k
Vitamin k, Vitamin c, Vitamin d, Folic acid
For the baby only to prevent intervent.
hge

138 - P2 DVT in previous pregnancy start LMWH: ASAP, At 12 weeks , At 24

weeks Answer : asap( as soon as possible)+ 6WS P

139 - 33 years previous difficult forceps delivery, now fully dilated OP

position: According to the station

[CS, Trial of forceps in the theatre] If -1 or above do cs

If 0 or below forceps in the theater

Incomplete q???

140 - Suture material for 3rd

and 4th perineal tear Answer :
rd
3 ..20 vicryl or 30 pds
4th 30 vicryl
Pds 180 to 210ndays

141 - Suture material for b-Lynch

Answer :monocryl no 1
 142 - MCDA twin from when to do U/S : 16 ,18, 24 wee Answer : 16ws

Chorioncity from 10w – 13w6d

143 - MCDA twin DVP one twin < 1.5, other > 10 cm :
Death 15% Answer ; ttts
TTT, TRAP
Neurological 26%

144 - PMS first line ttt : New OCP, LNG IUS, Progesterone
1st line Exercise, cogntive behavioural therapy, vit. B6 Answer : ocp
Combined new generaon pill (continuously rather than cyclically)
Continuous or luteal phase (day 15–28) low dose SSRIs, e.g. citalopram/escitalopram 10 mg
2nd line Estradiol patches (100 micrograms) + micronised progesterone (100 mg or 200 mg [day 17–28],
orally or vaginally) or LNG-IUS 52 mg
Higher dose SSRIs continuously or luteal phase, e.g. citalopram/escitalopram 20–40 mg
3rd line GnRH analogues + add-back HRT(continuous combined E + progesterone)or( Tibolone 2.5 mg)
[estrogen= 50–100 micrograms estradiol patches or 2–4 doses of estradiol gel + progesterone =
micronised progesterone 100 mg/day]
4th line Surgical treatment + HRT

145 - Patient with cystic fibrosis died at 36 days postpartum with respiratory
infection
Answer : early indirect maternal death
Direct maternal death

Indirect maternal death

146 - Woman refusing cs her husband insists to save the baby

Do cs

Follow the woman’s wish

answer : woman wishes
147 - Malig Growth involving hood of the clitoris
Local excision

Wide local excision + ipsilateral groin LN dissection

Answer : widelocal incision with bilateral GLN dissection
 Wide local excision + bilateral groin LN dissection

NB
1 - large ca vulval lesion (> 4 cm)+ suspected LNs = radical vulvectomy + en bloc groin LND [to remove
the tissue between the vulva and involved nodes]
2 - vulval basal cell ca = wide local excision ( no LND(
3 - vulval verrucous tumour = wide local excision (no LND)
4 - vulval melanoma = wide local excision (no LND)
5 - lateral lesion + < 2 cm + invasion < 1 mm = wide local excision (no LND)
6 - lateral lesion + > 2 cm + invasion > 1 mm = wide local excision + ipsilateral pelvic node dissection (if
+ve , will do contralateral)
7 - medial lesion + > 2 cm + invasion > 1mm = triple incision)
8 - close to vital organ ( urethra/anus) + > 2 cm + > 1 mm invasion = multimodal therapy
)radiotherapy to reduce size first, then surgery)
9 - VIN = wide local excision
10 - Vulval cancer is staged surgicopathologically

148 - Waht drug you choose for an asthamtic lady with post partum HTN? B-
blocker & ACEi not RR in asthma
Answer : nifadepine
 ACEi in the options but not enalapril/captopril so we can not choose it

Methydopa shoud be stop 2 days after delivery to avoid postpartum depression

Beta blocker as labetolol contraindicated in asthmatic patient

Calcium chanel blocker canbe use but not amlodipine

Avoid niphadepin in the mi or hypotensive patient

149 - What is the definition of perinatal mortality rate

Answer : still birth + neonatal death( 1st w) /totalbirth( l+d)

??

Live + stillbirth
151 - A question about the mode of delivery in HIV on HAART whose last VL
was 150
Offer planned CS to Answer : cs
* HIV who are not receiving any retroviral therapy
* HIV and a VL > 400 copies / ml regardless of ART
* HIV with hepatitis C virus
= Consider either a vaginal birth or CS [BHIVAConsider CS// NICE not routinely offer CS]
* HIV on ART with a VL 50-400 copies/ml
* R. of HIV transmission is the same for CS & VD, So give the ptn. the choice
* MTCT Risk in untreated HIV +ve in the UK 15-20%
* MTCT Risk in HIV +ve treated with HAART in UK 1-2%
* 80 – 90 %of MTCT of HIV occurs around time of birth * vd if viral lood < 50 copies /ml
Prevalence of HIV in pregnant in UK is highest in London, at 3.5/1000, and 1.6/1000 in the rest of England
Prevalence in sub-Saharan Africa 2-3%
Rate of HIV MTCT has reduced from 25.6 % in 1993 to 1-2%
In treated + undetectable VL HIV MTCT is 0.1%
Untreated HIV 25--30% transmisssion to fetus in utero
Treated HIV approximately 8% transmission to fetus inutero
Untreated HIV 50---60'% transmission to baby during breastfeeding
152 - Drug to stop in pregnant woman with renal transplant .

methotrexate/ ACEI Answer : ACEI

153 - Simple Postmenopausal cyst CA125 < 35 ……..
Answer : U/S surveillance
U/S surveillance , ovarian cystectomy

154 - Most predictive of subsequent preterm labour

Answer : previous preterm labour If one 20%…if2 40%...if3 50%

156 - The evidence shows that CTG------ onatal (death,

seizures, NICU admission) Answer : seizures

157 - VIN caused by HPV 16,18, 11

Answer: 16
16 for vulva…..18 vagina…..6 &11 warts
155 - Best SSRI in pregnancy….TCA (best antidepresent = safe), venlafaxine,
sertraline, paroxetine ( x sign) stratOG Answer : sertraline

158 - Symptoms of BA( bronchial asthma) increase in : > 36 weeks, 24- 36

weaks 1/3 improve….1/3 deteriorate…1/3 no change Answer : 24 - 36 weeks

159 - Polygonal violet vulval lesion Answer : License planus

160 - Thin white vulval skin Answer : Lichen sclerosis

161 - When to stop CC after hystroscopic sterilization

Answer : 3 months (hsg)

162 - Reducing OVD by

Answer : support
a) Support

b) Epidural

c) Partogram

d) PG in labour distressed with painasking for CS allowed you to do PV , 5 cam LOT

163 -
Answer : CEFM
1 - Borderline/ mild dyskaryosis = HPV triage
2 - treated CIN 3 + positive margin = smear in 6 month & HPV (if borderline or
mild) (not re-excision)
3 - benign endometrial cells (non cervical) <40ys= not significant, routine
recall
4 - benign endometrial cells >40ys = urgent referral to gyn opinion (2 weeks)
5 - severe dyskaryosis + normal colposcopy = Biopsy
6 - severe dyskaryosis + normal colposcopy + un-treated = Colposcopy and
cytology every 6 months
7 - moderate dyskaryosis + colposcopy :low grade lesion= multiple biopsies
8 - mild dyskaryosis+ colposcopy: satisfactory= repeat cytology in 6 months
9 - <50 yrs + treated for CIN 3+ positive margin= cytology & colposcopy in
6 months
10 - > 50 yrs + treated for CIN 3 + positive margin = re-excision
11 - Woman (any age) + treated for cGIN+ positive margin= re-excision
12 - Woman+ treated for ? invasive ca+ positive margin= re-excision
13 - woman with severe dyskaryosis + for colposcopy+ but now pregnant=
perform colposcopy and repeat 3 month after delivery
14 - woman with severe dyskaryosis + colposcopy done in first trimester ?
CIN 1 = repeat colposcopy 3 month after delivery
15 - woman with severe dyskaryosis + colposcopy done in first trimester+ ?
CIN 2/3 = repeat colposcopy at end of second trimester and 3 months PP. ( if
late in pregnancy, then only 3 month PP)
16 - ca cx Stage 1A1 - 1B1 = surgical Rx
17 - ca cx stage 1B2 - iv A= chemoradiation
18 - ca cx 1A1 + fertility is not a concern= simple hysterectomy ( no PLND* &
Ovs reserved)
19 - ca cx 1A1 + fertility is a concern = radical trachelectomy + PLND
20 - ca cx 1A2 + fertility is not a concern= simple hysterectomy + PLND
21 - ca cx 1B1 + fertility is not a concern= radical hysterectomy + PLND
22 - ca cx 1A1/1B1 + fertility is a concern= cold knife conisation + PLND
)or LLETZ : both more adequate than trachelectomy(
23 - pregnant > 16 weeks + stage 1 B1 ca cx= allow maturity then treat
24 - pregnant < 16 weeks + stage 1B1 ca cx = treat immediately as non-
pregnant
25 - Treated CIN 3+ Positive HPV = Colposcopy
26 - Treated CIN 3 + borderline/mild follow up smear + negative HPV = 3 years
recall ( regardless the age)
27 - Treated CIN 1,2,3 + negative follow up cytology+ positive HPV =
colposcopy
28 - Treated CIN 1,2,3 + low grade cytology in follow up + inadequate HPV
test= repeat in 3 months
29 - Treated cGIN = test of cure in 6 months ( HPV + cytology )
30 - Treated cGIN + Negative test of cure = repeat in 12 months
31 - Treated cGIN + the repeat test of cure negative= 3 years recall
32 - Treated cGIN + mild/borderline smear in 6 months= complete 10 years
33 - Treated CIN 1,2,3 + mild/borderline in 6 months = HPV testing
34 - Pregnant at time of first smear call = defer till 12 months postpartum
35 - CIN 2/3 suspected at first trimester = repeat at the end of second
trimester
36 - if passed second trimester = repeat 12 weeks postpartum ,
37 - pregnant + invasive cancer suspected = biopsy (not punch as it can not
)exclude invasion)
= PLND : pelvic lymph node dissection
You can still make more equations, as it is the most lengthy and confusing
guideline
In case of confusion, or conflict, please recheck with the original guide
= I tried, and please, forgive me if I failed to make it simple
All the best
Mustafa
 Dr / Hamada said abo romh

Please please if notice any mistakes or defects

Send me for repare

We are students just studying in group

Thanks