MRCOG 2 common questions

1. MRCOG 2
Jan 2023
Aisha Rizwan

2. A 45-year-old sexually active woman is having vaginal hysterectomy and pelvic floor
repair for pelvic organ prolapse. At the end of the vaginal hysterectomy, the vaginal
vault is noted to be 1cm above the hymen.
What is the appropriate management?
Interval colpocleisis
Interval sacrocolpopexy
McCall’s culdoplasty
Mesh posterior repair
Sacrospinous fixation
Ans.Sacrospinous fixation

3. A Brainstorming B Delphi technique C Doughnut rounds D Goldfish bowl E Lecture F Problem based learning G
Schema activation H Schema refinement I Simplified procedural hierarchy J Snowballing K complex procedural
hierarchy
For each of the teaching scenarios described in the items below select the single most correct term from the list of
options. Each option may be used once, more than once or not .at all
Q 1 You are asked to initiate ideas among group of junior trainees You get the trainees together .different
perspectives. ANS BRAIN STORMING
You are required management of hirsutism. You begin by physiology and biochemistry and give the basic concepts.
Then, you give the group a series of in to lead a group of senior trainees on concepts in the clinical g of activating
their recall of the relevant them tutorial to clarify their understanding clinical problems.
hirsutism was the presenting complaint. The trainees recall what have experienced in the tutorial and solve clinical
problems
ANS Schema refinement

4. .Which incision best CS for a 55 BMI? [pfannestiel, joil cohein, transverse above panniculous, midline,......+
ANS Transverse above panniculous
A pt. with previous 3 lscs now placenta anterior and low lying what is the best to rule out accreta.
1. Mri
2. CT
3. TVS
4. Colour Doppler
5. GRAY scale
6. 3D power dopplers
ANS 3 D power doppler
82 - 22 years old has 28 days regular cycle is on Day 20...condom burst.. Took levonle1 week before , ask now for
emergency contraception ?
A - copper T
B - Levonelle 1.5 mg
C - ulipristal acetate
D - nothing just reassure
E – mirena
ANS Copper T

5. A patient with Previous cs for preterm breech delivery , now 6wks pregnancy test positive and mild bleeding p/v.
cervical canal and upper segment empty . GS near LUS and negative sliding test positive. Diagnosis?
A - CS scar ectopic
B - Cervical ectopic m
C - Retained POC
D - incomplete abortion
E – displaced pregnancy sac Breach with cs ectopic
ANS CS Scar ectopic
A patient nulliparous 5 wks. came as she missed periods asymptomatic - Used to have regular periods of 28-30 days -
scan showed thick ET. Both ovaries? Adnexa normal no free fluid seen - beta hcg 356 after 48 hours repeat beta hcg
385 - management - options
A. methotrexate
B. diagnostic laproscopy
C. laparoscopic salpingectomy
D. repeat scan after 1 wk
E. repeat scan after 2 wks
F. follow up after 1 wk
G. repeat beta hcg after 1 wk
H. repeat beta hcg after 2 wks —— what is correct answer
ANS Repeat Bhcg after one wk.

6. Instructions: For each clinical scenario described below, choose the single most appropriate management
option from the list of options above. Each option may be used once, more than once, or not at all.
Options
Offer Csection
Call for help
Suorapubic
Macroberts
1. A 30-year-old woman, para 2, attends the antenatal clinic at 37 weeks of gestation to discuss mode of
delivery. She had her last delivery two years ago and gives a history of a difficult forceps delivery following
which her child developed Erb palsy.
ANS Offer CSestion
2. A 30-year-old woman, para 1 (vaginal delivery), presents to the labour ward at 42 weeks of gestation with
regular contractions. Clinically, the baby appears bigger than 4 kg (her previous child weighed 3.9 kg). She
progresses quickly until 7 cm cervical dilatation but subsequently takes 8 hours to progress to full dilatation of
cervix. Vaginal examination reveals an occipito-posterior position of the fetus with presenting part at +1
stationA turtle sign is noted following delivery of the head.
ANS Call for help

7. 3. A 42-year-old primigravida presents to the labour ward with spontaneous labour at 38 weeks of gestation. She is
a type 2 diabetic on insulin. Her last scan at 36 weeks of gestation revealed an estimated fetal weight of 3.7 kg.
During labour she needed oxytocin augmentation to progress to full dilatation. Two hours after pushing, she had a
spontaneous vaginal delivery with the head on the perineum. An emergency buzzer is pulled by the midwife. On
entering the room, you notice the patient in McRoberts position and the midwife is giving traction to the fetal
head.
ANS Suprapubic
4.A 30-year-old woman body mass index (BMI 41), para 1, presents to the labour ward at 40 weeks of gestation
with a spontaneous onset of labour. Clinically, it is difficult to assess the size of the baby as she has a high body
mass index (growth scan at 36 weeks of gestation revealed an estimated fetal weight of 3.8 kg). Ten hours later she
has a vaginal delivery but the midwife puts out an obstetric crash call after noticing a turtle sign. registrar attends
and tries all the possible named rotational manoeuvres following McRoberts position but fails to deliver the
impacted shoulders.
ANS Delivery of posterior arm.
5. A 30-year-old Asian woman presents to the labour ward at 40 weeks of gestation with spontaneous onset of
labour. She is unbooked (she has had no prior appointments, scans or blood tests) and clinically the baby appears
big. Blood sugar levels are 10.1 mmol/L. She progresses slowly to full dilatation of the cervix after 18 hours. e
registrar was called in anticipation of shoulder dystocia.. head is delivered and there is an obvious turtle sign. An
obstetric crash call was put out. All the manoeuvres were tried including removal of the posterior arm but failed to
deliver the impacted shoulder.
ANS All four
GTG no 42

8. Regarding SD which of the following statements is true?
A) A large majority of infants with a birthwt >4500g do not develop SD
B)All women with history of SD should be offered ELLC/S in their subsequent pregnancies
C)Conventional risk factors predicted about 96/ of Sd that resulted in infant morbidity
D) IOL prevent SD in non diabetic woman with a suspected macrosomic fetus
E)while managing SD suprapubic pressure should not be used
A✅
# Shoulder dystocia
6. With regar

9. #HMB📚
A levonorgestrel IUS
B UAE
C internal illiac artery embolisation
D Hysteroscopic resection
E Myomectomy
F Abd Hysterectomy
G VH
H GnRH analogue for 3 months prior to hysterectomy
I Endometrial ablation
1 A 28yrs old woman has multiple fibroids(all greater than 3cm ) which are causing pressure pain and HMB.she
has been trying to conceive for the past 3yrs.she understands and accept surgery for complication
2) A 27yr old woman wishes to have a procedure that has the best evidence for future fertility following tm for
fibroids
3 A 46 yr old woman has had period problem throughout her life.she has multiple fibroid, the largest of which
is 4cm.she has had 2 SVD IN past
Key EEH🔑

10. #HMB 📕
A 39 yr old woman presents to gyn unit with HMB and dysmenorrhoea. She is otherwise fit and well. pelvic
exam is unremarkable. She is not keen on hormonal method. What tm would you initially recommend.
A Danazol
B Ethamsylate
C mefenemic acid
DNorethisterone
E Tranexamic acid
Key C🔑
#HMB.📕
A 40 yrs.old woman attends for a consultation in a primary care complaining of HMB.she is otherwise fit and
well and examination is unremarkable. What investigation should be undertaken.
A coagulation screen
B Endometrial biopsy
C FBC
D pelvic USG
E Serum ferritin
Key C🔑

11. #HMB📕
A 38yr old woman is seen in gyn clinic.she presented with HMB.history and exam are unremarkable and she is
commenced on tranexamic acid,to be taken during menstruation only.should this tm ultimately prove to be
ineffective ,for how many cycles should she have tried it to come to this conclusion
A 3 cycles
B 6 cycles
C 9 cycles
D12 cycles
E 18 cycles
Key A🔑
#HMB📕
Overall complication of hysterectomy?
a 4%
b 5%
c 6%
d 7%
Key A🔑
#HMB📕
Vaginal discharge and post op .pain are most common complications of UAE
T
F
Key t🔑

12. #HMB📕
A) very common
B) Common
C) less common
D) Rare
E) very rare
EMQ
1) Deep vein thrombosis is ________ complication of Oral contaceptive pills
2) Intraoperative hemorrhage is _______ complication of hysterectomy
3) Hemorrhage is _______ complication of myomectomy
4) osteoporosis is ______ complication of GnRH analogue use more than 6mnths
5) Endometrial thickening is _______ complication of ulipristal acetate
Key ECDCA🔑
#HMB📕
A 28 year old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over
the past 9 months she has hard two dilation and curettages (D & C’s), which have failed to resolve her symptoms,
and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding.
a) Perform a hysterectomy
b) Perform hysteroscopy
c) Perform endometrial ablation
d) Treat with GnRH agonist
e) Start the patient on a high dose progestational agent
Ky B🔑

13. #HMB📕
# Risk of need to repeat endometrial ablation::::::::::
A-2.6 times
B-3.6 times
C-4.6 times
D-5.6 times
E-6.6 times
Key B🔑
#HMB 📕
With LNG IUS common complication is irregular bleeding, less common complication is amenorrhea, rare
complication is perforation . In explaining potential unwanted outcome, wat does "RARE" mean?
A) 1 in 100
B) 1 in 1000
C 1in 10000
D) 1 in 100000
Key C🔑
#HMB📕
uterine artery embolisation has higher risk of minor complications but same risk of major complications as compared
to myomectomy
T
F
Key T🔑

14. #HMB📕
Normal saline as a distension medium has better view compared to glycine while performing TCRE
T
F
Key F🔑
#hmb,nice📕
A healthy 33 year old woman presents with a 6 months history of heavy menstrual
bleeding and no other symptoms. Her LMP was 6 days ago and she has a regular 32
days cycle. She is sexually active but not planning a pregnancy. She does not wish to
use an intra-uterine contraceptive device for personal reasons
A Offer oral progestogens during the luteal phase
B Offer oral progestogens from days 5 to 26
of the cycle
C Offer depo-medroxyprogesterone acetate
D Offer the combined oral contraceptive pill
E Offer tranexamic acid
Key D🔑
Medical treatment should be considered if no structural or histological abnormality or for fibroids less
than 3 cm in diameter which are

15. not distorting the cavity If both hormonal and non-hormonal treatments are acceptable, treatments should be considered
in
the following order
1. levonorgestrel-releasing IUS provided long-term (at least 12 months) use is anticipated
2. tranexamic acid or NSAIDs or COCP
3. norethisterone (15 mg) daily from days 5 to 26 of the menstrual cycle, or injected long acting
progestogens.
Contraception needed therefore COCP best option
hmb📕
A 32 year old woman presents with a 6 months history of heavy and painful
periods. Her LMP was 3 weeks ago and she has a regular 28 day cycle. There
is no inter-menstrual or post-coital bleeding. She is sexually active but does
not want to use contraceptives. Pelvic ultrasound scan is normal
A Offer diagnostic laparoscopy
B Offer MRI to exclude adenomyosis
C Offer tranexamic acid
D Offer mefenamic acid
E Offer the combined oral contraceptive pill
Key D🔑

16. - 50 yrs. Cx screening mild dyskaryosis HPV negative next step
A. colposcopy
B.RR in 3yrs
C.RR 5yrs
D. Hysterctomy
ANS Routine recall 5 yrs

17. What was lactate level for septic shock
2 for sepsis
4 for septic shock
Parvovirus incubation period
14-21 d
What is the risk to neonate?
If it is early 30%
If late 10-15%

19. Q-What was vitamin needed for thalassemia
ANS-Folic acid 5 mg
So one scenario was that Pt with bmi 40 or 46 came for anc at 10 week already taking folic acid and she was advised
by midwife to take vit d
So what was answer to give 10 micro gram od or as already told in scenario that midwife advised
So needed any more vitamins One was on epielsy medicine and pregnancy or anc came for advice
Answer was 5 mg folic acid

21. 12 weeks missed miscarriage treatment options
Options
Cervical ripening
Mife and meso
Synto
Mesoprostol
ANS meso
9 wks with mild lower abdomen pain and light bleeding
Options;
Anti D 250
No anti D
Anti D500
ANS No antiD
22+ wks with FMH of 4
How much anti D
Options;
250
500
1500
1000
ANS 500 units

22. Elderly lady with pain Lower abdomen, painful urination.... mild haematuria, cystoscopy showing hemorrhagic spots
Options;
UTI
BLADDER TUMOR
INTERSTITIAL CYSTITIS
ANS IC
Mcda twins ttt screening from
14
16
18
20
ANS 16 wks
Scenario where Hb low
Mcv low
Ferritin normal
Options;
Iron deficiency anemia
Thalassimia
Megaloblastic anemia
ANS Thallesemia

23. There's was a long scenario on..... I think ans was Bolam principle
Here about consent for nercrotising fascitis was not written in the form and it is very rare complication post abdominal
hysterectomy
ANS Montgomery
Pt with mental retard going for laparotomy?
Consent
ANS Legal opinion
Pt with Esinmenger syndrome
Best contraception
ANS progesterone contraception
Blood results low PAPP A
It was for Down syndrome confirmation .asked next step .so invasive procedure for diagnosis.
Major risk for SGA;
ANS Serial usg doppler monitoring from 26-28 wks
CTG 40 min reduced variability
Suspicious/Nonreassuring
USS positive dongut sign BHcg 2220
ANS Systemic methotrexate
Malodorous vag discharge
ANS Gardella vaginallis (Bacterial vaginosis)

24. Rash at face and behind ears and in extremities,upper chest and lymphadenopathy
Measles
Varicella
Rubella
Parvovirus
ANS Measles
Itch at site of abdominal straie
Umbilical sparing good prognosis for mother and baby
ANS PEP
Pt. collapsed at corridor fits for 6 min
Not compliant with her antiepileptics
Not able to put Ivline
ANS Perrectal diazepam pessary
Pt fits in labour 5 minutes
Both epileptic
ANS Phenytoin
Definitive diagnostic investigation of choice of anterior placenta previa to rule put placenta accreta
3D colour Doppler or MRI
ANS 3 D doppler

25. Upt positive,
Uterus empty, cx empty;
Negative slip Sign
sac found ant Lower in usg
ANS Cs scar pregnancy
Q asking about action of tranexaamic acid
ANS Inhibits conversion from plasminogen to plasmin

26. SBA
Lignocaine dose 3mg/kg
But they gave weight of 80 kg
So max dose 240mg
Hemophilia Factor 8 and 9 def.
Aim for factor VIII/IX levels of at least 0.5 iu/ml to cover surgical or invasive procedures, or
spontaneous miscarriage. If treatment is required, factor levels of 1.0 iu/ml should be aimed
for and not allowed to fall below 0.5 iu/ml until haemostasis is secure.
Tranexamic acid should be considered in combination with treatment for all those with levels
of less than 0.5 iu/ml or as sole therapy for those with levels above 0.5 iu/ml if clinically
indicated. Following miscarriage, it should be continued until the bleeding settles.
Desmopressin (DDAVP) can be used antenatally to raise factor VIII levels
GTG no 17

27. Emq on ctg came to answer accordingly to nice 2017 and caragorize it
One was having abruptio with blood stain liquor and baseline was 160 < 5 variable for 45 min like this and no
deceralation
ANS Abnormal
Preterm in labour
Mgso4
Ans Dexamethasone
Osce
Ans Summative
Or formative
Vitamin B12 deficiency causing
neuropsychiatric manifestations such as peripheral neuropathy, subacute combined degeneration of cord, dementia,
ataxia, optic atrophy, psychosis and mood disturbances is well known. We report a case with recurrent seizures
resulting from vitamin B12 deficiency.
So answer was combined degeneration of cord
What causes seizures in wernick encephalopathy?
Ans Vit B1 def

28. Pt 20 weeks RH -ve anti D 250 or 500
ANS 500 units
Male azoospermic low FSH LH
ANS kallman
Other unexplained infertility of 2 yrs.
ANS IVF
Cervical ca 1b1
16 weeks Wks deliver at viability
33 wks pregnant deliver after dexa.
Vulval itch received fluconazole no improvement
ANS: High potency steroid
65 yrs ET 3 mm some fluid in cavity.If ecogenic fluid need endometrial sampling.
ANS IF 3 mm ET or less with clear fluid in cavity need endocervical sampling.
Query bank rcog
Normal Hb , ferritin 55 MCV74
ANS Thallesemia trait
ferritin should be less than 55 for diagnosis of Iron deficiency, so the answer should be thalassemia trait.
Pt with thalathemia major in early pregnancy what best for her anemia

30. Case of recurrent herpes ,40weeks in labour, fully dilated,midwife noticed small lesion on right labia-
What action you do
ANS Allow VD and referral to GUM clinic .
1) artery injury in lower part of ureter close to bladder happened during extensive treatment of endometriosis
during laparoscopy due to vascular necrosis
Options
Ovarian?
ANS Vesical artery
2) artery injury during 4th degree tear- no inferior rectal artery given
ANS Int pudendal ?
Deep circumflex
1) 3) artery injury during retro pubic Transvaginal tape
1) Epileptic on lavetracitem had Grand mal seizures - immediate management
ANS Clobazem
Diazepam
2) Epileptic non compliance with treatment 26weeks fallen unconscious in clinic
ANS Per rectal diazapam

33. Warty lesion on clitoral hood
Excision or keys including normal skin some part
Keyes
No excisions
ANS Keys

34. One emq for vulva Pt pregnant with ulcer single on thigh or vulva painless and patient not noticed anything before
and booking test were normal nothing was written regarding lymphadenopathy
Ans primary syphillis
Vdrl-at booking because of prior treatment
In same emq one old lady with resorption of vulva it was lichens sclerosis
Emq was very confusing as answers were three starting with words “ commense * and three were starting with
*advise*
So one with dvt in last fracture
ANS is commense lmwh till 6 weeks
Mesh used in colpopexy ,is it non absorble material,
Ans Polypropylene type1

35. there was 1 question on prevention of infection in caesarean and options were like, hair clipping, shaving,
antibiotic after skin incision and bath with antiseptic before surgery.
Ans Bath with Antiseptic before surgery- this was an evidence Cochrane data base
For women with cardiac disease the decision to use intrauterine contraception should involve a cardiologist. The
intrauterine method should be fitted in a hospital setting if vasovagal reaction presents a particularly high risk, for
example, women with single ventricle circulation, Eisenmenger’s physiology, tachycardia or pre-existing
bradycardia.