MRCOG Part 2 – Free Trial Questions

A 40 year old primiparous woman is referred from a routine growth scan at 32 weeks gestation with significant polyhydramnios. On scan, there is abnormal appearance of the abdomen with double bubble sign seen and severe polyhydramnios with deepest vertical pool of 17cm and AFI of 40.  What is the most appropriate investigation?

• A 40 year old woman presents with painful regular contractions and confirmed preterm prelabour rupture of membranes at 29+0 weeks gestation. She has previously had a midtrimester loss and had an ultrasound indicated vaginal cervical cerclage inserted at 18 weeks gestation. On speculum examination, the cervix is 2cm dilated and bedside ultrasound scan confirms that the fetus is cephalic.  Her blood results show a WCC of 6 and CRP of 5. Maternal observations show HR:80, BP 120/80, RR 14, T36.2, Sats 100% RA.

A 30 year old woman presents with headache at 22 weeks gestation in her first pregnancy. She reports a generalized headache which is worse when coughing and associated with nausea, blurred vision and diplopia. Neurological examination is normal. She has no significant past medical history but has a booking BMI of 41.  What is the most appropriate next investigation?

For each of the following scenarios, select the most appropriate risk profile:

• A 24 year old woman is referred to pre-pregnancy counselling.  She is tall and thin with a history of scoliosis and hypermobility. There is a family history of aortic dissection and genetic screening has shown a mutation in the type II procollagen gene, COL3A1. Her most recent ECHO shows aortic root dimension of 45mm.

A primiparous woman with a metallic mitral valve replacement is booked for a planned Caesarean section for breech presentation at 39 weeks gestation. She weighs 65kg and has been on antenatal warfarin since the second trimester of pregnancy. What is the most appropriate management of her anticoagulation?

• A woman in spontaneous labour at 40 weeks gestation requests rapid onset effective pharmacological analgesia for the duration of her labour.  She has a history of immune thrombocytopenia and her platelets on admission are 70.

Which of the following assisted vaginal births should be conducted in theatre?

• A woman in her first pregnancy attends in spontaneous labour at 30 weeks gestation and requests epidural analgesia which is sited and is effective. During the second stage of labour, the CTG is abnormal with repetitive late decelerations. On vaginal examination, the presenting part is at station 0 with occipito-posterior fetal position.

A RhD negative woman has given birth via Caesarean section for suspected placenta accreta and has received reinfused blood from intra-operative cell salvage. Which of the following options is most appropriate immediate management with regards to her Rh status?

For each scenario described below, choose the single most appropriate thromboprophylaxis option:

• A woman is 3 days after an emergency Caesarean section under spinal anaesthetic and has a post-dural puncture headache for which the anaesthetic team would like to perform a blood patch. How long after her prophylactic low molecule weight heparin can this be safely performed?

A 23 year old presents with secondary amenorrhoea for 6 months.She is nulliparous with a BMI of 31 and her periods have been irregular for the last three years with cycles varying between 2 and 4 months apart. A urinary pregnancy test is negative.  Her past medical history includes irritable bowel syndrome for which she takes regular antispamodics and metoclopramide.  Her blood test results are shown below:

FSH – 10.5                   (1.0-11.0 IU/L)

LH – 8.5                       (0.5-14.5 IU/L)

Testosterone – 1.8      (0.8-3.1 nmol/L)

Prolactin – 996            (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?

For each scenario described below, choose the single most appropriate treatment option:

• A 36-year-old patient is seen in gynaecology clinic. She was found to have endometrial hyperplasia with atypia at the age of 31 years. She had not completed her family and therefore underwent initial treatment with the Levonorgestrel Intrauterine System (LNG-IUS) followed by regular surveillance of the endometrium. All biopsy results following removal of LNG-IUS were normal. She has now completed her family. She has had 3 caesarean sections and has a BMI of 39. Her cycles are regular and with her most recent endometrial biopsy 2 months ago histology showed proliferative endometrium with no evidence of hyperplasia or atypia. Her past medical history includes a deep vein thrombosis in her second pregnancy.

A 29-year-old woman presents to your fertility clinic with an 18-month history of secondary infertility. She has had a child with a previous partner, he has no children. All her investigations have returned as normal. He has had 2 semen analysis performed in the last 4 months, they have both shown evidence of oligozoospermia, the last semen analysis being as follows:

Given NHS funding restrictions for them in view of his partner’s child, what treatment can he take to improve his semen analysis?

For each scenario described below, choose the single most appropriate initial treatment option:

• A 30-year-old woman presents to your fertility clinic with her partner with an 18-month history of primary infertility. She has oligomenorrhea, she has 4-5 periods a year. Her BMI is 27.Her ultrasound scan had shown a normal size anteverted uterus and shown ovaries with over 20 follicles on both ovaries with an ovarian volume of 11ml. HyCosy examination has demonstrated patent fallopian tubes. She has no other medical issues. The semen analysis of her partner was normal.

A 24-year old woman contacts the sexual health clinic for contraceptive advice. She is taking the combined oral contraceptive pill and has been vomiting for the last 24 hours and is concerned that she has vomited her last pill.  She is currently on Day 5 of her pill packet and has had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

For each of the following scenarios, select the most appropriate diagnostic test:

• A 20 year old woman presents to her local sexual health clinic with symptoms of profuse vaginal discharge which she describes as offensive. On examination, there is profuse frothy yellow offensive vaginal discharge and there is a strawberry cervix appearance with small punctate haemorrhages with ulceration.

A recent randomised trial has demonstrated a benefit in progesterone therapy for women with early pregnancy bleeding and one or more previous miscarriages.What is the recommended regime to use for these women?

• A 25-year-old woman presents to your early pregnancy unit with vaginal bleeding and pelvic pain and a positive pregnancy test. Her last menstrual period was approximately 10 weeks ago, her cycles are 35 days in length. She is a para 1 who had an emergency caesarean section 2 years ago for fetal distress. A transvaginal ultrasound scan is performed which shows an anteverted uterus, with a closed cervix. The cavity of the uterus is empty. A gestational sac measuring 33x32x30 mm is seen laterally. The sac is surrounded by a thin rim of myometrium. Both ovaries appeared morphologically normal, with a corpus luteum seen on the right ovary. There was no evidence no evidence of free fluid in the pouch of Douglas.

A 65 year old woman is diagnosed with advanced ovarian cancer. Which of the following is an indication for neoadjuvant chemotherapy followed by interval debulking surgery?

You are counselling a 58-year-old patient about her upcoming sacrospinous fixation (SSF) surgery for a post hysterectomy vaginal vault prolapse. Her hysterectomy for uterine prolapse was 7 years ago. She presented 9 months ago with a lump in the vagina and complaining of a significant dragging sensation. She was diagnosed with a vault prolapse. She has tried several vaginal pessaries, all of which needed to be removed due to discomfort. She has also attended pelvic floor physiotherapy without success. Her case was discussed in urogynaecology multidisciplinary team meeting, and she has now been offered surgery. What is the most frequently occurring risk that you would discuss?

A woman in her first pregnancy presents at 17 weeks gestation requesting cytomegalovirus (CMV) testing because her husband had been hospitalised with confirmed CMV illness. She tested positive for CMV IgM and IgG. Booking serum is IgM and IgG positive. What is the next most appropriate management?

A 34 year old woman is referred to colposcopy following a routine cervical smear showing CIN3. Loop biopsy confirms a 17mm cervical adenocarcinoma with 6mm of stromal invasion.  MRI confirms that the cancer is confined to the cervix and there is no parametrial or lymph node involvement. She has two young children and feels her family is complete. What is the most appropriate management?