MRCOG Part 2 Free Mini Mock EMQ – Jan 9

Option List:
A. Radical wide local excision with unilateral lymphadenectomy
B. Radical wide local excision with no lymphadenectomy
C. Surgery with NO adjuvant Chemotherapy
D. Surgery with adjuvant Chemotherapy
E. Neoadjuvant chemotherapy f/b radiation
F. Surgery
G. Radiotherapy
H. Chemoradiation
I. Radical wide local excision with bilateral lymphadenectomy
J. Combination of surgery +/- radiotherapy +/- chemotherapy for palliation
K. Chemotherapy +/- radiotherapy
L. Surgery followed by adjuvant radiotherapy

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. What is the management for the below given scenarios.

1. A 37-year-old woman has been referred to the colposcopy clinic with a referral smear reporting severe dyskaryosis. Colposcopy reveals frank invasive disease, which is confirmed by a cervical biopsy. Examination under anaesthesia confirms these findings. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of the cancer and what is management in this stage?

2. An 82-year-old woman presents to the emergency department with postmenopausal heavy bleeding and her haemoglobin is 70 g/L. She receives 2 units of blood transfusion and undergoes hysteroscopy and an endometrial biopsy on an emergency basis, because she continued to bleed heavily. An endometrial biopsy reveals clear cell carcinoma. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of the cancer and what is management in this stage?

3. A 55-year-old woman is referred to a rapid-access gynaecologic clinic with PMB. Transvaginal ultrasound scan reveals endometrial thickness of 6mm. She underwent pipelle biopsy results which reveal endometrial cancer. She is otherwise fit and healthy. The following is the picture of her disease. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of the cancer and what is management in this stage?

4. Margrette is 58 years old visits her GP with complaints of increasing abdominal upset since 4-5 months. She also complaints of decreased appetite but feels that there is increasing belly fat. On abdominal examination her GP finds that there is fluid in abdomen with eliciting shifting dullness.she refers the patient to specialist where after detailed history, ultrasonography and CA-125 diagnosis of ovarian cancer was made. After all pre-op investigations she is undergoes laparotomy for a pelvic mass, 5 litres of ascites was drained with a complex pelvic mass involving ovaries, tubes and uterus, with a normal looking omentum. However the histology showed an ovarian cancer with microscopic deposits on the omentum. What is the International Federation of Gynecology and Obstetrics (FIGO) stage of the cancer and what is management in this stage?

Option List:
A. Cisplatin
B. 5-Fluorouracil
C. Paclitaxel
D. Topotecan
E. Doxorubicin
F. Gemcitabine
G. Etoposide
H. Carboplatin
I. Bleomycin
J. Docetexal
K. Ifofosfamide
L. Oncovin
M. Desensitisation

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

5. This chemotherapy agent is associated with a dose dependent risk of cardiac failure?

Option List:
A. Syntometrine
B. Oxytocin intramuscular
C. Group specific blood transfusion
D. Carboprosti.m 0.25 mg 
E. Rh negative blood transfusion
F. Oxytocin intravenous
G. EUA
H. Oxytocin infusion
I. FFP and cryprecipitate
J. HDU care
K. Misoprostol 1000mg sublingually
L. MOEWS chart
M. Involve the consultant
N. Ergometrine im or iv

For each of the following scenario, choose the single most appropriate option from the list given above. Each option may be used once or more than once or not at all. Questions

6. 29 year old multiparous delivered male baby weighing 3.6 kg by spontaneous vaginal delivery with a good APGAR. Following delivery placenta and membranes expelled intoto. She had atonic PPH following delivery which was managed with oxytocin. Her pulse is 98/min and her BP is 100/60 mmhg. The best management option is

7. 30 year old multiparous woman delivered vaginally at A&E following a precipitate labour with profuse vaginal bleeding. On examination she was found to have atonic Uterus with a small perineal tear. IV access was secured and immediate resuscitate measures started. The best management is

8. 36 year old woman delivered her first baby by outlet forceps delivery for fetal distress. Following the placental delivery she had profuse vaginal bleeding and on examination was found to have well contracted uterus and the placental membranes were completely removed. Immediate resuscitate measures initiated. The management option is

9. A 24 year old primigravida undergoes induction of labour at 34 weeks of gestation for severe preeclampsia for which she was on magnesium sulphate infusion. Following vaginal delivery she was found to have PPH for which oxytocin injection and infusion was started. Resuscitative measures initiated.Bimanual uterine compression also is being performed. Bleeding persisted and the next management option is

Option List:
A. Abandon operative procedure and reschedule
B. Defer the operative procedure
C. Fraser competence must be demonstrable before obtaining consent
D. Obtain legal advice on individuals who withhold consent for treatment
E. Obtain legal advice on interpretation on the Abortion Act 1967
F. Obtain legal advice on interpretation on the Human Fertilisation and Embryology Act 1990 and the Code of Practice of Human Fertilisation and Embryology Authority Act 2009
G. Obtain legal advice on interpretation on the Mental Capacity Act 2005
H. Parental consent need not be obtained before proceeding
I. Paternal consent must be obtained before proceeding
J. Perform additional procedure without explicit consent to do so
K. Proceed without consent in order to save the fetus’ life
L. Proceed without consent in order to save the woman’s life
M. Respect the rights of the putative father of the fetus to withhold consent
N. Respect the rights of the unborn fetus and proceed to delivery
O. Respect the rights of the woman to withhold consent for treatment
P. Specific consent is unnecessary
Q. Verbal consent alone is acceptable
R. Verbal consent with witness and case note documentation
S. Written consent must be obtained

10.A couple are referred to the fertility service because the 24-year-old male partner has developed testicular cancer that will require orchidectomy followed by chemotherapy. They wish to have his semen stored for artificial insemination of his wife if he were to become azoospermic in the future

11. A 12.5 girl requires a hymenotomy to treat her cryptomenorrhea

12. A 14-year-old girl attends the gynaecology clinic requesting a termination of pregnancy. Her last period was 10 weeks ago. She doesn't want her parents to know

Match the following options with the appropriate scenarios described below. Each option may be used one or more times or may not be used at all.
Option List:
A. Strongly advise to defer pregnancy
B. Start insulin
C. Advise diet & exercise
D. Increase the dose of insulin
E. Advise use of insulin pump
F. Monitor blood glucose 4 times a day
G. Monitor blood glucose twice a day
H. Start metformin & or insulin

13. Mrs Sarah,primi with 24 weeks pregnancy.OGTT done bcos BMI is 35.Fasting glucose 7 mmol/L.

14. A 30 year old lady with type 1 diabetes,attending preconceptionally clinic.HbA1c is 90 mmol/L

15. A 35 yrs old multipara with GDM in this pregnancy not controlled with diet & exercise & metformin.now on treatment with multiple injections of insulin .

16. Primi with GDM diagnosed after OGTT.fasting glucose is 5.9mmol/L

17. A multigravida ,known type 1 diabetes.Blood glucose level is not being maintained despite diet,exercise & insulin injections.

Option List:
A. Pleural effusion
B. Asthma
C. Pulmonary embolus
D. Pulmonary oedema
E. Basal atelectasis
F. Angina pectoris
G. Myocardial infarction
H. Pneumonia
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

18. A 44 -year-old Emily had laparoscopic hysterectomy. She is a known heavy smoker. On the evening following surgery, she complained of central chest pain and shortness of breath which lasted for more than a few minutes and patient expired.

Option list:
A. 4/100 000
B. 13/100 000
C. 0.08%
D. 0.02%
E. 1.5 fold
F. 2 fold
G. 4 fold
H. 75%
I. 5%
J. 3%
K. 35%
L. 40%

19. A G2P1 ( previous 1/ LSCS ) at 38+6 weeks of gestation is admitted with a history of abdominal pain and clear fluid leaking vaginally for 5 hours.She is having regular painful uterine contractions 3 in 10 minutes and cervical dilatation is found to be 4 cm.. How much is the risk of hypoxic ischaemic encephalopathy (HIE) in fetus

20. A 29 year old G2P1 ( previous 1 ) at 39 weeks with spontaneous onset of labour. On vaginal examination she is 5 cm dilated fully effected vertex 0, what is the risk of anal sphincter injury?

21. A 29 year old G2P1 ( previous 1 / LSCS) was anxiously wanted to deliver vaginally so she was induced with PGE2, what is her risk of uterine rupture

22. A 30 year old G3P2 with history of cesarean section 3 years back due to fetal distress, now visited antenatal at 36 weeks, what would be her risk of instrumental vaginal delivery

Option List:
A.  40%
B. 13%
C. 36%
D. 21%
E. 17%
F. 90%
G. 80%
H. 45%
J. 100%
K. 0%
L. 88%
M. None of the above

The above percentages indicate various sites of perforation of uterus , The labelled images show various sites of perforation . Identify the labelled image and choose appropriate percentages . Choose the option once or more than once or not at all

23. Image A

24. Image B

25.Image c