MRCPI Part 2 Written – Free Mini Mock 02 – March 2021

1.When counseling a recently postmenopausal woman with unpleasant vasomotor symptoms wishing to take hormone replacement therapy (HRT), it is important to discuss fully the risks and benefits of HRT. As part of the discussion she should be informed the following, except:

2) A 50-year-old Asian woman presents to her GP with one episode of postmenopausal minimal vaginal bleeding which lasted for 2 days but has now stopped. Clinical examination reveals atrophic vagina and cervix. A transvaginal scan shows an endometrial thickness of 4 mm. She gives a history of breast cancer in her first cousin who is 69 years old. What is the most appropriate hormonal drug therapy for her?

3) You are asked to review a 22-year-old woman in her first pregnancy because she has type 4 female genital mutilation. Which of the following does this include?

4) A 23 year old primigravida is booked with a midwife at 21 weeks. She reveals that she had female circumcision done when she was a child. On examination, the labia minora is completely fused in the middle. You are going to document the type of female genital mutilation (FGM). What type of FGM is this best described as?

5) A 26-year-old woman in her first pregnancy presents to the labour ward at 28 weeks + 4 days gestation with abdominal pain. Maternal observations are all within normal limits. A CTG reveals she is contracting at a rate of three times in 10 minutes, with a normal fetal heart rate. Speculum examination shows the cervix is effaced and dilated 3 cm. The ST3 obstetric trainee wants to know the correct dose of magnesium sulfate for neuroprotection for the baby. Which of the following statements is the most appropriate answer?

6) Which of the following is not true regarding adverse effects of magnesium sulphate?

7) A 34 year old woman G3P2 wishes to discuss testing for gestational diabetes. She should be offered screening if she

8) A 34 year old lady in her first pregnancy has hypothyroidism and is on Levothyroxine 125ugm/day and is seen in the combined endocrine clinic at 13 weeks gestation. In what increment should thyroxine be adjusted?

9) A 33-year-old woman with insulin dependent diabetes mellitus presents to the antenatal clinic at 7 weeks. She wants to know about the risks to her baby. Which of the following is not associated with diabetes?

10) What is the incidence of domestic violence in Ireland?

11) A 33-year-old woman attends the gynaecology outpatient clinic with a six-month history of pelvic pain and dyspareunia. She reports having had chlamydia in the past. On examination you notice bruises of various colours on the medial aspect of her thighs. What is the most appropriate next step?

12) A 35-year-old woman attends the gynaecology clinic complaining of worsening HMB. Investigations have been performed in primary care. Her haemoglobin level is 123 g/l and a pelvic ultrasound scan showed no obvious abnormality. What is the most appropriate first-line pharmacological treatment?

13) A 40-year-old woman attends for a consultation in primary care complaining of HMB. She is otherwise fit and well and examination is unremarkable. What investigation should be undertaken?

14) A 24-year-old woman presents in clinic at 12 weeks gestation with monochorionic twins. Upon discussing the risks associated with monochorionic twins, she asks you how common twin-to-twin transfusion syndrome is. What is your answer?

15) Chorionicity in multifetal pregnancy is best assessed at what gestation:

16) A 34 year old P2 lady unfortunately sustained a spinal cord injury above T4 level. She has given birth to her 2nd child and is planning to breast feed the baby. Breast-feeding is affected in the following manner:

17) A 41 year old lady 36 weeks gestation presents to labour ward with chest pain. An ECG is performed. Which of the following ECG changes in not a normal variation in pregnancy?

18) While on the delivery suite, you are called to the emergency department to assess a 30-week pregnant woman known to be a brittle asthmatic. She complains of shortness of breath, widespread wheeze and is tachycardic at 98 bpm. She takes salbutamol 100 mcg two puffs as required, a salmeterol/fluticasone 50/500 inhaler twice daily and theophylline 500 mg twice daily. On this admission, there is no evidence of pneumonia and her oxygen saturations are 98%. How would you change her medication?

19) A 24-year-old woman experiences an antepartum stillbirth at 34 weeks gestation. Which one of the following maternal serological investigations may be helpful in identifying a cause for the stillbirth?

20) A 37-year-old woman in her first pregnancy has attended maternity triage at 38 weeks gestation with reduced fetal movements. An ultrasound scan by two practitioners has confirmed intrauterine fetal death. She has had routine antenatal care and the pregnancy has been uneventful up to this point. Which one of the following is correct with regards to further management?