Part 2 MRCOG Short Answer Questions September 2013 Questions from feedback forms

Question 1:
A healthy 45-year-old woman has been sent for an ultrasound scan to locate her coil because
the strings were not visible on a routine check. The scan report revealed the copper coil to be in
situ but found an incidental 5 cm complex ovarian cyst. There is no free fluid in the pelvis but
the report does not given any other details.

A. Discuss how further information from this patient’s history and examination might help
clarify the differential diagnosis for the ovarian cyst: (8 marks)
B. Evaluate the investigations that would aid diagnosis: (12 marks)

Question 2:
A healthy 24-year-old woman attends gynaecology clinic asking for advice about secondary
amenorrhoea. Her last menstrual period was more than a year ago. She also complains of hot
flushes and night sweats. Her BMI is 22. On arrival at clinic, a pregnancy test is negative. The
General Practitioner has already tried a progestogen challenge but this did not produce a period.
Attached to the referral letter are the results of a prolactin level which was normal and an FSH
level which was 44 iu/L (reference range 2-10 iu/L).

A. Justify investigations you would arrange to assist in her subsequent clinical management:
(7 marks)
B. Evaluate the options available to treat her vasomotor symptoms: (10 marks)
C. What advice would you give about her fertility? (3 marks)

Question 3:
A 39-year-old healthy primigravid woman is found to have dichorionic diamniotic twins at her
11-week dating scan.

A. Describe the implications of the twin pregnancy that you would discuss with her at this
stage and explain how this would alter her antenatal care: (12 marks)

At 36 weeks of gestation she comes to antenatal clinic to discuss delivery. Her pregnancy has
been uncomplicated to date and the first twin is a cephalic presentation.
B. Outline the specific issues you would discuss with her: (8 marks)

Question 4:
You receive a referral about a 30-year-old accountant who is wheelchair-bound on account of
spina bifida. She had a first-trimester miscarriage several years ago but has now stopped using
contraception again and is planning a pregnancy. She is on no medication. The referral letter
requests pre-pregnancy counselling so that she can understand how her spina bifida may affect
pregnancy and birth.

A. What specific information would you need from her history? (5 marks)
B. Discuss the advice you would give her regarding pregnancy and birth: (11 marks)
C. Describe the issues that the maternity unit should consider in her peripartum care: (4 marks)