RECALL JANUARY 2018

1. What is the 5 year survival of stage 3 ovarian ca

A) 5 percent
B 10 percent
C) 20 percent
D) 30 percent
E) 40 percent
2. There is a lady with confirmed SUI, who is not keen for any surgery involving mesh or i think it was
major operative procedure.
What are her options
A paraurethral bulking agent
B marchall marchenti kranz
C vaginal slingpasty
D paravaginal defect repair
E needle suspension procedure.

3. Which antiepileptic drugs are known to be associated for SGA?

Carbamazepine
Lamotrigine
Levetericiticam
Phenytoin
Sodium valproate
4. Pregnant 26wks,hyperthyridism, on carbimazole 15 mg, had a sore throat , urgent investigation:
A. Blood cultures and lactate.
B. FBC
C. CRP
D. Throat swabs
E. Thyroid function tests.

5.Previous classical C.S. for fetal indication, came to discuss plan for delivery ,
A Allow vaginal delivery at term.
B, Classical C.S. at 38 wks.
C. Lower segment C.S at 38 wks.
D. Lower segment C.S at 39 wks.
e.lower classical cS at 39 weks
6. A woman with known type 1 diabetes develops fever, tachycardia and abdominal pain. What are
changes in blood gases of the condition that she is experiencing?

ph P02 PCO2 HCO3

low High/normal High low
low low low high
low High/normal Low high
Low low high low
low High high high
EMQ on ethics
Autonomy
Benificience
Non maleficience
Justice
Veracity

Non benificience

Next of kin

Take consent from husband

Equality

Paternalism
so on ...

7. a girl with down syndrome who is unable to give consent suffers from HMB. A decision is made to
insert a Mirena for her.

8. a g2p1 at 34 weeks with severe pre-eclampsia refuses treatment and want to allow nature to run its
course. She has been adequately counselled and still refuses treatment.

9. a g1p0 requests IOL at 36 weeks as her husband is travelling and she wants him to be present for the
labour. The consultant decides to refuse the request.

10.Hyperemesis...intractable...came to A and E 1st line treatment

a.promethazine
b.ondansterone
c.metoclopromide
d.steroid
e,domperidone
11.Uterine perforation incidence after TOP

5/1000

2/10000

10/1000

2.5/10000
EMQ

Pictures of instruments

Zepillin

Lahey

Babcok

Littlewood

Haeney forcps

So on…….

12.Which is for clamping of ut artery pedicle

13.Which is used for clamping round ligament during hysterectomy

.EMQ infections

Ebv

Syphilis

Falciparum

Chicken pox

Dengue

Coxcahie vir

14.Lady went to wedding in ghana took mefloquine prophylaxis n felling unwell with fever n anaemia hb
6.5

15.Lady has reddish rash in ear canal & unilatersl facial paralysis

16. 28 yrs old suffering from Ulcerative Colitis on Mesalazine, planning for pregnancy and

came for prepregnacy counselling. What advice will you give regarding Mesalazine on

pregnancy?

a) No risk

b) Increased congenital defects

c) Increased miscarriage

d) Increased preterm delivery

e) Interferes with Breast feeding

17..a lady has hemophilia A ,gave birth to female baby what are the chances of her dautghers being
carrier

a) 0%

b) 25%

c) 50%

d) 75%

e)100%

18. Lady with itching.At what level of bilirubin will be her worst adverse outcome:

A.Less than 5

b.5-10

c.10- 19,

d.20 -30

e.40-50

19. Microscopic haematuria with painful bladder fill-in and haemorrhagic spots on cystoscopy

a.Interstitial cystitis

b.Painful bladder syndrome

c.Transitional cell carcinoma

EMQ prenatal testing

GA 11-14 weeks ,choose most appropriate test

cvS

amniocentesis

hemoglobinopathy of male only

hemoglobinopathy screening of both partners

hemoglobinopathy screening of partner isn’t neded

no need to do screening

screening of baby by DAT at birth

CFFDNA

Neonatal spot screening

20.21 yr with SCD 12 wk booking partner no contact don’t know where abouts – not interested in any
ivasive diagnostic testing – options family quest/ neonatal spot screening/ no intervene

21.on family questionare from midwife to a couple working in UK,Husband from netherland , wife from
Belgium

22. DM Lady underwent TAH+ BSO 4 ½ hrs back,sx at 12:00 called at 5:15 pm as c/o abdominal pain,
discomfort Observation chart was given – initial bp hypo, then maintained on 100/60, mild tachycaria–
pt was on PCA hypotension at 5 pm, alert respond to voice, on o2 6L FROM 4 PM

a. int bleeding

b.Over dose morphine

c.pul embolus

d.sepsis

e.pneumonia

23.Rate of infaumbilical adhesions after midline laparotomy

a.10

b.25

c.55

d.75

24.long scenario in the end asked ,in sepsis which analgesic to be avoided

Codeine

Brufen

Naproxen

25.complex atypical hyperplasia without atypia ,risk of progression to cancer ?

a.2

b5

c 15

d.25

e.30

EMQ .post menopausal women ,management

Options

Do nothing

Repeat office hysteroscopy

Repeat Op biosy in 6 month

Repeat OP biopsy in 3months

Hysteroscopy

Fractional curettage

Biopsy under GA

Transvaginal ultrasound

Tvs+TAS BOTH

& so on

26.lady has come with report she has her polyp Removed by hysteroscopy she has BMI 36...biopsy
shows in th polyp simpe hyperpalsia without atypia .when to repeat EB.

27.Breast ca lady on tamoxifen for last 10 years asymptomatic,incidental finding on TAS with ET 22mm.

28.lady with mirena in situ ,BMI 38 ,chronic smoker ,has simple hyperplasia without atypia .

29. 18 weeks pregnancy has exposure with slapped cheek syndrome infected pupils at nursry worried
about transmission.

a)5%

b)10%

c)15%

d)20%

e)25%

teaching EMQ

Workplace base assessment

ARCP

OSAT

NOTSS

MINI CEX

OSCE
SBa & EMQ

Mock papers

So on……..

30.Which formative assessment tool to check cognitive + psychomotor skills+behavioral skills of any
trainee at NHS.

31.which form of summative assessment is used for a trainee to assess his yearly performance (long
scenario )

32.which form of formative & summative assessment is used to evaluate…….long scenario (OSAT is the
answer )

33. During evacuation of retained products of conception, what is the most common site of uterine

perforation

Anterior uterine wall

Posterior uterine wall

Right lateral uterine wall

Left Lateral uterine wall

Uterine fundus

34. A lady presents with vulval irritation. On examination you found a 1cm growth on the clitoral hood.
What is your management

Excisional biopsy

vulvectomy

keyes biopsy

biopsy from the center

35. An Epileptic drug whose efficacy is reduced if used concomitantly with COCPs

Phenytoin

Valproic acid

Lamotrigine

Carbamazepine

36. A 65 years old, complaining of stress incontinence. She has tried physiotherapy and pelvic floor
exercise but of no benefit. You advise her for surgical management, but she refused. She asks you if
there is any medication available for her case. What is your management:

Duloxetine
Imipramine

Desmopressin

Oxybutinin

you tell her that there are no medications for her condition

EMQ .POST OP COMPLICATIONS

What is the most likely cause in each of these cases:

Options:

Bowel obstruction

Intrabdominal bleed

Vaginal haematoma

Infected vault haematoma

UTI

Chest infection

Narcotic misuse

PE

Mismanagement of IV fluids

37. You went to review the patient 72 hrs post-operative who is postmenopausal , 60 years old with
difficulty in passing urine burning micturition .

38. A patient post TAH after 3 days who is a cigarette smoker is having pyrexia, feeling unwell. Her
observations are normal and abdomen is soft. She is obese with BMI of 39.

39. Day 1 post TAH, she is having oliguria. Urine output is ; 30 ml/hr. Abdomen soft, wound with signs of
bruises but no bleeding or signs of infection. All observations are normal.

40. A lady with MCDA twins presents antenatally. At what gestational age you should start screening for
TTTS

14 weeks

16 weeks

18 weeks

20 weeks

24 weeks

41. Regarding the anatomy of the Inferior Epigastric artery. From which branch it originates?
External iliac artery

Internal Iliac artery

Femoral artery

.EMQ

CHOOSE artery damage in surgical procedures

External iliac artery

Internal Iliac artery

Femoral artery

Internal pudendal

Inf guteal

Inf epigastric a

Superficial epigastric a

42.artery damaged in SSF

43.long scenario,in the end asked fo laparoscopically damaged a causing bleed after laparoscopy .

PPH EMQ

Choose either prophylacatic/management

Oxytocin 5u iv

Oxytocin 10 IU IM

Oxytocin 10 un iv

protamine sulphate

stop thrombophylaxis from 26 wks

carboprost

misoprost

synto+ methergine.

B lynch

Stepwise devascularization

Bakri balloon

4 units FFP

4 units FFP , 10units CP, 1 unit platelets

 Hystrectomy

10 units CP & 1 unit Platelets

44.28 years old scheduled appointment in midwifery lrd csre unit . Pt had H/O PPH in previous
pregnancy at 36 wks with still birth , on investigations she was diagnoses as protein C deficiency after
delivery .now worried in this pregnancy - how will you prevent PPH in this pregnancy.

45.PATENT IS scheduled for elective LSCS for twins with frequent episodes of APH d/t prev scan
showing low lying posterior placenta which later ruled out .

46.Atonic PPH blood loss 1500ml, pharmacological and conservative mechanical measures

given. Not profusely Bleeding now, 4th blood running. Parameters (blood count, APTT, PT,(n)

Fibrinogen 1.2??)

TOP EMQ

Provided these 3 cases were treated at 3 –6 wk preg – given mife + miso according to British laws, after
72 hrs GP telephoned you for advice .

a) Reassure and to take simple analgesics

b) Report to EPAU with in 24 hrs

c) Report to GP at the earliest

d)Admission, Antibiotics & IV fluids

e) USG after 1 wk

f) Report with home pregnancy test after 1 wkk

g) Report after a week for pregnancy test

47.u get Phone call that patient is just spotting since then

48.on phone she is complaining of severe Cramps+ bleeding moderate with passage of clots – now
bleeding within normal limits

49. abdominal cramps + mod bleeding+ several bouts of diarrhea ,rest patient is stable

50- Postpartum with mechanical heart valve on warfarin.

Femal Genital Mutulation

Refer for psychological assessment

Refer for sexual assesment

Document with anonymisation

Document without anonymisation

Agree with request

Consider de-infibulation

Refuse request

inform police

51. PATIENT at 6 weeks primigravida , come to ask TOP as having FGM.

52.Pt with FGM delivered a male baby. 39- Ptn with FGM with clitoredectomy, now requesting for
reconstruction. No difficulty in passing urine,she just wants sexual satisifaction .

53.You are a registerar on call in labour ward u see a 16 years gave birth to a healthy male baby,midwife
notes tells u that she has undergone FGM in her childhood.

54.The most sensitive feature of acute myocardial infarction on ECG is:

ST segment elevation

ST segment Depression

Prolonged Q-T interval

55. The RCOG exam has two componenets written and OSCE, Which choice best describes each:

a.Written OSCE

b.Formative Summative

c.Formative Formative

d.Summative Formative

e.Summative Summative

56. This is a study that was done in a hospital where the researcher recommends that according to his
findings all preterm babies should be delivered by CS as it improves the survival rate.

CS SVD P value

Number 150 450

GA 26+5 26+5

Survival high low 0.003

Why is that wrong:

The numbers on each arm are not even

The P-value is not significant

it was not done with intention to treat

wrong statistical analysis

P value is statistically significant

57. A pregnant patient who recently arrived to the UK, mentioned to you that she had genital cutting as
a child. On examination: there is no clitoris, no labia minora, labia majora are sutured together in the

midline was small opening admitting 1 finger at the fourchette. How do you classify that:

Grade 1 FGM

Grade 2 FGM

Grade 3 FGM

Grade 4 FGM

Female circumcision

58. Pt is for scan

Anomaly scan shows

Brachychephaly

Duodenal Artesia

Bilateral VSD

Mild calyceal dilatation

limb femur length less than 5th centile

Diagnosis ??

a.trisomy 13

b.trisomy 18

c.trisomy 21

d.Turner syndrome

59. A unit wants to assess their still birth rate against national data. What is the bench mark in UK

1 in 100

1 in 200

1 in 500

1 in 1000

60. Risk of recurrence of shoulder dystocia

2 fold

4 fold

5 fold

7b fold

10 fold

61. SBA on enhanced recovery.Which practice is right . Scenario was of a unit where in-patient stay was
longer than national standards

a.Thrombopropylaxix is not needed

b.Abdominal drains should be kept

c.Fasting for more than 4 hours

d.Regional anaesthesia is not beneficial

e.Complex carbohydrate drinks before major gynae abdominal surgery.

62. Patient developed rashes over her body at 26 weeks gestation. Which of the following criteria of the
rash would be reassuring:

Sparing the umbilicus

if abdominal striae are present

If rashes are on the trunk and the extensor surfaces

63. Patient had normal delivery with multiple tears: parauretheral , labial and a tear involving 50% of the
EAS but intact mucosa and IAS. Which grade you will classify her tear:

2nd degree

3a 3rd degree

3b 3rd degree

3c 3rd degree

4rth degree

64.long scenario in the end asked The most common side effect of excessive use of oxytocin is:

Hypernatremia

Hypoglycemia

Hypokalemia

Hypomagnesaemia
65. A pregnant patient in the first trimester with H/o oligomenorrhea .not sure of her LMP ,how will u
calculate EDD from this scan findings

BPD 24,CRL 94,HC 111,AC 32

a-HC

b-BPD

c-AC

d-CRL

EMQ Choose the most appropriate option according to MBRRACE

Late indirect maternal death

Indirect maternal death

direct maternal death

Coincidental death

Early indirect maternal death

sudden death

Does not fulfill maternal mortality criteria

66. A lady was murdered by her husband at 20 weeks gestation.

67. A lady who was admitted at 14 weeks gestation and had surgical management for missed
miscarriage.2 days later she died and was discovered to have cardiac disease with Eisenmenger
syndrome.

68. A lady who had IOL for preeclampsia. On day 4 postnatal her BP was 222/115. She developed

intracranial haemorrhage and died at 5 weeks postnatal.

69.suicide by pregnant lady will be termed as which type of death

A.indirect maternal death

B-direct maternal death

C-Coincidental death

D- -Sudden death

E-Does not fulfill maternal mortality criteria.

EMQ ON LEGAL ISSUES

What is your management in each of the following cases:

Inform the police

Can’t proceed as consent requirements not complete

Defer the procedure

Take husband consent

Get another opinion

Respect patient’s rights

Proceed with the procedure

Take parental consent

Encourage her to tell her parents

It only needs girl consent

Report to hospital legal department

Report to NHS legal department

70. 14 years old girl came to see you in the clinic with her boylfriend from school that is 15 years old too.
She is pregnant and requesting TOP, and she does not want to inform her family.they deemed
competent mentally & seem to understand

71. Surrogate had a cardiac defects on Tiffa.. doesn't wish to tell the legal parents about it

72.severe OHSS develops oliguria despite fluid replacement,whats next

a.Dialysis

b.Paracentesis

c.Encourage oral intake

d.Reassure

73. Patient in second stage of labour you want to infiltrate the perineum with lignocaine

without vasopressor how much you give

A. 1mg/kg

B.2mg/kg

C.3mg/kg

D.5mg/kg

E.7mg/kg

74. Pregnant women , had spinal cord injury above T 6 level. Admitted in labour ward, her
baseline BP 60/50 mmHg. Suddenly she developed tachycardia, BP 110/80mmHg. Which of

the following explains these changes?

a) Autonomic dysreflexia

b) Hypogycemia

c) Panic attacks

75.44 yr old Mild dyskaryosis+ negative HPV, What next

a.RR in 3 years

b. RR in 5 years

c.urgent colposcopy referral

d.LLETZZ

76.17 weeks pregnant with Severe dyskaryosis on colposcopy. ..what next

A.LLETZ

B.Simple hysterectomy

C.Radical trachelectomy

D.TAH BSO with elective CS at viability

77..young girl presents with large Warty sessile growth which is painless .

A.warts

b.syphilis

c.chlamydia

78.vulval HPV 16,18.type of vulval carcinoma which is associated with these ,patient was on routine
recall with negative cervical smear neg she is more prone to

A.Basloid carcinoma

b.malanoma

c.VIN

d.lichen planus

e.lichen simplex

79. long scenario & asked about Risk of ovarian cancer in BRCA carriers?

A.Endometriod adenocarcinoma

B.High grade serous carcinoma

C.Low grade serous carcinoma

D.Mucinous carcinoma

E.Brenner cell tumors

80.scenario of a ptient in labour with face presentation

81.next q face presentation diameter

82. Labouring women, midwifery noticed multiple shallow ulcers, women has noticed first

time. What is the risk of Herpes simplex transmission to newborn.

a)5-10%

b) 10- 20%

c) 20-30%

d) 30 -40%

e) 40 50%

83. Patient present in labour nulliparous was low risk following with consultant serial scan

baby in 70th centile how to follow her in labour:

A.intial cefm for 30 minutes then intermittent auscultation

B. intermittent A using hand held Doppler

C. intermittent auscul using ctg machine

D.CEFM

E. US to see fetal heart

84. Breast cancer suspected in pregnant lady referred to breast specialist 1st line investigation:.42

A.mamogram

B.US

C.CT

D. MRI

E.CXR

85. Pregnant women diagnosed as stage 1 invasive intraductalca , undergone mastectomy.

Now 18 wks,recurrent symptoms? What is appropriate agent to continue in pregnancy ?

a) Anthracycline

b) Tamoxifen
c) Taxanes

d) Methotrexate

86. a lady came in cilinic with USS Report showing MCDA with co twin death next step.

A. IOL

B. immediate CS

C. MRI brain for other twin

D.reassure

E.fDP

87 .35yrs old undergone surgery ( bowel resection) for Crohn’s disease. Now pregnant,

Adviced VitD & calcium intake as they are deficient. What is the main mechanism of action of

Vit D on calcium metabolism?

a) Stimulates Parathyroid gland and promotes bone formation

b) Decreses renal excretion of calcium from tubules

c) Increases the calcium absorption from Small bowel

d) Increases the calcium absorption from large bowel

88. Patient postoperative 18 hrs on PCA collapsed with pinpoint pupil RR12 normal O2

saturation what medication to be given

A. adrenaline

B. naloxone

89. Perimortem cs time

A.3mins

B.4mins

C.6mins

D.10mins

90. 71.Asthmatic pregnant lady received short acting beta blocker and 800 steroid but her asthma

not controlled next step:

A. steroid

B. LABA

C.theophillin
D.leukotriene

91. Which condition put pregnant lady in high risk of stroke

A.hypothyoidism

B.migraine

C.celiac disease

D.marfan

92. pregnant at 12 wks had vaginal bleeding and evacuation of ROPC after 4 days discovered

RH D negative.till how many days anti D can be given

2 days

5 day s

7 days

9 days

10days

93. A pregnant lady complaining of severe chest pain. X ray was abnormal.& asked for next
investigation?

CtPA

DUPLEX USS

DOPPLER

V/Q SCAN

94. H/o migraine and essential hypertension ,delivered and now post op headache started suddenly for
last 1 day and not responding to simple analgesia.diplopia and Edema and now altered conscious level
cause

a.Sagittal vein thrombosis

b.Aneurysm

c.Eclampsia

d.cerbral infarction

e,SAH

95. Granulosa cells Timor follow up for recurrence is by

a.LDH

b.Inhibin
c.Alpha fetoprotein

d.biopsy

96..Question on megaloblastic anemia caused by vit B12 deficiency ,blood picture showed MCV 98 &
low vit B12 level

a.Ferrous SO4 + Folic acid

b) Ferrous sulphate + B12

c) Oral folic acid 5mg od

d) B12 injections

97..Question was on CBC report showin dec hb,dec MCH (not MCHC) ,ferritin 55

a.Thalesemia carrier

b.IDA

c.Megaloblastic anemia

98.Previous cs for preterm breech delivery , now 6wks pog pregnancy test positive and mild

bleeding p/v. cervical canal and upper segment empty . GS near LUS and neg sliding test

positive. Diagnosis?

a) CS scar ectopic

b) Cervical ectopic

c) Retained POC

EMQ on breast feeding

A.stop lactation
B.prescribe another medication
C. commence lactation
D. take minimum dose
E.measure the drug concentration in the mother
F. measure the drug concentration in the baby
G. measure the drug concentration in the mother and baby
H. stop lactation after administration of the medication

I. continue or commence lactation

99.pt wants to take psudoephedrine for nasal congestion for common cold.
100.. pt with valve replacement and on warfarin ,worried about effects on baby
101. pt 4rth post natal day came with c/o headache BP160/100 ,, she qwa treated with labetalol in
pregnancy & was dicharrged on that .u decide to her pre pregnancy drug enelapril.
102..a unit is carrying out a study in which participants are being paid but they are not being told about
other arm of drug

a.Conflict of interests

b.Consent is ot fulfilled

c.Intention of harming the patients

.EMQ on ethics

Report to police
Inform Social worker
give information regarding womens refugee places and support groups
Take advise from NHS trust legal team

Inform hospital legal department

102.female came at 20 weeks with reduced fetal movements bruises on arms she admitted husband
beats her but says he is a devoted husband with violent temper. She pleads with u not to escalate or
report the issue
103.

EMQ. URODYNAMICS

Midurethral sling

bladder training ,

pelvic floor physiotherapy ,,

bladder retraining & PFMT

ANTICHOLINERGIC DRUGS

Anticholinergic drugs +CISC

Colposuspension

cisc

supra pubic catheterization

104.patient with genuine stress urinary continence,tried PFMT ,what next ?

105.OAB +stress ui asked for treatment

106.patient with multiple sclerosis & complaining of retention of urine ,treatment

107. GP called lady with SLE with flare on glucocorticoid + methotrexate, appears to have herpes like

lesion & difficulty in passing uribne palpalbel bladder ,whats next best step ?
a.admit in gyne ward as an emergeny

b.evaluate & assess

c.start acyclovir I/V

d. refer to GUM

e.refer to urologist

108. 30 wks pregnancy with right iliac fossa pain, long history & C0n examination

RIF tenderness,tachycardia investigations. USG shows non compressible mass in RIF. Most

appropriate treatment?

a)transverse incision &appendicectomy

b) Vertical incision &appendicectomy

c) Incision over the point of maximum tenderness and appendicetomy

d) laparotomy, CS, appendicetomy& peritoneal lavage

109. Primigravida on HAART at 35 wks, presented with preterm labour and rupture of

membranes, Viral load < 40 copies done 1 week ago, S/E confirmed Leaking P/V

a) Immediate CS

b) IOL after acourse of steroids

c) Immediate IOL

d) IOL at 37 wks

e) Antibiotics and expectant mgt

110. Preterm labour at 31wks, delivered vaginally. Postnatally, early imaging done for

Newbor,Which is the most specific lesion of severe HIE to predict long term neurodevelopmental

outcome?

a) Germinal matrix haemorrhage

b) IVH

c) Periventricular Leukomalacia

d) Ventriculomegaly

111. pregnant women with Previous lscs, NOW at 32 wks diagnosed to have preterm labour.

What is incidence of scar rupture in this women?

a)< 0.5%
b) 0.5%

c) 1%

d) 2%

112. 43yrs old occasional smoker had previous normal vaginal delivery 10 yrs back. Later,

undergone LEETZ for severe dyskaryosis. Now pregnant ,attebded booking at 10wks. Which

risK factor more predictive of PTL?

a) LEETZ

b)maternal age

c) smoking

d) Pregnancy interval more than 10 yrs

113.. Pregnant women on Tab. Fluoxetine 40mg for severe depression and her symptoms are

well controlled, came for booking worried about effect of Tab.Fluoxetine on the fetus. What

is the most appropriate advice?

a) Stop the drug abruptly

b) Reduce to 20mg dose

c) Change to another drug

EMQ ON Newborn

a) Hypoglycaemia

b) Hypocalemia

c) Polycythemia

d) Hyponatremia

e) Hyperbilirubinemia

114. Gestational diabetes mother on Metformin delivered a baby and fed him within 30

mins..after two hrs has difficulty in feeding?

115. Multiple pregnancy , second twin is LGA at 36 weeks.what problems expected.,

EMQ Labour

a) Oxytocin infusion
b) Forceps in room

c) Ventouse in room

d) FBS

e) Reasses in 15 min

f) Reasses in 1hr

g) Reasses in 30 min

h) Continue the same

i) CS

116. G2,fully dilated for 2hrs actively pushing 45mins, FHR normal

117. P2 Fully dilated for 2hrs , pushing for 1hr with moulding+1/2, caput , head 2 cm below

the spines, descent with contractions ,FHR normal.

118. Primi under epidural, actively pushing for 105 minutes, contractions 2/10 , FHR normal,

adequate descent with contractions.

EMQ .Preterm Labour

All patients are diagnosed PTL

a) Administer nifedipine

b) Administer steroids & nifedipine

c) Administer Atosiban

d) Emergency CS

e) Administer steroids and CS 48 hrs later

f) Administer Mg So4 immediately followed by CS 24 hrs later

g) Administer Mg So 4 and expectant mgt

h) Observation

119. G 2Preterm 28+ 2 wks pregnancy , received a course of steroids 3 days back for threatened preterm
labour. Now C/O pain abdomen, O/E. mild irregular uterine contractions, cephalic presentation S/E,
parous cervix 3 cm dilated. Next appropriate management ?

120. Previous LSCS with Preterm 28+ 2 wks, recived steroids 3 days back,had heavy bleeding PV at home
now settled, now c/o pain in abdomen. O/E irritable uterus. & 3 cm dilated. USG shows breech, AFI 19.
Next line of mgt?
121. Multigravida with 22wks, admitted with pain abdomen, O/E uterine contracions +, on exam 2cm
dilated, membranes found prolapsed in vagina.

VTE &Thromboprophylaxis

a) Prophylactic LMWH throughout Antenatally& 6wks Postpartum

b) Therapeutic LMWH throughout Antenatally & 6wks Postpartum

c) Aspirin & TEDS

d) Fit TEDS

e) High dose prophylactic LMWH throughout antenatally & Postpartum

f) Prophylactic LMWH From 28 wks and 6wks Postpartum

g) Antenatal Prophylactic LMWH & 10 days Postpartum

h) Postnatal LMWH for 10 days

i) Warfarin antenatal & postpartum

J.Start LMWH as soon as possible & 10 days post partum

So on………………………

122. Primigravida delivered baby by vaginally. She is a chronic smoker and also having gross

varicose veins

123. Pregnant women came for booking she gives h/o DVT and investigated diagnosed to

have Antithrombin 3 deficiency.

124. G2 35 yrs known chronic hypertensive, now proteinuric admitted at 32 weeks for investigation,

BMI 32kg/m2 & DCDA twins

GBS bacteriuria& Urinary tract complications

Pregnant women with previous history of pretem labour is having UTI symptoms, diagnosed

to have GBS bacteriuria at 16 wks& treated. During AN period follow up at 31 wks

options

a) Refer for renal USG

b) Refer to urologist

c) Admit, analgesics and Inj cefuroxime & Gentamycin IV 8 hrly

d) Tab Cefazolin 250 mg stat and repeat

e) Reassure

f) Admit, analgesics and Inj Ciprofloxacin IV 8 thhrly

g) Deliver immediately

h) Tocolytics& Antibiotics

i.treat outpatient with ANTIBIOTICS

125.On Day 0 : 0700 hrs

C/o Abdominal discomfort & mild vaginal discharge. on examination there was white

discharge os closed. No uterine contractions. CTG normal. Dipstick urine showed protein

1+,nitrites 1+,leukocytes1+. Blood investigations shows WBC 14 & CRP 10mg/dl .What is

the appropriate management?

126. Day 1 10:00 hrs

Patient become unwell, tachycardic, tachypenic and c/o pain in loin ,O/E irritable uterus, 2

cm dilated os. ? USG shows pelvicalyceal dilatation.What is the next appropriate

management?

EMQ antenatal management

U are seeing patient in secondary care with thse scenarios

A.Ecv in office

B.C section now

C.Offer ECV

D.review next week

E.wait for spontaneous onset of labour

E.give elective date for c section

F.Admit of IOL

127. multigravida at 38 weeks ,visisting her sister in next week

128.diabetic.on controlled levels at 37 weeks .

129.twins at 36 wks ....MCDA first cephalic & second breech ,not in labor, good fetal movement
,ultrasound done shows one twin with normal growth & 2nd twin 5th centile.
130. Pregnant woman at 6 wks , abdominal pain & mild spotting PV, suspected to have

ectopic. Midwifery has sent blood for serum B Hcg test. Which of the following B Hcg pattern, we expect
in normal Intrauterine pregnancy?

there were pictures of 5 beta hcg curves

131 . which type of data is mode of delivery?

a.Binary

b.nominal

c.ordinal

d.continuous

132. Type2 Diabetic woman on metformin and h/o DVT and HTN after TAH 5hours at 12:00 at 5:00
feeling unwell and abdominal pain,shortness of breath,MEOWS chart given as oxygen at rate of 6L/min
pulse??and oxygen saturation 100%(with oxygen flow), abdominal examination is unremarkable full
picture of meows chart ,at one point BP low at 2 places and then recovered,
a.diabetic Ketoacidosis

b.Intraabdominal bleeding

c.Pulmonary embolism

d.anesthesia complication

133. lady underwnent TAH +BSO for endometrial cancer .on histopathology <50% involvement of
myometrium ,no LN involved whats next step

a.do nothing

b. chemotherapy

c.radiotherapy

d.chemo+radio

134. 47 year old lady with oncreasing vulval irritation ,on examination WHITE plaques,thinned skin,,
Fused with labia... tried emmolients &weak steroids?? Next line of management ?

a.high potent steroids

b.Antibiotics

c.excision

d.modified vulvectomy

e.????
135. Previous cs for preterm breech delivery , now 6wks pog pregnancy test positive and mild

bleeding p/v. cervical canal and upper segment empty . GS near LUS and neg sliding test

positive. Diagnosis?

a) CS scar ectopic

b) Cervical ectopic

c.PUL

d.heterotopic

136. Pregnant lady recovered from intractable hyperemesis, discharged. On taking oral diet

suspected refeeding syndrome, suspected some electrolyte disturbance, in which insulin shift

back into cells.

a) Hypokalemia

b) Hyponatremia

c) Hypomagnesemia

d) Hypocalcemia

137. women with high AMH 500?? WHAT IS RISK FACTOR?

a. high likelihood of success with high risk of OHSS

B.ovarian failure

C. risk of failure to ovum retrival

D.less likelihood of successful outcome & inc chance of OHSS.

138.LONG SCENARIO OF PCOD ,Aasked about sleep apnea &its long term effect

a.cardiovascular disease

b.alzeihmer

c.resp acidosis

d.diabetes mellitus type 2

139.an old lady with OAB who had received 3 antimuscarinic drugs ,what next best treatment to
offer
Mirabegron
Trospium
Duloxetine
Oxybutynin patch
MDT referral for urodynamics
140. .22 years old ectopic preg with some sign , no heart beat , bhcg :2000

ovarian cystectomy

systemic methotrexate

,salpingectomy

Salpingotomy

MTX in sac

142-40 yr lady 19 wk anomaly scan has twins ,one twin empty sac ,wants to know risk ,how will u
calculate her risk of having congenital abnormalities in respect of her age ?

a.Maternal age +NT

b.maternal age + NT+ PAPP-A + b hcg

c.Maternal age alone

d.Ccfdna

e.NT thickness +nasal bone+maternal age+PAPP-A

143. overactive bladder pt who drank de caffeinated drinks best management

A. bladder retraining

b.bladder diary

c.PFMT

d.antimuscarinic drugs

144. 22 years old has 28 days regular cycle is on Day 20...condom burst.. Took levonle1 week b4...
WATS now for emergency contraception

a.COPPER T

b.EVONELLE 1.5 mg

c.ULIPRISTAL acetate
d.Nothing just reassure

e.Mirena

145..according to NICE first line for HMB

a.Mirena

b.Progesterone

c.UPA

146. B-hcg before the surgery was 3000+,,Salpingectomy done for ectopic and on histopath minimal
decidial tissue found.. most cost effective option for follow up for this patient is

a.B HCG

b.TVS

c.laproscopy

d.laparotomy

e.nothing

147. post laparoscopic ,24 hrs later presented in A & E With bilateral sapingectomy for hydrosalinges,
developed abd pain, distention, fluid shift... shown tests with creatinine high 250.

a.kidney failure

b.bladder injury with urine in abd

c. uereteral thermal injury..

d.uretral dissection

148. PG following in consultant lead unit for serial scans, growth is 70th centile and report as normal
antenatal case, presented in labor...
a.CTG continuous
b.Intermittent auscultation with hand held Doppler
c.initial 30 min CTG then intermittent auscultation

d.BPP

e.doppler
149. Most sensitive and specific ECG Marker for AMI?
ST inversion
ST depression
New onset Q wave
Symmetrical T wave inversion

150. 36 YEARS Worried about fertility ,she is not on any no contracepn,Overweight with
oligomenorrhea, hirsuitism & recurrent candidiasis, BMI 40, FSH:LH ratio increase ,next test

a.AMH

b.GTT

c.Prolactin

d.thyroid function tests

e.free androgen index(FAI)

151. In labouring woman midwifery used nitrous oxide for pain relief, what is the mechanism

of action?

a) Direct vaso dilatation

b) Increased release of Endorphins, dopamines

c) Decreases sodium influx into the cell

d) membrane stabilization

EMQ PREMENOPAUSAL OVARIAN CYSTS

Repeat ultrasound 3 months

Repeat ultrasound 6 month

1 year uSS

Discharge from Follow up

No need to follow up at all

Oncology referral with full staging laparotomy by gyne oncologist

Uniletreal oophorectomy laproscopically

unilateral cystectomy laproscopically

laparotomy
TAH+BSO

CA125,LDH & AFP

Doppler scan

Manage by gyne oncology with MDT referral

152. 35 years with simple cysts of 4cm? in diameter .rescan after 4 months shows persistence of cyst
,what is next best step

153. 6cm solid cyst? No malignant potential according to IOTA classification .complains of mild
abdominal discomfort

154.scenario of unilateral 7cm dermiod cyst

EMQ HYSTERECTOMY

YOU are teaching your FY1 colleague while perfrming TAH ,how will u explain steps accodrding to these
scenarios

a.clmp cut & ligate ovarian ligament

B.clamp cut & ligate infundibulopelvic ligament

c.cut round ligament first

d.make a hole in broad ligament & proceed

e.see all pedicles of hysterectomy

f.call consultant on call

g..incident reporting to NHS

h.transfuse blood

i.injection tranxamine

155. while doing TAH u have to conserve ovaries

156..after doing TAH u found blood loss >600ml ,patient is vitally stable

EMQ STATISTICS

Audit

Systematic review
Root cause analysis

Risk management

Meta analysis

Observational retrospective

Retrospective cohort

Cross sectional study

Double blind controlled trial

Well conducted RCT

157-a unit is studying on suture material & wants to compare aginst RCOG standards

158.literature review is what kind of study

EMQ What wil be outcome if pt refuses treatment

Chronic Anemia

Renal failure

Secondary spread

Liver failure

Vasomotor symptoms

Osteoposrosis

Sptic shock

Pelvis abscess

Systemic sepsis

159.28 wk size uterus , hmb on scan multiple fibroids , hb 9.8? Refuses treatment

160. pt with ca cervix i think stage 2b,morbidly obese & smokes 20-25 cigaretts /day , refusing
treatment

161..patient with IUCD in situ with acute STI,refusing treatment

162.a woman has copper iucd in situ & has infection on recent smear what to do

a.take swabs

b.leave as such

c.antibiotics for 48 hours

d.remove IUCD & treat infection

EMQ ANTIBIOTICS

you are a registerar on call & u want to see the scheduled list for tomorrow OT .a trainee has asked for
antibiotics in all these cases

inj genta +cephalosporin before operation and genta after 4 hrs

inj cephalosporin +inj ,metrogyl before ot

oral doxycycline

oral 1 gram azithromycin

Inj cefazolin 1.5 g iv

Inj cefazolin 1.5 g plus metronidazole iv stat
No antibiotics required

iV ampicillin 2 hours before skin incision

oral ampicillin 4 hours before proecedure

so on…….

163. What antibiotics to give in a patient with artificial mitral valve about to undergo TAH

164.. What antibiotics is any to give to someone about to undergo hysterescopy plus biopsy

165.on scheduled LSCS due to previous 2 C section

166.pt undergoing vaginal hysterectomy , h/O DM + atelectasis

EMQ ACUTE ABDOMEN

Ovarian torsion

Cyst rupture

OHSS

Appendicitis

Cholecystitis

Vessel injury

Ureteric injusy

Ovarian rupture
So on……………………..

166.a lady had undergone IVF treatment & retrieved arouend 25 oocytes ,flew back to Uk the woke up
suddenly with abdominal pain & tachycardia

167.lady had taken treatment for infertility ,came to A & E with c o lower abdominal pain & tightening of
her upper button of pants most likely cause

168.A lady had Ectopic pregnancy & rt salpingectomy in the past ,now came with rt sided sudden
abdominal pain inc pulse temp 37,rigidity &gaurding +ve ,tLc 9000,CRP 8 .diagnosis

169..a lady is surrogating her sister & went through IVF .she had successful 2 embryo transfers 5 weeks
before ,USS done 3 days ago showed a live intrauterine gestational scan .she woke up today with has
sharp abdominal pain & she collapsed .

EMQ MALE INFERTILITY

Autoantibodies

Prolactin

repeat semen analysis after 3 months

repeat semen analysis immediately

ivf

ivf + ICSI

sperm retrieval

testicular biopsy

170.previously fathered two ,,now headache,fatigue,,erection problem,FSH & LH low=1, testosterone

6nmol?

171. Sperm count 6million,morphology normal .

EMQ STDs & vulva

LICHEN SCLEROSIS

HERPES SIMPLEX

STRAWBERRY CERVIX

STEVEN JOHNSON SYNDROME

MALIGNANT MELANOMA

AMELANOMA
Herpes vulvitis

Molluscum contagiosum

candidiasis

vulval intraepithelial neoplasia

172.16 years old not sexually active presented with swollen vulva , ITCHING ,with retention of urine ,not
allowing to examine

173.multiple painful shallow ulcers,multiple sexual parteners & bilateral lymphadenopathy

174.women came from AUSTRALIA .1 cm sessile multiple lesion on vulva..not ulcerated,not painful.

175.pregnant with burning micturition & vaginal discharge on examination.thick white vaginal discharge
in vagina & red vulva & inner side of thighs .

176. occasional postcoidal bleeding ,45 year old woman with itching n vulval discomfort. She didn't
noticed any discharge but occasional postcoital bleeding .

EMQ FEMALE INFERTILITY

Repeat test on day 2-5 of menses

Serum prolactin

Urine PT

Suuportive care

Folic acid

Aspirin

& so on……..

177.21 Amenorrhea with high FSH 28 LH 15 RRL 600 next investigation ...

178. 34 yers lady P1,in a new relationship.she has had 3 recurreent miscarriages with previous
partner,what to do next

179.which of the following improves chances of live conception with a patient with recurrent
miscarriages of APLAS ?

a.aspirin alone

b.heparin alone

c.aspirin+heparin

d.no treatment

E.supportive care only

EMQ POST MENOPAUSAL OVARIAN CYSTS

Repeat ultrasound 4 months

Repeat ultrasound 12 month

Discharge from Follow up

Uniletreal oophorectomy laproscopically

unilateral cystectomy laproscopically

laparotomy

TAH+BSO

CA125,LDH & AFP

Doppler scan

Manage by gyneycologist

CT scan abdomen +pelvis

Refer to cancer centre

179. 51 year with asymptomatic simple ovarian cyst of 3 cm ,CA125 =35

184062 years with symptomatic solid ovarian cyst CA125=30

181..another scenario .

Thanks to all who shared .it was mere an effort to help our colleagues .so don’t judge about anything if
this recall is poorly recalled ☺

Best regards & wish u all the best for exam ☺

Dr.Zaib Qureshi
.what do next.