MRCOG Part 2 Recall

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JULY 2019
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MRCOG Recall Group
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1. The prevalence of third or fourth degree tearing at first birth by forceps
delivery?
A. 1%.
B. 3.8%.
C. 6.7%.
D. 18%.
E. 21%.
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Answer: C

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Over all incidence 2.9

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Primigravida 6.1
Multiparous 1.7
With forceps 8-12%
With vacuum 4-8%

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laceration
With vacuum 10%
With forceps 20%

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2. Stillbirth rate in 39 weeks gestation?
A. 1/100,
B. 1/200
C. 1/1000
D. 1/2000 Answer: B

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3- Mother is a carrier of Duchene's muscular dystrophy, father is normal.
What is the risk to their offspring to have a disease?

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B - 25% males will be affected 25% males will be normal
C - 50% Males will be affected 50 % males will be normal
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A - 25 % female will be carrier 25% females will be normal

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D - 50% daughters will be affected 25% daughters will be carrier

Answer: C

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. 1:4 affected children
1:4 Carrier children
1:2 normal children

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4. Pregnant women her gestational age was 18 weeks with parvovirus
chances of fetal infection percentage?
A. 5%
B. 15%
C. 25 %
D. 50%
E. 75%

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Answer: C
15 weeks -- 15%
15- 20weeks-- 25%
Term -- 70%

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The risk of maternal infection crossing the placenta to the fetus is 15%
from 5 to 15 weeks, 25% after 15 weeks, increasing up to 70% towards
term. Infection before 20 weeks can lead to intrauterine death with a

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5e10% fetal loss rate. Hydrops usually occurs 2e4 weeks after maternal
parvovirus infection. On average, there is a 3e10% risk of hydrops

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following parvovirus infection, with approximately a 50% fetal death rate

clip?

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5. Percentage of failure resulting in unplanned pregnancy in case of filshie

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A. 2 in 1000 procedures at 10 years
B. 2–5 in 1000 procedures at 10 years
Answer: B

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Filshie first described a titanium clip lined with a silicone coating used for

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surgical sterilization in 1981. These one-time use clips are applied with a
reusable applicator and can be used either laparoscopically or during open
procedures.
Failure rate flische clips =2-5/1000
Hysteroscopy --2/1000
 MRCOG Recall Group
6. Detection rate (Sensitivity) of quadruple test for Down’s syndrome?
A. 50%
B. 65%
C. 85%
D. 95%
Answer: B

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7. What’s the normal bladder finding in cytometry?
A. Bladder capacity is 400 to 600 ml
B. Residual volume is 50ml
C. First urge to void at 90ml
D. Flow rate 10ml/sec
Answer: B
 MRCOG Recall Group
For the normal female bladder, the first sensation of bladder filling occurs
at volumes of 150 to 200 mL, and the strong desire to void occurs at 400
to 600 mL. The maximal cystometric capacity (usually 400 to 600 mL) is
the volume that the bladder musculature can tolerate before the patient
experiences a strong, uncontrollable desire to urinate. The patient's
bladder gradually refilled with the fluid at a rate of 60–80 mL/min until
her functional bladder capacity is reached.

gynaecological surgery?

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8. Which nerve root of brachial plexus in nerve injuries associated with

A. C3–C4
B. C4–C5
C. C5–C6
F rAnswer: C

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D. C6–C7

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9. What’s is the risk of blood transfusion in cesarean section?
A. 0.20%
B. 0.53%
A. 1%
Answer: B
B. 3%

hospital

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Risk factors for transfusion in cesarean section deliveries at a tertiary

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First published: 30 May 2016 https://doi.org/10.1111/trf.13671
RESULTS: There were 271 patients who required a blood transfusion for
PPH. The blood transfusion rate was 0.53% (271/50,699). After potential
confounders were adjusted for, when compared with the non-transfused
group, assisted reproductive technologies was a risk factor for mild
transfusion (adjusted odds ratio [AOR] 2.452, 95% CI 1.250‐4.808) and

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moderate transfusion (AOR 2.075, 95% CI 1.069‐4.028); placenta previa was
a risk factor for moderate transfusion (AOR 2.736, 95% CI 1536‐4.874); and
pernicious placenta previa was a risk factor for all transfusion subgroups
(AOR 14.211, 95% CI 1.452‐39.089; AOR 12.462, 95% CI 1.275‐121.749; AOR

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73.636, 95% CI 9.041‐599.742). More women were treated with intrauterine
balloon pressure and uterine compression sutures in the mild, moderate,

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and massive transfusion groups

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10 - Patient in OR, during surgery, her arm abducted more than 90%, later

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developed ERB’S palsy, which part of the brachial plexus was got
damaged.

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A - Lower trunk of the brachial plexus of the, nerve roots, C5, C6
B - Upper trunk of the brachial plexus, nerve roots, C5, C6
C - Lower trunk of the brachial plexus, nerve roots of C8, T1
D - Upper trunk of the brachial plexus, nerve roots of C7
Answer: B
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11. Which is selective serotonin reuptake inhibitors (SSRIs) should be
avoided during pregnancy?
A. Citalopram (Celexa)
B. Escitalopram (Lexapro)
C. Fluoxetine (Prozac)
D. Paroxetine (Paxil)
E. Sertraline (Zoloft)
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Answer: D

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fetal heart defect.

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Most studies show that SSRIs aren't associated with birth defects. However,
paroxetine (Paxil) appears to be associated with a small increased risk of a

12. Which is Antidepressants should be avoided during pregnancy?

A.) Tricyclic antidepressants (TCAs)

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B. selective serotonin reuptake inhibitors (SSRIs
C. Bupropion (Wellbutrin)

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D. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Answer: A

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The tricyclic antidepressant clomipramine might be associated with fetal birth
defects, including heart defects. Use of these medications during the second

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or third trimester might also be linked with postpartum hemorrhage.

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13. Young Pt after treatment (LLETZ) for CIN 3. What will be follow up?
A. 3 month
B. 6 month
C. 12 month
D. 18 month
E. Discharge from follow up

Answer: A
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14. After packing bowel with roll gauze warmed moisted saline. Surgeon

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found uterine wall adhesion to bladder.
A. Inspection uterus, pod, adnexal

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B. Open uterovesical layer
C. Not blunt dissection

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D. Call urologist

Answer: D
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15. EMQ: Genetic counselling.
Options:
A. All offspring are affected.
B. All offspring are carriers.
C. All male offspring are NOT affected, all females are carriers.
D. All female offspring are affected, all males are affected.
E. 50% affected males, 50% normal males, 50% affected females & 50%

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normal females.

Answer: C X- Linked recessive

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1. If THE mother was normal and father had Duchene muscular atrophy?

Answer: C

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2. If the mother had Marfan’s syndrome and father is normal?

Answer: E

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16. Patient allergic to penicillin & need IAP. She vomiting. Options:

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a. Administer IAP (penicillin)
b. Cefuroxime/Cephalosporin ()
c. Vancomycin ()
d. Give clindamycin

Answer: A
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17. Pregnant women 10 weeks presents with protracted vomiting and NVP
if score is 10 and have no complain. What treatment?
A. Inpatient management
B. Antiemetics in community
C. Ambulatory daycare management until no ketonuria
D. Fast intravenous hydration with normal saline and potassium
E. Thromboprophylaxis

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Answer: B e
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18. Pregnant lady have a combined test show there is a risk for downs
syndrome 1/2. Patient was declined invasive perinatal test. Scan shows
cystic hygroma and short femur. What’s your diagnosis?
A. Turner syndrome
B. Edward syndrome
C. Patau syndrome
D. Down syndrome

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Answer: A

19. Young Pt has severe dyskaryosis asked for treatment?

A. Cone biopsy
B. LLETZ
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C. Trachelectomy
D. Hysterectomy
E. Referred for colposcopy

A T Answer: E

20. Pregnant lady at 8 weeks of gestation. She has past history of contact

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with patient with rubella infection. Investigation was done and result was
IgM antibodies positive. What’s your management?
A. Counsel to terminate pregnancy
B. Reassurance
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Rubella is more likely to infect the fetus earlier during pregnancy. For
example:
- If in the first 12 weeks of pregnancy, the fetus has about an 8 to 9 in
10 chance (85 percent) of getting infected.
- If at 13 to 16 weeks of pregnancy, the fetus has about a 1 in 2 chance
(50 percent) of being infected.
- If at the end or your second trimester or later, the fetus has about a 1
in 4 chance (25 percent).
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21. What are the recommended methods of analgesia in labour for WWE?
A. Pethidine
B. ketamine
C. Diamorphine
D. Sevoflurane Answer: C

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22. What’s the major congenital malformations of topiramate use during
pregnancy?

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A. Glaucoma, Uveitis
Answer: A
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23. Pain is scored from 0 to 10 via visual analogue scale. What kind of data
is this?
A. Categorical.
B. Ordinal.
C. Nominal.
D. Interval.
E. Continuous

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Answer: B

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24. What’s the side effect of Olanzapine in case of DM?
A. Hypoglycemia and ketoacidosis
B. Congenital malformations
C. Hyperglycemia and ketoacidosis
Answer: C

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25. Preconception advice. Schizophrenic on Olanzapine. Drug effect on
pregnancy? [More risk for]
A. Gestational diabetes
B. Anomalies
C. SGA
D. PTL
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E. Pre-eclampsia

F A Answer: A

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* Olanzapine is considered pregnancy category C drug. One study
involving pregnancy outcomes in 151 patients on different atypical

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antipsychotics (60 were on olanzapine) did not find any statistically
significant differences in various pregnancy outcomes between the

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exposed and comparison groups, except the rate of low birth weight,
which was 5 times higher in the exposed babies and a higher rate of
therapeutic abortions. One case of encephalocele with cleft lip and
aqueduct stenosis was reported in a patient on olanzapine
* 84% had normal delivery and postnatal course. The remaining 16%
suffered problems such as prematurity, postmaturity and low or high
birth weight. At least two of the mothers were noted to have gestational
diabetes.
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26. Implication of adalimumab on fetus

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A. It causes FGR
B. It cause congenital anomalies
C. It is safe to give live vaccine
D. It is safe to breast feed

Answer: D
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showing unclear margins?
A. Repeat LLETZ
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27. Management option after treatment [LLETZ] for CIN 3 with biopsy

B. Cone biopsy

F A Answer: A

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28. Old women who undergo hysterectomy and have completely excised
CIN. Should have vaginal vault cytology at?

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A. six months following their hysterectomy

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B. Vault Smear with colposcopy at 6 months
C. Discharge
D. Six and 18 months following their hysterectomy

Answer: D
 MRCOG Recall Group
29. Pt has vulvodynia was is 1st line treatment...
A. Gabapentin
B. Pregabline
C. Amitriptyline
D. Lidocaine
E. Vestibulectomy

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Answer: C

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Tricyclic antidepressants (TCAs) often are used as a first-line therapy.
Many patients tolerate TCAs well after approximately one week of use,
but prolonged fatigue, constipation, and weight gain may require a
change in the type of medication or dosage. Dry mouth is common when
taking TCAs but rarely necessitates discontinuation. Amitriptyline has

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been used primarily, but other TCAs with less severe side effects, such
as desipramine (Norpramin), may be effective as well.

A. Early fetal loss

B. Late fetal loss
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30. One pat delivered 22w 6d baby was alive after delivery then died?

C. stillbirth

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A stillbirth is defined as “a baby delivered without signs of life after 23+6
weeks of pregnancy”

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A early fetal loss (early miscarriage) defines a first trimester pregnancy
loss before this gestation.
A late fetal loss (late miscarriage) defines a second trimester pregnancy
loss before this gestation.
Early neonatal death is the death of a baby occurring within7 days after
birth; irrespective of gestation.
 MRCOG Recall Group
31. Patient with GBS and bacteriuria in her current pregnancy. What’s your
management?
A. Treat now+ IAP
B. No need for IAP
C. Reassurance Answer: A

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32. Asthmatic pregnant lady received short acting beta blocker and 800
steroids but her asthma not controlled. What’s the next step?
A. Steroid
B. LABA
C. Theophylline

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D. Leukotriene Answer: A

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33 - pregnant patient with bronchial asthma received steroid 800mcg
inhalation and short acting beta 2 agonists not settled what next to add
A - Long acting beta 2 agonist (LABA)
B - Leukotriene
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C - Oral steroids
D - Increased dose of inhaled steroids Answer: A

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34. Pregnant patient with her son got H1H1 what prophylactic measure?
A. Give influenza caccine
B. Oseltamivir

Answer: B
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35. A 15 Years old referred by GP with the complaint of primary
amenorrhea. On examination normal pubic hair, breast tanner stage 3 with
normal general growth. What is the best management plan?
A - Ultrasound pelvis
B - FSH, LH
C - Karyotyping

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D - Wait for a year, or conservative treatment

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Answer: D

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36. If patient 12wks pregnant and her Hb was 10.5 g/dl. Diagnosed as
microcytic anemia, how will you manage her?
A. Dietary advice
B. Oral iron
C. Parenteral iron Answer: D

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37. Vulval HPV 16,18. type of vulval carcinoma which is associated with

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these, patient was on routine recall with negative cervical smear neg she
is more prone to?

B. melanoma

C. VIN
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A. Basaloid carcinoma

D. lichen planus

E. lichen simplex

Answer:
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38. What preventive technique is of value at hysterectomy for enterocele
in vaginal vault prolapse?

A. Subtotal hysterectomy
B. Sacrospinous fixation (SSF)
C. McCall culdoplasty
D. Pelvic floor muscle training (PFMT)

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Answer: C

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39. At 17:00 exact the vitals were: BP 110/80 [but reached as low as 90/60
in previous hours], T 37 P0P c, PR 104, RR 18, O2 sat 100%, pain score 5,
fully alert. Her postop Hb is 104%. [No RBG reading was given] Previous
history of DVT, she complains of abdominal pain and shortness of breath.
What is the most likely underlying problem?
A. PE
B. Pelvic sepsis
C. DKA

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D. Opiate overdose
E. Internal bleeding

F r Answer: D

40. Previous cs for preterm breech delivery, now 6 weeks pregnancy test

A. CS scar ectopic
B. Cervical ectopic
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positive and mild bleeding p/v. cervical canal and upper segment empty.
GS near LUS and neg sliding test positive. Diagnosis?

C. Retained POC

F A Answer:
41. What’s is the most common type of ureteric injury during laparoscopic

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surgery?
A. Angulation
B. Ligation
C. Thermal
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D. Laceration
E. TransectionD Answer: E
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42. A 19 years old girl presented with amenorrhea and high FSH LH value?
A. Karyotype
B. US

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Answer: A

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43. 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. Hypoglycemia

C. Panic attacks

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Answer:

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44. A 26-year-old presents with several years of severe dysmenorrhoea

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(with little relief from non-steroidal anti-inflammatory drugs) and
dyspareunia which is increasingly affecting her relationship with her
partner. Her general practitioner suspect’s endometriosis, as endocervical

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swabs show no evidence of infection and her symptoms improve slightly
after he advises her to take the pill continuously. He refers her to a
gynaecologist with interest in endometriosis for more definitive
management of her symptoms. Laparoscopy confirms the diagnosis.

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What’s is surgical management of endometriosis?
A. Excision or ablation of endometriosis plus adhesiolysis for
endometriosis

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B. Perform hysterectomy (with or without oophorectomy) laparoscopically

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C. Consider ablation rather than excision to treat endometriomas

Answer: A

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45. A 57-year-old woman presents to clinic for a routine wellness exam.

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She reports bloating, gastrointestinal upset, and vaginal itching that has
been going on for about 2 months, which she attributes to menopause and

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vaginal dryness. She has pain with intercourse. O/E there was a 5cm
Vulval lesion involving Anus and no nodal metastasis. What’s the
management?
A. Wide local excision alone
B. Radical wide local excision with groin lymph node dissection

Answer: B
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 MRCOG Recall Group
Definitions of excision
Incisional biopsy
A biopsy taken with the intent of securing a diagnosis only. This should ideally
contain the interface between normal and abnormal epithelium and be large
enough for the pathologist to be able to adequately provide evidence of
substage (in stage I cases).
Excisional biopsy

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A biopsy taken that includes all of the abnormal epithelium but does not
provide a tumour-free zone of 1 cm (after fixation) on all dimensions. This

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would normally be performed in cases of vulval intraepithelial neoplasia (VIN)
or when there is a low suspicion of invasive carcinoma and the operator
wishes to limit the amount of cosmetic harm.
Radical excision

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An excision performed with the intent of achieving clearance of at least 1 cm
(after fixation) on all aspect of the tumour(s). Depending on the site and size of
the tumour, this could vary from a radical local excision to a radical

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vulvectomy.

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46. Under the HR-HPV triage protocol, women whose cervical samples are
reported as showing borderline changes (of squamous or endocervical
type) or low-grade dyskaryosis are given a reflex HR-HPV test. Those
who are HPV positive are referred to colposcopy; those who are HR-HPV

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negative are returned to routine recall. Women whose cervical sample is
reported as high-grade dyskaryosis or worse are referred straight to
colposcopy without a HR-HPV test.

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47. Mild dyskaryosis with HPV was positive. what’s next step?

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A. Routine recall
B. Referred to colposcopy

Answer: B
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48. Mild dyskaryosis, HPV positive followed by colposcopy which was
negative. Next step
A - Follow up with GP
B - Repeat cytology within 3 months
C - Repeat colposcopy after 6 months
D - Repeat cytology and HPV after 1 year.

Answer: A
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49. Twin pregnancy one twin delivered 30 min over other twin cephalic 2/5
head palpable management?
A. Assess after 30 minutes
B EMCS
C Ventouse Delivery

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D ARM

. Answer: D

50. EMQ R
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1. Securing uterine artery during hysterectomy
2. Securing round ligament (in my practice we used any crushing
instrument)
3. Grasping tube in tubal ligation:

Answer:
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51. A 29-year-old nulliparous woman who presented to hospital at 9am in
spontaneous labour with ruptured membranes at 39 weeks gestation. At
10.30pm the cervix was completely dilated. CTG was normal, at 11.30pm the
FHR was recorded at 150 beats per minute with occasional variable
decelerations. The amniotic fluid was lightly stained with fresh meconium.
Contractions were 3-4 minutes and the fetal head was assessed
abdominally to be ‘1/5th’ and, on subsequent vaginal examination was

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noted to be engaged at 0cm station. There was moderate caput and a
slight degree of moulding. A fetal scalp blood pH measured from a sample

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obtained at 11.35pm was 7.28. Next steps?
A. Review in one hour; anticipate normal delivery
B. Review in one hour; anticipate vacuum delivery
C. Review in one hour; anticipate caesarean delivery
D. Consider immediate delivery by vacuum extraction
E. Consider immediate delivery by caesarean section.
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Answer: A
52. EMQs:
A. Brainstorming
E. Lecture
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F. Problem based learning
G Schema activation

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H. Schema refinement
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I. Simplified procedural hierarchy
J Snowballing

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For each of the teaching scenarios described in the items below select the
single most correct term from the list of options. Each option may be used
once, more than once or not at all
1. You are asked to initiate ideas for research among a group of junior
trainees. You get the trainees together and everyone contributes ideas,
experiences and different perspectives. These are recorded onto a flip
chart.
Answer: A
 MRCOG Recall Group
2. The lecturer gave the student a tutorial on the anatomy, physiology and
endocrinology appropriate to amenorrhea followed by a series of clinical
cases which including post-chemotherapy amenorrhea, Turner syndrome,
hyperprolactinemia and complete androgen insensitivity syndrome. The
learners recall what they have experienced in the tutorial and attempt to
solve clinical problems.
Answer: H

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3. You are required to teach a group of junior trainees on the subject of
changes in the postmenopausal women. In the first instance, you ask the
trainees to recall their axis.

F r Answer: G

53. The small-for-gestational-age (SGA) fetus more prone for?

A. Hypoglycemia
B. Congenital abnormalities

T H Answer: A

Hypoglycemia, especially when fasting, occurs more commonly in IUGR

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infants than in any other group, apart from the infant of the poorly
controlled diabetic mother. The greatest risk for hypoglycemia is during
the first 3 days of life but it may persist for many weeks

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54. How to resuscitate if baby's heart is below 60 beat per min?

B. Do Nothing
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A. Start Chest compression with Positive pressure ventilation

Answer: A

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55. Recommends that the compression: ventilation ratio should?
A. Ratio of 30 compressions to 2 ventilations.
B. Ratio of 15 compressions to 2 ventilations.
Answer: A
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Guideline changes
Compression: ventilation ratios
Lay rescuers should use a ratio of 30 compressions to 2 ventilations.
Two or more rescuers with a duty to respond should use a ratio of 15
compressions to 2 ventilations.

Compression: ventilation ratios

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The publication, 2005 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science with

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Treatment Recommendations (CoSTR), recommends that the
compression: ventilation ratio should be based on whether one or more

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rescuers are present. CoSTR also recommends that lay rescuers, who
usually learn only single-rescuer techniques, should be taught to use a
ratio of 30 compressions to 2 ventilations. This is the same ratio as
recommended for adults and enables anyone trained in BLS techniques to
resuscitate children with minimal additional information. Two or more

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rescuers with a duty to respond should learn a ratio with more rescue
breaths (15:2), as this has been validated by experimental and
mathematical studies.2,3 This latter group, who would normally be

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healthcare professionals, should receive enhanced training targeted
specifically at the resuscitation of children.
Although there are no data to support the superiority of any particular
ratio in children, ratios of between 5:1 and 15:2 have been studied and

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there is increasing evidence that the 5:1 ratio delivers an inadequate

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number of compressions.4,5 There is certainly no justification for having
two separate ratios for children greater or less than 8 years, so a single
ratio of 15:2 for multiple rescuers with a duty to respond is a logical
simplification.

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Although the CoSTR recommendation is based on the number of rescuers

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present, it would certainly negate the main benefit of simplicity if lay
rescuers were taught a different ratio for use if there were two of them.
Similarly, those with a duty to respond, who would normally be taught to
use a ratio of 15:2, should not be compelled to use the 30:2 ratio if they are
alone, unless they are not achieving an adequate number of compressions
because of difficulty in the transition between ventilation and compression
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56 -A woman has got confirmed H1N1 infection despite receiving the
vaccine 4 weeks earlier. She is about to be isolated. What is the expected
duration of her being infectious?
A. 1 day before symptoms to 1 day after.
B. 1 days before symptoms to 4 days after.
C. 2 days before symptoms to 2 days after.
D. From start of symptoms to 2 days after.
E. From start of symptoms to 7 days after

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Answer: A

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57. A 32-year-old woman with erosive rheumatoid arthritis on
adalimumab is referred by her rheumatologist for prepregnancy
counselling. She has been told that this might not be a safe medication in
pregnancy and could potentially lead to fetal malformations. In the past,
she had been advised to discontinue the medications 6 months prior to
becoming pregnant. On adalimumab, she is back to cycling and doing yoga.
Prior to this medication she was on high doses of steroids, had Cushingoid

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features, yet remained stiff and had spent quite a lot of time off work. She
has been told that once pregnant, her rheumatoid arthritis will ‘melt away

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‘and she will not need medication. It is best if she ‘puts up with the pain’ for

A. Continue
B. Discontinue F r
a few months in order to have a safe and healthy pregnancy. How would
you advise her?

Answer: A

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58 - A meta-analysis was carried out to review the effect of metformin in
those with PCO, A subanalysis was carried out on its effects in relation to
BMI. The results were illustrated on forest plot below [This is just a]

Interpretation]

F A
representative figure but at least the 3 diamonds were to the left?

.
R
D
A. More effect on obese (BMI>30)
B. More effect on BMI<30
C. Equal effect
D. Neither effective in both groups

Answer: A
 MRCOG Recall Group
59. Forest plot. Metformin in obese and non-obese. CI was 1 in both
studies but one study with touches the line [Compare to Q.87 march 2016].

e e
F r
T H
This analysis above is taken from a meta-analysis of ovulation rates in
women with polycystic ovarian syndrome (PCOS) taking metformin
compared with clomiphene ovulation induction therapy. Subgroup analysis

A
was also carried out using a cut-off BMI level of 30 kg/m2. Which
statement of the following best describes the above findings?

F
.
A-Metformin is equally as effective as clomiphene in the obese group (BMI
> 30)

R
B-Metformin is less effective than clomiphene in the non-obese group
(BMI <30)

>30)
D
C-Metformin is less effective than clomiphene in the obese group (BMI

D-Metformin is more effective than clomiphene in the non-obese group

(BMI < 30)
E-Metformin is more effective than clomiphene in the obese group (BMI
>30)
Answer: C
 MRCOG Recall Group
60. How u will monitor blood sugar in pat with bariatric surgery?
A. Hemoglobin A1c monitoring
B. GTT
C. FBS and 2 hr ppb
Answer: A

e
61. Outpatient with intractable vomiting after all complimentary treatment
from GP (clinic). Need second line treatment (not responding to 1st line).
(score 10 & other score 12)

e
Reassure
A- Admit and give N/S without thiamine & multivitamin
B- Admit and give N/S with Thiamine & multivitamin
F r
H
C- Reassure & discharge
D- Go back to GP (clinic)

62. EMQs with numbers

A. 5%
A T Answer: B

B. 1
C. 3
.F
D. 10

R
1. Booked for cs at 39 weeks risk of going to labour before her booked cs

D Answer: D
2. Booked cs at 38 weeks and offered steroids reduction in respiratory
morbidity?
Answer: A

3. Booked for second elective cs risk of blood transfusion

Answer: B
 MRCOG Recall Group

e e
F r
T H
63. ABOUT 20 weeks pregnant with Severe dyskaryosis on colposcopy.
what next?

A. LLETZ

F A
B. Simple hysterectomy
.
R
C. Radical trachelectomy

D.TAH BSO with elective CS at viability

D Answer:

64. Post-menopausal woman with simple 6cm ovarian cyst and normal
CA125 (RMI, after calculation, was less than 250). What is the most
appropriate management?
A. Repeat TVS after 4 months
B. Repeat TVS and CA125 after 4 months. Answer: B
 MRCOG Recall Group

e e
65. Sinusoidal pattern of CTG due to viral infection?
F r
A. CMV
B. Rubella
C. Parvovirus 19
D. HIV
T H
F A Answer: C

.
R
D
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e e
F r
T H
A. 1%

F A
66. Treatment of lichen sclerosis after failure of all types of steroid

B. 3%
C. 10%
.
R Answer:

D
67. Diagnosis of DM during pregnancy best option?
A. 2 h pp
B. HB AIc
C. GTT

Answer: C
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68. The most common complication of laparoscopic surgery
A. Ureteric injury
B. Large blood vessels injuries
C. Bowel injuries
Answer: C

e e
F r
T H
F A
.
R
abruption?
A. 4%
D
69. The percentage of recurrence of placental abruption with one

B. 4.4%
C. 12%
D. 19-25% Answer: B
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With one abruption....4.4%

e e
With 2 abruptions...19-25%

F r
T H
F A
.
R
70. Patient the on tamoxifen due to cancer breast came for follow up ET. 7
what next step of management?

D
A. Mammograph
B. Pelvic US
C. D& C
D. Endometrial biopsy
Answer: D
 MRCOG Recall Group
71. EMQ: APH
1. A 31 weeks with bleeding settled scan cephalic speculum dark blood in
vagina cx closed CTG normal contracting 2 in 10 min.
Tocolytics, antenatal corticosteroid, mgso4
2. A 27 weeks bleeding now settled scan breech speculum pink blood in
vagina cx closed CTG normal contracting 3 in 10 min
LSCS
3. A 36 weeks bleeding cephalic cx 3 cm CTG suspicious

e e
ARM-fetal blood sampling

72. Zika male symptomatic. 24 weeks?

F r
T H Clindamycin

73. Percentage of planned VBAC, who go into labour before 39 weeks?

A. 4%
B. 7%

F A
C. 10%
D. 15%
. Answer: C

R
74. Risk of concurrent Ca endometrium in a patient with endometrial polyp
A. 1.2%
B. 2.3%
C. 2.7%
D
D. 3.1%

Answer: D
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75. Steroids decrease interventricular haemorrhage %

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

A. Promethazine

B. Ondansetron

C. Metoclopramide

D. Steroid
e e
E. Domperidone

F r Answer: A

T H
F A
.
R
D
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77. Haematuria with painful bladder fill-in and hemorrhagic spots on
cystoscopy?

A. Interstitial cystitis

B. Painful bladder syndrome

C. Transitional cell carcinoma

e
Answer: A

e
A.10%

B.25% F r
78. Rate of infraumbilical adhesions after midline laparotomy?

C.55%

D.75%

T H Answer:

A
79. What is the incubation period toxoplasmosis?

F
.
A. 1-2 weeks

B. 2-3 weeks

C. 3-4 weeks

R
D
D. 4-5 weeks

Answer: B
In adults, the incubation period for T. gondii infection ranges from 10 to
23 days after the ingestion of undercooked meat and from five to 20 days
after the ingestion of oocysts from cat feces.
 MRCOG Recall Group
80. EMQ: Teaching

A. Workplace base assessment

B. ARCP

C. OSAT

e
D. NOTSS

E. MINI CEX

F. OSCE

r e
Q1. Which formative assessment tool to check cognitive + psychomotor
skills+ behavioral skills of any trainee at NHS.

F
Q2. which form of summative assessment is used for a trainee to assess
his yearly performance (long scenario)

H
81. EMQs: CHOOSE artery damage in surgical procedures

A. External iliac artery

T
B. Internal Iliac artery

C. Femoral artery

F A
D. Internal pudendal
.
E. Inf gluteal

F. Inf epigastric a
R
D
G. Superficial epigastric a

H. Obturator artery

Q1. long scenario, in the end asked for laparoscopically damaged a causing
bleed after laparoscopy. NEAR BLADDER,

Q2. Bleeding after episiotomy?

 MRCOG Recall Group
82. A lady with MCDA twins presents antenatally. At what gestational age
you should start screening for TTTS?

A. 14 weeks

B. 16 weeks

C. 18 weeks

D. 20 weeks

E. 24 weeks

e e
F r Answer: B

83. 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

that?

A. Grade 1 FGM
T H
small opening admitting 1 finger at the fourchette. How do you classify

B. Grade 2 FGM

C. Grade 3 FGM

F A
D. Grade 4 FGM
.
R
E. Female circumcision
Answer:

A. 2-fold

B. 4-fold
D
84. Risk of recurrence of shoulder dystocia?

C. 5-fold

D. 10-fold

Answer: D
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e e
F r
T H
85. 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

F A
B. BPD

C. AC
.
D. CRL
R
D Answer: D

86. Management of persistent simple ovarian cyst in post-menopausal

woman?
 MRCOG Recall Group
87. According to MBRRACE the suicide after 4 weeks postpartum can be
classified as?

A. Direct death

B. Indirect death

C. Late direct death

D. Late indirect death

E. Coincidental

e e
r
Answer:

F
88. Severe OHSS develops oliguria despite fluid replacement, what’s next?

A. Dialysis

B. Paracentesis

C. Encourage oral intake

D. Reassure
T H
F A Answer:

.
89. Sensitivity and fpr of quadruple test 70-75 % FPR: 5%

R
D
 MRCOG Recall Group

e e
F r
T H
F A
.
R
90. One question asked about cytomegalovirus i.e.; women heard that her
friend has a baby born with deafness and options were

D
A. Sensorineural Hearing Loss

B. Microcephaly

C. Thrombocytopenia

D. Seizures Answer:
 MRCOG Recall Group
91. 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

e e
lignocaine with vasopressor: 7mg/kg

F r Answer: C

Total ml acc. to dose & solution conc. 1or 2% = [)3or7(‚ 10] x [wt. ‚ conc

T H
92. Which condition put pregnant lady in high risk of stroke (MI)?

A. Hypothyroidism

B. Migraine

F A
.
C. Celiac disease

D. Marfan’s

R Answer: B

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

A. CTPA

B. Duplex US

C. Doppler US

D. V/Q Scan Answer: B

 MRCOG Recall Group
94. What are the management options for cervical cancer Stage 1B1?

A. Chemotherapy

B. Total abdominal hysterectomy

C. Radical hysterectomy and bilateral pelvic lymphadenectomy

e
Answer: C

e
F r
T H
F A
.
Stages IB and IIA
R
D
Options for treatment are radical hysterectomy and bilateral pelvic
lymphadenectomy or radical radiotherapy, with equivalent cure rates. In
general terms, the medically fit, younger patient is treated with surgery
and the unfit, older patient treated with radiotherapy.

Surgery involves removal of the pelvic lymph nodes from the common
iliac artery to the femoral canal. There is no clear role for the routine
removal of the para-aortic nodes. To achieve adequate clearance of the
 MRCOG Recall Group
tumour, the ureters are mobilised and the ureteric tunnels exposed, to
allow paracervical removal along with a vaginal cuff.

Serious complications include haemorrhage, damage to the bladder,

ureter or bowel, venous thrombosis and pulmonary embolus. In the longer
term, there is a small risk of lymphoedema (3%), sexual dysfunction (2%)
and bladder dysfunction (3.5%). Surgery is usually preferable in the
medically fit younger patient, with the potential advantages of

has the advantage of allowing accurate surgical staging.

e e
preservation of ovarian and sexual function. In addition, primary surgery

F r
Radiotherapy in the UK is usually combined with cisplatin chemotherapy,
since there is evidence that this improves survival, although it does
prolong treatment and increase morbidity. Adjuvant chemotherapy alone
has not been shown to offer significant survival or disease-free
advantage. Thus, if chemotherapy is poorly tolerated it may be stopped,
particularly if it were to otherwise compromise a full course of
radiotherapy being achieved.

T H
A course of radical chemo-radiotherapy involves weekly cisplatin (50
mg/m2) chemotherapy with daily external-beam radiotherapy

A
(teletherapy) on an outpatient basis for 32 to 35 days (equating to 48
Grays of radiotherapy being administered in 24 fractions). Pelvic
radiotherapy encompasses the primary tumour, uterus, parametrium,

. F
upper vagina and pelvic lymph nodes up to the common iliac vessels. This
is followed by the insertion of a central source of radiotherapy (or
brachytherapy). Once the brachytherapy applicators are in place an MRI is

R
performed to plan the delivery of radiotherapy. The usual dose of
brachytherapy is 21 Grays in 3-weekly fractions. Radical brachytherapy
alone can also be used in early stage disease but at higher doses of 35 to

D
37 Grays delivered in 5 weekly fractions. When brachytherapy is not
possible an external beam boost should be considered.

Cystitis, abdominal discomfort and diarrhoea are common adverse effects

but these are usually self-limiting. There are also the disadvantages of a
radiation-induced menopause and, in the long-term, carcinogenesis in
younger patients. Vaginal stenosis is common but the regular use of
vaginal dilators can usually prevent this becoming a major problem.
 MRCOG Recall Group
For women with early-stage (stage IB1 or less) tumours less than 2 cm in
diameter, where there is a strong desire to retain fertility, a radical
trachelectomy may be offered. This involves the removal of the cervix and
paracervical tissue, together with bilateral pelvic lymphadenectomy, and
aims to conserve the uterine body. The patient should be counselled
carefully, including the implications for future pregnancies, an increased
incidence of miscarriage and premature delivery. The operation can be

e
performed via the vaginal, abdominal or laparoscopic routes, as well as
robotically. A Shirodkar suture is inserted simultaneously into the uterine

e
isthmus to reduce the incidence of cervical weakness.

F r
If the surgical margins are close to the tumour or the lymph nodes are
involved in the tumour, adjuvant pelvic radiotherapy should be considered.
However, the combination of radiotherapy and surgery significantly
increases morbidity and the aim of preoperative imaging is to minimise
the need for this combination.

Infliximab or mesalamine on pregnancy?

T
A. Increased rates of spontaneous abortion,
H
95. Regarding the treatment of Ulcerative colitis, What’s effect of

B. Stillbirth
C. Congenital malformations

F A
D. Preterm delivery

.
E. Not interferes with organogenesis

R
Answer: E

D
 MRCOG Recall Group

e e
F r
T H
F A
.
R
D
96. Provocation stress test was positive for leakage?
A. Stress incontinence
B. Vesicovaginal fistula
C. Bladder painful syndrome
Answer: A
 MRCOG Recall Group

e e
F r
T H
97. There was one standard EMQ of a woman refusing cesarean section
(SGA baby with ADEF), partner trying to convince her. The last line of the
question was ‘you have advised a cesarean section and are asking her to

A
sign the consent form’
A. Cannot proceed with procedure as consent requirements not fulfilled
B. Best interest,

.
C. Save life of unborn baby F
R Answer: A

A. 2.5 %
B. 4%
D
98. Risk of carcinoma in endometrial polyp?

C. 10%

Answer: A
 MRCOG Recall Group

99. Bacteroides fragilis?

100. Non treatment or refusal consequences of advanced endometriosis

and Bp 158/100 protein ++

101. Nice intrapartum and infertility

e e
102. 18 weeks parvo transmission

F r
103. Level of anti D above which fetal anaemia likely to occur.

T H
104. Risk of adhesions below umbilicus if previous midline vertical incision
laparotomy

F A
105. A 17-year-old Jehovah’s Witness has documented and signed in all
her previous hospital notes that she doesn’t want blood products. (The

.
word ‘advance directive’ was not there). She has ruptured ectopic,
collapses, Hb 5.

R
Don’t remember options exactly

D
106. Case of acute appendicitis

107. Case of down syndrome they gave us the Nuchal t size + cystic
hygroma
 MRCOG Recall Group
108. Other case with features of Edward syndrome

109. A 41 years pregnant smoking and BMI 27 how to follow the baby? UA
Doppler

deceleration. How to manage?

e e
110. Also scenario of diabetic patient in labour, CTG reduce variability with

F r
111. EPAU 7 plus weeks 24mm sac no heart beat right abdominal cramp
pain and vaginal bleeding, 32mm into 28mm right hemorrhagic ovarian
cyst with small line of fluid in pouch of Douglas?

T H
112. Pregnant came into contact with H1N1 infected sister what to do?

113. One patient with atypical hyperplasia and she refused treatment and

A
wants to follow her, what to do?

F
.
114. A case of primary amenorrhoea has cyclical pain 4-5-day a month on
examination bind vagina?

R
115. Follow up in women taking tamoxifen outpatient biopsy, inpatient,

D
annual biopsy, ...

116. Tumor > 2 cm + close to vital organ (urethra/anus) + > 1 mm invasion =

multimodal therapy (radiotherapy to reduce size first, then surgery)
 MRCOG Recall Group
117. If women are unable to tolerate oral antiemetics or oral fluids then
ambulatory daycare management, which provides parenteral fluids,
parenteral vitamins (multi and B-complex)30 and antiemetics, is
appropriate if local resources allow.

118. Scenario previous 1 at 36 weeks ecv and failed ecv breech 3.8 kg

119. Primigravida. labouring breech at +3 average size

e e
120. the zika diagram

F r
121. Regarding sterilization n other refused lscs

T H
122. Regarding vaginal infection - Young girl with itching and redness
This Candida

F A
123. Percentage of PMB for malignant change. 10%

.
R
124. And risk of hemorrhage in uncomplicated cs is 5/1000 consent advice.

D
125. One q anti d positive and has hemolytic dis of newborn.... Anti k

126. Teacher has contact with infectious pt. with rubella at 20 weeks

127. A 58 years old diabetic with vulval itching n discharge. Took antibiotic
1 week back for throat infection???
 MRCOG Recall Group
128.A 52-year-old - CIN3 removed completely - histopathology -CGIN
extending in deeply excised tissue. After 6 months both smear and HPV
negative. What next?

129. Hysterectomy for HMB. CIN 3 found. Margins clear...

e
130. What to do to prevent rectocele - What to do if C came in introitus

e
F
This is insignificant bacteruria because less than 100000
So no need to treat
r
131. GBS Bacturia 10 to the power 4 shouldn't be treated during pregnancy?

T H
132. During hysterectomy after ligating round ligament and infundibular
pelvic. i found bladder adherent to the lower uterus I want to protect the
ureter.

A
Do I open the utero-vesical pouch (my choice) or dissect the ureteric
tunnel or identify ureter course? Blunt dissection of bladder.

F
I CHOOSE open the pouch as sharp dissecting in my belief causes less
bladder perforation

.
R
133. The stage IB vulvar cancer had wide excision. Only 4 mm free margin I

D
choose adjuvant chemo. When I searched, I found i can use adjuvant
chemo or adjuvant chemo-radio or repeat excision

134. Stage II 5 cm encroaching on the anal canal

I choose neo-adjuvant chemo then surgery. instead of neoadjuvant chemo
radiotherapy. I believe this is wrong now.
 MRCOG Recall Group
135. Epilepsy.... Topiramate
No evidence for congenital anomaly

136. Acute fatty liver and DIC?

Acute fatty liver dd from pre-eclampsia...... Hypoglycemia
Hyponatremia hypokalemia high urea

e e
of PPH with pp than 20percent

F r
137. If only cs no placenta praevia than 1.1...round about 2 percent and risk

138. What is the emergency CC option for an epileptic lady who denied

H
IUCD in epileptic on inducing drugs for cc 3 iii (IUCD / LNS-
IUS/injection/levonella 3mg)?
levonella 3mg

A T
139. Contraception for epileptic patient has bicornate uterus
Injection DMPA

. F
R
140. Obese with h/o DVT - EMQ
1. The one losing weight in hyperemesis I admitted n the other one

D
ambulatory care
2. 36ys 32 BMI smoker
3. Lmwh28 w
4. 36ys heterozygous for factor 5 and 32bmi
 MRCOG Recall Group
141. One patient booked for sterilization then stepped back obese want
effective method?
Implanon

142. Study design?

143. One retrospective observational?

e e
bicornuate
I choose LNS-IUS
F r
145. Patient on carbamazepine. LNS-IUS or DMPA? The patient has

146. One Question related to MRSA?

T H
F A
.
R
D
 MRCOG Recall Group

MRCOG Recall Group/Telegram

e e
F r
T H
F A
.
R
D
With best wishes

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