5 - Data Interpretation - PASS - MRCOG 2017

PASS‐MRCOG | Data Interpretation
Question 1
What is the lower reference limit for sperm concentration according to the WHO criteria?
A) 1.5 million million spermatozoa per ml

B) 15 million spermatozoa per ml
C) 50 million spermatozoa per ml
D) 150 million spermatozoa per ml
E) 500 million spermatozoa per ml
Correct Answer:
15 million spermatozoa per ml
Explanation: Semen Analysis
The NICE quality standard [QS73] sets out reference ranges for semen analysis using the WHO
guideline. They are as below:
 Semen volume: Greater than or equal to 1.5 ml

 pH: Greater than or equal to 7.2
 Sperm concentration: Greater than or equal to 15 million spermatozoa per ml
 Total sperm number: 39 million spermatozoa per ejaculate or more
 total motility (% of progressive motility and nonprogressive motility): 40% or more
motile or 32% or more with progressive motility
 Vitality: 58% or more live spermatozoa
 Sperm morphology (percentage of normal forms): 4% or more
Question 2
You review a 61 year old patients blood results in pre‐op clinic. They are as follows:
Corrected Calcium 3.0 mmol/l (Reference range 2.20 ‐2.60)

Alkaline Phosphatase 120 U/l (Reference range 30 ‐ 140)
Phosphate 1.5 mmol/l (Reference range 0.8 ‐ 1.4)
PTH 5.0 pmol/l (Reference range 1.0 ‐ 7.0)
What is the likely diagnosis?

A) Bone mets
B) Hypothyroidism
C) Myeloma
D) Hypoparathyroidism
E) Vitamin D deficiency
Correct Answer:
Myeloma
Explanation: There are a number of approaches to interpreting hypercalcemia results. One

method is to start with the alkaline phosphate (ALP).
A normal ALP suggests myeloma or calcium‐alkali syndrome. Myeloma normally has normal or
high PTH whereas calcium‐alkali syndrome typically causes low PTH.
Other disorders that may cause hypercalcaemia with normal ALP are thyrotoxicosis or
sarcoidosis however a raised ALP is also common with these two conditions so it is unlikely the
exam would ask this. These conditions are associated with low PTH.
Question 3
Evidence from a single randomised control trial is what level of evidence
A) IIIa
B) IIIb
C) IVa
D) IVb
E) none of the above
Correct Answer:
none of the above
Explanation: RCTs are the best form of trial evidence and will fall into one of the level I
categories below:
Ia ‐ Evidence from Meta‐analysis of Randomized Controlled Trials
Ib ‐ Evidence from at least one Randomized Controlled Trial
Question 4
Plasma typically accounts for what percentage of body weight?
A) 4%
B) 14%
C) 20%
D) 40%
E) 80%
Correct Answer:
4%
Explanation: Total body water accounts for 60% of body weight.

40% of body weight is ICF 20% is ECF (with 4‐5% plasma).
Question 5
A patient undergoes an oral glucose tolerance test. The results are shown below:
fasting plasma glucose 5.9 mmol/l

2‐hour plasma glucose 7.0 mmol/l
What does this result show?
A) No evidence gestational diabetes

B) Impaired fasting glycaemia
C) Impaired glucose tolerance
D) Indeterminant result
E) Gestational diabetes
Correct Answer:
Gestational diabetes
Explanation: This women has a fasting glucose of >5.6 mmol/l and therefore fulfils the
diagnostic criteria for GDM. Diagnose gestational diabetes if the woman has either:
a fasting plasma glucose level of 5.6 mmol/litre or above

OR
a 2 hour plasma glucose level of 7.8 mmol/litre or above
You should be aware of the new lower limit of fasting glucose (fasting glucose limit used to be
7.0 mmol/litre. NICE changed this in 2015)
Question 6
With regard to the spirometry trace below:
Image sourced from Wikipedia
What lung volume is represented by E?
A) Vtal capacity
B) Tidal volume
C) Total lung capacity
D) Inspiratory reserve volume

E) Expiratory reserve volume
Correct Answer:
Tidal volume
Explanation: Spirometry
Question 7
A 45 year old woman attends the fertility clinic for the results of her recent blood tests:
Test Result
Follicle stimulating hormone 54.0 IU/l
Leutinizing hormone 30 IU/l
Progesterone 0.2 nmol/l
Prolactin 20 ng/ml
TSH 2.5 mIU/ml
What is the most likely cause of her subfertility?
A) Hypothyroidism
B) Hyperthyroidism
C) Male factor infertility
D) Menopause
E) Pituitary dysfunction
Correct Answer:
Menopause
Explanation: This patient has raised FSH (>30) with low progesterone. This is consistent with
menopause. Her thyroid function and prolactin are normal
Question 8
Regarding accelerations on the CTG which of the following statements is true regarding the
RCOG interpretation of FHR (fetal heart rate):
A) Their presence is abnormal

B) Their presence is reassuring
C) Their presence is not‐reassuring
D) Their absence is not‐reassuring
E) Their absence is abnormal
Correct Answer:
Their presence is reassuring
Explanation: According to the RCOG the presence of accelerations is reassuring. Their absence
is neither abnormal or not‐reassuring but of uncertain clinical significance
RCOG FHR
Variability Range Accelerations
Interpretation Range
 5 bpm or more 110‐
Reassuring Present
160
100‐
 <5 bpm for 40 mins or
109 absence is of uncertain clinical
Non‐Reassuring more
160‐ significance
180
 <5 bpm for 90 mins or
<100 absence is of uncertain clinical
Abnormal more
>180 significance
Question 9

What lung volume is represented by B?
A) Inspiratory capacity
B) Tidal volume
C) Functional residual capacity
D) Vital capacity
E) Total lung capacity
Correct Answer:
Vital capacity
Question 10
A 32 year old has a transvaginal ultrasound that shows a left ovarian mass. The ultrasound
report describes a unilocular cyst with acoustic enhancement and diffuse homogeneous
ground‐glass echoes as a result of the haemorrhagic debris. What is the likely diagnosis?
A) Functional cyst
B) Physiological cyst
C) Endometrioma
D) Teratoma
E) Germ cell tumour
Correct Answer:
Endometrioma
Explanation: Endometrioma (AKA chocolate cyst) is defined as a blood‐containing pseudocyst

resulting from endometriosis tissue with haemorrhage.
Typical ultrasound features of endometrioma are:
 Diffuse homogeneous low level echoes

 Echoes sometimes described as "ground glass' the result of haemorrhagic material

 The EuropeanSociety of Human Reproduction and Embryology guidelines on
management of endometriosis (which replaced the previous RCOG guidelines )
recommends clinicians base the diagnosis of ovarian endometrioma in premenopausal
women on the following ultrasound characteristics:
 Ground glass echogenicity

 1 to 4 compartments and no papillary structures with detectable blood flow

A point to remember in the exam is that the syllabus expects you to interpret imaging of
benign pathology so potentially malignant pathologies such as germ cell tumour are
unlikely answers
Question 11
Evidence from meta‐analysis of RCTs is what level of evidence?
A) Ia
B) Ib
C) IIa
D) III
E) IV
Correct Answer:
Ia
Explanation: Ia = Evidence from Meta‐analysis of Randomized Controlled Trials

This is the highest level of evidence
Question 12
A 35 year old women has been admitted to the ward. One of the nurses asks to you to review
her as she appears to be sweaty and a little agitated. You review her bloods which are as
follows:
Hb 10.2 g/l reference range 11.5 to 16.5

Platelets 120 * 109/l reference range 150 to 400
WBC 3.5 * 109/l reference range 4.0 to 11.0
MCV 102 fl reference range 80 to 97
Sodium 135 mmol/l reference range 135 to 145
Potassium 3.8 mmol/l reference range 3.5 to 5.5
Urea 1.9 mmol/l reference range 2.8 to 7.8
Creatinine 54 umol/l reference range 45 to 90
What is the likely cause?
A) Gastrointestinal bleed
B) Iron deficiency
C) Alcohol abuse
D) Thyrotoxicosis
E) Leukaemia
Correct Answer:
Ia
Explanation: There are several markers here of alcohol abuse. Alcohol is the most common
cause of macrocytosis and can suppress production of all cell lines (platelets being the most
common) This patient has low WCC and platelets. There is also low urea. This is commonly seen
in people who abuse alcohol due to impaired hepatic synthetic function and reduced urea
synthesis.
Coupled with the biochemical and haematological markers the patient is also showing signs of
withdrawal with sweating and agitation
Question 13
A 28 year old is being seen in EPU and you are asked to review her ultrasound. There is no fetal
heartbeat. Ultrasound shows a fetal pole. CRL is measured at 7.6mm. What is the likely
diagnosis?
A) Viable Pregnancy
B) Pregnancy of uncertain viability
C) Miscarriage
D) Molar Pregnancy
E) Partial Mole
Correct Answer:
Miscarriage
Explanation: Be familiar with the criteria for miscarriage (CRL >/= 7.0mm or Gestational sac >/=
25mm). Also be aware they may give you this scenario and ask what you do next. If the
diagnostic criteria for miscarriage are met you should either:
 Seek a second opinion

 Rescan in 7 days
Question 14
What lung volume is represented by C?

A) Tidal volume
B) Vital capacity
C) Functional residual capacity
D) Expiratory reserve volume
E) Residual volume
Correct Answer:
Residual volume
Question 15
You are carrying out analysis of a new test for DVTs and decide to plot a ROC curve. What are
the axes of the curve?
A) Sensitivity v Specificity
B) Specificity v Sensitivity
C) Positive Predictive Value v Negative Predictive Value
D) Sensitivity v (1‐Specificty)
E) (1‐Sensitivity) v Specificity
Correct Answer:
Sensitivity v (1‐Specificty)
Explanation: ROC Curves plot Sensitivity against 1‐Specificty as shown in the diagram below.
They are a useful measure of how good a test is at distinguishing those with and without
disease. The greater the area under the curve the better the test.
A common question is why not plot sensitivity vs specificity. Well you could do that but then
the area under the curve wouldn't represent how good the test is at distinguishing those with
and without disease.
Question 16
You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood
pressure is 147/96. Automated reagent strip testing shows protein 2+. You send for a
protein:creatinine ratio and this shows a ratio of 36 mg/mmol. What is the appropriate course
of action?
A) Admit for observation

B) Admit and start labetolol
C) Discharge with follow up in 1 week
D) Discharge with plans for daily BP monitoring
E) Discharge with plans for BP monitoring four times daily
Correct Answer:
Admit for observation
Explanation: It is important to be aware of the difference between management of simple

hypertension and pre‐eclampsia in pregnancy.
A BP of 140/90 to 149/99 mmHg is classed as mild hypertension. Without proteinuria this can
be monitored once weekly and the patient can be discharged.
If proteinuria is present with any degree of hypertension the patient requires admission and BP
should be monitored at least 4 times daily according to NICE guidance
Question 17
A patient undergoes an oral glucose tolerance test. The results are shown below:
fasting plasma glucose 5.5 mmol/l

2‐hour plasma glucose 8.0 mmol/l
What does this result show?
A) No evidence gestational diabetes

B) Impaired fasting glycaemia
C) Impaired glucose tolerance

D) Indeterminant result
E) Gestational diabetes
Correct Answer:
Gestational diabetes
Explanation: This women has a 2 hour glucose of >7.8 and therefore fulfils the diagnostic
criteria for GDM. Diagnose gestational diabetes if the woman has either:
a fasting plasma glucose level of 5.6 mmol/litre or above

OR
a 2 hour plasma glucose level of 7.8 mmol/litre or above.
You should be aware of the new lower limit of fasting glucose (fasting glucose limit used to be
7.0 mmol/litre. NICE changed this in 2015)
Question 18
Regarding CTG (cardiotocography) analysis of variability which of the following would be

classed as non‐reassuring according to RCOG guidance?
A) >15 bpm for 90 mins

B) >30 bpm for 45 mins
C) <5 bpm for 30 to 90 mins
D) <5 bpm for >45 mins
E) >5 bpm for >90 mins
Correct Answer:
<5 bpm for 30 to 90 mins
Explanation: See the tables below.

BPM variability < 5 bpm for 90 mins or more is classed as abnormal.
Question 19
Which of the following is the major intracellular cation?
A) Sodium
B) Chloride
C) Potassium
D) Bicarbonate
E) Phosphate
Correct Answer:
Phosphate
Explanation: Electrolytes
Body Fluids
 Intracellular fluid 40% of body weight

 Extracellular fluid 20% of body weight
 ECF comprises plasma and interstitial fluid
 Plasma volume typically around 3 litres (5% of body weight)

Extracellular Fluid (ECF)
 Sodium (Na) main cation

 Chloride (Cl) main anion

Intracellular Fluid (ICF)
 Potassium (K) main cation

 Phosphate (PO4) main anion
Question 20
Polyhydramnios is defined as an amniotic fluid index of?
A) > 2cm
B) > 5cm
C) > 8cm
D) > 15cm
E) > 25cm
Correct Answer:
> 25cm
Explanation: AFI involves measuring the depth of amniotic fluid pockets in all 4 quadrants.
 Oligohydramnios AFI< 5cm or deepest amniotic fluid pocket < 2cm

 Polyhydramnios AFI > 25cm or deepest amniotic fluid pocket > 8cm
Question 21
You are asked to review the serology results of a 33 year old women from China who had
deranged liver function tests. The results are as follows:
Marker Result
HBsAg Positive
Anti HBs Negative
Anti HBc Positive
IgM Anti HBc Negative
What does this indicate regarding her hepatitis B status?
A) Immune due to past infection

B) Immune due to vaccination
C) Acute infection
D) Chronic infection
E) Susceptible
Correct Answer:
Chronic infection
Explanation: This indicates chronic infection. When analysing Hep B serology be systematic:
 Is the patient currently infected? if HBsAg positive the answer is yes

 Is the patient recently infected? if yes then IgM Anti HBc will be positive
 Has the patient ever been infected? Yes if Anti HBc is positive

China, Senegal, and Thailand are classed by WHO as having very high rates of hepatitis B
(>8% prevalence).
Question 22
A 40 year old women has a transvaginal ultrasound reported as showing a 6cm x 5cm cystic
mass of the right ovary with multiple septa noted and varying degrees of echogenicity within
locules. What is the likely diagnosis?
A) Endometrioma
B) Serous cystadenoma
C) Dominant follicle
D) Mucinous cystadenoma
E) Susceptible
Correct Answer:
Mucinous cystadenoma
Explanation: Features of mucinous cyst adenoma are:
 Usually large
 Multilocular
 Thin walled septa
 Locules may vary in echogenicity due to variation in fluid content
Note : Serous cyst adenomas are usually unilocular
Question 23

What lung volume is represented by D?
A) Vital capacity
B) Tidal volume
C) Expiratory reserve volume
D) Functional residual capacity
E) Residual volume
Correct Answer:
Functional residual capacity
Question 24
A fetal blood sample is taken during labour due to failure to progress. What pH is the cut‐off
below which delivery should be considered
A) 7.45
B) 7.35
C) 7.25
D) 7.20
E) 7.10
Correct Answer:
7.20
Explanation: Fetal Blood Sampling (FBS)
Indications for FBS
 1. Pathological CTG in labour (cervix dilated >3 cm)

 2. Suspected acidosis in labour (cervix dilated >3 cm)
Contraindications to FBS
 Maternal infection e.g HIV, HSV and Hepatitis

 Known fetal coagulopathy
 Prematurity (< 34 weeks gestation)
 Acute fetal compromise
Interpretation of FBS results
pH Interpretation Action
>7.25 Normal Repeat in 1 hour if CTG remains abnormal
7.21 to 7.24 Borderline Repeat in 30 minutes
<7.20 Abnormal Consider delivery
Question 25
Regarding CTG (cardiotocography) analysis what is the normal range for variability?
A) <5 bpm
B) 1‐5 bpm
C) 5‐15 bpm
D) 5‐40 bpm
E) None of the above
Correct Answer:
5‐15 bpm
Explanation: Fetal hypoxia may cause absent, increased or decreased variability. Other causes
of decreased variability include: normal fetal sleep‐wake pattern, prematurity and following
maternal administration of certain drugs including opioids.
Interpretation Variability Range

Normal 5 bpm ‐ 15bpm
Increased >15 bpm
Decreased <5 bpm
Absent <2 bpm
NOTE: RCOG classes variability into Reassuring, Non‐reassuring and abnormal depending on
duration of decreased variability
Question 26
A 40 year old women is being reviewed in the fertility clinic following some initial blood tests:
Test Result
Follicle stimulating hormone 4.0 IU/l
Leutinizing hormone 20 IU/l
Progesterone 6.2 nmol/l
Prolactin 20 ng/ml
TSH 2.5 mIU/ml
What is the most likely underlying cause of her subfertility?

A) Early Menopause
B) Hypothyroidism
C) Pituitary dysfunction
D) Male factor subfertility
E) Anovulation
Correct Answer:
Anovulation
Explanation: In this patient the Progesterone is low. Many labs quote a level as <30 nmol/l as
supporting anovulation but NICE guidance suggests ovulation is possible with levels between 16
and 28 nmol/L. In the exam if the question is hinting at anovulation then the level is likely to be
<16.
All the other parameters are normal
Question 27
A patient who is 12 weeks pregnant is being seen in the antenatal clinic. Urinalysis shows
protein ++. A 24 hour urine collection is organised. Greater than what level would indicate
significant proteinuria?
A) 100 mg over 24 hours

B) 150 mg over 24 hours
C) 250 mg over 24 hours
D) 300 mg over 24 hours
E) 350 mg over 25 hours
Correct Answer:
300 mg over 24 hours
Explanation: Proteinuria
If urinary dipstick shows greater than 1+ a urinary protein:creatinine ratio or 24‐hour urine
collection should be performed to quantify proteinuria.
Significant proteinuria is considered when:
 Urinary protein:creatinine ratio is >30 mg/mmol OR

 24‐hour urine collection >300 mg protein
Question 28
A 29 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary.
According to the IOTA ultrasound rules which of the following is suggestive of malignancy?
A) Unilocular
B) Acoustic Shadowing
C) Solid components <7mm diameter
D) Multilocular tumour <100mm diameter
E) Very strong blood flow
Correct Answer:
Very strong blood flow
Explanation: The RCOG green top guideline 62 refers to the IOTA ultrasound guidance on
benign (B‐rules) and malignant (M‐rules) features on ultrasound. These are summarised below:
B‐rules M‐rules
Unilocular cysts Irregular solid tumour
Presence of solid components where the largest
Ascites
solid component <7 mm
Presence of acoustic shadowing At least four papillary structures
Smooth multilocular tumour with a largest Irregular multilocular solid tumour with
diameter <100 mm largest diameter 100 mm
No blood flow Very strong blood flow
Question 29
You are asked to review a 33 year old patient on the ward. They had been seen in A&E earlier
with lower abdominal pain. The patient informs you they take Cerazette and PRN ranitidine.
A&E had gained IV access, started fluid resuscitation, sent bloods and given analgesia.
Unfortunately the bloods were lost. You repeat a set of U&Es and the results come back as
below. What is the likely cause of this biochemical abnormality?
Na+ 147 mmol/l ref range 135‐145

K+ 3.6 mmol/l ref range 3.5‐5.5
Urea 4.5 mmol/l ref range 2.5‐8.0
Creatinine 70 µmol/l ref range 40‐130
Glucose 4.9 mmol/l
A) Cerazette
B) Ranitidine
C) Blood loss
D) Excess IV saline
E) Lab error
Correct Answer:
Excess IV saline
Explanation: This patient has hypernatraemia. Cerazette and Ranitidine do not typically cause
hypernatraemia. There is no confirmed blood loss. Excess IV Saline is a recognised cause of
hypernatraemia.
Be aware excess IV fluids (particularly dextrose solution) can cause hyponatraemia
Question 30
Which of the following is the major intracellular anion?
A) Sodium
B) Potassium
C) Chloride
D) Bicarbonate
E) Phosphate
Correct Answer:
Phosphate
Explanation: Protein and phosphate are the major intracellular anions
Remember ANION (A Negatively charged ION)

Question 31
You are asked to review the serology results of a 27 year old women. She was noted to have
had deranged liver function tests. The results are as follows:
Marker Result
HBsAg Negative
Anti HBs Positive
Anti HBc Negative
A) Acute Infection
B) Chronic Infection
C) Immune due to past infection
D) Immune due to vaccination
E) Susceptible
Correct Answer:
Immune due to vaccination
Explanation: This patient has Anti HBs antibodies ‐ this suggests immunity.
Anti HBc persists for life after infection so is a marker of past infection. In this case anti HBc is
negative suggesting immunity by vaccination rather than past infection.
Question 32
A patient who is 14 weeks pregnant is being seen in the antenatal clinic. Urinalysis shows
protein ++. A hour protein:creatinine ratio is organised. Greater than what level would indicate
significant proteinuria?
A) 10 mg/mmol
B) 20 mg/mmol
C) 30 mg/mmol
D) 40 mg/mmol
E) 50 mg/mmol
Correct Answer:
30 mg/mmol
Explanation: Proteinuria
If urinary dipstick shows greater than 1+ a urinary protein:creatinine ratio or 24‐hour urine
collection should be performed to quantify proteinuria.
Significant proteinuria is considered when:
 Urinary protein:creatinine ratio is >30 mg/mmol OR

 24‐hour urine collection >300 mg protein
Question 33
Regarding Decelerations on the CTG which of the following statements regarding the RCOG
interpretation of the CTG is true
A) Their presence is reassuring

B) Their absence is reassuring
C) A single deceleration >3min is non‐reassuring
D) Atypical variable decelerations are non‐reassuring
E) Early decelerations are abnormal
Correct Answer:
Their absence is reassuring
Explanation: Unlike accelerations (the presence of which is reassuring) the absence of

decelerations is reassuring.
The presence of decelerations is either non‐reassuring or abnormal depending on the type (see
the table below)
RCOG FHR
Variability Range Accelerations Decelerations
Reassuring  5 bpm or 110‐ Present None
RCOG FHR
Variability Range Accelerations Decelerations
more 160
 Early deceleration
 Variable
 <5 bpm for 100‐
absence is of Deceleration
40 mins or 109
Non‐Reassuring uncertain clinical  Single prolonged
more 160‐
significance deceleration
180
<3mins
 Atypical variable
Decelerations
 <5 bpm for
absence is of  Late Decelerations
90 mins or <100
Abnormal uncertain clinical  Single prolonged
more >180
significance deceleration
>3mins
Question 34
A 30 year old patient attends for non‐invasive pre‐natal screening for Down's syndrome. You
advise her that the result will take the form of a risk score and higher risk results will be offered
CVS or amniocentesis. What is the cut‐off figure between low and high risk?
A) 1 in 1000
B) 1 in 500
C) 1 in 150
D) 1 in 99
E) 1 in 50
Correct Answer:
1 in 150
Explanation: 1 in 150 is the cut off. Where pre‐natal screening shows a risk of 1 in 150 or
greater invasive testing is typically offered.
Question 35
A baby who has undergone fetal blood sampling during labour due to CTG changes is delivered
and cord blood samples are taken. What is the normal arterial pH range for the cord sample?
A) 7.35 ‐ 7.45
B) 7.25 ‐ 7.35
C) 7.26 ‐ 7.30
D) 7.1 ‐ 7.26
E) 7.0 ‐ 7.2
Correct Answer:
7.26 ‐ 7.30
Explanation: Cord Blood Samples
Ideal pH 7.26 ‐ 7.30

Threshold pH for adverse neurological outcomes 7.1
Source: BJOG The relationship between umbilical cord arterial pH and serious adverse neonatal
outcome: analysis of 51 519 consecutive validated samples P Yeh, K Emary, L Impey
Question 36
What is the maximum normal diameter of the yolk sac on transvaginal ultrasound?
A) 3mm
B) 6mm
C) 12mm
D) 18mm
E) 25mm
Correct Answer:
6mm
Explanation: The yolk sac increases in size up until the 10th week reaching a maximum diameter
of 6mm in normal pregnancy. After the 10th week the yolk sac will gradually disappear. It is
usually sonographically undetectable by 20 weeks.
A yolk sac greater than 6mm diameter is suspicious of failed pregnancy.
Please rate this question:
Ultrasound Early Pregnancy
Structure size when Gestational sac size when

Structure Visible TVS
visible structure visible on TVS
Gestational
4wks+3d 3mm 3mm
sac
5 to 5+3wks
Yolk sac 3mm 10mm
(chorionic cavity)
Embryonic
5wks+3d to 6 wks 3mm 16mm
pole
TVS = Transvaginal ultrasound scan
Question 37

What is the most likely diagnosis?
A) Thyrotoxicosis
B) Graves
C) Ketoacidosis
D) Primary hyperparathyroidism
E) Secondary hyperparathyroidism
Correct Answer:
Primary hyperparathyroidism
Explanation: The low phosphate is suggestive of hyperparathyroidism or malignancy.
Remember primary hyperparathyroidism is the most common cause of hypercalcaemia.
Please rate this question:
Hypercalcaemia
table showing conditions causing hypercalcaemia and the typical biochemical findings
Condition Alkaline Phosphatase Phosphate PTH

Normal (unless fractures Normal/High (high in renal
Myeloma Normal/High
occur) failure)
Calcium Alkali
Normal Normal/High Low
Syndrome
Sarcoidosis Norma/High Normal/High Low
Hyperthyroidism Normal/High Normal/High Low
Hyperparathyroidism Normal/High Low High
Malignancy High Normal/Low Variable
Vitamin D Excess Low High Low
Question 38
A 29 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is
anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is
the likely diagnosis?
A) Functional cyst
B) Endometrioma
C) Ketoacidosis
D) Mucinous cystadenoma
E) Germ cell tumour
Correct Answer:
Functional cyst
Explanation: Features of functional ovarian cysts on ultrasound are:
 Thin walled and unilocular

 Must be >3cm diameter (if <3cm described as follicle)
 Anechoic (absence of internal echoes)
 No colour flow
 No solid components
Question 39
A baby who has undergone fetal blood sampling during labour due to CTG changes is delivered
and cord blood samples are taken. What is the threshold arterial pH for adverse neurological
outcomes?
A) 7.35
B) 7.30
C) 7.26
D) 7.10
E) 6.90
Correct Answer:
7.10
Explanation: Most units in the UK use a arterial cord pH of <7.1 as an obstetric trigger
Question 40

What is the likely diagnosis?
A) Myeloma
B) Calcium‐alkali syndrome
C) Sarcoidosis
D) Malignancy
E) Hyperthyroidism
Correct Answer:
Malignancy
Explanation: Malignancy is the most likely to cause these results
Question 41
What is the normal range for urea concentration in an adult?
A) 1.0 ‐ 10.5 mmol/l

B) 1.5 ‐ 9.5 mmol/l
C) 2.0 ‐ 7.3 mmol/l
D) 2.5 ‐ 7.8 mmol/l
E) 3.5 ‐ 9.8 mmol/l
Correct Answer:
2.5 ‐ 7.8 mmol/l
Explanation: Electrolyte Balance

In 2011 UK wide reference ranges were agreed for most electrolytes as part of phase 3 of the
pathology harmony initiative (see http://www.pathologyharmony.co.uk). Although some labs
may use older reference ranges or have different ranges due to a differing testing method
those below are in line with the UK wide agreed ranges:
Electrolyte Normal Range

Sodium 133‐146 mmol/l
Potassium 3.5 ‐ 5.3 mmol/l
Urea 2.5 ‐ 7.8 mmol/l
Creatinine (male) 64 ‐ 104 mmol/l
Creatinine (female) 49 ‐ 90 mmol/l
Albumin 35‐50 g/l
Question 42
A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid
collection of echoes with numerous small (3‐10 mm) anechoic spaces. What is the likely
diagnosis?
A) Ectopic Pregnancy
B) Molar Pregnancy
C) Partial Molar Pregnancy
D) Pregnancy of uncertain viability
E) Miscarriage
Correct Answer:
Molar Pregnancy
Explanation: This is typical appearance of molar pregnancy. This used to be referred to as

"snowstorm sign" as with older poorer resolution ultrasound the anechoic species looked like a
snowstorm.
Question 43
You are asked to review the full blood count of a 61 year old patient in pre‐op clinic. The
results are as below:
Hb 9.0 g/l
MCV 118 fl
Platelets 155 * 109/l
WBC 9.4 * 109/l
You note her past medical history records a diagnosis of vitiligo 4 years ago but nil else. She
takes no regular medications. You note routine bloods done by the GP 1 month earlier show
normal thyroid function, urea and electrolytes and HBA1C. What is the likely diagnosis?
A) Iron deficiency anaemia

B) Gastrointestinal bleed
C) Endometrial bleed
D) Hashimotos
E) Pernicious anaemia
Correct Answer:
Pernicious anaemia
Explanation: The raised MCV is the clue here. Bleeding and iron deficiency typically result in
microcytic anaemia.
Hypothyroidism and pernicious anaemia are recognised causes of megaloblastic anaemia. This
patient is the typical age for pernicious anaemia to present. In addition she has had recent TFTs
making hypothyroidism unlikely.
Also note Pernicious anaemia has associations with other autoimmune conditions such as
vitiligo, autoimmune hypothyroidism and diabetes mellitus.
Question 44
Patients with GBS Patients without GBS

Test Positive 84 2
Test Negative 6 40
A new test for Group B strep has been designed and the results are shown above. Which of
the below represents the Positive Predictive Value?
A) 0.93
B) 0.95
C) 0.97
D) 15.5
E) 18.6
Correct Answer:
0.97
Explanation: Sensitivity = 84 / 84 +6 = 0.93

Specificity = 40 / 40 +2 = 0.95
PPR = 84/84 +2 = 0.97
NPR = 40/40+6 = 0.86
LR+ = Sensitivity/ (1‐Specificty) = 18.6
LR‐ = (1‐Sensitivity) / Specificity = 0.07
Question 45

What lung volume is represented by A?
A) Inspiratory capacity
B) Inspiratory reserve volume
C) Tidal volume
D) Residual volume
E) Vital capacity
Correct Answer:
Inspiratory capacity
Question 46
Intracellular fluid typically accounts for what percentage of body weight?
A) 5%
B) 20%
C) 40%
D) 75%
E) >90%
Correct Answer:
40%
Explanation: Total body water accounts for 60% of body weight.
40% of body weight is ICF 20% is ECF (with 4‐5% plasma).
Question 47
What is the normal rage for adjusted serum calcium?
A) 1.80 ‐ 3.00 mmol/l

B) 2.00 ‐ 3.00 mmol/l
C) 2.10 ‐ 2.8 mmol/l
D) 2.60 ‐ 3.30 mmol/l
E) 2.20 to 2.60 mmol/l
Correct Answer:
2.20 to 2.60 mmol/l
Explanation: Calcium Metabolism

Question 48
You are asked to review a 33 year old patient on the ward. They had been seen in A&E earlier
with lower abdominal pain. The patient informs you they take Cerazette and PRN ranitidine.
A&E had gained IV access, started fluid resuscitation, sent bloods and given analgesia.
Unfortunately the bloods were lost. You repeat a set of U&Es and the results come back as
below. What is the likely cause of this biochemical abnormality?

K+ 3.6 mmol/l ref range 3.5‐5.5
Glucose 4.9 mmol/l
A) Cerazette
B) Ranitidine
C) Blood loss
D) Laboratory error
E) Excess IV fluids
Correct Answer:
Excess IV fluids
Explanation: This patient has hyponatraemia. In the exam the question should lead you to the
cause. In this case neither Ranitidine or Cerazette are associated with hyponatraemia. Be aware
several drugs can cause hyponatraemia such as:
 Thiazide diuretics
 PPIs
 SSRIs
 Opiates
 ACE inhibitors
The history doesn't confirm the patient has lost any blood and although laboratory error is
possible this patient has had IV fluids which are a common cause of hyponatraemia.
Be aware that hypernatraemia can occur with excess saline. Hyponatraemia is more likely with
use of dextrose solution.
Question 49
You are called to see a 24 year old patient who is currently in labour but is failing to progress. A
fetal blood sample is sent for analysis. pH is 7.18. Which of the following is the appropriate
course of action?
A) No action required
B) Consider delivery
C) Repeat in 30 minutes
D) Repeat in 30 minutes if CTG remains abnormal
E) Repeat in 1 hour if CTG remains abnormal
Correct Answer:
Consider delivery
Explanation: A FBS pH less than or equal to 7.20 is abnormal and delivery should be considered.
Question 50
heartbeat. Ultrasound shows a fetal pole. CRL is measured at 6.0mm. What is the likely
diagnosis?
A) Pregnancy of unknown viability

B) Inevitable Miscarriage
C) Molar Pregnancy
D) Partial Molar Pregnancy
E) Threatened Miscarriage
Correct Answer:
Pregnancy of unknown viability
Explanation: The ultrasound criteria do not meet the miscarriage criteria. This should be
treated as Pregnancy of uncertain viability. Another scan should be performed in 7 days.
Fetal heart rate is not typically visible until CRL reaches 2‐4mm.
RCOG guidance has been replaced by the NICE guidance which state CRL >/= 7mm with no fetal
heart rate is consistent with miscarriage
Question 51
A 45 year old women has a transvaginal ultrasound that is reported as showing a partially
echogenic mass with posterior sound attenuation owing to sebaceous material and hair within
the cyst cavity. What is the likely diagnosis?
A) Mature teratoma
B) Functional cyst
C) Endometrioma
D) Cystadenoma
E) Germ Cell Tumour
Correct Answer:
Mature teratoma
Explanation: Demoid cysts and teratomas contain elements from multiple germ cell layers.
They are often considered the same entity (even in medical texts) however a dermoid is
composed only of dermal and epidermal elements. A teratoma has mesodermal and
endodermal elements
Mature teratomas are composed of well‐differentiated derivations from at least 2/3 germ cell
layers (i.e. ectoderm, mesoderm, and endoderm). They contain developmentally mature skin
complete with hair follicles, sweat glands, sometimes hair, and sometimes sebum, blood, fat,
bone, nails, teeth, eyes, cartilage, and thyroid tissue.
Question 52
You review a 25 year old patient who is 26 weeks pregnant. Her liver function tests are as
below:
Bilirubin 14 µmol/l
ALP 205 u/l
ALT 25 u/l
γGT 20 u/l
Albumin 36 g/l
What is the appropriate management?

A) Reassure
B) Organise repeat test in 7 days
C) Organise urgent biliary ultrasound
D) Send hepatitis serology
E) Send autoimmune screen
Correct Answer:
Reassure
Explanation: Alkaline phosphatase is secreted by the placenta and levels rise to peak in the 3rd
trimester. Reference ranges vary but the upper limit ALP in the 3rd trimester is around 230 u/l.
These results are therefore within normal limits and the patient can be reassured.
Question 53
The graph shows the ROC curve results for 5 tests for ovarian cancer. Which is the LEAST
accurate test?
A) A
B) B
C) C
D) D
E) E
Correct Answer:
E
Explanation: When interpreting the ROC Curve the closer to the top left corner (i.e. the most
area under the curve) the more accurate the test. The closer the bottom right the worse the
test.
In this case the blue line (D) represents the most accurate test and the purple line (E) the least
accurate test.
Question 54
pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate
course of action regarding the urine result?
A) No action required
B) Test urine protein daily
C) Test urine protein weekly
D) Send urine for protein:creatinine ratio
E) Check protein at routine visits
Correct Answer:
Send urine for protein:creatinine ratio
Explanation: According to NICE guidance:
 If an automated reagent‐strip reading device is used to detect proteinuria and a result of

1+ or more is obtained, use a spot urinary protein:creatinine ratio or 24‐hour urine
collection to quantify proteinuria.
 Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol
or 24‐hour urine collection result shows greater than 300 mg protein

Question 55
You are called to a delivery as the midwife is concerned about CTG changes. She suggests a
fetal blood sample (FBS). You inspect the cervix. At what dilatation would you NOT perform
FBS?
A) less than 2cm

B) Less than 3cm
C) Less than 4cm
D) Less than 5cm
E) Less than 6cm
Correct Answer:
Less than 3cm
Explanation: The cervix should be greater than 3cm dilated to perform FBS
Question 56
What is the most common cause of hypercalcaemia?
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Tertiary hyperparathyroidism
D) Myeloma
E) Thyrotoxicosis
Correct Answer:
Primary hyperparathyroidism
Explanation: Primary hyperparathyroidism is the most common cause of hypercalcaemia with

incidence rates in the UK approximately 30 per 100,000
The majority of patients are postmenopausal women

Question 57
A pregnant patient who is needle phobic has her nuchal translucency (NT) scan but refuses
serum markers. You advise her the False Positive Rate of the scan is 5%. What would you
advise the mother regarding the detection rate of Down Syndrome using NT alone?
A) 40%
B) 50%
C) 70%
D) 90%
E) 95%
Correct Answer:
70%
Explanation: In the first trimester, NT combined with serum screening and maternal age has an
estimated detection rate of 85% and a 5% false positive rate for screening for trisomy 21.
To maintain an 85% detection rate with NT alone the false positive rate (FPR) would jump to
20%.
At 5% FPR the detection rate will be around 70% (multiple studies quote figures ranging from
62‐88% but the consensus is around 70%)
Question 58
A patient who has been seen in fertility clinic phones regarding the timing of her progesterone
blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her
cycle should she have the test on?
A) 7
B) 14
C) 21
D) 28
E) 35
Correct Answer:
28
Explanation: The mid‐luteal progesterone sample should be taken 7 days before the expected
period i.e. day 21 in a 28‐day cycle or day 28 of a 35 day cycle
Question 59
heartbeat and ultrasound shows a gestational sac of 27mm with no fetal pole. What is the
likely diagnosis?
A) Molar Pregnancy
B) Pregnancy of uncertain viability
C) Miscarriage
D) Pregnancy of unknown location
E) Partial Molar Pregnancy
Correct Answer:
Miscarriage
Explanation: This scan meets the diagnostic criteria for miscarriage. NICE guidelines state in this
scenario:
If the mean gestational sac diameter >/= 25.0 mm using a transvaginal ultrasound scan and
there is no visible fetal pole OR if there is a fetal pole and CRL >/= 7mm:
 seek a second opinion on the viability of the pregnancy and/or

 OR perform a second scan a minimum of 7 days after the first before making a diagnosis
Question 60
You are asked to review the serology results of a 27 year old women. She was noted to have
had deranged liver function tests. The results are as follows:
Marker Result
HBsAg Negative
Anti HBs Positive
Anti HBc Positive

C) Chronic Infection
D) Acute Infection
E) Susceptible
Correct Answer:
Immune due to past infection
Explanation: This patient has Anti HBs antibodies ‐ this suggests immunity.
Anti HBc persists for life after infection so is a marker of past infection. In this case anti HBc is
positive suggesting immunity following past infection.
Question 61
A 46 year old is being reviewed in the pre‐op clinic prior to hysterectomy. Her medical history
reveals she was diagnosed with Polymyalgia Rheumatica 18 months ago and for the past week
has also had diarrhoea. She takes the following medications:
 Omeprazole 20mg OD
 Alendrotnic acid 70mg weekly
 Calcichew D3 two tablets OD
 Prednisolone 5mg daily
 Paracetamol 1g PRN
You review her ECG below. What is the likely cause of this ECG appearance?
A) Hypercalcemia
B) Hyperkalaemia
C) Hypocalcaemia
D) Hypokalaemia
E) Hypernatraemia
Correct Answer:
Hypokalaemia
Explanation: Sodium and Calcium disturbances do not typically cause T‐wave changes. Calcium
disturbance typically causing QT interval changes.
Hyperkalaemia causes peaked T‐waves.
Hypokalaemia causes T‐wave flattening as seen here. Note this patient has been on long term
steroids and currently has diarrhoea. Both of these can cause hypokalaemia.
Question 62
Regarding CTG analysis what is considered the normal baseline fetal heart rate (FHR)?
A) 90‐120
B) 100‐160
C) 110‐180
D) 130‐160
E) 130‐180
Correct Answer:
100‐160
Explanation: The normal FHR is 100‐160
Note RCOG criteria have previously used 110‐160 however NICE guidance was updated
December 2015
Question 63
pressure is 149/98. Urine dip shows protein 3+. You send a for a protein:creatinine ratio. What
level would be diagnostic of significant proteinuria?
A) >10 mg/mmol
B) >30 mg/mmol
C) >100mg/mmol
D) >130 mg/mmol
E) >300 mg/mmol
Correct Answer:
>30 mg/mmol
Explanation: Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol

or 24‐hour urine collection result shows greater than 300 mg protein
Question 64
The graph shows the ROC curve results for 5 tests for ovarian cancer. Which is the most accurate test?
A) A
B) B
C) C
D) D
E) E
Correct Answer:
D
Explanation: When interpreting the ROC Curve the closer to the top left corner (i.e. the most area
under the curve) the more accurate the test. The closer the bottom right the worse the test.
In this case the blue line (D) represents the most accurate test and the purple line (E) the least accurate
test.
Question 65
You are reviewing a couple in the fertility clinic and note the semen analysis results are as
below:
Progressive motility 35%

Total sperm number: 42 million spermatozoa
Normal morphology: 2%
Vitality: 63% live spermatozoa
pH: 7.25
Which of these findings is abnormal?
A) Progressive motility 35%

B) Total sperm number: 42 million spermatozoa
C) Normal morphology: 2%
D) Vitality: 63% live spermatozoa
E) pH: 7.25
Correct Answer:
Normal morphology: 2%
Explanation: Normal morphology should be 4% or more

Question 66
You are called to see a 24 year old patient who is currently in labour but is failing to progress. A
fetal blood sample is sent for analysis. pH is 7.26. Which of the following is the appropriate
course of action?
A) No further action required

B) Repeat FBS in 30 minutes
C) Consent patient for C‐section delivery
D) Repeat FBS in 30 minutes if CTG remains abnormal
E) Repeat FBS in 60 minutes if CTG remains abnormal
Correct Answer:
Repeat FBS in 60 minutes if CTG remains abnormal
Explanation: This is a normal FBS result. The patient can be reassured but if the CTG remains
abnormal a further sample should be checked in 60 minutes.
Question 67
What is the normal upper limit for serum potassium concentration in an adult?
A) 3.0 mmol/l
B) 3.5 mmol/l
C) 4.5 mmol/l
D) 5.3 mmol/l
E) 6.0 mmol/l
Correct Answer:
5.3 mmol/l
Explanation: Electrolyte Balance
In 2011 UK wide reference ranges were agreed for most electrolytes as part of phase 3 of the
pathology harmony initiative (see http://www.pathologyharmony.co.uk). Although some labs
may use older reference ranges or have different ranges due to a differing testing method
those below are in line with the UK wide agreed ranges:


Sodium 133‐146 mmol/l
Potassium 3.5 ‐ 5.3 mmol/l
Urea 2.5 ‐ 7.8 mmol/l
Creatinine (male) 64 ‐ 104 mmol/l
Creatinine (female) 49 ‐ 90 mmol/l
Albumin 35‐50 g/l
Question 69
Evidence from a panel of experts is what level of evidence
A) I
B) IIb
C) IIc
D) III
E) IV
Correct Answer:
IV
Explanation: Level IV = Evidence from a panel of experts
This is the weakest form of evidence
Question 70
You are asked to review the serology results of a 35 year old women who has returned to the
UK after working in Thailand for 18 months. She was noted to have had deranged liver function
tests. The results are as follows:
Marker Result
HBsAg Positive
Anti HBs Negative
Anti HBc Positive
IgM Anti HBc Positive

C) Acute infection
D) Chronic infection
E) Susceptible
Correct Answer:
Acute infection
Explanation: This indicates acute infection. When analysing Hep B serology be systematic:
 Is the patient currently infected? If HBsAg positive the answer is yes

 Is the patient recently infected? If yes then IgM Anti HBc will be positive
 Has the patient ever been infected? Yes if Anti HBc is positive
China, Senegal, and Thailand are classed by WHO as having very high rates of hepatitis B (>8%
prevalence).
Question 70
Regarding the diagnosis of Gestational Diabetes (GD) which of the following values for OGTT is
diagnostic according to the (non‐modified) WHO criteria diagnosis?
A) FPG 5.3mmol/L; 2hour 8.6mmol/L

B) FPG 7.1mmol/L; 2hour 7.8mmol/L
C) FPG 6.1mmol/L; 2hour 7.8mmol/L
D) FPG 7.1mmol/L; 2hour 11.1mmol/L
E) FPG 6.1mmol/L; 2hour 11.1mmol/L
Correct Answer:
FPG 6.1mmol/L; 2hour 7.8mmol/L
Explanation: Diagnosis of GDM can be confusing so don't be annoyed if you were marked
incorrect on this question! There are WHO and modified WHO criteria for diagnosing
gestational diabetes. Answer B is the modified WHO whilst answer C is the WHO criteria. The
WHO is the most commonly used.
This question highlight that If you are asked in the exam it is important to read the question and
answer according to the criteria stated.
You may also be asked for the NICE criteria which were changed in February 2015. According to
NICE FPG of 5.6mmol/l or above and 2hour glucose of 7.8mmol.l or above is diagnostic.
Regarding the other options:

Random glucoses and OGTT 2 hour readings of >11.1 are diagnostic of diabetes in non‐pregnant
states but are not part of the gestational diabetes criteria
Stem A is part of the criteria of American College of Obstetricians and Gynaecologists (ACOG)
which is different to the WHO criteria
GDM Diagnostic Criteria FPG greater than (mmol/l) 2 hour Glucose greater than(mmol/l)
NICE 5.6 7.8
WHO 6.1 7.8
Modified WHO 7.1 7.8
Question 71
A 46 year old is being reviewed in the pre‐op clinic prior to hysterectomy. Her medical history
reveals she was diagnosed with Polymyalgia Rheumatica 18 months ago and takes the following
medications:
 Omeprazole 20mg OD
 Alendrotnic acid 70mg weekly
 Calcichew D3 two tablets OD
 Prednisolone 3mg daily
 Paracetamol 1g PRN
Her blood results come back as follows:

+
K 3.3 mmol/l ref range 3.5‐5.5
Glucose 4.9 mmol/l
What is the likely cause of these results?
A) Chronic renal failure

B) Acute renal failure
C) Bisphosphonate use
D) Steroid use
E) Haemolysed sample
Correct Answer:
Steroid use
Explanation: This patient has hypokalaemia. The U&Es do not support the diagnosis of renal
failure as she has normal urea and creatinine. Bisphosphonates do not typically cause
hypokalaemia. Haemolysed samples usually cause raised potassium.
Steroids increase potassium excretion from the kidney and are a recognised cause of
hypokalaemia (usually mild)

5 - Data Interpretation - PASS - MRCOG 2017

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PASS‐MRCOG | Data Interpretation

A) 1.5 million million spermatozoa per ml

Explanation: Semen Analysis

 Semen volume: Greater than or equal to 1.5 ml

Corrected Calcium 3.0 mmol/l (Reference range 2.20 ‐2.60)

What is the likely diagnosis?

Explanation: There are a number of approaches to interpreting hypercalcemia results. One

Evidence from a single randomised control trial is what level of evidence

Plasma typically accounts for what percentage of body weight?

Explanation: Total body water accounts for 60% of body weight.

fasting plasma glucose 5.9 mmol/l

What does this result show?

A) No evidence gestational diabetes

a fasting plasma glucose level of 5.6 mmol/litre or above

With regard to the spirometry trace below:

Image sourced from Wikipedia

What lung volume is represented by E?

D) Inspiratory reserve volume

What is the most likely cause of her subfertility?

A) Their presence is abnormal

With regard to the spirometry trace below:

Image sourced from Wikipedia

What lung volume is represented by B?

Explanation: Endometrioma (AKA chocolate cyst) is defined as a blood‐containing pseudocyst

Typical ultrasound features of endometrioma are:

 Diffuse homogeneous low level echoes

 Echoes sometimes described as "ground glass' the result of haemorrhagic material

 Ground glass echogenicity

Evidence from meta‐analysis of RCTs is what level of evidence?

Explanation: Ia = Evidence from Meta‐analysis of Randomized Controlled Trials

Hb 10.2 g/l reference range 11.5 to 16.5

Creatinine 54 umol/l reference range 45 to 90

What is the likely cause?

 Seek a second opinion

With regard to the spirometry trace below:

Image sourced from Wikipedia

What lung volume is represented by C?

A) Admit for observation

Explanation: It is important to be aware of the difference between management of simple

fasting plasma glucose 5.5 mmol/l

What does this result show?

A) No evidence gestational diabetes

C) Impaired glucose tolerance

a fasting plasma glucose level of 5.6 mmol/litre or above

Regarding CTG (cardiotocography) analysis of variability which of the following would be

A) >15 bpm for 90 mins

Explanation: See the tables below.

Which of the following is the major intracellular cation?

 Intracellular fluid 40% of body weight

 Sodium (Na) main cation

 Potassium (K) main cation

Polyhydramnios is defined as an amniotic fluid index of?

 Oligohydramnios AFI< 5cm or deepest amniotic fluid pocket < 2cm

What does this indicate regarding her hepatitis B status?

A) Immune due to past infection

 Is the patient currently infected? if HBsAg positive the answer is yes

Explanation: Features of mucinous cyst adenoma are:

Note : Serous cyst adenomas are usually unilocular

With regard to the spirometry trace below:

Image sourced from Wikipedia

What lung volume is represented by D?

Explanation: Fetal Blood Sampling (FBS)

Indications for FBS