Get through MRCOG Part 2 : SBAs

221 Pages·2018·1.093 MB·English

by  Hollingworth, Tony, Kalidindi, Madhavi, Wuntakal, Rekha

GET
THROUGH
MRCOG Part 2:
SBAs

GET
THROUGH
MRCOG Part 2:
SBAs
Rekha Wuntakal, MBBS, MD, DNB, MRCOG, DFFP
Consultant in Gynaecological Oncology and Gynaecology
Department of Obstetrics and Gynaecology, Queen’s Hospital
BHR University Hospitals NHS Trust, London
Madhavi Kalidindi, MRCOG
Consultant Obstetrician and Gynaecologist
Queen’s Hospital, BHR University Hospitals
NHS Trust, London
Tony Hollingworth, MB ChB, PhD, MBA, FRCS(Ed), FRCOG
Consultant in Obstetrics and Gynaecology
Whipps Cross Hospital, Barts Health NHS Trust
and
Senior Research Fellow
Centre for Cancer Prevention
Wolfson Institute of Preventive Medicine
QMUL, London
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Library of Congress Cataloging-in-Publication Data
Names: Wuntakal, Rekha, author. | Kalidindi, Madhavi, author. | Hollingworth, Tony, author.
Title: Get through MRCOG Part 2 : SBAs / by Rekha Wuntakal, Madhavi Kalidindi
and Tony Hollingworth.
Description: Boca Raton, FL : CRC Press, [2018] | Includes bibliographical references and index.
Identifiers: LCCN 2018000007| ISBN 9781138482128 (hardback : alk. paper) |
ISBN 9781498724012 (paperback : alk. paper) | ISBN 9781351058612 (eBook)
Subjects: | MESH: Obstetrics | Gynecology | United Kingdom | Examination Questions
Classification: LCC RG111 | NLM WQ 18.2 | DDC 618.10076--dc23
LC record available at https://lccn.loc.gov/2018000007
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CONTENTS
1 Maternal medicine 1
Questions 1
Answers 8
2 Antenatal care 21
Questions 21
Answers 29
3 Postpartum problems (the puerperium) 43
Questions 43
Answers 47
4 Ethics and legal issues and consent 55
Questions 55
Answers 58
5 Medical statistics 63
Questions 63
Answers 66
6 Management of labour and delivery 71
Questions 71
Answers 77
7 Gynaecological oncology 87
Questions 87
Answers 92
8 Gynaecological problems 113
Questions 113
Answers 117
9 Contraception 137
Questions 137
Answers 141
v
C 10 Sexual and reproductive health 151
O
N Questions 151
T
E Answers 154
N
T
S 11 Genetic problems 165
Questions 165
Answers 168
12 Reproductive medicine or subfertility 177
Questions 177
Answers 180
13 Surgical procedures and core surgical skills 187
Questions 187
Answers 190
14 Post-operative complications 199
Questions 199
Answers 201
Index 205
vi
1
MATERNAL
MEDICINE
Questions
THYROID
1. A 36-year-old woman with known hypothyroidism has been taking
levothyroxine 100 micrograms once a day. Her most recent thyroid function
tests performed 3 months ago were normal with a thyrotropin (TSH) of
2.5 mU/L. She has come to the early pregnancy unit with abdominal pain and
a positive pregnancy test. Transvaginal ultrasound confirmed an intrauterine
pregnancy.
How would you advise with regards to her levothyroxine dosage?
a. Decrease dose to 75 micrograms per day
b. Decrease dose to 50 micrograms per day
c. No change required
d. Increase dose to 125 micrograms per day
e. Increase dose to 150 micrograms per day
2. A 25-year-old woman known to have hyperthyroidism is going for radioactive
iodine therapy. She has been trying to conceive for the last 6 months.
How long should she avoid pregnancy after this treatment?
a. 3 months
b. 6 months
c. 9 months
d. 12 months
e. 15 months
3. A 28-year-old para 1 woman at 40 weeks’ gestation delivered a baby with a
skin condition, diagnosed as ‘Aplasia cutis congenita’. She is known to have
hyperthyroidism secondary to Grave disease and has been on anti-thyroid
medication throughout the pregnancy.
Which one of the medications below is known to cause the above
condition?
a. Carbimazole
b. Hydrouracil
1
C c. Levothyroxine
h d. Methythiouracil
a
p e. Propylthiouracil
t
e
r
1
RENAL DISEASE IN PREGNANCY
M
A
T
E
R 4. A 38-year-old nulliparous woman with moderate chronic renal failure
N
A comes to the preconception clinic as she wishes to have a baby. She had
L
M renal transplantation 3 years ago and her recent creatinine is around 130
E with estimated glomerular filtration rate (GFR) of approximately 45. She
D
IC is currently taking prednisolone, mycophenolate, angiotensin-converting
IN enzyme (ACE) inhibitors and aspirin. You have advised her to stop
E
mycophenolate and to start another immunosuppressant.
Which one of the immunosuppressant drugs would be contraindicated in
pregnancy?
a. Azathioprine
b. Cyclosporine
c. Hydroxychloroquine
d. Sirolimus
e. Tacrolimus
5. A 25-year-old para 1 woman at 30 weeks’ gestation was brought in to the
Obstetric day assessment unit with abdominal and back pains, vomiting and
feeling unwell. Her observations are temperature 38.2°C, pulse 110 bpm, blood
pressure (BP) 100/60 mm Hg, respiratory rate 18/min and oxygen saturations
98% on room air. On examination, she has suprapubic and right flank
tenderness with 3+ leucocytes and positive nitrates on urine dipsticks. Foetal
movements were good and cardiotocography was normal. You have admitted
her and started broad spectrum intravenous antibiotics for acute pyelonephritis
after doing the septic screen.
What is the recurrence rate of pyelonephritis during the pregnancy?
a. 5%
b. 10%
c. 15%
d. 20%
e. 25%
RENAL TRANSPLANTATION
6. A 35-year-old nulliparous woman with chronic renal failure had a successful
renal transplantation surgery recently. She wishes to have children in the
future and her GP has referred for preconception advice.
What is the recommended time interval for conception after an allograft
transplantation?
a. 6 months
2
b. 12 months C
h
c. 18 months a
p
d. 24 months t
e
e. 30 months r 1

M
DERMATOLOGICAL CONDITIONS IN A
T
E
PREGNANCY R
N
A
L
Skin M
E
D
IC
7. A 28-year-old woman at 32 weeks’ gestation in her first pregnancy presented
IN
with a rash and itching on the abdomen, trunk, legs and hands. On E
examination, there were vesicles and bullae. A diagnosis of pemphigoid
gestationis was made by the dermatologists after skin biopsies.
Which one of the following statements is true about pemphigoid
gestationis?
a. Associated with other autoimmune diseases
b. Most common dermatosis of pregnancy
c. Not associated with any adverse effect on mother or foetus
d. Rash usually begins in the abdomen with periumbilical sparing
e. Recurrence in subsequent pregnancies is rare
8. A 30-year-old primigravida at 35 weeks’ gestation with monochorionic
diamniotic pregnancy presents with intense itching and rash on the abdomen.
On examination there were erythematous papules and plaques in the striae
gravidarum with umbilical sparing.
The most likely diagnosis is which one of the following?
a. Pemphigoid gestationis
b. Polymorphic eruption of pregnancy
c. Atopic eruption of pregnancy
d. Prurigo of pregnancy
e. Pruritic folliculitis of pregnancy
GASTROINTESTINAL TRACT (GIT) AND LIVER
9. A 34-year-old woman at 36 weeks’ gestation was admitted with feeling
unwell, vomiting and right-sided upper abdominal pain. On examination
she was tender in the right upper quadrant with BP 140/90 mm Hg, pulse
90 bpm, temperature 37.6°C and protein 1+ in the urine. Her Hb was 128 g/L,
platelets 160, white blood cell (WBC) count was elevated at 18, liver function
was deranged with hyperbilirubinaemia and moderately raised alanine
aminotransferase (ALT) and aspartate aminotransferase (AST). She was
hypoglycaemic and clotting was mildly deranged with prolonged prothrombin
time (PT) and activated partial thromboplastin time (aPTT). Renal function
and liver scan were normal.
3