Jan – 2018 Recalls-MRCOG 2 ( Paper 1)

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

A) 5 percent
B 10 percent
C) 20 percent
D) 30 percent
E) 40 percent

2) Normal cytology,hpv positive( 16 & 18) with vulval irritation. which most likely vulval
pathology can arise?
a) Verruca vulgaris
b) Basaloid carcinoma
c) Lichen Planus
d) Lichen simplex
e) Lichen Sclerosus
3) Severe dyskaryosis on cytology, for colposcopy , appropriate treatment ?
a) LLETZ
b) Punch biopsies
c) Hystrectomy
d) Repeat smear in 6 months
4) Described about PCOS and asked about Obstuctive sleep apnea is a risk factor for?
a) Cardiovascular
b) Dementia
c) Type 2 DM
d) Pulmonary obstructive disease
e) Respiratory acidosis
5) A study conducted to see whether the method of induction of labour influences the
mode of delivery? Which type of data is mode of delivery?
a) Nominal
b) Ordinal
c) Interval
d) Binary
e) Ratio

6) Scenario was of a unit where in-patient stay was longer than national standards. Which
is part of ERS?
a) Abdominal drains
b) Fasting for 4 hours
 c) Regional anaesthesia not beneficial
d) Complex carbohydrate drinks before major gynae surgery.
e) Clear Fluids before 4 hrs of surgery

14) Inferior Epigatric A , Branch of which Artery?

a) External Iliac Artery
b) Internal pudendal A
c) Internal Iliac A
d) Femoral A

15) Patient with history of midline laparotomy admitted for laparoscopy. What is the
incidence of infra umbilical adhesion?

a) 30%
b) 40%
c) 50%
d) 60%
Answer : C
16) The study has been carried out to know the effect of drug. The people are paid for
expenses to participate in the study. However they’ve not informed about a group of people
will be receiving the placebo. Which ethical issue arise later?
a) Failure to gain consent
b) Inadequate information for consent
c) Conflict of interest
d) Indused to participate in the study
17) MRCOG part 2 written & OSCE, what type of assessment?
a) Formative & Formative
b) Summative & Formative
C) Formative & Summative
d) Summative & Summative ( Ans)
20) Obese diabetic women on metformin & chronic smoker underwent underwent TAH &
BSO 4 ½ hrs back, surgery at 12.00pm called at 5.15 pm & c/o abdominal pain, discomfort.
Abdomen is soft & non tender. MEOWS observation chart given. The chart shows Initial BP
90/50-60, then maintained on 110 - 100/60, mild tachycardia by 4 pm Patient was on Patient
Controlled Analgesia – given 23mg on 4.15pm, 28mg on 4.30 pm, 5.30 pm 18 mg, temp 37 at
4.45pm, hypothermia at 5 pm, alert respond to voice, Spo2 & Urine output normal , O2 flow
4L/min initially then from 6L/min. Which of the following will you suspect?
a) Internal bleeding
b) Over dose morphine
c) Pulmonary embolus
d) Sepsis
e) Diabetic Ketoacidosis
Answer : E

21) Ovarian tumour Operated & reported as Granulosa cell tumor. During follow up for
recurrence ,which markers are used?
a) CA125
b) Alpha fetoprotein
c) Inhibin
d) B Hcg
e) LDH

22) Patient with family history ovarian ca and found to have BRCA1 and BRCA2 positive.
Which type is most commonly found?
a) Endometroid carcinoma
b) Low grade serious
c) High grade serious
d) Mucinous carcinoma
23) Endometrial hyperplasia with atypia. Risk of progression to carcinoma?
a) 5%
b) 10%
c) 15%
d) 25%
e) 30%
f) 40%

24) Perimenopausal lady with confirmed stress urinary incontinence does not want
surgery with mesh. Whish of the following is the better surgical alternative for her?

a) Paraurethral bulking agent

b)Marchall Marchenti Kranz
c) Paravaginal defect repair
d) needle suspension procedure
e) Anterior colporraphy
 25) Postoperative patient, 18 hrs on Patient Controlled Analgesia , noticed RR12, BP
80/40& Spo2 normal . She soon collapsed with pinpoint pupil. What to give?
a) Adrenaline
b) Naloxone
c) Atropine
d) DC shock
e) Intralipid
26) Women with Epilepsy on Antiepileptic, requested for COC pills. Which AED concentration is
affected by COCs ?
a) Carbamazepine
b) Phenytoin
c) Lamotrigene
d) Phenobarbitone

27) Statistical study which compares the rate of blood transfusion in CS vs Vaginal
delivery. Result interpreted as Blood transfusion rate is higher in vaginal delivery is
more compared to CS. Which is against this study?
No of women Elective CS (around 30 tsd) planned VD ( around 3lac)
( VD & Emergency CS)
No of BT 1.75% 2.25% P < 0.01
a) Not statistically significant
b) Wrong interpretation of test
c) Small sample size
d) Not a Intention to treat analysis
e) Repeat the test with different sample size

28) Perimenopausal Women operated TAH +BSO for endometrial hyperplasia with
atypia . HPE reported as Grade 1 Endometrioid carcinoma with no involvement of
myometrium. What postoperative adjuvant therapy will you advice?
a) Do nothing
b) Chemotherapy
c) Pelvic RT
d) Vaginal brachytherapy
29) MC site of Uterine perforation after TOP
a) Anterior wall
b) Cervix
c) Fundus
d) Posterior wall
30) 60yr old with 3 month h/o vulval itching treated with topical & oral fluconazole, but
no improvement O/E thinned skin , Fused labia. Next step in treatment?
a) High potent steroids
b) Antibiotics
c) Lubricants

31) Post menopausal women with Vulval itching, O/E 1 cm lesion near clitoral hood .
next step in management ?
a) Keyes punch biopsy
b) Wide local excision
c) Excisional biopsy
d) Vulvectomy
32) Which is the most sensitive test for chlamydia testing?
a) Point of Care testing
b) NAAT

33) Women underwent laparoscopic Salpingectomy for ectopic and in histopathology

report came as minimal decidual tissue found. Which is the most cost effective
option?
a) TVS after 7 days
b) B HCG 48 hrs later
c) Pregnancy test after 7 days
d) TVS after 3 weeks
34) Most sensitive and specific ECG Marker for Acute Myocardial Infarction?
a) ST elevation
b) ST depression
c) New onset Q wave
d) Symmetrical T wave inversion
35) Symptoms of OAB who drinks decaffeinated drinks. What is the first line of
management?
a) Bladder retraining
b) Fluid modification
c) Antimuscarinics
36) Women with dyspaurenia & chronic pelvic pain,Recurrent Microscopic haematuria
with painful bladder filling during urodynamic and haemorrhagic spots on
cystoscopy. What is the probable diagnosis?
a) Bladder pain syndrome
 b) Chronic cystitis
c) Interstitial cystitis
d) Bladder tumour
37) Incidence of uterine perforation after Surgical evacuation?
a) 2/1000
b) 4/1000
c) 5/1000
d) 10/1000

38) Lady suffering from stress incontinence tried PFMT, no improvement. Not willing for
Midvaginal tapes or any other procedures. Asking for medicines to control her
symptoms. Which one will you prescribe?
a) Darifenacin
b) Duloxetine
c) Tolterodine
d) Oxybutinin
39) 65 yr old lady with OAB symptoms tried 3 antimuscarinics, what is the next
appropriate management?
a) Trospium
b) Mirabegron
c) Desmopressin
d) Imipramine

40) Young Patient with left sided abdominal pain, scan shows 3. 5cm cyst with ground
glass appearances. What is the best management?
a) Reassure

b) Ovarian Cystectomy

c) Cyst drainage

d) Excision of cyst wall

41) Infertile women underwent laparoscopic salpingectomy in some other hospital for
Hydrosalpinx before IVF. She is not having any records. 6 hrs later, she attended
A&E dept with c/o severe abdominal pain & reduced urine output. O/Eof abdomen
– tenderness & shifting dullness +
 Investigations revealed Urea & creatinine raised. What is the most probable
complication?
a) Internal bleeding
b) Bowel injury
c) Ureter injury/ bladder injury.
d) Ureteric Thermal injury
e) Acute Renal Failure
42) Women with IUCD insitu came for cervical smear follow up. Cytology shows normal
smear with Actinomycosis organism. What is the next appropriate management?
a) Remove IUCD
b) Antibiotics
c) Reassure
43) GP called you and informed that lady with SLE with flare on glucocorticoid +&
methotrexate. Developed herpes like lesion with difficulty in passing urine &
palpable bladder . next step?
a) Admit in gynec as emergeny
b) Prescibe tab.acyclovir
c) Refer to GUM clinic
d) Refer to Urologist
44) 16 yr old with 28 days regular cycle cycle came to sexual clinic on D 20 with h/o
condom rupture a day before .she took LNG EC on D13 for UPSI & then using
condoms daily . She is worried & asking your advice.
a) Cu IUD
b) Reassure
c) LNG IUS
d) LNG EC
e) UPA EC
45) Clinical scenario of OHSS presented with persistent oliguria despite fluid
replacement. Next line of management?
a) Diuretics
b) Paracentesis
c) Dialysis
d) Reassure

46) 17 year old asking for surgical TOP. She admits ‘’ Cutting ‘’ in childhood.O/E Labia
majora& minora partly removed & labia majora sutured together & allowing tip of
finger for examination. Type of FGM?
a) Type 1
 b) Type 2
c) Type 3
d) Type 4
e) Not classified as FGM
47) 44 yr old cytology report came as Mild dyskaryosis with negative HPV. What is the
next step?
a) Routine recall after 5 years
b) Routine recall after 3 years
c) Colposcopy
d) LLETZ
48) Lady with 6 weeks amenorrhoea, Urine Pregnancy test is positive with Mild
abdominal pain & spotting pv. TVS shows thickened endometrium with ill defined
mass with echogenic rim ( Dough nut sign) with in the ovary. B HCG 2050. What is
the next apporiate step?
a) Laparosocopic salphingectomy
b) B HCG 48 hrs later
c) Systemic methotrexate
d) Lapaoscopic Salphingotomy
49) According to NICE, first line management for HMB
a) COC
b) LNG IUS
c) DMPA
d) NET EN
50) pregnant women at 17wks , diagnosed as Cervical ca Stage 1a1. What is the
most appropriate treatment?
a) LLETZ
b) Laparoscopic Hystrectomy
c) LH + BSO
d) RH + BSO
e) Radical Trachelectomy

EMQS

A. Ovarian Cysts
 1) Postmenopausal women came for USG follow up of asymptomatic ovarian cyst , scan
shows simple cyst of 4cm size , the similar findings noticed 4 months back. What is the
next course of action?
2) Pregnant women, scan shows 6 weeks intrauterine pregnancy with left sided 6 cm
ovarian cyst ( description of dermoid cyst). No symptoms.Next step in the
management?
3) Postmenopausal women with asymptomatic multiloculated unilateral cyst of 4cm
size. Next step in the management?
4) Postmenopausal women underwent USG requested by urologist. Found 3.5cm simple
anechoic cyst in Right ovary. Immediate line of management?
a) laparotomy with full staging with gynae oncology
b) Annual scans
c) Laparoscopic bilateral Oophrectomy
d) Laparoscopic unilateral Oophrectomy
e) Rescan after 6 weeks
f) Rescan after delivary
g) Rescan after 3 – 4 months
h) Laparotomy & ovarian cystectomy
i) Reassure
B. Relevant association
5) Obese hirsute women with oligomenorrhoea & recurrent vaginal candidiasis ,family
history of type 2 diabetes.
Acnathosis Nigricans
(Sorry I couldn’t remember 2more scenarios & options too)

c. Urogynaecolgy

6. 28yr old Primi, delivered 4 months back vaginally now c/o involuntary leakage on
straining.

Urodynamics Confirmed GSI. Next appropriate management?

7. 70 yrs old C/O nocturia, frequency, urgency with urge incontinence & incontinence on
coughing.

What is the First line treatment?

8. 56 yrs old Multiple sclerosis is having difficulty in passing urine

a) UB retraining 6wks
b) Administer antimuscarinics
 c) PFMT
d) Antimuscarinics , bladder retraining & PFMT
e) Antimuscarinics , Bladder retraining
f) Bladder retraining & PFMT
g) TOT
h) TVT
i) Burch colposuspension
j) Reassure
k) Botulinum toxin intravesical injection
l) Supra pubic catheter
m) Clean Intermittent Self Catherisation

D. Arterial bleeding

9. Lap salphingectomy done, peroperative assured haemostasis is secure. Post operative

period went hypovolemic shock.

10. SSF while taking bite, bleeding noticed

a) Internal Iliac Artery

b) Inferior epigatric artery

c) Inferior gluteal artery

d) Internal Pudendal Artery

e) Superior gluteal Artery

E. Surgical instruments with pictures & name ( pics are not clear, always try to remember
names)

11. Uterine A ligation during TAH

12. Round ligament ligation during TAH

a) Moyinhan’s forceps

b) Gwilliams clamp

c) Babcocks forceps

d) Littlewood forceps
 e) Allis forceps

f) lahey forceps

F. Oligomenorrhoea

13. 20yrs old with 18 months amenorrhoea, fatigue and intermittent headaches. Otherwise
fit & healthy, FSH 28 LH 14 prolactin 600mU/l. What will be the next investigation?

14 ) 35yrs old trying for conception presented with Increasing weight gain , oligomenorrhea.
Next appropriate test for this women?

15) A couple came for secondary infertility workup. She is having amenorrhea for 6 months.
H/O surgical management of miscarriage twice for retained products. she is a marathon athlete
& her BMI 21. FSH & LH normal. Estradiol 220pmol. What is the next line of investigation?

a) Free Androgen Index

b) MRI pituitary

c) MRI Pelvis

d) Progesterone Challenge Test

e) Synacten test

f) Thyroid Function test

g) Serum Prolactin

h) Repeat FSH after 7 days

i) Repeat FSH & LH at 1-5 days of period

j) Karyotyping
G. Short Term Complication if left untreated/ refused treatment

15. 26 wks size fibroid with bleeding and USG shows unilateral mild hydronephrosis Hb
95g/l, patient looking pale & lethargic

16. BMI 40 kg/m2 , smokes 20-30 cigarretes per day with Ca cervix Stage 2 B

17. IUCD with PID features, antibiotics started not responding even after 3 days. Not
willing for removal. Swab found isolated species of bacteroides fragilis.
 a) Circulatory collapse

b) Renal failure

c) PID

d) Severe anaemia

e) Death

f) Jaundice

g) Pelvic abscess

h) Chronic pelvic pain

i) Sepsis

j) Peritonitis

k) CVA

H. Antibiotic Prophylaxis

18. Patient undergoing VH & PFR with DM & Atelectasis

19. Patient with mechanical mitral valve replacement on Warfarin , planned for TAH

for Menorrhagia

20. PMB Posted for Hystrescopy & EMB

a) Amoxicillin 1 gm orally 1hr before procedure

b) Amoxicillin 2gm orally 1 hr before procedure

c) Inj Ampi 1gm & GM 120mg just before procdure and Inj Ampi 1gm 6 hrs post

procedure

d) Inj Vancomycin 1gm with in 30 min start of procdure

e) No Antibiotic Prophylaxis

f) Inj Cefuroxime 1.5gm + Inj.Metronidazole 500mg iv

 I. Assesment

21. A summative assesment tool, help to assess the cognitive, psychomotor skills ,

attitude domain on a whole curriculum/ wide areas

22. A formative assessment tool to assess the trainee’s knowledge about cognitive,

psychomotor skills , attitude domain on a specific clinical task

23. A formative or summative assessment tool to assess the clinical practice of

certain task

a) NOTSS

b) MCQs

c) OSATS

d) OSCE

e) CbD

f) MiniCEX

g) Annual Carrier Progression

h) SBAs

J. Vulval lesions
Probable diagnosis for the following vulval lesions?
24) 16yr old with acute retention of urine with swollen vulva doesn’t allow for
examination.
25) Sexually active women with multiple shallow ulcers in the vulva & inner thigh
26) 20 yr old just returned from Australia trip, complained “ Some lumps like
feeling from
down” O/E multiple sessile lesions 1 cm in size over the vulva & perineum
which is
neither ulcerated nor painful .
a) Listeriosis
b) Herpes simplex
c) Lymphogranuloma Venerum
 d) Cutenaeous leishmaniasis
e) Vulval warts
f) Dubin Johnson syndrome
g) Steven Johnson syndrome
h) Candidiasis
i) Primary Syphilis
j) Secondary Syphilis
k) Chancroid

K. Male infertility

27) An obese men with frontal balding, father of 2 child, on infertility workup found to
have azospermia & erectile dysfunction.
LH & FSH = 1.2 and testosterone level = 6nmol (low). Which other tests one would do?
28) A couple came for infertility workup, investigations for female partner found to be
normal. Semen analysis shows 6 million count, 45% motility, 5% normal morphology. What
is the next appropriate management?
a) Karyotyping
b) Smell test
c) Repeat semen analysis after 3months
d) Repeat semen analysis immediately
e) Injection Testosterone im
f) Thyroid function tests
g) Serum Prolactin
h) OGTT
i) Testicular biopsy
j) Antisperm antibodies
k) Serum prolactin
L. Probable Clinical findings
29) 35 yrs old presented with intermentrual & post coital bleeding P/V
30) Women c/o vulval irritation, soreness and severe dyspaurenia despite use of
lubricants. Not noticed any discharge pv. Occasional Post coital bleeding is also noticed.
What you expect in clinical examination?
31) Sexually active women c/o burning sensation in vulva & dysuria. Also having
flu like symptoms. Which findings will you likely see in examination?

a) Craggy cervix
b) Abnormal cervix
 c) Strawberry cervix
d) Multiple shallow ulcers
e) Vagina inflamed with white plaques
f) Cervical polyp
g) Endometrial polyp

M. Research

32) A study is carried out to see the effectiveness of sutures & technique used
for third & fourth degree perineal tears by senior consultant over the last 2 years. The results
are compared against RCOG basic standards.
33) A group of doctors want to review the literature about Mirena use in
HMB

a) Audit
b) Cohort study
c) Randomized control study
d) Meta analysis
e) Systematic review
f) Reverse benchmarking audit
g) Prospective case control study
h) Retrospective cohort study
N. Post op Complications
Post TAH
34. Day 0 , 6 hrs, HR 106bpm, BP 110/70mmhg, abdomen soft & non
tender. Urine output slightly reduced.
35. Obese Chronic smoker post op D 3 clinically unwell with fever &
tachypneic.
36. Day 3, patient feeling unwell c/o abdominal & back pain request
excessive analgesia. Also noticed mild oliguria. Abdomen soft & not
distended.

a) Acute renal failure

b) Bilateral ureteric obstruction
c) Vault haematoma
d) Urinary fistula
e) Urinary tract infection
 f) Infected vault haematoma
g) Internal bleeding
h) Fluid overload
i) Fluid undercorrection
j) Chest infection
k) Pulmonary embolism

O. Infertility Complications

37) PCOS women took Clomid tab 50mg come on D 21 for Serum Progesterone,
c/o tightness of jeans & minimal abdominal discomfort

38) Infertile women came back from spain after 20 oocycte retrival and
discharged on same day, only had mild abdominal discomfort , fly back to uk in 8hrs . She woke
up from the sleep in early morning experienced sudden severe abdominal pain & vomiting .

a) Ruptured ovarian cyst

b) Bowel injury
c) OHSS
d) Ovarian torsion
P. Early pregnancy complications
Probable diagnosis for the following case scenarios
39) PCOS women with 2months amenorrhoea c/o brownish discharge & mild
right iliac fossa pain. Urine pregnancy test positive. USG shows central fluid filled sac of
8mm with irregular mass with mixed echoes of 45*34mm near the right ovary. B HCG 2142
iu/l. minimal free fluid in POD

40) Infertile women trying for past 3 years having regular cycles, c/o 6 -7
weeks amenorrhea & mild bleeding pv. Urine pregnancy test positive. USG shows no
evidence of intrauterine gestational sac & ill defined mass of 18* 12mm in the right adnexa.
Both ovaries are not visuvalized. B HCG 1057 iu/l. No free fluid in the POD
41) 32 year old P3 had 2 embryos transfer as she is a surrogate for her sister,
scan done last week ago confirmed viable IU pregnancy. Now c/o acute onset of right sided
abdominal pain, Usg shows viable IU pregnancy & complex mass??? size in the right adnexa,
minimal free fluid in the POD.
a) Too early to confirm as ectopic pregnancy

b) Ectopic pregnancy with failing trophoblast

 c) Heterotopic pregnancy

d) Ruptured ovarian cyst

e) Haemorrhagic corpus luteal cyst

f) Tubal ectopic pregnancy

g) Ovarian torsion

h) Viable intrauterine pregnancy with corpus luteal cyst

i) Pregnancy of unknown location

Q . Surgical steps

Consultant is teaching FY1 trainee while doing Total Abdominal Hysterectomy with
ovarian conservation. What will be expected next step?
42) He has opened the abdomen by low transverse incision. The operating fields are
determined.
43) He has completed the procedure. Estimated blood loss around 600ml. suturing of
vault is done.
a) Inspect uterus , adnexa , POD
b) Clamp & cut round ligament
c) Clamp & cut fallopian tubes
d) Identify the course of ureter
e) Clamp & cut the Infundibulo pelvic ligament
f) Check haemostasis of all pedicles
g) Close peritoneum and put abdominal drain
h) ligation of broad ligament
i) Close the abdomen & keep rectus sheath drain
j) Dissection of bladder peritoneum

h) Packing of bowel

L. Endometrial Hyperplasia

44) 52yr old BMI 36kg/m2 undergone polypectomy removal by hysteroscopy. HPE
shows Endometrial Hyperplaia without atypia. What is the next appropriate management?
45) 39 year old operated for breast ca & taking Tamoxifen since 10yrs, refer by
urologist for abdominal USG. The scan shows endometrial thickness of 22 mm . what will
be the next appropriate management?
 46) 65yr old Postmenopausal bleeding, USG shows ET 4.5mm. Atrophic changes
noticed in hysteroscopy. Endometrial sampling report came as insufficient endometrium.
Now she is asymptomatic.Next line of management?
47) 35 yr old BMI 40kg/m2 , smoker fitted with LNG IUS for endometrial
hyperplasia without atypia in another centre. Now came to you, How will you follow up her?

a) Outpatient Endometrial sampling after 6mnths

b) Outpatient Endometrial sampling after 3 months
c) CT abdomen & pelvis
d) MRI abdomen & pelvis
e) Trans Vaginal Scan
f) Hysteroscopy & EMB
g) Reassure
h) Fractional curettage
i) Annual endometrial sampling
j) Report if symptom recurs
k) Rescan after 1 month
l) Rescan after 3 months
m) Rescan after 4 months

Note : Many questions including SBA, long exhausting scenarios and many distractors ( like lead
in will be entirely different to the scenario).

Thanks to all who has shared.

Special Thanks to Reham Tuaimah
Sameena Noor
Bushra
Ammara Kasif
Rukshana
Maimoona
Hend
Nagwa
Indira Murugan
Subashini
Forgive me if I’ve done mistakes. Awaiting for the suggetions.

Best of Luck to all

Dr Maheswari