Demo MOCK 2 – MRCOG 2 Show session ID Load progressSave Session Correct0Incorrect0Skipped0 Welcome to your Demo MOCK 2 - MRCOG 2 Name Email 1. A 35-year-old woman with a previous history of one spontaneous vaginal delivery, followed by two caesarean sections for breech babies attends the clinic to discuss delivery of her fourth child. If the baby is cephalic at term she would like to try for a vaginal delivery. During your counselling you mention the risk factors for uterine rupture during VBAC. Which one of the following options does NOT increase the risk of uterine rupture? Induction of labour Fetal macrosomia Preterm labour Shorter inter-delivery interval Two or more previous caesarean sections None 2. A healthy 35-year-old woman attends the antenatal clinic at 37 weeks gestation in her third pregnancy. She has had two previous caesarean sections for breech presentation, but the current preg- nancy has a cephalic presentation and she would like to have a vaginal birth after caesarean (VBAC). What would be the risk of uterine rupture if she labours with such a history? 4.8–6.7% 2.5–3.1% 0.9–1.8% 0.7–0.9% 0.4–0.5% None 3. History of previous vaginal birth in a woman with a caesarean section attempting to deliver vaginally is associated with the planned VBAC success rate of: 99% 85–90 % 72–76 % 60–67 % 50% None 4. 40 year old previous normal vaginal delivery at age of 17 years. One csection at age of 38 yrs. Currently 28 weeks pregnant. She is not sure if she wants to try for vaginal delivery or elective c section. She wants to know what her chance of death if she has csection. 5/100000 13/100000 1/100000 11 /100000 15/100000 None 5. Ms XY is a G3P2 at 30 weeks with a previous CS done 3 years ago for presumed fetal distress. She would like to attempt a VBAC this time. What success rate would you quote for VBAC? >90% 80–85 % 87–90 % 75–80 % 72–75 % None 6. In counselling women regarding the risks of vaginal delivery on the background of one previous caesarean section, which one of the following would not generally be considered an absolute contraindication to a VBAC attempt? Twin pregnancy A previous classical caesarean section Previous uterine rupture A previous T-shaped incision Low-lying placenta at term None 7. A 42-year-old woman is 39 weeks gestation in her second pregnancy having had a prior emergency caesarean section for fetal distress three years earlier. She is keen to give birth vaginally but is requesting induction of labour because of concerns regarding the increased risk of perinatal mortality associated with her age. What is the most appropriate method of induction to minimise the risk of uterine rupture in labour? Misoprostol Transcervical Foley catheter Dinoprostone Oxytocin alone Amniotomy and oxytocin None 8. What is the single best predictor for a successful VBAC? Epidural analgesia Spontaneous labour Previous caesarean section at full dilatation (d) BMI <30 Previous vaginal birth Estimated fetal weight None 9. A 34-year-old woman presents in spontaneous labour at 38 weeks gestation in her second pregnancy, having had a previous prelabour caesarean section for breech presentation. In the first stage of labour, she develops continuous lower abdominal pain and a tachycardia. The fetal heart rate becomes bradycardic. She is delivered by urgent (category1) caesarean section and uterine rupture is confirmed. What is the risk of perinatal mortality? 5% 2% 1% 0.5% 0.2% None 10. Risk of OASIS in VBAC is 1% 8% 3% 5% 10% None 11. A multiparous patient presents with severe abdominal pain at 36 weeks gestation, preceded by mild uterine tightening following a clear gush of fluid passed per vaginam 2 days before, which she thought was urine. She hasn’t vomited, but feels sick and has noticed shoulder tip pain. She has a history of biliary colic, a previous caesarean section and moderate asthma. She is apyrexial but tachycardic on examination, with a blood pressure of 85/45. She has rebound tenderness, guarding and rigidity and absent bowel sounds. Speculum examination reveals a closed cervix, but blood stained liquor. The CTG shows a fetal tachycardia with poor variability and unprovoked decelerations. Her Hb is 87 g/l and her white cell count is 13.7 ×109/l. Which is the most likely diagnosis? Appendicitis Uterine rupture Placental abruption Cholecystitis Chorioamnionitis None 12. With regard to postpartum psychosis. When does this typically present? Days 7-14 postpartum Weeks 4-6 postpartum Days 1-3 postpartum Weeks 2-4 postpartum Days 5-7 postpartum None 13. A patient with beta thalassemia is seen in preconception clinic. She is known to be diabetic. What is the optimum test for monitoring diabetes in patients with beta thalassaemia? Fasting glucose levels C-peptide levels HBA1C Serum glucose Serum fructosamine None 14. The midwife has called you to see a 28 year old patient who has significant bleeding postpartum. You suspect uterine atony as the most likely cause. Which of the following would you do next? Start oxytocin infusion (40 iu in 500ml isotonic crystalloids at 125 ml/hour) Oxytocin 5 iu by slow IV injection Ensure bladder is empty / insert Foley catheter Misoprostol 800 micrograms sublingual Give carboprost 0.25 mg by IM injection None 15. You are called to see a patient who delivered 2 hours earlier via operative vaginal delivery. Her blood pressure has dropped and she is tachycardic. On examination you note there appears to be inward bulging of the superior vagina. You suspect supralevator haematoma. Injury to branches of which of the following vessels is responsible for a supralevator haematoma? Vaginal artery Internal pudendal artery Vaginal venous plexus Uterine artery Middle rectal artery None 16. A 25 year old nulliparous woman asks you what her risk is of sustaining a significant perineal tear during childbirth. What is the incidence of 3rd and 4th degree perineal tears in nulliparous women? 1.7% 2.9% 6% 12% 22% None 17. You are called to see a patient who delivered 2 hours earlier via operative vaginal delivery. She is complaining of increasing rectal and lower abdominal pain. On examination you note bulging into the vagina and suspect a paravaginal haematoma has developed. A paravaginal haematoma is bounded superiorly by what? Uterosacral ligament Urogenital diaphragm Colle's fascia Levator ani Cardinal ligament None 18. A 28 year old woman is on labour ward. Her friend recently had a forces delivery and sustained a fourth degree perineal tear. She is worried if she has to have a forceps delivery that she will sustain a significant tear. What is the approximate incidence of third or fourth degree tears in forceps delivery without episiotomy? 2.5% 5% 20% 10% 15% None 19. Puerperal genital haematomas are most commonly associated with which of the following? Heparin induced thrombocytopenia Perineal tear and sutured episiotomy Coagulopathy Puerperal sepsis Caesarean section None 20. A 28 year old woman asks you what her risk is of sustaining a significant perineal tear during childbirth. You note her only previous pregnancy was delivered by term vaginal delivery where she sustained a third degree tear. What is her approximate risk of sustaining a 3rd or 4th degree perineal tear in this pregnancy? 1.5% 3% 7% 10% 16% None 21. For the following scenario select the most appropriate management option: A 29 year old woman returns to the obstetric unit 7 days after delivery by Caesarian section. She complains of mild lower abdominal pain and has had mild vaginal bleeding. Her observations are as follows: Temperature 37.5 oC BP 120/80 Heart rate 88 Respiration rate 15 She has no known drug allergies No treatment required Oral phenoxymethylpenicillin Oral ampicillin and metronidazole Oral clindamycin Oral clindamycin and metronidazole IV piperacillin and tazobactam IV co-amoxiclav Evacuation retained products Ultrasound assessment Hysterectomy None 22. You are reviewing a patient in antenatal clinic. You note she was taking lithium for bipolar disorder but stopped when she found out she was pregnant. She has no history of postpartum psychosis. What is the risk of patients with bipolar disorder developing postpartum psychosis? 1 in 2 1 in 4 1 in 10 1 in 100 1 in 1000 None 23. You are discussing the health benefits of breastfeeding with a woman who has recently delivered her child. When does NICE advise breastfeeding should ideally occur? within 1 hour after birth within 15 minutes after birth within 6 hours after birth within 3 hours after birth within 12 hours after birth None 24. With regard to puerperal genital haematoma. Which of the following is NOT a risk factor? Prolonged 2nd stage of labour Maternal age ≥ 30 Genital tract varicosities Multiparity Instrumental delivery None 25. For the following scenario select the most appropriate management option: A 31 year old woman returns to the obstetric unit 7 days after delivery by Caesarian section. She complains of mild lower abdominal pain and has had mild vaginal bleeding. Her observations are as follows: Temperature 37.8 oC BP 122/85 Heart rate 85 Respiration rate 14 She is allergic to penicillin and trimethoprim No treatment required Oral phenoxymethylpenicillin Oral ampicillin and metronidazole Oral clindamycin Oral clindamycin and metronidazole IV piperacillin and tazobactam IV co-amoxiclav Evacuation retained products Ultrasound assessment Hysterectomy None 26. A 24 year old patient is brought to A&E by her partner following vaginal delivery 2 days earlier. She had been complaining of feeling very unwell with lower abdominal pain and had complained of offensive smelling vaginal discharge. She had vomited several times in the past 2 hours and is now drowsy and difficult to rouse. Her observations on arrival were: Temperature 39.8ºC Heart rate 140 Respiratory rate 25 BP 66/40 The patient is transferred to ITU following initial resuscitation in A&E but remains critically unwell. You speak to the family regarding the diagnosis of puerperal sepsis and the risk of death. Which organism is responsible for the majority of deaths from maternal infection in the UK? Group B Streptococcus Group A Streptococcus Streptococcus pneumoniae Staphylococcus aureus Escherichia coli None 27. You are called by the foundation doctor on the ward. They are concerned that one of the patients who gave birth a few days earlier seems confused and delusional. They wonder if she may have postpartum psychosis. You review the patients notes to see if there is any history that would place this patient at high risk of postpartum psychosis. What percentage of patients who develop postpartum psychosis will have no history to class them at high risk? 75% 50% 25% 15% 5% None 28. For the following scenario select the most appropriate management option: A 27 year old has been admitted and started on intravenous antibiotics due to vaginal bleeding which started 7 days postpartum. Despite 48 hours of intravenous antibiotics the bleeding continues. No treatment required Oral phenoxymethylpenicillin Oral ampicillin and metronidazole Oral clindamycin Oral clindamycin and metronidazole IV piperacillin and tazobactam IV co-amoxiclav Evacuation retained products Ultrasound assessment Hysterectomy None 29. A 31 year old woman is considering what mode of delivery she should opt for with regard to her current pregnancy. You note her only previous pregnancy was delivered by term vaginal delivery where she sustained a third degree tear. What percentage of women who sustain a third or fourth degree tear at their first birth will opt for elective Caesarean section for the birth of their second child? 50% 25% 15% 10% 5% None 30. You are called to see a patient who delivered 2 hours earlier. You note a bulging vulval haematoma has developed. Injury to branches of which of the following vessels is responsible for a vulval haematoma? Uterine artery Internal Pudendal artery Ovarian artery Middle rectal Vaginal artery None 31. For the following scenario select the most appropriate management option: A 24 year old woman is undergoing elective C-section. She has no risk factors for PPH. What treatment, if any, should be used to reduce blood loss No treatment required Oxytocin 10 IU by IM injection Oxytocin 5 IU by IV injection Misoprostol 600 mcg orally Misoprostol 800 mcg sublingually Bimanual uterine compression Ergometrine 5 IU by slow IV injection Ergometrine 0.5 mg by slow IV or IM injection Balloon tamponade Hysterectomy None 32. The midwife has called you to see a 27 year old woman who has given birth but is bleeding postpartum. With regards volume of blood loss which of the following statements is true? Major PPH is defined as blood loss of more than 250 ml Major PPH is defined as blood loss of more than 1500 ml Major PPH is defined as blood loss of more than 750 ml Major PPH is defined as blood loss of more than 1000 ml Major PPH is defined as blood loss of more than 500 ml None 33. A patient wants to ask your advice about contraception following delivery of her baby 3 days earlier. She is not breastfeeding and would like the Mirena coil. When would you advise the patient it would be safe to have this fitted? 3 months after delivery 6 weeks after delivery 4 weeks after delivery 3 weeks after delivery Anytime None 34. Female on Apixaban for treatment of atrial fibrillation. will undergo outpatient hysteroscopic polypectomy under local anaesthesia? Use LMWH Stop it for 2 weeks Stop it for 4 weeks Stop it for 1 week No need to stop Apixaban None 35. What's is the most common type of ureteric injury during laparoscopic surgery? Transection Thermal Ligation Angulation Crushing None 36. A 33-year-old woman has a 2-year history of heavy menstrual bleeding. She exhibits regular menstrual cycles without any associated pelvic pain and does not suffer from intermenstrual or postcoital bleeding. She is not clinically anaemic and all previous cervical smears normal and her last smear was 1 year prior. What's the first line for treatment? Condom Combine Oral contraceptive pills LNG-IUS Tranexamic acid Reassure None 37. 46 years old lady with HMB, ultrasound show endometrial thickness 16 mm. What's the most appropriate investigation? Outpatient endometrial biopsy Inpatient biopsy LNG-IUS Hysterectomy Repeat US None 38. A 43 years old lady had UAE for fibroids. What's the chance of re-operation for leiomyoma-related symptoms by this 5-year follow up? 62-75% 50-60% 30-40% 20-29% 10-20% None 39. Patient of PMS on long-term GnRH and add-back tibolone therapy. What should be done if she is on long term therapy? DEXA after 2 years DEXA after 3 months Calcium supplementation DEXA annually DEXA after 6 months None 40. A15 years old girl came with her mother complain of frequent menses and kind of hirsutism, the mother told you the girl undergo surgery in genitalia due to abnormality after birth (Clitoromegaly). Which of the following is most likely ? Klinefelter syndrome MRKH Complete AIS Turner syndrome Congenital adrenal hyperplasia Patrial AIS None 41. A 27 years old lady with oligomenorrhea, hirsutism, high level of progesterone. What's the most appropriate investigation? Free T4 Free testosterone Serum prolactin Cortisol level Serum estrogen None 42. 22 years old female. With high testosterone and 17 hydroxy progesterone. Diagnosis? Cushing syndrome PCOS Hirsutism Congenial adrenal hyperplasia (CAH) Sertoli-leydig cell tumor None 43. A 24 years, presented to A&E at 22 weeks of gestation, had IVF conception for tubal pathology. She gave a 24 hrs. history of right sided abdominal pain and feeling generally unwell. She had some nausea but no vomiting. On examination: temperature of 38.1°C, abdomen was soft, with tenderness. US shows 5x10 mm a non-compressible, blind-ending tubular structure in the right iliac fossa. What the most likely diagnosis? Tubal abscess Torted hydrosalpinx Acute appendicitis Irritable bowel disease Ovarian torsion None 44. A 65 years old women presented with bleeding. On TVS the endometrial thickness was 2 mm and small simple cyst 8 mm. What should be done? Reassure arrange for a routine pelvic ultrasound arrange for a routine gynaecology outpatient appointment continue HRT arrange for an urgent pelvic ultrasound TVS None 45. A lady with a skin lesion on vulva and scalp not responding to topical steroids and she diabetic, which of the following is most likely? Lichen sclerosis Fungal infection Lichen planus Eczema Vulval psoriasis None 46. Vulval itching not Responding to topical steroids. what should be your next step ? Estrogen therapy Ultra-potent topical steroid Take biopsy and start tacrolimus Take biopsy Podophyllin Tri-chloro-acetic acid imiquimod None 47. A 45 years old with endometriosis. woman's family is complete and she wishes to contemplate the operation. Management should include which of the following ?? CHC Cystectomy Subtotal hysterectomy Laparoscopic excision Hysterectomy with bilateral oophorectomy None 48. A CT abdominal done for cholecystitis and incidental finding of ovarian cyst which not properly visualized, which of the following should be your next step ? RMI MRI TVS TAS CT with contrast None 49. Vulval itching not Responding to topical steroids. what should be your next step ? Estrogen therapy Ultra-potent topical steroid Take biopsy and start tacrolimus Take biopsy Podophyllin Tri-chloro-acetic acid imiquimod None 50. You are asked by the FY1 on the ward to review a patients pelvic ultrasound report as it has shown an ovarian mass. Which of the following would be suggestive of a benign lesion? Ascites Irregular multilocular solid tumour ≥ 100mm Irregular solid tumour four or more papillary structures No blood flow None 51. For the following scenario choose the most appropriate management option : A 48 year old patient comes to see you as she hasn't had a period for 14 months, has noted occasional hot flushes at night but most concerning feels low in mood. She has been taking Tamoxifen for the past three years following successful treatment of breast cancer. She has a uterus. What would you recommend for treatment of her low mood? Fluoxetine Soy isofavones Black cohosh St Johns wort Oestrogen and progesterone HRT Oestrogen only HRT CBT Check FSH Gabapentin Vitamin E None 52. A 16 year old woman with a history of cyclical pelvic pain for 2 years was admitted to the accident and emergency department for an inability to pass urine for 16 hours. She has not started menstruating yet, and pregnancy has been ruled out. A pelvic ultrasound revealed a full bladder and pelvic mass. A transvaginal ultrasound was attempted, but it was impossible to insert the vaginal probe. choose the single most appropriate syndrome. Rokintansky syndrome Familial delayed puberty Turner's syndrome Polycystic ovary syndrome Androgen insensitivity syndrome Kallmann's syndrome Premature ovarian failure Asherman's syndrome Sheehan's syndrome Imperforate hymen None 53. A 65 year old women is referred to the outpatient clinic with postmenopausal bleeding. Her BMI is 27.5kg/m². She isn't taking any regular medications and isn't known to be diabetic. There is no personal or family history of cancer. What is her pre-test probability of having underlying endometrial cancer? <1% 10% 25% 50% 90% None 54. You review a 25 year old patient in the clinic. She has bee referred by her GP who was unable to perform a smear due to a narrow introitus. You note she is originally from Somalia but has been living in the UK since she was 6 years old. On examination there is scar tissue between the labia. What is the likely diagnosis? Idiopathic labial fibrosis Type 1 female genital mutilation Type 2 female genital mutilation Type 3 female genital mutilation Type 4 female genital mutilation None 55. You are reviewing a patient in clinic who would like to proceed with surgery for her fibroids. You agree to start goserelin preoperatively. What sort of reduction in size would you advise this patient is typical? Reduction in size by 20% after 12 weeks Reduction in size by 70% after 12 weeks Reduction in size by 10% after 12 weeks Reduction in size by 50% after 12 weeks Reduction in size by 35% after 12 weeks None 56. What is the most common presenting sign or symptom in patients with endometrial cancer? urinary symptoms pelvic pain vaginal discharge post-menopausal bleeding bloating None 57. Pregnant woman with severe pre-eclampsia with proteinuria at 29 weeks underwent lower segment cesarean section. She admitted to ICU her BP was very high 220/120 mmHg. She developed intracranial hemorrhage and collapsed 5 weeks after delivery. Coincidental deaths Direct maternal death Indirect maternal death Late indirect death Accident None 58. primigravidae had evacuation of uterus for miscarriage/early pregnancy. Post-evacuation she developed of central cyanosis and chest pain and she died two days after evacuation. found in post-mortem examination to have Eisenmenger's syndrome. Coincidental deaths Direct maternal death Indirect maternal death Late indirect death Accident None 59. Trainee has bad attitude, difficult to work with, college supervisor informed. what type of assessment tool/method to deal with the situation. Mini-CEX (mini clinical evaluation exercise) Appraisal OSATS (objective structured assessment of technical skill) Multisource feedback Reflection CBD (case-based discussion) None 60. With LNG IUS common complication is irregular bleeding, less common complication is amenorrhea, rare complication is perforation. In explaining potential unwanted outcome, what does "Uncommon” mean? 1 in 100 1 in 1000 1 in 10000 1 in 100000 1 in 10 None 61. Trainee reflect on an incident which had bad outcome. You have been involved in the incident and you notice incorrect information in the reflection Talk to him privately Inform deanery Warn him in private Warn him in writing Inform clinical lead Refer to occupational health Inform police Inform GMC Arrange another OSAT None 62. Hospital collects all water birth deliveries of 3 years duration to identify effectiveness of analgesia, which assessment method is being used? Audit Risk management RCT Appraisal Reflection None 63. Statistical test for: Proportion of thrombocytopenia in PET and non- PET? Student test Unpaired t test Paired t test ANOVA Chi square test None 64. A statician collected data using Questionnaire girl in school to find prevalence of a disease what study will choose? Case Control Descriptive study Cross section study Cohort RCT None 65. group of 400 women who underwent TAH/BSO followed to study outcome based on BMI the effect of BMI| on the outcome what statistics measured will help? Incidence Relative risk Prevalence Odd ratio Likelihood ratio None 66. Which indicator predicts disease among whom actually has the disease ? Sensitivity Specifity Positive predictive value Negative predictive value Positive likelihood ratio Negative likelihood ratio None 67. MRCOG grade A recommendation is which of the following? Case reports Cohort studies Meta-analysis Case control Expert opinion None 68. a women admitted in ward with medical induced abortion. Patient complained pain abdomen.ST 3 refused to review case because of religious belief he can’t do abortion. In this time ST 1 was busy in maternity ward. Consultant on the way in 30 minutes , which of the following is appropriate ?? Wait for consultant Wait ST1 Request senior midwife to give analgesia. Inform consultant and request senior midwife to give analgesia. Inform consultant and request ST3 to give analgesia. None 69. National alerts are received by whom? Clinical director Deaneary Heads of departments Medical director Head nurse None 70. We want to find the relationship between umbilical artery doppler & pre-eclampsia, after other factors like age, parity, BMI are taken into consideration, which of the following tests should be used ? Multiple regression logistic regression Pearson correlation Spearman correlation Man-whitney None 71. Donation of embryos for research purposes requires which of the following? Verbal consent Written consent No consent Consent from both parents Legal advice Advance directive Consent from both parents and court order None 72. A patient has MEWOS score 5 and pain after medical termination which IS against your faith and your consultant 30mins away. ST1 is busy with another patient assessment who is not well. How will you manage it? Call ST1 to attend as soon as he can Wait for ST1 Wait for consultant Tell senior nurse to evaluate her and tell you finding while you are prescribing analgesia. Analgesia can be prescribed by senior nurse None 73. A student in clinic discussing a breech case with consultant, which of the following is this ? OSAT Audit DSL Mini CEX CBD None 74. To find the relationship between maternal BMI & fetal birth weight , which of the following tests should be used ? Multiple regression logistic regression Pearson correlation Spearman correlation Man-whitney None 75. To look for the different outcomes of pregnancy in relation to BMI , which of the following tests should be used ? Multiple regression logistic regression Pearson correlation Spearman correlation Man-whitney None 76. Regarding the following diagram for hysteroscopy , Which of the following represents the part labelled E ? Proximal lens Irrigating channel Distal lens Operating channel Fiberoptic bundle connection Separable bridge Light transmitting cable None 77. Regarding the following diagram for hysteroscopy , Which of the following represents the part labelled C ? Proximal lens Irrigating channel Distal lens Operating channel Fiberoptic bundle connection Separable bridge Light transmitting cable None 78. Regarding the following diagram for hysteroscopy , Which of the following represents the part labelled F ? Proximal lens Irrigating channel Distal lens Operating channel Fiberoptic bundle connection Separable bridge Light transmitting cable None 79. Regarding the following diagram for hysteroscopy , Which of the following represents the part labelled D ? Proximal lens Irrigating channel Distal lens Operating channel Fiberoptic bundle connection Separable bridge Light transmitting cable None 80. During consenting for a diagnostic hysteroscopy under general anaesthetic the patient should be informed of which of the following risks? Infection is a rare risk associated with hysteroscopy The small possibility of failed access to the uterine cavity in case of cervical stenosis Damage to the bowel at hysteroscopy is a very rare event The overall risk of serious complication from the above procedure is 2/1000 40/100 000 women undergoing a hysteroscopy die as a result of complications None 81. A 55 year old woman attends for review at a postmenopausal bleeding clinic. She complains of intermittent PV bleeding on wiping. A transvaginal ultrasound demonstrated an echolucent area at the fundus of the uterus measuring 20 mm x 5 mm. Endometrial thickness was 5mm. The most likely diagnosis is an endometrial polyp. What is the most appropriate next investigation? Chest X ray CT pelvis CT pelvis with contrast MRI pelvis Hysteroscopy None 82. A 55 year old woman attends for review at a postmenopausal bleeding clinic. She complains of intermittent PV bleeding on wiping. A transvaginal ultrasound demonstrated an echolucent area at the fundus of the uterus measuring 20 mm x 5 mm. Endometrial thickness was 5 mm. What is the most likely diagnosis? Endometrial polyp Overlying bowel gas shadow Endometrial cancer Submucous fibroid Cervical polyp None 83. Miss Lisa , a 24 year old with history of endometriosis, will be going through laparoscopy and treatment for endometriotic deposits with release of adhesions. Which of the following is evidence based to try and improve outcome following surgery? Conception Progesterone based medication Combined COCP GnRH analogues Anti adhesive agent None 84. Following microwave ablation you perform a laparoscopic sterilisation. At this time you notice a white devascularised area on a piece of bowel in the Pouch of Douglas. Choose the most appropriate management ? Laparotomy Bowel anastomosis Drainage Instillation Indwelling catheter for 72 hours Indwelling catheter for 14 days Nil by mouth Conservative management KUB USS Laparotomy and colostomy Laparotomy and repair Transfusion None 85. Following a laparoscopic subtotal hysterectomy for fibroids using the morcellator there is the suspicion that there may have been a small bladder injury. The catheter bag has very blood stained urine. Choose the most appropriate management ? Laparotomy Bowel anastomosis Drainage Instillation Indwelling catheter for 72 hours Indwelling catheter for 14 days Nil by mouth Conservative management KUB USS Laparotomy and colostomy Laparotomy and repair Transfusion None 86. A 60 year old woman with postmenopausal bleeding is found to have a normal endometrium and a 1.5 cm endometrial polyp on hysteroscopic assessment. With regards to management options, which of the following is the most appropriate? Hysteroscopic resection should be performed under general anaesthetic as it is not tolerated in an outpatient setting Hysteroscopic resection or morcellation should be offered Expectant management should be considered The size is an independent risk factor for malignancy Blind avulsion should be offered None 87. During the 360 degree check following the insertion of the primary trocar, a small area of small bowel appears to show a perforation. In trying to see the area you drop the piece of bowel you were examining and on searching cannot find the area. Choose the most appropriate management ? Laparotomy Bowel anastomosis Drainage Instillation Indwelling catheter for 72 hours Indwelling catheter for 14 days Nil by mouth Conservative management KUB USS Laparotomy and colostomy Laparotomy and repair Transfusion None 88. On 360 degree inspection you see that the primary trocar has transected two loops of bowel adherent under the umbilicus. Choose the most appropriate management ? Laparotomy Bowel anastomosis Drainage Instillation Indwelling catheter for 72 hours Indwelling catheter for 14 days Nil by mouth Conservative management KUB USS Laparotomy and colostomy Laparotomy and repair Transfusion None 89. During consenting for a diagnostic laparoscopy the patient should be informed of the following risks. The overall risk of serious complications during a diagnostic laparoscopy is 1/200 Infection is a serious risk of laparoscopy Infection is a serious risk of diagnostic laparoscopy 3–8/100 000 patients undergoing a laparoscopy die as a result of complications Shoulder tip pain is a rare risk during a diagnostic laparoscopy None 90. Which of the following techniques should be employed to reduce entry related laparoscopic injuries when performing a diagnostic laparoscopy? Trendelenberg tilt and insertion of the veress needle at right angles to the skin Trendelenberg tilt The veress needle should be blunt to prevent any intraabdominal trauma Horizontal positioning of the patient Veress needle should be moved laterally to check it is free before gas insufflation occurs None 91. A patient with painful bladder syndrome which affects her quality of life and anxious. What is the first line treatment? Acupuncture Cimetidine Cyclophosphamide Amitriptyline Intra-vesical DMSO None 92. A 55 years old female have vaginal prolapse with uterine descent stage 2 to 3. failure to pessary. She refused abdominal hysterectomy. What's your management? Anterior repair Pessary Vaginal hysterectomy TAH PFMT None 93. Patient she had urgency frequency and urge incontinence. Overactive bladder not respond to anticholinergic medicines, next step? Urodynamic study Posterior tibial nerve neuromodulation Botulinum toxin injection Augmentation cystoplasty Sacral nerve stimulation None 94. A lady came to outpatient clinic and diagnosed as bladder pain. She anxious with said that symptoms cause poor quality of life. Your management? Intravesical hyaluronic acid Intravesical lidocaine Amitriptyline Intravesical heparin Fluoxetine None 95. Patient with suspected Vesicovaginal fistula (VVF). How to be diagnosed? MRI CT urogram Cysto-urethroscopy Color Doppler ultrasonography Examination under anaesthesia None 96. For the following scenario select the most appropriate management option form the list below. A couple have been trying to conceive for 2 years. They have a 6 year old son and are having regular intercourse. The male partner (28) semen analysis shows: Volume 1.0ml, 9 million sperm/ml, 40% motility and 3.5% normal forms. Female partner (27) normally has regular periods but since a miscarriage 12 months ago has continuous irregular light bleeding. FSH and LH are normal. Her BMI is 24.5 kg/m². Physical examination of both partners is unremarkable. Oestradiol (E2) Prolactin Inhibin B Ovarian volume Luteinizing hormone Maternal age bHCG Body mass index Anti-Mullerian hormone Sperm antibodies None 97. For the following scenario select the most appropriate management option form the list below. A patient comes to see you regarding her fertility and asks about ovarian reserve. What parameter do NICE advise be used as initial predictor of her overall chance of success through natural conception or with in vitro fertilisation (IVF) Oestradiol (E2) Prolactin Inhibin B Ovarian volume Luteinizing hormone Maternal age bHCG Body mass index Anti-Mullerian hormone Sperm antibodies None 98. A couple have been referred for fertility investigations. The female partners investigations are all normal. The male partners sperm count reveal oligospermia. Which of the following conditions results in hypogonadotropic hypogonadism? Kallman syndrome Young's syndrome Noonan syndrome Vasectomy Kleinfelter's syndrome None 99. A couple come to see you in clinic. The male partner reveals he has cystic fibrosis and wants to know what his likelihood of being infertile is. What is the male infertility rate in CF patients? 18% 40% 75% 90% 98% None 100. A couple where the female partner has complete Rokitansky syndrome with right renal absence, Choose the appropriate management ? Adoption Clomifene with ultrasound monitoring +/ hCG Clomifene without follicle tracking In vitro fertilisation using own gametes In vitro fertilisation using donor oocytes In vitro fertilisation with donor sperm Intracytoplasmic sperm injection No treatment is available Oocyte donation Stimulated intrauterine insemination Surrogacy Unstimulated intrauterine insemination None You’ve already answered some of the questions! 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