Get Through MRCOG Part 2: Short Answer Questions

Euan Kevelighan, Jeremy Gasson, Makiya Ashraf

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000153187
• Edition: 1
• Topic: Medicina
• Subtopic: Teoria, pratica e riferimenti medici

Get Through MRCOG Part 2: Short Answer Questions is an essential revision guide for candidates preparing for the MRCOG Part 2 exam. This comprehensive collection of practice Short Answer Questions (SAQs) is designed to help candidates test and assess their own knowledge, aiding thorough preparation for the exam. The book opens with an introduction to the exam and includes advice on how to prepare for it, information on what to expect, and guidance on how to write excellent answers. This is followed by two sections: the first provides a wide range of SAQs divided into obstetric and gynaecological topics, and the second presents six practice exams set out in the format of the actual exam. For each question, the authors highlight the key words in the question, followed by a brief essay plan and then give a worked example answer. The specimen answers indicate how many marks the candidate would obtain for each point made, and are supplemented with valuable extra information and further reading, to enhance understanding and aid further revision.

SECTION 1

PRACTICE QUESTIONS

Obstetrics: Questions

1.1.1 Shoulder dystocia

A What is the incidence of shoulder dystocia (SD) and what factors are associated with it? (5 marks)

B Discuss how you would manage a case of shoulder dystocia. (10 marks)

C What are the maternal and neonatal complications of this obstetric emergency? (5 marks)

1.1.2 Group B streptococcal (GBS) disease

A woman attending the booking clinic is very anxious, as she lost her last baby at one week of age from early-onset Group B streptococcal (GBS) disease.

A What are the risk factors for GBS disease? (5 marks)

B How should this woman’s pregnancy and delivery be managed? (8 marks)

C What are the arguments against universal screening and treatment in the UK? (7 marks)

1.1.3 Uterine inversion

You are called to attend a collapsed patient on the labour ward.

A What is the estimated incidence of uterine inversion and what findings are associated with this condition? (4 marks)

B What are the symptoms and signs of uterine inversion? (5 marks)

C You diagnose uterine inversion in this case. What is your initial management? (6 marks)

D What are your options for replacement of the uterus? (5 marks)

1.1.4 Cord prolapse

A Define cord prolapse and outline the difference between it and cord presentation. (2 marks)

B What is the incidence of cord prolapse and discuss the antenatal (nonprocedural) risk factors associated with it? (8 marks)

C What procedures are associated with an increased risk of cord prolapse? (5 marks)

D What would you advise a paramedic in the community to do when faced with a cord prolapse prior to transfer to hospital? (5 marks)

1.1.5 Twin-twin transfusion

A 35-year-old woman attends the booking clinic at 12 weeks’ gestation and ultrasound scan reveals a twin pregnancy.

A What are the important features of this pregnancy on ultrasound scan and why? (6 marks)

B How should her antenatal care be planned? (7 marks)

C What is twin-to-twin transfusion syndrome (TTTS) and how is it managed? (7 marks)

1.1.6 Gestational diabetes

A primigravid woman at 28 weeks’ gestation is referred from midwifery-led care with an ultrasound diagnosis of a macrosomic fetus but with no other abnormalities.

A What are the risk factors for gestational diabetes mellitus (GDM) and how is it diagnosed? (7 marks)

B If GDM is confirmed, how will her delivery be planned? (7 marks)

C What postnatal care and advice should she be given? (6 marks)

1.1.7 Non-immune hydrops

A 24-year-old woman who is 25 weeks’ pregnant contacts her community midwife as her daughter has just been diagnosed with ‘slapped cheek’ syndrome. She is concerned about the potential effects of her daughter’s illness on her pregnancy. The midwife contacts the hospital for advice.

A What advice should the patient receive at this stage? (6 marks)

B Two weeks later this woman’s fetus develops non-immune hydrops (NIH). How should this be investigated? (9 marks)

C Assuming the NIH is due to infection following her daughter’s ‘slapped cheek’ syndrome, how should this be managed antenatally? (5 marks)

1.1.8 Thyroid disease

A woman attends the antenatal clinic at 20 weeks’ gestation. Investigations show she has thyrotoxicosis due to Graves’ disease.

A Identify three of the more discriminatory features of hyperthyroidism in pregnancy. (3 marks)

B How is thyrotoxicosis caused by Graves’ disease diagnosed and what are the risks to this pregnancy? (8 marks)

C Outline your management of this woman’s thyrotoxicosis. (7 marks)

D What are the indications for thyroidectomy in pregnancy? (2 marks)

1.1.9 Obesity in pregnancy

A chronically morbidly obese patient undergoes emergency caesarean section (CS) at full cervical dilatation.

A What difficulties might the obstetrician encounter during CS? (5 marks)

B Describe possible postoperative complications and how you might reduce them. (11 marks)

C What pre-existing diseases might a patient who is chronically morbidly obese have at booking for antenatal care? (4 marks)

1.1.10 Cardiopulmonary arrest

You are the registrar on call for the labour ward and you are called to attend a collapsed patient in triage who was admitted at 34 weeks’ gestation with a swollen left leg.

A What is your initial management of this situation? (3 marks)

B How would you diagnose a cardiopulmonary arrest? (4 marks)

C Assuming that this patient has had a cardiopulmonary arrest, describe how you would perform basic life support. (6 marks)

D How would you use an automated external defibrillator (AED) and what are the two shockable rhythms? (6 marks)

E What is the likely diagnosis? (1 mark)

1.1.11 Vaginal birth after caesarean section (VBAC)

A 32-year-old woman in her second pregnancy attends the antenatal clinic at 24 weeks’ gestation to discuss the method of delivery for her current pregnancy. She had an emergency caesarean section for fetal distress at 6 cm last time.

A What are the contraindications to vaginal birth after caesarean section (VBAC) in general? (5 marks)

B Outline the risks and benefits of VBAC. (I I marks)

C What intrapartum support would you plan for this labour? (4 marks)

1.1.12 Ovarian cysts in pregnancy

A 34-year-old woman is seen in the antenatal clinic with an asymptomatic adnexal mass identified on ultrasound scan (USS) at 11 weeks’ gestation.

A Give four causes of an adnexal mass in pregnancy. (Assume the pregnancy is intrauterine.) (4 marks)

B In what percentage of pregnancies are adnexal masses reported on USS? (1 mark)

C Discuss the management of this case, assuming the adnexal mass was ovarian. (13 marks)

D Is there a role for assessment of tumour markers in ovarian cysts in pregnancy? (2 marks)

1.1.13 Alcohol in pregnancy

A 36-year-old attending the antenatal booking clinic smells of alcohol. On questioning she admits to regular binge drinking (>5 drinks at one session) and a heavy alcohol intake for the past two years.

A What advice would you give this woman? (7 marks)

B Outline the potential risks to this pregnancy related to her alcohol intake. (9 marks)

C What are the diagnostic criteria for fetal alcohol syndrome (FAS)? (4 marks)

1.1.14 Preterm premature rupture of membranes

A 37-year-old primigravida with a pregnancy from in vitro fertilization and normal antenatal progress presents to the antenatal day unit (ANDU) at 26 weeks’ gestation with a history suggestive of ruptured membranes.

A Outline your immediate management. (10 marks)

B Assuming rupture of membranes is confirmed, describe your subsequent management. (10 marks)

1.1.15 Consent to caesarean section

You are the registrar on the labour ward. You are asked to obtain Mrs Smith’s consent for her elective caesarean section for breech presentation.

A Describe to Mrs Smith (in non-medical language) what the procedure involves. (7 marks)

B What are the alternatives to delivery by caesarean section for Mrs Smith and what are the risks? (8 marks)

C What are the serious risks of caesarean section you would discuss with Mrs Smith? (5 marks)

1.1.16 Renal disease in pregnancy

A primigravida attends booking clinic at eight weeks’ gestation and gives a history of polycystic kidney disease.

A Outline the relevant management at this booking visit? (5 marks)

B She is diagnosed as having moderate renal impairment. What specific risks does she have during this pregnancy? (4 marks)

C How will you plan the management of her pregnancy? (5 marks)

D At 28 weeks’ gestation she presents with fever, loin pain and rigors. A provisional diagnosis of acute pyelonephritis is made. How should this be managed? (6 marks)

1.1.17 Cardiac disease in pregnancy

A 22-year-old primigravida attends the booking clinic at 14 weeks’ gestation. She has recently arrived in the UK from Pakistan and gives a history of rheumatic fever in childhood. On examination she is found to be mildly dyspnoeic.

A What is the most likely diagnosis? (1 mark)

B Outline appropriate antenatal management. (7 marks)

C How should her delivery be managed? (9 marks)

D How should she be managed in the puerperium? (3 marks)

1.1.18 Screening

A What are the principles of screening? (10 marks)

B What serum screening tests are available for Down syndrome? What are the detection rates, assuming a 5% false positive rate? (6 marks)

C Discuss the combined test for Down syndrome. (4 marks)

1.1.19 Blood transfusion ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Dedication
• Foreword
• Introduction
• Section 1: Practice Questions
• Section 2: Practice Papers
• Index