‫بسم هللا الرحمن الرحمن‬

2 – MARCH 2017 RECALLS TELEGRAM GROUP start 3 November

1 - Patient with endometrial hyperplasia without atypia risk of

progression to endometrial cancer
R. of endometrial hyperplasia without
A.<1% atypia progressing to endometrial
cancer is < 5% over 20 years and
B.2% majority will regress spontaneously
.during f/up
C.4% Source : RCOG/BSGE Green-top
Guideline No. 67
D.10% But risk of co-existing cancer is <1%
and in atypia, risk is 25-33% up to
. 59%
TOG: Malignant potential
TOG MALIGNANT POTENTIAL :
* HYPERPLASIA WITHOUT ATYPIA……….2%
WHEN ATYPICAL HYPERPLASIA( SIMPLE OR COMPLEX) WAS AT DIIAGNOSIS
*…..23%
* WHEN COMPLEX ATYPICAL HYPERPLASIA AT INITIAL DIAGNOSIS ……29%

: 2 - . Risk of placenta previa after 3 CS

ANSWER : A 3 % With one, two, or > three previous CS a 1%, 1.7% or
A.3% 2.8% risk respectively of placenta praevia in
2.8 % ,subsequent pregnancies
B.10% Placenta accreta occurs in
11 – 14%of placenta praevia and 1 prior CS and %
C.30% 23 – 40%of placenta praevia and 2 prior CS
67 % of placenta praevia and > 5 prior CS6
D.50%

E.60%

3 - Para 1 CS due to labour dystocia want to know her chance to

: have successful VBAC ANSWER : C
 VBAC score by 5 features: admission Bishop score, age, previous CS
A.30% .indication, BMI and previous vaginal birth
VBAC score of > 16 …. > 85% success rate, VBAC score of 10 .. 49%
B.40 .success rate
IOL, no previous vaginal delivery, BMI > 30 and previous CS for labour
.dystocia .. 40% successful VBAC
C.60% previous CS for fetal malpresentation 84% Successful VBAC
previous CS for labour dystocia (64% success rate), fetal distress
D.70% )61%((73% success rate), Unsuccessful OVD

E.80%
In case of term it reduce 4_6% in 38 wk 1-1.7% in 39 and 11%
4 - Patient forelective CS at 38wks need to know how much in 37 wk
steroid will reduce respiratory

:morbidity at this GA Neonatal deaths 31% (95% CI 19–42%)

Reduced respiratory distress syndrome 44% (95% CI 31–57%)
A.4-6% Reduced intraventricular haemorrhage 46% (95% CI 31–67%)
Antenatal corticosteroid use is also associated with
B.40% A reduction in necrotising enterocolitis
Respiratory support
C.50%D.60% Intensive care admissions
Systemic infections in the first 48hours of life compared with
E.70% no treatment or treatment with placebo

5 - Patient with previous abruption need to know recurrence in

:current pregnancy

A.3%
Prev. one abruption 4.4% (10-folds)recurrence. Prev. 2 abruption
B.4-6% 20-25% recurrence
ANSWER : B
C.10%

D.19%
E.25%
6 - Previous shoulder dystocia want to know recurrence
:compared to general population
A. 2fold

B.3fold
C.4fold GTG: Incidence of SD 0.58-0.7%, Recurrence 1-25%, Conventional
RFs predict 16% of SD
D.5fold Infants of diabetic mothers have 2-4 fold ↑ for SD
Midcavitary forceps = 10 fold SVD, Elective CS in > EFW 4.5kg of
E.10fold diabetic mothers

7 - Female and partner retained from trip from somewhere

suspected zika virus infection when

to check for zika virus infection or seroconversion

Check for zika virus infection > 4wks after trip from area suspected zika virus infection to
A.2wks B 4 WS….2 WEEKS MAX I P…… AND 2 WS FOR
.exclude recent zika virus infection, then no need extra fetal U/S f/up (28-30wks)
IMMANSWER :
Where ZIKV is identified on laboratory testing (RT-PCR for symptomatic patients with onset
B.4wks of symptoms within the previous week), referred to a fetal medicine service. If the test for
ZIKV is -ve, serial (4-weekly) fetal U/S scans to monitor fetal growth and anatomy
C.8wks If there is fetal abnormality on U/S and Zika virus PCR on amniocentesis is +ve, it is
highly likely that the abnormality is Zika virus associated. When brain abnormalities are
D.12wks identified on U/S scan, do fetal brain MRI that may detect further abnormalities. When a
significant brain abnormality or microcephaly is confirmed, discuss TOP with the woman,
E.16wks .regardless of gestation
Consider condoms to prevent against infection for women whose partner has been to an
:area with ZIKV transmission
for 28 days after his return home if he had no ZIKV symptoms, either whilst abroad or •
within 2 weeks of his leaving the affected country
for 6 months following recovery if he had ZIKV symptoms during that period •
On returning to the UK, they should avoid becoming pregnant for a further 28 days; this
allows for a maximum two week incubation period and possible two-week viraemia and
.seroconversion
:Transmission
The bite of infected female Aedes mosquito are, similar to dengue fever (caused by a
related flavivirus) and chikungunya (an alphavirus). So, IgM & IgG can’t differentiate
.between them
Human-mosquito-human, & direct human to human transmission does not occur. sexual
.transmission of the virus in human semen can occur
Maternal fetal transmission have been confirmed. ZIKV can cross the placental barrier and
.the virus has been detected in blood and tissues of affected fetuses/infants

N/E that ZIKV can be transmitted to babies through breast milk

4 weeks the new

guidlines
8 - The most common time
for presentation of post
partum psychosis:
A. 1-3 days B. 1 – 3 wks C.4wks D.6wks E.8wks

9 - Haemophilia male female stutus not mentioned pregnant by baby boy

want to know risk to X-linked ... The Father will not pass to boys. As X-Linked

:baby
if (f ) is carrier 25% affected / 25% carrier 50% SEX – LINKED RECESSIVE
A.zero unaffected child
Male to male never 1 – DUCHENE MUSCULLAR
B.1in2 risk of doughter carrier 1 : 2 occurs ATROPHY

C.1in4 risk of having affected child 1 : 4 2 – HEMOPHILIA A

risk of having affected son 1 : 4 3 – COLOR BLINDNESS

D.1in8
( f ) with x linked recessive all (f) baby carriers[
E.1in 16 100% m to f transmission ] ,and all (m ) baby normal [ no
(m) to ( m) transmission
10 - Precious puberty the cut off time Answer : A 8 YS

A.7yrs develop 2ry sexual ch.ch. before 8 yrs old in girls, 9 yrs in boys

B.8yrs

C.9yrs

D.10yrs

E.12yrs

11 - Hospital want to benchmark still birth rate which is consistent with

:UK stillbirth rate ANSWER : A : SB rate
* In singleton births. 0.5%
A.1in 200 * In twin births. 1.25%
* In triplet and higher-order multiple births.
B.0.5/1000 3%
Extended perinatal mortality rate = 5.92 /
C.5/10000 1,000 total births = SB 4.16 / 1,000 total births
+ neonatal deaths 1.77 per 1,000 live birt
D.5/100000

:12 - Unrecognised ureteric injury during laproscopy

A.10%
.30%

Answer : 50%( 2/3)

 Bladder injury rates 0.02% - 8.3%. Most injuries occur during dissection of bladder
-ureteric bar. 50%
recognised, 50% unrecognised bladder injury. 15% of bowel injuries unrecognised
B.15% .at the time of laparoscopy
The most common sites of ureteric injury in laparoscopic surgery are at the pelvic
C.30% brim (where the ureter comes into close proximity with the infundibulo-pelvic
ligament which
D.40% contains the ovarian vessels) and lateral to the cervix (during division or
)coagulation of the uterine artery or the uterosacral and cardinal uterine ligaments
E.50% Transection is the most commonly reported at laparoscopy
1/3 of ureteric injuries are recognised intraoperatively, 2/3 are unrecognised
(missed)
of the ipsilateral kidney 25%
Cystoscopy allows visualisation of the ureteric orifices and urine jets which rules
out obstruction, but does not exclude other types of injuries
Intravenous administration of indigo carmine colours the urine blue within 5 to 10
minutes and will assist a cystoscopic assessment as well as identify a urine leak
laparoscopically
Insertion of a stent alone can be therapeutic if injury was angulation (kinking) of
ureter
.Ureteroscopy may locate the approximate height and extent of injury
Retrograde, antegrade and/or intravenous uretero-pyelography can confirm or
refute the diagnosis and determine the location of an injury
Electrocautery may be involved in up to 1/4 of ureteric injuries
Thermal injury r fistula that will often
present clinically between 10 and 14 days postoperatively. Ultrasound and/or CT
.scan, whereas a CT intravenous urogram (CT IVU) will locate the injury
Upper 1/3 -to-end re-anastomosis of the ureter (uretero
ureterostomy)
Middle 1/3 -ureterostomy or a trans-uretero-ureterostomy
end-to-side anastomosis of the injured ureter with the contra-lateral healthy (
)ureter
Lower 1/3 -neocystostomy (re-implantation of ureter into bladder)

13 - During laproscopy for severe endometriosis ANSWER : A 1 IN 5

ureteric injury is
A.1in 5

B.1in10

C.1in 20

D.1in 25

14 - After ventose delivery ask about the accepted preductal oxygen in

:2min
 Ventose delivery THIS TABLE FOR SVD

TIME TARGET
A. 60 - 65 SPO2

1 MIN 60 – 65 %
B. 65- 70
2MIN 65 – 70 %
C. 70 - 90
3 MIN 70 – 75 %
D.80 - 95 4 MIN 75 – 80 %

E. 90- 95 5 MIN 80 – 85 %

10 MIN 85 – 95 %

:15 - When prescribed complication in OB&GYN as very rare means

A.1in 1000 ANSWER : C

B.1in 1500

C.1in10000-1/100000

D.<1/100000 E.1in 30

16 -40 years lady first trimester pregnancy ask about her risk to
: have miscarriage
Answer : E
A. 12%

B.20%
C.30%

D.40%
E.50%
17 - Patient need to have forceps delivery in

second stage ask about risk of 3/4 perineal tear

with forceps * 3rd & 4th degree perineal tear, 1–4 %

.with vacuum and 8–12 % with forceps
A.5%
* extensive vaginal/vulval tear, 10% with
B.10% vacuum, 20% with forceps

ANSWER : B
C.15%

D.20%

E.25%

18 - Patient present in labour nulliparous was low risk following with

consultant serial scan baby in 70th centile how to follow her in labour

A.intial cefm for 30 minutes then intermittent auscultation ANSWER : B

B. intermittent A using hand held Doppler

C. intermittent auscul using ctg machine

D.CEFM

E. US to see fetal heart

19 - Patient delivered baby at the acid base PH7.1 HCO -11 at zero
APGAR 3 then 5 and 9 he and his mother did fine for how long do you
keep the ctg paper ANSWER : E

A.5yrs

B. 10yrs NICE: Intrapartum care:

care of healthy women and their babies during childbirth
C.20yrs .Keep CTG traces for 25 years and, if possible, store them electronically
In cases where there is concern that the baby may experience
D.25yrs developmental delay, photocopy CTG traces and store them indefinitely in
.case of possible adverse outcomes
E.indefinitely

:20 - Main cause of litigation due to ctg is

Answer : b
A. failure to act

B.failure to recognise an abnormal one

C.failure to monitor

D.failure to refer

D.inappropriate oxytocin use

Choose the most appropriate action *

A.CS

B.oxytocin

C.ARM

D.CEFM

E.exam in 2hrs

F.forceps D

21 - multiparous poor uterine contraction 2/10 admitted cx os 4cm check

in 4hrs 8cm MI ANSWER : E

22 - nulliparous contraction3/10 admitted cx 4cm checked in 4hrs was cx

5cm ANSWER : C

23 Unstable neonate post ventouse delivery low APGAR found to have

:scalp swelling with ill defined edges whats your diagnosis

A. cephalohaematoma

B.subglialial H

C.capaut

D.ICH

E.chingon

* Choose appropriate mangment

A.cat1cs Patients with subgaleal hematoma may present

with hemorrhagic shock. The swelling may
B.cat2 cs obscure the fontanel and cross suture lines
(distinguishing it from cephalohematoma), watch
C.cat3 cs .for significant hyperbilirubinemia
D.cat4 cs

E.ECV

F.ARM
G.instrumental delivery

H.exam in 2hr

I.exam in4hrs

24 - 3rd pregnancy 38wks now breech present with reduced fetal

movement twice normal US AF breech extended and normal ctg opted
for VD

25 - parous term low risk pregnancy present in labour at 4cm intact

membranes cord felt pulsating through the membrane on pelvic

exam

26 - A 30 year old nullipara presented to labour ward , she is low risk and
39 wks GA ; on examination the cervix is 6 cm dilatation , intact
membrane with the presenting part on Rt. Occipito posterior position
. and fully effaced cervix with the head at the level of the ischial spine

:Choose the single most appropriate next action

ANSWER : A
A. intermittent auscultation
a & d are right answers
B. CEFM but the 4hs is the routine
and rt op position may add some risk for fetal
C.exam in 2hrs
distress so fetal monitoring is needed so i choose a
D.exam in 4hrs

E.ARM

27 - Patient in second stage of labour you want to infiltrate the perineum

with lignocaine without vasopressor how much you give

A. 1mg/kg

B.2mg/kg

C.3mg/kg .

D.5mg/kg
Total ml acc. to dose & solution conc. 1or 2% = [)3or7( ‚ 10] x
E.7mg/kg [wt. ‚ conc
:28 - SLE lady pregnant worried about fetal risk what test should be done

A. APS antibodies Another name Sjogan ANSWER : C

SLE
B.lupus anticoagulant More than 90% of mothers of affected offspring have anti-Ro antibodies,
and 50%–70% have anti-La antibodies
C. Anti Ro &La antibodies The prevalence of anti-Ro in the general popu- lation is <1%, although
anti-Ro/La are present in about 30% of patients with SLE, commonly
D.dstranded DNA associated with photosensitivity, Sjögren’s syndrome, subacute lupus
erythematosus and ANA-negative SLE
E.antinuclear abs In babies of Ro/La-positive mothers, the risk of transient cutaneous lupus
is about 5% and the risk of CHB about 2%
The risk of neonatal lupus is increased if a previous child has been
affected, rising to 16%–18% with one affected child and 50% if two
children are affected; subse- quent infants tend to be affected in the same
.way as their siblings

29 - 38 wks patient with primery herps plus HIV what measures you do to
prevent vertical transmission

A. IOL
CS for all ( nice : may permit vd ) 1st episode genital herpes in
B. acyclovir T3, particularly within 6 weeks of EDD, as the risk of neonatal
transmission of HSV is very high at 41% and in recurrence 0 – 3
C. ELCS at 39wks .%
D.vaginal delivery

* most appropriate mangment

A.admit to control glucose

B.IOL 37 -40wks C. increase pre lunch insulin

if uncontrolled type 1 or 2 DM iol before 37 weeks with
D.US for umbilical artery Doppler steroids

E.CS at 38 wks F. reassurance and to be seen in 2wks

G.many others options if complicated deliver before 37 wks

30 - known type 1 daibeties at 36wks GA controlled in insulin HBA1C

6.5% came after lunch to diabetic joint clinic urine++ glucose US baby ok
in 40th centile otherwise patient stablE
31 - known diabetic at 33wks variable control HBA1C 7.4% urine++
glucose US baby in 10th centile otherwise ok

32 - type 2 diabeties para 2 with 1 previous CS HBA1C 7.4% US baby in

70th centile keen for vaginal delivery

* 7.4.1.Explain to pregnant women with diabetes who have an ultrasound-

diagnosed
macrosomic fetus about the risks and benefits of vaginal birth, induction of
labour and caesarean section. [2008
* 1.4.2 Advise pregnant women with type 1 or type 2 diabetes and no other
complications to have an elective birth by induction of labour, or by elective
caesarean section if indicated, between 37+0 weeks and 38+6 weeks of
pregnancy. [new 2015
* 1.4.3 Consider elective birth before 37+0 weeks for women with type 1 or type 2
.diabetes if there are metabolic or any other maternal or fetal complications
new 2015 ]
Diabetes should not in itself be considered a contraindication to attempting
vaginal birth after a previous caesarean section. [2008

Causative agent

A. zika virus Vertical transmission in Rubella infection

occurs during maternal viraemia; the risk
B.Epstien bar virus of fetal infection is
90% before 12 weeks of gestation, about
C.p.falcipram 55% at 12–16 weeks, and it declines to
45% after 16 weeks
D.measels virus

E.varicella virus

F.others 2

33 - Patient pregnanat came from Zambia found to have parasitaemia

>2% ANSWER : C
34 - 5. pregnant present with flu like symptom tell to come back if she
devolped any …presented 2days latter with itchy red spot behind ears
and scalp then the forehead ANSWER :F RUBELLAE

** A red-pink rash
Picture of the rubella rash
The rubella rash is typically a red-pink colour. It consists of a number of small spots, which may
.be slightly itchy
The rash usually starts behind the ears before spreading around the head and neck. It may then
spread to the chest and tummy (the trunk), and legs and arms. In most cases the rash disappears
by itself within three to five days
** The measles rash appears around 2 to 4 days after the initial symptoms and normally fades
.after about a week
.You'll usually feel most ill on the first or second day after the rash develops
:The rash
is made up of small red-brown, flat or slightly raised spots that may join together into larger
blotchy patches
usually first appears on the head or neck, before spreading outwards to the rest of the body
is slightly itchy for some people
can look similar to other childhood conditions, such as slapped cheek syndrome, roseola or
rubella
is unlikely to be caused by measles if the person has been fully vaccinated (had 2 doses of the
.MMR vaccine) or had measles

.The main symptom of chickenpox is a red rash made up of spots or blisters

It usually takes between one and three weeks for symptoms to appear after becoming infected
(the incubation period) Early symptoms
Sometimes other symptoms may start a day or two before the rash appears
:These can include :
feeling tired and generally unwell
a high temperature (fever) of 38C (100.4F) or over
feeling sick
a headache
aching, painful muscles
loss of appetite
Not everyone has these symptoms. They tend to be more common and more severe in older
.children and adults with chickenpox
koplicks spot Pathogonomic

35 - pregnant at 38 wks admitted with pnaemonia her GP give history of

generlised skin rash and conjunctivitis and otitis media 3days ago red
spots with blue white centers found in the mouth ANSWER : D

36 - what is commonest cause for malaria in UK

Answer :c
A. P.malarae B. P.ovale C. P.falcipram D.
P.vivax E.

*suitable prophylaxis In post natal you have 2 option

A.aneinatal LMWH and 6wks post natal
B. highdose antenatal LMWH and 6wks postnatal
C.theraputic LMWH and 6wks postnatal
D.antenatal antiembolism stoking and
10 days postnatalLMWH
E.LMWH 10days post natal
BMI above 30 and antepartum 1
score
BMI 30 or above and p.partum 1
score
If in question only mentioned
postnatal and didn't give any
comments about antenatal so if
2 or 3 or 4 or more risk give 10
d

This mean deal as 2 group and

F. thromboprophylaxis from 28wks
what factors present now
G. no need for thromboprophylaxis
Again count the risk factor for
h.many others options antinatal and count again post
natal
37 - smocker with HTN BMI 32 admitted to control her BP
SMOKER +32 + ADMITION = 3 RISK FACTORS= ( now as admission ) ANSWER : E
+10 days pp

38 - onther pregnant with antithrombin deficiency and prvious history of

VTE Mid. or rot. ANSWER :B

He did not
say
39 - 31yrs lady undergone CS BMI 30 blood loss 1100 ml ANSWER : E

40 - patient with growth varicose vein and instrumental delivery..??.

41 - Patient delivered vaginaly and devolped PPH whats the level of HB

to define postnatal anaemia .

A. 120g B. 110g C.115 g D.100 g E.105g

1ST AND 2ND TRIMESTER 110 MG

3RD TRIMESTER 105 MG

42 - Breast cancer suspected in pregnant lady referred to breast
specialist 1st line investigation:.

A.mamogram

B.US

C.CT

D. MRI

E.CXR
ANSWER : B
43 - Patient pregnant with breast cancer need chemotherapy needed

A. cyclophpshamide C.steroid D.etoposide B.anthracycline

Anthracycline (Doxorubicine, Epirubicine) in T2

& T3

,Cadiotoxic need echo

coming step in Management*

A.oxytocin

B.Bakri balloon

C. 3doses of carbpoprost

G.hystrectomy

E.uterine artery ligation

F.interventional radiology

.B.lynch
ANSWER : E
44 - patient with previous scar in her 2 nd

CS placenta found to involve the uterovesical space deliverd and trying

to control bleeding uterotonic and B lynch but still there is bleeding from
one corner at vesicoureteric junction.. anesthetist concerned but said
patient stable
* -There are no trials comparing the prostaglandin carboprost (15-methyl prostaglandin F2a)
with other
uterotonic agents. Two case series from the USA,137,138 comprising 26 and 237 cases,
respectively, have
reported on the use of carboprost in the successful management of PPH, without resort to
surgical
interventions in 85% and 95% of cases. Two of the four failures in the smaller series were
associated with
placenta accreta. If bleeding occurs at the time of caesarean section, intramyometrial
injection of
carboprost may be used (although not licensed). It is also possible to inject intramyometrial
carboprost
through the abdominal wall in the absence of laparotomy. The recommended dose is 250
micrograms
intramuscularly. This may be repeated every 15 minutes to a total dose of 2 mg (eight
doses). However, if
significant atonic haemorrhage continues after a third dose of carboprost, without
significant improvement
(i.e. 30 minutes or more after the first dose was given), the team should consider transfer to
the
operating theatre for examination under anaesthesia, with an awareness of the impending
need for
laparotomy and/or hysterectomy
* If pharmacological measures fail to control the haemorrhage, surgical interventions should
be
initiated sooner rather than later. D
Intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most
women where uterine atony is the only or main cause of haemorrhage. C
Conservative surgical interventions may be attempted as second line, depending on clinical
circumstances and available expertise. C
.It is recommended that a laminated diagram of the brace suture technique be kept in theatre
Resort to hysterectomy sooner rather than later (especially in cases of placenta accreta or
uterine rupture). C
Ideally and when feasible, a second experienced clinician should be involved in the decision
for
.hysterectomy

45 - patient previous 3 scar have atony respond at start to

oxytocin,ergometrine and 2doses of carboprost intramyometrial but
again start to bleed anesthetist concerned and mention patient unstable
Answer : g HYSTERECTOMY (
UNSTABLE )

46 - Patient pregnant came from vacation to some African area screening

for syphilis was positive need confirmation which test
Answer : b
A. VDRL
B.tropenema agglutination particles
C. tropenema NB: Diagnostic test for Syphilis
fluorescent test Agglutination test, FTA (fluorescernce treponemal antibody test (
D. lesion smear Treponemal antibody tests - TPHA (treponema Pallidum
haemagglutination) and FTA-ABS (fluorescent treponemal antibody -
E.RPR
absorption test)
Diagnosis
* Dark ground microscopy for spirochaetes / serology (routine (
screening
* VDRL / RPR (rapid plasma reagin) - cardiolipin antibody tests, +ve
in untreated 2ry / latent / tertiary syphilis, become -ve with ttt
* Treponemal antibody tests - TPHA (treponema Pallidum
haemagglutination) and FTA-ABS (fluorescent treponemal antibody -
absorption test) - remain +ve even with adequate ttt. FTA-ABS
becomes +ve before VDRL or RPR
* Do not monitor for FFTS in T1. Start from 16 wks, every 2 weeks until 24 wks
uncomplicated MCDA 9 antenatal appointments
uncomplicated DC twin 8 antenatal appointments
uncomplicated MCTA and DCTA triplet 11 antenatal appointments
uncomplicated TCTA triplet 7 antenatal appointments
* MCDA, MCTA, DCTA App. + scan /2wks from 16 to 24wks to detect TTTs
,DC twins, TCTA App. only (no scan) at 16 wks then
App. + scan / 4wks from 20 to 32wks to detect FGR (discordant or concordant)
MCMA, DCDA (Twins and Triplet), DCDA (Triplet) refer to tertiary level fetal medicine
centre, it is not our job, above our level

46 - Patient with MCDA when to start U/S Answer : B

A. 12wks B. 16wks C. 20 wks D. 24 wks

E. 28 wk 11ws -13wks+6ds for chorionicity

47 - MCDA with co twin death next step

A. IOL B. CS C. MRI brain for other twin D.?

E.? Forget Answer : c

15 %Risk of death in other twin is 15

25 % Risk of neurological abnormalities is

48 - Ptient with HIV on HAART present at 35wks with PPROM VL < 50

next step
A. CS now B.CS at term C.IOL now D. wait for
VD E.?
Answer: c

49 - Screening for GDM in current pregnancy for previous GDM, when

should be

A.at booking if negative repeat at 24-28wks

B. at 18wks and if negative repeat 24-28wks

C. At 24-28wks D. At 28wks

E. At 16 -24wks Answer : a
50 - Postpartum patient with preeclampsia devolped dyspnia
,tachycardia,basal crepitation and O2 saturation 91 and low urine out put
diagnosis Answer : b
A. Pul embolism B. Pul.oedema C. Pneumonia D. MI E.
Ischemic heart disease

51 - pregnant lady with high BP C/O of headache for many days present
collapse GCS3 BP 200/120 your diagnosis

A. SAH B.CVT C. Intraventricular Hge D . Idiopathic

intracranial hypertension
Answer : a
E. Preeclampsia

52 - Patient have massive PPH finding platelets 80 APTT 1.3 fibrinogen

1.2 what blood component pt need

A. FFP B. Cryopreciptate C. Platelets D. factor VIII

E. Packed RBCs Answer: b

To maintain fibrinogen more than 2 ( new

gtg)
Untill blood is available, infuse up to 3.5 L of warmed clear fluids, initially 2 l of warmed isotonic
crystalloid and / or 1.5 litres of colloid.
6:4 RBCs:FFP
FFP 4 units for every 6 units of RBCs / if prothrombin time/activated partial thromboplastin time is >
1.5 times normal, at a dose of 12–15 ml/kg
4 units FFP + 10 units crPPT  empirically in severe bleedeing while awaiting result of coag. studies.
Cryoprecipitate 2 pools if hge is ongoing and fibrinogen < 2 g/l  to maintain plasma fibrinogen level of
> 2 g/l
Cryoprecipitate 2 pools ↑ fibrinogen by 1 g/l  30 mg/Kg concentrate fibrinogen
platelets should be transfused when the platelet count is < 75 X 109 / l
the main therapeutic goals of the management of massive blood loss as maintaining:
 Hb > 80 g/l
 platelet count > 50 X 109/l
 prothrombin time (PT) < 1.5 times normal
 activated partial thromboplastin time (APTT) < 1.5 times normal
 fibrinogen > 2 g/l.
recombinant Factor VIIa  acting by activation of clotting factors,
so need platelet > 20 X 109 / l & fibrinogen > 1 g/l.
↑ R. of art., not venous thromboembolism.
Need no Acidosis, Hypothermia or Thrmbocytopenia to act well

53 - Patient postoperative 18 hrs on PCA collapsed with pinpoint pupil

RR12 normal O2 saturation wt medication ???BP 80/40

A. Adrenaline B. Naloxone C. Atropine D. DC shock

E. Intralipid Answer : b
54 - During S2 CS which measure has evidence in reduction of neonatal
trauma

A. delivery by breech B. forceps for disimpaction C. pressure from below

by the
Answer : d or a the 2 are other
same

D.Pull method

E.??64
 [.try to test ptn. > HIV-ve ..> D]
55 - * What action you do Ptn. is +ve >check the doctor + take prophylaxis
either in occupational health (morning working
A. Deliver by CS hours) or in accident&emergency department
(evening hours)
B. IOL C. Report to occupational health tomorrow /

C. Report to occupational health tomorrow

D. Reassure and check for seroconversion

E. Start cART

F.many other options Answer : e

55 - patient asylum seeker refused HIV testing during CS on
Friday evening your assistant ST2 have needle stick injury
56 - Patient pregnant HIV -ve at booking discovered her
hasband HIV +ve 6month ago she is worried about risk to baby
the risk of hiv per /sexual intercourse> Answer : d
1%
The risk of transmission for each act of sexual intercourse is 0.001% – 0.03%. This risk
is significantly reduced, if the male partner has a viral load of < 50 copies/ml and is
taking HAART. The risk can be further reduced by limiting exposure to the fertile period
of the cycle and ensuring that all genital infections have been treated.• Couples who are
serodiscordant choosing to have intercourse should
57 - 57. Perimortem CS time
A. 3mins B. 4mins C. 6mins D.
10mins Answer :b 4 min

Perimortem CS: > 20 wks, if > 4 min with no response

from CPR, achieved within < 5 min
* select the suitable Mx
A. Steroid B. Plan delivery C. Uterine artery Doppler D. Umbilical
artery Doppler E. U/S for EFW

58 - Midwife referred patient at 28wks with SFH less than 10th

centile Answer : e

59 - Patient serial scan indicate static growth

Answer : b

60 - Patient high BMI and first pregnancy smoke on occasion

her sister has still birth because of SGA want to know at 18wks
GA Answer : c

60 - Primigravida comes to booking at 11 wks and wants to the

risk of her baby having Down syndrome
B. Amniocentesis C. Haemoglubinopathy for the A.CVS
hasband

D. Nuchal translucency E. Non invasive maternal test

F. Combined test Answer : f

EMQ
A. CVS

B. Amniocentesis

C. Haemoglubinopathy for the hasband

D. Use of nuccal translucency

E. Non invasive maternal test

F. many other options Answer : e ffDNA

61 - Patient known thalsaemia carrier, hasband status unknown

and cant test him he is in prison
 62 - Midwife did family questionare, patient & hasband born in
UK ,hasband parent born in Turkey Answer : c
63 - Midwife did family questionare, patient and hasband born
in UK, hasband was adoption know nothing about his mother
Answer : c CF or thalassemia

NICE CG 62 0f ANC:
Screening for sickle cell diseases and thalassaemias should be offered to all women ASAP
in pregnancy (ideally by 10 weeks).

Where prevalence of sickle cell disease is high (fetal prevalence > 1.5 cases per 10,000
pregnancies), laboratory screening to all pregnant women to identify carriers of sickle cell
disease and/or thalassaemia.

Where prevalence of sickle cell disease is low (fetal prevalence < 1.5 cases per 10,000
pregnancies), all pregnant women should be offered screening for haemoglobinopathies
using the Family Origin Questionnaire.
 If the Family Origin Questionnaire indicates a high risk of sickle cell disorders,
laboratory screening should be offered.
 Mean corpuscular haemoglobin is < 27 picograms  laboratory screening.

If the woman is identified as a carrier , the father of the baby should be offered counselling
and appropriate screening without delay.

64 - Pregnant combined test show risk for Down 1/12 patient

cystic hygroma and
short femur whats your diagnosis
A. Down syn B. Edward synd C. Patau D. Turner
Answer : d

65 - Patient with protracted vomiting at 11 wks pregnancy first

line antiemetic

A. cyclizine im iv oral
B.meteclopromide
C.ondansteron
 Answer : a
D.corticosteroid

66 - Couple with 1st and 2nd trimester miscarriage came for

counseling what can be the most
Answer :B
:likely cause of miscarriage

A.women age <20 yrs

B. man age>40 yrs

C.working with vedio monitor
67 - Common finding in ECG of patient with MI Answer : b
A. depressed st in lead avl
B.elevation of st in wave in V2 V3 V6
68 - patient blood group negative received FFP group positive
what you give
Answer: D
A.anti D 250
B.anti D 500

C. plasmaphresis
 D. no need for antiD
Pregnant lady known haemophillia her baby status not known. .
plan of delivery will be and

when to check factor VIII

A. CS check factor VIII now

B. induction of labour
C.allow VD and avoid FBS

and instrumental delivery

Answer: A
check factor VIII in 3rd tm
70 - Patient known Von W disease bleed during labour wt .
medication ANSWER : D
A. fVII
B.fVIII

C.platelet
D. desmopressin

E.cryopreciptate
* Desmopressin (DDAVP)
Aspirin and NSAIDs should not be given to women with vWD

factor VIII levels may be indicated, e.g., prior to procedures, delivery, epidural
or C.S
If not respond to DDAVP, FFP or plasma-derived factor concentrates
containing vWF and factor VIII may be used to control or prevent severe
bleeding
*( DDAVP ) Fluid intake should be restricted to 1 litre for 24 hours following
DDAVP administration to prevent maternal hyponatraemia. If additional fluid is
required, electrolytes should be monitored .
71 - Asthmatic pregnant lady received short acting beta blocker .
and 800 steroid but her asthma not controlled next step

A. steroid

B. LABA
C.theophillin

D.leukotriene
72 - Pregnant lady with renal transplant stable came for .
prepregnancy counseling which drug to stop
ANSWER : D
A.ciclosporin

B.predinsolone
C.calcium

D. Ramipril

73 - Which condition put pregnant lady in high risk of MI

A.hypothyoidism Answer : B
B.migraine TOG 2014: Migraine have a > 2-fold ↑ risk
of pre-eclampsia, a 17-fold ↑ risk of stroke
C.celiac disease and a 4-fold ↑ risk of acute myocardial
infarction
D.marfan
74 - which condition without other risk factor let you consider
thromboprophylaxis during pregnancy ANSWER: B

A.diabeties
B.sickle cell anaemia

C. IUGR
??.D
 all of them take score 3
* All medical comorbidities: cancer, heart failure ,active SLE inflammatory
polyarthropathy ,ibd .ns , type 1 dm with nephropathy , scd .ivud
* hyperemesis in the 1st trimester
* any vte provoked by surgery
* any hight risk thrombophelia
* any surgery in perperium el surgery
all of them take score 4
AntiD* * previous vte not provoked by surgery
* ohss in yhe 1st trimester
A.offer antiD 250 B.anti D 500 C. no anti D needed D. paternal
genotype E.CFFDNA F.measure maternal antibodies G.CVS

h.amniocentesis answer : c no anti d needed

75 - early pregnancy confirmed IUP 2wks ago at 8 wks

presented with vaginal bleeding US done empty uterus
76 - pregnant lady has previous hydropic baby father is DD RH
negative Answer : f
77 - pregnant at 12 wks had vaginal bleeding and evacuation of
ROPC after 4 days discovered RH D negative
Answer : A.offer antiD 250
antibiotics
A. gentamycin plus clindamycin UK national guidelines on the management
of syphilis 2015:
B. benzyl penicillin 3g then 1.5g 4hrly Testing and ttt for syphilis is the same
HIV+ve as HIV -ve
C. benzyl penicillin 2.4 stat Potentially incubating
syphilis/epidemiological ttt
D. cefodar different concenteration oral 1 - Benzathine penicillin G 2.4 MU IM
E.augmentin single dose
2 - Doxycycline 100mg PO BD. 14 days
F. all PID regimen 3 - Azithromycin 2 g PO

78 - Sudanese asylum seeker screening venereal disease

confirmed by TPHA and also HIV positive has mitronidazole
allergy cause her vomiting and rash Answer :C

79 -3 days postpartum referred by her midwife due to excessive

lochia and clots abd pain and mild pyrexia
Answer : A. gentamycin plus
clindamycin
80-Pregnant lady with headache no neurological deficit O/E
what Invest. Answer : C

A.CT with contrast

TOG 2014: Magnetic resonance imaging with T2-
B.MRI without contrast weighted imaging and magnetic resonance
venography (MRV) is the imaging modality of
C.MRV .choice

D.2 others not remember

MATERNAL MORTALITY Any pre pregnancy dis

……..indirect
A.direct Any dis related to preg. …..direct
Within 6 weeks ………early
B.indirect After 6 weeks ……….late

C.coincidental

D.accidental
E.late
ANSWER : A
F.not maternal death
81 - lady with pre eclampsia developed ICH take 5wks in ICU .
and died
82 - Lady is collapsed 48 hrs post delivery postmortem was
Esimenger synd ANSWER B

83 - Lady murded by her hasband

* early pregnancy Answer c

A. scan in 7 to 10 days

B.HCG in 48 hrs
C.surgical mx

D.expectant mx
 ANSWER
E. evacuation RPOC :A

F.others options ANSWER

:A
84 - Pregnant lady US CRL 8mm no cardiac activity
ANSWER
85 - Pregnant US show MGD 24mm :A

86 – pregnant with vaginal spotting on u/s crl 7 mm and no

cardiac activity
Diagnosis *

A. ectopic
B.appendicitis

C. OHSS
D.hetertopic
E. tortion

F.miscarriage
87 - Surrogate for her sister retained 2 babies at 6wks
confirmed single IUP present with sudden onset of lower abd
pain and tenderness Answer : D

88.Lady after egg collection of 20 folliclle present with abd pain

and sense of fullness in the lower tight clothes at width (not
exactly but nea
ANSWER C
:
89. Young lady present with sudden onset of LT iliac fossa pain
nausea and vomiting ANSWER : E
90.Patient with RH D negative kell negative devolped PPH need
blood

A.O negative

B. cross match blood

ANSWER : A
C.others

91 - Indication for IAP for patient had GBS in previous pregnancy

: and had healthy baby ANSWER : B

INDICATION FOR OFFERING GBS-SPECEFIC IAP

A. previous colonization
B. GBS bacturia in current
C.PPROM
D.PROM
1 – previous baby with invasive GBS inf.
2 – GBS bacteruria in current preg.
3 – vaginal swap + ve for GBS in current preg.
4 – pyrexia ( +38 c ) in labour ( give ab broud – sp to
include GBS)
5 – chorioamnionitis ( b-s ab include GBS cover
SCREENING 33 – 35 WS IF PREV. / INC 6/ 1000
Intact memb. Lscs not necessary for GBS
92.Which analgesic should be avoided during sepsis

A. morphine ANSWER : B

B.NSAID Source: GTG No. 64b Bacterial sepsis following

.pregnancy
C. cocodamol NSAIDs should be avoided for pain relief in cases
of sepsis as they impede the ability of polymorphs
D.paracetamoL .to fight GAS infection

93 - Booking US CRL 90 BPD 12 AC ? what to use to date her

pregnancy ANSWER : D - HC

A.BPD

B.AC

C.CRL

D.HC

E.FL

TOP next step *;

A. reassure and prescribe analgesic

B. surgical evacuation

C. US

D. do pregnancy test 1wk later

E. others

94. early pregnancy loss follow medical TOP call gyn C/O of cramps and
some bleeding otherwise ok ANSWER : A
95 - 14 days post medical TOP call the midwife that her PT is positive
ANSWER D

96 - Pregnant with IUFD at 26 wks wt the best regimen to induce labour

ANSWER : C
A. mife 200mg miso 100 mg 6hrly max 4doses
B.mife 200mcg miso 100mcg 6hrly 4doses

C. mife 200mg miso 100mg 6hrly 5doses

D.mife 200 mg miso200mcg 6hrly 5doses

mefiprostol 200 mg for all increse sensitivity of myometrium to pg 5 times

mefiprostol –misoprostol interval 36 – 48 hs

97 - Pregnant lady with rash involve the abd striae what is good
prognostic finding for baby ANSWER : B
TOG 2013
A. involve face
Polymorphic eruption of preg. Have
B. periumlical spare C.presence of C3 no impact on maternal / fetal
outcome
98 - Cystic fibrosis both parent carrier under gone IVF 12 embryo how
many will be affected
Answer : b 3
A. 2
 B.3

C.4
Commonest leathal g condition in
D.6 coucasian affecting 1 / 2000 and carrier
risk is 1/25 in uk
Aurosomal recessive disease
99 - Evidence based step to avoid perineal trauma during vaginal
delivery
answer : C
A. perineal massage

B. hand on technique

C.warm compresses

100 - CEMAC report 2006-2008 common cause of death in preeclampsia

:is Answer : B ICH

A. eclampsia

B.ICH

C.P.edema

Answer : c

NICE 2014, February 2017: Intrapartum

interventions to reduce perineal trauma:

1.13.12 Do not perform perineal massage in S2

.of labour

1.13.13 Either the 'hands on' (guarding the

perineum and flexing the baby's head) or the
'hands poised' (with hands off the perineum and
baby's head but in readiness) technique can be
.used to facilitate spontaneous birth
Demonstrated pictures for many instrument *

101 - instrument used to dissect the

ureter in abd hysterectomy Answer : lahey

102 - .Instrument used to held skin edges

Allis
together for staples to be in sit

103 - Hyperplasia description

low gland to stroma ratio

but cells show large nucleus

A. simple without atypia C.complex with atypia Answer : b

B.simple with atypia D.complex without atypia

104 - Patient with HMB diagnosed as having endometrial hyperplasia

without atypia whats the risk of it to devolp cancer

A.<1% B.3% C. 4% D.8%

Answer : C
B.3%
Endometrial hp without atpia cancer less than 5% / 20 ys

Risk of co existing cancer 1%

In case of atypia the risk 25- 33 % may reach 59%

105 -Couple with infertility of one yr women 25yrs man 40yrs whatis th e
most likely cause
Answer : b
A.unexplained

B.male problem

C.tubal factor

D.uterine factor

E.ovulotory

105 – couples with 2ry infertility of one year ,women is 25 ys , male is 40

ys , obese and semen analysis shows azoospermia what is the most
likely cause ?

A -unexplained B- hypothyroidism C- Y chromosome microdeletion

Answer : B ?
D – klinfilter syndrome E – kallmann syndrome

Clue 2ry inf. Obesity azospermia

Un explained can be good choice if it wasnot for word ( obese ) other option
are cause of 1ry infertility

INFERTILITY

A.clomid 50mg od B.clomid 100mg od C.clomid 50mg +timed hcg

D.clomid 100mg +timed hcg E. gnrh analo F.ovarian drilling G.IUI

h.IVF

106 - infertile couple man ok woman PCO with anovulation induced with
clomid 50mg estrogen level was high follicle 20mm but progestron on
day 23 of 26 cycle showed un ovulation 3 ithink Aswer : c

Follicle 20 no clomid ( LUF / harm the pt. )

Just need a trigger

107 - infertility 2yrs all investigations normal except woman PCO with
anovulation evident by progestron
Red level
clomid for 6 m lap drilling add
Answer : a metformin or gonadotophin ( FSH & LH ) IVF

108 - nfertility 3 yrs all normal woman PCO received 6 cycle of clomifen
citrate day 23 out of 26 cycle progestron range between 32 to 67
Answer : h IVF
infertility *

Oligomenorrhea A.ocp B.progestron C.repeat hormone premenstrual wk

D.repeat hormone day 1 to 5 of cycle E. PT F. cc G.CT h.MRI

i.karyotyping

j.many other options ANSWER : D POF

109 - Young referred from her gp with oligomenorrhea every 3 to 5month

ithink her hormonal profile FSH 28, LH 11 prolactin 500

110 - Young oligomenorrhea feel nausea ,fatigue,breast pain ,control her

family by barrier method ,,hormonal profile FSH 0.2 LH 1 prolactin 750
answer : E. PT
111 -1 9 yrs secondary amenorrhea hormonal profile FSH 88 LH high
prolactin low Answer : I
oligomenorrhea* karyotyping

A. ocp Turner mosaic

B.vaginal progesterone dialy

C.cyclical progesterone

D.merina

E.induction of ovulation

F.CC

112 - Young concerned about her period .irregular last was 9month
ago.BP 150/104 not in sexual relation ship ( pco >>>>>ht) Answer : c
113 - same scenario with high BP and adult polycystic kidney PCO and
not in sexaual relation Answer : d
As kidney disease ass with endometrial hyperplasia and HMB so Mirena

114 - 28yrs in relationship not want pregnancy concerned about her

irregular period. Answer : a

Ethics
A. non malficience ‫عدم االيذاء‬

B.beneficience ‫االعانه‬

C. veracy ‫الصدق واالمانه‬

D.paternalism ‫االبوة‬

‫الحكم الذاتى‬
E. autonomy

F.justice G.others ‫العداله‬

 Answer :E
autonomy
115 - Patient Down syn with HMB affecting her quality of life
accompanied by her mother who agree to offer merina to her daughter
..You discuss the mother and patient about merina pros and cons

Answer : E some down sy. Have level of IQ and they are not complete
‫د‬MR SO THE doctor discuss the patient and the examinar put this word
‫اخمد البيهوتي‬

116 -Patient with IUGR Ithink abnormal CTG need CS patient refused
and said she rely on nature and every thing will be ok Answer : e
*autonomy[1] is the capacity to make an informed, un-coerced decision
*Paternalis is the opposite
117 - Pregnant at 36wks ask for induction because her hasband will
travel somewhere you refuse to offer her induction
Cohort Study (Prospective Observational
Anawer : A Answer :a
Study)
A clinical research study in which people who
STUDY as Q99 M 2016
presently have a certain condition or receive a
particular treatment are followed over time and
A.cohort
compared with another group of people who are
B.case control not affected by the condition. Example:
Smokeless tobacco cessation in South Asian
C.retrospective observational study communities: a multi-centre prospective cohort
study. Croucher R, et al. Addiction. 2012
D.systematic review Some time cohort my be retrospective
E. metaanalysis Case-control Study
Case-control studies begin with the outcomes and
F.RCT do not follow people over time. Researchers
choose people with a particular result (the cases)
G.other option and interview the groups or check their records to
Answer :a ascertain what different experiences they had.
They compare the odds of having an experience
118 - . DR conducted study over 15 yrs with the outcome to the odds of having an
experience without the outcome. Example: Non-
to see effect of carbiplatin on 5yrs use of bicycle helmets and risk of fatal head

survival of patient with cancer

119 - DR looks in literature to see effect of merina in HMB Answer : D

120 - DR conduct study among drs to see effect of smoking and non
smoking in lung cancer Answer : b
Case control you start with the disease

Cohort start with exposure risk factor Some time cohort my be retrospective

COHART STUDY

Systemic review : collection of data of different type of study FROM litrature

as retrospective , Prospective , cohort study , case control no
conclusion

Of certain supject ,collect all studies about that supject , no inclusion or

exclusion criteria

Meta-analysis : collection of data from same type conclusion

More specific in data collection ,may use studies collected in systemic review
and filter them according to exclusionand inclusion criteria high level
of evidence

LEARNING

A.brainstorming

B.ischema activation

C.ischema refinement

D.1step perception
E.snowballing

F.goldfishbowel
Answer : B
G.icebreaking

121 - The facilitator let group of learners to study about

physiology,pathology of subject(not remember it )

Schema Activation, Construction, and Application. Readers rely on their prior

knowledge and world experience when trying to comprehend a text. It is this
organized knowledge that is accessed during reading that is referred to as
schema (plural schemata)

122 -scenario for 5 steps OF Answer : d

123 - Group of student sit discuss how to solve problem of project

Answer : a
Teaching methods solved EMQs
Options

A Brainstorming

B Delphi technique

C Doughnut rounds

D Goldfish bowl

E Lecture

F Problem based learning

G Schema activation

H Schema refinement

I Simplified procedural hierarchy

J Snowballing

K complex procedural hierarchy

For each of the teaching scenarios described in the items below select the single most
correct term from the list of options. Each option may be used once, more than once or not
.at all
Q 1 You are asked to initiate ideas for research among a group of junior trainees .
You get the trainees together and everyone contributes ideas, experiences and
.different perspectives. These are recorded onto a flip chart

ANSWER A Brainstorming

Q 2 You are asked to teach a group of 3 trainees on the structure of the cell
membrane and membrane receptors. Each of the trainees is given a chapter to read
on the relevant subjects. You also require each trainee to develop 10 questions on
the subject material. A week later they cover the facts by sitting together and testing
.each other by using their questions

ANSWER C Doughnut rounds

Q 3 You are paired with a Consultant and are required to demonstrate good practice
in “Breaking Bad News” to a group of 14 trainees. Both of you facilitate learning by a
role play in front of the whole group to demonstrate behaviour you want the
.members of the group to assimilate

Answer D Goldfish bowl

Q4 The lecturer gave the student a tutorial on the anatomy, physiology and
endocrinology appropriate to amenorrhoea followed by a series of clinical cases
which including post-chemotherapy amenorrhoea, Turner syndrome,
hyperprolactinaemia and complete androgen insensitivity syndrome. The learners
recall what they have experienced in the tutorial and attempt to solve clinical
.problems

Answer H Schema refinement

Q5 consultant asked a trainee to assist in the operation of total abdominal

hysterectomy. After several such operations, dur ing which the educational
experience of the trainee consists of observing surgical techniques, the consultant
then asked the trainee to describe the operation in order to ascertain that he had
grasped the steps, techniques and use of instruments that are vital to a safely
conducted operation. The consultant then assisted the trainee in the procedure. After
several operations with ongoing assessment, evaluation and feedback , the
consultant asked the trainee to carry out the operation while assisted by another
.trainee. The consultant would be immediately available

Answer K complex procedural hierarchy

Q6 You are required to lead a group of senior trainees on concepts in the clinical
management of hirsutism. You begin by activating their recall of the relevant
physiology and biochemistry and give them tutorial to clarify their understanding of
the basic concepts. Then, you give the group a series of clinical problems in which
hirsutism was the presenting complaint. The trainees recall what have experienced in
.the tutorial and solve clinical problems

Answer H Schema refinement

Q7 You are required to lead the development of a consensus on the educational

expectations of medical students in the gynaecological operation theatre . Your
group consists of 40 medical students who have had limited experience. in the
speciality and who are about to start their clerkship. Individuals are asked to think
about the issues themselves, then you pair them and then the pairs join up into 2
groups of 20 each.The large 2 groups continue working on the and then join up to
.reach a consensus

Answer J Snowballing

Q8 You are required to teach a group of junior trainees on the subject of changes in
the postmenopausal women. In the first instance, you ask the trainees to recall their
knowledge of basic endocrinology concerning the hypothalamic -pituitary ovarian
.axis

Answer G Schema activation

All the best

Mustafa

 Teaching methods at a glance:

 Case-based discussion: you will present your case[patient] to your supervisor,
just like when we were house-officers , reading our case notes in front our
consultants. Your consultant[teacehr] will explore the clinical knowledge,
judgment and reasoning of the learner using patient records and test results.
 Mini-CEX: consists of a consultation between you & your patient; which is
observed and assessed by your consultant. [Something like OSCE; but here the
role-player is a real patient].
NB: Case-based discussion & Mini-CEX are known as Workplace-based
assessments
 Problem-based learning: A group of learners [doctors/students] will have multiple
sessions[meetings with facilitators] over a certain period of time to discuss a
given problem.
 The 1-minute preceptor: These are the teaching opportunities that arise in the
clinical environment. For example you were taking a walk with your students In the
hospital when suddenly a pregnant woman collapses In front of you, or; you notice
a lady In the labour ward whose is poorly progressing & you’ll take the chance &
gather your students to discuss & mange.
 Directly observed procedures [with feedback]: You’ll observe observes your
junior doctor/student carrying out a task (e.g insertion of an indwelling urinary
catheter,intrauterine contraceptive device or vaginal pessary).
 Brainstorming: Not clear for me but this is a spontaneous group discussions & flip
charts.
  Schema activation: The tuotorial is PRECEEDED by recalling te basics.
 Schema refinement: Tuotorial on a subject, FOLLOWED by clinical scenarios.
 Snowballing: When you are unsure of the current level of knowledge or skills of
the learners; you start at a very basic level , then base further teaching on the
knowledge displayed by the students.
 Simplified procedural hierarchy: The learner is simply shown how to do something
[eg you show them how to assemble a laparoscope].There is no demand for
assessment, evaluation or feedback.
 Complex procedural hierarchy: Teaching over a significant time span. Your
consultant will let you to operate TAH by your self after several
encounters[observing then assisting then…..].
 Delphi technique : A panel of experts gatehr to reach a consensus
 Doughnut rounds: The learner themselves are asked to make points/questiosn &
later discuss them among themselves.
 Goldfish bowl : Involve a role-play set by the facilitator.
 Peercoaching: Peer coaching is a confidential process through which two or more
professional colleagues work together to reflect on current practices; expand,
refine, and build new skills; share ideas; teach one another; conduct classroom
research; or solve problems in the workplace
 PQ[Patient questionarre] &TO [Team observation]: assesses doctor
communication skills, attitdue & professionalism ; by patient input[PQ] or your
collegeus[TO]

124 - Senario about trainee score 3 in appraisal his consultant comment

that they extend to him due to poor performance and he sit many times
for part one .what to do for him now
ANSWER : C
A. extend again

B.specific attention and not to extend again

C. questionable information need confirmation

D.stop training

125 - Mechanism of action of asprin

A. increase thromboxane

B. irreversible inhibition of COX

ANSWER : B
C.platelet aggregation

126 - Active metabolite of androgen is

A.testesterone

B. DHEA ANSWER :
D
C.DHEAS

d.dihydrosterone = androstanalone or standalone

127 - AED that reduced by COCs is

ANSWER : C
A. phenytoin

B.carbamazepine

C.lamotrigne

D. phenobarbitone RMI = U x M x CA125

* The ultrasound result is scored 1 point for each of the following
*Postmenopausal ovariancharacteristics:
cyst multilocular cysts, solid areas, metastases,
.ascites and bilateral lesions
A.repeat US in 4 month U = 0 (for U/S score of 0) U = 1 (for U/S score of 1) U=3
(for U/S score of 2–5)
B.BSO
* The menopausal status is scored as: 1 = premenopausal 3 = •
C. TAH+BSO postmenopausal
RMI I < 200
D. CA125
* Cysts fulfilling ALL of the following: asymptomatic, simple cyst,
E. MRI < 5 cm, unilocular, unilateral .. Consider conservative
management = Repeat assessment in 4–6 months CA125, TVS ±
F.CT TAS
*Cysts with ANY of the following: symptomatic, non-simple
G. expectant without
features, > 5 cm, multilocular, bilateral Consider surg.
follow up salpingo-oophorectomy (usually bilateral)
RMI I > 200
h.unilateral SO

128 - 60 yrs present .MDT

with multilocular Answer :B

ovarian cyst CA125 30

129 - 50yrs present with simple ovarian cyst 4x4x4.5 and in her note
there cyst 1 yr ago not followed 4x4x4.5 and CA125 is 25 (repeated
question in all recalls) Answer : A

130 - 40 yrs lady present with multilocular or solid component( not sure )
not simple cyst CA125 30
Answer : B
131 - 9years girl came with her parent to the ER with sudden onset of Lt
iliac fossa pain with nausea and vomiting ithink high TWBC
Answer : E
A. analgesia and observation

B. Suspect cyst accident give analgesia

C. Suspect cyst torsion and give analgesia

D. Suspect appendicitis send for surgery

e- suspectcyst tortion and prepare for LAPROSCOPY

 Q
130

Q12
8

Q 129
132 - Patient with history of subfertility and PID present with Rt iliac
fossa pain nausea and vomiting …TWBCS 19.000 CRP 20 US non
compressible mass 5cm diameter 10mm what is the diagnosis
ANSWER : A
A. acute appendicitis * Ct for app. In preg. Potentially carcinogenic and is it useful
after u/s
B. fallopian tube infection * MRI is the alternative immging
* THE ACOG dicatates mri if us not incluosive
C.pelvic abscess
5 - yrs survival

A. 40 -50

B.60-70

C.70-80

D.80-90

E. . (not exact numbers)

133 - Ovarian cancer in young did unilateral SO histopathology reviled

tumor confined to ovary intact capsule negative wash
ANSWER : D stage 1 a

134 - Cervical cancer undergone radical trachelectomy tumor completely

excised found parameterial invasion and no other abnormalities
ANSWER : A stage 2b

135 - Vulvar cancer histopathology come after surgery positive 1 LN with

extracapsular extension ANSWER : A stage 3c

136 80 yrs lady present with 1cm vulval mass near the clitoreal hood
next step ANSWER : B
A. excisional biopsy

B. keyes biopsy from margin

C. wide local excision

D. biopsy from centre( ithink

137 - Young lady in sexually active present with pain less fleshy lesion at
vulva diagnosis

A.hpv

B.syphlis C.herps simplex D.H.dec ANSWER A

HPV FLESHY PAINLESS

SYPHALIS ULCER PAINLESS

CANCER CERVIX
 Answer : c
138 - Lady using IUD for yrs asymptomatic cervical screening revieled
actinomycosis
ACTINOMYOSIS LIKE ORGANISM (ALOS) COMMONLY A/W IUD

A.treat the condition ** IF NO SYMPTOMS NO ACTION

** IF SYMPTOMS REMOVE IUD ( ENSURE NO UPSI IN THE

B.remove IUD PAST 5 DAYS )

C. no intervention now SEND IUD FOR CULTURE AND GIVE AB . GIVE ALTERNATIVE CC &
GYNE REFERAL TO CHECK RESOLUTION OF SYMPTOMS +
NHSCSP:
RESULT
2016

:139 - 50 yrs Cx screening mild dyskaryosis HPV negative next step

ANSWER : C
A. colposcopy

B.RR in 3yrs

C.RR 5yrs

D. hystrctomy
 140 - 50 yrs Cx screening high grade colposcopy unsatisfactory next
:step( CONE / LLITZ)

A.hysterectomy

B.multiple punch biopsies ( if colpo abnormality ,but unsatisfactory=not seen

tz)

C. HPV d RR 5yrs E .RR 3yr

Colposcopy : Colposcopy referral guidelines

Women should be referred for colposcopy if they have

1 - three consecutive inadequate smears 2 - borderline nuclear abnormality

(squamous or glandular) with highrisk 3 - HPV positive 4 - one mild
dyskaryosis with highrisk

6 - one moderate dyskaryosis 7 - one severe dyskaryosis 8 - one smear with

possibility of invasion 9 - one smear with possibility of glandular neoplasia 11 -
after treatment (by loop or thermocoagulation) if highrisk HPV positive (irrespective
of cervical smear result)

Colposcopic examination

Colposcopic examination involves magnified stereoscopic visualisation of the cervix.

It allows a clinical opinion to be formed and acilitates directed tissue sampling. For
colposcopic examination of the cervix to be satisfactory, the entire transformation
zone and the full extent of abnormal (atypical) epithelium is visible must be visible. If
the new squamocolumnar junction can be seen colposcopically, then the entire
transformation zone can be visualised
141 - After how long risk of HRT for breast cancer revert like general
population for lady taking HRT for 5yrs after stop treatment

A.1 yr TOG Oct.2014

Over a mean f/up of 5 years, HRT did not ↑ recurrence rates, but ↓ rate of
B.2ys
recurrence
ANSWER : E
C.3yrs TOG Jan.2015
D.4yrs Risk a/w HRT is much lower than R. a/w obesity, moderate alcohol intake or
delaying 1st pregnancy after 35 years
E.5yrs
The absolute ↑ in breast cancer risk is 6 extra cases per 1000 women for 5
years of estrogen and progestogens, and reverts back to the population risk
5 years after stopping
Vascular injury*

A. Superior gluteal

B. inferior gluteal
The Inferior rectal nerves (inferior anal nerves, inferior
C. ovarian hemorrhoidal nerve) usually branch from the pudendal nerve
but occasionally arises directly from the sacral plexus; they
D. uterine cross the ischiorectal fossa along with the inferior
hemorrhoidal[disambiguation needed] vessels, toward the
E.internal pudendal
anal canal and the lower end of the rectum, and is distributed
F. internal iliac to the Sphincter ani externus (external anal sphincter, EAS)
.and to the integument (skin) around the anus
G.others

142 - Patient undergone laproscopic salpingectomy for ectopic

pregnancy surgon tell intraoperative haemostesis secureD..in the
recovery room patient devolped hypovolemic shock retained for
laprotomy ANSWER : INF EPIGASTIC ART.

143 - Patient durig VD had 4th degree tear and massive bleeding
ANSWER : B The inferior rectal artery arises from the internal pudendal artery

144 - Patient bleed after sacrospinous fixation

inferior gluteal art. from Internal pudendal art
1 - Midline episiotomy bleeding: inferior rectal artery
.2 - Forceps delivery followed by vaginal haematoma: vaginal artery
.3 - Mediolateral episiotomy bleeding: perineal artery
.4 - Pudendal block haematoma/ sacrospinous fixation: Pudendal artery
5 - TOT: obturator artery
.6 - Secondary port in laparoscopy: inferior epigastric artery
.7 - Ruptured uterus with retroperitoneal haematoma: internal iliac artery ??
8 - Cephalohaematoma following ventouse delivery: subperiosteal blood
vessels
.9 - Erb's palsy: C5-C6 injury
.Klumpke's paralysis: C8-T1 injury -10
unexpected pathology

A. abundant and medical ttt

B.abundant and further assessment

C.laproscopic removal of the tube

D. remove x from y

E.remove x &y

F. laprscopic biopsy and abundant

G. go as planned

145 - Patient consented for laproscopic hysterectomy with past history

of dermoid cyst removal. Intra op surgeon find dermoid cyst X 4cm
adherent to the pelvic wall in the overy Y ANSWER : G

146 - Opened for appendicitis laproscopically appendix found normal but

there is torted ischemic Rt fallopian tube with watery dischargE
ANSWER : C

Beneficience,For the best interest of the pt, GANGEROUS tube or overy With
clear diagnosis, we do exesion but otherwise we do re-tortion

Post hysterectomy complication

A. wound infection B. chest infection

C. UTI

D.infected vault haematoma

E. vault haematoma

F. bowel injury

G. check fluid blance

h.active bleeding

I .others post op complication

147 - Patient smocker present 48 hrs post hysterectomy with fever temp
39 ,tachycardia and tachypnea ANSWER :B

148 - 3days post op not recoverd well ask for analgesia with abd and
back pain not febrile mild tachycardia poor urine out put ANSWER :G

This scenario my be with urinary tract injery ( bladder) if in

the option with any key word loin pain
…creatinine……choose it
149 - 12 hrs post surgery pulse 100 BP 90/45 poor urine out put but said
..in 3hrs its 80 ml O/E tender abdomen ANSWER :H

V. Heamtoma taking more than 24 hrs and fever shd be sign ,no symptoms is infection
and discharge rigid tender abdomin means internal HE , common symptoms for VH is
vaginal discharge

150 -The commonest site for uterine perforation during surgical

evacuation

A.anterior wall

B.posterior

C. cervical

D.fundus

ANSWER :A
151 -What you do to reduce risk of uterine perforation during evacuation

A. straiten the Cx caudally ANSWER :A

TOG 2014: Medical TOP, Accurate estimation of gestational
B. done under US guidance age, Identifying the size, position and attitude of the uterus,
Experienced operator , Cervical preparation with
C. less Cx dilatation
prostaglandins, Adequate and gradual cervical dilatation,
Avoiding excessive force . Additionally, ultrasound guidance in
experienced hands as can laparoscopic guidance if an
abdominal procedure is being carried out

Prevention of uterine perforation initially involves risk assessment and

adequate preparation. The option of medical TOP would reduce the risk
of perforation in the second trimester. This involves accurate estimation
of gestational age. Correct equipment and bimanual assessment
correctly identifying the size, position and attitude of the uterus together
with an experienced operator all reduce the risk of uterine perforation

==================================

As per RCOG guidelines2 on best practice in outpatient

hysteroscopy, cervical preparation with prostaglandins or misoprostol is associated
with a reduction in cervical resistance and need for cervical dilatation in
premenopausal

women compared with placebo, although no such benefit is noted in

postmenopausal women.17–19 The advantages of prostaglandin administration prior
to surgical TOP are well established, with significant reductions in dilatation force,
haemorrhage and uterine or cervical trauma. However, there are no randomised
controlled trials to guide practice in cases of first-trimester miscarriage, particularly
in the presence of an intact sac. Therefore, the RCOG advises that practitioners
consider oral or vaginal cervical preparation based on individual patient
circumstances.20 Adequate and gradual cervical dilatation, avoiding excessive force
and the use of half-size dilators again

reduces the risk of perforation Reports have also suggested that the use of a tapered
.

Hawkins-Ambler dilator requires less force to achieve cervical dilatation than the
parallel-sided Hegar dilators that are used in many NHS units in the UK.21
Additionally, ultrasound guidance in experienced hands can reduce the risk of
perforation, as can laparoscopic guidance if an abdominal procedure is being carried
out on the patient at the same time

152 - Patient with breast cancer positive receptors on tamoxifen with

severe PMS ttt

A. SSRI Answer : d

B.OCP Not ssri but snri

C. E patch +merina

D. GNRH anal +tibilone

 Dr mostafa

c. 1

A .2

E.3

H.4

E.5

153 - MRCOG 2+MRCOG3 is ANSWER : A

A.summative summative

B.formmative formative

C. sum +form

D.form + sum
154 - Multiple sclerosis patient with history of difficulty emptying bladder
with high residual volume
ANSWER: B
A. indwelling catheter

B. CISC

C.urodynamic

:155 - Commonest symptom of vault prolapsed

ANSWER : A
A. vaginal bulge

B.SUI

C. constipation

D.voiding dysfunction

E.sexual symptom ANSWER : A

156 - Patient tried 3 antimuscurinic not tolerate them next step

A. mirabegron

B.trospium

C. deluxtine

157 - UI in 82 years old ttt

A. oxybutanin

B. merabegron

C.trospium

D.deluxtine ANSWER : D

Duloxetine

1.7.19 Do not use duloxetine as a first-line treatment for women with

predominant

stress UI. Do not routinely offer duloxetine as a second-line treatment

for

women with stress UI, although it may be offered as second-line therapy

if
 158 - actually EMQ patient SLE on methotrexate and predinsolone
devolped herps simplex with pain and palbable bladder optin
ANSWER : B
A.give acyclovir

B. refer to GUM

C.admit

159 - EMQ patient C/O watery blood stained vaginal discharge and
colicky pelvic pain wt finding A. polyp protruding through Cx

Autonomic neuropathy, resulting in urinary retention. (Suprapubic

catheterisation is preferred due to reduced risk of ascending infection, being a
less painful procedure, and allowing normal micturition to be restored without
multiple removals/recatheterisations.)
Vault prolapsed

A. PMFT

B. PMFT &bladder retraining

C.ASC

D. SSF

E. pessay

F.pessary plus local estrogen

answer : asc………ssi contraindicated for
G.laproscopic SC
short vagina it for normal vagina
h. V.hystrectomy

160 - 80yrs with vault prolapse and sopting normal vaginal exam patient
had comorbidities
ANSWER : E ……HE SAID NORMAL
161 - PHVP with short vagina VAGINA

162 - Patient with anterior vaginal wall prolapsed and uterine prolapse
ask for definitive ttt
ANSWER : H VH
 163 - Patient athlet devolped SUI post VD O/E anterior prolapse grade 2
patient start PFMT not improved next step ANSWER : B
A. colposuspension Before operation
B. urodynamic

Colposuspension
Do not offer laparoscopic colposuspension as a routine procedure for the
treatment of stress UI in women. Only an experienced laparoscopic surgeon
working in an MDT with expertise in the assessment and treatment of UI should
perform the procedure. [2006]
Considerations following unsuccessful invasive SUI procedures or recurrence of
symptoms Women whose primary surgical procedure for SUI has failed (including women whose
symptoms have returned) should be
referred to tertiary care for assessment (such as repeat urodynamic testing including additional
tests such as imaging and urethral function studies) and discussion of treatment options by the
MDT, or
offered advice as described in recommendation 1.6.9 if the woman does not want continued
invasive SUI procedures. [new 2013]

* If conservative treatment for SUI

has failed, offer: synthetic mid-
urethral tape (see
recommendations 90–94) or open
colposuspension (see
recommendation 95), or autologous
rectus fascial sling (see
recommendation 96). [new 2013
Colposuspension
Laparoscopic colposuspension is
not recommended as a routine
procedure for the treatment of
]2006[ .stress UI in women.

Answer : c
164 - Confirmation of post hystroscopic sterlisation
 A.it work immidiatly

B. X.ray with out time limit

C. HSG in 3month Answer : a

165 - The following enhanced recovery in gyn surgery

A. complex carbohydrate drink before major surgery

B.can drink up to 4 hrs to prevent dehydration

166 - Risk of pelvic adhesion following midline incesion .

A.10%
Answer : d
B.20%
Transenersr 23 %
C.40%
0.5 % without sur.
D.50%

167 - most common serious complication with abd hysterectomy

A. PE

B.urinary tract injury

C.blood transfusion

D.bowel injury

E.ovarian failure ?

Answer : c bl transfusion

:ABDAbdominal Hysterectomy CFoforOM HYSTERECTOMY FSerious risks

* the overall risk of serious complications from abdominal hysterectomy is approximately
four women in every 100(common)
Damage to the bladder and/or the ureter (7 women in every 1000) and/or long-term
disturbance to the bladder function (uncommon)
*Damage to the bowel, 4 women in every 10 000 (rare)
* Haemorrhage requiring blood transfusion, 23 women in every 1000 (uncommon)
* Return to theatre, 7 women in every 1000 (uncommon)
* Pelvic abscess/infection, 2 women in every 1000 (uncommon)
* Venous thrombosis or pulmonary embolism, 4 women in every 1000 (uncommon)
 Answer : d

168 . Subfertility couple normal male partner female mild endometeriosis

when to offer IVF

A.6month

B.12month

C.18 month

D.24month

E.30month

169 - Which of the following reduce post Answer : B

Operative wound infection

A. sheaving use clipers

B. wash with antiseptic solution

C.bowel preparation

Pelvic pain
A.uretheral prolapsed

B.abnormal Cx

C.fistula

D.vaginal septum

C.thikening of uterosacral ligment

E.tender bilateral adenxial mass

Answer a
170 - 17yrs with history of dysuria recurrent UTI and dyspareunia

171 - Patient age ? with dysmenorrhea and blood with defecation( or

something like this)
Answer : c thickening of utrosacral
ligament

172 - 37 yrs yrs with history of chronic pelvic pain Answer : E

173 - . Patient with suspected deletion of chromosome 9 or 10 want to

know investigation of
ANSWER : A
choice to confirm

A. microarray CGH

32

B. PCR

C.FISH

174 - 56yrs old thin vulval skin fused labia taken fluconazole orally and
topically no relieve best Answer : b
:option

A. biopsy

B.high potency steroid

C. emollient

175 - Most common site of tubal pregnancy Answer : ampulla

 176 - How long to continue ttt with clomofine (cc) before stop ttt. (3m
6m 12m)

Open laparoscopy will reduce the incidence of vascular trauma and is

advocated in

patients with an anticipated complicated entry due to previous surgery. Current

evidence suggests that bowel injury is not reduced, but is more readily

identified
Serotonin Norepinephrine Reuptake Inhibitor ( SSNRI) will be treatment of choice as
SSRIs paroxetine and fluoxetine should not be offered to women with breast cancer
who Is on tamoxifen
The selective serotonin re-uptake inhibitor (SSRI) antidepressants paroxetine [14]
and fluoxetine [14] may be offered to women with breast cancer for relieving
menopausal symptoms, particularly hot flushes, but not to those taking tamoxifen. In
ER negative
Women with vaginal dryness can use moisturisers and lubricants such as Replens
. in ER positive on tamoxifen
significant amount of evidence exists for the efficacy of selective serotonin reuptake
inhibitors (SSRIs)
and selective noradrenaline reuptake inhibitors ( SNRIs) in the treatment of
.vasomotor symptoms
Although there are some data for SSRIs such as fluoxetine12 and paroxetine,13 the
most convincing data
.are for the SNRI venlafaxine at a dosage of 37.5 mg twice daily
The main drawback with these preparations (especially the SNRIs) is the high
incidence of nausea
In women with estrogen/progesterone-dependent tumours, such as breast cancer,
general clinicians
should probably avoid using phytoestrogens and progestogens/progesterone as
first-line therapy, as these
preparations may have an effect on breast tissue (an SNRI may be the best choice
here). If possible, the
hormone receptor expression of the tumour should be taken into account. The main
drawback of SNRIs
can be reduced by uptitrating the dosage. Also, there are concerns that paroxetine
reduces tamoxifen’s
effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6),
resulting in an
.increased risk of death from breast cancer
Dr / hamada said aboroumh

With my best wiches for all