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MRCOG Part 2 > Past paper questions > Flashcards

Past paper questions Flashcards

1
Q

How much Levonorgestrel is contained in a mirena coil?

A

52mg

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2
Q

How long after a trachelectomy can a patient start trying to conceive?

A

6 months
Vaginal progesterone pessaries from 12 weeks - 36 weeks

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3
Q

What percentage of epileptic women have intrapartum seizures?

A

3.5%

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4
Q

According to Department of Health data, how many episodes of domestic violence do women experience before they report it?

A

35

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5
Q

What is iron’s role in electron transfer?

A

Iron acts as an electron donor when it is in the ferrous state and an acceptor in the ferric state.

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6
Q

Where in the body is iron found?

A

About two-thirds of the body’s iron is found in haemoglobin, with the remainder stored as ferritin and haemosiderin in the liver and reticuloendothelial system

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7
Q

What is Hepcidin and what does it do?

A

During normal physiological functioning, iron levels are regulated by a homeostatic system which is controlled by hepcidin, a peptide hormone mainly synthesised in the liver.

Hepcidin expression increases in response to high circulating and tissue levels of iron.

Conversely, hepcidin levels decrease in tissue hypoxia, blood loss (then increased importation of iron by ferroportin) iron deficiency and increased erythropoietic activity as a result of inhibited transcription.

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8
Q

What is the recommended daily intake of iron for women of reproductive age

A

12mg/day

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9
Q

What percentage of girls undergoing cranial irradiation for childhood cancer present with hypogonadotrophic hypogonadism?

A

11%

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10
Q

When do the majority of ACS in pregnancy occur?

A

Peripartum - about 50%

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11
Q

What percentage of prolactin is in monomeric form?

A

Approximately 80–90% of prolactin is monomeric (23 kDa), and this is its most potent biological form; 8– 20% is dimeric (45–50 kDa); and 1–5% is polymeric (150 kDa). The latter fraction is called macroprolactin (or ‘big-big prolactin’).

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12
Q

What percentage of hyperprolactinaemia is due to macroprolactin?

A

10%

Macroprolactin is composed of an antigen–antibody complex of monomeric prolactin and immunoglobulin G. It is immunoreactive but biologically inactive. Macro-prolactinaemia is generally associated with normal gonadotrophin activity and gonadal function. It has been estimated that approximately 10% of cases of hyperprolactinaemia are attributed directly to macroprolactinaemia, which is generally asymptomatic and not usually associated with pituitary pathology.

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13
Q

What is the percentage risk of macroprolactinoma enlarging in pregnancy?

A

30%

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14
Q

What ultrasound feature is diagnostic of TOA?

A

Cogwheel sign

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15
Q

What is Bosentan and what considerations should be taken when prescribing contraception to patients taking it?

A

Bosentan - used to treat pulmonary hypertension
Dual Endothelin receptor antagonist

Enzyme Inducer
Avoid: COCP, POP, implant
Can have: Depot or coil, double COCP dose

Also - theoretically teratogenic, to avoid pregnancy whilst taking

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16
Q

Endometrial ablation techniques aim to permanently destroy the functionally active endometrial glands, which are located in the endomyometrial junction. Up to what thickness of myometrium is ablated?

A

Upto 5mm

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17
Q

What is normal cervical length at 18 weeks?

A

In normal pregnancy the cervix is more than 40 mm long at 18 weeks of gestation.
This is manifested by approximately 2 cm of vaginal cervix and 2 cm of supravaginal cervix.

18
Q

The only skin condition which carries an increased risk of pregnancy loss?

A

Pustular psoriasis of pregnancy

19
Q

Which skin condition in pregnancy has an increased risk of fetal prematurity and SGA?

A

Pemphigoid gestationis

Also has neonatal cutaneous manifestations.

20
Q

What are the physiological changes of the cardiac system in pregnancy?

A

Increased preload (increased circulating volume)
Decreased afterload (reduced BP/peripheral vascular resistance)
Increased cardiac output by 20% by 8 weeks of gestation (upto 40% later in pregnancy)
Decreased serum colloid osmoid pressure by 10-15%

21
Q

What proportion of pre-eclampsia can be predicted by maternal history alone in first trimester of pregnancy?

A

40-50%

22
Q

What amount of vitamin A is safe in pregnancy?

A

Pregnant women should be informed that vitamin A supplementation intake above 700 micrograms may be teratogenic and should be avoided.

23
Q

At what point in pregnancy should women be offered the whooping cough vaccine?

A

Pregnant women should be offered a single dose between 16-32 weeks to maximize likelihood that baby will be protected from birth.

24
Q

How long should women wait after receiving the MMR vaccine before getting pregnant?

A

28 days

25
Q

Active management of labour is associated with nausea and vomi􏰀ng in what percentage of women? (old stats)

A

10%

26
Q

What is the benefits of active management of 3rd stage?

A

ACTIVE
Nausea and vomiting, headache, hypertension 186/1000
Haemorrhage >500ml 68/1000
Haemmorhage >1000ml 13/1000
Blood transfusion 13/1000
Post-partum anaemia 30/1000
Need for further uterotonic 47/1000

PHYSIOLOGICAL
N&V, headache, hypertension 90/1000
Haemmorhage >500ml 188/1000
Haemmorhage >100ml 29/1000
Blood transfusion 35/1000
Post-partum anaemia 60/1000
Need for further uterotonic 247/1000

27
Q

What are risk factors for recurrent OASIS injury?

A

Risk factors for sustaining recurrent OASIS in the subsequent pregnancy include:
Asian ethnicity (OR 1.59, 95% CI 1.48–1.71)
Forceps delivery (OR 4.02, 95% CI 3.51–4.60)
Birthweight more than 4 kg (OR 2.29, 95% CI 2.16–2.43).

28
Q

What percentage of women are found to sustain “occult “anal sphincter injury following vaginal delivery?

A

33%

29
Q

What is the incidence of suture migration after repair of OASIS?

A

7%

The risk of sustaining a further third- or fourth-degree tear after a subsequent delivery is 5–7%

The risks of a subsequent vaginal delivery after a third- degree tear have been assessed, with 17% of women developing worsening faecal symptoms after a second vaginal delivery

30
Q

What is the incidence of 3rd or 4th degree perineal tear following vaginal deliveries complicated with shoulder dystocia?

A

3.8%

31
Q

Most babies who sustain brachial plexus injury (BPI) do not have any residual neurologic dysfunc􏰀on, but what percentage of babies who have sustained BPI have permanent neurological dysfunction?

A

10%

32
Q

What percentage of twin pregnancies in the UK are monochorionic?

A

30%

33
Q

How is twin to twin transfusion graded? what are the stages?

A

QUINTERO SYSTEM (5 STAGES)

  1. Significant discordance in amniotic fluid - Oligo (<2cm) and Poly (>8cm before 20/40 and >10 after 20/40)
    Normal copper and bladder seen
  2. Bladder of donor twin not seen. Dopplers not critically abnormal.
  3. Critically abnormal doppler - reversed flow during atrial contraction within the ductus and or pulsatile umbilical vein velocities
  4. Ascites, pericardial or pleural effusion, scalp oedema, hydrops
  5. Demise of one or both babies
34
Q

What percentage of MCDA pregnancies are affected by TAPS?

A

2% uncomplicated
13% post laser ablation

Characterised by signs of fetal anaemia and polycythemia without significant change in FI. Associated increased MCA peak velocity or decreased MCA velocity.

35
Q

How do you categorise selective growth restriction in twin pregnancies?

A

Growth discordance of >20%
Affects 10-15% of MCDA twins

  1. Growth discordance but normal dopplers
  2. Absent or reversed end diastolic flow velocities
  3. Growth discordance with cyclical artery diastolic waveforms (positive then absent then reversed in a cyclical pattern over several minutes)
36
Q

Regarding infertility in women of childbearing age: Absolute uterine factor infertility (AUFI) is considered to affect how many women?

A

1/500

37
Q

Which side effects are associated with monopoly and which with bipolar?

A

Monopolar
Capacitive coupling
Direct coupling

Bipolar
Mushroom effect
Electrical bypass effect (from over compression of tissues)

Both
Lateral thermal spread
Insulation failure
Current leakage through cord
Inadvertent activation

38
Q

What is the rate of inconclusive results from V/Q or CTPA scans when assessing for PE?

A

The median frequency of inconclusive results was 5.9% for CTPA and 4.0% for V/Q scanning.

39
Q

What is Type 1 and Type 2 error?

A

Type 1 Error - risk of false positive
Normally set with p value of <0.05, therefore 5%
Also known as ‘alpha’

Type 2 Error - risk of false negative
Also known as ‘beta’

40
Q

How do you calculate power for a study?

A

1 - beta

Typically set at 80%

41
Q

How do you calculate positive and negative likelihood ratio?

A

POSITIVE

Sens/ 1-Spec

NEGATIVE
1-Sens/Spec

MRCOG Part 2 (10 decks)

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