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Title: Part 2 MRCOG : single best answer questions / Andrew Sizer, Chandrika Balachandar, Nibedan Biswas, Richard Foon, Anthony Griffiths, Sheena Hodgett, Banchhita Sahu, Martyn Underwood.

Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc., 2016. | Includes bibliographical references and index.

Subjects: | MESH: Obstetrics | Gynecology | Great Britain | Examination Questions

Classification: LCC RG111 | NLM WQ 18.2 | DDC 618.10076—dc23 LC record available at http://lccn.loc.gov/2015047746

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Notes on Authors

Andrew Sizer

Andrew Sizer completed specialist training in 2005 and was appointed as Consultant Obstetrician & Gynaecologist at Shrewsbury and Telford Hospital NHS Trust in 2007 and as Senior Lecturer at Keele University School of Medicine in 2008.

He is currently Clinical Director for Gynaecology and Lead Medical Appraiser for the Trust. He is the Chair of Intermediate training (ST3-5) at the West Midlands Deanery.

At the RCOG, he was a member of the Part 1 exam sub-committee from 2008 to 2011. At the end of this time he wrote ‘SBAs for the Part 1 MRCOG’ (RCOG Press) in conjunction with Neil Chapman.

From 2011 to 2014 he was Convenor of Part 1 revision courses. In 2014, he was appointed as Chair of the Part 1 exam sub-committee. He is an examiner for the Part 2 MRCOG.

Chandrika Balachandar

Chandrika Balachandar has been a Consultant Obstetrician and Gynaecologist at Walsall Healthcare NHS Trust since 1995. She has been Director of Postgraduate Medical Education for the Trust since 2010 and has established simulation training following training and certification as an instructor from the Center for Medical Simulation, Harvard, Cambridge MA. She is an examiner for Part 2 MRCOG since 2007 and coordinates the DRCOG examinations in Birmingham. She is a faculty member of the RCOG Part 2 revision courses, was a moderator for the RCOG Enhanced Revision Programme in 2013 and 2014 and member of the RCOG Assessment sub-committee from 2009 to 2012. From June 2015 she has taken on the role of Chair – Part 2 MRCOG Extended Matching Questions sub-committee. Mrs Balachandar is a generalist with special interests in High Risk Obstetrics, Colposcopy and Paediatric and Adolescent Gynaecology.

Nibedan Biswas

Nibedan Biswas completed his specialist training in Wessex Deanery in 2011 and worked as a locum Consultant at Poole hospital before joining Shrewsbury and Telford Hospital NHS Trust in 2012 as Consultant Obstetrics and Gynaecology. He is the audit lead for the department and led the team that was successful in obtaining CNST level 3 status.

He is an undergraduate tutor for Keele University School of Medicine.

Richard Foon

Richard Foon started his professional career as a secondary school teacher before entering medical school.

He completed his training in Obstetrics and Gynaecology in 2012, which included 3 years of Subspecialty training in Urogynaecology in Bristol/Plymouth.

He has been a Consultant in Obstetrics and Gynaecology (with a special interest in Urogynaecology) at the Shrewsbury and Telford Hospital NHS Trust, since April 2012.

Currently, he is the Urogynaecology lead for the unit, the lead for Practical Obstetric Multi-Professional training and also the RCOG College Tutor.

Anthony Griffiths

Anthony Griffiths completed his specialist training in 2006 and was appointed as Consultant Obstetrician and Gynaecologist at the University Hospital of Wales the same year. He works closely with Cardiff University delivering postgraduate training for an MSc programme in ultrasound.

He holds postgraduate diplomas in both medical education and advanced endoscopy. He was awarded fellowship of the higher education academy in 2007.

Previously he served as an RCOG college tutor during 2006–2012 and is now Clinical Director for Obstetrics and Gynaecology. He is a preceptor for the ATSM in advanced laparoscopic surgery.

At the RCOG he was a member of the Part 1 examination sub-committee during 2011–2014. At that time he wrote an MRCOG Part 1 SBA resource. Since 2014 he has been convenor for the RCOG London Part 1 revision course. He also teaches on several international MRCOG courses.

Sheena Hodgett

Sheena Hodgett was appointed Consultant Obstetrician and Gynaecologist in 2000, and was initially at University Hospitals of Leicester prior to her appointment at Shrewsbury and Telford Hospital NHS Trust in 2009.

Her specialist areas of interest are intrapartum care and maternal and fetal medicine. She is the departmental lead for obstetric guidelines and for clinical research.

She is an examiner for Part 2 MRCOG having previously been a DRCOG examiner and undergraduate examiner at the University of Leicester. She has participated in MRCOG Part 2 courses in the United Kingdom and abroad.

Banchhita Sahu

Banchhita Sahu is a Consultant in Obstetrics and Gynaecology at the Shrewsbury and Telford Hospital NHS Trust. She completed specialist training in Obstetrics and Gynaecology in India and the United Kingdom.

She complemented her clinical training by working as a Clinical Research Fellow at University College London, a post with a substantial teaching and research commitment.

She has several first author publications in peer reviewed journals.

Her special interests include minimal access surgery, gynaecological oncology and simulation training in obstetrics and gynaecology.

Martyn Underwood

Martyn Underwood was appointed as Consultant Obstetrician and Gynaecologist to the Shrewsbury and Telford Hospital NHS Trust in 2014. He has interests in Ambulatory Gynaecology, Colposcopy and Minimal Invasive Surgery. He has taught on the RCOG Part 1 revision course for several years and also on the ACE Courses MRCOG Part 1 course in Birmingham. More recently, he has contributed to the Part 2 MRCOG course led by Andrew Sizer in Birmingham.

He has an interest in research in field of Gynaecology and Early Pregnancy and has recently contributed to several books in the field of Gynaecological Surgery.

Introduction

Attainment of the membership to the Royal College of Obstetricians and Gynaecologists (MRCOG) is an essential component of specialist training in Obstetrics and Gynaecology in the United Kingdom. Possession of the MRCOG is also highly prized by specialists working in many countries worldwide.

In March 2015, there were some significant changes to the format of the written component of the Part 2 MRCOG examination, although there was no change in the syllabus.

Previously, the examination had consisted of short answer questions (SAQs), true-false (TF) questions and extended matching questions (EMQs). However, in order to keep abreast of modern thinking in medical assessment, the SAQs and TF questions were dropped in favour of single best answer questions (SBAs).

SBAs had already been introduced into the Part 1 MRCOG examination in 2012, so many candidates were familiar with them. From March 2015, the Part 1 exam consisted solely of SBAs.

Format of the Part 2 MRCOG Written Examination

The exam consists of two written papers with a short break (approximately 30 minutes) between them.

The two papers are identical in format and carry the same amount of marks.

Each paper consists of 50 SBAs and 50 EMQs, but the weighting between the two question types (reflecting the different format and time taken to answer) is different.

The SBA component is worth 40% of the marks and the EMQ component is 60%.

Each paper is of 3 hours duration, but in view of the weighting the RCOG recommends that candidates spend approximately 70 minutes on the SBA component and 110 minutes on the EMQ component. There are however, no buzzers or warning regarding this, so candidates are responsible for their own time management.

Traditionally, Paper 1 is mainly Obstetrics and Paper 2 mainly Gynaecology, but there is no guarantee that this is the case and theoretically, any type of question or subject could appear in either paper.

Why Have SBAs Been Introduced?

SBA questions have been used as a form of written assessment for decades in a variety of subjects at a variety of levels, but have found increasing use in undergraduate and postgraduate medical examinations over the past 15 years as well as in the General Medical Council (GMC) assessment of poorly performing doctors.

SBAs allow much wider coverage of the syllabus when compared to SAQs and questions can be mapped to the entire syllabus using a blueprinting grid.

Compared to TF questions, SBAs are considered to be a higher level form of assessment. When considering their assessment ability according to Millers pyramid, they can assess ‘knows how’ and ‘knows’ as opposed to ‘knows’ alone (see Figure 1).

images — **Figure 1** Millers Pyramid (see Miller, 1990)

An SBA question usually consists of an introductory stem, which in a clinical question could recount a clinical history or scenario. There is then a lead-in question that should ask a specific question. Following this, there will be five options, one of which is the correct, or best, answer.

There are therefore two variations of SBAs: single ‘best’ answer where one of the answer stems is clearly more appropriate or better than the rest, although the other answer stems are plausible, and the single ‘correct’ or single ‘only’ type of question where only one stem is correct and the remaining are incorrect.

Where SBAs are used for basic science questions in medical examinations the single ‘correct’ type of question tends to predominate, since the answers are generally very clear-cut. However, when SBAs are used to assess clinical knowledge, the single ‘best’ type of question predominates since clinical scenarios and their management tend to be more open to interpretation, or, indeed, there may be more than one type of management that is perfectly reasonable.

A good SBA question should pass the ‘cover test’, meaning that in a properly constructed question a good candidate should be able to cover the answer options and deduce the answer merely from the information in the stem and the lead-in question. In practice this can be difficult, and question writers often resort to a ‘which of the following…’ style of questioning. However, this is not a true SBA and is really a true-false question in the guise of an SBA.

Our advice would be always to apply the cover test. In other words, read the question with the five options covered. If you feel you know the answer and it appears in the list of options, your answer is almost certainly correct. A well-constructed question will have plausible ‘distractors’ that could make you doubt yourself. Therefore, it is best to try and answer the question without initially looking at all the options.

There are a number of potential flaws in SBA questions, which the well-prepared candidate could possibly use to their advantage. Many of these (with examples) are summarised in Hayes and McCrorie (2010). In addition to these, numerical questions will have a preponderance of answer ‘C’ being correct. This is because it is more common to spread the ‘distractors’ around the correct answer. However, the wily question writer can use this phenomenon to his advantage and place the correct numerical answer at either end of the spectrum.

We hope that our 400 questions give a broad coverage of the syllabus and that you will find the different styles of question writing useful. However, as Obstetrics & Gynaecology is such a vast subject, it is impossible to cover everything unless the questions run into several volumes.

We have not included questions in core modules 1, 2, 4 and 19 as we do not feel these subjects lend themselves to the SBA format and can be better assessed by other assessment tools. The number of questions in the included core modules represent what we consider to be an appropriate weighting.

We hope you find this book helpful as part of your exam preparation.

References

Hayes, K and McCrorie P (2010) The principles and best practice of question writing for postgraduate examinations. Best practice & research Clinical Obstetrics and Gynaecology, 24, 783–794.
Miller, GE (1990) The assessment of clinical skills/competence/performance. Academic Medicine, 65, S63–S67.

Module 3

IT, Governance and Research

1
If involved in a serious incident requiring investigation (SIRI), initial steps would involve completing an incident form, ensuring completion of notes accurately and participating in team debrief.
If a trainee is involved in an SIRI, what action should be taken as soon as possible?
1. A. Discuss with the medical defence organisation
2. B. Engage fully with the investigation
3. C. Meet with the educational supervisor to discuss the case
4. D. Write a formal statement
5. E. Write a reflection of the vent
2 In surrogacy arrangement, the commissioning couple need to obtain parental orders. Within what time frame after delivery must these be made?
1. A. 6 months
2. B. 12 months
3. C. 18 months
4. D. 24 months
5. E. 36 months
When managing a patient with surrogate pregnancy, who decides about the treatment required for any clinical situation that may affect the pregnancy?
1. A. The binding agreement
2. B. The commissioning father
3. C. The commissioning mother
4. D. The surrogate mother
5. E. The unborn child
4
A primigravida at 24 weeks gestation has come to the antenatal clinic with a fear of childbirth and is asking for elective caesarean section as a mode of delivery.
What would be the recommended management?
1. A. Adequate exploration of the fears with counselling by trained personnel
2. B. Discharging the patient to midwife care with advise for vaginal delivery
3. C. Enlisting the patient for elective caesarean section
4. D. Referral to another obstetrician for second opinion
5. E. Referral to the supervisor of midwife
5 Women requesting caesarean section on maternal request might have posttraumatic stress disorder (PTSD) after previous childbirth.
What is the incidence of PTSD after childbirth?
1. A. 0–1%
2. B. 6–7%
3. C. 12–13%
4. D. 24–25%
5. E. 36–37%
6 Among those receiving gynaecological treatment, what is the reported incidence of domestic violence in the United Kingdom?
1. A. 11%
2. B. 21%
3. C. 31%
4. D. 41%
5. E. 51%
7 When obtaining consent for a procedure, a doctor should take reasonable care in communicating with the patients, as their inability to recall from such discussion is often evident.
What percentage of the information that is discussed during the process of obtaining consent before surgery is retained at 6 months?
1. A. 10%
2. B. 20%
3. C. 30%
4. D. 40%
5. E. 50%
8
One of the main challenges faced by clinical trials is a lower than expected rate of recruitment.
What is the key to successful recruitment?
1. A. Collaboration and collective effort in multicentric trials
2. B. Do nothing, as clinical trials are not important
3. C. Provide incentives for participation in medical studies
4. D. Wait for colleagues to publish clinical trials
5. E. Withhold care to patients if they do not agree to participate in clinical trials
9 Improved outcomes are often observed in women participating in a clinical trial.
What is the reason behind this improved outcome, irrespective of study findings?
1. A. Positive change in the behaviour of clinicians and participants along with improved delivery of care
2. B. There is no difference in the outcome of care
3. C. Treatment is provided in a new hospital with latest technology
4. D. Treatment is provided in a tertiary hospital
5. E. Treatment is usually based on postal delivery of medication
10 On completing a consent form with a patient for a diagnostic laparoscopy, you mention that the chance of suffering a bowel injury is ‘uncommon’.
How would you define ‘uncommon’ in this context in numerical terms?
1. A. 1/1–1/10
2. B. 1/10–1/100
3. C. 1/100–1/1000
4. D. 1/1000–1/10,000
5. E. <1/10,000

Module 5

Core Surgical Skills

11
A medical student asks you how to measure blood pressure.
What maximum pressure should you inflate the cuff to measure systolic blood pressure in pregnancy?
1. A. Always initially inflate to 200 mmHg then deflate
2. B. Patient's palpated diastolic blood pressure
3. C. Patient's palpated systolic blood pressure
4. D. Patients palpated systolic blood pressure + 20–30 mmHg
5. E. Patients palpated systolic blood pressure + 5 mmHg
12 A healthy 39-year-old woman with no significant past medical history attends a preoperative assessment clinic.
She is due to undergo a total abdominal hysterectomy for heavy menstrual bleeding following a local anaesthetic endometrial ablation that was unsuccessful.

She is fit and well.

What preoperative investigation is required?
1. A. Chest X-ray
2. B. Coagulation screen
3. C. Electrocardiogram
4. D. Full blood count
5. E. Renal function tests
13 On deciding where to place your secondary lateral ports at laparoscopy, care should be taken to avoid the inferior epigastric vessels.
Where can these be found?
1. A. ∼2 cm from the midline
2. B. Lateral to the lateral umbilical ligaments
3. C. Lateral to the medial umbilical ligaments
4. D. Medial to the lateral umbilical ligaments
5. E. Medial to the medial umbilical ligaments
14
Your hospital has recently had an increase in postoperative infections. As a result, you are formulating a new guideline that includes information on skin preparation and hair removal prior to surgery.
What is the most appropriate method of hair removal prior to surgery?
1. A. Electric clippers
2. B. Electrolysis
3. C. Laser
4. D. Shaving
5. E. Waxing
15 Following delivery, a woman is found to have a third degree tear and a trainee wishes to do the repair under supervision.
Which two suture materials have equivalent efficacy when repairing the external anal sphincter?
1. A. Polydiaxanone (PDS) and chromic catgut
2. B. Polydiaxanone (PDS) and nylon (Prolene)
3. C. Polydiaxanone (PDS) and Polyglactin (Vicryl)
4. D. Polyglactin (Vicryl) and chromic catgut
5. E. Polyglactin (Vicryl) and nylon (Prolene)
16 A 45-year-old woman is undergoing an abdominal hysterectomy for a history of heavy menstrual bleeding that has not responded to medical treatment. The patient has a past history of pelvic pain and the operation notes from a previous laparoscopy comments that the patient had ‘pelvic adhesions’
What is the most appropriate action in terms of protecting the ureter?
1. A. Identify the ureter tracing it from the pelvic brim and mobilise the ureter by incising the peritoneum and sweeping the tissues laterally
2. B. Mobilise the entire ureter with the aid of electrosurgery to reduce the blood loss
3. C. Perform a preoperative MRI
4. D. Perform a preoperative MRI and Intravenous urogram to assess the ureters
5. E. Perform preoperative ureteric stenting
17 A 45-year-old asthmatic patient attends the gynaecology clinic with heavy menstrual bleeding and an ultrasound scan suggests the presence of an endometrial polyp.
The patient is booked for an outpatient hysteroscopy.

What analgesia should be prescribed at least 1 hour before the procedure?
1. A. Buprenorphine
2. B. Diclofenac
3. C. Ibuprofen
4. D. Paracetamol
5. E. Tramadol
18 What is the preferred distension medium for outpatient diagnostic hysteroscopy?
1. A. Carbon dioxide
2. B. Dextran
3. C. Glycine
4. D. Icodextrin
5. E. Normal saline
19 At what pressure should the pneumoperitoneum be maintained during the insertion of secondary ports for a laparoscopic procedure?
1. A. 5–10 mmHg
2. B. 12–15 mmHg
3. C. 20–25 mmHg
4. D. 30–35 mmHg
5. E. >35 mmHg
20 What is the background rate of venous thromboembolism in healthy non-pregnant non-contraceptive using women?
1. A. 0.5/10,000/year
2. B. 2/10,000/year
3. C. 5/10,000/year
4. D. 10/10,000/year
5. E. 20/10,000/year

Module 6

Postoperative Care

21 What proportion of patients having a surgical procedure will develop a surgical site infection?
1. A. 5%
2. B. 10%
3. C. 15%
4. D. 20%
5. E. 25%
22 What is the most common source of microorganisms causing surgical site infection?
1. A. Anaesthist
2. B. Contaminated surgical equipment
3. C. Patient
4. D. Postoperative nursing staff
5. E. Surgeon
23 A 54-year-old patient has had an insertion of a mid urethral retropubic tape and following the procedure there was a significant fall in the haemoglobin levels from 12.3 g/dl to 7.8 g/dl. Imaging investigations show the presence of retropubic hematoma. A decision is made to evacuate the hematoma. The most appropriate incision would be:
1. A. Cherney incision
2. B. Kustner incision
3. C. Maylard incision
4. D. Midline (median) incision
5. E. Pfannenstiel incision
24 A postoperative patient who had a hysterectomy received morphine in recovery and then again in the gynaecology ward. Her respiratory rate is suppressed; she is drowsy and has pinpoint pupils.
What medication would you give to reverse this potential morphine overdose?
1. A. Atropine
2. B. Buprenorphine
3. C. Flumazenil
4. D. Naloxone
5. E. Pethidine
25 A patient who is frail, old and overweight has undergone a midline laparotomy and pelvic clearance for an endometrial cancer.
On postoperative day 4, the nursing staff notice that she has a pressure ulcer with full thickness skin loss, but the bone, tendon and muscle are not exposed.

What type of pressure ulcer grade is this?
1. A. Grade 1
2. B. Grade 2
3. C. Grade 3
4. D. Grade 4
5. E. Grade 5
26 A woman had an emergency caesarean section for a pathological CTG and pyrexia in labour. She was discharged on postoperative day 4 but re-admitted on day 6 with pyrexia, tachypnoea, tachycardia and hypotension. Haemoglobin is 105 g/l.
Septic shock is the main differential diagnosis.

Following the Sepsis 6 bundle, along with antibiotics and blood cultures, which other important blood test needs to be taken?
1. A. C-Reactive protein
2. B. Fibrinogen
3. C. Lactate
4. D. Urea and electrolytes
5. E. White Cell Count
27 A patient undergoes a challenging hysterectomy. A drain is left in the pelvis. You are called to review the patient eight hours later as the nurses have noted a high serous drain output and poor urinary output.
What finding would identify if the drain fluid is urine (suggestive of a bladder/ureteric injury) or normal peritoneal fluid?
1. A. Peritoneal creatinine > urine nitrogen
2. B. Peritoneal urea > urine urea
3. C. Serum creatinine > peritoneal creatinine
4. D. Serum nitrogen > drain fluid nitrogen levels
5. E. Urine nitrogen > peritoneal nitrogen
28 A patient has a ventouse delivery. Two days later she reports general malaise, fever and feeling unwell.
With sepsis, which is the first clinical sign to deteriorate, which can be detected through the use of early warning scores?
1. A. Altered consciousness
2. B. Hypotension
3. C. Hypoxia
4. D. Tachycardia
5. E. Tachypnoea
29 Oral fluids and food are often delayed following major gynaecological surgery.
Which gastrointestinal complication is improved by early postoperative feeding?
1. A. Abdominal distension
2. B. Incidence of diarrhoea
3. C. Need for nasogastric tube placement
4. D. Recovery of bowel function
5. E. Rectal bleeding
30 Following a difficult hysterectomy, a 65-year old woman has returned to the gynaecology ward. She had large amounts of morphine in the recovery area for pain relief and is also connected to a patient-controlled analgesia device.
The nurses note that she is drowsy and her respiratory rate is low.

The anaesthetist decides to perform arterial blood gas sampling.

What disturbance of acid–base balance is this most likely to show?
1. A. Metabolic acidosis
2. B. Metabolic alkalosis
3. C. No disturbance
4. D. Respiratory acidosis
5. E. Respiratory alkalosis

Module 7

Surgical Procedures

31 Which type of ureteric injury is most commonly reported at laparoscopy?
1. A. Crush
2. B. Laceration
3. C. Ligation
4. D. Thermal
5. E. Transection
32 During laparoscopic pelvic surgery, which visceral structure is most likely to be damaged?
1. A. Aorta
2. B. Bladder
3. C. Ileum
4. D. Rectum
5. E. Ureter
33 Theoretically, what kind of injury related to laparoscopic entry should be reduced by the Hasson (open) technique, compared to a Veress needle entry?
1. A. Bladder injury
2. B. Bowel injury
3. C. Major vessel injury
4. D. Splenic injury
5. E. Ureteric injury
34 An 18-year-old nulliparous girl presents as a gynaecological emergency with severe left-sided pelvic pain, tachycardia and vomiting. A pregnancy test is negative. An ultrasound scan is performed in the emergency department, which appears to demonstrate a left adnexal cyst.
In theatre, a laparoscopy is performed which shows an ovarian torsion that has twisted three times on its pedicle. The left tube and ovary appear purple and congested.

What is the most appropriate surgical management?
1. A. Convert to laparotomy and perform a left salpingo-oophorectomy
2. B. Laparoscopic left salpingo-oophorectomy
3. C. Untwist the tube and ovary and perform a laparoscopic ovarian cystectomy
4. D. Untwist the tube and ovary and perform a oophoropexy
5. E. Untwist the tube and ovary, drain the ovarian cyst and leave the tube and ovary in situ
35 A patient undergoes a laparoscopic cystectomy for a dermoid cyst and some spillage of the contents occurs into the peritoneal cavity. What will be the incidence of chemical peritonitis?
1. A. 5%
2. B. 15%
3. C. 25%
4. D. 35%
5. E. 45%
36 When comparing robotic-assisted surgery to conventional laparoscopic surgery for gynaecological procedures, what would be the major drawback?
1. A. Intraoperative complication rate
2. B. Length of hospital stay
3. C. Operative time
4. D. Postoperative complication rate
5. E. Safety and effectiveness in gynaecological cancer
37 A 19-year-old is undergoing a laparoscopy for pelvic pain.
What is the estimated risk of death due to a patient undergoing a laparoscopy?
1. A. 1 in 100
2. B. 1 in 1000
3. C. 1 in 10,000
4. D. 1 in 100,000
5. E. 1 in 1,000,000
38 A 22-year-old is undergoing a laparoscopy for suspected endometriosis.
What is the estimated risk of bowel, bladder or blood vessel injury?
1. A. 1.2:10,000
2. B. 2.4:10,000
3. C. 1.2:1000
4. D. 2.4:1000
5. E. 4.8:1000
39 Consent is being obtained from a 24-year-old for a diagnostic laparoscopy and it is correctly documented that there is a risk of laparotomy if any injury to bowel, bladder or blood vessels were to occur during the procedure.
The patient wishes to know what proportion of cases would be converted to a laparotomy should an injury occur?
1. A. 17%
2. B. 31%
3. C. 48%
4. D. 67%
5. E. 92%
40 A healthy 54-year-old lady is due to attend the outpatient postmenopausal bleeding hysteroscopy clinic.
Which medication should she be advised to consider taking prior to her attendance at the clinic?
1. A. Benzodiazepines
2. B. non-steroidal anti-inflammatory agents (NSAIDs)
3. C. Opioids
4. D. Paracetamol
5. E. Prostaglandins
41 A 62-year-old is due to undergo a hysteroscopy due to a thickened endometrium detected as part of her investigations for postmenopausal bleeding.
Which medication should be used to ‘prime’ the cervix prior to the hysteroscopy?
1. A. Mifepristone
2. B. Misoprostol
3. C. No medication required
4. D. Non-steroidal anti-inflammatory
5. E. Vaginal oestrogen
42 A 43-year-old lady with a history of heavy menstrual bleeding and a scan suggesting a polyp is due to undergo an outpatient hysteroscopy.
Which distension medium is routinely recommended due to its improved quality of image and speed of the procedure?
1. A. Carbon dioxide
2. B. Gelofusin
3. C. Normal saline 0.9%
4. D. Purosol
5. E. 5% glucose
43 A 32 year old is due to undergo a laparoscopic operation for investigation and management of an ovarian cyst detected on scan.
What is the expected serious complication rate following a laparoscopy?
1. A. 1:500
2. B. 1:1000
3. C. 1:2500
4. D. 1:5000
5. E. 1:10,000
44 With respect to instrumentation of the uterus, which operation has the highest risk of perforation?
1. A. Division of intrauterine adhesions
2. B. Outpatient hysteroscopy
3. C. Postpartum suction evacuation for haemorrhage
4. D. Second generation endometrial ablation
5. E. Surgical termination of pregnancy
45 What is the most frequently encountered complication of suction evacuation of the uterus for first trimester miscarriage?
1. A. Haemorrhage
2. B. Pelvic infection
3. C. Perforation
4. D. Retained products of conception
5. E. Significant Cervical Injury
46 A 19-year-old woman is to undergo a laparoscopy for pelvic pain.
How would you describe the correct technique for entry with the veress needle?
1. A. Enter below the umbilicus horizontally and then pass the needle at 45° to the skin
2. B. Enter below the umbilicus transverse plane and then pass the needle at 45° to the skin
3. C. Enter below the umbilicus vertical to the skin
4. D. Enter at the base of the umbilicus and pass the needle at ∼60° to the skin
5. E. Enter the base of the umbilicus vertical to the skin
47 What is the most common complication of the bottom up single-incision retropubic tape procedure?
1. A. Bladder perforation
2. B. De novo urinary urgency
3. C. Retention
4. D. Tape erosion
5. E. Voiding dysfunction
48 You have attempted to perform a direct entry for your laparoscopy and opted to undertake a Palmer's point entry.
Where would you find Palmers point?
1. A. 1 cm below the left costal margin in the mid-clavicular line
2. B. 1 cm below the right costal margin in the mid-clavicular line
3. C. 3 cm below the left costal margin in the mid-axilla
4. D. 3 cm below the left costal margin in the mid-clavicular line
5. E. 3 cm inferior to the right intercostal margin
49 A laparoscopic hysterectomy has been completed and several port sizes have been used.
When the port is in the midline, what size of port requires closure of the rectus sheath?
1. A. <5 mm
2. B. 5 mm
3. C. 7 mm
4. D. >10 mm
5. E. All midline ports
50 A laparoscopy oophorectomy has been completed and the port sites are about to be closed.
What diameter of nonmidline port site required closure of the rectus sheath?
1. A. No nonmidline port
2. B. <5 mm
3. C. 5 mm
4. D. >7 mm
5. E. All midline ports
51 A woman is due to undergo an outpatient hysteroscopy and is concerned about pain.
Which hysteroscope is associated with the least discomfort in the outpatient setting?
1. A. All are the same
2. B. Flexible Hysteroscope
3. C. Rigid Hysteroscope 0°
4. D. Rigid Hysteroscope 15°
5. E. Rigid Hysteroscope 30°
52 A woman is due to undergo an outpatient hysteroscopic polypectomy using a bipolar resectoscope.
Which distension medium should be used?
1. A. Glucose 5%
2. B. Glycine
3. C. Manitol
4. D. Normal Saline
5. E. Purisol
53 A woman is due to undergo a routine diagnostic laparoscopy.
According to RCOG data what is the expected incidence of bowel injury during a laparoscopy?
1. A. <0.1/1000
2. B. 0.36/1000
3. C. 3.6/1000
4. D. 3.6/10,000
5. E. 3.6/100,000
54 A woman with a stage 3 uterine prolapse is considering a variety of surgical options.
She understands the potential benefits of a mesh repair but is concerned about the risk of mesh erosion.

What is the risk of mesh erosion for a patient undergoing a subtotal hysterectomy with sacrocolpopexy?
1. A. 4%
2. B. 7%
3. C. 14%
4. D. 18%
5. E. 24%
55 A woman had a total abdominal hysterectomy in the past using a lower transverse incision.
She has now developed a persistent ovarian cyst and is due to have a laparoscopic bilateral salpingo-oophorectomy.

What will be the incidence of adhesions in the region of the umbilicus in this scenario?
1. A. 11%
2. B. 17%
3. C. 23%
4. D. 31%
5. E. 45%
56 A morbidly obese woman is due to undergo a total laparoscopic hysterectomy for endometrial cancer.
What type of complication is more common compared to traditional open hysterectomy in this situation?
1. A. Bowel injury
2. B. Hernia
3. C. Infection
4. D. Urinary tract injury
5. E. Venous thrombosis
57 A woman has been offered a sacrocolpopexy for a vault prolapse. Her friend had a similar operation but developed stress incontinence following the procedure.
What is the incidence of de novo stress incontinence after a sacrocolpopexy?
1. A. 1–5%
2. B. 7–12%
3. C. 14–19%
4. D. 21–26%
5. E. 27–32%
58 A woman presents with a history of dysuria, postmicturition dribble and vaginal discharge.
On examination, a tender mass anteriorly inside the introitus is found. You suspect a urethral diverticulum.

What investigation would you use to diagnose the presence of a urethral diverticulum?
1. A. Urethroscopy using a 0° endoscope
2. B. Urethroscopy using a 12° endoscope
3. C. Urethroscopy using a 30° endoscope
4. D. Urethroscopy using a 70° endoscope
5. E. Urodynamics
59 A 45-year-old multiparous woman is due to have a hysterectomy for heavy menstrual bleeding. The patient is considering having a subtotal hysterectomy as she has had normal cervical smears history.
When comparing a subtotal hysterectomy to a total hysterectomy, which perioperative complication is reduced?
1. A. Bowel injury
2. B. Cyclical vaginal bleeding
3. C. Intraoperative blood loss
4. D. Pyrexia
5. E. Urinary retention
60 At the end of a total laparoscopic hysterectomy (in which the woman was placed in a steep Trendelenburg position) you observe that the woman's shoulder brace was placed too laterally.
What type of nerve injury may present in the postoperative period?
1. A. Femoral nerve injury
2. B. Lower brachial plexus injury
3. C. Radial nerve injury
4. D. Ulnar nerve injury
5. E. Upper brachial nerve injury

Part 2 MRCOG: Single Best Answer Questions