EBCOG Part 1 – Mega Mock EMQ – Paper B

Option List:
A. Tuberculous cavity
B. Pulmonary embolism
C. Musculoskeletal pain
D. Gastro-esophageal reflux
E. Pneumonia
F. Pneumothorax
G. Ischemic heart disease
H. Aortic stenosis
I. Cardiac tamponade
J. Myocarditis
K. Aortic dissection
L. Pleural effusion
M. Anemia
N. Pericardial effusion
O. Costochondritis
P. None of the above

1. 45 years old conceived thru ovum donation presented at 34 weeks with sudden onset of central chest pain & breathlessness. She smokes about 15 cigarettes/day. On exam-pulse 98 bpm & BP-100/70 mmHg. SFH is appropriate for gestation & fetal heart is well heard. Chest X-Ray is normal. An ECG shows sinus rhythm with T wave inversion in leads III, aVL & aVF.?

2. 26 years old woman in 2nd pregnancy at 27 weeks gestation with severe chest pain that radiates to her back. Her height is 170 cm & she has hypermobile joints. On exam she looks unwell with a pulse of 136 bpm & BP 76/46 mmHg. Chest Xray is normal & ECG shows sinus rhythm with rate of 128 bpm.

3. 32-year-old Asian lady in 3rd pregnancy at 20 weeks with sevre left sided chest pain. She has recently moved to Uk. She gives a h/o easy fatiguability & lassitude & becoming breathless over past 4 weeks. On exam-pulse 88 bpm & BP-96/70 mmHg. Auscultation of chest reveal muffled heart sounds & ECG shows low voltage complexes.

4. 30 year old school teacher at 30 weeks gestation with right sided chest pain that is worse on coughing. She has a productive cough. On exam pulse is 110 bpm & BP-100/76 mmHg. Her temp is 38֯c. Heart sounds are normal & breath sounds are diminished on right side. Chest Xray shows ground glass appearance on right side.

Option List:
A. Marfan syndrome
B. SLE
C. Ehler Danlos syndrome
D. Psoriatic arthritis
E. Rheumatoid arthritis
F. Pelvic girdle pain

5. Condition with a tendency to have less flares in pregnancy.

6. Increased incidence of pre-eclampsia in pregnancy

7. Increased risk of aortic dissection in pregnancy.

Choose the correct options for the scenarios listed below. The option below may be used once or again or may not be used at all.
Option List:
A. Refer to genitourinary physician.
B. Perform lumbar puncture for HSV PCR
C. Normal postnatal care
D. Consider acyclovir 400 mg 3 times a day from 36 weeks gestation.
E. Discharge home if baby well at 24 hours .
F.  Start acyclovir 20 mg/kg 3 times a day for 10 days, awaiting resultsof swabs of skin,conjunctiva,rectum & oropharynx.
G. Offer elective caesarean delivery
H. Offer vaginal delivery.

8. Baby of a mother with primary genital herpes in third trimester, born vaginally. Mother treated with Aciclovir in primary episode. Baby well at birth.

9. Primi with primary genital herpes at 12 weeks.

10. Baby of a mother with primary genital herpes in 3rd trimester treated with acyclovir. Mother refused caesarean section & baby born vaginally, at birth baby looks unwell.

11. 36 years old multi with recurrent herpes at 36 weeks treated with acyclovir& had a normal vaginal delivery.

12. 26 years old multi with recurrent genital herpes treated with aciclovir from 36 weeks of pregnancy. Mother had genital lesions during labour & had a normal vaginal delivery.

Option List:
A. Carbamazepine
B. Eslicarbazepine
C. Gabapentin
D. Lamotrigine
E. Levetiracetam
F. Oxcarbazepine
G. Phenobarbitol
H. Phenytoin
I. Pregabalin
J. Primidone
K. Sodium valproate
L. Tiagabine
M. Topiramate
N. Vigabatrin

13. A woman taking anti epileptic medicine attends for a routine foetal anomaly scan at 20 weeks of gestation. The foetus is found to have spina bifida & a cleft lip. Which medication Is she most likely to be taking ?

14. A pregnant woman attends antenatal clinic and is taking a single anti epileptic drug. She has been informed that the drug she is taking has two main advantages
i. It carries the lowest risk of congenital malformations,
ii. It does not increase the risk of hemolytic disease of the newborn. Which drug is she most likely to be taking?

15. A woman with epilepsy has a seizure in labour. Benzodiazepines are administered, but the seizures continue. Which second line therapy should now be administered ?

Option List:
A. Mesenteric vein thrombosis
B. Pancreatitis
C. Appendicitis
D. Ureteric colic
E. Pyelonephritis
F. Torsion of an ovarian cyst
G. Pre-eclampsia
H. Red degeneration of fibroid
I. HELLP
J. Acute fatty liver
K. Severe constipation
L. Abruption
M. Preterm labour
N. Urinary retention
O. Sickle cell crisis
P. Crohns disease
Q. Ulcerative colitis
R. None of the above

16. 18 Year old primi with severe abdominal pain at 28 weeks gestation. Pain is radiating from her back to the groin. She was treated for an episode of fever with chills a month ago. Urinalysis shows leucocytes & blood. Blood test results are as follows-Hb-10.7 g/dl,WBC-17x 109/L, platelets 187x109/L, uric acid 0.30mmol/L, amylase 250u/dl, AST 17IU/L& ALT 23 IU/L.

17. 35 year old, G4P3A0 with 32 weeks pregnancy came to the day assessment unit with abdominal pain. She gives h/o nausea & vomiting since morning. No pv bleeding or tightening. She drinks 20 units of alcohol/week. On exam pulse-100 bpm & BP-130/86 mmHg. Urinalysis is normal. Blood results are as follows-Hb-13.7g/dl,WBC-14x109/L, CRP-200 units, AST-40 IU, GGT-50 IU, ALK-20 IU, amylase 900 IU & bilirubin 28 mmol/L.

18. 28-year primi at 14 weeks gestation, presents with lower abdominal pain. No vaginal bleeding or dysuria. There is an episode of vomiting in the morning. On exam-Temp 37.8֯c. There is tenderness over lower abdomen-right lower quadrant. Vaginal exam-os closed. Blood results-Hb 11.7 g/dl,WBC 17 cells/mm3, CRP-100 U, AST-30 IU, GGT 17 IU, ALP 150 IU, bilirubin 22 mg/dl, amylase 50 IU & SE. albumin 25 g/dl.

19. 35 years old primi with 24 weeks pregnancy. She is a known case of fibroid uterus undergone myomectomy & now conceived with IVF. She has had recurrence of the fibroid in this pregnancy.

20. A 19-year-old presents to A& E with severe lower abdominal pain & fainting attack 1 hour ago. She is brought by mother in a collapsed state. On exam her pulse is 110 bpm thread, BP-70/50. She is unresponsive to oral commands. She is resuscitated & a scan done which shows free fluid in Pouch & Douglas & a 3 cm mass in the right adnexa.

Option List:
A. HIV RNA done in infant that will decide treatment
B. Zidovudine daily for 3 months
C. Zidovudine for 4 weeks
D. Zidovudine + Lamivudine for 4 weeks
E. Zidovudine + Lamivudine for 6 weeks
F. Zidovudine + Lamivudine for 3months
G. Zidovudine + Lamivudine + Nevirapine for 4 weeks
H. Zidovudine + Lamivudine + Nevirapine for 6 weeks
I. Zidovudine for 2 weeks
J. Zidovudine + Lamivudine for 6 weeks
K. Tenofovir + emitricitabine+efavirenz for 6 weeks
L. Zidovudine + Lamivudine + Nevirapine for 3 months
M.Tenofovir + emitricitabine+efavirenz for 4 weeks
N. Zidovudine for 6 weeks
O. Tenofovir + emitricitabine+efavirenz for 6 weeks
P. Tenofovir + emitricitabine+efavirenz for 3months
Q. Only PCP prophylaxis started
R. No treatment required
These infants were delivered to HIV-positive women at various gestations. For each infant, choose from the above option list the next most appropriate treatment for the infant. Each option may be chosen once, more than once or not at all.

21. Aly is a full-term baby delivered to an HIV-positive mother who is on cART since 12 weeks of gestation, and her viral load at 32 weeks and at 36 weeks was <50 HIV RNA copies/mL.

22. Hailey, is born at 38 weeks of gestation to an HIV-positive mother who had cART from 30 weeks of gestation. Her viral load at 36 weeks of gestation was <50 HIV RNA copies/mL.

23. Kelly, was delivered at 32 weeks of gestation vaginally to an HIV-positive mother who had been on cART from 24 weeks of gestation. Her viral load at the last record was 75 HIV RNA copies/mL.

Option List:
Management of endometrial cancer->
A. Laparoscopically assisted vaginal hysterectomy
B. Radical hysterectomy, radiotherapy and chemotherapy
C. External radiotherapy
D. Pipelle biopsy
E. Laparoscopic hysterectomy with bilateral salpingectomy
F. Laparotomy and bilateral salpingo-oophorectomy (BSO)
G. Presurgical radiotherapy followed by completion hysterectomy
H. Chemoradiation
I. Hysteroscopy with biopsy
J. Palliative care
K.Laparotomy, total hysterectomy, bilateral salpingo-oophorectomy, pelvic nodes dissection and radiotherapy.
L. Combination of surgery +/- radiotherapy +/- chemotherapy for palliation
M. Progesterone
N. Annual follow-up
O. Optimal debulking surgery
P. Combined surgery and chemotherapy
Q. No further therapy
R. Laparoscopic hysterectomy with bilateral salpingo-oophrectomy

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

24. A 40-year-old parous woman underwent simple hysterectomy with ovarian conservation for severe menorrhagia. Later histopathological examination has shown a well-differentiated endometrial adenocarcinoma limited to the endometrium with no Lymph vascular space invasion. What is the appropriate next step?

25. A 55-year-old lady undergoes outpatient hysteroscopy and endometrial sampling for postmenopausal bleeding. Histopathological examination has shown well- differentiated adenocarcinoma cells. A subsequent magnetic resonance imaging (MRI) scan has the following findings? Which of the following the best treatment option for this stage as understood by the MRI scan?

26. A 53-year-old Asian woman presents to her GP with PMB. She had a left mastectomy and axillary node dissection for breast cancer 4 years ago. She is currently on two medications: tamoxifen and anastrozole. She has been up to date with her smears and all her previous smears, including the current one, are normal. A TVS performed in the clinic reveals 14 mm endometrial thickness and normal ovaries. A recent breast appointment shows no clinical evidence of recurrence of breast cancer. Which is single most important next step in her management?

27. An 82-year-old woman presents to the emergency department with postmenopausal heavy bleeding and her haemoglobin is 70 g/L. She receives 2 units of blood transfusion and undergoes hysteroscopy and an endometrial biopsy on an emergency basis, because she continued to bleed heavily. An endometrial biopsy reveals clear cell carcinoma. What is the appropriate management according to stage?

Option List:
A. Refer to colposcopy
B. Colposcopy-directed cervical biopsy
C. High vaginal swab and Chlamydia swab
D. Reassurance
E. 6 monthly follow up with hrHPV testing
F. Conisation
G. Smear test after childbirth
H. Perform a first smear test
I. Await the next smear test results
J. Punch biopsy of the cervix on naked-eye examination
K. Pipelle endometrial sampling
L. Regular 6 monthly colposcopic examination with cervical smear and biopsy if indicated
M. MDT review within 2 months
N. TVS followed by endometrial biopsy
O. No follow up in CIN-2 , she has to undergo LLETZ.
P. Repeat colposcopy in 12 months
Q. LLETZ- large loop excision of transformation zone.
R. Gynecologist reference
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

28. A 28-year-old pregnant lady presents with bleeding per vaginum at 20 weeks of pregnancy. Ultrasound reveals an active appropriately grown fetus with a small area of retroplacental haematoma. The cervix appears normal on clinical examination. She has had no smear tests so far. What is appropriate management with respect to her cervical screening?

29. A 25-year-old lady has a routine screening with hr HPV positive was referred for colopocospy. Reflex cytology done was reported as having high grade dyskaryosis. Colposcopy was done and was adequate but normal. What is appropriate management in this case?

30. A 32-year-old lady has a routine hrHPV test done was found to be positive and was referred for colposcopy. Reflex cytology before colposcopy shows low grade dyskariosis. Colposcopy was performed, but was found to be inadequate and not able to give any conclusion. What is appropriate management?

31. A 46-year-old lady is being followed up with an annual smear for a previous abnormal smear. The smear has been reported to have possible normal endometrial cells. She is in day 16 of her menstrual cycle. What is appropriate management?

Option List:
A. Vulvectomy
B. Excisional biopsy
C. Punch biopsies of vulva
D. Stage 1b with wide local excision
E. Treat with oestrogen cream
F. Treat with steroids cream
G.Radiotherapy
H. Radical vulvectomy unilateral lymphadenectomy
I. Refer to gynaecology cancer centre.
J. Radical wide local lesion with ipsilateral inguino-femoral lymph node removal
K. Radical vulvectomy and bilateral groin lymph adenectomy
L. Steroid cream
M. Stage 1a cancer with wide local excision.
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

32. A 70-year-old is referred to the gynaecology clinic with a history of vulval itching and soreness for the last year, with worsening of symptoms over the last month. On examination, irregular exophytic growth on vulva. Some areas show elevated and irregular surface contour and feel firm and tender to palpate. There is no obvious ulceration. On biopsy squamous cell cancer is diagnosed. What would be the most appropriate treatment option for her?

33. Mrs. Emily is 70 year-old woman is referred to rapid-access, 2-week wait gynaecologic clinic with a vulval lesion. She is otherwise fit and healthy, but often smokes. Her smears were always normal and the last one done about 6 years back. On examination of vulva, there is a 2.5 cm left labial lesion. Biopsy of the lesion reveals squamous cell carcinoma of the vulva with > 1mm stromal invasion. What is management in the patient?

Option List:
A. Reduction of Allergens
B. Anti-Fungals
C. Pelvic floor exercises
D. Topical estrogens
E. Urine pregnancy test
F. Amitryptiline
G. Cognitive behaviour therapy
H. Local lignocaine application
I. Refer to specialist
J. Psychosexual counselling.
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

34. Windy is 25 years of age visits her GP 4 months after her first child birth. The delivery was traumatic, with shoulder dystocia resulting in a third-degree tear. The scar took some time to heal and still hurts a little during sex. Jimmy has also found it difficult to make sense of her experiences since her son is born. She finds herself feeling angry with him for being so big as he is a very big man himself. She knows this is completely unjustified so says nothing to anyone about it. Most of the time she can put these thoughts to one side, but when it comes to having sex, she finds these angry thoughts keep popping into her head. So what is the best treatment for her as sex for her is being a problem now after delivery.
On examination:-
Scar seems healthy
No discharge
Which of the above is initial management in this case?

35. Jane is 24 years of age and has never been able to enjoy penetrative sex. She has considerable vaginismus (of which she is unaware) and also finds she is extremely dry. She finds the whole idea of sex a little disgusting, but tries to put up with it for the sake of her boyfriend, Peter. His repeated attempts at penetration have resulted in the skin cracking at her introitus. She is also inclined to clean herself rather vigorously after sex, and likes to put Dettol in her bath. On examine of the posterior fourchette:- 1. Stretching the fingers apart in the vaginal orifice of the woman will cause her to experience pain and erythema and/or 2. Superficial cracking can be seen with hairline scarring. Her investigations:- HB- 9 gm% Serum ferritin- 90ng/ml TLC- 8x109/L PLT- 230 Which of the above is initial management in this case?

36. 27-year-old P1 lady presents to the clinic with a history of deep dyspareunia for last 2 months. Her last menstrual period was 11 weeks ago. She also complains of bloating of her abdomen, abdominal pain and occasional diarrhoea for last 6 months. She had a forceps delivery with episiotomy 3 years ago. She was diagnosed to have polycystic ovary syndrome 8 months ago following investigations for infrequent periods and weight gain. Subsequently, she split with her boyfriend 3 months ago and stopped using any contraception. She has been in a same-sex relationship for last 2 months. Her abdominal and pelvic examination are unremarkable. Which of the above is initial management in this case?

Option List:
A. Treat with doxycycline 100mg BD for 14 days
B. Treat with cefixime 200mg BD for 14 days
C. Itraconazole 200mg orally twice daily for 1 day PO
D. Treat with azithromycin 1gm stat
E. Promptly refer her for desensitization and treatment of syphilis with penicillin
F. Fluconazole capsule 150mg as a single dose, orally
G. Doxy 100mg BD for 7 days
H. Metronidazole gel 0.75%, one full applicator (5 grams) intravaginally, once a day for 8 days
I. BV not treated during pregnancy
J. Benzathine penicillin 2.4 MU IM weekly for three weeks (three doses):
K. Fluconazole 150mg oral single dose
L. Nystatin cream 100,000 units intravaginally twice daily for 7 days
M. Clotrimazole 10% cream 5 grams intravaginally daily for 7 days
N. No antifungal is considered safe in pregnancy
O. Amoxicillin 500mg twice daily for 7 days
P. Doxy 200mg BD for 7 days
Q. Metronidazole 2g orally in a single dose
R. Dicloxacillin 250mg QID for 10 days
S. Azithromycin 1 gram orally in a single dose followed by 500mg OD for next 2 days.
T. Benzathine penicillin G 2.4 MU IM single dose
U. Erythromycin 500 mg orally four times daily for 21 days
Which of the above is the best treatment option for the scenarios given below? Each option may be used once, more than once, or not at all. What is your next best course of management?

37. A 19-year-old woman presents for a new maculopapular rash on her trunk, which includes the palms of her hands and soles of her feet. She has no other medical problems, takes no medications, and denies illicit drug use. She has never been tested for sexually transmitted infections (STIs) before. She has had three male partners in the past 6 months with intermittent condom use. One of her male partners also has sex with men. What is the treatment for the female?

38. A 35-year-old female presents with a 5-day history of severe vaginal itching and pain during urination. She denies fevers, chills, or pelvic pain. She is sexually active with one male partner and uses condoms consistently. On physical examination, vulvar erythema and thick white vaginal discharge are visualized. Microscopic picture of the organism taken from culture media is as follows. What is the treatment?

39. A 39-year-old woman presents to clinic with a 5-day history of abnormally increased and slightly malodorous vaginal discharge. She has no dysuria or polyuria. She has been sexually active with two men in the past month and reports that she does not routinely use condoms. Point of care testing for both HIV and pregnancy are negative in clinic. Evaluation for bacterial vaginosis (using Amsel criteria) yielded only an abnormally elevated pH level. The dark ground microscopy of the discharge reveals the following. What is the treatment in the following condition?

Option List:
The most suitable advice for emergency Contraception:-
A. LNG 1500 mg stat
B. LNG 750 mg now & after 12 hrs
C. LNG 750 mg 4 doses 12 h apart
D. IUCD and STI screening
E. Mirena
F. Mifepriston 600mcg
G. Misopristol 800mcg
H. UPA 30 mg stat
I. UPA 5 mg stat
J. Wait for her next period then discuss.
K. No emergency contraception required .
Which is correct emergency contraception for the following questions given below. Each of the above options can be used once, more than once or not at all. Probable diagnosis for the following?

40. Emiy is Para 1, is using Cerazette as a contraception. She is an actress by profession and never misses her pill taking. Unfortunately because of busy shooting schedule this month she missed 1 pills on day 18 of her cycle and had UPSI after missing her pill. She visits you on day 19 of her cycle. She never wants to get pregnant again. What is the emergency contraception in this case advised?

41. Hailey is Para 4, and is using combined transdermal patch as a contraception. She is a house wife and never misses to change her patch. Unfortunately because of busy schedule this month she missed to change her patch and it is 3 days overdue with the same patch now. She had UPSI 2 days before with her husband. She visits you on day 10 of her cycle. She never wants to get pregnant again. What is the emergency contraception in this case advised?

42. A 23-year-old female teacher has been on a low-dose (20 mg ethinylestradiol) combined oral contraceptive pill for the past 3 years. Unfortunately, she forgot to take her pill, on day 18 of her pill taking. She has UPSI 4 days back. What is advised to her?

43. Helen is a 27 years old housewife. She is para 2. She is medically fit and healthy, came for repeat DMPA after 15 weeks. . She has history of multiple episodes of UPSI in the last few days. She is travelling abroad tomorrow so want the injection before she leaves. What is the emergency contraception advisable in this patient?

44. 37yrs old Marry is a lawyer by profession. She is not married and not in a stable relationship. She was travelling from London to Bangkok and found love of her life. She is still not sure about the man he met whether he is her Mr. Right or not. She has regular periods since menarche. She has several episodes of sexual intercourse with condom with this man while on vacation. But there was Burst condom 2 days ago. She has returned yesterday from vacation and has come to you for advice about emergency contraception. Her LMP was 12 days ago. But she states that she is not willing for future fertility. What is the best effective EC for her?

Option List:
A. 0 wks
B.12 wks
C.14 wks
D.16 weeks
E.18 wks
F. 20 wks
G. 24 wks
H. 28 wks
I. 32 wks
J. 34 weeks
K. 35 wks
L. 36 weeks
M. 37 weeks
N. 38 weeks
O. 39weeks.
For each of the following clinical scenarios pertaining to multiple pregnancy, choose the single most appropriate gestational age from list above .each option may be used more than once,more than once or not at all.

45. A 24 year old woman is referred to the antenatal clinic. She is uncertain of her last menstrual period and is thought to be in 2nd trimester. An ultrasound scan shows a twin pregnancy. Ideally by what gestational age should chorionicity have been determined.

46. A 34 year old woman is found in the first trimester to have a MCDA twin pregnancy. From what gestational age should serial assessment of fetal weight commence?

47. A 25-year-old woman is seen in the antenatal clinic with a DCDA twin pregnancy. It has so far been uncomplicated. From what gestational age should delivery be offered if it remains complicated?

Option List:
A. Amniotic fluid volume and umbilical artery Doppler in 1 week
B. Amniotic fluid volume and umbilical artery Doppler in 2 week
C. Amniotic fluid volume and umbilical artery Doppler in twice per week.
D. Iophysical profile.
E. Continue low risk pathway.
F. Ductus venosus Doppler.
G. Growth scan in 3 to 4 weeks
H. Growth scan, amniotic fluid volume
I. Growth scan, amniotic fluid volume and umbilical art Doppler
J. Growth scan, amniotic fluid volume and umbilical Doppler in 2 weeks.
K. Middle cerebral artery Doppler
L. Serial growth scan from 28 weeks.
M. Umbilical vein Doppler.
N. Uterine art Doppler at 18 weeks.
For the  following clinical scenarios ,choose the most important USG ,investigation or action to take next. Assume that you are in a hospital where fetal medicine scanning  is available.each option may be used once ,more than once or  not at all.

48. A 28-year-old woman has a growth scan as her previous baby was born with a weight below the 5th centile, she is now at 28 weeks gestation. The growth scan for obstetric history shows that the estimated fetal weight is on 50th centile, amniotic fluid volume and umbilical art Doppler are normal.

49. A 32-year-old woman in her first pregnancy is seen at 28 weeks of gestation. She has had a growth scan due to a symphysis fundal height measurement below the 10th centile. The growth scan shows an EFW of less than 5th centile with normal amniotic fluid volume and umbilical art Doppler.