EBCOG – PART 1 – DATA INTERPRETATION

1.Which of the following is true concerning CTG monitoring.

a.The paper speed is 1 cm/min in the UK
b.The CTG is not a legal document.
c.Variability <5 bpm for >90 mins is a non reassuring factor.
d.As per NICE 2 abnormal features are needed to classify a CTG as pathological.
e.FBS may be considered in fetuses over 32 weeks gestation.

2.Which of the following regarding diagnosis of diabetes in pregnancy is incorrect?

a.An OGTT is performed at approximately 20 weeks gestation.
b.Diabetes is diagnosed if fasting glucose level is above 7mmol/L
c.Diabetes is diagnosed if a 2 hr glucose level is >11.1 mmol/L
d.Polyhydramnios can indicate gestational diabetes
e.GDM is diagnosed if 2 hr glucose level is>8.2 & <10.1 mmol/L

3.A positive result for protein on urine dipstick can indicate all of the following except

a.pre-eclampsia
b.Urinary tract infection
c.Renal colic
d.Normal pregnancy
e.Chronic renal disease

4.Regarding serum β HCG ,which of the following is incorrect?

a.High levels of serum β HCG can indicate gestational trophoblastic disease.
b.An increase in β HCG of 65% in 48 hours is considered normal.
c.An intrauterine pregnancy should be visible on TVS when the β HCG is >500 iu/L
d.Se .β HCG has no role when there is a known IU pregnancy confirmed on USG.
e.Serial βHCG monitoring typically involves checking levels every 48 hrs.

5.Regarding semen analysis,which of the following is correct?

a.Total motility should be >80%
b.The count should be atleast 15 million sperm/ml
c.A volume of 1 ml is acceptable
d.The average ejaculate should have a minimum of 49 million sperm
e.Analysis should be performed within 90 mins of production.

6.Fetal blood sample is performed on a primiparous 24 year old woman at 7 cm dilatation,due to a pathological CTG.The result shows a pH of 7.24.Which is the most appropriate action based on this result?

a.A repeat sample should be performed in 30 minutes.
b.It is a normal result & the pt should be reassured
c.No further sample should be performed unless there is a terminal trace
d.Proceed straight to caesarean section.
e.The patient should be placed in left lateral position.

7.An 18 year old pregnant woman attends antenatal clinic at 32 weeks gestation.Her urine sample reveals protein + & leucocytes +.She is asymptomatic of a urinary tract infection & is otherwise well.What is the most appropriate action?

a.Antibiotics & send urine for culture.
b.Blood tests including a FBC & Renal function.
c.Renal scan & antibiotics
d.Routine urine dipstick at next appointment
e.Send urine for culture & treat if positive

8.A 22 year old primi books her pregnancy at 11 weeks gestation.Her booking blood tests reveal a Hb level of 10.1 g/dl.Electrophoresis reveals Hb karyotype HbAS.what is the diagnosis?

a.Βeta –Thal major
b.Beta –thal trait
c.Hereditary spherocytosis
d.Sickle cell anemia
e.Sickle cell trait

9.A 32 year old woman is being continuously monitored during labour using a CTG.she has had one previous LSCS for breech presentation at term.She is currently 40 weeks gestation & in spontaneous labour.The baseline of the CTG is 115 bpm.What is the accepted range for the baseline rate?

a.80-90 bpm
b.90-120 bpm
c.100-150 bpm
d.110-160 bpm
e.120-180 bpm

10.A 32 year old multiparous pregnant woman attends the antenatal clinic for review at 28 weeks gestation.she mentions that her 4 year old daughter has chicken pox.she is unsure whether she has had chicken pox before.serology results are as follows. VZ virus IgM—negative,VZ virus IgG—positive.what do the serology results suggest regarding her immune status with respect to chicken pox?

a.Acute episode of shingles
b.VZ-chronic carrier
c.VZ-current acute infection
d.VZ-no acute infection,no previous exposure
e.VZ-previous exposure

11.A 40 year old primi is admitted & investigated for raised BP.Protein is 3+ on urine dipstick.a 24 hr urine collection is sent for protein calculation.What level of urinary protein excretion in 24 hrs indicates significant proteinuria?

a.>0.1 g
b.>0.2 g
c.>0.3 g
d.>0.4 g
e.>0.5 g

12.A 27 year old primi presents with lower abdominal pain & some vaginal spotting.Her LMP was 5 weeks ago.Her se.βHCG on presentation is 258iu/L.as she is clinically stable ,with no risk factors for ectopic pregnancy,she goes home & returns to the EPAY 2 days later for a repeat se.βHCG.The results are as follows D1-βHCG 258,D2 –βHCG 460 iu/L.Which of the statements below best describes this pts se.βHCG trend?

a.Normal rise,cant exclude ectopic pregnancy
b.Normal rise,confirmatory of a viable intrauterine pregnancy
c.Suboptimal rise ,suggestive of early miscarriage
d.Suboptimal rise,suggestive of ectopic pregnancy
e.None of the above

13.A couple with primary subfertility who have been trying to conceive for over 12 mths,attend a reproductive medicine unit.The male partner has already given a sample for analysis.The results of semen analysis are as follows—volume 4.5ml,sperm count 12million/ml,total motility 61%.What does this analysis indicate?

a.Normal semen analysis
b.Reduced normal morphology,with other parameters normal
c.Reduced sperm count,other parameters normal
d.Reduced total motility,other parameters normal
e.Reduced volume,other parameters normal

14.A 34 year old primi is induced at 40 weeks gestation & 12 days for postdates.The fetus is continuously monitored via a CTG.At 6 cm dilatation the CTG becomes pathological & FBS is done.the results of the FBS are as follows-sample 1-pH 7.19,sample 2-pH 7.20.What are the most appropriate interpretation & action based on the FBS results?

a.Abnormal result,consider immediate delivery
b.Abnormal result,rpt sample within 30 mins if CTG remains pathological
c.Borderline result,rpt within 30 mins if CTG remains pathological
d.Normal result,no further action required
e.Normal result,rpt sample within 1 hr if CTG remains pathological.

15. A 37-year-old multiparous woman with gestational diabetes is in labour. The labour is being continuously monitored using a cardiotocograph (CTG). She is reviewed by the obstetric team and the parameters of the CTG are noted.
Baseline: 130 beats per minute
Accelerations: present
Variability: < 5 beats per minute for 50 minutes
Decelerations: typical variable decelerations with more than 50% of contractions for 30 minutes
Contractions: three to four contractions in 10 minutes
On the basis of this report how is the CTG best classified?

A Normal CTG
B Normal CTG with one non-reassuring feature
C Suspicious CTG with one non-reassuring feature
D Pathological CTG with one abnormal feature
E Pathological CTG with two non-reassuring features

16. A 23-year-old woman is admitted at 6 weeks’ gestation with severe hyperemesis gravidarum. Her serum potassium is 2.7 mmol/L. What is the normal range of serum potassium?

A 2.5–3.0 mmol/L
B 2.7–3.5 mmol/L
C 3.0–4.0 mmol/L
D 3.5–5.0 mmol/L
E 4.0–5.5 mmol/L

17.A 64 year old woman undergoes a TAH with BSO for endometrial carcinoma.The staging of the specimen is described as stage 1b.What is the definition of stage 1b endometrial carcinoma?

a.Endocervical invasion only
b.Extension to adjacent organs
c.Extension to vagina
d.More than ½ of myometrial invasion seen
e.Limited to endometrium

18. An 82-year-old woman is undergoing investigation for postmenopausal bleeding. Her serum lactate dehydrogenase (LDH) is found to be raised. Which of the following conditions is associated with a normal level of LDH?

A Haemolysis
B Myocardial infarction
C Paget’s disease
D Pulmonary embolism
E Tumour necrosis

19. A 54-year-old woman is investigated for abdominal bloating and weight loss. A range of blood tests are sent as part of her investigations. Which of the following serum levels would be increased if the she had hepatocellular cancer?

A Alpha-fetoprotein
B CA 15-3
C Carcinoembryonic antigen
D Creatinine kinase
E Neurone specific enolase

20. A 67-year-old woman is undergoing investigation for postmenopausal bleeding. An ultrasound scan shows her endometrial thickness to be 6 mm. What is considered a normal endometrial thickness for a postmenopausal woman?

A <2 mm
B <3 mm
C <4 mm
D <6 mm
E <8 mm

21. A 32-year-old primiparous woman attends the maternity day unit at 34 weeks’ gestation complaining of itching of the palms of her hands. Her blood tests show raised bile acids of 17 μmol/L. Her alanine aminotransferase is raised to 180 IU/L. What is the most likely diagnosis?

A Alcoholic liver disease
B Dermatitis
C Gallstones
D Hepatitis B
E Obstetric cholestasis

22. A 38-year-old woman attends a colposcopy clinic following an abnormal result of moderate dyskaryosis at cervical screening. The results of the biopsy taken at colposcopy indicate cervical intraepithelial neoplasia (CIN) II. What is the extent of cervical involvement in CIN II?

A 1/4 thickness of squamous epithelium affected
B 1/3 thickness of squamous epithelium affected
C 2/3 thickness of squamous epithelium affected
D Full thickness of squamous epithelium affected
E None of the above

23. A 25-year-old nulliparous woman attends cervical screening for the first time. The results of her smear test show borderline nuclear changes. What is the appropriate follow-up for this woman?

A Immediate referral to colposcopy
B Repeat smear in 1 year
C Repeat smear in 3 years
D Repeat smear in 3 months
E Repeat smear in 6 months

24. A 25-year-old primiparous woman has a forceps delivery. She sustains trauma to the perineum. You perform a per rectal examination. You note that <50% of the thickness of the external sphincter has been torn. What grade of perineal tear has the patient sustained?

A Fourth degree tear
B Second degree tear
C Third degree tear – class A
D Third degree tear – class B
E Third degree tear – class C

25. A 38-year-old multiparous woman is admitted with a heavy antepartum haemorrhage (APH) at 26 weeks’ gestation. She has had three previous caesarean sections. On examination, her abdomen is soft and non-tender. What is the most likely cause of this woman’s APH?

A Abruption
B Placenta praevia
C Trauma
D Vasa praevia
E Uterine rupture

26. A 32-year-old primiparous woman with gestational diabetes is 32 weeks pregnant. At her antenatal clinic review her symphysis fundal height is measured as 38 cm.She is referred for an urgent scan to assess fetal growth and amniotic fluid index. Which amniotic fluid index would indicate polyhydramnios?

A ≥5 cm
B ≥10 cm
C ≥15 cm
D ≥18 cm
E ≥22 cm