EBCOG Part 1 – Mega Mock – Paper B SBA

1.In a pregnant lady undergoing chest X-ray with abdominal shield,the estimated fetal dose of
 radiation per exam is 2-7/  milligray.what is the dose that has negligible risk to the developing pregnancy in any trimester?

2. 2.A 21 year old lady in her first pregnancy has come for booking visit at 9 weeks.on enquiry about any significant history in the past ,she gives history of recurring epistaxis,but she did not visit any doctor.Nor has she been investigated,You order a set of investigations including a FBC which reads as follows.What is the most likely diagnosis based on this report?Result of FBC

   Hb-112g/L

   WBCs-4

   Platelets-89

   MCV-30

   MCH-35

3.You are the ST5 in the antenatal clinic & have been asked to review a 35 year old woman who is into her third pregnancy.She has undergone a renal transplant 2 years ago .She has no other medical or surgical history of note.She has 2 uncomplicated spontaneous vaginal births before the renal transplant.She is now 14 weeks pregnant & on the following medications-prednisolone & azathioprine.she is not a smoker or alcoholic & her BMI is 27.Her BP measured in the clinic is 125/85 mmHg & she is not on any antihypertensive.Her blood reports are as follows-Hb-10.2g/dl,Se.albumin-32g/dl,Se.creatinine-110 mmol/L,urine proteincreat ratio-16.What will you tell her about the pregnancy outcome & management in her case?

4. Headache in pregnancy & postpartum is extremely common.Mrs Sara presented to the antenatal clinic at 30 weeks of pregnancy with a diagnosis of Tension type headache.Which of the features of headache below is not associated with tension type headache?

5. A 35 year old primi presents to antenatal clinic at 28 weeks of gestation to discuss about her mode of birth.She is a known case of Crohns disease.She is under care of a gastroenterologist & is taking T.prednisolone & Ifliximab infusion to control her symptoms.She has multiple perianal ulcers,which are healing now.What would you tell her regarding the intrapartum care & mode of birth?

6. The perinatal period is an anxious time for women adapting to the physical,hormonal & social changes of pregnancy,childbirth & postpartum period.Anxiety disorders during this period include all of the following except?

7.You are seeing a 28 year old woman in the preconceptional clinic with CKD stage 3 & recurrent UTIs.She is a non-smoker with BMI of 23 & is planning her first pregnancy.Her HT is controlled with ramipril.She takes nitrofurantoin 100 mg daily .Her investigations are as follows-urinalysis proteinuria 3+,Se.Create-150 & eGFR is 38.her protein creat ratio is 350mg/mmol.What will you counsel regarding change of medications at this stage?

8. 8.A 35 year old woman with DCDA twin pregnancy presents to A&E with acute chest pain.Her BMI is 41.An ECG is done to confirm or rule out myocardial infarction.Which ECG change will help you conclusively come to a diagnosis of myocardial infarction?

9. 9.A 35 years old multiparous who had 3 spontaneous vaginal deliveries,is referred to the antenatal clinic by the midwife at 30 weeks of gestation.Her Hb done at 28 weeks was found to be 90 g/L.She was prescribed oral iron for 2 weeks & a repeat FBC 2 weeks later showed the following.She is fine except feeling a bit tired.What will you do next her for her?                                                  FBCHb-89g/L

   WBCs-5

   Platelets-320

   MCV-75 fl

   MCH-30

10.26 year old is seen in the combined obstetric cardiology clinic at 14 weeks gestation.She has a history of Tetralogy of Fallots that was repaired in childhood.What is the main cardiac issue that she potentially faces in pregnancy?

11. 11.In a pregnant woman complaining of abdominal pain,if the pain is sharp & she is able to point the origin of the pain with one finger,the pain is usually?

12.A 25 year old lady has beta thalassemia and seen in the pre pregnancy clinic .which of the following advice is true ?

13. 33 yrs old Barbara ,G3P2A0 with chronic kidney disease presents to the preconceptional clinic.She wants to know what is her chance of having a successful outcome in this pregnancy.She is in fairly good health at present.Her BP is well controlled & her recent investigations show that her Se.Creatinine is 130.What will you tell her about her chances of having a successful obstetric outcome?

14. A 27 year old Asian woman in her first pregnancy is known to have thalassemia major.She is 28 weeks pregnant.She comes to the emergency department with shortness of breath that has rapidly deteriorated.Despite resuscitation,she died within 20  minutes.What is the most likely cause of death?

15. Lactate levels are used in the recognition of sepsis & response to treatment.Goal directed sepsis therapy is indicated if lactate levels are above?

16. 23 year old primi with 39 weeks pregnancy was admitted to labour suite with complaints of pain in abdomen.She was in early labour.She was a diagnosed case of covid-19 infection.As per protocols her oxygen saturation was monitored hourly.The target saturation to be maintained is?

17. A 28 year old with anti-phospholipid syndrome & a previous venous thromboembolism while on oral contraceptive pills is planning to conceive & seeks your advise.Which one of the options is the most appropriate with regards to her thromboprophylaxis in pregnancy?

18.A 35 year old primi with 32 weeks pregnancy.Pregnancy has been uneventful so far.No other past medical or obstetric history.The lady has been admitted for investigation of a suspected lower limb DVT .She is found collapsed & unresponsive in the corridor.The midwife who found her has called for the emergency team.You are the next person to arrive on the scene.What is the first most appropriate step in her care?

19.23 years old lady at 22 weeks gestation is referred by her GP with flu like symptoms & temperature of 39֯c with chills & rigors.She has recently returned from Nigeria after visiting her family.Which one of the following will rule out a diagnosis of malaria?

20. A 19 year old woman in her first pregnancy presents to the emergency department with sudden breathlessness.On exam her lips are swollen.Her pulse is 110 bpm & her BP is 100/60.On auscultation there is diminished air entry on both sides .She has no past medical history.What would be the best immediate action?

Q21. Which of the following is associated with the highest risk for cancer ovary?

Q22. What is the main cause of death in women with epithelial ovarian cancer?

Q23. A 36-year-old woman is found to be 15 weeks pregnant when she is diagnosed with stage IB2 cervical cancer. What will be the most appropriate management?

24. Mrs. Rachel is 66 years old and is postmenopausal. She has recently been diagnosed with a 5X6 cm complex ovarian cyst on a trans-vaginal scan. The scan could not identify the other ovary as the bowel obscured it. The scan was being undertaken for suspected gallstones with the cyst being an incidental finding. Ms. XY is very anxious that this may represent ovarian cancer. GP advised her CA-125, which was found to be 255. What is the next step in her management?

25. A27-year-oldwoman has been referred for genetic counselling and screening for the mutations associated with ovarian cancer. Her mother and sister both had ovarian cancer at the ages of 40 and 45 years, respectively. She has been screened and has BRCA1 mutation. What will be the effect of prophylactic salpingo-oopherectomy on her cancer risk?

26. A 65 -year-old who has been suffering from vague abdominal symptoms was diagnosed with ovarian cancer followingvariousinvestigations. It is suspected that she had advanced disease that cannot be optimally resected, she has liver metastases. What would be the best approach to managing this patient†

27. Whatisthe 5-year survival of ovarian cancer in the UK?

28. An 80-year-old woman presented to the rapid-access, 2-week wait gynaecologic clinic with vulval itching and soreness. Clobetasol propionate 0.05%prescribed by her GP for vulval application bad had no effect Examination revealed bilateral lichen sclerosis of the labia with midline labial fusion. Vulval adhesiolysis and vulval mapping biopsies were undertaken under general anaesthesia. Histology showed vulval squamous cell carcinoma of the left labia majora with a depth of invasion of > 1 mm, MRI of the pelvis showed a thickened area on the left labia that measures <2 cm but no inguinal lymphadenopathy. After discussion in the multidisciplinary team meeting, she undergoes RWLE and left groin node dissection. The final histology report shows a 2 cm tumour with clear margins; l out of 5 nodes sampled from the left groin contains metastatic tumour.

What final International Federation of Gynecologyand Obstetrics (FIGO) stage needs to be allocated after the definitive surgery for vulval cancer from histology results?

29. What is the effectiveness of HPV vaccines available all over the world?

30.  A 37 years old underwent LLETZ for CIN-3 . she should be advised to abstain sex for how long? 

31. A25-year-old woman attends the emergency department. She has recently changed partners. She complains of pelvic pain and vaginal discharge. Speculum and pelvic examination reveal discharge at the cervix and vagina, with pelvic tenderness and cervical excitation. As the on-call registrar who examined her, you suspect Chlamydia infection. What is the best test to confirm/ most sensitive test your suspicion?

32. G2P1 on HAART at 35 wks,presented with complaints of pain abdomen and gush of watery fluid per vagina, her Viral load < 50 copies/ml done 1 week ago, on examination fetal heat was regular and per speculum examination leaking of amniotic fluid was confirmed .

What is the most appropriate management in this case ?

33. A 25-year-old G2P1 woman books at 24 weeks’ gestation, and her booking bloods show human immunodeficiency (HIV) antibodies, which are later confirmed by polymerase chain reaction. Her CD4 cell count is 900/mm. she was started on CART. Her fetal anomaly scan is reported as normal. What is the most appropriate advice for postpartum continuation of CART?

34. A primigravida complains of primary genital herpes at 36 weeks gestation. She has been treated with Acyclovir . She would opts for normal vaginal delivery. What would you advise her about risk of neonatal infection in case of primary genital herpes if the foetus delivers via vaginal route?

35. 24 years old Ammi complaints dirty vaginal discharge with vaginal itching and excoriation. She is in a stable relationship but is quite worried about her perineal hygiene and regularly does vaginal douching. She is planning pregnancy and has unfortunate history of three recurrent miscarriage. What is the most likely diagnosis in this case?
    • Chlamydia trachomatis
    • Nesseria Gonorrhoea
    • Bacterial vaginosis
    • Trichomonas vaginalis
    • pallidum

36. Emily is 27 years old and is suffering from epilepsy since 7 years of age. She is on carbamazepine as an anti-epileptic. Her last seizure episode was 1 year back. Well controlled since then. She is not in a permanent relationship. She attended a hen’s party and had unprotected sexual intercourse with a boy. Her LMP was 10 days back and she has regular 30 days cycle. She came for advice for emergency contraception and is reluctant for cupper IUC. What suitable alternative for her?

37. 45years old Mrs.Zen is on nexplanon for contraception. She is happy with implant use. She has regular monthly periods no problem otherwise. But she has recently read somewhere and is worried that implant is associated with osteoporosis. She has come to you for advice for another contraception In view of implant associated with osteoporosis. What is the best advice you will give her?

38 What is the percentage of failure resulting in unplanned pregnancy due to use of Filschie clips?

39.25 years old Emily is on anti-epileptic since 5 years. She has decided to be in a relationship but not planning pregnancy right now. Long back she was diagnosed to have bicornuate uterus. What is the best option for her?

40. A 48-year-old woman had a copper coil fitted. Her last menstrual period was 6 months ago. She wishes to know whether she has gone through the menopause and therefore can have the coil removed.

41. A Sexualy active 19 yrs old woman came for contraceptive advice, and after considering all her options, she decided to start on the combined oral contraceptive pill. As you have to advise her on the best method of using these pills, you are giving her some directions. Which of the following statements is incorrect with regard to start of COC?

42.  An 80-year-old hypertensive lady has Overactive bladder symptoms. The single best option for drug therapy:

43) A 56-year-old para 4 woman presents with a vault prolapse. The patient is sexually active and urodynamic investigations fail to reveal urodynamic stress incontinence even after reduction of the

prolapse. The patient is keen on having surgery. Which of the following operations should be offered?

44) A 52-year-old woman attends the gynaecology clinic with a history of a heaviness & dragging sensation in her vagina. She had a hysterectomy 10 years ago overseas and does not know the reason for it. She is otherwise healthy and well. She is not currently taking any medication. Rumination reveals stage I post-hysterectomy vaginal vault prolapse. How should she be managed?

 45) A 35-year-old woman present with painful micturition and increased frequency and nocturia. A provisional diagnosis of interstitial cystitis is made. Most definitive feature in bladder biopsy in insterstitial cystitis

46. A 24 year old woman with 12 weeks pregnancy presents with confirmed venous thromboembolism. What would you advise her regarding her treatment?

47. A 28 year old woman with a BMI of 25 kg/m2 books into the antenatal clinic at 12 weeks.2 years previously she had a confirmed iliofemoral thrombosis in her left leg after major knee surgery.What will be your advise regarding thromboprophylaxis?

48. What is the incidence of post thrombotic syndrome following a DVT in pregnancy?

49. Mrs Jane is a primi at 36 weeks gestation,She is in the antenatal clinic to discuss her mode of birth.The pregnancy has been uneventful till noe.Mrs Jane was diagnosed with a microprolactinoma prior to pregnancy.After conception she stopped taking Cabergoline.What advise will you give her regarding labour & delivery?

50. It is important to optimise pre pregnancy health in a womanwith sickle cell disease .You have advised many blood tests and systemic evaluations to a 29 year old womanwith sickle cell disease to help determine pre pregnancy health status . She’s asking you for clarification regarding the exact eye test you have advised. It is most likely to be