FCPS PART 2 WRITTEN SELLABLE MEGA MOCK – PAPER B

1. A 22-year-old woman, primigravida 20 weeks, comes to the accident and emergency unit complaining of lower abdominal pain and discharge pervaginum. Her temperature is 38. 4 C. On abdominal examination tenderness present in bilateral groin area. You diagnosed a pelvic inflammatory disease (PID). The patient tells you that she has been abroad and had unprotected sex. What is the recommended regimen for this patient?

2. A 25-year-old woman attends antenatal clinic at 29 weeks of gestation. She recently had visited a sexual health clinic for investigation of her painless vulval ulcer and inguinal lymphadenopathy. What treatment would be appropriate for her from the following options?

3. Mrs. Tina is 26 year old woman asks for your advice. She is 12 weeks pregnant and is concerned as she went to a children’s party12 days back where one of the children had the appearance in image given below .

You checked Parvovirus B19-specific IgG and IgM .

The results show the following:

Parvovirus IgG Positive

Parvovirus IgM positive

So you got tests  from booking serum ,Which showed 

Parvovirus IgG Negative

Parvovirus IgM Negative

What does this suggest regarding the patients Parvovirus status?

4. Mrs. Rosy , A 28-year-old woman with type I diabetes attends the pre-conception clinic and is found to be struggling to control her diabetes. She is found to be well motivated but she has related hypoglycemia attacks  .Her insulin requirements are not high. Multidisciplinary team decision is taken to commence her on an insulin pump in order to get her glycaemic control better before pregnancy. What would be the minimum interval  you ask her to continue to use contraception  so  her blood sugars can be controlled well with pump ?

5. A 57-year-old woman presents following two episodes of postmenopausal bleeding. What is her risk of endometrial polyps or endometrial hyperplasia?

6. A 54 year old lady had PMB. On evaluation her endometrium was 6mm and she underwent a outpatient hysteroscopic endometrial biopsy which shows EH without atypia. What would you tell her regarding risk of progression to endometrial cancer:

7. First line treatment for EH without atypia is:

8. A 56 year old P3 diabetic, postmenopausal lady underwent evaluation for PMB and was diagnosed to have endometrial hyperplasia without atypia. Her BMI was 40. She opted for continuous oral progesterone treatment and underwent 2 endometrial biopsies at 6 monthly intervals, both negative. What should her further plan be:

9. Regarding the clinical scenario the enhanced recovery programme (ERP) has comparable complication rates to, or better than, those seen following conventional surgery. Typically, there is no increase in readmissions or postoperative work for primary care and for faster postoperative recovery that has been implemented for many aspects of obstetrics and gynaecology. Which of the following is not included in ERP?

10. An 18-year-old nulliparous girl presents as a gynaecological emergency with 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?

11. A 32-year-old woman attends the colposcopy clinic after a high-grade smear result. After discussion, the woman accepts the LETZ procedure.

What is the minimum depth of excision that is accepted in the LETZ procedure?

12. FGM Is traditional cultural practice in many countries of the world. Which of the  following country has highest Percentage of girls and women aged 15–49  who has undergone FGM?

13. You are seeing 56 year old postmenopusal Amy ,  in clinic, has been referred for uncontrollable Vulval itch & soreness which is worse at night . she has visited her GP and he has given her some lubricants which was of no benefit. On examination thinning of skin, labial adhesions seen Skin looks like cigarette paper vulval biopsy showed thinned  epidermis  with  sub-epidermal hyalinization and  deeper  inflammatory  infiltrate.

Choose correct diagnosis

14. Mrs. x is  51-year-old woman with hot flushes  . She has   No significant past medical or family history. You prescribe hormone replacement therapy (HRT). During her appointment you counsel her regarding the risks of estrogen and progestogen HRT. How many estimated additional cases of breast cancer are there per 1000 women using HRT for five years?

15. Mrs, Jacqueline , A 50-year-old woman presents with amenorrhoea for a period of 1 year. She has hot flushes, which are.troublesome. Her main concern is osteoporosis, as her mother has recently been admitted with a hip fracture. You explain options , she ask you regarding tibolone ,all are tru except .

16. A 35-year-old para 3 underwent a TAH+BSO for severe pelvic endometriosis that had not responded to medical and conservative surgical treatment. She attends for her follow-up appointment complaining of hot flushes and sweating. Which HRT regime should you consider?

17. Mrs., Lucy , A 33 year-old woman is diagnosed with chlamydia. .  As you are worried about her compliance about  her treatment  when u should ask her her to come for test of cure ?

18. Ms. sweetie, 30-year-old woman has been  coming with recurrent vulval itching and curvy white vagina discharge ,she has been treated couple of times for this . Examination image is enclosed

What treatment will you recommend for this patient?

19. Mrs. x, 19 year old  Ruby has presented with An often foul-smelling vaginal discharge  which is green. Complains of and itching. Complains of dysparuenia .Identify gram stained organism

20. A 55-year-old woman with early stage low grade endometrial cancer diagnosed on outpatient biopsy. She attends her pre-assessment appointment for her planned laparoscopic hysterectomy and bilateral salpingo- oophorectomy. She has hypertension, hyperlipidaemia, ischaemic heart disease and a BMI of 39. She smokes 25 cigarettes day. Which of the following statements is not correct? Choose the single best answer.  

21. Vulval cancers are relatively rare cancers with surgery as the main- stay of treatment. In recent years, a lot of emphasis has been given to sentinel node biopsy to decide management.  What is the role of sentinel node biopsy in the management of early vulval cancer?

22. Vulval cancers account for 6% of gynaecological cancers in the United Kingdom. In 2009, a new FIGO staging was introduced with greater emphasis on the inguino-femoral lymph node status to understand prognosis. What is the FIGO stage for a woman who has a 3cm vulval cancer involving the anus with metastases in 2 lymph nodes <5 mm?

23. What is the treatment of stage IA1 endometrial cancer

24. What is the treatment of stage 1 germ cell tumour

25. A 32-year-old woman is referred to the colposcopy clinic because of a suspicious looking cervix on speculum examination done because of heavy menstrual bleeding. She is diagnosed with cervical adenocarcinoma with depth of invasion of 2 mm and horizontal spread of 6 mm. What is the risk of lymph node invasion in her case?

26. Ms. Meena , A  16-year-old  patient  delivered  a  term infant  yesterday.itwas an unwanted preganncy , couldn’t terminate as she had crossed 28 weeks,so   She  is  placing  the  child  for  adoption  and  is not  going  to  breast-feed.  She  asks  for  something  to  suppress  lactation.  What  is  simplest  and  safest method  of  lactation  suppression?

27. Mrs. XY underwent a subtotal hysterectomy as treatment for heavy menstrual bleeding. What (approximate) percentage of women will have cyclical bleeding as a persistent symptom after a subtotal hysterectomy?

28. Maraim Ahmed / 35 year mutiparous lady with large intramural fibroid She is requesting for uterine artery embolisation ,  All the following criteria would be appropriate to accept her wish except

29. Mrs, X has undergone  salpingectomy  for bilateral  hydrosalphynx .What is the term pregnancy rate.she is going for IVF .she asks you after treatment what’s the live birth rate ?

30. 32year old   indian woman with BMI32 kg/m2 , with oligomenoorheoa and hirustism , on USg -she has bilateral polycystic ovaries. Her mother and sister do have similar complaints .all are true regarding inheritance of PCOS except

31. A 22-year-old  medical student  presents  with  a  request  for  contraception.  Her  menstrual cycle is  irregular  and  she complains  of  acne and  hirsutism.  Previous  investigation  has diagnosed  polycystic  ovary  syndrome (PCOS)

What is the estimated prevalence of this above syndrome in women with  polycystic ovary syndrome (PCOS)?

32. What is the mechanism of action of Metformin?

33. Mr, Stuart is 26year  old   Presented with features of sub-fertility with clinical  features in image enclosed ?

Identify the labelled image  corresponding karyotyping ?

34. What is the estimated prevalence of endometriosis in infertile women?

35. A 31-year-old lady presents with secondary subfertility. She had difficulty con- ceiving her first child and has now been trying for 4 years. She gives a history of cyclical premenstrual pain, painful periods and deep dyspareunia. Her day 21 progesterone is 38 nmol/L with normal levels of FSH and LH. What is the most likely cause?

36. The following sign in ultrasound  image given below is seen in

37. Mrs, Tessily 25 year old in her second pregnancy Her first delivery was induced as it was SGA baby delivered normally , baby’s weight 2000gm. She was booked in consultant unit , Her growth curve and Doppler study is enclosed

What’s the further management ?

38. Image shows which type of fetal abnormality ?

39. 32 year old  presented with vulval itching and soreness . It’s aggravated during her periods. It’s relieved during summer  On examination  Pitted nails noted  Skin lesions on scratching shows minute Haemorrhages  Thick red plaques with silvery  scales seen over vulva  Same lesions seen under breast  Pitted nails noted  Skin lesions on scratching shows minute Haemorrhages  Choose correct diagnosis

40. A 36-year-old woman has had a LETZ procedure for cervical glandular intraepithelial neoplasia (CGIN). The histopathology result showed negative margins. Six months later the repeat cervical smear is negative but the HPV test-of-cure is positive. What will be your next management?

41. A 45-year-old woman has had a total hysterectomy for abnormal uterine bleeding. The histopathology result shows positive margins for CIN1. What will be your further management?

42. A 32-year-old woman is referred to the colposcopy clinic because of a suspicious looking cervix on speculum examination done because of heavy menstrual bleeding. She is diagnosed with cervical adenocarcinoma with depth of invasion of 2 mm and horizontal spread of 6 mm. What is the risk of lymph node invasion in her case?

43. A 25-year-old smoker is diagnosed to have mild dyskariosis in her index smear at the GP surgery. The smear is HPV negative. What is the ideal management?

44. At the evening handover of a busy labour ward, you are informed that cord prolapse has been diagnosed after amniotomy by a consultant with the presenting part at –3station.   CTG, the baseline is 115 bpm with 10 bpm variability and one variable deceleration lasting less than 30 seconds over the last 10 minutes.now fetal heart rate is normal . The obstetric emergency theatre is currently being used for a manual removal of the placenta. What is the most appropriate management for this woman?

45. You are asked to repair a vaginal tear following a normal delivery. The mother’s weight is 50 kg. She is otherwise well with no allergies. What is the maximum dose of lidocaine 1% without epinephrine that you can use for perineal infiltration?

46. A 34-year-old multiparous woman presents at term with a breech presentation. Her CTG in labour is enclosed .What is true regarding CTG trace shown in image below ?

47. You are teaching your junior colleagues about labour interventions impacting CTG . Which of the following drugs can cause these changes

48.  A woman died in the second trimester as a result of multiple fatal injuries sustained in a road traffic accident two days before a planned social services parenting assessment. She was the driver and sole occupant of a car. She had a history of mental health problems and substance abuse. She underwent intensive resuscitation but died from her injuries. No local review of her care was carried out.

This death is classified as

49. A liveborn  baby  born  at 23 weeks gestational  with a birthweight of  1000gm  or  who died  after 7  completed days but before  28 completed  days after birth.  This death is classified as

50. 22years old Tina, has come with painful sex , difficulty  having sex.she has history of child hood abuse , after examination u conclude this is a case of primary vaginismus.You  advise her Vaginal dilators Vaginal dilators helps in relieving this reflex..