FCPS PART 2 – WRITTEN SELLABLES 500 MEGA MOCK – PAPER B

1. A woman with chronic essential hypertension was converted from Lisinopril to methyldopa in a preconception counselling clinic. The pregnancy was uncomplicated and she delivered spontaneously at term. At what stage postnatally should the antihypertensive medication be switched back to Lisinopril?

2. A 32-year-old woman primigravida who is 34 weeks pregnant attends the antenatal clinic complaining of severe itching. Serum bile acids are found to be elevated and she is diagnosed with obstetric cholestasis. What is the most effective medication to improve her itching?

3. What is the main contraindication to the use of antenatal corticosteroids?

4.An anaesthetist is asked to assist with the insertion of an intravenous cannula prior to the commencement of a Syntocinon infusion in labour. The cannula is inserted successfully, but shortly after it was flushed through as the woman starts to have convulsions and becomes hypotensive and bradycardic. The syringes on the trolley are unlabeled and the anaesthetist suspects he may have flushed the cannula with a local anaesthetic solution. What is the appropriate management of her collapse?

5.A 32-year-old woman with known HIV-1 infection is being seen in antenatal clinic in her first pregnancy. Her viral load is <50 copies/ml at 36 weeks gestation and she wishes to have further pregnancies in the future. What is the most significant intervention to reduce mother to child transmission?

6. Prior to the development of highly active antiretroviral therapy (HAART), elective caesarean section was the standard mode of delivery to reduce intrapartum mother to child transmission of HIV. At what viral load should caesarean section be considered with present HAART management?

7.With the present multidisciplinary management of HIV in pregnancy using HAART, what is the rate of mother to child transmission of HIV in the United Kingdom?

8.A woman who is HIV positive attends antenatal clinic at 36 weeks gestation. She has an uncomplicated pregnancy. At what plasma viral load could vaginal delivery be recommended?

9.A 29-year-old primigravida attends her booking visit at 12+2days. An ultrasound scan has confirmed a live fetus appropriate for the period of gestation. She is known to be HIV positive and is not in need of treatment for her own health, with a viral load of >35,000 copies/ml and is very keen for a vaginal delivery. What is the most appropriate intervention with regards to reducing the risk of neonatal transmission of HIV?

10. A 29-year-old gravida 2 para 1 is admitted with history of preterm prelabour rupture of membranes at 31+ 5 weeks gestation of 4 hours duration. She is a known HIV patient with a low viral load and had been commenced on HAART at 22 weeks. Her viral load at 28 weeks was <50 copies/ml. On admission, she is apyrexial, vital signs are within normal limits and the CTG is reassuring.What is the most appropriate immediate management with regard to delivery?

11.29-year-old gravida 2 para 1 is seen in an antenatal clinic at 37 weeks for the first time. She has transferred her booking from another region, where she had been diagnosed as HIV positive. Her viral load is 1000 copies/ml. She does not need treatment for her own health and was started on zidovudine monotherapy at the previous hospital. Her previous delivery was spontaneous vaginal delivery with no complications. What is the most appropriate management plan for delivery?

12. A young primigravida attends assessment unit at 32 weeks gestation following an assessment of raised blood pressure by the community midwife. Urine protein: creatinine ratio is 32 mg/mmol and her blood pressure is 152/102 mmHg. What is the most appropriate management plan?

13. A 39-year-old Type 2 diabetic of Asian origin presents with an acute onset of epigastric pain, chest pain and breathlessness at 30 weeks gestation. She is gravida 5 Para 4 (four normal vaginal deliveries), and has a BMI of 41 kg/m2. This was an unplanned pregnancy. Her diabetes is poorly controlled and her haemoglobin was 85 g/1 at 28 weeks. She is on oral iron and there is history of familial hyperlipidemia. What is the most likely working diagnosis for this mother?

14. A 32-year-old primigravida is admitted in spontaneous early labour at 39 + 2 weeks. She is a known asthmatic and has had repeated admissions in this pregnancy with acute exacerbations of asthma. The previous admission had been at 36 weeks gestation when she was commenced on oral prednisolone 7.5mg/day in view of persistent poor asthmatic control. What is the most appropriate intervention to maintain asthma control in labour?

15. A 31-year-old primigravida presents for booking at 10 weeks. She is known to be hypothyroid and is on Levothyroxine 75 μg. She is complaining of feeling tired and lethargic and her TSH is 6.5mU/ml. What would be the target TSH level at this gestation to indicate optimal control?

16. A 30-year-old woman is diagnosed with gestational diabetes following an oral glucose tolerance test (OGGT) at 26 weeks gestation in her first pregnancy. Her fasting blood glucose is 7.2 mmol/l. What is the appropriate management?

17.A 20-year-old woman with Type 1 diabetes presents at 32 weeks gestation in her first pregnancy with regular painful contractions, a closed cervix and a positive fetal fibronectin test. What is the most appropriate management plan?

18.A woman attends the peri mental health antenatal clinic at 8 weeks of gestation. She wishes to stop her lithium therapy with the support of her psychiatrist and seeks advice. What should be the recommended action after fully counselling the patient?

19.25-year-old woman presents at 12 weeks gestation. Four years earlier she presented with a deep vein thrombosis after fracturing her femur and undergoing a major orthopaedic operation. Her thrombophilia screen result is negative, she has no family history of thrombosis and she has a body mass index of 23 kg/m2. What thromboprophylaxis should be offered to this woman?

20. Ovarian hyperstimulation syndrome (OHSS): which of the following is not true

21. With regards to autosomal recessive inheritance which of the following is not correct:

22. A semen sample is said to be normal if:

23. With regards to luteinising hormone (LH) and follicle-stimulating hormone (FSH):

24. Clomiphene citrate:

25. With regards to hyper prolactinaemia:

26.A 45-year-old multigravida is referred to gynaecology clinic with large fibroids. Which one of the following would be a contraindication for uterine artery embolisation (UAE) in her case?

27.Which of the following statement is false about UAE ?

28. One of the following is a recognised cause of gynaecomastia:

29.Patient has an abnormal cervical smear and biopsy results are reported as high-grade cervical glandular intraepithelial neoplasia (CGIN). This patient is at increased risk of

30. 45-year-old woman with heavy menstrual bleeding had an endometrial Pipelle biopsy. The histology shows endometrial hyperplasia. To treat her appropriately the following need to be determined except for

31. A 46-year-old woman is referred to a menopausal clinic with severe vasomotor symptoms and low mood. She has a history of oestrogen-receptor-positive and progesterone-receptor-negative breast cancer which was treated with wide local excision and radiotherapy. She is currently on tamoxifen. What would you prescribe to treat her menopausal symptoms?

32. A 39-year-old woman is referred to gynaecology clinic by GP. She gives history of amenorrhoea for the past 6 months. She has two children delivered by caesarean section and regular periods prior to this. Her urine pregnancy test is negative. Her mother had premature menopause at the age of 30. The diagnosis in her case is based on

33. 44 year old p1 transvaginal scan reveals a hyper-echoic intracavitary shadow suggestive of an endometrial polyp. The size of the polyp was 16 mm in diameter. Hysterscopy guided polypectomy and endometrial biopsy has been don and indicated endometrial hyperplasia with atypia what would be the management

34. A 48-year-old para 3 with a history of heavy menstrual bleeding in association with infrequent cycles (every 2–3 months) for 1 year. Her BMI is 45kg/m2. The hysteroscopic biopsy suggests a proliferative endometrium. What would be treatment of choice

35.Which of the following procedure has highest risk of bowel injuries ?

36. Which of the following procedure has highest risk of haemorrhage?

37.A 22-year-old girl presents with lower abdominal pain, which is cyclical in nature. Which modality is the only way to reliably diagnose peritoneal endometriosis?

38.Which ONE of the following clinical scenarios is considered diagnostic of polycystic ovarian syndrome?

39.What is the recommended test for the biochemical detection of hyperandrogenism in women with PCOS?

40.Women with premature ovarian insufficiency are not at increased risk of:

41.Using high-risk HPV as the primary screening test is an attractive option for countries with existing cervical screening programmes. Compared to liquid-based cytology for detection of borderline changes or worse, HPV primary screening is:

42.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?

43. A 56year 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:

44.A 64-year-old para 4 is undergoing a vaginal hysterectomy for procidentia. At the end of the anterior vaginal wall closure the vaginal vault could be pulled to the introitus. What is the most appropriate next step to avoid vaginal vault prolapse?

45.A 60-year-old woman presents with vault prolapse. In treating post-hysterectomy vaginal vault prolapse, the operation with the highest success rate is

46.What is the role of sentinel node biopsy in the management of early vulval cancer?

47.A 33year old p1 has been recently diagnosed as a case of cervical cancer, Her biopsy report suspect tumour has Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 10 mm in diameter, she wish to preserve her fertility, what would be the best option for her

48. An 18-year-old nulliparous woman with a right ovarian mass has been diagnosed with a stage IA choriocarcinoma. Which is the most appropriate surgical treatment option?

49. A 68-year-old woman presents to the OPD with 2 weeks of bleeding. Her last period was at the age of 52 years. 2. She had a 2-week referral for gynaecology outpatient where she had a Pipelle biopsy. The results of the latter, ultrasound and CT scan confirm endometrial carcinoma confined to the endometrium with less than half of the myometrium invaded. She is understandably devastated but very keen to discuss management with you. Which one of the following is not the suitable option

50. A 65-year-old woman with a BMI of 40, early menarche, late menopause and Type 2 diabetes mellitus presents with postmenopausal bleeding. The exit cervical cytology was normal. She has previously had a cone biopsy and is known to have cervical stenosis. An ultrasound scan of her uterus reveals an endometrial thickness of 20 mm. Both pipelle biopsy in the clinic and general anesthesia hysteroscopy and biopsy were unsuccessful due to cervical stenosis. What further step would you discuss with the woman?