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MRCOG PART 2 SBAs and EMQs

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SBA 3

SBA 3 Posted by PAUL A.

Question 1

When measuring blood pressure, the cuff should be inflated to

(a)   200 mmHg

(b)   10-20 mmHg above systolic BP

(c)    20-30 mmHg above systolic BP                   

(d)   30-40 mmHg above systolic BP

(e)   At least 210 mmHg

 

Question 2

When measuring blood pressure

(a)   The cuff should be deflated at 2 mmHg per second and BP recorded to the nearest 2 mmHg      

(b)   The cuff should be deflated at 5 mmHg per second and BP recorded to the nearest 5 mmHg

(c)    The cuff should be deflated at 4 mmHg per second

(d)   BP should be recorded to the nearest 1 mmHg

(e)   BP should be recorded to the nearest 2, 4 or 5 mmHg depending on clinician preference

 

Question 3

Diastolic BP can be recorded using Korotkoff phase IV (K4) or V (K5).  In women with hypertension in pregnancy

 

(a)   Those managed with K4 have fewer episodes of severe hypertension

(b)   Those managed with K5 have as many episodes of severe hypertension as those managed with K4

(c)    The rate of adverse maternal outcome is higher in those managed with K5

(d)   The rate of adverse fetal outcome is higher in those managed with K4

(e)   The rate of adverse fetal outcome is not different in women managed with K4 compared to those managed with K5                     

 

Question 4

When measuring blood pressure manually, deflating the cuff too rapidly will result in

(a)   Over-estimation of systolic BP

(b)   Over-estimation of systolic and diastolic BP

(c)    Over-estimation of diastolic BP                                    

(d)   Under-estimation of diastolic BP

(e)   Under-estimation of systolic and diastolic BP

 

Question 5

Compared to mercury sphygmomanometers, aneroid devices

(a)   Require less frequent maintenance

(b)   Require less frequent calibration

(c)    Are not associated with threshold avoidance

(d)   Are less accurate

(e)   Are equally associated with observer bias                            

 

Question 6

Automated blood pressure measuring devices

(a)   Rely on Korotkoff phase IV for diastolic BP

(b)   Rely on Korotkoff phase V for diastolic BP

(c)    Determine BP by oscillometry                                       

(d)   Are associated with threshold avoidance

(e)   Are associated with observer bias

 

Question 7

Automated BP measuring devices tend to

(a)   Under-estimate systolic BP in pregnancy

(b)   Over-estimate systolic BP in women with pre-eclampsia

(c)    Under-estimate BP in women with pre-eclampsia                             

(d)   Over-estimate diastolic BP in obstetric haemorrhage

(e) Over-estimate systolic BP in obstetric haemorrhage

 

Question 8

Posterior reversible encephalopathy syndrome

(a)   Will only occur in women with chronic hypertension

(b)   Occurs at a higher systolic BP during pregnancy compared to outside pregnancy

(c)    Will not occur if mean arterial pressure is below 140 mmHg

(d)   Occurs at a lower systolic BP in pregnancy compared to outside pregnancy                         

(e)   Is associated with cerebro-vascular haemorrhage

 

Question 9

With respect to the use of mean arterial pressure in the management of hypertension in pregnancy

(a)   Mean arterial pressure should only be used in women wit pre-existing hypertension

(b)   Mean arterial pressure is a better indicator of outcome in women with chronic renal disease

(c)    Mean arterial pressure should not be used in the management of hypertension in pregnancy                                   

(d)   Mean arterial pressure should be used for women with systolic BP below 90 mmHg at booking

(e)   Mean arterial pressure should be used for women with a diastolic pressure below 40 mmHg at booking

 

Question 10

A 23 year old woman books for antenatal care at 16 weeks gestation. Her BP = 72/45 mmHg and there is no proteinuria. At 32 weeks gestation, BP = 112/70 mmHg and there is no proteinuria. She has no symptoms and is feeling good fetal movements.

(a)   A diagnosis of pregnancy induced hypertension should be made

(b)   A diagnosis of pregnancy-induced hypertension should be considered

(c)    The woman should continue with low-risk antenatal care                             

(d)   The woman should be referred to a consultant clinic for assessment

(e)   The woman is at increased risk of adverse pregnancy outcome

 

Question 11

A 34 year old woman is experiencing heavy vaginal bleeding following spontaneous vaginal birth. Estimated blood loss is 1500 ml.  Pulse = 140 / min and BP = 60/40 mmHg. Her shock index is

(a)   Red

(b)   2.3                                               

(c)    Amber

(d)   23

(e)   3.5

(f)     35

 

Question12

A 35 year old woman is admitted because of heavy vaginal bleeding. She is known to have a large fibroid uterus with a fibroid polyp. She also has a history of paranoid schizophrenia but lives independently with her husband and works in a supermarket. Over 10 days in hospital, she recieves 10 units of blood and 6 units of FFP to manage acute haemorrhage. She refuses to have surgery or interventional radiology. It is clear that she would die without intervention.

 

(a)  Do not undertake surgery or interventional radiology even if it means she would die                              

(b)  Detain the woman under the Mental Health Act and then undertake surgery or interventional radiology

(c)  Obtain consent from her husband and undertake surgery or interventional radiology

(d)  Perform surgery or interventional radiology in the woman’s best interest

(e)  Apply to the court for permission to treat the woman

 

Question13

 

A 35 year old woman is admitted because of heavy vaginal bleeding. She is known to have a large fibroid uterus with a fibroid polyp. She also has a history of paranoid schizophrenia and was an in-patient in the psychiatry ward until her transfer to the gynaecology ward. Over 10 days in hospital, she recieves 10 units of blood and 6 units of FFP to manage acute haemorrhage. She repeatedly refuses to have surgery or interventional radiology. She has been assessed to have capacity. Following a massive bleed, she suffers a cardiac arrest. Resuscitation is successful and she is intubated and admitted to the intensive care unit. Vaginal bleeding continues.

 

(a)  Perform surgery or interventional radiology in her best interest

(b)  Conclude that the woman no longer has capacity and treat her in her best interest

(c)  Apply to the courts to treat the woman in her best interest

(d)  Obtain consent from the woman’s next of kin and treat her as necessary

(e)  Do not undertake surgery or interventional radiology even if it means the woman dies              

 

Question14

A 20 year old woman has been admitted to the antenatal ward at 32 weeks gestation because of vasa previa. Caesarean section is recommended and the woman agreed to the procedure and signed the consent form. On the day of planned caesarean section at 34 weeks gestation, she has a panic attack because of needle phobia and refuses to have the operation.

 

(a)  Proceed with caesarean section based on the previously signed consent form

(b)  Proceed with caesarean section in the best interest of the baby and ultimately the woman

(c)  Apply to the court for permission to perform caesarean section against the woman’s wishes             

(d)  Respect the woman’s wishes not to have a caesarean section

(e)  Wait for an emergency such as fetal bradycardia or antepartum haemorrhage then perform a class 1 caesarean section

 

Question15

A 23 year old woman with a low risk pregnancy presents in spontaneous labour at 39 weeks gestation accompanied by her husband. Fetal heart rate abnormalities are identified at 7 cm dilatation and fetal blood sampling is performed. pH = 7.16 with base excess of -9.5. The woman had been given 10 mg of im diamorphine 30 minutes earlier and she appears drowsy and confused. She says she does not want to have a caesarean section.

 

(a)  Get her husband to sign the consent form and proceed with caesarean section

(b)  Undertake caesarean section as consent is not needed for a category 1 procedure

(c)  Apply to the court for permission to treat the woman against her will

(d)  Conclude that the woman has lost capacity and perform caesarean section in her best interest                     

(e)  Invoke the Mental Health Act and undertake caesarean section under Section II of the Act

 

Question16

 

A healthy 74 year old woman was admitted to the gynaecology ward with vaginal bleeding and abdominal distension. A diagnosis of stage 4 ovarian cancer is eventually made. The woman is being treated with blood transfusion and intravenous fluids. Her daughter is her next of kin and lives 2,000 miles away. She plans to visit in 7 days and requests all necessary treatment until she arrives. The 74 year old woman asks for blood transfusion and intravenous fluids to be stopped. She understands that she will die within a few days if treatment is discontinued.

 

(a)  Encourage the woman to continue treatment until her daughter arrives

(b)  Continue treatment in the woman’s best interest

(c)  Discontinue treatment in line with the woman’s wishes                    

(d)  Request review by a psychiatrist to assess the woman’s capacity

(e)  Discontinue treatment but re-start if the woman becomes drowsy and loses capacity

 

Question17

 

A healthy 37 year old woman attends the antenatal clinic at 36 weeks gestation. Her BP = 170/99 mmHg and there is 3+ proteinuria on urine analysis. Urine PCR = 234 mg/mmol. Growth scan shows estimated fetal weight on the 3rd centile with absent end-diastolic frequencies. Pre-eclampsia blood tests are normal. The woman refuses admission to hospital or induction of labour because she does not agree with intervention during pregnancy. She understands the risks associated with her decision.

 

(a)  Request assessment by a psychiatrist to ensure that the woman has capacity

(b)  Detain the woman under section II of the mental health act and treat her as necessary

(c)  Support the woman’s decision and plan for daily monitoring in the assessment unit                 

(d)  Accept the woman’s decision but refuse to see her again in your maternity unit

(e)  Make an application to the courts to sanction treatment in the best interest of the baby and ultimately the woman

 

Question18

 

A 47 year old woman has been admitted for total abdominal hysterectomy and bilateral salpingo-oophrectomy because of chronic pelvic pain and a large fibroid uterus. She has signed an advanced treatment directive declining all blood products. The operation is challenging secondary to dense intra-abdominal adhesions. Sub-total hysterectomy is performed but the woman is returned to theatre 6 hours later because of intra-abdominal bleeding. It is clear that transfusion of blood products is needed to save her life.

 

(a)  Transfuse blood products in her best interest and deal with the consequences later

(b)  Respect the woman’s wishes even if she dies                        

(c)  Apply to the courts for permission to administer blood products

(d)  Discuss the severity of the situation with her next of kin and obtain consent for treatment with blood products

(e)  Administer blood products because the woman no longer has capacity and is not in a position to change her decision

 

Question19

A 33 year old mother of 3 children has been admitted for total abdominal hysterectomy because of heavy menstrual bleeding and a large fibroid uterus. She requests bilateral salpingo-oophrectomy at the same time. You consider that this is not appropriate at her age. However, she insists on having salpingo-oophrectomy and states that she would not have surgery unless you agree to her request.

 

(a)  Explain and document the risks of bilateral salpingo-oophrectomy and perform the operation if she signs the consent form

(b)  Refuse to perform bilateral salpingo-oophrectomy                 

(c)  Offer to perform unilateral salpingo-oophrectomy as a compromise

(d)  Seek permission from the courts to perform hysterectomy without salpingo-oophrectomy

(e)  Include bilateral salpingo-oophrectomy on the consent form but only perform total abdominal hysterectomy

 

Question20

 

A 35 year old woman is undergoing total abdominal hysterectomy because of a large fibroid uterus. She is found to have a 7 cm simple left ovarian cyst. The right ovary appears normal.

 

(a)  Leave the ovarian cyst in-situ as there is no consent for cystectomy or oophorectomy                

(b)  Also perform a left salpingo-oophrectomy in the woman’s best interest

(c)  Also perform a left ovarian cystectomy in the woman’s best interest

(d)  Seek permission from the woman’s next of kin to perform an ovarian cystectomy or oophorectomy

(e)  Get a second opinion from another doctor and perform ovarian cystectomy or oophorectomy if you concur 

 

Question21

 

A 35 year old woman is undergoing total abdominal hysterectomy because of a large fibroid uterus. She is found to have a 7 cm complex left ovarian cyst and a 5 cm complex right ovarian cyst . There is no ascites and the rest of the abdominal cavity is normal.

 

(a)  Perform total abdominal hysterectomy, bilateral salpingo-oophrectomy and omentectomy

(b)  Perform total abdominal hysterectomy only and take peritoneal washings                        

(c)  Perform total abdominal hysterectomy and biopsy both ovaries

(d)  Perform total abdominal hysterectomy and bilateral ovarian cystectomies

(e)  Biopsy both ovaries for frozen section and then decide on most appropriate operation

 

 

1-b;2-a;3-e;4-d;5-a;6-b;7-c;8-b;9-c;10-b;11-a;12-e;13-c;14-d;15-e;16-d;17-c;18-b;19-a;20-a;21-c Posted by sarwat A.

1-b;2-a;3-e;4-d;5-a;6-b;7-c;8-b;9-c;10-b;11-a;12-e;13-c;14-d;15-e;16-d;17-c;18-b;19-a;20-a;21-c

SBA 3 Posted by anitha  Y.

1  c ; 2   a  ;     3  e  ;   4  c   ;5  e   ;  6  c   ;   7  c;   8  d  ;  9  c  ;  10  c  ;  11  b  ;  12  a  ;  13  e  ;  14  d  ;  15  c  ;  16  c  ; 17  c  ;  18  d  ; 19  a  ;  20  a  ;  21  b.

Answers Posted by PAUL A.

Answers

 

1)   C

2)   A

3)   E

4)   C

5)   E

6)   C

7)   C

8)   D

9)   C

10)                  C

11)                  B

12)                  A

13)                  E

14)                  C

15)                  D

16)                  C

17)                  C

18)                  B

19)                  B

20)                  A

21)                  B

Question 14 Posted by Stacey B.

Question 14

 

I am uncertain as to why you would apply to court to do her caesarean when there is no bleeding and no  compromise with mum or baby