Practice Single Best Answer Questions: MRCOG Part-II Seema Sharma, Neelanjana Mukhopadhaya, Rabia Mushtaq
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1Practice Single Best Answer Questions MRCOG Part-II2
3Practice Single Best Answer Questions MRCOG Part-II
Author Neelanjana Mukhopadhaya MBBS DGO FICOG PGcert (Med Edu) FRCOG Consultant Obstetrician and Gynaecologist Clinical Director for Gynaecology Undergraduate Lead for Obstetrics and Gynaecology Luton and Dunstable University Hospital United Kingdom Convenor for International MRCOG Part 1 Courses Member of Assessment subcommittee Royal College of Obstetricians and Gynaecologists London, United Kingdom Co-authors Seema Sharma MBBS DGO MD FMAS MRCOG Dip advanced infertility management Consultant Obstetrician and Gynaecologist Nominated Member—MTP Advisory Committee, Government of India Director of Srishti Health Care Centre New Delhi, India Rabia Mushtaq FCPS MRCOG Specialist Registrar in Obstetrics and Gynaecology Luton and Dunstable University Hospital London, United Kingdom Foreword Sir Sabaratnam Arulkumaran
4
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Practice Single Best Answer Questions: MRCOG Part-II
First Edition: 2015
9789351527411
Printed at:
5Dedicated to
My late father who has always encouraged, motivated and inspired me. 6
7Foreword
Medicine, Biomedical Sciences, Health and Social Care Science
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Sir Sabaratnam Arulkumaran DSc PhD FRCS FRCOG
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“Practice makes the act perfect” is a common phrase; perfection increases with more practice. Neela and her colleagues Seema Sharma and Rabia Mushtaq have authored an excellent practice SBA questions and answers book for candidates who wish to appear for the part II MRCOG examination. It is a timely edition as the Royal College of Obstetricians and Gynaecologists (RCOG) have just introduced the SBAs instead of the traditional MCQs. Even if one reads a textbook many times it is difficult to remember all the facts and figures and to recall them especially in an examination setting. By practising questions and answers one's mind tends to focus on the essentials or core issues. The answers may differ based on where one gets the facts. The authors have made reference to the RCOG green top guidelines or scientific opinion papers for answers given to every question—this makes this book highly evidence based. The questions are based on clinical scenarios making it more relevant to our daily practice and easy to remember.
The eight chapters are neatly arranged into areas of Obstetrics and Gynaecology. Answering the questions in the first eight chapters will reveal to the candidate, the area of their weakness in knowledge and promote further reading in that area. Chapter 8 is specifically designed to practice a SBA paper in examination settings and would help one to time their speed with which they need to complete a paper. Answers with the source of information provide additional useful information for further reading.
Continuous reading to acquire knowledge is essential and answering the SBAs sharpens that knowledge and helps one to pass the examination. I would highly recommend the book for those appearing for the exam and to the others practising Obstetrics and Gynaecology. For those appearing for the exam—Good luck and best wishes.
Sir Sabaratnam Arulkumaran
30’Th December 20148
9Preface
The Royal College of Obstetrics and Gynaecology is constantly reviewing the style of questions in its membership examinations to ensure that the reliability and validity of the examination is of the highest standard.
The single best answer (SBA) style of question is widely accepted by Royal Colleges and boards globally as the best tool for assessing basic scientific knowledge and clinical application. From March 2015, MRCOG 2 will have two papers of 50 SBAs and 50 EMQ type questions.
I have tried to cover almost all the RCOG and NICE guidelines and written questions based on them. The answers have been explained and the source of information provided. In this way, I have signposted you to the relevant educational materials—mainly guidelines. As most of the examination questions will be sourced from these materials, I encourage you to read them in detail.
While all the questions in this book are SBAs, not all topics in gynaecology lend themselves to such an approach. These questions test your knowledge thoroughly, but may not all necessarily appear as SBAs in the examination.
There are over 200 questions arranged in eight topics—specific chapters that cover obstetrics and gynaecology. The eighth chapter is a sample question paper consisting of 50 questions.
This book will give you a clear idea of the examination style and assist you in the overall preparation for the entire examination.
I wish you the best of luck with your examinations and medical careers.
Neelanjana Mukhopadhaya10
11Acknowledgements 15Abbreviations AC:
Abdominal Circumference
APH:
Antepartum Haemorrhage
ART:
Artificial Reproductive Technology
A&E:
Accident and Emergency
AFP:
Alpha fetoprotein
ASRM:
American Society of Reproductive Medicine
APTT:
Activated Partial Thromboplastin Time
BJOG:
British Journal of Obstetricians and Gynaecologists
BMI:
Body Mass Index
BP:
Blood Pressure
BHCG:
Beta-Human Chorionic Gonadotrophin
CT:
Computed tomography
CRL:
Crown Rump Length
CHC:
Communicable Disease Control
COC:
Combined Oral contraception
CIN:
Cervical Intraepithelial Neo­plasia
CVS:
Chorionic Villus Sampling
CRP:
C-reactive Protein
CS:
Caesarean Section
CTG:
Computerised Tocography
CMV:
Cytomegalovirus
CMW:
Community Midwife
DCDA:
Di-chorionic di-amniotic
DVT:
Deep Vein Thrombosis
DV:
Ductus Venosus
FGM:
Female Genital Mutation
FHR:
Fetal Heart Rate
FBC:
Full Blood Count
FSH:
Follicle Stimulating Hormone
FVS:
Fetal Varicella Syndrome
GTT:
Glucose Tolerance Test
GBS:
Group B Streptococci
GAS:
Group A Streptococci
HELLP:
Haemolysis, Elevated Liver Enzymes, Low Platelets
HPV:
Human Papilloma Virus
HB:
Haemoglobin
HAART:
Highly Active Anti-Retroviral Therapy
HSV:
Herpes Simplex Virus
HCG:
Human Chorionic Gonadotrophin
IAP:
Intrapartum Antibiotics
IUD:
Intrauterine Device
IBS:
Irritable Bowel Syndrome
IVF:
In Vitro Fertilisation
ICSI:
Intracytoplasmic Sperm Injection
IUI:
Intrauterine Insemination
IV:
Intravenous
LN:
Lymph Node
LNG-IUS:
Levonorgestrel- Intrauterine system
LMWH:
Low Molecular Weight Heparin
LFT:
Liver Function Test
MCQ:
Multiple Choice Question
MPS:
Maternal Plasma Screening
MCA:
Middle Cerebral Artery
MC:
Monochorionic
MGSO4:
Magnesium Sulphate
MDT:
Multi-disciplinary Meeting
MCV:
Mean Corpuscular Volume
MCHC:
Mean Corpuscular Haemoglobin Concentration
MRI:
Magnetic Resonance Imaging
MOM:
Mean of Median
NHS:
National Health Service
NT:
Nuchal Translucency
NSAIDs:
Nonsteroidal Anti-Inflammatory Drugs
OA:
Occipito-Antetrior 16
PCOS:
Polycystic Ovarian Disease
POP:
Progesterone Only Pill
PPH:
Postpartum Haemorrhage
PGE2:
Prostaglandin E2
PPROM:
Prelabour Preterm Rupture of Membranes
PE:
Pulmonary Embolism
PCR:
Protein Creatinine ratio
RMI:
Risk of Malignancy Index
STI:
Sexually Transmitted disease
SLE:
Systemic Lupus Erythematosus
SFH:
Symphysio-Fundal Height
TORCH:
Toxoplasma, Rubella, Cytomegalovirus, Herpes simplex
UAE:
Uterine Artery Embolisation
US:
Ultrasound
VBAC:
Vaginal Birth after Caesarean Section
VZIG:
Varicella Zoster Immunoglobulin
VEGF:
Vascular Endothelial Growth Factor
17Introduction; Why Single Best Answer?
MRCOG part 2 is a well-structured examination, standardised to the cur­riculum within the United Kingdom, attempted by doctors training in Obstetrics and Gynaecology worldwide. The RCOG reviews the examination pattern at regular intervals so that the most valid, relevant and reliable method of assessment of knowledge is used. More recently the SBA technique has gained popularity as an assessment tool at all levels of undergraduate and postgraduate examinations in medicine.
Why SBA?
The single best answer format of question is:
How are the questions structured?
All the questions are aligned with the RCOG blueprinting which allows mapping of the questions to specific learning outcomes and ensures adequate coverage of the topics. The question style sets a clinical or scientific problem. This may be a patient history, signs and symptoms or physical examination findings, results of tests or a diagnosis. The “lead in” statement then poses a question. There are five choices most of which are correct but one of them will be the best answer in the given scenario. Hence, it is very important to read the question carefully.
For example: Read this question carefully.
A woman attending the preconception clinic for counselling has a history of congenital atrial septal defect. She would like to know the overall risks of her baby developing congenital heart disease.
What is her risk?
(a) 1%
(b) 3-6%
(c) 8-12%
(d) 15%
(e) 20%
18How to answer? Remember that one of the answers is the best; others may be correct too.
Cover test: All or most questions must pass the cover test. This means if you were to cover the answer options you should still be able to answer the question based on your knowledge and understanding of the clinical scenario.
Source of information for the above question: Handbook of Obstetric Medicine, Catherine Nelson-Piercy (heart disease: genetic counselling)
In the above question, the woman has a personal history of ASD. Overall risk of the fetus developing a congenital heart disease if the mother or father have congenital heart disease is 2-5%. This is double that of the general population. But the fetus tends to develop the same lesion if affected. Mothers who have ASD have a risk of 5-10% of their fetus developing ASD. 18-20% of fetuses will develop aortic stenosis (AS) if the mother has AS.
Hence in the above question, option b is the best answer.
Marking scheme: Full marks are awarded if you answer correctly. If you mark two options or do not mark the options at all you do not receive marks. There is no negative marking. If you make a wild guess you are only about 20% likely to get the correct answer compared with 50% for a true or false MCQ question. Therefore, you are unlikely to answer the questions correctly unless you have understood the answer such that you could use it in daily practice.
Syllabus and curriculum: There are two papers with 50 questions each to answer. The curriculum is blueprinted and freely available on the RCOG website. You are advised to read all the green top guidelines, scientific impact papers, clinical governance and patient information documents. The TOG articles and BJOG articles are also important sources of information to cover certain topics in obstetrics and gynaecology.