important to answer all of the questions even if you are unsure of the answer. It has been found that the first answer a participant chooses to an MCQ is often the correct one, so if uncertain do not alter your answers.

THE BOOK The questions in this second edition of the book are completely new and have been written in a similar format to the new style of examination questions. They are set out as six papers with obstetric and gynaecological questions mixed. We have tried to cover all the main topics and apologize for any omissions. Answers are provided at the back of the book (true answers only - in bold print) with brief explanations for the false answers. The reader is referred to the appropriate topics in Key Topics in Obstetrics and Gynaecology for further information. If that information is not available or supplementary reading is advised, references have been added. We have tried to ensure that the questions are accurate and unambiguous. Sometimes the more knowledge you obtain the more difficult it becomes to answer a question. Read the questions carefully but do not look for the hidden meanings - there are none. We take responsibility for all of the views expressed. By use of extensive references we hope to show you why we have decided on each answer. You may disagree with some of our thoughts. if so please write (or email) the publishers and let us know. The idea of these questions are to familiarize yourselves with the examination format, to stimulate thought and encourage you to read in greater depth those areas where you are uncertain. We would like to thank Charlotte, Tini and Gitasri for putting up with us over the last 6 months. We would like to thank Jonathan Ray at BIOS for his encouragement and Mr Roger Jackson, the Examination Secretary at the Royal College of Obstetricians and Gynaecologists for allowing us to reproduce the answer sheet. Finally, for those amongst you of nervous disposition, the only true answer for the specimen statements on induction of labour is number 4, the others are false. (Reference: Induction of labour. RCOG Guideline 16, July 1998). Good luck.

Andrew Pickersgill Apollo Meskhi

Sudipta Paul

X PREFACE

Royal College of Obstetricians and Gynaecologists Part 2 Membership Examination

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PREFACE xi

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xii PREFACE

PAPER ONE

Allow 2 hours for completion of this paper

Regarding early pregnancy loss

1. A woman presents for the second time with vaginal bleeding and lower abdominal pain, her cervix is closed. A scan 1 week previously noted an intrauterine gestation sac. On rescanning she is now found to have an empty uterus. She can be reassurred that she has suffered a complete miscarriage and needs no follow up

2. A woman presenting in early pregnancy with heavy vaginal bleeding, an open cervical os and an echogenic area in the uterine cavity should be told that she is having an inevitable abortion and needs an immediate uterine evacuation

3. An incomplete miscarriage differs from a complete miscarriage as judged by a closed cervical os in presence of heavy vaginal bleeding

4. A Rhesus negative woman presents with a complete miscarriage, the injection of anti-D is unnecessary

5. In a woman with a threatened miscarriage, if a scan shows a fetal heart the risk of a miscarriage is 30%

Raised maternal serum alpha-fetoprotein (MSAFP) concentrations are associated with the following fetal abnormalities

6. Polycystic kidney 7. Closed spina bifida 8. Gastroschisis 9. Congenital nephrosis (Finnish type)

10. Epidermolysis bullosa 1 I. Tay-Sachs disease 12. Teratoma 13. Duodenal atresia

Impotence mag be caused by

14. Sulphasalazine therapy 15. Chronic renal failure

PAPER ONE 1

Recognized causes of non-immune hydrops fetalis include

16. Renal agenesis 17. Duodenal atresia 18. Cystic adenomatous malformation 19. Cytomegalovirus infection

In a paper describing the use of a new drug for the treatment of hypertension in pregnancy you read: The mean fall in diastolic blood pressure in the treated group (n = 30) was 10 mmHg + / -3 (SD) and in the control group (n = 29) given placebo the mean fall was 4 mmHg + /-2.6 (SD). Using the t-test, p> 0.001. The following statements are correct:

20. Assuming a normal distribution, approximately 68% of the treated group would have shown a fall in the diastolic pressure of between 7 and 13 mmHg

21. The difference observed in the fall of blood pressure between the two groups did not reach a level of statistical significance

22. If the trial was properly conducted, the doctors involved should have known which patients were receiving the active drug and which the placebo

23. The most appropriate way to allocate patients to the drug and to the placebo group would have been to give the drug or placebo to alternate patients

24. It would be possible to calculate the value of x (Chi-squared) on the data given

With regard to hysterectomy

25. One in ten women in the UK will have a hysterectomy before becoming

26. Vaginal hysterectomy is performed four times more rarely than abdominal 27. Overall mortality is 4.1-14.6/10 000 hysterectomies 28. Overall morbidity is 500-1000/10 000 hysterectomies 29. Vault prolapse is a common complication of vaginal hysterectomy and can be

30. 3&40% of ovaries can be removed vaginally if desired 31. Vaginal hysterectomy is associated with an overall complication rate 40-50%

menopausal

prevented by suturing the utero-sacral ligaments together

less than for abdominal hysterectomy

The following drugs administered in pregnancy may have adverse effects on the newborn

32. Betablockers 33. Barbiturates 34. Magnesium sulphate 35. Naloxone hydrochloride

2 PAPER ONE

In the UK the following incidences are correct 36. Toxoplasmosis 37. Down's syndrome 38. Rhesus sensitization

2/ 1000 1.3/1000 15/1000

The following are not advantages of magnetic resonance imaging (MRI) in investigating cervical tumours

39. It is safe 40. It can be used in pregnancy 41. MRI demonstrates depth of stromal invasion (in up to 90% of cases) 42. It may show total tumour volume 43. MRI is superior to clinical staging and CT images

Ovarian cysts are relative contraindications to the use of

44. The combined pill 45. Depo-provera 46. Norplant

Prostaglandins

47. Are polypeptides 48. Hypertonus cannot be reversed by beta-mimetics 49. PGF2, is 20 times more potent than PGE2 in causing uterine contractions 50. PGE2 is five times more potent than PGF2, in ripening the cervix 51. PGF?, is commonly used in induction of labour 52. PGE2 is the drug of choice in refractory post-partum haemorrhage at Caesarean

section 53. Are diuretics

PAPER ONE 3