Infertil SPR PDF

Infertility / andrology / endocrinology EMQ-1
10 random questions for EMQ Test

Options for Questions 1-1
A
Prolactinoma
Pre-mature ovarian failure
Turners syndrome
Ovarian hyper-stimulation syndrome
Polycystic ovary syndrome
Hypothyroidism
Cushings syndrome
Congenital adrenal hyperplasia
Hypothalamic amenorrhoea
Hyperthyroidism
Androgen insensitivity syndrome
Pure gonadal dysgenesis
Instrunctions:For each of the case histories described below, choose the single most likely
cause of menstrual abnormalities from the above list. Each option may be used once, more than
once, or not at all.
Explanation
Question 1
A 36 year old woman and her 40 year old partner have been referred to
the fertility clinic because of a failure to conceive after 18 months of
unprotected intercourse. The semen analysis is normal. The woman
has irregular periods every 3-6 months but no other symptoms and her
E
BMI is 27. The woman?s results are as follows: FSH (day 3) =
6mIU/ml, LH (day 3) = 8mIU/ml, prolactin = 110 ng/ml, progesterone
(day 21) = 3ng/ml, testosterone = 4.0pg/ml, DHEA, DHEA-sulphate
and thyroid function tests were normal.

A
Prolactinoma
Turners syndrome
Hypothyroidism
Cushings syndrome
Hyperthyroidism
cause of menstrual abnormalities from the above list. Each option may be used once, more than
Explanation
Question 2
A 35 year old woman and her 40 year old partner have been referred to
the fertility clinic because of a failure to conceive after 3 years of
unprotected intercourse. The semen analysis is normal. The woman
B
has irregular periods every 3-6 months but no other symptoms and her
BMI is 27. The woman?s results are as follows: FSH (day 3) =
20mIU/ml, LH (day 3) = 8mIU/ml, prolactin = 110 ng/ml,
progesterone (day 21) = 1.5ng/ml, testosterone = 2.0pg/ml, DHEA,

DHEA-sulphate and thyroid function tests were normal.

A
Prolactinoma
Asherman?s syndrome
Hypothyroidism
Androgen secreting tumour
Cervical stenosis
Hyperthyroidism
cause of amenorrhoea from the above list. Each option may be used once, more than once, or not
at all.
Explanation
Question 3
A 25 year old woman and her 24 year old partner attend the fertility
clinic because of a failure to conceive after 2 years of unprotected
intercourse. The man?s semen analysis is normal. The woman
complains of absent menses over the last 2 years. On examination, her
B
height is 1.6m and BMI is 22 but there are no abnormalities. FSH =
35mIU/ml, LH = 12mIU/ml, prolactin = 22ng/ml, testosterone =
1.5pg/ml and thyroid function tests and pelvic ultrasound scan are
normal. Karyotype shows 46XX / 45XO.

A
In-vitro fertilisation
Intra-uterine insemination
Laparoscopy and dye test
Laparoscopic ovarian drilling
Clomephene citrate
Gonadotrophin induction of ovulation
Metformin
Carbegolline
Oocyte donation
Weight reduction
Weight gain
Measure serum androgen concentrations
Instrunctions:For each of the case histories described below, choose the single most appropriate
initial management from the above list. Each option may be used once, more than once, or not at
all.
Explanation
Question 4
A 24 year old woman with her 35 year old partner has been referred to
J
the infertility clinic because of 2 years of primary infertility. The
woman has an irregular menstrual cycle every 2-4 months and her
partner's semen analysis shows a volume of 2.5ml, concentration of
30,million/ml and motility of 65%. The woman?s BMI is 34 and there
is no significant past medical history. Investigations have confirmed a
diagnosis of polycystic ovary syndrome.
Question 5
partner?s semen analysis shows a volume of 3ml, concentration of
E

A
Clomephene citrate
Metformin
Carbegolline
Oocyte donation
Weight reduction
Weight gain
all.
Explanation
Question 6
woman has a regular 28 day cycle and her periods are heavy with
severe dysmenorrhoea. She also complains of deep dyspareunia and
C
intermittent lower abdominal and pelvic pain. Her BMI is 27.
Investigations have shown normal LH, FHS, Thyroid function tests,
prolactin and day 21 progesterone concentration confirms ovulatory
cycles. Her partner?s semen analysis is normal.

A
Clomephene citrate
Metformin
Carbegolline
Hystero-salpingogram
Weight reduction
Weight gain
all.
Explanation
Question 7
woman has a regular and normal 28 day cycle, her BMI is 26 and she
has no other symptoms. Investigations have shown normal LH =
B
7.5mIU/ml, FHS = 17mIU/ml, Thyroid function tests, prolactin and
day 21 progesterone concentration confirms ovulatory cycles. Her
partner?s semen analysis is normal. Hystero-salpingogram confirms
bilateral patent fallopian tubes.

A
FSH & LH concentration on days 2-5
Serum prolactin
Day 21 progesterone
Random serum oestradiol
Neonatal 17-hydroxy-progesterone
concentration
Pelvic ultrasound scan
Serum androgen concentrations
Progesterone challenge test
Dexamethasone suppression test
MRI scan of abdomen and pelvis
Karyotype
Random serum FSH concentration
investigation from the above list. Each option may be used once, more than once, or not at all.
Explanation
Question 8
An 38 year old woman has just had a forceps delivery and the neonate
has been found to have ambiguous external genitalia. Her medical
records show that she had amniocentesis at 18 weeks gestation
E
because of a high risk of Down?s syndrome on serum screening and
the fetus was found to have a 46XX karyotype.
Question 9
A 20 year old woman has been referred to the gynaecology clinic

because she has not had any menstrual periods for over 2 years. She
has no other symptoms. On examination, her height is 1.6m and BMI K
is 22. There was slight webbing of the neck, widely spaced nipples and
a wide carrying angle.

A
Cancel IVF cycle
Freeze embryos
Admit for iv fluids and

thromboprophylaxis
Termination of pregnancy
Transfer to ITU
Fluid restriction
Drain pleural effusion
Drain ascites
Drain ovarian cysts
Proceed with embryo replacement
Avoid unprotected sexual intercourse
Diuretics
management from the above list. Each option may be used once, more than once, or not at all.
Explanation
A 35 year old woman with PCOS is undergoing IVF treatment. She
attends for embryo replacement 6 days after HCG administration and
complains of abdominal distension and pain with nausea and vomiting
B
Question 10
2-3 times per day over the previous 48h. Clinical examination showed
a mildly distended abdomen and ultrasound scan confirmed bilateral
ovarian enlargement 8-10cm. All her blood tests were normal.
10 random questions for EMQ Test
A
Serial beta-HCG assay
Laparoscopy
Repeat trans-vaginal scan in 24h
Repeat trans-vaginal scan in 7 days
Counsel and discharge
Offer surgical evacuation of products of

conception
Offer medical treatment with

methotrexate
Laparotomy
Serum progesterone assay
Serum AFP assay
Refer to molar pregnancy centre
Refer to other specialty
Instrunctions:Instructions: For each patient described below choose the single most appropriate
initial management option from the list. Each option may be used once, more than once, or not at
all.
Explanation
Question 1
An asymptomatic 30 year old woman with a previous ectopic

pregnancy presents at 6 weeks amenorrhoea for trans-vaginal scan to
exclude a repeat ectopic pregnancy. Her pregnancy test had been
positive 2 weeks earlier. The scan is reported to show a 14mm
B
endometrium with no gestation sac. There is a 4cm cystic structure in
the right adnexum suggestive of an ectopic pregnancy but no free fluid
in the pouch of Douglas
Medical evacuation with misoprostol
Medical evacuation with mifepristone +

misoprostol
Suction evacuation without cervical

preparation
Suction evacuation with cervical

preparation
Dilatation and curettage
Medical evacuation with oxytocin

infusion
Medical evacuation with mifepristone +

H
oxytocin infusion
Administer iv oxytocin
Administer im ergometrine
Expedite suction evacuation
Blood transfusion
Administer im carboprost
Instrunctions:For each scenario described below, choose the single most appropriate
management from the above list of options. Each option may be used once, more than once, or
not at all.
Explanation
Question 2
A healthy 23 year old woman is on the gynaecological ward awaiting

treatment for a complete molar pregnancy at 7 weeks gestation. You
are called to see her because she is bleeding heavily. Pulse = 100/min,
BP = 110/80.

A
Chest X-ray
V/Q scan
Lung perfusion scan
Lung ventilation scan
CTPA
Pulmonary angiography
ECG
Lower limb Doppler ultrasound scan
Arterial blood gases
D-dimers
Spirometry
Lower limb venogram
Instrunctions:For each of the scenarios below, select the single most appropriate subsequent
investigation from the above list. Each option may be used once, more than once, or not at all.
Explanation
Question 3
A healthy 32 year old woman presents at 34 weeks gestation with

sudden onset shortness of breadth and pleuritic chest pain. She has a
pulse of 110 / min, BP 120/80 and SO2 = 95% on air. She is
administered a therapeutic dose of low molecular weight heparin.
E
Chest X-ray and lower limb Dopplers are normal. Following
counselling, the woman prefers the investigation that exposes her fetus
to the lowest level of radiation.

A
Prolactinoma
Asherman?s syndrome
Hypothyroidism
Cervical stenosis
Hyperthyroidism
at all.
Explanation
Question 4
A 25 year old woman and her 24 year old partner attend the fertility
clinic because of a failure to conceive after 2 years of unprotected
intercourse. The man?s semen analysis is normal. The woman
complains of absent menses over the last 2 years. On examination, her
B
height is 1.6m and BMI is 22 but there are no abnormalities. FSH =
35mIU/ml, LH = 12mIU/ml, prolactin = 22ng/ml, testosterone =
1.5pg/ml and thyroid function tests and pelvic ultrasound scan are
normal. Karyotype shows 46XX / 45XO.

A
Prolactinoma
Asherman?s syndrome
Hypothyroidism
Cervical stenosis
Hyperthyroidism
at all.
Explanation
Question 5
An 18 year virgin has been referred to the gynaecology clinic because

she has not started menstruating but she has no other symptoms.
Clinical examination showed that her height was 1.67m with BMI of
23. She had normally formed breasts but no axillary or pubic hair.
There was a 2-3cm mass palpable in each inguinal canal.

A
Clomephene citrate
Metformin
Carbegolline
Oocyte donation
Weight reduction
Weight gain
all.
Explanation
Question 6
partner's semen analysis shows a volume of 2.5ml, concentration of
J

A
Intravenous labetalol
Immediate delivery by caesarean section
Intravenous magnesium sulphate
Measure serum aspartate transaminase

immediately
Measure serum magnesium
Blood transfusion
Immediate induction of labour
Provide a fluid challenge with colloids
Antihypertensive treatment
Administer iv phenytoin
Measure 24h urine protein excretion
Place in left lateral position
Instrunctions:For each patient described below choose the single most appropriate management
option from the list. Each option may be used once, more than once, or not at all.
Explanation
Question 7
A 20-year-old primigravida has an emergency caesarean section at 30

weeks gestation because of severe gestational proteinuric hypertension
and IUGR. Her FBC, LFTs and U&E pre-op were within normal
limits. 12 hours after delivery, investigations show that her serum
C
lactate dehydrogenase concentration is markedly elevated, serum
aspartate transaminase concentration is 224 iu/l, platelet count is 80 x
10E9 /l and her renal function is normal. Her BP is 140/90 on oral
anti-hypertensive therapy and her urine out-put is 80ml/h.

A
Intravenous labetalol
Immediate delivery by caesarean section
Intravenous magnesium sulphate
Measure serum aspartate transaminase

immediately
Measure FBC and clotting profile
Blood transfusion
Provide a fluid challenge with colloids
Antihypertensive treatment
Administer iv phenytoin
Arrange in-utero transfer to tertiary

centre
Explanation
Question 8
A 30 year old primigravida attends as an emergency at 32 weeks

gestation with a twin pregnancy and complains of 12h of severe
vomiting and upper abdominal pain. Her BP is 130/80mmHg with a
trace of proteinuria. A growth scan one week earlier had shown
normal fetal growth. Investigations show a serum aspartate
transaminase concentration of 600iu/l, alkaline phosphatase =
1550iu/l, serum uric acid = 0.57mmol/l and serum creatinine =
130micromol/l. FBC and coagulation profile are normal.

A
Induction of labour
Discharge home
Community midwife follow-up
Anti-hypertensive therapy
Caesarean section at 39 weeks
Manage as out-patient with day

assessment unit
External cephalic version
Induction of labour at 40 weeks
Induction of labour at 42 weeks
Explanation
Question 9
A 35 year old primigravida is an in-patient because of hypertension

and 1+ proteinuria on stix testing at 37 weeks gestation. Her BP is
130/80mmHg on oral methyldopa and all her blood tests are within
normal limits. 24h urine protein excretion is 200mg/24h.

A
Stage I cervical cancer
Stage Ia cervical cancer
Stage I endometrial cancer
Stage Ib endometrial cancer
Stage II cervical cancer
Stage IIb cervical cancer
Stage IIa cervical cancer
Stage IV endometrial cancer
Stage IV cervical cancer
Stage Ib cervical cancer
Stage IVa cervical cancer
Stage IIIb cervical cancer
Instrunctions:For each scenario described below, choose the single most appropriate tumour
stage from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
An 87 year old woman has been referred to the gynaecology clinic
because of a 7 day history of frank haematuria. A fungating lesion is
Question 10
identified on her cervix and histology confirms a squamous cell
carcinoma. Cystoscopy shows invasion of the bladder mucosa

A
Counsel and offer termination of

pregnancy
Counsel and offer rubella immune

globulin
Treat with intravenous zidovudine
Counsel and offer intra-uterine therapy
Offer amniocentesis for karyotype
Reassurance
Immunise neonate against rubella
Immunise mother against rubella
Treat with intravenous acyclovir
Amniocentesis and viral culture
Amniocentesis and PCR for fetal

viraemia
not at all.
Explanation
A 20 year old student has been immunised against Rubella 2 weeks
before travelling to the UK. She attends as an emergency because she
Question 11 has missed a period and is found to be 10 weeks pregnant on
ultrasound scan. She is concerned about the effect of the vaccine on
her fetus

A
Avoid breast-feeding
Administer VZIG to neonate and avoid

breast-feeding
Administer VZIG to neonate but breastD

feeding encouraged
Delay delivery with tocolytics
Offer termination of pregnancy
Treat neonate with oral acyclovir
Treat neonate with intravenous

acyclovir
Examine neonate for evidence of

congenital anomalies
Reassurance
Delay delivery for 5-7 days if possible
Delay discharge for at least 7 days
not at all.
Explanation
A 30 year old woman has delivered her second child by caesarean
section for breech presentation. While she is in hospital, she is
Question 12
informed that her 5 year old daughter has chickenpox. She has had
chicken pox in the past but is concerned about taking her baby home

A
Stage I cervical cancer
Stage Ia cervical cancer
Stage I endometrial cancer
Stage Ib endometrial cancer
Stage II cervical cancer
Stage IIb cervical cancer
Stage IIa cervical cancer
Stage IV endometrial cancer
Stage IV cervical cancer
Stage Ib cervical cancer
Stage IVa cervical cancer
Stage IIIb cervical cancer
Instrunctions:For each scenario described below, choose the single most appropriate tumour
stage from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
A 67 year old woman is referred to the gynaecology clinic with a 6
weeks history of post-menopausal bleeding. Clinical examination
Question 13 shows a fungating lesion on the cervix extending into the lower third
of the vagina. On rectal examination, the tumour extends to the pelvic
side-wall.

A
Amniotic fluid embolism
Placental abruption
Cardiomyopathy
Placenta praevia
Chest infection
Pulmonary embolism
CVA
Pulmonary hypertension
Endocarditis
Sepsis
Haemorrhage
Substance misuse
M HELLP syndrome
Thromboembolism
Myocardial infarcation
Instrunctions:For each case described below, choose the single most likely cause of maternal
death from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
A 30 year old woman is re-admitted 3 days after spontaneous vaginal
delivery complaining of feeling generally unwell and having rigors.
She has a history of rheumatic fever and intravenous drug abuse.
Question 14
Clinical examination showed a temperature of 39C, bulky uterus with
offensive vaginal discharge and a new ejection systolic murmur. She
suffered a stroke 24h later and died.

A
Administer H1N1 vaccine
Transfer to the intensive care unit
Deliver by caesarean section
Induce labour
Administer oseltamivir
Administer zanamivir
Avoid contact with partner
Transfer neonate to the neonatal

intensive care unit
Administer HINI vaccine to the neonate J
Take swabs for H1N1
Sputum for culture and sensitivity
Administer oseltamivir within 48 hours
M Administer zanamivir within 48 hours
Administer zanamivir within 36 hours
not at all.
Explanation
An H1N1 influenza pandemic has been declared and a 35 year old
woman presents with a 24 hour history of flu-like illness with
Question 15 diarrhoea and vomiting. Her temperature is 38.5C, pulse 90 / min and
respiratory rate is 20 / min. SO2 is 96% on air. She had a vaginal
delivery 3 days earlier and is breastfeeding.
Congenital syphilis
Congenital varicella syndrome
Parvovirus B19 infection
Turner?s syndrome
Parder-Willy syndrome
Fetal hydantoin syndrome
Group B streptococcal infection
Congenital rubella syndrome
Cri-du-chat syndrome
Edward?s syndrome
Patau?s syndrome
Down?s syndrome
cause of fetal abnormality from the above list of options. Each option may be used once, more
than once, or not at all.
Explanation
A 42 year old epileptic on phenytoin is late booking for antenatal care.
The estimated gestation age by ultrasound scan is 22 weeks and the
Question 16
L
fetus is found to have an atrio-ventricular septal defect and a double
bubble sign in the upper abdomen

A
Quadruple test
Integrated test
Nuchal transluscency
Serum integrated test
Triple test
Anomaly scan
Fluorescent in-situ hybridisation
Amniocentesis
Chorionic villus sampling
PCR
No investigation
Fetal blood sampling
Instrunctions:For each of the case histories described below, choose the single most important
investigation from the above list of options. Each option may be used once, more than once, or
not at all.
Explanation
Question 17
A 30 year old woman is found to have a fetus with duodenal atresia on

H
anomaly scan at 20 weeks gestation

A
Amniocentesis
Triple test
Quadruple test
Integrated test
Anomaly scan
PCR
Restriction fragment length

polymorphisms
not at all.
Explanation
A 30 year old woman is known to be a carrier of Haemophilia A.
Question 18 Amniocentesis at 16 weeks gestation shows that she is carrying an
unaffected male fetus. She is now 20 weeks pregnant.

A
Triple test
Quadruple test
Integrated test
Amniocentesis
Anomaly scan
PCR
Restriction fragment length

polymorphisms
M Karyotype
Instrunctions:For each of the conditions described below, choose the single most appropriate
diagnostic tests from the above list of options. Each option may be used once, more than once, or
not at all.
Explanation
Question 19 Down?s syndrome

A
Cystoscopy and cystodistension
Bladder re-training
Tension-free vaginal tape
Anterior repair + TVT
Posterior repair
Paravaginal repair
Para-urethral collagen injection
Tolterodine + bladder re-training
Pelvic floor physiotherapy
Duloxetine
Amitriptyline
Oestrogen replacement therapy
treatment option from the above list of options. Each option may be used once, more than once,
or not at all.
Explanation
A 30 year old woman presents 6 months after spontaneous vaginal
delivery with urinary leakage on coughing and straining. Clinical
Question 20
examination was normal and urinary leakage was not demonstrated
with coughing.

A
Cystoscopy & cystodistension
Cystoscopy
Urine microscopy, culture and

sensitivity
Cystometry
Pelvic ultrasound scan
Colposuspension
Bladder retraining
Three swab test
Intra-venous urogram
Return to theatre
Catheterise
Pelvic floor exercises
initial management from the above list of options. Each option may be used once, more than
Explanation
A 45 year old woman complains of feeling wet all the time 10 days
after a radical hysterectomy for cervical cancer. Clinical examination
Question 21 showed a small amount of clear fluid in the vagina but no other
abnormalities. A three swab test showed a wet swab which was not
stained with dye.

A
Cystoscopy
MRI scan
Urodynamic studies
Bladder re-training
Urine for cytology
Cystoscopy and biopsy
Examination under anaesthesia
MSU for culture and sensitivity
Urine electrolytes
Renal function tests
Instrunctions:For each of the case histories described below, choose the single most important
not at all.
Explanation
A 45 year old woman complained initially of urinary frequency
urgency and urge incontinence and also leaked urine on coughing or
straining. She was treated medically initially and her symptoms of
Question 22
urinary frequency and urgency have largely resolved. Over the last 6
months, she is finding that urinary leakage on coughing and straining
is increasingly affecting her social life.

A
Rhesus disease
Parvovirus infection
Beta thalassaemia
Sickle cell disease
Syphilis infection
Congenital heart disease
Idiopathic
Congenital diaphragmatic hernia
Twin-to-twin transfusion syndrome
Congenital toxoplasmosis
Alpha thalassaemia
Chronic feto-maternal haemorrhage
cause of fetal hydrops from the above list of options. Each option may be used once, more than
Explanation
A 24 year old woman with beta thalassaemia trait is referred for
growth scan at 30 weeks gestation in her first pregnancy and is found
Question 23 to have a hydropic fetus. She is Rhesus negative with no red cell
antibodies. Her partner has beta thalassaemia trait and all other
investigations are normal

A
Induction of labour
Termination of pregnancy
Selective fetocide by intra-cardiac KCl

injection
Selective fetocide by cord occlusion
Laser ablation of placental anastomoses
Septostomy
Amnioreduction
Serial ultrasound scans
Detailed fetal cardiac scan
No treatment recommended
Corticosteroids for fetal lung maturity
not at all.
Explanation
A 35 year old woman with twin-to-twin transfusion syndrome has
been treated at the fetal medicine unit and both pregnancies are
Question 24
progressing well. Corticosteroids had been administered at 30 weeks
gestation and she has attended for ultrasound scan at 32 weeks.

A
No additional intervention at this stage
Increase dose of oxytocin
Lovset?s manoeuvre
Decrease dose of oxytocin
Forceps delivery
Delivery of the posterior arm
Episiotomy
Inhaled salbutamol
McRobert?s manoeuvre
Administer maternal facial oxygen
management from the above list. Each option may be used once, more than once, or not at all.
Explanation
A 34 year old woman with 3 previous vaginal deliveries presents in
spontaneous labour at 39 weeks gestation. The cervix is fully dilated
with thick meconium stained liquor. The CTG shows a base-line fetal
Question 25 heart rate of 135bpm with variability of 3-4bpm with variable
G
decelerations. There are 3-4 uterine contractions every 10 minutes.
The fetus is in a direct occipito-anterior position 1cm below the ischial
spines.

Add COCP containing second
generation progestogen for up to 3
months
Add COCP containing third generation

progestogen for up to 3 months
Add progesterone-only pill for 3 months D
Give next dose of depomedroxyprogesterone acetate 4 weeks

earlier
Tranexamic acid during bleeding
Use progestogen-only implant
Add 30mcg ethinyloestradiol daily for 3

H
months
Stop depo-medroxyprogesterone acetate
Administer another dose of depomedroxyprogesterone acetate
Add desogestrel-only pill
Add COCP for 1 week
Mefenamic acid 500mg 2-3 times / day

for 3 months
not at all
Explanation
A healthy 28 year old woman complains of irregular vaginal bleeding
Question 26 3 weeks after her first dose of depo-medroxyprogesterone acetate.
History and clinical examination are normal

A
Maternal androgen therapy
Down?s syndrome
Turner?s syndrome
Maternal diabetes mellitus
Maternal lithium therapy
Maternal warfarin therapy
Maternal heparin therapy
Group B streptococcus infection
Maternal anti-epileptic drug therapy
Maternal smoking
Maternal cocaine abuse
cause of neonatal collapse from the above list of options. Each option may be used once, more
Explanation
Question 27 A 3 hour old neonate weighing 4900g at birth

A
Down?s syndrome
Turner?s syndrome
Maternal smoking
Explanation
Question 28 A 6 hour old neonate with ambiguous genitalia

A
Down?s syndrome
Turner?s syndrome
Maternal smoking
Explanation
A 6 hour old neonate delivered by rotational forceps delivery for
prolonged second stage of labour. Initial examination showed
Question 29
C
epicanthic folds with up-slanting palpebral fissures and a loud systolic
murmur

A
Can be delivered in a midwifery-led unit B
Can have a home birth
Should deliver in a consultant-led unit
Should have venous access in the

second stage of labour
Should have an anaesthetist at ST3 level

F
or above available
Should have an obstetrician at ST3 level

or above available
Consultant obstetrician should be

immediately available
Consultant anaesthetist should be

immediately available
Should have an anaesthetist at ST6 level

J
or above available
Should be delivered in a tertiary centre
Should have venous access in the third

stage of labour
Should have blood cross-matched

during labour
Instrunctions:For each scenario described below, choose the single most appropriate plan for
labour from the above list of options. Each option may be used once, more than once, or not at
all.
Explanation
A 35 year old woman has attended the consultant antenatal clinic at 36
Question 30 weeks gestation to discuss her birth plan. Her BMI was 42 at booking I
and 45 at 36 weeks. Her pregnancy is otherwise uncomplicated

A
Produces visible light
Produces light which can be transmitted

through fibre optic systems
Is not absorbed by pigmented tissue
Produces tissue damage to a depth of 0.2

mm
Produces tissue damage to a depth of

0.02 mm
Cannot be transmitted through clear

fluids
Requires a series of articulated mirrors

for transmission
Is not suitable for tissue coagulation
Produces ultra violet light
Is no longer recommended for use in

surgical procedures
Instrunctions:For the statement below, select the single most appropriate option from the above
list of options. Each option may be used once, more than once, or not at all.
Explanation
Question 31 The Nd:YAG laser

A
No further treatment
Adjuvant chemotherapy
External beam radiotherapy
Intracavitary radiotherapy
Intra-peritomeal chemotherapy
TAH + unilateral salpingo-oophrectomy
Unilateral salpingo-oophrectomy
Monthly pelvic ultrasound scans
Monthly pelvic ultrasound scans +

tumour markers
Ovarian stimulation + IVF
TAH
not at all.
Explanation
A 37 year old woman with a complex ovarian mass had a staging
laparotomy with unilateral salpingo-oophrectomy to conserver
fertility. Peritoneal washings, the omentum and peritoneal biopsies are
Question 32 negative. There is a poorly differentiated clear cell adenocarcinoma
B
confined to the ovary and the ovarian capsule is not invaded. There is
invasion of lymphovascular space. Biopsies from the conserved ovary
and lymph nodes are normal.

A
Total abdominal hysterectomy
Repeat colposcopy in 6 weeks
Repeat colposcopy in 6 months
Laser ablation
Cryotherapy
Laser cone biopsy
Radical abdominal hysterectomy
Radical abdominal hysterectomy +

pelvic lymphadenectomy

external beam radiotherapy

pelvic lymphadenectomy + external
beam radiotherapy
Total abdominal hysterectomy +

bilateral salpingo-oophrectomy
not at all.
Explanation
A 42 year old mother of 5 children is found to have severe dyskaryosis
Question 33 on routine cervical smear. Colposcopy and biopsy confirms carcinoma A
in-situ.

A
Repeat colposcopy in 6 weeks
LLETZ
Cold knife cone biopsy
Radical hysterectomy + pelvic

lymphadenectomy
Intracavitary + external beam

radiotherapy
Combined chemo-radiotherapy
Total abdominal hysterectomy + BSO
Cryotherapy
Cold knife cone biopsy + laparoscopic

not at all.
Explanation
A 32 year old mother of 4 children has a cervical smear showing
Question 34 severe dyskaryosis. Colposcopy identifies a 3 x 4 mm lesion on the
ectocervix. Punch biopsy confirms a squamous cell carcinoma with
depth of invasion of 1.5mm. There is no invasion of the lymphovascular space. The woman has completed her family.

A

lymphadenectomy + chemotherapy

lymphadenectomy + radiotherapy
Chemotherapy + intracavitary and

external beam radiotherapy
Chemotherapy
Radical hysterectomy + para-aortic

lymphadenectomy
Palliative care
not at all.
Explanation
A healthy 60 year old woman presents with a 6 months history of postcoital bleeding. Clinical examination identifies a 3cm ulcerated lesion
on the cervix extending into the upper third of the vagina. Biopsy
Question 35
G
confirms squamous cell carcinoma. MRI scan confirms that the
tumour is limited to the upper third of the vagina and there is
parametrial invasion. The pelvic side-wall is not involved.

A
Cerazette (desogestrel) progestogenonly pill
Noriday (norethisterone) progestogenonly pill
Norgeston (Levonorgestrel)
Progestogen-only pill
Combined oral contraceptive pill
Depo-medroxyprogesterone acetate
Depo- Norethisterone oenanthate
Copper IUCD
Levonorgestrel IUS
Etonorgestrel implant
Male condom
Levonorgestrel post-coital contraception L
All options may be used
Instrunctions:For each scenario described below, choose the contraceptive option that should
not be used (UKMEC category 3 or 4) from the above list of options. Each option may be used
once, more than once, or not at all.
Explanation
A 23 year old woman has undergone termination of an unwanted

Question 36 pregnancy at 12 weeks gestation. She gives a history of migraine
without aura. Her BMI is 25 kg/m2 and she is a non-smoker.
A 33 year old woman has undergone termination of an unwanted

pregnancy at 18 weeks. She has a history of suicidal depressive illness
Question 37
L
that is currently well controlled with anti-depressants. Her BMI is 22
kg/m2 and she is a non-smoker.

A
Total abdominal hysterectomy + BSO +

D

omentectomy

F
para-aortic lymphadenectomy
Total laparoscopic hysterectomy + BSO
Intracavitary + external beam

radiotherapy

J
radiotherapy

chemotherapy

L
combined chemo-radiotherapy
Radical abdominal hysterectomy + BSO
Radical abdominal hysterectomy + BSO

+ pelvic lymphadenectomy
Instrunctions:For each scenario described below, choose the appropriate treatment option that is
associated with the lowest risk of morbidity from the above list of options. Each option may be
used once, more than once, or not at all.
Explanation
A healthy 67 year old woman has been referred to the gynaecology
oncology clinic with a 3 months history of post-menopausal bleeding.
Endometrial biopsy shows a well differentiated endometrial
Question 38
carcinoma. MRI scanning shows that the tumour is confined to the
inner 50% of the myometrium but extends to the endocervical glands.
There is no invasion of the cervical stroma

A
Perform amniotomy
Reassess in 2 hours
Reassess in 3 hours
Reassess in 4 hours
Commence CTG and reassess in 2 hours
Commence CTG and reassess in 3 hours H
Commence CTG and reassess in 4 hours
Perform amniotomy and commence
Commence oxytocin infusion
CTG
K
Commence oxytocin infusion and CTG
Administer vaginal prostaglandin tablets

3mg
M No additional intervention
not at all.
Explanation
A 34 year old woman with a dichorionic-diamniotic twin pregnancy
presents in spontaneous labour at 37 weeks gestation. At 08:00, the
Question 39
cervix is 4cm dilated with intact membranes. At 12:00, the cervix is
5cm dilated with intact membranes. She is contracting 3-4 in 10.
A healthy 39 year old woman presents with pre-labour rupture of the

membranes at 39 weeks gestation. Re re-attends 8 hours later in
Question 40 spontaneous labour and the cervix is 6cm dilated with a direct
occipito-posterior position. Four hour later, the cervix is 7cm dilated
with a left occipito-transverse position.

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Infertility / andrology / endocrinology EMQ-1

10 random questions for EMQ Test

Pre-mature ovarian failure

Ovarian hyper-stimulation syndrome

Polycystic ovary syndrome

Congenital adrenal hyperplasia

Androgen insensitivity syndrome

Pure gonadal dysgenesis

Options for Questions 2-2

Pre-mature ovarian failure

Ovarian hyper-stimulation syndrome

Polycystic ovary syndrome

Congenital adrenal hyperplasia

Androgen insensitivity syndrome

Pure gonadal dysgenesis

Infertility / andrology / endocrinology EMQ-2

progesterone (day 21) = 1.5ng/ml, testosterone = 2.0pg/ml, DHEA,

Options for Questions 3-3

Pre-mature ovarian failure

Ovarian hyper-stimulation syndrome

Polycystic ovary syndrome

Androgen secreting tumour

Androgen insensitivity syndrome

Pure gonadal dysgenesis

Options for Questions 4-5

Laparoscopy and dye test

Laparoscopic ovarian drilling

Gonadotrophin induction of ovulation

Measure serum androgen concentrations

Infertility / andrology / endocrinology EMQ-3

Options for Questions 6-6

Laparoscopy and dye test

Laparoscopic ovarian drilling

Gonadotrophin induction of ovulation

Measure serum androgen concentrations

Options for Questions 7-7

Laparoscopy and dye test

Laparoscopic ovarian drilling

Gonadotrophin induction of ovulation

Infertility / andrology / endocrinology EMQ-4

Measure serum androgen concentrations

Options for Questions 8-9

FSH & LH concentration on days 2-5

Random serum oestradiol

Pelvic ultrasound scan

Serum androgen concentrations

Progesterone challenge test

Dexamethasone suppression test

MRI scan of abdomen and pelvis

Random serum FSH concentration

A 20 year old woman has been referred to the gynaecology clinic

Options for Questions 10-10

Cancel IVF cycle

Infertility / andrology / endocrinology EMQ-5

Admit for iv fluids and

Drain pleural effusion

Drain ovarian cysts

Proceed with embryo replacement

Avoid unprotected sexual intercourse

Serial beta-HCG assay

Repeat trans-vaginal scan in 24h

Repeat trans-vaginal scan in 7 days

Counsel and discharge