Part 2 MRCOG Short Answer Questions March 2014

Question 1:
A 56-year-old nulliparous woman is referred to the urogynaecology
clinic with a history of urinary frequency every 30 minutes, urgency
and urge incontinence since her menopause three years ago. She
does not complain of stress incontinence or nocturia and has no
prolapse symptoms. She is not currently sexually active, has no past
medical history and is not taking any medication.
A. What features in the initial clinical assessment of this woman
would help with the differential diagnosis in her case? (14 marks)
B. Justify further investigations you might consider for this woman:
(6 marks)
Question 2:
A 46-year-old woman who weighs 170 kg is referred by her general
practitioner to the gynaecology clinic with continuous bleeding
unresponsive to medical treatment. The referral letter contains a
transvaginal scan report showing a normal size uterus with no
fibroids. Endometrial biopsy done in the outpatient clinic confirms
complex atypical hyperplasia and the oncology multi-disciplinary
team has decided that she should undergo abdominal total
hysterectomy and bilateral salpingo-oophorectomy.
Discuss strategies that could be adopted to minimise the risks and
difficulties associated with hysterectomy in a woman with morbid
obesity: (20 marks)
Question 3:
A midwife asks you to assess an antenatal patient admitted with
abdominal pain at 31 weeks of gestation. This woman has attended
hospital before with various problems during the pregnancy and
several people have noted bruising. The midwife is worried that the
woman is being assaulted by her partner but when questioned
previously, the woman has denied it.
A. Define domestic abuse and discuss its importance in relation to
pregnancy: (6 marks)
B. Describe features that would lead you to suspect domestic abuse
in antenatal patients: (6 marks)
C. Outline the risks to the fetus if she stays in an abusive
relationship: (4 marks)
When you discuss the bruises with her, she admits that "things at
home aren't easy at the moment" and that she is experiencing
violence. She declines advice and help to escape from the situation.
D. Discuss the reasons why women might stay in abusive
relationships: (4 marks)
Question 4:
In antenatal clinic you see a primigravid woman who has been
referred for an opinion regarding her recent full blood count (FBC)
results which were done at the general practitioners surgery a few
weeks ago. She is well when she attends at 37 weeks of gestation,
with a blood pressure of 110/70 mmHg

(110/75 at booking) and negative urinalysis. The platelet count

given on the referral letter is 82 x 10 9/L (normal range 150 400)
but all the other parameters on the FBC result are normal.
A. What information do you need from her history and medical notes
to aid diagnosis? (6 marks)
B. Describe your management plan at this stage of pregnancy: (6
marks)
She presents to hospital several days later with spontaneous rupture
of membranes and vaginal examination reveals that the cervix is 5
cm dilated. Her platelet count on admission is 55 x 109/litre.
C. Justify your management of this woman now she is in labour: (8
marks)