SBAs and EMQs for MRCOG II
Questions 1- 4
A. Amniocentesis
B. Fetal blood sampling
C. Chorionic villus sampling (CVS)
D. Maternal Doppler study
E. Fetal blood sampling
F. Fetal fibronectin
G. NT scan
H. Cervical length by TVS
I. Fetal ultrasound study
1. Consanguineous couple, now 11 weeks pregnant. G4 P2L1 A1 with one live child with
thalassaemia minor, one previous child who died of thalassaemia major and one termination of
pregnancy following fetal diagnosis.
ANSWER: C
Explanation: at 11 weeks gestation with a previous history of genetic syndrome, in this case
beta-thalassemia, autosomal recessive with a 25 % chance of recur- rence, a CVS would be
ideal. CVS can be done at 11 weeks to obtain fetal DNA—allows for earlier diagnosis and, if
results are unfavourable, gives the option of a first-trimester TOP.
2. Mrs. X, 34 years of age at 17 weeks’ gestation has a 1 in 16 risk of Down syndrome on the
quadruple test and wants to confirm fetal karyotype.
ANSWER : A
Explanation :Amniocentesis is a method of obtaining fetal cells from the amniotic fluid which can
then be cultured to obtain a fetal karyotype. It can be done after 15 weeks of gestation and in this
scenario is the ideal option to con- firm fetal karyotype as per the patient’s wish.
3. Mrs. Y, G3A2 previous two preterm births of AGA fetuses at 22–24 weeks gestation due to
cervical incompetence. Now 11 weeks pregnant.
ANSWER: H
Explanation: Women with a history of spontaneous second- trimester loss or preterm delivery
who have not undergone a history-indicated cerclage may be offered serial sonographic
surveillance, as there is evidence to suggest that those who experience cervical shortening are at
an increased risk of subsequent second-trimester loss/preterm birth and may benefit from
ultrasound- indicated cerclage, while those whose cervix remains long have a low risk of
second-trimester loss/premature delivery.
, 4. Mrs.Z, 32 years of age, 29 weeks pregnant, has an SGA fetus with reduced amniotic fluid. She is
perceiving reduced fetal movements since a day.
ANSWER: I
Explanation:Ultrasound scan assessment should be undertaken as part of the preliminary
investigations of a woman presenting with RFM after 28+0 weeks of gestation if the perception of
RFM persists despite a normal CTG or if there are any additional risk factors for FGR/stillbirth.
Questions 5-8
A. Maternal IV antibiotics
B. Fetal antibiotic therapy
C. Selective feticide
D. Fetoscopic laser coagulation of placental anastomotic vessels
E. Amniodrainage
F. Vesicoamniotic shunt
G. Fetal blood transfusion
H. LASER septostomy
I. Immediate delivery by LSCS
5. Mrs. A, a primary school teacher, 27 years of age, is 34 weeks pregnant. She contracted
parvovirus infection following an outbreak at her school 2 weeks back. Now the ultrasound scan
shows fetal hydrops.
ANSWER: G
Explanation : Fetal parvovirus infection is known to cause fetal anaemia and hence hydrops. Intrauterine
fetal blood transfusion will help correct the fetal anaemia and resolve the hydrops. As parvoviral infection
is generally self-limiting, the overall results of fetal blood transfusion are very good.
6. Mrs. B has monochorionic diamniotic twins(division would have happened around day 4-8) and is
now 24 weeks pregnant. The fetal scan shows excessive amniotic fluid with a large fetal urinary
bladder in one sac with almost no liquor and non-visualisation of fetal urinary bladder in the other
with a growth discrepancy of 35 % between the twins.
ANSWER: D.. i think cause got evidence of TTTS
Explanation: This is a case of severe twin to twin transfusion in an MCDA twin pregnancy. The ideal treat-
ment in this case is fetoscopic LASER photocoagulation of the anastomotic vessels. Severe twin–twin
transfusion syndrome presenting before 26 weeks of gestation should be treated by laser ablation rather
than by amnioreduction or septostomy.
, 7. Mrs. C has dichorionic diamniotic twins(not yet separate maybe day 1-3) with one anencephalic
fetus and a structurally normal co-twin. She is 22 weeks pregnant, and there is polyhydramnios in
the sac of the anencephalic fetus. The mother understands that anencephaly is a lethal anomaly
and wants to minimise the perinatal risks for the normal co-twin.
ANSWER:C (selective feticide)
8. Mrs. D has a singleton fetus diagnosed with an omphalocele. Fetal karyotyping was normal and
after conferring with the paediatric surgeon, she is planning for postnatal surgical correction of the
abdominal wall defect. She is now 29 weeks pregnant and has developed severe polyhydramnios
causing maternal respiratory discomfort.
ANSWER: E
explanation:Therapeutic amniocentesis (amnioreduction/amniodrain- age) has also been
proposed in singleton pregnancies to reduce maternal symp- toms, given by overdistension of the
uterus in severe and acute hydramnios. The reduction in maternal distressing symptoms is
significant.
QUESTIONS 9-12
A. Lichen sclerosus
B. Seborrhoeic dermatitis
C. Atopic vulvitis
D. Lichen simplex
E. Psoriasis
F. Herpes simplex
G. Behcet’s disease
H. Hidradenitis suppurativa
I. Paget’s disease
J. Tinea cruris
9. A 5-year-old girl presents with burning on micturition and vulvaI scratching. On examination the
vulva is noted to have a well-demarcated white area around the introitus. The overlying skin
appears thin with extensive fissuring. The perianal area is not involved.
ANSWER: A.
Explanation: Lichen sclerosus can occur in any age group. Skin in the whole genital region may be
affected, including the perianal area and genitocrural folds. The skin has well- demarcated whitening that
does not extend to the vaginal mucosa. Pruritus is a common associated symptom.
Questions 1- 4
A. Amniocentesis
B. Fetal blood sampling
C. Chorionic villus sampling (CVS)
D. Maternal Doppler study
E. Fetal blood sampling
F. Fetal fibronectin
G. NT scan
H. Cervical length by TVS
I. Fetal ultrasound study
1. Consanguineous couple, now 11 weeks pregnant. G4 P2L1 A1 with one live child with
thalassaemia minor, one previous child who died of thalassaemia major and one termination of
pregnancy following fetal diagnosis.
ANSWER: C
Explanation: at 11 weeks gestation with a previous history of genetic syndrome, in this case
beta-thalassemia, autosomal recessive with a 25 % chance of recur- rence, a CVS would be
ideal. CVS can be done at 11 weeks to obtain fetal DNA—allows for earlier diagnosis and, if
results are unfavourable, gives the option of a first-trimester TOP.
2. Mrs. X, 34 years of age at 17 weeks’ gestation has a 1 in 16 risk of Down syndrome on the
quadruple test and wants to confirm fetal karyotype.
ANSWER : A
Explanation :Amniocentesis is a method of obtaining fetal cells from the amniotic fluid which can
then be cultured to obtain a fetal karyotype. It can be done after 15 weeks of gestation and in this
scenario is the ideal option to con- firm fetal karyotype as per the patient’s wish.
3. Mrs. Y, G3A2 previous two preterm births of AGA fetuses at 22–24 weeks gestation due to
cervical incompetence. Now 11 weeks pregnant.
ANSWER: H
Explanation: Women with a history of spontaneous second- trimester loss or preterm delivery
who have not undergone a history-indicated cerclage may be offered serial sonographic
surveillance, as there is evidence to suggest that those who experience cervical shortening are at
an increased risk of subsequent second-trimester loss/preterm birth and may benefit from
ultrasound- indicated cerclage, while those whose cervix remains long have a low risk of
second-trimester loss/premature delivery.
, 4. Mrs.Z, 32 years of age, 29 weeks pregnant, has an SGA fetus with reduced amniotic fluid. She is
perceiving reduced fetal movements since a day.
ANSWER: I
Explanation:Ultrasound scan assessment should be undertaken as part of the preliminary
investigations of a woman presenting with RFM after 28+0 weeks of gestation if the perception of
RFM persists despite a normal CTG or if there are any additional risk factors for FGR/stillbirth.
Questions 5-8
A. Maternal IV antibiotics
B. Fetal antibiotic therapy
C. Selective feticide
D. Fetoscopic laser coagulation of placental anastomotic vessels
E. Amniodrainage
F. Vesicoamniotic shunt
G. Fetal blood transfusion
H. LASER septostomy
I. Immediate delivery by LSCS
5. Mrs. A, a primary school teacher, 27 years of age, is 34 weeks pregnant. She contracted
parvovirus infection following an outbreak at her school 2 weeks back. Now the ultrasound scan
shows fetal hydrops.
ANSWER: G
Explanation : Fetal parvovirus infection is known to cause fetal anaemia and hence hydrops. Intrauterine
fetal blood transfusion will help correct the fetal anaemia and resolve the hydrops. As parvoviral infection
is generally self-limiting, the overall results of fetal blood transfusion are very good.
6. Mrs. B has monochorionic diamniotic twins(division would have happened around day 4-8) and is
now 24 weeks pregnant. The fetal scan shows excessive amniotic fluid with a large fetal urinary
bladder in one sac with almost no liquor and non-visualisation of fetal urinary bladder in the other
with a growth discrepancy of 35 % between the twins.
ANSWER: D.. i think cause got evidence of TTTS
Explanation: This is a case of severe twin to twin transfusion in an MCDA twin pregnancy. The ideal treat-
ment in this case is fetoscopic LASER photocoagulation of the anastomotic vessels. Severe twin–twin
transfusion syndrome presenting before 26 weeks of gestation should be treated by laser ablation rather
than by amnioreduction or septostomy.
, 7. Mrs. C has dichorionic diamniotic twins(not yet separate maybe day 1-3) with one anencephalic
fetus and a structurally normal co-twin. She is 22 weeks pregnant, and there is polyhydramnios in
the sac of the anencephalic fetus. The mother understands that anencephaly is a lethal anomaly
and wants to minimise the perinatal risks for the normal co-twin.
ANSWER:C (selective feticide)
8. Mrs. D has a singleton fetus diagnosed with an omphalocele. Fetal karyotyping was normal and
after conferring with the paediatric surgeon, she is planning for postnatal surgical correction of the
abdominal wall defect. She is now 29 weeks pregnant and has developed severe polyhydramnios
causing maternal respiratory discomfort.
ANSWER: E
explanation:Therapeutic amniocentesis (amnioreduction/amniodrain- age) has also been
proposed in singleton pregnancies to reduce maternal symp- toms, given by overdistension of the
uterus in severe and acute hydramnios. The reduction in maternal distressing symptoms is
significant.
QUESTIONS 9-12
A. Lichen sclerosus
B. Seborrhoeic dermatitis
C. Atopic vulvitis
D. Lichen simplex
E. Psoriasis
F. Herpes simplex
G. Behcet’s disease
H. Hidradenitis suppurativa
I. Paget’s disease
J. Tinea cruris
9. A 5-year-old girl presents with burning on micturition and vulvaI scratching. On examination the
vulva is noted to have a well-demarcated white area around the introitus. The overlying skin
appears thin with extensive fissuring. The perianal area is not involved.
ANSWER: A.
Explanation: Lichen sclerosus can occur in any age group. Skin in the whole genital region may be
affected, including the perianal area and genitocrural folds. The skin has well- demarcated whitening that
does not extend to the vaginal mucosa. Pruritus is a common associated symptom.
