21 May 2018
1
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How to prepare. What to read. Revision system.
Study buddies. Statistics. Urogynae.
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2
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SBA. RCOG sample obstetric questions. Go through all of them as they feature in the exam and make for easy
marks.
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3
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EMQ. Cystic fibrosis.
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4
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SBA. Placenta accreta, increta & percreta.
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5
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SBA. Cowden syndrome
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6
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EMQ. Clue
cells, koilocytes etc.
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7
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Basic communication skills.
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1. How to prepare.
I have written to Julie Morris and
Kapil Kaur asking if they can give tutorials on statistics and uro-gynae
respectively. Both are excellent teachers. The problem is the short time-scale
until the exam.
2. RCOG sample questions.
These can be found on the RCOG website:
https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-2-mrcog/format/part-2-mrcog-sbas-single-best-answer-questions/.
3. Cystic fibrosis. There is no option list so you have to behave in a model
fashion and decide the correct answer without assistance.
Question 1.
A woman is 8 weeks pregnant
and known to be a carrier of cystic fibrosis.
Her husband is Caucasian.
What is the risk of the child
having cystic fibrosis?
Question 2.
A healthy woman attends for
pre-pregnancy counselling.
Her brother has cystic
fibrosis. Her husband is Caucasian.
He has been screened for
cystic fibrosis. The test was negative.
What is the approximate risk
of them having a child with cystic fibrosis?
Question 3.
A healthy woman is a known
carrier of cystic fibrosis.
She attends for pre-pregnancy
counselling. Her husband has cystic fibrosis.
What is the risk of them
having a child with CF?
Question 4.
A healthy woman
attends for pre-pregnancy counselling. Her sister has had a child with cystic
fibrosis.
What is her risk
of being a carrier?
Question 5.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk that she is a
carrier?
Question 6.
A woman attends for
pre-pregnancy counselling. Her mother has cystic fibrosis.
The partner’s risk of being a
carrier is 1 in X.
What is the risk that she will
have a child with CF?
Question 7.
A healthy Caucasian woman is
10 weeks pregnant.
Her husband is a known carrier
of cystic fibrosis.
Which test would you arrange?
Question 8.
A woman attends for
pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from
maternal blood. Is it possible to test for CF in this way?
Question 9.
A woman and her husband are
known carriers of cystic fibrosis.
What is the risk of them
having an affected child?
Question 10.
A woman and her husband are
known carriers of cystic fibrosis.
What can they do to reduce the
risk of having an affected child?
Question 11.
A woman and her husband are
known carriers of cystic fibrosis.
Can CVS exclude an affected
pregnancy?
Question 12.
A woman with cystic fibrosis
is planning pregnancy. Her husband is a carrier of cystic fibrosis. What is the
risk of having an affected child?
Question 13.
A woman with cystic fibrosis
has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised
not to breastfeed because her breast milk will be protein-deficient due to
malabsorption.
Is this advice correct?
Question 14.
A woman with cystic fibrosis
has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised
not to breastfeed because her breast milk will contain abnormally low levels of
sodium.
Is this advice correct?
4. Placenta accreta increta & percreta
This topic
has been chosen to remind you of the existence of UKOSS and the various Reports
it has produced as they would make perfect EMQs or SBAs.
Abbreviations.
Creta: term
to describe accreta, increta or percreta.
PET: pre-eclampsia
PIH: pregnancy-induced
hypertension
Question 1.
Lead-in
Choose the
best option from the option list for the definition of placenta accreta.
Option List
A.
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Placenta which is difficult to remove, but can be
separated digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 2.
Lead-in
Choose the
best option from the option list for the definition of placenta increta.
Option List
A.
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Placenta is difficult to remove, but can be separated
digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 3.
Lead-in
Choose the
best option from the option list for the definition of placenta percreta.
Option List
A.
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Placenta is difficult to remove, but can be separated
digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
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E.
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Placental villi
invade adjacent organs, e.g. the bladder
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Question 4.
Lead-in
What is
the approximate incidence of placenta creta in the UK?
Option List
A.
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1-2 per 1,000
deliveries
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B.
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1-2 per 1,000
maternities
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C.
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1-2 per 5,000
deliveries
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D.
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1-2 per 5,000 maternities
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E.
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1-2 per 10,000 deliveries
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F.
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1-2 per 10,000 maternities
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Question 5.
You need
to be able to define “maternity” and know why it is important.
Lead-in
What is a
“maternity”?
Option List
A.
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Any pregnancy, including ectopic pregnancy
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B.
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Any pregnancy, excluding ectopic pregnancy
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C.
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Any pregnancy resulting in a live birth
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D.
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Any pregnancy resulting in live birth or stillbirth
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E.
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Any pregnancy ending from 24 completed weeks plus any
pregnancy resulting in a live birth.
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Question 6.
Lead-in
Why is the
term “maternity” important.
Option List
A.
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We should take best possible care of our pregnant
patients
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B.
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It is used as the denominator in calculations of the
maternal mortality rate
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C.
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It is used as the numerator in calculations of the
maternal mortality rate
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D.
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It is used as the denominator in calculations of the
maternal mortality ratio
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E.
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It is used as the numerator in calculations of the
maternal mortality ratio
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Question 7.
This
question relates to risk factors for placenta accreta
Lead-in
Match each
of the risk factors listed below with an
adjusted odds ratio from the Option List. Each option can be used once, more
than once or not at all.
Note that
some of the adjusted odds ratios show a reduced risk.
Risk factors and adjusted odds
ratio.
Risk factor
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Adjusted odds ratio
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BMI > 30
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Cigarette smoking in pregnancy
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Ethnic group non-white
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IVF pregnancy
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Maternal age > 35
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Parity ≥ 2
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PIH or PET
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Placenta previa diagnosed pre-delivery
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Previous Caesarean section > 1
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Previous Caesarean section x 1
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Previous uterine surgery – not C. section
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Option List
Adjusted odds ratio
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0.53
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0.57
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0.66
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0.9
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1.0
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2.0
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3.06
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3.4
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3.48
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10
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14
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16.31
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32.13
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65.02
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102
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Question 8.
Lead-in
This
question relates to estimated incidence of placenta creta for various risk
factors.
Match the
risk factors with the estimated incidence in the option list. Each option can
be used once, more than once or not at all.
Risk factors and estimated
incidence per 10,000 maternities.
Risk factor
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Estimated incidence
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No previous C section
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≥ 1 C section
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Placenta previa not diagnosed pre-delivery
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Placenta previa diagnosed pre-delivery
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Previous C section but placenta previa not
diagnosed pre-delivery
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Previous C section + placenta previa diagnosed
pre-delivery
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Option List
0.3
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0.6
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1
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3
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5
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9
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108
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577
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1,000
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5. Cowden syndrome.
Scenario 1.
Lead in.
Which
feature is associated with Cowden syndrome?
Option list.
A. albinism
B. hamartoma
C. hammer-toe
D. hypertrichosis
E. stammer
Scenario 2.
Lead in. Which condition has the highest risk
of occurrence in women with Cs?
Option list.
A. breast
cancer
B. bowel
cancer
C. congenital
absence of Müllerian tract derivatives
D. hypertension
E. hypothyroidism
Scenario 3.
Lead in. Which gynaecological cancer is a
particular risk for women with Cs?
Option list.
A. Bartholin’s
gland cancer
B. cervical
cancer
C. choriocarcinoma
D. endometrial
cancer
E. vulval
cancer
Scenario 4.
Lead in. Which cancer is more common in men
with Cs?
Option list.
A. breast
cancer
B. colon
cancer
C. melanoma
D. renal
cancer
E. thyroid
cancer
F. all
of the above
6. Clue cells
Lead-in.
The following scenarios relate to genital infection.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
Ct: Chlamydia trachomatis
HSV: Herpes simplex virus
LGV: lymphogranuloma venereum
Ng: Neisseria gonorrhoeae
Tv: Trichomonas vaginalis
Option list.
A
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Actinomyces
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B
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Bacterial vaginosis
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C
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Bacteroides
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D
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Chlamydia trachomatis
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E
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Chlamydial infection of the genital tract
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F
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Herpes Simplex
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G
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Human Papilloma Virus
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H
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Lymphogranuloma venereum
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I
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Monilia
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J
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Neisseria gonorrhoeae
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K
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Trichomonas vaginalis
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Scenario
1.
Which option or options from
the option list best fit with “clue cells”
Scenario
2.
Which
option or options from the option list best fit with “fishy odour”?
Scenario
3.
Which
option or options from the option list best fit with “flagellate organisms”?
Scenario
4.
Which
option or options from the option list best fit with “inflammatory smear”?
Scenario
5.
Which
option or options from the option list best fit with “koilocytes”?
Scenario
6.
Which
option or options from the option list best fit with “non-specific urethritis
in the male”?
Scenario
7.
Which
option or options from the option list best fit with “strawberry cervix”?
Scenario
8.
Which
option or options from the option list best fit with “thin grey/ white
discharge”?
Scenario
9.
Which
option or options from the option list best fit with “white, curdy discharge”?
Scenario
10.
Which
option or options from the option list best fit with “frothy yellow discharge”?
Scenario
11.
Which option or options from the option list best fit
with “protozoan”?
Scenario
12.
Which option or options from the option list best fit
with “obligate intracellular organism”?
Scenario
13.
Which option or options from the option list best fit
with “blindness”?
Scenario
14.
Which option or options from the option list best fit
with “LGV”?
Scenario
15.
Which option or options from the option list best fit
with “multinucleated cells”?
Scenario
16.
Which option or options from the option list best fit
with “serotypes D–K”?
Scenario
17.
Which option or options from the option list best fit
with “serovars L1-L3”?
Scenario
18.
Which of the following are true in relation to Amsel’s
criteria?
A
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used for the diagnosis of
bacterial vaginosis
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B
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used for the diagnosis of
trichomonal infection
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C
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clue cells present on
microscopy of wet preparation of vaginal fluid
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D
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flagellate organism present
on microscopic examination of vaginal fluid
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E
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pH ≤ 4.5
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F
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pH > 4.5
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G
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thin, grey-white, homogeneous
discharge present
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H
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frothy, yellow-green
discharge present
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I
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fishy smell on adding alkali
(10%KOH)
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J
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fishy smell on adding acid
(10%HCl)
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K
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koilocytes present
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L
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absence of vulvo-vaginal
irritation
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Scenario
19.
Which of the following are true in relation to Nugent’s
Amsel’s criteria?
A
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used for the diagnosis of
bacterial vaginosis
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B
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used for the diagnosis of
trichomonal infection
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C
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clue cells present on
microscopy of wet preparation of vaginal fluid
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D
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pH ≤ 4.5
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E
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pH > 4.5
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F
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count of lactobacilli
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G
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count of Gardnerella and
Bacteroides
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H
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count of white cells
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Scenario
20.
Garnerella vaginallis can be cultured from the vagina of
what proportion of normal women?
A
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< 10%
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B
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11 - 20%
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C
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21 - 30%
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D
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31 - 40%
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E
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41 - 50%
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F
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> 50%
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7. Basic communication
skills.
Now is the time to start practising
communication skills, which are so important in the Part 3 exam. There is
advice on my website: http://www.drcog-mrcog.info/MRCOG.htm.
Click on the header ‘Topics like CNST and communication”. You have a lot of
things to get polished before the exam – you don’t want to be trying to explain
recessive inheritance for the 1st. time in front of an examiner!
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