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Tonight we had the good fortune to have a tutorial from Claire Candelier, who has recently become a part II examiner.
She discussed a number of essays she had sent out a couple of weeks ago.
She spaced out the text so that the essays would print on both sides of an A4 sheet, like the exam.
So, you'll need to scroll down to see the whole list of questions.
MRCOG PART 2
Despite being advised not to travel to Ghana, a Caucasian woman, now 20 weeks pregnant, is planning a two-week holiday there in a month’s time.
What illness-avoidance advice would you offer her? (4 marks)
What other advice would you also offer her? (5 marks)
What chemoprophylaxis would you recommend against malaria? (3 marks)
One month after her return to England, she develops a flu-like illness with headaches, chills and a temperature. You suspect she has caught malaria. What are your initial investigations? (2 marks)
Plasmodium falciparum malaria has been confirmed. What is your management? (4 marks)
What are the fetal risks of maternal malaria? (2 marks)
MRCOG PART 2
A 24 year old woman attends her GP surgery. She is 14 weeks pregnant. She has had a pruritic, maculopapular rash for the past 16 hours. What is your diagnosis and your initial management? (2 marks)
What are the fetal risks associated with this maternal infection? (3 marks)
How would you manage the pregnancy antenatally? (2 marks)
MRCOG PART 2
A 25 year old woman attends antenatal clinic for booking at 12 weeks of gestation. She is known to be HIV positive and is on highly active anti-retroviral therapy (HAART). This is her first pregnancy.
What is your initial management plan, including investigations? (8 marks)
Following screening for Down syndrome, she wishes a diagnostic test as her risk is 1 in 50. What should be discussed with her before the amniocentesis?
(2 marks)
At 36 weeks of gestation, she is on HAART and her viral load is 20 copies per ml. What advice would you give her regarding mode of delivery? (2 marks)
At 38 weeks of gestation, she is admitted to hospital in labour. On admission, her cervix is 4cm dilated with intact membranes and the presentation is cephalic. Her wish is for a vaginal birth. What is your care plan for her labour and delivery? (4 marks)
What is your immediate care plan for her baby? (3 marks)
MRCOG PART 2
A 20 year old pregnant suffers from recurrent attacks of genital herpes during her pregnancy, at 16 weeks and at 28 weeks of gestation. She self-medicates with acyclovir. At 36 weeks of gestation, she is seen in the hospital antenatal clinic. She wants a vaginal delivery but is worried about infecting her baby with herpes. What would you advise her? (2 marks)
What are the transmission risks and the risks to the neonate? (2 marks)
MRCOG PART 2
A 35 year old teacher attends antenatal clinic. She is 16 weeks of gestation and has recently been in contact with a child with slapped cheek (parvovirus). She is very anxious. What would your initial management be? (2 marks)
The maternal B19 specific IgM level is raised with absent IgG. What is the significance of this result? (1 mark)
What are the fetal risks? (4 marks)
What is your management plan? (4 marks)
MRCOG PART 2
A woman is admitted with her breastfed baby to the postnatal ward 9 days after a home birth. Her GP has been treating her with co-amoxiclav for mastitis. Her symptoms are worsening with breast engorgement, cellulitis and worsening pain in her left breast. She has developed a swinging temperature and is now complaining of diarrhoea and vomiting.
What is your initial management? (5 marks)
Blood cultures have grown GAS (streptococcus pyogenes). What infection control measures should be in place to reduce the risk of transmission?
(4 marks)
What risks are there for her baby? What measures should be implemented?
(1 mark)
What are the indications for admission of this woman to an Intensive Care Unit? (5 marks)
MRCOG PART 2
A 28 year old woman attends the pregnancy counselling clinic. She is a Para 0+1 and is wishing to conceive. She is currently using condoms for contraception. Aged 12, she was diagnosed with type 1 diabetes and takes humalog mix 50. Her BMI is 24. There is a strong family history of hypertensive disorders.
What is your management? (marks 6)
This woman is seen after a reassuring dating scan at 12 weeks of gestation. What is your antenatal care plan? (marks 6)
At 30 weeks of gestation, she is admitted to the delivery suite with a 24 hour history of persistent vomiting. She has not been aware of fetal movements for the past 12 hours. On admission, she looks unwell, dehydrated, has a temperature of 38 degrees and ketonuria. A cardiotocograph records a fetal heart rate of 165 bpm baseline, with reduced variability for the past 30 minutes.
Explain your initial management plan. (marks 4)
She is reviewed in the antenatal clinic at 38 weeks of gestation. Her blood glucose profile is satisfactory. Fetal movements are normal. Serial ultrasound scans have shown a reassuring growth profile with an estimated fetal weight at 36 weeks of 3.2kg. The presentation is cephalic.
What is your care plan for mode and timing of delivery? (marks 3)
MRCOG PART 2
A Para 0+0 woman is seen in the antenatal clinic following her dating scan at 12 weeks of gestation. She suffers from epilepsy and takes lamotrigine 100mg per day. She has been fit-free for the past 12 months. Her GP has advised her to continue her anticonvulsant medication.
What antenatal care plan would you advise? (marks 3)
Are there increased risks to her pregnancy due to her epilepsy? What are the maternal and fetal complications? (marks 5)
What care plan for labour would you advise? (marks 4)
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