MRCOGManchester: August 2025

Tuesday, 26 August 2025

MRCOG tutorial 28th. August 2025

21 August 2025. Role-players: 1.

Role-players: 2.

27	Role-play.
28	Role-play.
29	EMQ. Hepatitis B
30	SBA. Kisspeptin

27. Role-play 1. Candidate’s instructions will be e-mailed shortly before the tutorial.

28. Role-play 1. Candidate’s instructions will be e-mailed shortly before the tutorial.

29. Topic. Hepatitis B and pregnancy.

Abbreviations.

GDM: gestational diabetes mellitus.

HBeAg: hepatitis B e antigen

HBsAg: hepatitis B surface antigen

HBcAb: antibody to hepatitis B core antigen

HBsAb: antibody to hepatitis B surface antigen

HBIG: hepatitis B immunoglobulin

Question 1. Is screening for HBV in pregnancy recommended in the UK?

Question 2. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV

infection 4 months ago. What results on routine blood testing would indicate that she has an acute HBV infection?

Question 3. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV

infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of infection?

Question 4. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV

infection 4 months ago. What results on routine blood testing would indicate that she is immune to the HBV as a result of HBV vaccine?

Question 5. An asymptomatic primigravida books at 10 weeks. Her partner had an acute HBV

infection 9 months ago. What results on routine blood testing would show that she is a chronic carrier of HBV infection, assuming that she became infected early in the partner’s illness?

Question 6. Testing shows that he is positive for HBsAg, positive for HBcAb but negative for IgM

HBcAb. What does this mean in relation to his HBV status?

Question 7. Testing shows that he is negative for HBsAg, positive for HBcAb and positive for

HBsAb. What does this mean in relation to his HBV status?

Question 8. How common is chronic HBV carrier status in UK pregnant women?

Question 9. What is the risk of death from chronic HBV carrier status?

Question 10. A primigravid woman at 8 weeks gestation is found to be non-immune to HBV. She has

recently married and her husband is a chronic carrier. What should be done to protect her from infection?

Question 11. A woman is a known carrier of HBV. What is the risk of vertical transmission in the first

trimester?

Question 12. What is the risk of the neonate who has been infected by vertical transmission

becoming a carrier without treatment?

Question 13. Should antiviral maternal therapy in the 3^rd. trimester be considered for women with

HBeAg or high viral load?

Question 14. How effective is hepatitis B prophylaxis for the neonate in preventing chronic carrier

status as a result of vertical transmission?

Question 15. What alternative treatment could be used if HBIG is not available?

Question 16. Can a woman who is a chronic HBV carrier breastfeed safely?

Question 17. Hepatitis B infection is the most dangerous of the viral hepatitis infections in

pregnancy.

Question 18. A pregnant woman who is not immune to HBV has a partner who is a chronic carrier.

Can HBV vaccine be administered safely in pregnancy?

Question 19. How long can HBV survive outside the body?

Question 20. A pregnant woman who is not immune has a partner with acute hepatitis due to HBV.

He cuts his hand and bleeds onto the kitchen table. How should she clean the surface to ensure that she gets rid of the virus?

Question 21. Is it true that the presence of HBeAg in maternal blood is a particular risk factor for

vertical transmission? Not really a scenario, but never mind!

Question 22. What does 5 log10 copies /mL mean?

A	> 10 copies / mL
B	> 100 copies / mL
C	> 1,000 copies / mL
D	> 10,000 copies / mL
E	> 100,000 copies / mL
F	this has scared me witless and I am going straight home to complain to my Mum

Question 23. Which, if any, of the following statements are true about amniocentesis and CVS and

the risk of vertical transmission if the mother is HbsAg+ve?

A	they are contraindicated
B	they should be done with cover with HBIG
C	they should be done with cover with a drug that is effective for HBV and safe in pregnancy.
D	none of the above

Question 24. Which, if any, of the following statements are true about treatment in the third

trimester to reduce the risk of vertical transmission?

A	women who are HbsAg+ve should be offered testing for HBV DNA levels in the 3^rd. trimester
B	there is no effective treatment for HBV in the 3^rd. trimester
C	the risks of treatment for HBV in the 3^rd. trimester outweigh the benefits
D	drug treatment for HBV in the 3^rd. trimester adds nothing beneficial to the normal use of HBIG + HB vaccination of the neonate
E	none of the above.

Question 25. Which, if any, of the following drugs is recommended for use in the third trimester to

reduce the risk of vertical transmission?

A	acyclovir
B	lamivudine
C	telbivudine
D	tenofovir

Question 26. Does elective Cs before labour and with the membranes intact reduce the vertical

transmission rate?

Question 27. Which hepatitis virus normally produces a mild illness, but represents a major risk to

pregnant women, with a mortality rate of up to 5%?

Question 28. A pregnant woman has a history of viral hepatitis and informs the midwife at booking

that she is a carrier and that she has a significant risk of cirrhosis and has been advised not to drink alcohol. Which is the most likely hepatitis virus?

Question 29. Which hepatitis virus is an absolute contraindication to breastfeeding after

appropriate treatment of the infected mother and prophylaxis for the baby?

Question 30. Which hepatitis virus is linked to an increased risk of obstetric cholestasis?

Question 31. Which, if any, of the following statements is true in relation to HepB and the risk of

GDM?

A	the risk is about the same
B	the relative risk is about 0.1.
C	the relative risk is about 0.2.
D	the relative risk is about 0.5.
E	the relative risk is about 1.2.
F	the relative risk is about 1.5.
G	the relative risk is about 2.0
H	the relative risk is about 3.0
I	the risk is unknown

30. Kisspeptin.

DYNOP: dynorphin

KSP: kisspeptin.

NKB: neurokinin B

Question 1. Pick the best statement.

A	is a pheromone released by the salivary glands during passionate embraces which syntocinon secretion and sense of pleasure
B	is a digestive enzyme released by the salivary glands during passionate embrace
C	is a digestive enzyme found in human carnivores but not vegetarians
D	is thought necessary for trophoblastic invasion and low levels have been linked to miscarriage, recurrent miscarriage and ↑ risk of PET
E	is named after “Kiss me quick” chocolate
F	does not exist and this question is a very poor joke by someone who should know better

Question 2. Which, if any of the following are true.

A	KSP is a KNDy neuropeptide secreted in the hypothalamus
B	KSP stimulates GnRH neurones
C	KSP stimulates FSH production > LH production
D	KSP stimulates FSH production < LH production
E	KSP stimulates FSH production and LH production equally
F	KSP is a key factor in puberty
G	KSP is a key factor in normal reproductive physiology
H	¯ KSP is pathognomonic for Kallmann’s syndrome.
I	dynorphin stimulates GnRH neurones
J	neurokinin B stimulates GnRH neurones

Tuesday, 19 August 2025

MRCOG tutorial Thursday 21st. August 2025

Contact me

Website

21 August 2025. Role-players: 1.

Role-players: 2.

23	Role-play.
24	Role-play.
25	SBA. Chickenpox and pregnancy
26	SBA. Yellow card reporting system

23. Role-play 1. Candidate’s instructions will be e-mailed shortly before the tutorial.

24. Role-play 1. Candidate’s instructions will be e-mailed shortly before the tutorial.

25. Chickenpox + pregnancy.

Introduction.

This is a regular topic in the exam. The “Green Book” updated its advice on post-exposure prophylaxis in 2022 which probably brought it to the minds of examiners.

Abbreviations.

FVS: fetal varicella syndrome

VZV: varicella-zoster virus

VZIg: varicella-zoster immunoglobulin

Question 1. What type of virus causes chickenpox?

A	avian virus
B	herpes virus
C	retrovirus
D	picovirus
E	pox virus

Question 2. Which of the following best describes the chickenpox virus

A	DNA virus
B	RNA virus
C	Prion
D	All of the above
E	None of the above

Question 3. What is the main reservoir of the chickenpox virus?

A	domestic chickens
B	chickens in battery farms
C	sparrows
D	humans
E	earthworms

Question 4. Which, if any of the following are true about how chickenpox is spread?

A	via respiratory droplets
B	direct contact with the fluid from the vesicles
C	contact with fomites
D	contact with stalactites
E	from lavatory seats

Question 5. Fomites - which of the following statements are true?

A	fomites are bedclothes infested with bed bugs which can carry the chickenpox virus
B	“fomites” in Latin is the plural of “fomes”, the noun meaning “tinder” in English
C	fomites are inanimate objects that can effect the transfer of communicable diseases from the infected person to someone who is not infected
D	fomites are horizontal stalagmites, particularly found in the Dolomite mountains and capable of fostering the growth of viruses, including the chickenpox virus
E	fomites are the viral particles in vomit that form the aerosols particularly associated with the respiratory spread of viruses such as the chickenpox virus.

Question 6. Which, if any, of the following are listed in GTG13 as examples of fomites?

A	bathtubs used by person with chickenpox at the infectious stage
B	bedding
C	blood, fresh or dried, from person with chickenpox at the infectious stage
D	clothing
E	hair
F	paper money
G	skin cells
H	viral remnants in vomit from person with chickenpox at the infectious stage

Question 7. With regard to the epidemiology of chickenpox in the UK, which of the following statements are true?

A	Chickenpox is endemic
B	Chickenpox is endemic with mini-epidemics every 3-4 years in the early part of the year
C	The main reservoir is chickens, particularly those that are reared intensively
D	The main reservoir is human sensory nerve root ganglia after primary infection
E	The main reservoir is fomites

Question 8. What proportion of the ante-natal population of the UK is immune to chickenpox?

A	50%
B	60%
C	70%
D	80%
E	90%
F	≥ 90%

Question 9. Which population of immigrant women is least likely to have immunity to chickenpox?

A	Middle-Eastern
B	Those from Antarctica
C	Those from the EEC
D	Those from tropical and sub-tropical Africa
E	One-eyed Mongolians with the bad habit of spitting in public

Question 10. What is the incidence of chickenpox in pregnancy in the UK?

A	1 in 1,000
B	3 in 1,000
C	5 in 1,000
D	8 in 1,000
E	14 in 1,000
	20 in 1,000

Question 11. What is the usual presentation of chickenpox in a child?

A	Mild fever with malaise then vesicles which appear after 2 days and disappear after 4 – 5 days
B	Mild fever with malaise then vesicles which appear after 2 days and disappear after about 7 days
C	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 5 days
D	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 7 days
E	Mild fever, malaise, pruritic maculopapules that develop into vesicles and normally crust over within 10 days

Question 12. What is the duration of infectivity after primary infection?

A	From the onset of fever until 48 hours after the vesicles form
B	From the onset of fever until 5 days after the vesicles form
C	From 48 hours before the development of the vesicles until 5 days later.
D	From 48 hours before the development of the vesicles until they crust over
E	From the development of the vesicles until 5 days later.
F	From the development of the vesicles until they crust over

Question 13. A woman books at 8 weeks. Her 6-year-old son lives with her and has recently

developed chickenpox? She is tested and found to be non-immune. What is her risk of infection from the domestic contact with her son?

A	50%
B	60%
C	70%
D	80%
E	90%

Question 14. Which of the following contacts with a case of chickenpox would be significant?

A	contact with the mother of a child who has just developed the typical chickenpox rash
B	contact with the mother of a child who has not developed the typical chickenpox rash
C	a four-hour journey on a school bus with 20 children, one of whom develops the typical chickenpox rash the next day
D	having a coffee with a neighbour who is having chemotherapy and has just developed shingles
E	visiting a neighbour who has developed ophthalmic shingles and has been admitted to an old-fashioned 20-bed ward
F	having a coffee with an 80-year-old neighbour who is in good health but has just had recurrence of thoracic shingles.

Question 15. In relation to shingles, which, if any, of the following statements are true?

A	Shingles is due to reactivation of the virus which has lain dormant in the sensory nerve root ganglia
B	Shingles is due to reactivation of the virus which has lain dormant in the motor nerve root ganglia
C	Shingles is due to reactivation of the virus which has lain dormant in the autonomic nerve root ganglia
D	Shingles should always be regarded as infectious.
E	Shingles in the immuno-compromised should always be regarded as infectious.
F	Ophthalmic shingles should always be regarded as infectious

Question 16. This is about prophylaxis with chickenpox vaccine.

Which of the following statements are true? Pick the best option from the option list.

A	Chickenpox vaccine does not exist.
B	Chickenpox vaccine uses a killed virus of the Okra strain.
C	Chickenpox vaccine uses an attenuated virus of the Oka strain.
D	All children who have not had chickenpox should be offered the vaccine after 1 year of age.
E	Women should be screened for immune status as part of pre-pregnancy counselling or fertility treatment with ART

Question 17. This relates to vaccination in early pregnancy

A 25-year-old woman is given varicella vaccine. Her period is due the next day, but does not occur. A pregnancy test a few days later is +ve. What should be the management?

A	She should be advised that there is a 5% risk of congenital varicella syndrome and be offered TOP.
B	She should be advised that there is a 10% risk of congenital varicella syndrome and be offered TOP.
C	She should be advised that the level of risk of congenital varicella syndrome after vaccination in early pregnancy is unknown and be offered TOP.
D	She should be advised that the level of risk of congenital varicella syndrome after vaccination in early pregnancy is unknown and be offered referral to a feto-maternal medicine expert.
E	She should be advised that inadvertent vaccination has been studied for > 20 years no evidence has been found to harm to the mother or child.
F	She should be advised that the vaccine contains no live virus and cannot cause fetal infection.

Question 18. A woman has been referred to the booking clinic by her GP. Screening for immunity to chickenpox showed her to be seronegative. What advice would you give her?

A	Advise her that there is no risk unless she comes into contact with a case of chickenpox or shingles and to speak to GP or midwife if possible contact occurs.
B	Advise her to have the chickenpox vaccine because of the 10% risk and high mortality associated with varicella in pregnancy.
C	Advise her to have VZIG to reduce her risk of infection.
D	Advise her to take oral acyclovir until two weeks post-delivery.
E	None of the above.

Question 19. A woman is referred to the booking clinic by her GP for urgent assessment as she was in contact with a case of chickenpox two days before. What action should be taken?

A	take a detailed history to determine the significance of the contact and her history of and likely immunity to chickenpox.
B	check for VZV immunity if there is a history of a significant contact and possibility that she is not immune.
C	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer oral acyclovir
D	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer VZIg
E	if the contact was significant and the tests for VZV immunity show her to be seronegative, offer oral acyclovir + VZIg
F	if the contact was significant and the tests for VZV show her to be seronegative, discuss TOP.
	none of the above

Question 20. Which, if any, of the following statements about VZIg are correct?

A	VZIg is manufactured using recombinant technology
B	VZIg is effective in pregnancy when given within 10 days of the contact
C	If VZIg is given, the woman is potentially infectious for up to 28 days
D	Repeat doses of VZIg should not be given in the event of repeated significant contact
E	There are reliable supplies of VZIg and no problems regarding availability

Question 21. How does the administration of VZIG affect the duration of infectivity for the woman?

A	With no VZIG she is potentially infectious from day 8 to 28.
B	VZIG destroys virus and the woman is potentially infections from day 8 to 21.
C	VZIG does not alter the period in which the woman is potentially infections.
D	VZIG reduces the risk of shingles in later life
E	None of the above

Question 22. With regard to established varicella in pregnancy, which, if any, of the following statements are true? Choose the best option from the option list.

A	the main risk to the mother comes from pneumonia, with an incidence of about 10%
B	the main risk to the mother comes from pneumonia, with an incidence of about 40%
C	hepatitis and encephalitis are more common compared to the non-pregnant state
D	mortality from varicella pneumonia have fallen to < 15%
E	the death rate from varicella pneumonia is estimated to be 5 times greater than in the non-pregnant

Question 23. A GP phones to say that a patient of his at 10 weeks’ gestation has developed the typical rash of chickenpox. Her son had proven chickenpox a couple of weeks previously. She had been tested and found to be non-immune, but declined VZIG. Which, if any of the following statements would you include in your advice to the GP.

A	admit the woman for assessment, VZIG and acyclovir after counselling re risks and benefits.
B	arrange for her to be seen in the next antenatal clinic.
C	advise re prevention of secondary bacterial infection of the lesions
D	advise about her avoiding contact with susceptible individuals until at least 7 days after the lesions crust over
E	advise the GP of the criteria for hospital admission and the need for the woman to be informed of them.
F	advise the GP to discuss the risks and benefits of acyclovir 800mg five times daily for seven days and to prescribe it if the woman agrees.
G	advise that acyclovir is contraindicated once the rash appears
H	advise that VZIG is ineffectual once the rash has appeared
I	advise that acyclovir is not licensed for use in pregnancy and any use would be ‘off-label’.
J	advise that acyclovir is potentially teratogenic and not to be used in the 1^st. trimester.

Question 24.What kind of drug is aciclovir?

Question 25. How effective is aciclovir?

Question 26. Which, if any, of the following statements are true in relation to the diagnosis of fetal varicella syndrome?

A	detailed ultrasound examination by a fetal medicine expert should be offered
B	fetal MRI is superior to US examination and should be the 1ry test if available
C	amniocentesis should be offered as detection of varicella DNA makes FVS probable
D	amniocentesis should be done as early as possible, avoiding any varicella lesions
E	PCR which is –ve for varicella DNA in amniotic fluid has a strong NPV for FVS
	PCR which is +ve for varicella DNA in amniotic fluid has a strong PPV for FVS

Question 27. Which, if any, of the following statements are true in relation to fetal varicella syndrome?

A	FVS occurs in relation to 1ry. infection in-utero
B	FVS occurs in relation to 2ry. infection in-utero
C	the risk of FVS is ~ 5% when 1ry. infection in-utero occurs < 13 weeks
D	the risk of FVS is ~ 10% when 1ry. infection in-utero occurs between 13 and 20 weeks
E	the risk of FVS is greatest when 1ry. infection in-utero occurs within 4 weeks of birth

Question 28. Which, if any, of the following statements are true in relation to administration of varicella vaccine in pregnancy.

A	varicella vaccine is a recombinant vaccine and licensed for use in pregnancy
B	varicella vaccine contains a live, attenuated vaccine and is contraindicated in pregnancy
C	varicella vaccine contains a live, attenuated vaccine and is safe to use after 12 weeks
D	TOP should be advised if varicella vaccine is given in the 1^st. trimester
E	VZV immunoglobulin should be given if varicella vaccine is given in the 1^st. trimester
F	varicella vaccine should not be given to women who are breastfeeding

Question 29. Which, if any, of the following are true in relation to neonatal varicella (NV)

A	the risk of NV is 90% with fetal infection in the 1^st. trimester
B	the risk of NV is 50% with fetal infection in the 2^nd. trimester
C	the risk of NV is 10% with fetal infection in the 4 weeks before delivery
D	planned delivery should be delayed, if safe, until 7 days after start of the maternal rash
E	women with active chickenpox should not breastfeed until 10 days after the lesions crust

Question 30. Is chickenpox notifiable?

26. Yellow Card Reporting System. SBA. Questions.

Abbreviations.

BNF: British National Formulary.

MHRA: Medicines & Healthcare products Regulatory Agency.

YCRS: Yellow Card Reporting System.

Scenario 1. What is the purpose of the YCRS?

A	to report suspected side-effects of air pollution
B	to report suspected side-effects of alcohol
C	to report suspected side-effects of e-cigarettes
D	to report suspected side-effects of medical device use
E	to report defective or fake medical products
F	to report sellers of defective or fake medical products
G	none of the above.

Scenario 2. Which organisation runs the YCRS?

A	British National Formulary
B	Metropolitan Police
C	MHRA
D	NHS
E	NICE
F	Royal College of Medicine
G	none of the above

Scenario 3. How does one report an issue using the YCRS?

A	completing a form from the BNF and posting it to ‘FREEPOST YELLOW CARD’
B	completing a form from the BNF and posting it to ‘Metropolitan Police’
C	completing a form from the BNF and posting it to ‘FREEPOST MHRA’
D	completing a form from the BNF and posting it to ‘FREEPOST NHS’
E	completing a form from the BNF and posting it to ‘FREEPOST ’NICE’
F	completing a form from the BNF and posting it to ‘FREEPOST ’Royal College of Medicine’
G	on-line at https://yellowcard.mhra.gov.uk/
H	none of the above