MRCOG Part SBAs and MCQs

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1 MRCOG Part SBAs and MCQs

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3 MRCOG Part SBAs and MCQs Katherine Andersen MBBS BSc (Hons) Specialist Trainee in Obstetrics and Gynaecology, Barnet and Chase Farm Hospitals NHS Trust, London, UK Tara Woodward MBBS BSc (Hons) PgDip Journalism Specialist Trainee in Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK Edited by Maryam Parisaei MRCOG Consultant Obstetrician and Gynaecologist, Homerton University Hospital NHS Foundation Trust, London, UK Amit Shah MD MRCOG Consultant in Reproductive Medicine and Surgery, Homerton University Hospital NHS Foundation Trust, London, UK London St Louis Panama City New Delhi

4 2013 JP Medical Ltd. Published by JP Medical Ltd 83 Victoria Street, London, SW1H 0HW, UK Tel: +44 (0) Fax: +44 (0) Web: The rights of Katherine Andersen, Tara Woodward, Maryam Parisaei and Amit Shah to be identified as authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission in writing of the publishers. Permissions may be sought directly from JP Medical Ltd at the address printed above. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. ISBN: British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress JP Medical Ltd is a subsidiary of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India Commissioning Editor: Senior Editorial Assistant: Design: Steffan Clements Katrina Rimmer Designers Collective Ltd Copy edited, typeset, printed and bound in India.

5 Foreword The Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) remains the cornerstone for the assessment of knowledge required by trainee doctors in the UK. Passing the exam is a prerequisite for the progression through the structured training programme, towards the Certificate of Completion of Training (CCT) and entry on to the Specialist Register. The standard of the exam remains high and the curriculum is based on UK practice. The MRCOG Part 1 exam can be taken at any time after graduation and must be passed before transition from ST2 to ST3 of the training programme. This book aims to provide an exam revision guide for trainee doctors in ST1 and ST2, and international candidates preparing to sit the exam. For international graduates often working outside of recognised training programmes it is a tough exam to pass. Yet many candidates continue to take the exam knowing that success will demonstrate the acquisition of knowledge to a high standard, which will enhance the treatment of the women and babies in their care. The MRCOG Part 1 has changed in the last few years. It has always tested the knowledgebase in all the basic sciences as they pertain to obstetrics and gynaecology, but a new question format has been introduced to allow the syllabus to be tested in a more clinically relevant manner. Doctors planning to take the exam must now learn how to answer both multiple choice questions (MCQs) and the new single best answer (SBA) format, and for this they require exam technique and clinical knowledge. This book contains 550 SBAs and MCQs arranged into individual chapters based on the exam syllabus. Covering all the basic sciences as well as current RCOG clinical recommended practice, it provides a comprehensive revision aid with helpful explanations after each question. The book also offers guidance on other information sources and a suggested reading list. At the back of the book there are two practice papers for readers to test their knowledge and practise exam technique. Maggie Blott FRCOG Consultant in Obstetrics and Maternal Medicine, University College London, London, UK Former Vice President (Education) of the Royal College of Obstetricians and Gynaecologists, UK v

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7 Preface Passing the MRCOG Part 1 is regarded as the first step in becoming an obstetrician and gynaecologist. For many candidates, it will be their first postgraduate exam and the task of passing at first sitting can seem daunting. However, we believe that with appropriate preparation candidates can feel confident in passing the exam first time. The new curriculum now combines subject matters from everyday clinical practice as well as all the basic medical sciences and is much more clinically orientated than before. There is also a new format with the introduction of single best answer (SBA) questions, the removal of extended matching questions (EMQs) and the reduced proportion of multiple choice questions (MCQs). This book reflects both the new curriculum and format. The 550 questions presented in this book cover the syllabus in a format which mimics the exam itself. Working through the book will allow trainees to gauge their level and breadth of knowledge and will highlight topics which need to be concentrated on further. Within the answer sections, references are made to the latest evidence-based practice, and tables and diagrams are used to aid in the assimilation of this information. The philosophy of this book is to provide trainees with an insight into the new assessment technique of the MRCOG Part 1 and to build confidence by approaching the exam in a systematic manner. We hope you enjoy working through the questions in this book and wish you best of luck in the exam. Katherine Andersen Tara Woodward Maryam Parisaei Amit Shah April 2012 Acknowledgements We would like to thank Dr Helen Hammond for her eagerness to review all 550 questions and for her excellent advice regarding their content. Thanks also to Dr Simon Tod from Sydney, Australia, who gave much appreciated advice regarding the book s statistical content. Katherine Andersen Tara Woodward vii

8 Exam revision advice Exam format The MRCOG Part 1 exam consists of Paper 1 and Paper 2. Each paper consists of 60 single best answer (SBA) questions and 30 multiple choice questions (MCQs). Each paper must be completed within two hours and thirty minutes. The SBA and MCQ sections are marked out of 150 marks each. Single best answer (SBA) questions A SBA comprises three components: a stem (most commonly a clinically relevant vignette), a lead in question and five answer options. The answer options are homogenous and are presented in alphabetical or numerical order for ease of reference. Candidates should read the question carefully then select the single most appropriate answer from the five options. The nature of a SBA means that there are four distracters surrounding the correct answer. Of the four distracters, there may be one or two distracters which can reasonably be identified as incorrect. There are also likely to be one or two distracters that are plausible answers. At this point, candidates will need to read the stem and lead in question again, then make a judgement as to which answer fits best. Multiple choice questions (MCQs) A MCQ is made up of five stems, which must each be answered true or false. Marks are given for answering stems correctly. All the questions need to be answered and there is no negative marking for answering stems incorrectly. How to use this book We believe that one of the best ways to revise for the exam, and crucial to passing at first attempt, is to work through practice questions again and again. In this way, confidence will be gained with the new question format and the full curriculum will be covered. Further reading suggestions are provided to accompany explanations in this book to direct further learning. We feel that this is a more appropriate way for trainee doctors to improve knowledge in certain topics in obstetrics and gynaecology than by memorising sections from large textbooks. We hope that directed learning will enable trainees to concentrate on areas of weakness. We have included two mock exam papers at the end, which can be tested under timed conditions to provide a good sense of the time restraints of the real exam. Allow two and a half hours to sit each paper, and remember that in the new format there are 60 SBAs and only 30 MCQs. Finally, having a study buddy is good way to maximise exam preparation. In addition to keeping each other on track, you will be able assist each other with areas of the curriculum that the other may be struggling with. We both studied for the exam together, which gave us focus, a timetable to keep to and some friendly competiveness to make sure we took our exam preparation seriously. viii Katherine Andersen Tara Woodward

9 Contents Foreword Preface and acknowledgements Exam revision advice Recommended reading v vii viii x Chapter 1 Anatomy 1 Chapter 2 Biochemistry 29 Chapter 3 Embryology 45 Chapter 4 Endocrinology 53 Chapter 5 Statistics and epidemiology 85 Chapter 6 Genetics 99 Chapter 7 Physiology 111 Chapter 8 Biophysics 133 Chapter 9 Clinical management 143 Chapter 10 Data interpretation 159 Chapter 11 Immunology 177 Chapter 12 Microbiology 187 Chapter 13 Pathology 205 Chapter 14 Pharmacology 231 Chapter 15 Mock paper Chapter 16 Mock paper Index 347 ix

10 Recommended reading Bennett P, Williamson C (eds). Basic Sciences in Obstetrics and Gynaecology: A Textbook for MRCOG Part 1, 4th edn. Edinburgh: Churchill Livingstone, Chamberlain G, Steer P (eds). Turnbull s Obstetrics, 3rd edn. London: Churchill Livingstone, Collins S, Arulkumaran S, Hayes K, et al. Oxford Handbook of Obstetrics and Gynaecology, 2nd edn. Oxford: Oxford University Press, Connor JM. Medical Genetics for the MRCOG and Beyond. London: RCOG Press, Fiander A, Thilganathan B (eds). Your Essential Revision Guide MRCOG Part 1. London: RCOG Press, Kumar V, Abbas A, Fausto N, Aster J. Robbins and Cotran Pathologic Basis of Disease, 8th edn. Philadephia: Saunders Elsevier, Nelson-Piercy C. Handbook of Obstetric Medicine, 4th edn. London: Informa Healthcare, Royal College of Obstetricians and Gynaecologists, Green-top Guidelines. London: RCOG. x