Sample questions and answers for the RCOG’s Diploma exam (DRCOG)
Extended matching questions (EMQs)
The EMQ paper consists of option lists, each with a set of question items, giving 40 questions in total.
Two examples (6 question items in total) are given below.
Options for questions 1–3
A. Cervical biopsy
B. Cervical smear (liquid-based cytology)
E. Diagnostic laparoscopy
F. Endometrial biopsy
G. High vaginal swab
H. Intravenous urogram
I. Laparoscopy and dye test
J. MRI scan
K. Ultrasound scan
Each of the clinical scenarios below relates to women complaining of menstrual disorders. For each patient, select the single most appropriate investigation. Each option may be used once, more than once, or not at all.
Question 1: A 30-year-old nulliparous woman complains of longstanding heavy painful periods and deep dyspareunia. She has taken the contraceptive pill which has not helped. On vaginal examination she has a normal sized retroverted uterus and no adnexal masses, but has tenderness in the posterior fornix.
Answer: E. Diagnostic laparoscopy
Question 2: A 44-year-old multiparous woman has a long history of menorrhagia but attends with a recent history of intermenstrual bleeding. Her recent cervical smear is negative and there are no abnormal findings on vaginal examination.
Answer: F. Endometrial biopsy
Question 3: A 45-year-old woman presents with a 9-month history of menorrhagia, dragging lower abdominal discomfort and urinary frequency. On examination she has a mass arising from the pelvis equivalent in size to a 14 weeks’ gestation pregnancy.
Answer: K. Ultrasound scan
Options for questions 4–6
A. Combined oral contraceptive pill
B. Non-pharmcological and herbal products (e.g. Red Clover®)
C. Estrogen implant
D. Oral continuous combined estrogen/progestogen therapy
E. Oral estrogen and Levonorgestrol intrauterine system
F. Oral estrogen therapy
G. Oral sequential estrogen and progestogen therapy
I. Topical vaginal estrogen
J. Transdermal continuous combined estrogen/progestogen therapy
K. Transdermal estrogen
Each of the clinical scenarios below relates to prescribing dilemmas in the perimenopause. For each patient select the single most appropriate treatment from the list above. Each option may be used once, more than once, or not at all.
Question 4: A 55-year-old woman presents with heavy withdrawal bleeding on a sequential HRT preparation. She requests an alternative hormone replacement therapy that will give more acceptable bleeding. She would prefer not to take a tablet preparation. What is the most appropriate treatment?
Answer: J. Transdermal continuous combined estrogen/progestogen therapy
Question 5: A 50-year-old woman presents with severe climacteric symptoms requesting hormone replacement therapy. She had a total abdominal hysterectomy for menorrhagia 10 years ago. She has contact dermatitis and psoriasis. What is the most appropriate treatment?
Answer: F. Oral estrogen therapy
Question 6: A 52-year-old woman presents with 4 years of amenorrhoea and requests hormone replacement therapy for control of debilitating climacteric symptoms. She has two sisters who have had breast cancer and genetics studies have been uninformative. She is willing to accept any increased risk of breast cancer associated with hormone replacement therapy. She is having annual mammograms. What is the most appropriate treatment?
Answer: H. Tibolone®
Single best answer questions (SBAs)
SBAs require you to select the single most appropriate answer from the 5 options.
Question 1: You are asked to see a baby who was born normally at home 18 hours ago. The mother has been breastfeeding. The midwife has noticed that the baby is jaundiced. From the list below choose the single most appropriate management option:
A. Encourage more frequent breastfeeding
B. Ensure that vitamin K has been administered to the baby
C. Advise that breastfeeding should be stopped
D. Supplement breastfeeding with water from a cup
E. Refer for an urgent paediatric opinion
Answer: E. Refer for an urgent paediatric opinion
Question 2: A 54-year-old woman attends your GP surgery. For the last year she has had vulval soreness which is severe enough to prevent intercourse. Her last menstrual period was 2 years ago. She has had no postmenopausal bleeding but there has recently been a yellow/brown vaginal discharge. There have been no other symptoms of menopause. On examination the vulva and vagina look normal. A transvaginal scan shows a small uterus with an endometrial thickness of 3 mm. From the list below choose the single most appropriate treatment:
A. Transdermal estradiol gel 1 mg daily
B. Psychosexual counselling
C. Oral combined sequential estradiol and progesterone
D. Vaginal estradiol 25 micrograms daily
E. Oral tibolone 2.5mg daily
Answer: D. Vaginal estradiol 25 micrograms daily