RANZCOG Interview - Clinical Scenarios

Question 1

You’ve been called into a delivery room for a fetal bradycardia, what would you do in this situation?

Question 2

You are in ANC and you see a young Maori woman who has been diagnosed with GDM. She has been a poor attender previously. How would you proceed?

Question 3

You are the reg on delivery suite, emergency bell goes off and woman with no antenatal care who is thought to be 32/40 is having a tonic-clonic seizure what do you do?

Question 4

You are about to discharge someone from the post-natal ward and they disclose that their partner has been violent to them, how do you proceed?

Question 5

You are an O&G Reg on nights at 3am you get a call from a rest home about an 86yo with PMB. She is stable. What advice would you give?

Question 6

You get a call from a GP about a woman with a missed miscarriage found on a USS, how do you proceed?

Question 7

You are the O&G Reg looking after delivery suite, you are called into a room. The woman is multiparous, has had a previous CS and is in labour. She is sweaty, pale and has severe lower abdo pain over her scar. What do you do?

Question 8

You are called to ED to assess a woman who has recently had laparoscopic excision of endometriosis. On examination you find an acute abdomen. What are your differentials and why?

Question 9

A 26 year old woman with Down syndrome has a pelvic mass, how do you proceed?

Question 10

A woman admitted with an incomplete miscarriage becomes hypotensive and bradycardic on the ward, what do you do?

Question 11

A friend asks you for a prescription for the ECP, what do you do?

Question 12

You are asked to see a woman and her partner in clinic for infertility and during an examination you discover she has undergone FGM, what do you do?

Question 13

6/40 pregnant with painless PV bleeding, what do you advise?

Question 14

PET with seizures, consultant in OT, what do you do?

Question 15

31/40 pregnant, bleeding with midwife 1 hour away from hospital

Question 16

12/7 late for period with abdominal pain, review

Question 17

Primip OP pushing for 90mins with epidural. Ring consultant who says do a Kielands and to call if you get into trouble, what do you do?

Question 18

Consultant refuses to come in

Question 19

One of your colleagues is not keeping up with their share of the workload

Question 20

Patient that had plan for bloods, USS and review but mother of the patient calls demanding a laparoscopy

Question 21

Veiled Islamic woman speaks no English, haemorrhaging, how does informed consent apply?

Question 22

You are on birthing suite you get called to a room to see a 24 yr old primip in early labour complaining of chest pain

Question 23

You are called to ED to see a lady 6 days post c/s for breech complaining of abdo pain. On examination she has a tender abdomen and a high fundus

Question 24

Contraception 2 days post-delivery on PN ward for 21yo

Question 25

Woman postnatal Ward collapse after seemingly straightforward svd, immediate differentials

Question 26

You are asked to see a 42 year old primip at 40 weeks for a USS review. Her pregnancy has been uncomplicated thus far but her scan shows a baby with an AC and EFW <3rd with a raised UAPI. She told the MW that she plans to decline IOL and pursue a homebirth. How would you counsel her?

Question 27

14 year old presents to you asking for contraception – how do you proceed and what options would you discuss

Question 28

You are the registrar on call for delivery suite and are called to an emergency. You walk in to find a women who has just come in from the community and has a bradycardia on the CTG with an FHR of 60. Please outline your next steps

Question 29

You are on delivery suite with a new HO, you are a 1st year registrar. A woman who was transferred at 30/40, prev LSCS with TPTL has buzzed that she has had some bleeding. You examine her and find her to be 9cm dilated with a breech presentation. You are unable to get hold of the SMO. What do you do

Question 30

You are on call one evening and are called to a woman on the post-natal ward who is not happy with a perineal repair she had earlier that day. How would you assess her and handle the situation?

Question 31

You have been called to see a woman who is on the ward 3 days post-LSCS who is short of breath. What do you do?

Question 32

You are called to ED to assess a woman who has presented with collapse. What do you do and how do you manage it?

Question 33

You are a registrar on call in DU. The charge MW informs you that an LMC has 37/40 twins in labour and plans to perform delivery herself. She has not consulted. What do you do?

Question 34

You are approached by a husband of a woman in labour who is angry because the MW has said she cannot have an epidural. How do you manage the situation?

Question 35

Woman is 8 weeks by LMP had some PV bleeding which has now settled. Not sure she wants to continue with the pregnancy. How would you proceed?

Question 36

What are some challenges in the diagnosis, management and treatment of endometriosis?

Question 37

36yo primip wants to have a home birth, how would you counsel her?

Question 38

You have been working for 13 hours, about to leave, very tired. Colleague taking over from you is late, called to review a patient in ED (issue will take some time to resolve): what do you do?

Question 39

A fellow trainee comes to you as they are feeling very overwhelmed at work, not sleeping properly. They recently had a bad outcome they cannot stop ruminating on. How do you support them?

Question 40

Some consultants at your hospital are continuously using antibiotics when not indicated as per guidelines. How do you address this?

Question 41

28F, 30/40 pregnant, febrile, how do you assess?

Question 41

What makes a good/ effective clinical handover?

Question 42

Veiled lamic somali woman, speaks no English, presents hemorrhaging. How does informed consent apply and what would you do?

Question 43

Discuss times consent can be difficult (e.g. with LSCS) and ways you can manage this

Question 44

Patient refusing to adhere to treatment and, as a result, is deteriorating rapidly: what do you do?

Question 45

A patient wants to view their medical records – how do you approach?

Question 46

Dealing with an emergency and you are called to urgently review a patient on a different ward, how do you prioritise and deal with situation?

Question 47

Need to do a procedure you have only seen once (on call at night), emergency – if procedure not done soon patient suffer serious harm, what do you do?

Question 48

Adult A&E, unconscious, bleeding profusely, may require blood transfusion. Accompanying relatives tell you pt is longstanding JW. What do you do?

Question 49

20 yo multip, delivered 20 mins ago, placenta still inside, PPH 750mL and ongoing.

Answer 49

Concerns for haemodynamic instability
Call for help, emergency bell, CMM, obs reg
DRSABCD
IVL, bloods, fluids, IDC
Exam - placenta out, tears
Ecbolics - TXA, synto, synto infusion, syntometrine, carboprost, misoprostol
Bimanual compression
Weigh swabs/accurate EBL
Consider theatre/low threshold to activate MHP
Document and debrief

Question 50

19F ED resus hypotensive/ tachycardic with FAST showing large volume hemoperitoneum. What is your differential? How do you approach this situation?

Question 51

Maori grandmultip requires admission unstable lie at term 5 hours away, worried about other children: self discharge

Answer 51

Private setting
Explore her concerns, why she is not able to stay in hospital
any whanau or family who can take care of children, any partner in the picture, any friends? how old are her children?
Make sure she understands severity of situation. Explain why she neds admission, concerns for breech, footling, cord prolapse, can result in fetal and maternal complications/death
Offer social work help
D/w consultant
Give her time to consider then come back to review her
Inform her LMC
Strict return advice - start contracting, come in to hospital
Document and debrief

Question 52

Woman ANC requesting repeat ElLSCS, with husband, no eye contact/ not engaging

Answer 52

Concerns for IPV
Concerns for depression

Question 53

ED non pregnant woman with abdo pain: febrile (40), HR 120, RR 24. Talk us through initial assessment

Question 54

55F with ovarian mass, concerned it is cancer: what are key elements of history, how would you address her concerns about cancer

Question 55

45F post coital bleeding ED, key history/ exam/ investigations

Question 56

GP call: unstable ?ectopic 3 hours away. How would you manage over phone

Question 57

Early pregnancy clinic, PV bleeding ongoing pregnancy. You review her smears and note CIN 2/3 – how would you proceed

Question 58

They/them pronouns Gynae clinic wanting to discuss menstrual suppression – how do you approach

Answer 58

Private situation, emphasize confidentiality, clarify pronouns, making sure to be respectful, non-judgemental
Menstrual history
PMHx ?history of clots/migraines with aura
Meds - ?testosterone
Opportunistic sexual health screen - offer STI check if sexually active
IPV screen
Discuss with colleague re recommended type of menstrual suppression