EFOG-EBCOG Part 1 Knowledge Based Assessment

Which statement best describes the current EFOG-EBCOG Part 1 Knowledge Based Assessment structure?

• AIt consists of a single 6-hour integrated paper followed immediately by an OSCE.
• BIt consists of two 3-hour papers, one in Obstetrics and one in Gynaecology.
• CIt consists of two clinical OSCE circuits and no written paper.
• DIt consists of one Obstetrics paper only, with Gynaecology assessed in Part 2.

A candidate is planning time management for one EFOG-EBCOG Part 1 paper. Which item mix should they expect in each paper?

• A35 EMQ sets with 3 scenarios each plus 30 SBAs, giving 135 answerable items.
• B90 SBAs plus 35 oral viva questions, giving 125 answerable items.
• C30 EMQ sets with 4 scenarios each plus 35 SBAs, giving 155 answerable items.
• D30 EMQ sets with 3 scenarios each plus 35 SBAs, giving 125 answerable items.

Which statement about EFOG-EBCOG Part 1 assessment policy is correct?

• AThere is no negative marking, and the pass mark uses a modified Angoff method.
• BIncorrect answers lose marks, and the pass mark is fixed at 70%.
• COnly EMQs count toward the final score, and SBAs are formative.
• DThe pass mark is determined by the pass rate from the previous diet.

A doctor asks whether passing EFOG-EBCOG Part 1 allows them to practise independently in a European country. Which answer is most accurate?

• APassing Part 1 automatically confers specialist registration in all EBCOG member countrie…
• BPassing Part 1 confers a temporary licence to practise until Part 2 is passed.
• CPassing Part 1 is a fellowship quality benchmark and does not confer or imply a licence t…
• DPassing Part 1 is equivalent to national completion of training in obstetrics and gynaeco…

Which statement correctly describes the relationship between EFOG-EBCOG Part 1 and Part 2?

• APart 1 is an OSCE, and Part 2 is an online computer-based KBA.
• BPart 1 and Part 2 may be taken in either order if the candidate has completed training.
• CPart 1 is an online, computer-based KBA with remote virtual invigilation, and it must be…
• DPart 1 is remotely invigilated only for overseas candidates, while Part 2 is always writt…

At a first antenatal assessment, which finding most strongly indicates that consultant-led or specialist antenatal care should be arranged?

• APrevious classical caesarean section.
• BNausea without weight loss at 8 weeks.
• CUncomplicated appendicectomy in childhood.
• DAge 28 years with a body mass index of 23 kg/m2.

A healthy nulliparous woman attends at 10 weeks with uncertain menstrual dates. Which intervention most accurately establishes gestational age for ongoing antenatal care?

• ASymphysis-fundal height measurement at the booking visit.
• BMaternal serum alpha-fetoprotein concentration alone.
• CDate of first fetal movements reported by the patient.
• DFirst-trimester ultrasound measurement of crown-rump length.

A 7-week pregnant patient has light vaginal bleeding, a closed cervical os, mild cramping, and ultrasound evidence of a live intrauterine pregnancy. She is haemodynamically stable. What is the most appropriate diagnosis?

• AIncomplete miscarriage.
• BThreatened miscarriage.
• CInevitable miscarriage.
• DPregnancy of unknown location.

A 6-week pregnant patient presents with shoulder-tip pain, syncope, hypotension, and a positive pregnancy test. No intrauterine pregnancy has been confirmed. What is the immediate priority?

• AOutpatient serial serum hCG measurement in 48 hours.
• BUrgent resuscitation and surgical assessment for ruptured ectopic pregnancy.
• COral methotrexate after confirming the hCG trend.
• DReassurance because shoulder-tip pain is common in viable early pregnancy.

A stable patient has a positive pregnancy test, no intrauterine pregnancy on transvaginal ultrasound, and no adnexal mass. The serum hCG is below the discriminatory zone. Which approach is most appropriate?

• ADiagnose complete miscarriage and discharge without follow-up.
• BAdminister methotrexate immediately because an ectopic pregnancy is proven.
• CSchedule routine antenatal care because a viable intrauterine pregnancy is excluded.
• DManage as pregnancy of unknown location with safety-net advice and repeat hCG assessment.

Which patient with suspected ectopic pregnancy is most suitable for medical management with methotrexate, assuming local protocols are otherwise met?

• AHaemodynamically stable, unruptured tubal ectopic pregnancy, low hCG, no fetal cardiac ac…
• BHypotensive patient with free intraperitoneal fluid and shoulder-tip pain.
• CLive interstitial ectopic pregnancy with severe abdominal pain and falling haemoglobin.
• DPatient unable to return for serial hCG monitoring after treatment.

A 9-week pregnant patient has persistent vomiting, 6% pre-pregnancy weight loss, ketonuria, hypokalaemia, and inability to tolerate oral fluids. Which initial management is most appropriate?

• AReassurance and routine review because vomiting is physiological in the first trimester.
• BImmediate delivery because hyperemesis is an indication for pregnancy termination.
• CHospital assessment with intravenous fluids, electrolyte replacement, thiamine before dex…
• DHigh-dose oral iron as first-line therapy for ketonuria.

Which associated diagnosis should be considered when hyperemesis is unusually severe, begins very early, and the uterus is larger than expected for dates?

• APlacenta praevia.
• BAcute fatty liver of pregnancy.
• CMolar pregnancy.
• DIntrahepatic cholestasis of pregnancy.

A 12-week combined screening test reports increased risk of trisomy 21. Which counselling statement is most appropriate?

• AScreening estimates risk; diagnostic confirmation requires invasive testing such as chori…
• BA high-risk screening result confirms trisomy 21 and should be managed as a fetal diagnos…
• CA normal detailed anomaly scan later in pregnancy will definitively exclude trisomy 21.
• DNon-invasive prenatal testing always replaces the need for diagnostic testing after a hig…

Which ultrasound marker is a key component of first-trimester combined screening for trisomy 21?

• AUmbilical artery absent end-diastolic flow.
• BEstimated fetal weight below the 3rd centile.
• CPlacental cord insertion site.
• DNuchal translucency thickness.

A pregnant patient at 28 weeks has haemoglobin 92 g/L and ferritin 8 micrograms/L. Mean cell volume is low. What is the most likely diagnosis?

• APhysiological haemodilution only.
• BIron deficiency anaemia.
• CVitamin B12 deficiency.
• DBeta-thalassaemia major newly presenting in pregnancy.

A patient with iron deficiency anaemia at 30 weeks cannot tolerate oral iron and remains symptomatic. Which treatment is most appropriate?

• ANo treatment until after delivery.
• BIntravenous iron after assessing contraindications and gestational context.
• CRoutine red cell transfusion solely because ferritin is low.
• DFolate alone because all pregnancy anaemia is megaloblastic.

An unsensitised RhD-negative pregnant patient has vaginal bleeding at 13 weeks. What is the key purpose of anti-D immunoglobulin when indicated?

• ATo treat established fetal anaemia caused by anti-D antibodies.
• BTo prevent miscarriage by suppressing uterine contractions.
• CTo determine fetal RhD status by passive antibody transfer.
• DTo reduce the risk of maternal alloimmunisation against RhD-positive fetal red cells.

An RhD-negative patient is found to have immune anti-D antibodies at booking. Which implication is most important?

• AAnti-D prophylaxis will not reverse sensitisation, and the pregnancy needs fetal anaemia…
• BRoutine anti-D prophylaxis will remove the antibodies before delivery.
• CNo further assessment is needed unless the patient has vaginal bleeding.
• DThe fetus is unaffected because maternal IgG cannot cross the placenta.

A patient at 31 weeks has blood pressure 152/96 mmHg on repeat measurement and new proteinuria. She previously had normal blood pressure. What is the most appropriate diagnosis?

• AChronic hypertension.
• BWhite-coat hypertension only.
• CPre-eclampsia.
• DGestational trophoblastic disease.

A patient with pre-eclampsia develops severe headache, visual symptoms, epigastric pain, and blood pressure 170/112 mmHg at 34 weeks. What is the most appropriate immediate management principle?

• AArrange routine outpatient review in one week if fetal movements are normal.
• BGive oral iron and repeat blood pressure at the next scheduled antenatal visit.
• CAdmit urgently, control severe hypertension, assess maternal-fetal status, give magnesium…
• DAvoid antihypertensive treatment because it may mask the diagnosis.

Which patient has a clear indication for early pregnancy risk assessment for gestational diabetes?

• APrevious pregnancy complicated by gestational diabetes.
• BOne previous spontaneous vaginal birth of a 3100 g infant.
• CAge 24 years with no medical history and normal body mass index.
• DResolved first-trimester nausea without ketonuria.

A patient is diagnosed with gestational diabetes at 26 weeks. Fasting and postprandial glucose values are mildly elevated. What is the usual first management step if there are no urgent fetal or maternal concerns?

• AImmediate elective delivery because the diagnosis itself is an indication.
• BStop all carbohydrate intake until glucose values normalise.
• CTreat only after fetal macrosomia is confirmed on ultrasound.
• DDietary and physical activity advice with home glucose monitoring and escalation if targe…

At 32 weeks, ultrasound shows estimated fetal weight below the 3rd centile with elevated umbilical artery pulsatility index. What is the most likely interpretation?

• AConstitutionally small fetus with normal placental function.
• BFetal growth restriction with evidence of placental insufficiency.
• CIncorrect fetal sex assignment causing weight underestimation.
• DNormal third-trimester finding requiring no further surveillance.

A fetus with suspected growth restriction has absent end-diastolic flow in the umbilical artery at 30 weeks. Which management principle is most appropriate?

• ADischarge to routine antenatal care because absent end-diastolic flow is benign before 34…
• BIncrease surveillance in a specialist setting and balance prematurity against risk of fet…
• CInduce labour immediately in all cases regardless of fetal condition or neonatal faciliti…
• DUse maternal oral iron as definitive treatment for abnormal umbilical artery Doppler.

A woman at 30+2 weeks has confirmed preterm prelabour rupture of membranes. She is afebrile, the fetal heart rate is normal, there is no uterine tenderness and no bleeding. Which management is most appropriate?

• AImmediate induction with prostaglandin because latency is always harmful after membrane r…
• BOutpatient reassurance without antibiotics because infection is unlikely before 34 weeks
• CEmergency caesarean birth because PPROM itself is an absolute indication
• DExpectant management with maternal and fetal surveillance, latency antibiotics, antenatal…

A nulliparous woman at 28+5 weeks has painful regular contractions, intact membranes and cervical dilatation of 3 cm. There is no infection or bleeding. Which package of treatment best addresses the major fetal risks while allowing short-term delay of birth?

• ANifedipine tocolysis, antenatal corticosteroids and magnesium sulfate for fetal neuroprot…
• BOral betamimetic tocolysis alone until 37 weeks
• CImmediate caesarean birth because preterm labour is established
• DProgesterone therapy as acute treatment for the current labour

A woman at 31+4 weeks received a full course of antenatal corticosteroids at 28 weeks. She now has recurrent threatened preterm birth and is judged very likely to deliver within 48 hours. Which statement about further corticosteroids is correct?

• AWeekly corticosteroid courses should be given until 34 weeks
• BRepeat corticosteroids are contraindicated once membranes have ruptured
• CA single repeat course may be considered because the first course was more than 7 days ag…
• DCorticosteroids should be deferred until cervical dilatation reaches 6 cm

A woman receiving magnesium sulfate develops respiratory rate 8/minute, absent patellar reflexes and oliguria. What is the most appropriate immediate response?

• AIncrease the magnesium infusion because oliguria suggests inadequate dosing
• BContinue the infusion and recheck reflexes in 4 hours
• CStop magnesium sulfate, call for urgent senior review, support airway and breathing, and…
• DGive an additional magnesium bolus because absent reflexes predict eclampsia

During oxytocin augmentation at 39 weeks, the CTG shows baseline 170 beats/minute, variability less than 5 beats/minute for 60 minutes and recurrent late decelerations. What is the best interpretation and response?

• APathological CTG; stop oxytocin, correct reversible causes and expedite birth if the trac…
• BNormal CTG; continue oxytocin because the baseline is below 180 beats/minute
• CSuspicious CTG; repeat the review after 2 hours if labour progresses
• DBenign sleep cycling; give maternal sedation and continue observation

Which intrapartum situation is a clear indication to advise continuous CTG monitoring rather than intermittent auscultation?

• ALow-risk spontaneous labour with normal fetal movements and clear liquor
• BLatent phase contractions at home with no maternal or fetal risk factors
• CAntenatal screening CTG in an otherwise uncomplicated pregnancy
• DEstablished labour being augmented with an intravenous oxytocin infusion

A woman at 41+0 weeks is admitted for induction of labour. The fetus is cephalic, the head is well applied and the Bishop score is 8. Which induction method is most appropriate?

• ADinoprostone for cervical ripening because all inductions require prostaglandin first
• BAmniotomy with an intravenous oxytocin infusion
• CHigh-dose oral misoprostol every hour until contractions start
• DCaesarean birth because a favourable cervix makes induction unsafe

A woman receiving oxytocin in labour develops 6 contractions per 10 minutes with recurrent fetal heart rate decelerations. What is the most appropriate initial management?

• AIncrease oxytocin until cervical dilatation accelerates
• BStop oxytocin, reposition the woman, assess hydration and fetal status, and consider acut…
• CPerform fundal pressure to shorten the second stage
• DGive prostaglandin because oxytocin tachysystole indicates receptor exhaustion

After delivery of the fetal head, it retracts against the perineum and the shoulders do not deliver with gentle traction. What is the correct first-line response?

• AApply fundal pressure to push the anterior shoulder under the symphysis
• BCut an episiotomy and continue downward traction until the shoulder delivers
• CImmediately perform caesarean birth without attempting vaginal manoeuvres
• DCall for help, announce shoulder dystocia, avoid excessive traction, perform McRoberts ma…

A woman has an uncomplicated singleton breech pregnancy at 36+6 weeks and wishes to maximise her chance of cephalic vaginal birth. There is no placenta praevia, fetal compromise or contraindication to vaginal birth. What should be offered?

• AExternal cephalic version in an appropriate setting with fetal assessment and access to u…
• BImmediate induction of labour while the fetus remains breech
• CRoutine internal podalic version in early labour
• DNo intervention because breech presentation at this gestation is always transient

A fetal bradycardia occurs in the second stage. The cervix is 9 cm dilated, membranes are ruptured, the head is at +1 station and the fetal head position is uncertain. Which statement is correct regarding operative vaginal birth?

• AVacuum extraction is appropriate because the membranes are ruptured
• BForceps birth is appropriate because fetal bradycardia overrides prerequisites
• COperative vaginal birth should not be attempted because full dilatation and known fetal h…
• DOutlet forceps are indicated because the station is above the ischial spines

A woman at 32+0 weeks is fully dilated with a live cephalic fetus and urgent need to expedite birth. The head is low and position is known. Which statement about vacuum extraction is most appropriate?

• AVacuum extraction is preferred at 32 weeks because the preterm skull is easier to deliver
• BVacuum extraction is safe at any gestation if the operator is experienced
• CVacuum extraction is generally avoided before 34 weeks because of the increased risk of n…
• DVacuum extraction should be used only after a failed forceps attempt

At 38 weeks, umbilical cord prolapse is diagnosed after spontaneous membrane rupture. The fetal heart rate is 70 beats/minute and the cervix is 4 cm dilated. Which is the most appropriate management?

• AProceed to emergency caesarean birth while taking measures to relieve cord compression
• BBegin oxytocin augmentation and await vaginal birth
• CReplace the cord into the uterus and discharge if the fetal heart rate recovers
• DApply vacuum extraction because cord prolapse is best managed vaginally at any dilatation

A pregnant woman has a previous caesarean scar and an anterior low-lying placenta on ultrasound. Which complication is particularly important to assess for?

• AShoulder dystocia because previous caesarean scar increases fetal bisacromial diameter
• BTwin-to-twin transfusion because the placenta is anterior
• CUterine inversion because the placenta is low-lying
• DPlacenta accreta spectrum because placenta praevia over a uterine scar substantially incr…

Ten minutes after vaginal birth, a woman has heavy bleeding and a soft, enlarged uterus. The placenta appears complete. What is the most appropriate immediate management?

• AObserve for 30 minutes because this is physiological lochia
• BUterine massage, call for help, intravenous access, oxytocin, early tranexamic acid and s…
• CGive anticoagulation because the uterus is enlarged
• DProceed directly to hysterectomy before using uterotonics

Immediately after placental delivery, a woman has severe pain, shock out of proportion to visible bleeding, an absent uterine fundus abdominally and a red mass at the introitus. What is the priority management?

• AStart high-dose oxytocin before touching the uterus
• BImmediate manual replacement of the inverted uterus with resuscitation and senior help, f…
• CApply fundal pressure to push the uterus back through the cervix
• DWait for spontaneous correction because most inversions self-resolve

On day 3 after caesarean birth, a woman has fever, tachycardia, hypotension, uterine tenderness and offensive lochia. What is the most appropriate initial management?

• AOral antipyretics and review the next day if fever persists
• BDelay antibiotics until a positive blood culture identifies the organism
• CStart anticoagulation alone because postpartum tachycardia is most often pulmonary emboli…
• DImmediate senior assessment, sepsis screening, cultures if this does not delay treatment,…

Five days after emergency caesarean birth, a woman develops pleuritic chest pain, dyspnoea and oxygen saturation 91% on air. Pulmonary embolism is suspected and there is no major bleeding risk. What is the most appropriate immediate management?

• AStart therapeutic low molecular weight heparin while arranging objective diagnostic imagi…
• BReassure because mild dyspnoea is common after caesarean birth
• CWait for D-dimer before giving anticoagulation
• DGive a direct oral anticoagulant as first-line treatment before imaging

A breastfeeding woman needs ongoing anticoagulation after a confirmed postpartum pulmonary embolism. Which anticoagulant option is generally compatible with breastfeeding?

• ARivaroxaban as the default first-line breastfeeding anticoagulant
• BNo anticoagulant because breastfeeding protects against recurrent VTE
• CWarfarin or low molecular weight heparin
• DHigh-dose aspirin alone as definitive treatment for pulmonary embolism

A woman 6 days postpartum is not sleeping, is increasingly agitated, says the baby is possessed and has fleeting thoughts of harming herself. What is the most appropriate response?

• ARoutine health visitor follow-up because transient mood change is expected in the first w…
• BAdvise stopping breastfeeding and review in 6 weeks
• CUrgent same-day specialist perinatal mental health assessment and safety planning, with c…
• DStart hypnotics only and discharge if she sleeps for one night

A woman has intrusive flashbacks, avoidance of maternity appointments and hyperarousal after an emergency birth in which she believed she and the baby would die. Which treatment is most specifically indicated if post-traumatic stress disorder is diagnosed?

• ATrauma-focused psychological therapy such as trauma-focused CBT or EMDR
• BSingle-session debriefing for everyone after traumatic birth
• CBenzodiazepines as sole long-term treatment
• DReassurance that symptoms cannot be PTSD because the baby survived

A breastfeeding woman 2 weeks postpartum has unilateral breast pain, erythema and fever. There is no fluctuance. What advice is most appropriate?

• AStop breastfeeding from both breasts until all symptoms have resolved
• BBind the breasts tightly to suppress lactation
• CAvoid all anti-inflammatory medication because it enters breast milk
• DContinue breastfeeding or milk expression, optimise latch and milk removal, use analgesia…