Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) Basic and Applied Sciences for Reproductive Health (Part 1 Foundations) Syllabus

Basic and Applied Sciences for Reproductive Health (Part 1 Foundations) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Basic and Applied Sciences for Reproductive Health (Part 1 Foundations) in Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG), not a summary of it.

1. 1

   Anatomy of the Pelvis and Reproductive Tract

   5 topics

   • Female pelvic anatomy
     • Bony pelvis, pelvic diameters and planes
     • Pelvic floor muscles and perineal body
     • Uterus, cervix, vagina: structure and supports
     • Ovaries, fallopian tubes and broad ligament
   • Pelvic blood supply, lymphatics and nerves
     • Internal iliac artery branches and anastomoses
     • Lymphatic drainage of pelvic organs
     • Autonomic and somatic pelvic innervation
   • Anterior abdominal wall and surgical access
     • Layers, rectus sheath and inguinal canal
     • Vessels and nerves at risk during entry
   • Ureter, bladder and lower urinary tract relations
   • Fetal skull, sutures, fontanelles and diameters
2. 2

   Reproductive Physiology and Endocrinology

   5 topics

   • Hypothalamic-pituitary-ovarian axis
     • GnRH pulsatility and gonadotrophin secretion
     • Feedback loops and the LH surge
   • Menstrual cycle and folliculogenesis
     • Follicular, ovulatory and luteal phases
     • Endometrial cycle and decidualisation
   • Steroidogenesis and sex hormone action
   • Puberty, the menopause and reproductive ageing
   • Male reproductive physiology and spermatogenesis
3. 3

   Maternal and Fetal Physiology

   5 topics

   • Maternal cardiovascular and haematological adaptation
     • Plasma volume, cardiac output and blood pressure
     • Coagulation changes and physiological anaemia
   • Respiratory, renal and gastrointestinal adaptation
   • Placental structure, transfer and endocrine function
   • Fetal circulation and transition at birth
   • Amniotic fluid dynamics and fetal growth
4. 4

   Biochemistry, Cell Biology and Endocrine Pathways

   4 topics

   • Carbohydrate, lipid and protein metabolism in pregnancy
   • Cell cycle, signalling and apoptosis
   • Membrane transport and receptor mechanisms
   • Acid-base balance and electrolyte regulation
5. 5

   Genetics and Molecular Medicine

   4 topics

   • Patterns of inheritance
     • Mendelian, X-linked and mitochondrial inheritance
     • Imprinting and non-Mendelian patterns
   • Chromosomal abnormalities and aneuploidy
   • Molecular techniques and genetic testing
     • PCR, karyotyping, microarray and NGS
     • Prenatal and preimplantation genetic diagnosis
   • Population genetics and Hardy-Weinberg principles
6. 6

   Microbiology, Immunology and Pharmacology

   4 topics

   • Organisms relevant to obstetrics and gynaecology
   • Principles of immunology and the immune response
     • Innate and adaptive immunity
     • Maternal-fetal immune tolerance and isoimmunisation
   • Pharmacokinetics and pharmacodynamics
     • Absorption, distribution, metabolism, excretion
     • Drug handling in pregnancy and lactation
   • Antimicrobials, uterotonics and tocolytics

Basic and Applied Sciences for Reproductive Health (Part 1 Foundations) flashcards for Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG)

24 of 63 cards from the Basic and Applied Sciences for Reproductive Health (Part 1 Foundations) deck — real questions with worked answers.

1. Which artery is the main blood supply to the uterus, and where does it cross the ureter?

   The uterine artery (a branch of the anterior division of the internal iliac artery). It crosses ANTERIOR (above) the ureter approximately $2\ \text{cm}$ lateral to the cervix — the classic "water under the bridge" relationship.

2. List the levels of pelvic support (DeLancey's three levels).

   Level I: apical support (uterosacral and cardinal ligaments suspending the cervix/upper vagina). Level II: lateral attachment of mid-vagina to the arcus tendineus fasciae pelvis. Level III: distal fusion to the perineal body, levator ani and urethra.

3. What are the three branches of the anterior division of the internal iliac artery that supply pelvic viscera, plus key parietal branches?

   Visceral: uterine, vaginal, and superior/inferior vesical arteries (plus middle rectal). Parietal branches of the anterior division include the obturator, internal pudendal and inferior gluteal arteries.

4. What are the lymphatic drainage routes of the cervix and of the ovary?

   Cervix drains to the parametrial, obturator, internal/external iliac and sacral nodes. The ovary drains along the gonadal (ovarian) vessels directly to the para-aortic nodes at the level of $L1$-$L2$.

5. Which nerve roots form the pudendal nerve and what is its course through the pelvis?

   The pudendal nerve arises from $S2$-$S3$-$S4$ ("$S2$, $3$, $4$ keep the genitals off the floor"). It exits via the greater sciatic foramen, loops around the ischial spine, and re-enters through the lesser sciatic foramen into the pudendal (Alcock's) canal.

6. Name the layers traversed in a Pfannenstiel incision from skin to peritoneum.

   Skin, subcutaneous (Camper's and Scarpa's) fat, rectus sheath (anterior), the rectus abdominis muscles (separated in the midline, not cut), transversalis fascia, extraperitoneal fat, and parietal peritoneum.

7. Why is a transverse (Pfannenstiel) incision generally stronger and less painful than a midline incision?

   It follows Langer's lines (skin tension lines), is closed against the natural pull of the abdominal muscles, has a lower dehiscence/incisional-hernia rate, and severs fewer nerves — but it gives more limited access and a higher risk of nerve entrapment (ilioinguinal/iliohypogastric).

8. What is the blood supply of the anterior abdominal wall above and below the umbilicus?

   Above the umbilicus: superior epigastric artery (from the internal thoracic artery). Below: inferior epigastric artery (from the external iliac), which is the vessel at risk during lateral port placement at laparoscopy.

9. Describe the three physiological constrictions of the ureter where calculi commonly lodge.

   (1) The pelviureteric junction, (2) where the ureter crosses the pelvic brim/bifurcation of the common iliac artery, and (3) the vesicoureteric junction as it enters the bladder wall.

10. What are the relations of the ureter as it passes through the female pelvis to the bladder?

    It crosses the pelvic brim anterior to the bifurcation of the common iliac artery, runs on the lateral pelvic wall medial to the internal iliac vessels, then passes beneath the uterine artery ("water under the bridge") ~$2\ \text{cm}$ lateral to the cervix before entering the bladder.

11. Name the sutures and fontanelles of the fetal skull.

    Sutures: sagittal, two coronal (frontal), two lambdoid, and the frontal (metopic) suture. Fontanelles: the anterior (bregma, diamond-shaped, junction of sagittal/coronal/frontal) and the posterior (lambda, triangular, junction of sagittal/lambdoid).

12. State the key fetal skull diameters and their measurements.

    Suboccipitobregmatic (well-flexed vertex) $= 9.5\ \text{cm}$; suboccipitofrontal $= 10.5\ \text{cm}$; occipitofrontal (deflexed) $= 11.5\ \text{cm}$; mentovertical (brow, largest) $= 13.5\ \text{cm}$; submentobregmatic (face) $= 9.5\ \text{cm}$; biparietal $= 9.5\ \text{cm}$.

13. Compare the pulsatile GnRH secretion pattern required for the follicular versus luteal phase.

    Rapid GnRH pulses (~every $60\text{-}90$ min) favour LH secretion (follicular/ovulatory); slower pulses (~every $3\text{-}4$ h) favour FSH and predominate in the luteal phase. Continuous (non-pulsatile) GnRH desensitises the pituitary and suppresses gonadotrophins.

14. What triggers the mid-cycle LH surge, and what does it cause?

    A sustained, rising oestradiol level above ~$200\text{-}300\ \text{pg/mL}$ for ~$48$ h switches oestrogen feedback from negative to POSITIVE, triggering the LH surge. The surge induces resumption of meiosis I (completion to metaphase II), ovulation ~$36$ h after surge onset, and luteinisation of the follicle.

15. Describe the two-cell, two-gonadotrophin theory of ovarian steroidogenesis.

    LH stimulates theca cells to convert cholesterol to androgens (androstenedione/testosterone). These androgens diffuse to granulosa cells, where FSH-induced aromatase converts them to oestrogens (oestradiol). Thecal cells lack aromatase; granulosa cells lack $17\alpha$-hydroxylase.

16. Outline the hormonal changes across the menstrual cycle (FSH, LH, oestradiol, progesterone).

    Early follicular: FSH rises, recruiting follicles. Late follicular: oestradiol rises sharply from the dominant follicle. Mid-cycle: LH (and FSH) surge → ovulation. Luteal: the corpus luteum secretes progesterone (and oestradiol), peaking ~day $21$; if no pregnancy, both fall and menstruation follows.

17. Trace the stages of folliculogenesis from primordial follicle to ovulation.

    Primordial → primary (cuboidal granulosa, zona pellucida forms) → secondary/preantral (theca develops) → antral/Graafian (fluid-filled antrum) → preovulatory dominant follicle. Early growth is gonadotrophin-independent; antral growth and dominant-follicle selection are FSH-dependent.

18. What is the rate-limiting step of steroidogenesis and which enzyme catalyses it?

    The rate-limiting step is transport of cholesterol into the mitochondrion by StAR (steroidogenic acute regulatory protein), followed by conversion of cholesterol to pregnenolone by the side-chain cleavage enzyme $\text{P450scc}$ (CYP11A1).

19. Contrast the mechanism of action of steroid hormones versus peptide hormones.

    Steroids (oestrogen, progesterone, testosterone) are lipophilic, cross the cell membrane and bind intracellular/nuclear receptors that act as transcription factors (slow, genomic). Peptides (FSH, LH, hCG) bind cell-surface G-protein-coupled receptors, acting via second messengers (cAMP) for rapid, non-genomic effects.

20. Define the Tanner stages and what initiates puberty hormonally.

    Tanner staging (1-5) grades breast and pubic hair development. Puberty is initiated by reactivation of pulsatile GnRH (driven by kisspeptin/KISS1 neurons). Typical sequence in girls: thelarche → adrenarche/pubarche → growth spurt → menarche.

21. What endocrine changes define the menopause?

    Ovarian follicular depletion causes a fall in oestradiol and inhibin B, releasing the pituitary from negative feedback so FSH rises (diagnostic FSH $> 30\ \text{IU/L}$, and $> \text{LH}$). Menopause is defined retrospectively after $12$ months of amenorrhoea; average age ~$51$ years.

22. Outline the stages of spermatogenesis and its duration.

    Spermatogonia (mitosis) → primary spermatocytes (meiosis I) → secondary spermatocytes (meiosis II) → spermatids → spermatozoa (spermiogenesis). The full cycle takes ~$70\text{-}74$ days, occurring in seminiferous tubules supported by Sertoli cells; Leydig cells produce testosterone under LH.

23. What are the roles of FSH and LH in the male, and of Sertoli versus Leydig cells?

    LH acts on Leydig cells to produce testosterone. FSH acts on Sertoli cells to support spermatogenesis and produce inhibin (negative feedback on FSH) and androgen-binding protein. Sertoli cells form the blood-testis barrier.

24. Summarise the maternal cardiovascular adaptations to pregnancy (cardiac output, SVR, BP, blood volume).

    Cardiac output rises ~$40\text{-}50\%$ (increased stroke volume then heart rate); systemic vascular resistance falls; blood pressure drops in the 2nd trimester then returns to baseline; plasma volume increases ~$50\%$ and red cell mass ~$20\text{-}30\%$.

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