FRANZCOG Written MCQ common mistakes
FRANZCOG Written MCQ · Understand the traps and how to avoid them.
Committing to a single diagnosis in a stem that gives conflicting or evolving findings (for example, pain plus bleeding in early pregnancy answered as 'threatened miscarriage' without weighing ectopic pregnancy), rather than ranking differentials by immediate risk.
Candidates pattern-match the most familiar keyword in the stem and stop reasoning once a plausible label appears; exam stems deliberately include distractors that fit a second diagnosis.
What to do instead
Before selecting, write the top three differentials and the one feature that best discriminates each; if any differential is immediately life-threatening, the answer must first address excluding or managing it. Practise with stems that contain one contradictory vital sign or symptom.
Answering the management question with the investigation or the diagnosis instead of the next step (for example, choosing 'serum beta-hCG' when the stem asks what to do first in a haemodynamically unstable patient).
Under time pressure candidates read the stem's clinical content and overlook the exact interrogative, and investigations feel like a safe, low-risk answer.
What to do instead
Underline the final question line first and classify it as diagnosis, investigation, immediate management, ongoing management, or counselling. Eliminate any option that belongs to a different category before comparing the remainder.
Ignoring the haemodynamic status, gestational age, or parity embedded in the stem and giving a management answer that would only be correct in a stable or later-gestation patient.
These modifiers sit in a single clause and are easy to skim past, and candidates default to the textbook management of the named condition rather than the patient in front of them.
What to do instead
Adopt a fixed stem-scrub routine: extract age, parity, gestation, vital signs, examination findings, and investigation results into a mental list before looking at the options. Re-read the stem after choosing to confirm the answer fits every listed parameter.
Treating guideline thresholds as approximate and choosing an option just outside the stated cut-off, for example offering expectant management at a beta-hCG level or endometrial thickness that mandates intervention.
Many candidates carry remembered clinical habits rather than current numeric criteria, and exam writers deliberately place options either side of a published threshold.
What to do instead
Build a one-page numeric sheet covering the thresholds tested in obstetrics and gynaecology (hCG discriminatory zones, endometrial thickness, cervical length, Bishop score components, glucose criteria, blood pressure definitions) and revise it weekly until recall is exact.
Selecting an intervention that is contraindicated by a comorbidity listed in the stem, such as a prostaglandin in severe asthma, a combined hormonal method in migraine with aura, or ergometrine in hypertension.
Attention is focused on the primary condition and the past-medical-history line is treated as background rather than as the discriminator between two otherwise reasonable options.
What to do instead
Before finalising, scan the stem specifically for contraindication triggers (asthma, migraine, hypertension, thromboembolism, liver disease, smoking, breastfeeding) and check the chosen drug or device against each one.
Choosing the most definitive surgical answer for a scenario where the stem's fertility plans, patient preference, or acuity point to a conservative or medical first step.
Surgical options feel decisive and candidates equate 'best management' with 'most complete treatment', discounting the counselling and preference cues in the stem.
What to do instead
When two options are both clinically valid, apply the hierarchy: resuscitate and stabilise, confirm diagnosis, least invasive effective option consistent with the patient's stated priorities. Look explicitly for phrases about future fertility or patient preference.
Misreading the direction of a risk or screening question, for example answering with the positive predictive value when the stem asks what a negative result means, or confusing relative and absolute risk reduction.
Statistical terms look similar under time pressure and candidates answer the question they expected rather than the one written.
What to do instead
Restate the question in plain words before answering ('what is the chance of disease given a positive test?'). Keep a definitions card for sensitivity, specificity, predictive values, number needed to treat, and absolute versus relative risk, and apply the definition to the numbers given.
Overlooking the safest option when the stem describes a patient who is deteriorating or where the diagnosis is uncertain and the correct answer is escalation, senior review, or transfer rather than a specific therapy.
Candidates assume every question has a disease-specific answer and dismiss 'seek senior help' or 'urgent referral' options as filler.
What to do instead
Treat safety-netting and escalation options as genuine contenders. If the stem shows instability, uncertainty, or a situation beyond the stated scope of the setting, the safest option is frequently correct; compare it seriously against the specific therapy.
Spending disproportionate time on a small number of difficult items and then rushing the remaining questions, producing avoidable errors on straightforward stems.
Perfectionism plus the emotional pull of a familiar but tricky topic leads to repeated re-reading instead of a decision and move on.
What to do instead
Use a two-pass strategy: answer all items you can decide within a set time, flag the rest, and return only after completing the paper. Practise full-length timed papers so the pacing becomes automatic.
Changing a first answer on review without a specific new piece of evidence from the stem, or conversely refusing to revisit a flagged item where a misread word has been identified.
Anxiety during review produces second-guessing, while fatigue produces failure to re-check; both distort accuracy in opposite directions.
What to do instead
Only change an answer if you can name the stem word or fact that was misread. During review, re-read the final question line and the key modifiers rather than re-deriving the whole clinical scenario.