FMGE 2019 - Obstetrics and Gynecology PYQs Practice Questions

Q: A 32-year-old pregnant woman presents with mild bleeding and pain. On examination, the uterus is tender, and fetal heart sounds are absent. What is the most likely diagnosis?

Abruptio placenta. ***Abruptio placenta*** - This condition involves the **premature detachment of the placenta** from the uterine wall, leading to bleeding and severe abdominal pain due to uterine contractions and irritation. - The **tender uterus** is a characteristic finding, often described as a "woody hard" uterus in severe cases. - The absence of fetal heart sounds suggests **fetal demise**, which is a common and severe complication of placental abruption due to oxygen deprivation. *Uterine rupture* - **Uterine rupture** can present with abdominal pain, vaginal bleeding, and loss of fetal heart tones, making it an important differential. - However, it typically occurs during **active labor**, especially in women with previous cesarean sections or uterine surgery. - The presentation usually includes **sudden severe pain**, loss of uterine contractions, and the fetus may be palpable abdominally if completely extruded. *Ectopic pregnancy* - This occurs when the **fertilized egg implants outside the uterus**, most commonly in the fallopian tube. - Symptoms typically appear much earlier in pregnancy **(first trimester)** and the pain is usually localized, often presenting with a smaller, non-tender uterus. - Not consistent with the clinical picture of an obviously pregnant uterus. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical opening, leading to **painless vaginal bleeding**, often bright red. - The uterus is typically **soft and non-tender**, in contrast to the tender uterus described in the case. - This is the key differentiating feature from placental abruption. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the dose of mifepristone in medical abortion?

200 mg. ***200 mg*** - The standard dose of **mifepristone** for **medical abortion** in various protocols, including those up to 10 weeks of gestation, is **200 mg orally**. - This dose effectively blocks **progesterone receptors**, leading to endometrial breakdown and sensitization of the uterus to prostaglandins. - **WHO-recommended dose** with optimal efficacy and safety profile. *400 mg* - **400 mg is not a standard or recommended dose** for medical abortion in any established protocol. - The evidence-based regimens use either **200 mg** (current standard) or 600 mg (older protocol), but not 400 mg. - No clinical advantage has been demonstrated for this intermediate dose. *100 mg* - A dose of **100 mg of mifepristone is considered suboptimal** and less effective for inducing medical abortion compared to the standard 200 mg dose. - It may not sufficiently block progesterone receptors, potentially leading to **incomplete abortion** or treatment failure. - Not recommended in any standard medical abortion protocol. *600 mg* - Although **600 mg was an older protocol** for medical abortion, it has largely been replaced by the **200 mg dose**. - Research has demonstrated that **200 mg is equally effective** while resulting in a better side effect profile and lower cost. - The dose reduction from 600 mg to 200 mg represents evidence-based protocol optimization. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?

Vesicovaginal fistula. ***Vesicovaginal fistula*** - The continuous passage of urine from the vagina following delivery, especially in the context of an intrauterine fetal death where prolonged or difficult labor might occur, is highly suggestive of a **vesicovaginal fistula**. - A fistula creates an abnormal connection between the **bladder** and the **vagina**, leading to continuous urine leakage. *Urge incontinence* - Characterized by an **involuntary loss of urine** associated with a sudden, strong desire to void. - This is typically due to an **overactive detrusor muscle** and would not cause continuous leakage, especially not through the vagina itself after a delivery. *Stress incontinence* - Defined by the leakage of urine with activities that **increase intra-abdominal pressure**, such as coughing, sneezing, or laughing. - It results from weakness of the **pelvic floor muscles** or urethral sphincter, not continuous drainage from the vagina. *Bladder rupture* - While a bladder rupture can cause urinary leakage, it usually presents with **acute abdominal pain**, abdominal distension, and possibly **hematuria**, along with urine accumulating in the peritoneal cavity, rather than continuous passage solely from the vagina. - A rupture would likely be an acute, more severe event with systemic symptoms, distinct from the described continuous vaginal leakage of urine. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A woman comes after 96 hours post coitus. Best contraceptive of choice is?

IUCD. ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Uterine atony. ***Uterine atony*** - The most common cause of **postpartum hemorrhage (PPH)**, accounting for 70-80% of cases - **Multiparity** (Grand multipara with 5 deliveries) is a major risk factor, as repeated pregnancies lead to **overdistension and decreased uterine muscle tone** - Uterine atony is the failure of the myometrium to contract adequately after placental delivery, preventing compression of spiral arteries - Part of the **"4 Ts" mnemonic** for PPH causes: **Tone** (atony), Trauma, Tissue, Thrombin *Genital tract trauma* - Second most common cause of PPH (approximately 20% of cases) - Includes cervical lacerations, vaginal tears, or perineal trauma - However, the question specifically mentions **"normal vaginal delivery"** and bleeding **"after placenta removal"**, making trauma less likely - Trauma-related bleeding typically occurs **during or immediately after delivery**, not specifically post-placental *Retained placental tissue* - Accounts for approximately 10% of PPH cases - The question states the placenta **"is removed"**, suggesting complete placental delivery - If placental fragments were retained, bleeding would persist due to inability of the uterus to contract fully - Less likely given the clinical scenario described *Coagulation disorders* - Least common cause of primary PPH (1-2% of cases) - Includes conditions like **DIC, thrombocytopenia, or inherited coagulopathies** - No clinical history suggesting coagulopathy (e.g., no bleeding during pregnancy, no family history) - Would typically present with **oozing from multiple sites**, not just uterine bleeding [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A 32-year-old pregnant woman presents with mild bleeding and pain. On examination, the uterus is tender, and fetal heart sounds are absent. What is the most likely diagnosis?

Accepted Answer

Abruptio placenta

Answer

Uterine rupture

Answer

Ectopic pregnancy

Answer

Placenta previa

Question 2

What is the dose of mifepristone in medical abortion?

Accepted Answer

200 mg

Answer

400 mg

Answer

100 mg

Answer

600 mg

Question 3

A 32-year-old lady with intrauterine fetal death after normal vaginal delivery has continuous passage of urine from the vagina. What is the most probable diagnosis?

Accepted Answer

Vesicovaginal fistula

Answer

Urge incontinence

Answer

Stress incontinence

Answer

Bladder rupture

Question 4

A woman comes after 96 hours post coitus. Best contraceptive of choice is?

Accepted Answer

IUCD

Answer

Progesterone only pills

Answer

OCP

Answer

Mifepristone

Question 5

A 34-year-old lady with 4 children, after her 5th normal vaginal delivery, experiences excessive bleeding after the placenta is removed. What is the cause for this?

Accepted Answer

Uterine atony

Answer

Genital tract trauma

Answer

Retained placental tissue

Answer

Coagulation disorders

Question 6

A 67-year-old female with hypertension and diabetes presents with heavy vaginal bleeding. What is the next step in management?

Accepted Answer

Endometrial biopsy

Answer

Pelvic ultrasound

Answer

Detailed history and physical examination

Answer

Complete blood count and coagulation studies

Question 7

A 16-year-old girl with acute vaginal bleeding presents to the clinic. What is the immediate management?

Accepted Answer

Stabilize the patient and investigate the cause of bleeding

Answer

Administer high-dose estrogen

Answer

Perform dilation and curettage

Answer

Start tranexamic acid

Question 8

Angle of cut in episiotomy is?

Accepted Answer

60 degrees at the midline

Answer

45 degrees at the midline

Answer

30 degrees at the midline

Answer

15 degrees at the midline

Question 9

A multigravida woman in labor room, after delivery and placenta removal, uncontrolled bleeding was seen. What is the most common cause of PPH in this woman?

Accepted Answer

Atony

Answer

Clotting factor deficiency

Answer

Traumatic PPH

Answer

Retained tissues

Question 10

Most common organism causing the pelvic inflammatory disease?

Accepted Answer

Chlamydia

Answer

Gardnerella Vaginalis

Answer

Bacteroides

Answer

Neisseria gonorrhoeae

FMGE 2019 — Obstetrics and Gynecology