Bacterial vaginosis is caused by all except
Amsel's criteria are used for?
A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):
A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?
A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?
A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?
A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?
Double decidual sign is seen in?
A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
FMGE 2019 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 21: Bacterial vaginosis is caused by all except
- A. Coccobacillus
- B. Mobiluncus
- C. Proteus (Correct Answer)
- D. Gardnerella
Explanation: ***Proteus*** - **Proteus** species are commonly associated with **urinary tract infections (UTIs)** and wound infections, not typically with bacterial vaginosis. - The presence of **Proteus** in vaginal flora is generally considered an opportunistic infection rather than a causative agent of BV. *Coccobacillus* - **Coccobacillary bacteria**, such as **Gardnerella vaginalis**, are primary organisms contributing to the polymicrobial shift that defines bacterial vaginosis. - The disruption of normal lactobacilli dominance allows for the overgrowth of these specific anaerobic and facultative organisms. *Mobiluncus* - **Mobiluncus species** are curved, rod-shaped anaerobic bacteria frequently found in high numbers in women with bacterial vaginosis. - They are considered key anaerobic bacteria involved in the microbial imbalance characteristic of BV. *Gardnerella* - **Gardnerella vaginalis** is the most commonly isolated bacterium in bacterial vaginosis and is considered the primary initiating organism. - While BV is polymicrobial, **Gardnerella's** overgrowth is central to the diagnostic criteria and pathogenesis.
Question 22: Amsel's criteria are used for?
- A. Candidiasis
- B. Trichomoniasis
- C. Chlamydia infection
- D. Bacterial vaginosis (Correct Answer)
Explanation: ***Bacterial vaginosis*** - **Amsel's criteria** are a set of four clinical signs used to diagnose **bacterial vaginosis**, a common vaginal infection. - At least three of the four criteria must be present for a positive diagnosis: **thin, white, homogeneous discharge**, **clue cells** on microscopy, vaginal pH >4.5, and a **fishy odor** before or after adding 10% KOH (whiff test). *Candidiasis* - Diagnosed based on clinical symptoms such as **pruritus** and thick, white, **"cottage cheese-like" discharge**, along with identification of yeast (hyphae/pseudohyphae) on microscopy. - **Amsel's criteria** are not used for its diagnosis. *Trichomoniasis* - Typically diagnosed by microscopic observation of **motile trichomonads** in a wet mount, or by nucleic acid amplification tests (NAATs). - It presents with a **foamy, yellow-green discharge** and sometimes a **"strawberry cervix"**, none of which are part of Amsel's criteria. *Chlamydia infection* - Primarily diagnosed using **nucleic acid amplification tests (NAATs)** from urine or swab samples. - It is often **asymptomatic** or presents with non-specific symptoms like discharge or dysuria, and **Amsel's criteria** are not applicable.
Question 23: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):
- A. >2
- B. >=5 (Correct Answer)
- C. >3
- D. >4
Explanation: ***>=5*** - A **grand multipara** is defined as a woman who has delivered **five or more** viable fetuses (live births or stillbirths after 20 weeks of gestation). - This classification is important clinically due to the increased risks associated with grand multiparity, such as **postpartum hemorrhage** and complications during labor. *>2* - This definition is too broad, as a woman with 3 or 4 live births is considered a **multipara**, but not specifically a grand multipara. - The term **multipara** generally applies to women who have had two or more live births. *>3* - This definition includes women with 4 live births, who are considered **multipara** but do not meet the stricter criteria for **grand multipara**. - The term **grand multipara** specifically denotes a higher number of deliveries with associated increased obstetric risks. *>4* - While close, this definition would include a woman with 5 live births, but it does not specify "five or more." - The precise definition of a **grand multipara** is five or more, which carries specific clinical implications for pregnancy management.
Question 24: A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?
- A. Hypertension diagnosed before 20 weeks of gestation
- B. Hypertension diagnosed after 20 weeks of gestation without proteinuria (Correct Answer)
- C. Hypertension with proteinuria or end-organ damage
- D. Hypertension with seizures
Explanation: ***Hypertension diagnosed after 20 weeks of gestation without proteinuria*** - This scenario describes **gestational hypertension**, defined as new-onset hypertension (≥140/90 mmHg) presenting *after* 20 weeks of gestation, without associated proteinuria or other signs of preeclampsia. - The patient's presentation at **26 weeks** with **no proteinuria** directly aligns with the diagnostic criteria for gestational hypertension. *Hypertension diagnosed before 20 weeks of gestation* - This description corresponds to **chronic hypertension**, meaning the hypertension was present *before* pregnancy or diagnosed *before* 20 weeks of gestation. - The question explicitly states the hypertension is presenting for the **first time** and the gestational age is **26 weeks**, ruling out chronic hypertension. *Hypertension with proteinuria or end-organ damage* - This definition describes **preeclampsia**, which involves new-onset hypertension *after* 20 weeks accompanied by significant **proteinuria** or signs of **end-organ damage** like renal insufficiency, liver dysfunction, or thrombocytopenia. - The patient specifically has **no proteinuria**, making preeclampsia an unlikely diagnosis based on the provided information. *Hypertension with seizures* - This refers to **eclampsia**, a severe complication of preeclampsia characterized by the development of **generalized tonic-clonic seizures** in a pregnant patient with preeclampsia, unrelated to other brain conditions. - The patient in this case is not experiencing seizures; therefore, eclampsia is not the correct diagnosis.
Question 25: A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?
- A. Urine culture and sensitivity
- B. Repeat USG
- C. Hysterosalpingography (Correct Answer)
- D. Endometrial biopsy
Explanation: ***Hysterosalpingography*** - Given the history of **pelvic inflammatory disease (PID)**, there is a significant risk of **tubal blockage** or damage, which is a common cause of **infertility**. - **Hysterosalpingography (HSG)** is the gold standard investigation to assess the patency and morphology of the **fallopian tubes** and uterine cavity. *Urine culture and sensitivity* - This test is used to detect **urinary tract infections**. While important in general health, it is rarely the primary cause of infertility in the absence of urinary symptoms. - The patient's history of **PID** points towards gynecological causes rather than urinary ones as the likely source of infertility. *Repeat USG* - The initial **ultrasound (USG)** has already shown normal organs, indicating no obvious uterine or ovarian structural abnormalities. - Repeating the same investigation without new symptoms or findings is unlikely to provide additional diagnostic information regarding infertility, especially not **tubal patency**. *Endometrial biopsy* - An **endometrial biopsy** is typically performed to assess the health of the **uterine lining** for conditions like chronic endometritis or abnormal uterine bleeding. - While helpful in specific scenarios, it does not evaluate **fallopian tubal patency**, which is a crucial step in assessing infertility after **PID**.
Question 26: A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?
- A. Abruptio and C-section
- B. Ectopic pregnancy and abortion
- C. Impending dehiscence and Laparoscopy
- D. Uterine scar rupture with Laparotomy (Correct Answer)
Explanation: ***Uterine scar rupture with Laparotomy*** - The presentation of **low blood pressure**, **tachycardia**, and **free fluid in the peritoneum** in a 36-week pregnant woman with a **previous C-section** is highly indicative of uterine scar rupture given the signs of **hemorrhagic shock**. - **Laparotomy** (emergency abdominal surgery) is the immediate and definitive management to repair the ruptured uterus, control bleeding, and deliver the fetus. *Abruptio and C-section* - **Placental abruption** typically presents with painful vaginal bleeding, uterine tenderness, and fetal distress, which are not explicitly mentioned as the primary symptoms here. - While a **C-section** would be indicated for abruption, the presence of free fluid in the peritoneum and hemodynamic instability in a woman with a prior C-section points more towards rupture. *Ectopic pregnancy and abortion* - An **ectopic pregnancy** is ruled out by the 36-week gestational age; these occur much earlier in pregnancy. - An **abortion** refers to the termination of pregnancy and does not cause these specific signs and symptoms at 36 weeks. *Impending dehiscence and Laparoscopy* - **Impending dehiscence** (separation of the uterine scar without complete rupture) would likely cause localized pain but typically not the severe signs of **hypovolemic shock** and free peritoneal fluid seen here. - **Laparoscopy** is a minimally invasive procedure and would not be appropriate for the emergency management of a potentially life-threatening hemorrhage from uterine rupture.
Question 27: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?
- A. Barrier method
- B. Calendar method
- C. OCP (Correct Answer)
- D. Progesterone only pills
Explanation: ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content. - They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman. *Barrier method* - **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles. - Their effectiveness depends heavily on consistent and correct use with each act of intercourse. *Calendar method* - The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**. - It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy. *Progesterone only pills* - **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**. - While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.
Question 28: Double decidual sign is seen in?
- A. Pseudo gestational sac
- B. Threatened Abortion
- C. Uterine gestational sac (Correct Answer)
- D. Ectopic pregnancy
Explanation: ***Uterine gestational sac*** - The **double decidual sign** is a normal sonographic finding in early **intrauterine pregnancies**, representing the interface between the decidua capsularis and the decidua parietalis/vera. - It indicates a **viable intrauterine pregnancy** and helps differentiate it from a pseudogestational sac or ectopic pregnancy. *Pseudo gestational sac* - A pseudogestational sac is a collection of fluid within the **endometrial cavity** associated with an ectopic pregnancy. - It typically lacks the **double decidual sign** and may show internal echoes or irregular shape. *Threatened Abortion* - While it involves an intrauterine pregnancy, a threatened abortion is characterized by **vaginal bleeding** and/or mild cramping, with a closed cervix. - The presence of a **double decidual sign** confirms an intrauterine gestation but does not rule out the threat of abortion, as the viability is assessed by the presence of a fetal pole and heart activity. *Ectopic pregnancy* - An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the **fallopian tubes**. - It will **not show a double decidual sign** within the uterus, although a pseudogestational sac might be present.
Question 29: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
- A. Hep B vaccine+ IG (Correct Answer)
- B. Hep B vaccine only
- C. Only IG
- D. First IG then Hep B vaccine after 1 month
Explanation: ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.