FMGE 2019 - Obstetrics and Gynecology Practice Questions

Q: Bacterial vaginosis is caused by all except

Proteus. ***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.

Q: Amsel's criteria are used for?

Bacterial vaginosis. ***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.

Q: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

>=5. ***>=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.

Q: 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?

Hysterosalpingography. ***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**.

Q: 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?

Uterine scar rupture with Laparotomy. ***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.

Q: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

OCP. ***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.

Q: Double decidual sign is seen in?

Uterine gestational sac. ***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.

Q: 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?

Hep B vaccine+ IG. ***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.

Question 1

Bacterial vaginosis is caused by all except

Accepted Answer

Proteus

Answer

Coccobacillus

Answer

Mobiluncus

Answer

Gardnerella

Question 2

Amsel's criteria are used for?

Accepted Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

Trichomoniasis

Answer

Chlamydia infection

Question 3

A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

Accepted Answer

>=5

Answer

>2

Answer

>3

Answer

>4

Question 4

A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?

Accepted Answer

Hypertension diagnosed after 20 weeks of gestation without proteinuria

Answer

Hypertension diagnosed before 20 weeks of gestation

Answer

Hypertension with proteinuria or end-organ damage

Answer

Hypertension with seizures

Question 5

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?

Accepted Answer

Hysterosalpingography

Answer

Urine culture and sensitivity

Answer

Repeat USG

Answer

Endometrial biopsy

Question 6

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?

Accepted Answer

Uterine scar rupture with Laparotomy

Answer

Abruptio and C-section

Answer

Ectopic pregnancy and abortion

Answer

Impending dehiscence and Laparoscopy

Question 7

A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

Accepted Answer

OCP

Answer

Barrier method

Answer

Calendar method

Answer

Progesterone only pills

Question 8

Double decidual sign is seen in?

Accepted Answer

Uterine gestational sac

Answer

Pseudo gestational sac

Answer

Threatened Abortion

Answer

Ectopic pregnancy

Question 9

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?

Accepted Answer

Hep B vaccine+ IG

Answer

Hep B vaccine only

Answer

Only IG

Answer

First IG then Hep B vaccine after 1 month

FMGE 2019 — Obstetrics and Gynecology