FMGE 2023 — Obstetrics and Gynecology
22 Previous Year Questions with Answers & Explanations
Ovarian drilling is done in which of the following conditions?
Which type of hysterectomy is done in a case of carcinoma cervix stage IB?
A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?
A patient presents with an endometrial thickness of 14mm with an adnexal mass. She has a history of complex endometrial hyperplasia with the presence of atypical cells. Which of the following is likely the diagnosis?
All of the following are true about audit in obstetrics except:
In a primigravida what is a satisfactory dilation rate?
A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?
A 28-year-old mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?
A woman presents with complaints of greenish-frothy vaginal discharge for 1 month. On examination, vulvovaginal erythema is noticed. On saline microscopy, motile organisms are seen. What is the most likely diagnosis?
If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?
FMGE 2023 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 1: Ovarian drilling is done in which of the following conditions?
- A. Endometriosis
- B. Ovarian tumor
- C. Polycystic ovarian syndrome (Correct Answer)
- D. Ovarian hyperstimulation syndrome
Explanation: ***Polycystic ovarian syndrome (PCOS)*** - **Ovarian drilling (laparoscopic ovarian diathermy)** is a surgical treatment specifically indicated for **clomiphene-resistant PCOS** - The procedure involves creating multiple small perforations in the ovarian capsule using diathermy or laser - **Mechanism:** Destroys androgen-producing ovarian stroma, reduces serum LH and androgens, restores ovulation in 50-70% of cases - **Indications:** Failed medical management with clomiphene citrate, as an alternative to gonadotropin therapy - Advantages include lower multiple pregnancy risk compared to gonadotropins *Incorrect: Endometriosis* - Treated with laparoscopic excision/ablation of endometriotic deposits, not ovarian drilling - May involve ovarian cystectomy for endometriomas *Incorrect: Ovarian tumor* - Requires surgical excision (cystectomy or oophorectomy) based on pathology - Drilling would be inadequate and inappropriate for tumor management *Incorrect: Ovarian hyperstimulation syndrome (OHSS)* - Iatrogenic complication of ovulation induction with gonadotropins or IVF - Managed conservatively with fluid management, monitoring, and supportive care - Not a surgical condition requiring ovarian drilling
Question 2: Which type of hysterectomy is done in a case of carcinoma cervix stage IB?
- A. Type 2 hysterectomy
- B. Type 3 hysterectomy (Correct Answer)
- C. Type 4 hysterectomy
- D. Type 1 hysterectomy
Explanation: ***Type 3 hysterectomy***- This procedure represents the **classic radical hysterectomy** (Wertheim-Meigs operation) and is the standard surgical treatment for primary carcinoma of the cervix, specifically **FIGO Stage IB** and early Stage IIA- It requires the complete excision of the uterus, cervix, upper third of the vagina, and the removal of the *entire* **parametria** and uterosacral ligaments up to the pelvic sidewall, alongside meticulous **pelvic lymphadenectomy**.*Type 1 hysterectomy*- This is a **simple (extra-fascial) hysterectomy** that removes the uterus while preserving the deep pelvic fascia; it removes minimal to no parametrial tissue- It is inadequate for Stage IB disease and is typically reserved for benign indications or **FIGO Stage IA1** microinvasive carcinoma.*Type 2 hysterectomy*- Known as a **modified radical hysterectomy**, this procedure involves the resection of the uterus along with the medial half of the parametrium, providing less radical resection than Type 3.- It is usually reserved for smaller, low-risk lesions like **FIGO Stage IA2** or very small Stage IB1 tumors, depending on institutional protocol and tumor characteristics.*Type 4 hysterectomy*- This procedure is an **extended radical hysterectomy**, involving extensive removal of adjacent structures beyond Type 3, often including parts of the bladder or ureters (approaching pelvic exenteration).- It is generally reserved for critically advanced local cancers, those involving neighboring organs, or specific cases of local **recurrence**.
Question 3: A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?
- A. Uric acid
- B. Liver function test
- C. Complete blood count
- D. Urine dipstick (Correct Answer)
Explanation: ***Urine dipstick***- The initial requirement for diagnosing **preeclampsia** is the presence of new-onset hypertension (BP > 140/90) plus **proteinuria** (or signs of end-organ damage).- The urine dipstick is the quickest and easiest initial test to rapidly screen for the presence of **proteinuria** and establish the correct diagnostic category (Gestational Hypertension vs. Preeclampsia).*Uric acid*- Elevated **serum uric acid** is often associated with preeclampsia severity, correlating with increased poor maternal and fetal outcomes.- However, it is not the standard *initial* diagnostic screening test needed to define the condition itself, which primarily requires checking for proteinuria.*Liver function test*- LFTs (AST and ALT) are performed to evaluate for signs of **severe preeclampsia** or **HELLP syndrome**, indicated by elevated transaminases.- While crucial for assessing severity, the initial step after noting hypertension is to screen for **proteinuria**, not necessarily end-organ damage markers.*Complete blood count*- A CBC is necessary to check for signs of severity, specifically **thrombocytopenia** (platelet count < 100,000/µL), which defines severe preeclampsia or HELLP syndrome.- Like LFTs, this is part of the workup for *severity* or *end-organ damage*, but the priority after detecting hypertension is confirming proteinuria via an initial screening test.
Question 4: A patient presents with an endometrial thickness of 14mm with an adnexal mass. She has a history of complex endometrial hyperplasia with the presence of atypical cells. Which of the following is likely the diagnosis?
- A. Struma ovarii
- B. Metastasis endometrial cancer to ovary (Correct Answer)
- C. Polycystic ovarian disease
- D. Immature ovarian teratoma
Explanation: ***Metastasis endometrial cancer to ovary*** - A history of **complex endometrial hyperplasia with atypical cells** is a strong precursor or co-existing condition with **endometrial carcinoma**. - The combination of a highly suspicious thick endometrium (**14mm**) and an **adnexal mass** strongly suggests a primary uterine malignancy that has spread to the ovary, which is a common site for endometrial cancer metastasis. *Struma ovarii* - This is a rare specialized form of **mature cystic teratoma** composed predominantly of thyroid tissue and is generally benign. - *Struma ovarii* is not etiologically linked to primary uterine pathology like **atypical endometrial hyperplasia** or endometrial carcinoma. *Polycystic ovarian disease* - PCOD leads to unopposed **estrogen stimulation** causing endometrial hyperplasia, but it rarely produces a solitary, large **adnexal mass** as described. - While PCOD is a risk factor for endometrial hyperplasia, the finding of presumed *metastasis* (mass + primary cancer features) is inconsistent with this diagnosis. *Immature ovarian teratoma* - These are malignant **germ cell tumors**, typically presenting in young women and often associated with elevated **alpha-fetoprotein (AFP)** or LDH markers. - Immature teratomas are not associated with the development of primary **endometrial carcinoma** or its precursor lesions like atypical hyperplasia.
Question 5: All of the following are true about audit in obstetrics except:
- A. Improve treatment
- B. Change in hospital administration and practices
- C. Should be done before analyzing outcomes (Correct Answer)
- D. Fetal death data is analyzed
Explanation: ***Should be done before analyzing outcomes*** - An **audit** is defined as a systematic process of reviewing quality of care, which involves comparing current practice (outcomes and processes) against standards. - Therefore, analyzing existing outcomes is an integral **first step** of the audit process, not something that should be done before the audit itself, rendering this statement false. *Improve treatment* - The core objective of any clinical audit in obstetrics is to close the gap between actual performance and best practices, leading directly to the **improvement of patient care and treatment protocols**. - By identifying areas of deviation from established standards, audits enable the implementation of targeted interventions to enhance the quality of **maternal and neonatal outcomes**. *Change in hospital administration and practices* - If an audit reveals systemic failures or resource limitations contributing to poor outcomes, implementing necessary corrections often requires changes in **hospital administrative policies** and practices. - Auditing ensures that institutional resources, documentation, and organizational structures effectively support high standards of **obstetric care**. *Fetal death data is analyzed* - **Perinatal and maternal mortality audits** are essential components of obstetric quality assessment, focusing on severe adverse outcomes. - Analysis of fetal death data (e.g., stillbirths) is crucial for identifying key risk factors, preventable causes, and system weaknesses in **antenatal and intrapartum care**.
Question 6: In a primigravida what is a satisfactory dilation rate?
- A. 1.5 cm/hr
- B. 1.2 cm/hr (Correct Answer)
- C. 0.5 cm/hr
- D. 0.75 cm/hr
Explanation: ***1.2 cm/hr***- This rate is the classical minimum acceptable cervical dilation velocity during the **active phase of labor** in a **primigravida**, according to the Friedmann curve.- A dilation rate falling below **1.2 cm/hr** in a primigravida is generally treated as an abnormally slow progression, or a **protraction disorder**.*0.5 cm/hr*- A dilation rate of **0.5 cm/hr** is significantly protracted and would be indicative of a high-risk labor pattern requiring re-evaluation and typically intervention, such as **oxytocin augmentation**.- Even the modern, slower labor curves (Zhang curve) do not support such a slow rate as satisfactory for the entire active phase.*0.75 cm/hr*- This rate is below the recognized minimum benchmark of **1.2 cm/hr** for a primigravida during the active phase of labor.- Persistence at this slow rate would likely lead to a diagnosis of **protracted active phase** and increase the risk of maternal and fetal complications.*1.5 cm/hr*- While **1.5 cm/hr** represents rapid and favorable cervical progression, the classical standard for the *minimum satisfactory* rate in a primigravida is established as **1.2 cm/hr**.- **1.5 cm/hr** is often cited as the minimum satisfactory rate for a **multigravida**, who generally progresses faster than a primigravida.
Question 7: A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?
- A. After 24 hours
- B. After 4-6 hours
- C. Within 1 hour (Correct Answer)
- D. After 1 hour
Explanation: ***Within 1 hour***- The World Health Organization (WHO) and UNICEF strongly recommend initiating breastfeeding within the **first hour** of birth, often termed **early initiation**.- This practice stimulates early **suckling reflexes**, encourages bonding, and ensures the baby receives **colostrum**, which is rich in antibodies.*After 1 hour*- While better than waiting several hours, delaying beyond the first hour can miss the infant's period of **quiet alertness** immediately post-delivery, when they are most receptive to suckling.- The first hour is critical for the establishment of a successful maternal-infant bond and **optimal milk production signaling**.*After 4-6 hours*- Delaying breastfeeding significantly reduces the likelihood of successful **exclusive breastfeeding** later on, as the infant may become sleepy or less keen to latch.- Waiting this long deprives the newborn of the crucial **colostrum** and its protective immunological and nutritional benefits during a vulnerable period.*After 24 hours*- This is considered a significant and unnecessary delay, which greatly increases the risk of **neonatal hypothermia, hypoglycemia**, and poor feeding outcomes.- It is strictly against standard guidelines and often necessitates artificial formula supplementation, undermining the goal of achieving **exclusive breastfeeding**.
Question 8: A 28-year-old mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?
- A. Crack in the nipple (Correct Answer)
- B. Absence of lactation
- C. Breast engorgement
- D. Hormonal influence
Explanation: ***Crack in the nipple***- This provides a direct portal of entry for bacteria, usually **Staphylococcus aureus**, which are commonly found on the skin or transported from the infant's nasopharynx.- Infective mastitis, characterized by **pain**, **erythema**, and fever, typically follows bacterial invasion through damaged *nipple epithelium*.*Breast engorgement*- This is a non-infectious condition caused by **milk stasis** and increased vascularity, typically occurring early in lactation.- While severe engorgement and incomplete emptying can *predispose* to mastitis by causing ductal blockage, it is not the primary mechanism or the *most likely cause* of the subsequent bacterial infection.*Hormonal influence*- Hormones, primarily **prolactin** and **oxytocin**, regulate milk production and let-down; they do not cause acute bacterial infection.- Changes in estrogen and progesterone levels are associated with breast tenderness (mastalgia) but are not directly causative factors for infective mastitis.*Absence of lactation*- Acute infective mastitis is overwhelmingly a complication of **lactation** (puerperal mastitis) due to milk stasis and nipple trauma.- The absence of lactation drastically *decreases* the typical risk factors for infective mastitis in this demographic (milk stasis, nipple damage from feeding).
Question 9: A woman presents with complaints of greenish-frothy vaginal discharge for 1 month. On examination, vulvovaginal erythema is noticed. On saline microscopy, motile organisms are seen. What is the most likely diagnosis?
- A. Chlamydial cervicitis
- B. Candidiasis
- C. Bacterial vaginosis
- D. Trichomoniasis (Correct Answer)
Explanation: ***Trichomoniasis***- The classic triad for this parasitic infection caused by **Trichomonas vaginalis** includes vulvovaginal erythema, dyspareunia, and a characteristic **greenish-frothy discharge**.- The diagnosis is confirmed by visualizing the **motile, flagellated protozoa** on saline wet mount microscopy, which directly matches the findings in the clinical presentation.*Bacterial vaginosis*- This condition, usually due to an overgrowth of **Gardnerella vaginalis**, typically presents with a thin, **gray discharge** and a strong **fishy odor**.- Saline microscopy characteristically reveals **clue cells** (vaginal epithelial cells covered in bacteria), not motile parasitic organisms.*Chlamydial cervicitis*- Infections with **Chlamydia trachomatis** primarily cause **cervicitis**, which is often asymptomatic or results in **mucopurulent discharge** from the cervix.- The diagnosis is typically made using highly sensitive **nucleic acid amplification tests (NAATs)**, and motile organisms are not seen on microscopy.*Candidiasis*- Vaginal candidiasis (yeast infection) typically causes intense pruritus (itching) and a **thick, white, cottage-cheese-like discharge**.- Microscopy shows **pseudohyphae** and **budding yeasts**, which are non-motile fungal elements, differentiating it from the motile organisms of Trichomoniasis.
Question 10: If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?
- A. Dichorionic diamniotic
- B. Monochorionic diamniotic
- C. Monochorionic monoamniotic (Correct Answer)
- D. Conjoint twins
Explanation: ***Monochorionic monoamniotic*** - Division of the inner cell mass (ICM) occurring between **9 and 12 days** after fertilization results in a twin pregnancy where both fetuses share a single **chorion** and a single **amnion**.- This stage marks division after the amnion has formed (around day 8) but before complete differentiation, leading to high risks like **cord entanglement**. *Dichorionic diamniotic* - This pattern results from division occurring very early, typically within the first **3 days** (2-cell stage to morula stage).- Since separation happens before the differentiation of the trophoblast and inner cell mass, both the **chorion** and the **amnion** are separate. *Conjoint twins* - Conjoint twins (Siamese twins) occur when the separation is delayed beyond the **13th day** after fertilization.- The division is incomplete, as it occurs *after* the formation of the **embryonic disc**. *Monochorionic diamniotic* - This type of twinning arises from division occurring between **4 and 8 days** after fertilization, typically during the blastocyst stage.- It leads to the sharing of the **chorion** but the development of separate **amnions**.