FMGE 2025 — Obstetrics and Gynecology
60 Previous Year Questions with Answers & Explanations
Edematous villi with chromosome XY were found. What will be the diagnosis?
OCPs are not protective for?
This instrument is contraindicated for?
The image depicts which of the following early signs of pregnancy?
Which findings are most suggestive of tubal pregnancy?
A female presents with hirsutism, delayed periods, obesity. USG findings are given below. What is the likely diagnosis?
What is the likely diagnosis for the given image?
Which of the following drugs is not given for hypertension in pregnancy?
Which is the primary chemotherapeutic agent used for cervical cancer?
A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?
FMGE 2025 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 1: Edematous villi with chromosome XY were found. What will be the diagnosis?
- A. Complete mole (Correct Answer)
- B. Ectopic pregnancy
- C. Partial mole
- D. Cyst
Explanation: ***Correct: Complete mole*** The finding of **edematous/hydropic villi** with a diploid karyotype (**46,XY**) is characteristic of a **Complete hydatidiform mole**. - A complete mole results from the fertilization of an 'empty' ovum by a single sperm (which duplicates, 46,XX) or two sperm (**46,XY**), leading to no fetal parts and diffuse **trophoblastic proliferation**. *Incorrect: Partial mole* A **Partial mole** is almost always triploid (e.g., **69,XXY** or 69,XXX), resulting from fertilization of a normal ovum by two sperm. - Histologically, it presents with a mixture of **normal and abnormal** (hydropic) villi, focal trophoblastic changes, and often identifiable **fetal parts**. *Incorrect: Cyst* This is a nonspecific term referring to a fluid-filled sac and does not account for the specific histological findings of abnormal **placental tissue** (edematous villi). - The presence of an abnormal **diploid karyotype (XY)** points towards a specific gestational trophoblastic disease rather than a generalized cystic structure. *Incorrect: Ectopic pregnancy* Ectopic pregnancy involves implantation outside the uterine cavity and, if villi are present, they are usually **normal chorionic villi** and not diffusely edematous. - The histological finding of **diffuse edematous villi** accompanied by the specific complete mole karyotype (**46,XY**) excludes a typical ectopic pregnancy.
Question 2: OCPs are not protective for?
- A. Breast Ca (Correct Answer)
- B. Endometrial Ca
- C. Ovarian Ca
- D. Colorectal Ca
Explanation: ***Breast Ca (Correct Answer)*** - OCPs are **not protective** against breast cancer - Current or recent use is associated with a **small, reversible increase** in risk, particularly with prolonged use (>5 years) - The risk is attributed to **exogenous estrogen and progesterone** stimulating hormone-sensitive breast tissue proliferation *Endometrial Ca (Incorrect - OCPs ARE protective)* - OCPs offer significant protection against endometrial cancer, reducing risk by about **50%** - This benefit is primarily due to the reliable dose of **progestin**, which induces **endometrial atrophy** and counteracts unopposed estrogen effects *Ovarian Ca (Incorrect - OCPs ARE protective)* - OCPs provide powerful protection against ovarian cancer, with benefit increasing with duration of use and persisting for decades after cessation - Mechanism involves suppression of **gonadotropins** and prevention of **repeated ovulation**, reducing trauma and carcinogenic transformation potential of the ovarian epithelium *Colorectal Ca (Incorrect - OCPs ARE protective)* - OCP use provides a long-lasting protective effect against colorectal cancer - This protective effect is thought to be mediated by **synthetic progestins and estrogens** altering local hormone receptors or bile acid composition
Question 3: This instrument is contraindicated for?
- A. After coming head of breech
- B. Obstructed labor (Correct Answer)
- C. Caesarean section
- D. Occipital posterior position
Explanation: ***Obstructed labor*** - Using forceps in obstructed labor, such as in cases of **cephalopelvic disproportion (CPD)**, is absolutely contraindicated as it can cause severe maternal trauma like **uterine rupture** and significant fetal injury. - The definitive management for true obstructed labor is a **Caesarean section** to safely bypass the mechanical obstruction. *Caesarean section* - Wrigley's forceps are commonly used during a Caesarean section to assist in delivering the fetal head, especially when it is deeply engaged in the pelvis (a "lift-out" forceps application). - Therefore, a Caesarean section is an *indication* for the use of these specific forceps, not a contraindication. *After coming head of breech* - Forceps can be used to deliver the aftercoming head in a breech presentation to control delivery and prevent sudden decompression of the fetal head. **Piper's forceps** are specifically designed for this purpose. - This situation represents a specific indication for an assisted delivery, not a contraindication. *Occipital posterior position* - A persistent occiput posterior position can lead to a prolonged second stage of labor, which is a common indication for operative vaginal delivery. - Depending on the fetal head station, rotational forceps (like **Kielland's**) or outlet forceps (like **Wrigley's**) may be used to either rotate the head or deliver it directly in the posterior position.
Question 4: The image depicts which of the following early signs of pregnancy?
- A. Osiander sign
- B. Hegar sign (Correct Answer)
- C. Palmer sign
- D. Goodell sign
Explanation: ***Hegar Sign*** - The image demonstrates a bimanual examination where the lower uterine segment (isthmus) is compressed between the internal and external fingers, which is the classic maneuver to elicit **Hegar sign**. - This is a probable sign of pregnancy, characterized by the softening and compressibility of the uterine isthmus, typically detectable between **6 to 8 weeks** of gestation. *Goodell Sign* - **Goodell sign** refers to the significant softening of the **cervix** due to increased vascularity and edema, which feels like the consistency of lips rather than the tip of the nose. - The examination shown in the image is focused on palpating the **uterine isthmus**, which is located superior to the cervix. *Osiander sign* - **Osiander sign** is the detection of an increased **pulsation** in the **lateral vaginal fornices**, which is a result of increased blood flow through the uterine artery. - The image depicts the assessment of tissue consistency and compressibility, not the detection of arterial pulsations. *Palmer sign* - **Palmer sign** is characterized by regular, rhythmic **uterine contractions** that can be palpated during a bimanual examination in early pregnancy. - The maneuver shown is assessing the static compressibility of the uterine isthmus, not its dynamic contractile activity.
Question 5: Which findings are most suggestive of tubal pregnancy?
- A. Trilayer endometrium without adnexal mass
- B. Ovarian mass with single layer of endometrium
- C. Adnexal mass with empty uterus and fluid in pelvis (Correct Answer)
- D. Adnexal mass with empty uterus
Explanation: ***Adnexal mass with empty uterus and fluid in pelvis***- The visualization of an **adnexal mass** (corresponding to the tubal gestation) and an **empty uterus** confirms the diagnosis of an ectopic pregnancy.- The presence of **free fluid in the pelvis** (hemoperitoneum) is highly suggestive of a ruptured or leaking tubal pregnancy, representing the most urgent presentation.*Ovarian mass with single layer of endometrium*- An **ovarian mass** suggests pathology involving the ovary itself, such as an ovarian ectopic pregnancy or a cyst, rather than the most common site, the fallopian tube.- The **single layer of endometrium** (thin decidual reaction) may occur in ectopic pregnancy due to insufficient hormonal stimulus but is not sufficient evidence for a tubal location.*Adnexal mass with empty uterus*- While this constellation of findings definitely suggests an **ectopic pregnancy**, it is often indicative of an early and **unruptured** tubal pregnancy.- Lacking **free fluid (blood)** in the pelvis makes this option less suggestive of advanced or complicated tubal pregnancy compared to the correct option.*Trilayer endometrium without adnexal mass*- A **trilayer endometrium** is a typical ultrasound finding during the proliferative phase, or it may be seen in a developing intrauterine pregnancy (IUP).- The absence of an **adnexal mass** essentially excludes the possibility of a tubal ectopic pregnancy.
Question 6: A female presents with hirsutism, delayed periods, obesity. USG findings are given below. What is the likely diagnosis?
- A. Thecal luteal cyst
- B. POI
- C. PCOD (Correct Answer)
- D. OHSS
Explanation: ***PCOD*** - The clinical triad of **hirsutism** (excess hair growth), **oligomenorrhea** (delayed periods), and **obesity** are classic features of Polycystic Ovarian Disease (PCOD). - The ultrasound image shows multiple small, peripherally arranged follicles in an enlarged ovary, a classic finding known as the **"string of pearls"** sign, which fulfills one of the key **Rotterdam criteria** for diagnosis. *POI* - Primary Ovarian Insufficiency (POI) is characterized by amenorrhea and symptoms of estrogen deficiency (like hot flashes) before age 40, associated with elevated **FSH** levels. - Ultrasound in POI typically shows small, **atrophic ovaries** with very few or no visible follicles, which is the opposite of the enlarged, polycystic ovary shown. *OHSS* - Ovarian Hyperstimulation Syndrome (OHSS) is an acute, iatrogenic condition resulting from **fertility treatments** involving ovulation induction, not a chronic presentation. - Sonographically, OHSS presents with massively enlarged ovaries containing numerous large cysts, often accompanied by **ascites** and **pleural effusion**, which are not seen here. *Thecal luteal cyst* - Theca lutein cysts are caused by overstimulation from very high levels of **hCG**, commonly seen in conditions like **molar pregnancy** or multiple gestations. - These cysts are typically large, bilateral, and multiseptated, giving a **"soap-bubble"** appearance on ultrasound, which is distinct from the multiple small peripheral follicles of PCOD.
Question 7: What is the likely diagnosis for the given image?
- A. Hydrosalpinx
- B. Normal fallopian tube
- C. Genital TB (Correct Answer)
- D. Endometriosis
Explanation: ***Genital TB*** - The image displays multiple small, yellowish-white nodules, known as **tubercles**, scattered on the peritoneal surfaces and adnexa. This finding is a classic laparoscopic sign of **peritoneal tuberculosis**. - Genital tuberculosis often presents with infertility, menstrual irregularities, or chronic pelvic pain, and the diagnosis is often confirmed by identifying these **caseating granulomas** on biopsy. *Normal fallopian tube* - A normal fallopian tube appears as a smooth, mobile, pinkish structure without any surface lesions, adhesions, or inflammation. - The adnexal structures in the image are clearly abnormal, showing multiple surface nodules inconsistent with normal anatomy. *Hydrosalpinx* - A hydrosalpinx is characterized by a distally blocked fallopian tube that becomes dilated and filled with serous fluid, appearing as a translucent, **sausage-shaped** structure. - While genital TB can cause tubal blockage, the primary finding here is the presence of **tubercles**, not the characteristic gross distension of a hydrosalpinx. *Endometriosis* - Endometriosis typically presents as **"powder-burn" lesions** (dark blue or black), red implants, or "chocolate cysts" (**endometriomas**) on the pelvic organs. - The yellowish, solid nodules seen in the image are characteristic of **tuberculous granulomas** and differ in appearance from typical endometriotic implants.
Question 8: Which of the following drugs is not given for hypertension in pregnancy?
- A. Enalapril (Correct Answer)
- B. Nifedipine
- C. Methyldopa
- D. Labetalol
Explanation: ***Correct: Enalapril*** - **Enalapril** is an **Angiotensin-Converting Enzyme (ACE) inhibitor** which is strictly **contraindicated** throughout pregnancy, particularly during the second and third trimesters - The use of ACE inhibitors is associated with severe **fetal renal dysfunction**, resulting in **oligohydramnios**, **pulmonary hypoplasia**, and **fetal death** - ACE inhibitors are **NOT given** for hypertension in pregnancy due to these serious teratogenic effects *Incorrect: Methyldopa* - **Methyldopa**, a centrally acting **alpha-2 agonist**, is historically considered the first-line and safest drug for treating chronic hypertension during pregnancy - Its extensive use has demonstrated a favorable long-term safety profile for the development of the child - It operates by reducing **sympathetic outflow** from the central nervous system, thereby lowering peripheral vascular resistance *Incorrect: Labetalol* - **Labetalol** is a combined **alpha-1 and non-selective beta-blocker** and is a primary first-line choice for treating both chronic and **acute severe hypertension** in pregnant women - It is rapidly effective and safe, maintaining adequate **placental perfusion** - It exerts its antihypertensive effects by acting as a competitive antagonist at both adrenergic receptors *Incorrect: Nifedipine* - **Nifedipine** is a **dihydropyridine calcium channel blocker** frequently used for managing chronic hypertension and treating acute severe hypertension or **preeclampsia** in pregnancy - It is generally considered safe and effective - Its most common use is often an alternative first-line agent to Labetalol or for the management of hypertensive crises via its extended-release formulation
Question 9: Which is the primary chemotherapeutic agent used for cervical cancer?
- A. Platinum-based therapy (Correct Answer)
- B. Immunotherapy
- C. Hormonal therapy
- D. Targeted therapy
Explanation: ***Platinum-based therapy*** - **Cisplatin** is the foundational chemotherapeutic agent utilized, often combined with radiation (**chemoradiation**) for locally advanced disease. - For metastatic or recurrent cervical cancer, combinations using platinum agents (**Cisplatin** or **Carboplatin**) along with **Paclitaxel** are standard first-line systemic treatments. *Immunotherapy* - **Immunotherapy**, specifically checkpoint inhibitors like **Pembrolizumab**, is approved for recurrent or metastatic cervical cancer that progresses after first-line chemotherapy. - It is not the initial or primary systemic treatment modality, which is founded upon platinum agents. *Hormonal therapy* - **Hormonal therapy** is primarily used for hormone-responsive cancers such as **breast cancer** (estrogen/progesterone receptors positive) or **prostate cancer**. - Cervical cancer is typically driven by **HPV infection** and carcinogenesis, making it largely unresponsive to sex hormones. *Targeted therapy* - **Targeted therapy**, such as the **anti-VEGF** agent **Bevacizumab**, is often utilized, but only *in addition to* platinum-based chemotherapy for advanced or recurrent disease. - It is used as an adjunct to systemic chemotherapy, which remains centered on platinum compounds.
Question 10: A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?
- A. Repair the wound in the ward (Correct Answer)
- B. Inform senior about her
- C. Shift patient to OT
- D. Give Blood Transfusion
Explanation: ***Repair the wound in the ward*** - This patient has a **perineal hematoma** with hemodynamic instability (BP 80/60 mmHg indicating hypovolemic shock) - Surgical evacuation of hematoma requires **proper anesthesia, adequate lighting, sterile conditions, and availability of resuscitation equipment** - all available in OT, not in ward - Ward-based repair would be inadequate and dangerous in an unstable patient - **Standard protocol:** Hemodynamically unstable obstetric emergencies require OT management *Inform senior about her* - This SHOULD be done immediately - Perineal hematoma with shock is a **medical emergency requiring senior consultation** - Essential for proper decision-making and management *Shift patient to OT* - This SHOULD be done as part of proper management - **Surgical evacuation of hematoma** under anesthesia is required - OT provides controlled environment for managing complications *Give Blood Transfusion* - This SHOULD be done urgently - BP 80/60 indicates **hypovolemic shock** from concealed bleeding in hematoma - **Resuscitation with blood products** is essential before and during surgical management - Cross-matched blood should be arranged immediately