A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?
A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?
A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?
During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?
A patient presents with a history of dilation & curettage (D&C). Subsequent diagnostic tests reveal all hormone levels, including progesterone and estrogen, to be within the normal range. Based on this clinical presentation, which of the following is the most likely diagnosis?
Oral contraceptive pill prevents all except?
What is the importance of the following manoeuvre?
Identify the sign.
Fetal anaemia is primarily determined by Doppler assessment of which artery?
A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?
FMGE 2025 - Obstetrics and Gynecology FMGE Practice Questions and MCQs
Question 31: A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse & no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?
- A. Candida albicans
- B. Neisseria gonorrhoeae
- C. Gardnerella vaginalis
- D. Trichomonas vaginalis (Correct Answer)
Explanation: ***Trichomonas vaginalis***- The classic clinical presentation of **trichomoniasis** includes a copious, frothy (though not always), **yellowish-green**, and distinctly **foul-smelling** vaginal discharge.- The organism causes inflammation and tissue damage (vaginitis/vulvitis), leading to common symptoms like **dysuria** and **dyspareunia**, often without significant pruritus (itching). *Candida albicans*- This fungal infection typically causes a thick, **white, 'cottage cheese-like'** vaginal discharge.- The hallmark symptom is intense **vulvovaginal pruritus** (itching), which is explicitly reported as absent in this patient. *Gardnerella vaginalis*- This bacterium is the most common cause of **Bacterial Vaginosis (BV)**, which produces a thin, **grayish-white** discharge with a characteristic **fishy odor**.- BV often causes minimal inflammation (no significant vulvitis) and typically does not present with the bright yellowish-green discharge described. *Neisseria gonorrhoeae*- While *N. gonorrhoeae* can cause **cervicitis** and **urethritis** (leading to dysuria), the discharge is usually described as **mucopurulent** rather than copious, foul-smelling, and yellowish-green.- The overall clinical picture (discharge color, odor, and inflammation) points more specifically toward a **prototozoal vaginitis**.
Question 32: A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?
- A. Anti-Müllerian hormone (AMH) (Correct Answer)
- B. Serum inhibin levels on day 5
- C. Estradiol on day 3
- D. Follicle-stimulating hormone (FSH) on day 3
Explanation: ***Anti-Müllerian hormone (AMH)***- **AMH** is currently considered the single **best test** for assessing ovarian reserve because it is produced by **granulosa cells** of pre-antral and small antral follicles, directly correlating with the size of the **remaining follicle pool**.- It can be measured reliably at **any time** during the menstrual cycle or even while using oral contraceptives, providing a highly stable and convenient assessment compared to cycle-dependent hormones.*Follicle-stimulating hormone (FSH) on day 3*- While commonly used, day 3 **FSH levels** are less sensitive than AMH because they reflect the degree of **luteal-follicular axis feedback** rather than the absolute number of follicles.- FSH levels are subject to significant **cycle-to-cycle variability**, and elevated readings often represent an already **advanced stage** of ovarian decline.*Estradiol on day 3*- Day 3 **Estradiol** is primarily measured to exclude premature follicle recruitment (which could suppress FSH), but it is a **poor independent predictor** of ovarian reserve.- Estradiol levels fluctuate greatly and high levels can **falsely mask** elevated FSH readings, limiting its utility as a primary diagnostic tool.*Serum inhibin levels on day 5*- **Inhibin B** is produced by developing follicles and reflects ovarian reserve, but it exhibits significant **menstrual cycle variability**, making interpretation challenging.- It is considered a **secondary marker**; it is less standardized and has lower predictive accuracy for future fertility compared to **AMH**.
Question 33: A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?
- A. Non Stress test (Correct Answer)
- B. Biophysical profile
- C. Amniotic fluid index
- D. Contraction Stress test
Explanation: ***Correct Option: Non Stress test*** - This is the preferred **initial test** for **fetal surveillance** when a patient reports decreased fetal movements, as it is non-invasive, quick, and provides immediate information about **fetal well-being** through assessment of fetal heart rate accelerations in response to movement. - A reactive NST (showing adequate accelerations) indicates intact fetal **CNS function** and adequate **oxygenation**, which is reassuring. - Given the history of **gestational diabetes**, which increases the risk for **uteroplacental insufficiency** and fetal compromise, a reactive NST is crucial to rule out acute distress. *Incorrect Option: Biophysical profile* - A BPP is generally reserved as a **secondary test** if the initial Non Stress Test (NST) is **non-reactive** or otherwise unsatisfactory, or if a more comprehensive assessment (including **fetal tone, breathing, movement, and amniotic fluid**) is required in a high-risk setting. - Though highly comprehensive, it is more time-consuming (up to 30 minutes) and involves ultrasound, making the rapid, simpler **NST** the most appropriate initial screening tool. *Incorrect Option: Amniotic fluid index* - AFI assesses the volume of **amniotic fluid**, which is a marker of **chronic placental function** and fetal renal perfusion, useful for identifying **oligohydramnios**. - While an important parameter, it is usually used as part of a **Biophysical Profile** or modified Biophysical Profile, not as the primary, standalone initial screen for decreased movement or acute compromise. *Incorrect Option: Contraction Stress test* - The CST assesses **uteroplacental reserve** by inducing contractions (using **oxytocin** or nipple stimulation) and observing FHR response, but it carries risks (like inducing labor) and has many contraindications (e.g., placenta previa, prior classical C-section, preterm labor risk). - Due to its invasiveness, time commitment, contraindications, and the availability of safer alternatives like the NST and BPP, the CST is rarely used today for routine or initial fetal surveillance.
Question 34: During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?
- A. Immediate administration of 20 units of undiluted oxytocin intravenously
- B. Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth (Correct Answer)
- C. Controlled cord traction with immediate removal of the placenta
- D. Oxytocin 10 units IM with crowning
Explanation: ***Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth*** - This is the **cornerstone of active management of third stage of labor (AMTSL)** - **WHO/FIGO guidelines** recommend oxytocin 10 units IM administered within 1 minute after birth of the baby - This is the **most effective intervention** for preventing postpartum hemorrhage due to uterine atony - Reduces PPH risk by approximately **60%** - Standard dose is **10 units IM** or 5 units slow IV (over 1-2 minutes) *Immediate administration of 20 units of undiluted oxytocin intravenously* - **Dangerous practice**: 20 units IV undiluted can cause severe hypotension, cardiac arrhythmias, and cardiovascular collapse - Standard dose for IV is **5 units diluted**, given slowly over 1-2 minutes - Bolus IV oxytocin is associated with significant cardiovascular side effects *Controlled cord traction with immediate removal of the placenta* - Controlled cord traction (CCT) is part of AMTSL but is done **after signs of placental separation**, not immediately - CCT alone does not prevent uterine atony - the uterotonic agent is primary - CCT is performed with counter-traction on the uterus to prevent uterine inversion *Oxytocin 10 units IM with crowning* - Incorrect timing: oxytocin should be given **after delivery of the anterior shoulder** or within 1 minute of birth - Administration at crowning (before delivery) is not part of AMTSL protocol - May cause complications if given before full delivery of the baby
Question 35: A patient presents with a history of dilation & curettage (D&C). Subsequent diagnostic tests reveal all hormone levels, including progesterone and estrogen, to be within the normal range. Based on this clinical presentation, which of the following is the most likely diagnosis?
- A. Endometriosis
- B. Asherman Syndrome (Correct Answer)
- C. Premature Ovarian Insufficiency (POI)
- D. Polycystic Ovary Syndrome (PCOS)
Explanation: ***Asherman Syndrome***- This diagnosis is characterized by the presence of **intrauterine adhesions** (synechiae), typically caused by injury to the **basal layer of the endometrium** following procedures like **D&C**.- The normal **estrogen** and **progesterone** levels indicate normal ovarian function, suggesting the pathology is uterine (end-organ failure to respond to hormones/obstruction) rather than central or ovarian.*Polycystic Ovary Syndrome (PCOS)*- PCOS is associated with chronic **anovulation** and features of **hyperandrogenism** (hirsutism, acne) but usually presents with oligomenorrhea rather than complete amenorrhea following D&C.- Hormonal analysis typically shows an elevated **LH/FSH ratio** and potentially high androgens, resulting in *abnormal* cyclical hormone patterns, unlike the normal levels noted here.*Premature Ovarian Insufficiency (POI)*- POI is characterized by the cessation of ovarian function before age 40, leading to a state of **hypoestrogenism** and low progesterone.- Lab tests would reveal *markedly elevated* **FSH** and *low* **estrogen** due to loss of negative feedback, directly contradicting the finding of normal hormone levels in this patient.*Endometriosis*- Endometriosis involves ectopic endometrial tissue and typically presents with symptoms like **severe dysmenorrhea**, **dyspareunia**, and chronic pelvic pain.- While severe cases can impact fertility, it does not typically cause complete secondary amenorrhea with *normal* cyclical estrogen and progesterone levels; this clinical picture points overwhelmingly to a mechanical uterine issue.
Question 36: Oral contraceptive pill prevents all except?
- A. Colon cancer
- B. Cervical cancer (Correct Answer)
- C. Endometrial cancer
- D. Epithelial ovarian cancer
Explanation: ***Cervical cancer***- Oral contraceptive pills (OCPs) are associated with an *increased* risk of **cervical cancer**, particularly with prolonged use (typically >5 years), not a protective effect. - The mechanisms are unclear, but OCPs may increase the risk of persistent **HPV infection** or cervical ectopy, making the cervix more vulnerable.*Epithelial ovarian cancer*- OCPs provide substantial and long-lasting protection against **epithelial ovarian cancer**, with the benefit persisting for decades after cessation.- The protection is thought to be due to the suppression of **ovulation** and resultant decrease in the number of repair cycles of the ovarian surface epithelium.*Endometrial cancer*- OCPs significantly reduce the risk of **endometrial cancer** by providing a continuous supply of progestins.- The **progestin** component of OCPs counteracts the proliferative effects of estrogen on the endometrium, preventing hyperplasia and subsequent carcinogenesis.*Colon cancer*- OCP use is associated with a modest but consistent reduction in the incidence of **colorectal cancer** across numerous studies.- This protective effect is hypothesized to be due to OCP-induced changes in **bile acid metabolism** or effects on local hormone receptor signaling in the colon.
Question 37: What is the importance of the following manoeuvre?
- A. To rotate the shoulders during delivery
- B. To protect from tearing of the perineum (Correct Answer)
- C. To facilitate controlled extension of the fetal head
- D. To pull the baby out faster
Explanation: ***To protect from tearing of the perineum*** - The maneuver shown, known as **guarding the perineum**, involves one hand supporting the perineal body while the other hand controls the delivery of the fetal head. - This technique allows for a slow, controlled stretching of the perineal tissues, which significantly reduces the risk of **perineal lacerations** during the second stage of labor. *To pull the baby out faster* - Applying traction to the fetal head to expedite delivery is contraindicated as it increases the risk of both maternal trauma, such as severe **perineal tears**, and fetal injury, like **brachial plexus injury**. - The goal of modern obstetrics is a controlled, gentle delivery, not a rapid one, to ensure the safety of both mother and baby. *To facilitate controlled extension of the fetal head* - While controlling the extension of the fetal head is part of the maneuver (performed by the hand on the occiput), its primary purpose is to prevent sudden expulsion, which would tear the perineum. - Therefore, controlled extension is a means to achieve the ultimate goal of **perineal protection**, making it a secondary objective of the overall maneuver shown. *To rotate the shoulders during delivery* - Rotation of the fetal shoulders, specifically to an **anteroposterior diameter**, is performed only *after* the head has been fully delivered and has undergone **restitution** (external rotation). - The image depicts the **crowning** of the fetal head, which is the stage just before the head is born and well before the shoulders are delivered.
Question 38: Identify the sign.
- A. Goodell's sign
- B. Piskacek's sign
- C. Chadwick's sign
- D. Hegar's sign (Correct Answer)
Explanation: ***Hegar's sign*** - This sign is demonstrated during a **bimanual pelvic examination** where the lower uterine segment (isthmus) feels extremely soft and compressible, almost as if the cervix and the body of the uterus are separate structures. - It is a **probable sign of pregnancy**, typically appearing between 6 to 12 weeks of gestation, caused by hormonal changes leading to increased vascularity and softening of the uterine isthmus. *Chadwick's sign* - This is a visual finding, not a palpable one, characterized by a **bluish or purplish discoloration** of the cervix, vagina, and vulva. - It is an early, **presumptive sign** of pregnancy caused by increased blood flow (**venous congestion**) to the area, usually visible from about 6-8 weeks of gestation. *Goodell's sign* - This refers to the marked **softening of the cervix** itself, which changes from a consistency similar to the tip of the nose to that of lips. - While it is a probable sign of pregnancy also appearing around 6-8 weeks, it is distinct from Hegar's sign, which involves the softening of the **uterine isthmus** above the cervix. *Piskacek's sign* - This is the palpable **asymmetric enlargement** and softening of the uterus, where the area of implantation feels like a bulge or tumor. - It occurs when the embryo implants near one of the uterine cornua, leading to an uneven shape of the uterus, and is not what is depicted in the image.
Question 39: Fetal anaemia is primarily determined by Doppler assessment of which artery?
- A. Middle cerebral artery (Correct Answer)
- B. Umbilical artery
- C. Uterine artery
- D. Ductus venosus
Explanation: ***Middle cerebral artery***- The **Middle Cerebral Artery (MCA) peak systolic velocity (PSV)** is the most reliable non-invasive method for detecting moderate to severe fetal anemia.- An elevated MCA-PSV indicates increased cerebral blood flow velocity due to reduced blood viscosity (from anemia) and the **brain-sparing effect**.- *Umbilical artery*- Doppler assessment of the umbilical artery primarily evaluates **placental vascular resistance** (e.g., in fetal growth restriction) using indices like the resistive index (RI) or pulsatility index (PI).- While abnormalities like absent or reversed diastolic flow indicate severe placental insufficiency, they are not the primary diagnostic measure for fetal anemia.- *Ductus venosus*- Ductus venosus Doppler evaluates **fetal cardiac function** and is critical in assessing fetal compromise, especially in conditions leading to hydrops fetalis.- Although reverse flow can be an indicator of severe compromise and impending heart failure (potentially caused by severe anemia), it is secondary to MCA-PSV for the specific diagnosis of anemia.- *Uterine artery*- Uterine artery Doppler assesses **maternal placental perfusion** and resistance, primarily used for screening and monitoring conditions like **preeclampsia** and **fetal growth restriction**.- It measures maternal blood flow to the placenta and has no direct correlation or role in determining the severity of fetal anemia.
Question 40: A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?
- A. Inevitable abortion
- B. Threatened abortion (Correct Answer)
- C. Complete abortion
- D. Incomplete abortion
Explanation: ***Threatened abortion***- This diagnosis applies when there is **vaginal bleeding** (often painful) in the first 20 weeks of pregnancy, but the **cervix is closed** and **fetal viability** (confirmed by fetal cardiac motion) is observed on ultrasound.- It is the most common cause of bleeding in early pregnancy and signifies that while the pregnancy is at risk, it is still continuing with a live fetus.*Inevitable abortion*- This diagnosis is characterized by vaginal bleeding accompanied by cervical changes, specifically **cervical dilation**, making continuation of the pregnancy unlikely.- Viable fetal cardiac activity rules out inevitable or ongoing abortion processes.*Incomplete abortion*- This involves the partial expulsion of the products of conception; USG would show **retained placental tissue** or fetal tissue and the loss of fetal viability.- The existence of **fetal cardiac motion** and a complete gestation ring confirms the pregnancy is still intact and rules out incomplete expulsion.*Complete abortion*- In this scenario, all products of conception have been expelled, resulting in an **empty uterine cavity** on ultrasound.- The presence of a **well-formed gestation ring** and an actively moving embryo/fetus clearly excludes complete abortion.