FMGE 2025 - Obstetrics and Gynecology Practice Questions

Q: 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?

Trichomonas vaginalis. ***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**.

Q: 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?

Anti-Müllerian hormone (AMH). ***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**.

Q: 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?

Asherman Syndrome. ***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.

Q: Oral contraceptive pill prevents all except?

Cervical cancer. ***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.

Q: What is the importance of the following manoeuvre?

To protect from tearing of the perineum. ***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.

Q: Identify the sign.

Hegar's sign. ***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.

Q: Fetal anaemia is primarily determined by Doppler assessment of which artery?

Middle cerebral artery. ***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.

Q: 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?

Threatened abortion. ***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.

Question 1

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?

Accepted Answer

Trichomonas vaginalis

Answer

Candida albicans

Answer

Neisseria gonorrhoeae

Answer

Gardnerella vaginalis

Question 2

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?

Accepted Answer

Anti-Müllerian hormone (AMH)

Answer

Serum inhibin levels on day 5

Answer

Estradiol on day 3

Answer

Follicle-stimulating hormone (FSH) on day 3

Question 3

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?

Accepted Answer

Non Stress test

Answer

Biophysical profile

Answer

Amniotic fluid index

Answer

Contraction Stress test

Question 4

During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?

Accepted Answer

Administration of uterotonic agent (oxytocin 10 units IM) within 1 minute of birth

Answer

Immediate administration of 20 units of undiluted oxytocin intravenously

Answer

Controlled cord traction with immediate removal of the placenta

Answer

Oxytocin 10 units IM with crowning

Question 5

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?

Accepted Answer

Asherman Syndrome

Answer

Endometriosis

Answer

Premature Ovarian Insufficiency (POI)

Answer

Polycystic Ovary Syndrome (PCOS)

Question 6

Oral contraceptive pill prevents all except?

Accepted Answer

Cervical cancer

Answer

Colon cancer

Answer

Endometrial cancer

Answer

Epithelial ovarian cancer

Question 7

What is the importance of the following manoeuvre?

Accepted Answer

To protect from tearing of the perineum

Answer

To rotate the shoulders during delivery

Answer

To facilitate controlled extension of the fetal head

Answer

To pull the baby out faster

Question 8

Identify the sign.

Accepted Answer

Hegar's sign

Answer

Goodell's sign

Answer

Piskacek's sign

Answer

Chadwick's sign

Question 9

Fetal anaemia is primarily determined by Doppler assessment of which artery?

Accepted Answer

Middle cerebral artery

Answer

Umbilical artery

Answer

Uterine artery

Answer

Ductus venosus

Question 10

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?

Accepted Answer

Threatened abortion

Answer

Inevitable abortion

Answer

Complete abortion

Answer

Incomplete abortion

FMGE 2025 — Obstetrics and Gynecology