FMGE 2009 - Obstetrics and Gynecology PYQs Practice Questions

Q: A girl presents with primary amenorrhea, grade V thelarche (mature breast), grade II pubarche (sparse growth of pubic hair) and no axillary hair. Likely diagnosis is:

Testicular feminization. Androgen Insensitivity Syndrome (also known as testicular feminization) is characterized by a phenotype where primary amenorrhea occurs in a girl with mature (Grade V) breast development but sparse or absent pubic and axillary hair (Grade II pubarche). In this condition, androgens are produced but their receptors are non-functional, leading to normal breast development through the peripheral conversion of androgens to estrogens while inhibiting androgen-dependent hair growth [3]. *Turner syndrome* - Characterized by gonadal dysgenesis [1], leading to primary amenorrhea and absent or rudimentary breast development (grade I thelarche). Patients typically present with characteristic physical features such as short stature [1], webbed neck, and coarctation of the aorta, which are not mentioned here. *Gonadal dysgenesis* - This is a broader term for abnormal development of the gonads [2], often leading to primary amenorrhea and lack of secondary sexual characteristics [1]. Unlike the described case, individuals with gonadal dysgenesis would not have mature breast development. *Mullerian agenesis* - Presents with primary amenorrhea due to the absence or hypoplasia of the uterus and upper vagina, but normal ovarian function. Patients with Mullerian agenesis would typically have normal breast development and normal pubic and axillary hair growth, as their androgen receptors are functional. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Rate of uterine involution per day following delivery:

1 cm/day. ***1 cm/day*** - Following delivery, the uterus typically descends into the pelvis at a rate of **1 cm (or 1 finger breadth) per day**. - This process of **uterine involution** allows the fundus to return to its pre-pregnancy size and location within approximately **6 weeks**. *2.5 cm/day* - This rate of uterine involution is **too rapid** and not consistent with the normal physiological process. - A uterus undergoing such rapid changes might suggest an underlying complication, but it's not the typical rate. *1.25 cm/day* - While closer to the correct rate, **1.25 cm/day** is still slightly faster than the average expected rate of uterine involution. - The standard measurement used in clinical practice and textbooks is generally **1 cm/day**. *2.25 cm/day* - This rate is also **significantly faster** than the normal physiological process of uterine involution. - Such an accelerated rate would not be expected in a healthy postpartum woman. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A girl presents with primary amenorrhea, grade V thelarche (mature breast), grade II pubarche (sparse growth of pubic hair) and no axillary hair. Likely diagnosis is:

Accepted Answer

Testicular feminization

Answer

Turner syndrome

Answer

Gonadal dysgenesis

Answer

Mullerian agenesis

Question 2

Rate of uterine involution per day following delivery:

Accepted Answer

1 cm/day

Answer

2.5 cm/day

Answer

1.25 cm/day

Answer

2.25 cm/day

FMGE 2009 — Obstetrics and Gynecology