FMGE 2019 - Obstetrics and Gynecology Practice Questions

Q: After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Uterine inversion. ***Uterine inversion*** - Forceful traction on the umbilical cord when the placenta is still firmly attached can pull the **fundus of the uterus inside out**, leading to uterine inversion. - This is a rare obstetric emergency associated with significant **hemorrhage** and shock. *Hemorrhage* - While hemorrhage is a common complication of retained placenta and uterine inversion, it is a *consequence* of these conditions, not the direct complication of forceful cord traction itself in the same way uterine inversion is. - The direct mechanical complication from forceful traction is the pulling out of the uterus, which then *causes* the significant hemorrhage. *Uterine rupture* - Uterine rupture during the third stage of labor is exceptionally rare and usually associated with a **previously scarred uterus** or excessive uterine overdistension, not typically caused by forceful cord traction. - Forceful cord traction is more likely to cause inversion or avulsion of the cord, rather than a tear in the uterine wall. *Placental abruption* - Placental abruption involves the **premature separation of a normally implanted placenta** *before* the delivery of the fetus. - This event occurs during pregnancy or labor before birth, not after delivery when the placenta is simply retained.

Q: A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Threatened abortion. ***Threatened abortion*** - This diagnosis is characterized by **vaginal bleeding** in the first half of pregnancy with a **closed internal os** and evidence of fetal viability on ultrasound. - The fundal height being consistent with gestational age also indicates ongoing pregnancy, despite the bleeding. *Inevitable abortion* - This condition is indicated by vaginal bleeding accompanied by a **dilated cervix (open internal os)**, suggesting that the pregnancy cannot be salvaged. - While bleeding is present, the **closed internal os** in the given scenario rules out inevitable abortion. *Incomplete abortion* - This involves vaginal bleeding, an **open internal os**, and the **partial expulsion of pregnancy tissue**, with some products of conception remaining in the uterus. - The presentation does not include an open os or retained products of conception, as the fetus is viable and the os is closed. *Complete abortion* - This occurs when **all products of conception have been expelled** from the uterus, characterized by an initially open os that subsequently closes, and often a decrease in bleeding. - The presence of a **viable fetus** and a closed os clearly rules out a complete abortion.

Q: Amsel's criteria are used for?

Bacterial vaginosis. ***Bacterial vaginosis*** - **Amsel's criteria** are a set of four clinical signs used to diagnose **bacterial vaginosis**, a common vaginal infection. - At least three of the four criteria must be present for a positive diagnosis: **thin, white, homogeneous discharge**, **clue cells** on microscopy, vaginal pH >4.5, and a **fishy odor** before or after adding 10% KOH (whiff test). *Candidiasis* - Diagnosed based on clinical symptoms such as **pruritus** and thick, white, **"cottage cheese-like" discharge**, along with identification of yeast (hyphae/pseudohyphae) on microscopy. - **Amsel's criteria** are not used for its diagnosis. *Trichomoniasis* - Typically diagnosed by microscopic observation of **motile trichomonads** in a wet mount, or by nucleic acid amplification tests (NAATs). - It presents with a **foamy, yellow-green discharge** and sometimes a **"strawberry cervix"**, none of which are part of Amsel's criteria. *Chlamydia infection* - Primarily diagnosed using **nucleic acid amplification tests (NAATs)** from urine or swab samples. - It is often **asymptomatic** or presents with non-specific symptoms like discharge or dysuria, and **Amsel's criteria** are not applicable.

Q: A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

>=5. ***>=5*** - A **grand multipara** is defined as a woman who has delivered **five or more** viable fetuses (live births or stillbirths after 20 weeks of gestation). - This classification is important clinically due to the increased risks associated with grand multiparity, such as **postpartum hemorrhage** and complications during labor. *>2* - This definition is too broad, as a woman with 3 or 4 live births is considered a **multipara**, but not specifically a grand multipara. - The term **multipara** generally applies to women who have had two or more live births. *>3* - This definition includes women with 4 live births, who are considered **multipara** but do not meet the stricter criteria for **grand multipara**. - The term **grand multipara** specifically denotes a higher number of deliveries with associated increased obstetric risks. *>4* - While close, this definition would include a woman with 5 live births, but it does not specify "five or more." - The precise definition of a **grand multipara** is five or more, which carries specific clinical implications for pregnancy management.

Q: A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?

Hysterosalpingography. ***Hysterosalpingography*** - Given the history of **pelvic inflammatory disease (PID)**, there is a significant risk of **tubal blockage** or damage, which is a common cause of **infertility**. - **Hysterosalpingography (HSG)** is the gold standard investigation to assess the patency and morphology of the **fallopian tubes** and uterine cavity. *Urine culture and sensitivity* - This test is used to detect **urinary tract infections**. While important in general health, it is rarely the primary cause of infertility in the absence of urinary symptoms. - The patient's history of **PID** points towards gynecological causes rather than urinary ones as the likely source of infertility. *Repeat USG* - The initial **ultrasound (USG)** has already shown normal organs, indicating no obvious uterine or ovarian structural abnormalities. - Repeating the same investigation without new symptoms or findings is unlikely to provide additional diagnostic information regarding infertility, especially not **tubal patency**. *Endometrial biopsy* - An **endometrial biopsy** is typically performed to assess the health of the **uterine lining** for conditions like chronic endometritis or abnormal uterine bleeding. - While helpful in specific scenarios, it does not evaluate **fallopian tubal patency**, which is a crucial step in assessing infertility after **PID**.

Q: A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?

Uterine scar rupture with Laparotomy. ***Uterine scar rupture with Laparotomy*** - The presentation of **low blood pressure**, **tachycardia**, and **free fluid in the peritoneum** in a 36-week pregnant woman with a **previous C-section** is highly indicative of uterine scar rupture given the signs of **hemorrhagic shock**. - **Laparotomy** (emergency abdominal surgery) is the immediate and definitive management to repair the ruptured uterus, control bleeding, and deliver the fetus. *Abruptio and C-section* - **Placental abruption** typically presents with painful vaginal bleeding, uterine tenderness, and fetal distress, which are not explicitly mentioned as the primary symptoms here. - While a **C-section** would be indicated for abruption, the presence of free fluid in the peritoneum and hemodynamic instability in a woman with a prior C-section points more towards rupture. *Ectopic pregnancy and abortion* - An **ectopic pregnancy** is ruled out by the 36-week gestational age; these occur much earlier in pregnancy. - An **abortion** refers to the termination of pregnancy and does not cause these specific signs and symptoms at 36 weeks. *Impending dehiscence and Laparoscopy* - **Impending dehiscence** (separation of the uterine scar without complete rupture) would likely cause localized pain but typically not the severe signs of **hypovolemic shock** and free peritoneal fluid seen here. - **Laparoscopy** is a minimally invasive procedure and would not be appropriate for the emergency management of a potentially life-threatening hemorrhage from uterine rupture.

Q: A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

OCP. ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a highly effective method that also help regulate **menstrual cycles** due to their hormonal content. - They provide effective contraception while simultaneously addressing the symptom of **irregular menstruation** in a newly married woman. *Barrier method* - **Barrier methods** like condoms are effective for contraception but do not address or regulate irregular menstrual cycles. - Their effectiveness depends heavily on consistent and correct use with each act of intercourse. *Calendar method* - The **calendar method** relies on tracking the menstrual cycle to predict fertile windows and is unreliable with **irregular menstruation**. - It would be ineffective as a contraceptive for a woman with unpredictable cycle lengths, leading to a high risk of unintended pregnancy. *Progesterone only pills* - **Progesterone-only pills** (POPs) can be used for contraception, but they may cause or exacerbate **menstrual irregularities**. - While effective in preventing pregnancy, they do not offer the cycle-regulating benefits that combination OCPs do for women with irregular periods.

Question 1

After a normal delivery in a 27-year-old female, placenta is still attached to the uterus. Most common complication which can occur due to forceful traction of cord?

Accepted Answer

Uterine inversion

Answer

Hemorrhage

Answer

Uterine rupture

Answer

Placental abruption

Question 2

A lady with 12-week pregnancy presents with bleeding. On examination, vagina is normal, internal os is closed, and USG shows fetal viability with fundal height of 13 weeks. What is the diagnosis?

Accepted Answer

Threatened abortion

Answer

Incomplete abortion

Answer

Complete abortion

Answer

Inevitable abortion

Question 3

Amsel's criteria are used for?

Accepted Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

Trichomoniasis

Answer

Chlamydia infection

Question 4

A grand multipara is defined as a woman who has had how many viable pregnancies (≥20 weeks):

Accepted Answer

>=5

Answer

>2

Answer

>3

Answer

>4

Question 5

A 26-week pregnant female presents with hypertension for the first time. There is no proteinuria. What is the most likely diagnosis?

Accepted Answer

Hypertension diagnosed after 20 weeks of gestation without proteinuria

Answer

Hypertension diagnosed before 20 weeks of gestation

Answer

Hypertension with proteinuria or end-organ damage

Answer

Hypertension with seizures

Question 6

A 35-year-old female presented with complaints of infertility. She has previous history of PID. Preliminary investigations like USG showed normal organs and hormone levels were also normal. What is the next best investigation?

Accepted Answer

Hysterosalpingography

Answer

Urine culture and sensitivity

Answer

Repeat USG

Answer

Endometrial biopsy

Question 7

A lady with 36-week pregnancy with previous C-section comes with low BP, tachycardia, and on USG fluid present in peritoneum. What is the diagnosis and next management?

Accepted Answer

Uterine scar rupture with Laparotomy

Answer

Abruptio and C-section

Answer

Ectopic pregnancy and abortion

Answer

Impending dehiscence and Laparoscopy

Question 8

A newly married couple, the woman is having irregular menstruation. What is the contraceptive of choice?

Accepted Answer

OCP

Answer

Barrier method

Answer

Calendar method

Answer

Progesterone only pills

FMGE 2019 — Obstetrics and Gynecology