FMGE 2023 - Obstetrics and Gynecology PYQs Practice Questions

Q: Ovarian drilling is done in which of the following conditions?

Polycystic ovarian syndrome. ***Polycystic ovarian syndrome (PCOS)*** - **Ovarian drilling (laparoscopic ovarian diathermy)** is a surgical treatment specifically indicated for **clomiphene-resistant PCOS** - The procedure involves creating multiple small perforations in the ovarian capsule using diathermy or laser - **Mechanism:** Destroys androgen-producing ovarian stroma, reduces serum LH and androgens, restores ovulation in 50-70% of cases - **Indications:** Failed medical management with clomiphene citrate, as an alternative to gonadotropin therapy - Advantages include lower multiple pregnancy risk compared to gonadotropins *Incorrect: Endometriosis* - Treated with laparoscopic excision/ablation of endometriotic deposits, not ovarian drilling - May involve ovarian cystectomy for endometriomas *Incorrect: Ovarian tumor* - Requires surgical excision (cystectomy or oophorectomy) based on pathology - Drilling would be inadequate and inappropriate for tumor management *Incorrect: Ovarian hyperstimulation syndrome (OHSS)* - Iatrogenic complication of ovulation induction with gonadotropins or IVF - Managed conservatively with fluid management, monitoring, and supportive care - Not a surgical condition requiring ovarian drilling [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which type of hysterectomy is done in a case of carcinoma cervix stage IB?

Type 3 hysterectomy. ***Type 3 hysterectomy***- This procedure represents the **classic radical hysterectomy** (Wertheim-Meigs operation) and is the standard surgical treatment for primary carcinoma of the cervix, specifically **FIGO Stage IB** and early Stage IIA- It requires the complete excision of the uterus, cervix, upper third of the vagina, and the removal of the *entire* **parametria** and uterosacral ligaments up to the pelvic sidewall, alongside meticulous **pelvic lymphadenectomy**.*Type 1 hysterectomy*- This is a **simple (extra-fascial) hysterectomy** that removes the uterus while preserving the deep pelvic fascia; it removes minimal to no parametrial tissue- It is inadequate for Stage IB disease and is typically reserved for benign indications or **FIGO Stage IA1** microinvasive carcinoma.*Type 2 hysterectomy*- Known as a **modified radical hysterectomy**, this procedure involves the resection of the uterus along with the medial half of the parametrium, providing less radical resection than Type 3.- It is usually reserved for smaller, low-risk lesions like **FIGO Stage IA2** or very small Stage IB1 tumors, depending on institutional protocol and tumor characteristics.*Type 4 hysterectomy*- This procedure is an **extended radical hysterectomy**, involving extensive removal of adjacent structures beyond Type 3, often including parts of the bladder or ureters (approaching pelvic exenteration).- It is generally reserved for critically advanced local cancers, those involving neighboring organs, or specific cases of local **recurrence**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?

Urine dipstick. ***Urine dipstick***- The initial requirement for diagnosing **preeclampsia** is the presence of new-onset hypertension (BP > 140/90) plus **proteinuria** (or signs of end-organ damage).- The urine dipstick is the quickest and easiest initial test to rapidly screen for the presence of **proteinuria** and establish the correct diagnostic category (Gestational Hypertension vs. Preeclampsia).*Uric acid*- Elevated **serum uric acid** is often associated with preeclampsia severity, correlating with increased poor maternal and fetal outcomes.- However, it is not the standard *initial* diagnostic screening test needed to define the condition itself, which primarily requires checking for proteinuria.*Liver function test*- LFTs (AST and ALT) are performed to evaluate for signs of **severe preeclampsia** or **HELLP syndrome**, indicated by elevated transaminases.- While crucial for assessing severity, the initial step after noting hypertension is to screen for **proteinuria**, not necessarily end-organ damage markers.*Complete blood count*- A CBC is necessary to check for signs of severity, specifically **thrombocytopenia** (platelet count < 100,000/µL), which defines severe preeclampsia or HELLP syndrome.- Like LFTs, this is part of the workup for *severity* or *end-organ damage*, but the priority after detecting hypertension is confirming proteinuria via an initial screening test. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A patient presents with an endometrial thickness of 14mm with an adnexal mass. She has a history of complex endometrial hyperplasia with the presence of atypical cells. Which of the following is likely the diagnosis?

Metastasis endometrial cancer to ovary. ***Metastasis endometrial cancer to ovary*** - A history of **complex endometrial hyperplasia with atypical cells** is a strong precursor or co-existing condition with **endometrial carcinoma**. - The combination of a highly suspicious thick endometrium (**14mm**) and an **adnexal mass** strongly suggests a primary uterine malignancy that has spread to the ovary, which is a common site for endometrial cancer metastasis. *Struma ovarii* - This is a rare specialized form of **mature cystic teratoma** composed predominantly of thyroid tissue and is generally benign. - *Struma ovarii* is not etiologically linked to primary uterine pathology like **atypical endometrial hyperplasia** or endometrial carcinoma. *Polycystic ovarian disease* - PCOD leads to unopposed **estrogen stimulation** causing endometrial hyperplasia, but it rarely produces a solitary, large **adnexal mass** as described. - While PCOD is a risk factor for endometrial hyperplasia, the finding of presumed *metastasis* (mass + primary cancer features) is inconsistent with this diagnosis. *Immature ovarian teratoma* - These are malignant **germ cell tumors**, typically presenting in young women and often associated with elevated **alpha-fetoprotein (AFP)** or LDH markers. - Immature teratomas are not associated with the development of primary **endometrial carcinoma** or its precursor lesions like atypical hyperplasia. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: All of the following are true about audit in obstetrics except:

Should be done before analyzing outcomes. ***Should be done before analyzing outcomes*** - An **audit** is defined as a systematic process of reviewing quality of care, which involves comparing current practice (outcomes and processes) against standards. - Therefore, analyzing existing outcomes is an integral **first step** of the audit process, not something that should be done before the audit itself, rendering this statement false. *Improve treatment* - The core objective of any clinical audit in obstetrics is to close the gap between actual performance and best practices, leading directly to the **improvement of patient care and treatment protocols**. - By identifying areas of deviation from established standards, audits enable the implementation of targeted interventions to enhance the quality of **maternal and neonatal outcomes**. *Change in hospital administration and practices* - If an audit reveals systemic failures or resource limitations contributing to poor outcomes, implementing necessary corrections often requires changes in **hospital administrative policies** and practices. - Auditing ensures that institutional resources, documentation, and organizational structures effectively support high standards of **obstetric care**. *Fetal death data is analyzed* - **Perinatal and maternal mortality audits** are essential components of obstetric quality assessment, focusing on severe adverse outcomes. - Analysis of fetal death data (e.g., stillbirths) is crucial for identifying key risk factors, preventable causes, and system weaknesses in **antenatal and intrapartum care**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Ovarian drilling is done in which of the following conditions?

Accepted Answer

Polycystic ovarian syndrome

Answer

Endometriosis

Answer

Ovarian tumor

Answer

Ovarian hyperstimulation syndrome

Question 2

Which type of hysterectomy is done in a case of carcinoma cervix stage IB?

Accepted Answer

Type 3 hysterectomy

Answer

Type 2 hysterectomy

Answer

Type 4 hysterectomy

Answer

Type 1 hysterectomy

Question 3

A primigravida woman at 26 weeks gestation, presented with a BP of 150/90 mm Hg. Which test should be done next?

Accepted Answer

Urine dipstick

Answer

Uric acid

Answer

Liver function test

Answer

Complete blood count

Question 4

A patient presents with an endometrial thickness of 14mm with an adnexal mass. She has a history of complex endometrial hyperplasia with the presence of atypical cells. Which of the following is likely the diagnosis?

Accepted Answer

Metastasis endometrial cancer to ovary

Answer

Struma ovarii

Answer

Polycystic ovarian disease

Answer

Immature ovarian teratoma

Question 5

All of the following are true about audit in obstetrics except:

Accepted Answer

Should be done before analyzing outcomes

Answer

Improve treatment

Answer

Change in hospital administration and practices

Answer

Fetal death data is analyzed

Question 6

In a primigravida what is a satisfactory dilation rate?

Accepted Answer

1.2 cm/hr

Answer

1.5 cm/hr

Answer

0.5 cm/hr

Answer

0.75 cm/hr

Question 7

A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Accepted Answer

Within 1 hour

Answer

After 24 hours

Answer

After 4-6 hours

Answer

After 1 hour

Question 8

A 28-year-old mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?

Accepted Answer

Crack in the nipple

Answer

Absence of lactation

Answer

Breast engorgement

Answer

Hormonal influence

Question 9

A woman presents with complaints of greenish-frothy vaginal discharge for 1 month. On examination, vulvovaginal erythema is noticed. On saline microscopy, motile organisms are seen. What is the most likely diagnosis?

Accepted Answer

Trichomoniasis

Answer

Chlamydial cervicitis

Answer

Candidiasis

Answer

Bacterial vaginosis

Question 10

If the division in the zygote occurs between 9-12 days after fertilization, which of the following twins is expected?

Accepted Answer

Monochorionic monoamniotic

Answer

Dichorionic diamniotic

Answer

Monochorionic diamniotic

Answer

Conjoint twins

FMGE 2023 — Obstetrics and Gynecology