FMGE 2018 - Obstetrics and Gynecology PYQs Practice Questions

Q: Which one of the following is NOT a characteristic feature of bacterial vaginosis?

Thick white discharge. ***Thick white discharge*** - Bacterial vaginosis is characterized by a **thin, grayish-white, homogeneous discharge**, not a thick white one. - A thick, white, "cottage cheese-like" discharge is more typical of **vulvovaginal candidiasis (yeast infection)**. *Presence of clue cells* - **Clue cells** are epithelial cells covered with bacteria, which are a hallmark microscopic finding in bacterial vaginosis. - Their presence is a key diagnostic criterion (Amsel criteria) for the condition. *Vaginal pH >4.5* - Bacterial vaginosis is associated with an **elevated vaginal pH, typically greater than 4.5**, due to the shift in vaginal flora. - This alkaline pH is a critical diagnostic indicator. *Fishy odour* - A **distinctive fishy odor**, particularly after intercourse or douching, is a classic symptom of bacterial vaginosis. - This odor is due to the production of **volatile amines** by anaerobic bacteria. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Beta-hCG is secreted by:

Syncytiotrophoblast. ***Syncytiotrophoblast*** - The **syncytiotrophoblast** is the outer layer of the trophoblast that surrounds the blastocyst and later the chorionic villi. - It is responsible for the secretion of various hormones, including **beta-hCG**, which is crucial for maintaining the corpus luteum and pregnancy. *Yolk sac* - The **yolk sac** is involved in early nutrient transfer, hematopoiesis, and germ cell formation. - It does not produce **beta-hCG**. *Liver* - The **liver** is a major organ of metabolism, detoxification, and protein synthesis. - It does not produce **beta-hCG**, which is specific to pregnancy. *Umbilical cord* - The **umbilical cord** connects the fetus to the placenta, facilitating nutrient and oxygen exchange. - It does not have endocrine functions and does not secrete **beta-hCG**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: In a patient with ectopic tubal pregnancy which is the earliest to rupture?

Isthmus. ***Isthmus*** - The **isthmus** is the **narrowest part** of the fallopian tube with the **least distensibility** and thin muscular wall. - Due to its limited capacity to accommodate the growing pregnancy, ectopic pregnancies in the isthmus rupture **earliest**, typically between **6-8 weeks of gestation**. - Rupture is often severe due to the narrow lumen and limited ability to expand. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately **70%** of cases). - It is wider and more distensible than the isthmus, allowing the pregnancy to grow for a longer period. - Rupture typically occurs **later**, between **8-12 weeks of gestation**. *Interstitial* - The **interstitial** (or cornual) portion is located within the **uterine wall**, surrounded by myometrium and rich vascular supply. - This location allows significant distensibility, so rupture occurs **latest** among tubal sites, typically at **12-16 weeks of gestation**. - When rupture occurs, it is **most catastrophic** with severe hemorrhage and highest risk of **maternal morbidity and mortality** due to the vascular supply. *Infundibulum* - Ectopic pregnancies in the **infundibulum** or fimbrial end are very rare. - Due to the wide opening, these pregnancies typically present as **tubal abortion** through the fimbria rather than rupture. - The area is less muscular, making contained rupture uncommon. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Endometriosis. ***Endometriosis*** - The classic triad of symptoms in this 29-year-old female—**dysmenorrhea**, **dyspareunia**, and **infertility**—is highly suggestive of endometriosis. - **Ectopic endometrial tissue** can cause chronic abdominal pain, menorrhagia, and inflammation, contributing to infertility. *Adenomyosis* - This condition involves the presence of **endometrial tissue within the myometrium**, leading to a thickened uterine wall. - While it can cause dysmenorrhea and menorrhagia, **infertility** is not its primary presentation, and it is less commonly associated with severe dyspareunia compared to endometriosis. *Cervicitis* - **Inflammation of the cervix** typically presents with vaginal discharge, post-coital bleeding, or pelvic pain. - It is not a common cause of primary infertility, severe dysmenorrhea, or dyspareunia as described. *Myomas* - Uterine **fibroids (leiomyomas)** are benign tumors that can cause heavy menstrual bleeding (menorrhagia), pelvic pressure, and sometimes infertility. - However, they are less commonly associated with the triad of severe dysmenorrhea and dyspareunia as prominently as seen in endometriosis. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of these types of fibroid may be removed at the time of a cesarean section?

Pedunculated fibroid. ***Pedunculated fibroid*** - **Pedunculated subserosal fibroids** are the safest type to remove during cesarean section, particularly those on a **narrow stalk** - They can be easily accessed through the abdominal incision without disrupting the uterine wall integrity - The stalk can be **clamped, ligated, and divided** with minimal risk of hemorrhage if proper hemostatic technique is used - Removal does not compromise the **hysterotomy closure** or future uterine integrity - This is the **only type of fibroid** routinely considered safe for removal during C-section if clinically indicated *Intramural fibroid* - **Intramural fibroids** are embedded within the myometrial wall and their removal is **generally contraindicated** during cesarean section - Myomectomy during C-section carries significant risk of **severe hemorrhage** from the highly vascular pregnant uterus - Removal can compromise **uterine wall integrity** and interfere with proper hysterotomy closure - May increase risk of **uterine rupture** in subsequent pregnancies - Standard obstetric practice is to **avoid myomectomy at cesarean** unless the fibroid is directly obstructing delivery *Broad ligament fibroid* - **Broad ligament fibroids** are located between the layers of the broad ligament, often in close proximity to the **ureter** and **uterine vessels** - Removal carries extremely high risk of **ureteral injury** and **massive hemorrhage** from pedicle vessels - Their excision is **absolutely contraindicated** during cesarean section *Cervical fibroid* - **Cervical fibroids** are located in the cervix with its **rich vascular supply** from cervical branches of uterine arteries - Removal during C-section risks **uncontrollable hemorrhage** and can cause **cervical incompetence** - Excision is **contraindicated** during cesarean section and should be managed separately if needed [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Which one of the following is NOT a characteristic feature of bacterial vaginosis?

Accepted Answer

Thick white discharge

Answer

Vaginal pH >4.5

Answer

Fishy odour

Answer

Presence of clue cells

Question 2

Beta-hCG is secreted by:

Accepted Answer

Syncytiotrophoblast

Answer

Yolk sac

Answer

Liver

Answer

Umbilical cord

Question 3

In a patient with ectopic tubal pregnancy which is the earliest to rupture?

Accepted Answer

Isthmus

Answer

Infundibulum

Answer

Ampulla

Answer

Interstitial

Question 4

A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Cervicitis

Answer

Myomas

Question 5

Which of these types of fibroid may be removed at the time of a cesarean section?

Accepted Answer

Pedunculated fibroid

Answer

Broad ligament fibroid

Answer

Cervical fibroid

Answer

Intramural

Question 6

True about endometriosis:

Accepted Answer

Presence of endometrium at ectopic locations

Answer

Presence of endometrial gland in deep myometrium

Answer

Treated preferably with hysterectomy

Answer

Seen in multiparous women

Question 7

A G4P2 lady presented with history of two abortions at 16 weeks and 20 weeks POG. Which of the following could be the most likely reason for these abortions?

Accepted Answer

Cervical incompetence

Answer

Thyroid abnormality

Answer

Chromosomal abnormality

Answer

Placenta previa

Question 8

After a normal delivery, when can combined oral contraceptives be started for a non-breastfeeding mother?

Accepted Answer

6 weeks

Answer

Immediately after delivery

Answer

2 weeks

Answer

12 weeks

Question 9

EDD ( Expected Date of Delivery) is calculated by:

Accepted Answer

Naegele's formula

Answer

Cardiff Formula

Answer

McDonald's rule

Answer

Hadlock Formula

Question 10

In a couple, which of the following investigations are included in the initial work-up for infertility?

Accepted Answer

Semen analysis, Tubal patency test, Ovulation test

Answer

Testicular biopsy, USG, Sperm penetration test

Answer

Ovulation, tubal patency, Mantoux test

Answer

Semen analysis, CXR, Mantoux

FMGE 2018 — Obstetrics and Gynecology