FMGE 2024 - Obstetrics and Gynecology PYQs Practice Questions

Q: Which of the following is the correct definition of postpartum pyrexia?

After 24 hours, temperature > 100.4 degrees Fahrenheit. ***After 24 hours, temperature > 100.4 degrees Fahrenheit***- The standard definition of **postpartum pyrexia** (puerperal fever) requires a temperature of **100.4°F (38.0°C)** or higher, recorded on any two of the first 10 postpartum days.- Importantly, this definition **excludes the first 24 hours** post-delivery, as transient fever during this period is common and often non-infectious (**dehydration** or **trauma**).*After 6 hours, temperature > 100.4 degrees Fahrenheit*- This time threshold is too early; transient, often benign, fever spikes are common in the immediate six hours following delivery due to physiological changes or **epidural use**.- Using this timeframe would lead to over-diagnosis of **puerperal morbidity** or infection.*After 3 hours, temperature > 100.4 degrees Fahrenheit*- Fever occurring this early is usually reflective of labor-related issues like **chorioamnionitis** present before delivery or non-infectious causes related to the immediate **postpartum stress**.- The standard definition purposefully excludes the initial period to distinguish between immediate physiological responses and actual **puerperal infection**.*After 12 hours, temperature > 100.4 degrees Fahrenheit*- While closer to the standard definition, 12 hours is still too soon, as the standard clinical parameter for defining significant infection requires symptoms to persist starting **after the first 24 hours**.- This window still often includes temporary fevers that resolve spontaneously and are not indicative of true **postpartum infection**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 32-year-old woman presents with intermenstrual bleeding following the insertion of an intrauterine device (IUD). She reports no other complications. What is the most appropriate initial management step?

Reassure the patient and observe. **Reassure the patient and observe (Correct)** - Irregular bleeding (spotting or intermenstrual bleeding) is a very common and expected side effect, especially during the first **3 to 6 months** after IUD insertion (both copper and hormonal). - In the absence of signs of infection (fever, purulent discharge, pelvic pain), IUD expulsion, or pregnancy, the initial management is typically **reassurance** that symptoms often resolve spontaneously. *Remove the IUD (Incorrect)* - IUD removal is generally reserved for failure of medical management, **IUD expulsion**, severe complications (e.g., **perforation**), or persistent, unacceptable side effects after the initial adaptation period. - Removing the IUD prematurely for expected spotting unnecessarily terminates a highly effective form of **contraception**. *Perform a pelvic ultrasound (Incorrect)* - Imaging is usually indicated if there is suspicion of **IUD malposition** (e.g., missing strings, pain, suspected expulsion) or to rule out other causes of bleeding like **pregnancy** or structural uterine abnormalities (fibroids, polyps). - Since the bleeding is expected and transient in the immediate post-insertion phase, an ultrasound is generally not mandatory as the *initial* step in an otherwise asymptomatic patient. *Prescribe hormonal therapy (Incorrect)* - While treatments like low-dose **estrogen** or **NSAIDs** can sometimes manage persistent, heavy bleeding, simple spotting is typically managed conservatively first. - Adding hormonal therapy might mask important underlying issues or add unnecessary risk/side effects for a symptom that is likely to resolve spontaneously. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Identify the option with the least risk of TOLAC (trial of labor after cesarean)?

Low-segment transverse incision. ***Low-segment transverse incision*** - This type of uterine incision is preferred during a Cesarean section as it is made in the least active segment, carrying the **lowest risk** of **uterine rupture** (approximately 0.5% to 0.9%) during a subsequent trial of labor. - It is generally considered the standard requirement for safely proceeding with a **VBAC** (Vaginal Birth After Cesarean) attempt. *Classical C section* - A **classical C-section** involves a vertical incision in the contractile upper segment (**uterine fundus**), which has the highest risk of **uterine rupture** (4% to 9%) during labor. - A history of a classical incision is generally considered an absolute **contraindication** to TOLAC. *Pre-eclampsia* - The presence of **pre-eclampsia** increases the risk of adverse outcomes to both mother and fetus, such as **placental abruption** and **intrauterine growth restriction**. - While not an absolute contraindication, it complicates management and often necessitates induction or delivery, placing it at a higher risk level compared to an uncomplicated TOLAC attempt. *Breech presentation* - **Breech presentation** is itself a risk factor for difficult vaginal delivery in nulliparous women, and combining it with a prior Cesarean scar (TOLAC) elevates the overall obstetric risk. - Many practitioners consider **breech presentation** in the current pregnancy a relative contraindication to TOLAC, favoring a planned repeat Cesarean delivery due to increased risk of complications. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Identify the gynecological instrument shown in the image below:

Cusco vaginal speculum. ***Cusco vaginal speculum*** - In the given image, the instrument shows the characteristic **bivalve design** with two curved blades that can be opened and closed using a **screw mechanism** visible at the handle, which is the defining feature of a Cusco speculum. - The **self-retaining mechanism** and **smooth, curved blades** designed for routine gynecological examinations like **Pap smears** are clearly visible, distinguishing it from other speculums. *Graves vaginal speculum* - The Graves speculum has **wider, more angled blades** that contour to the vaginal fornices, which is not seen in the image. - It typically has a **different handle configuration** and blade curvature compared to what's shown in the instrument. *Auvard speculum* - This is a **weighted speculum** with a distinctly different design featuring a **heavy posterior blade** for retraction during procedures like **D&C**. - The instrument in the image lacks the characteristic **weighted design** and **single posterior blade** typical of an Auvard speculum. *Sims speculum* - The Sims speculum is **non-self-retaining** and has a **double-ended, curved design** that requires manual holding or assistance. - Unlike the instrument shown, it lacks a **screw mechanism** and has a completely different **curved, hook-like shape**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Identify the condition that is least likely to cause postmenopausal bleeding?

Ovarian follicular cyst. ***Ovarian follicular cyst*** * **Follicular cysts** result from failed ovulation and require active high **FSH** stimulation, making them generally rare or transient findings in **postmenopausal** women due to ovarian senescence. * Unlike other estrogen-producing tumors, simple follicular cysts usually do not produce sufficient sustained **estrogen** levels to pathologically stimulate the endometrium and cause bleeding in the postmenopausal period. *Endometrial CA* * **Endometrial carcinoma** is the most common cause of postmenopausal bleeding, accounting for 10-15% of cases, and must be ruled out in every patient presenting with this symptom. * Bleeding results from the erosion, ulceration, and breakdown of the friable, neoplastic tissue lining the **endometrium**. *Granulosa cell tumor* * This is a classic example of an **estrogen-producing ovarian tumor** (a sex cord-stromal tumor). * The chronic, unopposed **estrogen** stimulation causes proliferation of the endometrium, leading to subsequent **endometrial hyperplasia** or cancer, resulting in bleeding. *Genital tract trauma* * Trauma, including minor injuries, is a significant cause of postmenopausal bleeding due to underlying **vaginal and cervical atrophy**. * Postmenopausal tissue is thin, lacks pliancy, and is fragile, making it susceptible to bleeding even from minor trauma during examination, intercourse, or other physical contact. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

Which of the following is the correct definition of postpartum pyrexia?

Accepted Answer

After 24 hours, temperature > 100.4 degrees Fahrenheit

Answer

After 6 hours, temperature > 100.4 degrees Fahrenheit

Answer

After 3 hours, temperature > 100.4 degrees Fahrenheit

Answer

After 12 hours, temperature > 100.4 degrees Fahrenheit

Question 2

A 32-year-old woman presents with intermenstrual bleeding following the insertion of an intrauterine device (IUD). She reports no other complications. What is the most appropriate initial management step?

Accepted Answer

Reassure the patient and observe

Answer

Prescribe hormonal therapy

Answer

Remove the IUD

Answer

Perform a pelvic ultrasound

Question 3

Identify the option with the least risk of TOLAC (trial of labor after cesarean)?

Accepted Answer

Low-segment transverse incision

Answer

Breech presentation

Answer

Pre-eclampsia

Answer

Classical C section

Question 4

Identify the gynecological instrument shown in the image below:

Accepted Answer

Cusco vaginal speculum

Answer

Graves vaginal speculum

Answer

Auvard speculum

Answer

Sims speculum

Question 5

Identify the condition that is least likely to cause postmenopausal bleeding?

Accepted Answer

Ovarian follicular cyst

Answer

Genital tract trauma

Answer

Endometrial CA

Answer

Granulosa cell tumor

FMGE 2024 — Obstetrics and Gynecology