FMGE 2026 Previous Year Questions Practice Questions

Q: A pregnant woman has anemia despite adequate treatment with iron and folic acid. Her hemoglobin remains 9 g/dL but she is still asymptomatic. What is the most likely diagnosis?

Thalassemia trait. ***Thalassemia trait*** - This condition presents with **microcytic hypochromic anemia** that is typically refractory to **iron supplementation** because it is a genetic defect in globin synthesis, not an iron deficiency. - It is frequently identified during pregnancy as **asymptomatic, mild anemia** that fails to respond to standard **hematinics**. *Sickle cell anemia* - Usually presents with more severe clinical manifestations like **vaso-occlusive crises**, **hemolysis**, and **jaundice**, rather than being asymptomatic. - Often diagnosed earlier in life, and the blood smear typically shows **sickled cells** or **target cells** along with evidence of chronic hemolysis. *Thalassemia major* - Presents with severe, **transfusion-dependent anemia** starting from childhood, making it unlikely for a patient to remain asymptomatic during pregnancy. - Associated with significant complications like **hepatosplenomegaly**, **skeletal deformities**, and **iron overload**. *Hereditary spherocytosis* - Characterized by **hemolytic anemia** with findings of **jaundice** and **splenomegaly** due to extravascular hemolysis. - Peripheral blood smears typically reveal **spherocytes** and an increased **mean corpuscular hemoglobin concentration (MCHC)**. [Practice more FMGE 2026 questions on OnCourse]

Q: Identify the clinical sign shown in the image.

Chadwick sign. ***Chadwick sign*** - This sign describes the **bluish-purple discoloration** of the **vagina, cervix, and vulva**, caused by increased venous congestion and hyperemia associated with early **pregnancy**. - It is one of the classic **presumptive signs of pregnancy**, typically appearing around **6 to 8 weeks** of gestation. *Hegar sign* - This refers to the **softening of the uterine isthmus** (the area between the cervix and the uterine body), which can be felt by bimanual examination. - While also a **probable sign of pregnancy**, it relates to uterine consistency rather than discoloration. *Goodell sign* - This describes the **softening of the cervix** itself, which occurs due to increased vascularity and hypertrophy of the cervical glands. - It is a **probable sign of pregnancy** that is distinct from the color-based changes seen in Chadwick sign. *Osiander sign* - This refers to the **increased pulsation** that can be felt in the **lateral vaginal fornices** during early pregnancy. - This pulsation is due to the increased blood flow through the **uterine arteries** and is a distinct clinical finding from the discoloration of the vaginal mucosa. [Practice more FMGE 2026 questions on OnCourse]

Q: A 14-year-old girl presents with primary amenorrhea. On examination, the uterus is absent and ovaries are absent. Pubic hair is scanty. What is the most likely diagnosis?

Androgen insensitivity syndrome. ***Androgen insensitivity syndrome*** - Patients with **complete androgen insensitivity syndrome (CAIS)** have a 46,XY karyotype but fail to respond to androgens due to defective androgen receptors, resulting in an **absent uterus** (due to Anti-Müllerian hormone production by testes) and **absent ovaries**. - The testes remain intra-abdominal or inguinal, and **scanty or absent pubic hair** is a hallmark sign due to the absence of androgen-mediated hair growth. *Turner syndrome* - Involves a 45,X karyotype and typically presents with **short stature**, a **webbed neck**, and **streak ovaries**. - The uterus is usually present, albeit infantile, because there is no production of Anti-Müllerian hormone. *Gonadal dysgenesis* - Refers to a failure of gonadal development, often leading to **streak gonads** and variable development of Müllerian structures depending on whether Anti-Müllerian hormone is produced. - Pubic hair is generally present in these conditions, and it does not typically present with the specific constellation of a completely absent uterus with absent ovaries and sparse/absent hair seen in AIS. *Müllerian agenesis* - Specifically known as **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome**, it presents with an **absent uterus** and upper vagina, but with **normal ovarian function** and normal secondary sexual characteristics. - Patients have 46,XX karyotype, normal testosterone levels, and **normal pubic hair development**. [Practice more FMGE 2026 questions on OnCourse]

Q: A postmenopausal woman presents with intermittent vaginal bleeding. She subsequently undergoes hysterectomy. The resected specimen is shown. What is the most likely indication for which the hysterectomy was performed?

Endometrial carcinoma. ***Endometrial carcinoma*** - Postmenopausal bleeding is the **hallmark symptom** of endometrial carcinoma, necessitating investigation and often surgical management like a hysterectomy. - The resected specimen in this context would show **malignant glandular proliferation** invading the **myometrium**, confirming the diagnosis of adenocarcinoma. *Adenomyosis* - This condition presents with **menorrhagia** (heavy menstrual bleeding) and painful periods, typically in premenopausal women, rather than postmenopausal bleeding. - Pathology shows the presence of **endometrial glands and stroma** within the **myometrium**, causing a diffusely enlarged ( [Practice more FMGE 2026 questions on OnCourse]

Q: Which one of the following options is NOT an the indication of medical management in unruptured ectopic pregnancy

Fetal cardiac activity present. ***Fetal cardiac activity present*** - The presence of **viable embryonic cardiac activity** is a relative contraindication to **methotrexate therapy** due to significantly higher failure rates. - First-line medical treatment is most effective when the gestation is early and lacks **cardiac pulsation**. *Serum β -hCG level of 3500 IU/L* - While an initial **β-hCG** level < 5000 IU/L is generally considered an inclusion criterion for medical management, levels above this often suggest higher failure risk. - Since current protocols often accept values up to 5000 IU/L, this value does not strictly mandate surgical intervention over medical management. *Gestational sac size of 3 cm* - A gestational sac diameter of **≤ 3.5 cm** is typically considered a suitable parameter for **methotrexate eligibility**. - Cases exceeding 3.5 to 4 cm are usually prioritized for surgical management due to increased risk of rupture. *Hemodynamically stable mother* - **Hemodynamic stability** is a fundamental prerequisite for considering non-surgical options like **methotrexate**. - Any sign of hemodynamic instability mandates emergent **surgical intervention** (salpingostomy or salpingectomy) to address potential hemorrhage. [Practice more FMGE 2026 questions on OnCourse]

Question 1

A pregnant woman has anemia despite adequate treatment with iron and folic acid. Her hemoglobin remains 9 g/dL but she is still asymptomatic. What is the most likely diagnosis?

Accepted Answer

Thalassemia trait

Answer

Sickle cell anemia

Answer

Thalassemia major

Answer

Hereditary spherocytosis

Question 2

Identify the clinical sign shown in the image.

Accepted Answer

Chadwick sign

Answer

Hegar sign

Answer

Goodell sign

Answer

Osiander sign

Question 3

A 14-year-old girl presents with primary amenorrhea. On examination, the uterus is absent and ovaries are absent. Pubic hair is scanty. What is the most likely diagnosis?

Accepted Answer

Androgen insensitivity syndrome

Answer

Turner syndrome

Answer

Gonadal dysgenesis

Answer

Müllerian agenesis

Question 4

A postmenopausal woman presents with intermittent vaginal bleeding. She subsequently undergoes hysterectomy. The resected specimen is shown. What is the most likely indication for which the hysterectomy was performed?

Accepted Answer

Endometrial carcinoma

Answer

Adenomyosis

Answer

Leiomyoma uterus

Answer

Endometrial hyperplasia

Question 5

Which one of the following options is NOT an the indication of medical management in unruptured ectopic pregnancy

Accepted Answer

Fetal cardiac activity present

Answer

Serum β -hCG level of 3500 IU/L

Answer

Gestational sac size of 3 cm

Answer

Hemodynamically stable mother

Question 6

What is the most likely diagnosis?

Accepted Answer

Complete mole

Answer

Partial mole

Answer

Ectopic pregnancy

Answer

Hydropic degeneration

Question 7

What is the permanent method used for sterilization in females?

Accepted Answer

Pomeroy method

Answer

Salpingectomy

Answer

Salpingotomy

Answer

Salpingostomy

Question 8

A woman with 13 weeks gestation presents with a uterus corresponding to 18 weeks. Ultrasound shows a grape -like mass, with no fetus or amniotic fluid. What is the most appropriate management?

Accepted Answer

Suction & evacuation

Answer

Dilatation and curettage

Answer

Hysterectomy

Answer

Methotrexate therapy

Question 9

Identify the condition based on the following USG:

Accepted Answer

Monochorionic diamniotic (MCDA)

Answer

Dichorionic diamniotic (DCDA)

Answer

Monochorionic monoamniotic (MCMA)

Answer

Conjoined twins

Question 10

A 50-year-old postmenopausal woman presents with postmenopausal bleeding. Ultrasound shows a “feeding vessel” sign, suggestive of an endometrial polyp. What is the most appropriate management?

Accepted Answer

Hysteroscopic polypectomy

Answer

Watchful waiting

Answer

Medical therapy with progestins

Answer

Dilation and curettage

FMGE 2026

Internal Medicine

Obstetrics and Gynecology