FMGE 2026 - Obstetrics and Gynecology Practice Questions

Q: A woman presents with curdy white vaginal discharge with vaginal itching and burning. What Is this the most likely diagnosis?

Vulvovaginal candidiasis. ***Vulvovaginal candidiasis*** - The hallmark of this condition is a **thick, curdy white (cottage cheese-like)** vaginal discharge that is typically **odorless**. - Intense **vulvovaginal pruritus (itching)** and **burning** are classic presenting complaints, often exacerbated by sexual intercourse or urination. *Bacterial vaginosis* - Characterized by a **thin, grayish-white** discharge with a distinct **

Q: Which contraception is contraindicated in a woman with hypertension?

OCPs. ***OCPs*** - Combined Oral Contraceptive Pills containing **estrogen** are contraindicated in patients with hypertension because estrogen promotes a **prothrombotic state** and can further elevate blood pressure, increasing the risk of **stroke** and **myocardial infarction**. - According to medical eligibility criteria, OCPs should be avoided or used with extreme caution in women with uncontrolled or severe **hypertension** (systolic ≥160 or diastolic ≥100 mmHg). *CuT* - The **Copper T (CuT)** is a non-hormonal intrauterine device that works primarily by creating a local **inflammatory reaction** in the endometrium that is toxic to sperm. - It has no systemic metabolic effects and is considered a perfectly safe and **first-line contraceptive choice** for women with underlying conditions like hypertension. *LNG -IUCD* - The **Levonorgestrel-releasing intrauterine system (LNG-IUCD)** releases hormones locally and has minimal systemic absorption, making it safe for women with **cardiovascular risk factors**. - Unlike systemic hormonal contraceptives, it is generally not associated with significant increases in blood pressure or coagulopathy. *DMPA* - **Depot Medroxyprogesterone Acetate (DMPA)** is a progestin-only injectable contraceptive and is generally considered safe for use in patients with **hypertension**. - While there is some ongoing research regarding slight long-term metabolic impacts, it is not contraindicated in the same way as **combined oral contraceptives** are in hypertensive patients.

Q: A woman in labor, P/V findings -sagittal suture obliquely placed, posterior fontanelle at 4 o’ clock position & the anterior fontanelle easily palpable. What is the most likely fetal presentation?

Occipitoposterior presentation. ***Occipitoposterior presentation*** - In this scenario, the sagittal suture is oblique, and the posterior fontanelle is at the 4 o'clock position; since the posterior fontanelle is palpable and associated with a low-lying occiput relative to the pelvis, the occiput is posterior. - The palpable anterior fontanelle suggests that the sinciput (forehead) is also relatively prominent or accessible, common in **occipitoposterior positions**, where the fetal head is usually deflexed. *Cephalic presentation* - While this is technically a type of cephalic presentation (head-first), it is a non-specific term that encompasses vertex (flexed), sinciput (deflexed), and brow presentations. - Specificity is required for labor management, making the more precise anatomical diagnosis of **occipitoposterior** the correct clinical answer. *Breech presentation* - A breech presentation would imply that the **sacrum** is the presenting part, and the posterior fontanelle would not be the primary landmark palpated. - Clinical assessment of the presenting part (breech) would reveal the **buttocks**, anus, or genitalia rather than the vertex fontanelles. *Brow presentation* - In a brow presentation, the **anterior fontanelle** and the orbital ridges (supra-orbital ridges) are the primary landmarks, not the posterior fontanelle. - The **mentum (chin)** is often more difficult to palpate, and the head is in a state of partial extension, which is distinct from the vertex presentation described.

Q: Which of the following physiological changes occur during pregnancy?

Increase in cardiac output and plasma volume. ***Increase in cardiac output and plasma volume*** - Physiological adaptation to pregnancy involves a significant **increase in plasma volume** (by approximately 40-50%) to meet metabolic demands of the fetus and provide a reserve for blood loss at delivery. - **Cardiac output** rises due to both increased **stroke volume** and increased **heart rate**, ensuring adequate perfusion of the uteroplacental unit. *Decrease in cardiac output, decrease in plasma volume* - This pattern describes a state of **hypovolemic shock** or severe vascular collapse, which is the opposite of the hyperdynamic state seen in normal pregnancy. - Pregnancy is characterized by **hemodynamic expansion**, not depletion, making this option physiologically incorrect. *Increase in cardiac output, decrease in plasma volume* - While cardiac output does increase, a decrease in plasma volume would lead to **hemoconcentration** and impaired placental perfusion. - Pregnancy is defined by **physiological anemia** due to a greater expansion of plasma volume relative to the red cell mass. *Decrease in cardiac output, increase in plasma volume* - If cardiac output were to decrease while plasma volume increased, the patient would likely be in **decompensated heart failure**. - The cardiovascular system undergoes structural and functional changes specifically to **maintain or increase cardiac output** to support the growing fetus.

Q: A woman has delivered a stillbirth and now wishes to stop lactation. Which drug is most appropriate?

Bromocriptine. ***Bromocriptine*** - This medication is a **dopamine agonist** that acts on **D2 receptors** in the anterior pituitary gland to directly inhibit the secretion of **prolactin**. - Since **prolactin** is the primary hormone responsible for **lactogenesis** (milk production), suppressing it effectively facilitates the cessation of lactation. *Oxytocin* - **Oxytocin** is responsible for the **milk ejection reflex** (let-down) by causing contraction of myoepithelial cells in the breast, not for milk production. - It is commonly used for **induction of labor** or treating **postpartum hemorrhage** due to its effect on uterine smooth muscle, not for stopping milk synthesis. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 analogue** primarily used to induce uterine contractions, such as for **cervical ripening** or treating **postpartum hemorrhage**. - It has no role in the physiological regulation of **prolactin** or the inhibition of milk production. *Calcitonin* - **Calcitonin** is a hormone involved in **calcium homeostasis** and bone metabolism, often used in conditions like **Paget's disease** or osteoporosis. - It has no mechanism related to the **hypothalamic-pituitary-prolactin axis** and is not used to suppress lactation.

Q: A woman has had two second -trimester pregnancy losses. What is the most likely diagnosis?

Cervical insufficiency. ***Cervical insufficiency*** - Characterized by **painless cervical dilation** in the second trimester, leading to recurrent pregnancy loss if left untreated. - Diagnosis is often clinical, based on a history of **painless dilation and expulsion of the fetus** in the second trimester, usually without preceding labor or abruption. *Placental abruption* - Typically presents with **painful vaginal bleeding**, **uterine tenderness**, and fetal distress, rather than painless loss. - It is associated with **advanced maternal age**, hypertension, and trauma, and typically occurs later in pregnancy or presents with acute symptoms. *Placenta previa* - Classically presents with **painless, bright red vaginal bleeding** in the third trimester due to the placenta covering the internal cervical os. - It is a condition of placental position and does not inherently cause recurrent second-trimester pregnancy loss. *Uterine anomalies* - While müllerian duct anomalies (like a **septate uterus**) can cause pregnancy loss, cervical insufficiency is specifically the classic answer for recurrent, painless second-trimester losses in the absence of uterine structural malformations. - Structural anomalies of the uterus are typically diagnosed via imaging (e.g., **HSG** or MRI) rather than being the default diagnosis for isolated second-trimester losses.

Q: 30 year old female with cyclical rectal bleeding & pelvic pain. Pain increased with menses. Diagnosis ?

Endometriosis. ***Endometriosis*** - **Cyclical rectal bleeding** combined with pelvic pain that worsens during **menses** is a classic presentation of **bowel endometriosis**. - The ectopic endometrial tissue responds to hormonal fluctuations, leading to inflammation and bleeding at the site of involvement (e.g., the rectum or rectosigmoid). *Hemorrhoids* - While hemorrhoids cause rectal bleeding, the pain is typically related to **defecation** or irritation rather than the menstrual cycle. - **Cyclical symptoms** are not a feature of hemorrhoidal disease. *Endometrial cancer* - This condition typically presents with **postmenopausal bleeding** or intermenstrual bleeding, not strictly cyclical, menstrual-associated rectal bleeding. - The peak incidence is in **postmenopausal women**, whereas this patient is 30 years old. *Fibroids* - Uterine fibroids (leiomyomas) primarily cause **menorrhagia** (heavy menstrual bleeding) or pressure symptoms if large enough to affect adjacent organs. - Fibroids do not typically cause **cyclical rectal bleeding** unless there is direct invasion or significant extrinsic compression, which is rare.

Q: A woman’s Pap smear shows atypical glandular cells. What is the next appropriate investigation?

Colposcopy + Endocervical curettage. ***Colposcopy + Endocervical curettage*** - Atypical glandular cells (AGC) on cytology indicate a risk of both cervical and endometrial pathology, necessitating a thorough evaluation of the endocervical canal and transformation zone. - ASCCP guidelines recommend performing a colposcopy with endocervical curettage (ECC) and, depending on age and clinical factors, sampling of the endometrium to rule out pre-invasive or invasive lesions. *Biopsy* - While tissue sampling is crucial, a blind biopsy is insufficient without prior colposcopic evaluation to identify the abnormal lesion. - The term 'biopsy' is too non-specific; the gold standard for investigation here includes targeted examination and ancillary procedures like ECC. *Colposcopy* - Although colposcopy is part of the workup, it is incomplete on its own because the origin of glandular cells may be high in the endocervical canal, which may not be visible. - Endocervical curettage is essential to sample the glandular cells of the endocervical canal that cannot be visualized directly. *Hysterectomy* - Hysterectomy is a definitive treatment for certain conditions (like invasive cancer or severe hyperplasia) but is never a diagnostic test for abnormal cytology. - Performing a hysterectomy without a definitive diagnosis gained through appropriate cervical and endometrial sampling is both inappropriate and unethical.

Q: A woman had a LNG -IUCD inserted. She has been experiencing bleeding since the day of insertion, which is affecting her daily activities, and she demands removal. What is the appropriate management?

Remove the IUCD. ***Remove the IUCD*** - Patient autonomy is a fundamental principle in medical ethics; when a patient experiences bothersome side effects that significantly impact their quality of life and they explicitly demand the removal of the device, this request should be honored. - While minor bleeding is a common side effect of levonorgestrel intrauterine contraceptive devices (LNG-IUCDs), the provider-patient relationship and trust are preserved by respecting the patient's decision to discontinue the method when symptoms become intolerable. *Reassure and continue IUCD* - While reassurance is appropriate for patients with manageable, minor spotting, it is dismissive and inappropriate when the patient reports that the bleeding is affecting her daily activities and she has explicitly requested removal. - Ignoring the patient's distress and request can lead to medical mistrust and may result in the patient attempting unauthorized or unsafe removal. *Give NSAIDs / short course of combined oral contraceptive and continue IUCD* - Although these medications can be used to manage unscheduled bleeding associated with hormonal IUDs, this approach assumes the patient is willing to continue the method. - Since the patient has already demanded removal, attempting a trial of medication without addressing her immediate desire to discontinue the IUD is not the most appropriate initial step. *Evaluate for pregnancy or pelvic infection and manage accordingly* - While it is good practice to rule out underlying causes like infection or pregnancy in cases of abnormal uterine bleeding, the clinical vignette focuses on the patient's demand for removal due to persistent bleeding since insertion. - Evaluation is secondary to respecting the patient's request; furthermore, the context implies the bleeding is a known side effect of the device rather than a new pathology emerging later.

Q: Identify CTG..

Late deceleration. ***Late deceleration*** - These are characterized by a gradual decrease in fetal heart rate starting **after the onset of the contraction**, with the nadir occurring **after the peak of the contraction**. - They indicate **uteroplacental insufficiency** and suggest fetal hypoxia, requiring careful clinical evaluation. *Early deceleration* - These mirror the contraction shape, starting and ending with it, caused by **fetal head compression**. - They are typically **benign** and do not require intervention as they are a normal vagal response. *Variable deceleration* - These are abrupt decreases in heart rate unrelated to the timing of contractions, often looking like a 'V' or 'U' shape. - They are typically caused by **umbilical cord compression** and are usually benign unless recurrent or severe. *Prolonged deceleration* - These involve a decrease in heart rate of at least 15 beats per minute lasting **longer than 2 minutes** but less than 10 minutes. - They often indicate a **significant interruption** in oxygen supply to the fetus, such as cord prolapse or maternal hypotension.

Question 1

A woman presents with curdy white vaginal discharge with vaginal itching and burning. What Is this the most likely diagnosis?

Accepted Answer

Vulvovaginal candidiasis

Answer

Bacterial vaginosis

Answer

Trichomoniasis

Answer

Atrophic vaginitis

Question 2

Which contraception is contraindicated in a woman with hypertension?

Accepted Answer

OCPs

Answer

CuT

Answer

LNG -IUCD

Answer

DMPA

Question 3

A woman in labor, P/V findings -sagittal suture obliquely placed, posterior fontanelle at 4 o’ clock position & the anterior fontanelle easily palpable. What is the most likely fetal presentation?

Accepted Answer

Occipitoposterior presentation

Answer

Cephalic presentation

Answer

Breech presentation

Answer

Brow presentation

Question 4

Which of the following physiological changes occur during pregnancy?

Accepted Answer

Increase in cardiac output and plasma volume

Answer

Decrease in cardiac output, decrease in plasma volume

Answer

Increase in cardiac output, decrease in plasma volume

Answer

Decrease in cardiac output, increase in plasma volume

Question 5

A woman has delivered a stillbirth and now wishes to stop lactation. Which drug is most appropriate?

Accepted Answer

Bromocriptine

Answer

Oxytocin

Answer

Misoprostol

Answer

Calcitonin

Question 6

A woman has had two second -trimester pregnancy losses. What is the most likely diagnosis?

Accepted Answer

Cervical insufficiency

Answer

Placental abruption

Answer

Placenta previa

Answer

Uterine anomalies

Question 7

30 year old female with cyclical rectal bleeding & pelvic pain. Pain increased with menses. Diagnosis ?

Accepted Answer

Endometriosis

Answer

Hemorrhoids

Answer

Endometrial cancer

Answer

Fibroids

Question 8

A woman’s Pap smear shows atypical glandular cells. What is the next appropriate investigation?

Accepted Answer

Colposcopy + Endocervical curettage

Answer

Biopsy

Answer

Colposcopy

Answer

Hysterectomy

Question 9

A woman had a LNG -IUCD inserted. She has been experiencing bleeding since the day of insertion, which is affecting her daily activities, and she demands removal. What is the appropriate management?

Accepted Answer

Remove the IUCD

Answer

Reassure and continue IUCD

Answer

Give NSAIDs / short course of combined oral contraceptive and continue IUCD

Answer

Evaluate for pregnancy or pelvic infection and manage accordingly

Question 10

Identify CTG..

Accepted Answer

Late deceleration

Answer

Early deceleration

Answer

Variable deceleration

Answer

Prolonged deceleration

FMGE 2026 — Obstetrics and Gynecology