FMGE 2026 - Obstetrics and Gynecology Practice Questions

Q: A patient with pain, heavy menstrual bleeding and symmetrically enlarged uterus of size corresponding to 10 -14 weeks. Diagnosis?

Adenomyosis. ***Adenomyosis*** - Characterized by the presence of **endometrial tissue** within the **myometrium**, clinically manifesting as **menorrhagia** (heavy menstrual bleeding) and **dysmenorrhea** (pain). - On physical examination, it typically presents with a **symmetrically enlarged**, **globular**, and **tender** (boggy) uterus, usually corresponding to a size of 10-14 weeks. *Endometrial cancer* - Common presentation in **postmenopausal women** with **postmenopausal bleeding** rather than cyclic menorrhagia. - Uterine enlargement is typically **irregular** if present, and the diagnosis is confirmed via **endometrial biopsy** which would show adenocarcinoma. *Endometrial polyp* - Usually presents with **intermenstrual bleeding** or spotting and is often asymptomatic. - It does not typically cause **diffuse, symmetrical uterine enlargement**; ultrasound would show a focal intracavitary lesion. *Endometrosis* - Refers to **endometriosis**, which involves endometrial tissues outside the uterus, typically causing **cyclic pelvic pain** and **dyspareunia**. - It does not cause symmetrical uterine enlargement; the uterus is often normal in size unless accompanied by coexisting conditions.

Q: A 16-year-old girl presents with delayed and irregular menstrual cycles for the past year. On evaluation, ultrasound of the ovaries shows multiple small peripheral cysts giving a “string-of- pearls” appearance as shown below. What is the most likely diagnosis? Options

Polycystic ovary syndrome. ### ***Polycystic ovary syndrome*** - The combination of **irregular menstrual cycles** and the classic ultrasound finding of multiple small peripheral follicles, often described as a **"string-of-pearls" appearance**, is diagnostic for **Polycystic Ovary Syndrome (PCOS)** in the presence of hyperandrogenism or metabolic features. - This condition is the most common cause of **anovulatory infertility** and frequently manifests during adolescence with menstrual dysfunction and polycystic ovarian morphology. ### *Premature ovarian failure* - This condition is characterized by **primary or secondary amenorrhea** due to ovarian depletion before age 40, typically presenting with **high FSH levels** and low estrogen. - Ultrasound in this condition typically shows **atrophic ovaries** rather than the multicystic appearance seen in PCOS. ### *Ovarian hyperstimulation syndrome* - This is an **iatrogenic complication** occurring as a result of **ovulation induction** therapies (like IVF), causing massive ovarian enlargement and fluid shift. - It is not a primary diagnosis for chronic menstrual irregularity and would present in a patient currently undergoing **assisted reproductive technology**. ### *Endometriosis* - Endometriosis typically presents with **cyclic pelvic pain** and dysmenorrhea rather than primarily isolated menstrual irregularity. - Ultrasound findings in endometriosis are typically characterized by **endometriomas** ("chocolate cysts"), which appear as ground-glass opacities, not the peripheral small follicles typical of PCOS.

Q: A pregnant female at 16th week of gestation is diagnosed with anemia. What is the most appropriate treatment?

100 mg iron, 500 mcg twice daily. ***100 mg iron, 500 mcg twice daily*** - In the context of pregnancy, standard therapeutic guidelines for **iron-deficiency anemia** often recommend higher doses of elemental iron (such as 100-200 mg per day) to replenish **maternal iron stores** and support increased **red blood cell mass**. - The addition of **folic acid** (500 mcg) is critical for preventing **neural tube defects** and supporting rapid fetal erythropoiesis, with twice-daily dosing often utilized to maximize absorption and compliance in symptomatic patients. *100 mg iron, 500 mcg once daily* - While this dosage provides the necessary components, it may be insufficient for a patient with an established diagnosis of **anemia** who requires a more aggressive therapeutic repletion strategy in the **second trimester**. - Sub-therapeutic dosing might fail to adequately elevate **hemoglobin** levels before the third trimester, increasing the risk of preterm delivery and low birth weight. *60 mg iron, 500 mcg twice daily* - Though this regimen provides a total of 120 mg of iron, common therapeutic protocols favor specific elemental iron formulations and dosing frequencies designed to optimize **gastrointestinal tolerance** and iron uptake. - This total daily dosage is often considered a prophylactic or mild therapeutic dose, which might be suboptimal depending on the severity of the patient's diagnosed anemia. *60 mg iron, 50 mcg once daily* - The **folic acid** dosage here (50 mcg) is significantly below the recommended daily requirement for pregnant women, failing to provide adequate prophylaxis against **megaloblastic anemia** and fetal development issues. - The total amount of elemental iron provided is generally reserved for **prophylactic supplementation** in healthy pregnant patients, rather than the active treatment of diagnosed anemia.

Q: A woman with white and foul smelling vaginal discharge was subjected to PAP smear examination, which revealed clue cells. What is the appropriate treatment?

Metronidazole. ***Metronidazole*** - This is the **first-line treatment** for **bacterial vaginosis**, which is diagnosed here by the presence of **clue cells** (vaginal epithelial cells covered with bacteria). - Metronidazole acts by inhibiting **nucleic acid synthesis** in anaerobic bacteria like *Gardnerella vaginalis*, which are overrepresented in this condition. *Oral Itraconazole* - This is an **antifungal medication** used primarily for conditions like **vulvovaginal candidiasis**. - It is ineffective against the bacterial cause of bacterial vaginosis and is not indicated for this presentation. *Clotrimazole pessaries* - This is also an **antifungal agent** commonly used to treat **yeast infections** (candidiasis). - It would not address the **polymicrobial shift** involving anaerobes that characterizes bacterial vaginosis. *Selenium sulphide* - This is typically used as a **topical treatment** for conditions like **tinea versicolor** or **seborrheic dermatitis**. - It has no role in the management of gynecological infections or bacterial vaginosis.

Q: What investigation should be done when a patient is presented with leiomyoma in the uterine wall?

MRI pelvis. ***MRI pelvis*** - **MRI** is the gold standard imaging modality for uterine leiomyomas as it provides superior **soft-tissue contrast** to accurately map the number, size, and location of fibroids. - It is particularly useful for **surgical planning** (e.g., myomectomy) to distinguish between intramural, submucosal, and subserosal fibroids, and to differentiate fibroids from **adenomyosis**. *CT pelvis* - **CT scans** have limited utility in evaluating uterine pathology due to poor soft-tissue resolution compared to ultrasound or MRI. - It is generally reserved for identifying **extrapelvic masses** or evaluating for metastatic disease, not for routine characterization of benign **uterine leiomyomas**. *Hysterosalphingography* - **HSG** is primarily designed to assess **tubal patency** and uterine cavity contour, often in the workup of **infertility**. - It is not the modality of choice for characterizing an intramural mass, as it offers limited visualization of the **myometrium**. *Plain Roentgenogram - pelvis* - **Plain X-rays** lack the sensitivity and specificity to evaluate soft-tissue uterine structures. - While they might show large calcified fibroids (popcorn calcification), this is a non-specific incidental finding and not a diagnostic tool for **leiomyoma evaluation**.

Q: A girl was brought to the clinic for primary evaluation. Physical examination: Tanner stage -4 breast. USG: blind vagina, no uterus, no ovaries. Lab: High testosterone levels. What is the most probable diagnosis?

Complete AIS. ***Complete androgen insensitivity syndrome (Complete AIS)*** - In this condition, individuals with a **46,XY karyotype** have testes that produce **high levels of testosterone**, but peripheral tissues are insensitive to androgens due to a defective androgen receptor. - Breast development (Tanner stage 4) occurs because the high levels of circulating testosterone are **aromatized into estrogen**, and there is an **absence of a uterus and ovaries** (Müllerian agenesis) due to the presence of Anti-Müllerian Hormone (AMH) produced by the testes. *17 Alpha hydroxylase deficiency* - This condition typically presents with **hypertension and hypokalemia** due to excess mineralocorticoid production (precursors upstream of the block). - Patients would have **low testosterone levels**, unlike the high testosterone seen in this patient. *Swyer syndrome* - Individuals with Swyer syndrome have **46,XY pure gonadal dysgenesis**, which results in streak gonads (not functioning testes) and **low/absent testosterone**. - Because they lack functional testes to produce AMH and testosterone, they have a **uterus present**, which is absent in this case. *MRKH (Müllerian agenesis)* - MRKH patients have a **46,XX karyotype** with functional ovaries, resulting in **normal female-range testosterone levels**. - While they present with an absent uterus and blind vagina, they typically have normal secondary sexual characteristics like pubic hair, which is sparse or absent in Complete AIS.

Q: What is the next best step when a postmenopausal lady presents with complaints of irregular bleeding with endometrial thickness of 8mm?

Endometrial sampling. ***Endometrial sampling*** - In postmenopausal bleeding, any **endometrial thickness > 4-5 mm** warrants tissue diagnosis to rule out **endometrial carcinoma**. - Office-based **endometrial biopsy (pipelle)** is the gold standard initial investigation due to its accuracy, cost-effectiveness, and minimally invasive nature. *MRI pelvis* - MRI is not recommended as a first-line investigation for initial assessment of **postmenopausal bleeding** or abnormal **endometrial thickness**. - It is mainly reserved for **staging endometrial cancer** once a histologic diagnosis has been confirmed. *Diagnostic hysteroscopy* - While useful for visualizing the uterine cavity, it is generally considered a second-line procedure if **office-based biopsy** is non-diagnostic or technically difficult. - It is not the most suitable

Q: The maneuver shown in the image is done for which of the following conditions?

Second twin transverse lie. ***Second twin transverse lie*** - This maneuver, known as **internal podalic version** (IPV), is specifically indicated for the **second twin** when it is in a **transverse or oblique lie** after the delivery of the first twin. - It involves grasping the fetus's **feet** to convert the lie into a **breech presentation** to facilitate delivery safely. *Face presentation* - Face presentation is generally managed by observing labor progress as many convert spontaneously to occiput anterior; it is not resolved by **internal podalic version**. - Forceful manipulation in the presence of a **face presentation** is contraindicated due to risks of cervical spine injury and facial trauma. *Shoulder presentation* - While a transverse lie (shoulder presentation) in a singleton pregnancy might seem similar, **internal podalic version** is generally **contraindicated** in singleton pregnancies due to the high risk of **uterine rupture**. - Management of a singleton transverse lie is almost universally a **cesarean section** rather than manual manipulation. *Breech* - A breech presentation is already a longitudinal lie and does not require conversion via a version maneuver. - The maneuver shown is specifically used to **change** a presentation from transverse to breech, not to correct an existing breech presentation.

Q: A diabetic female with HbA1c of 8 and retinopathy wants to get pregnant. What is the best advice?

Preconception counselling. ***Preconception counselling*** - This is the most crucial first step for any diabetic woman planning pregnancy to optimize glycemic control, evaluate for **end-organ damage** (like her retinopathy), and adjust medications. - It allows for the identification and management of high-risk factors, such as optimizing **HbA1c levels** to minimize the risk of **congenital malformations** and obstetric complications. *Insulin* - While insulin is indeed the drug of choice during pregnancy, simply starting insulin is not the *first* step before comprehensive assessment and counseling. - The patient needs a holistic management plan, including **ophthalmology screening** for her existing retinopathy, which can worsen during pregnancy. *Metformin* - Metformin is generally considered safe in pregnancy, but patients often need to be transitioned to **insulin** to achieve the tighter glycemic targets required. - It is not the standalone answer as preconception management encompasses much broader care than just selecting a glycemic agent. *Control blood sugar* - Achieving normoglycemia is a goal within the broader framework of management, but it cannot be done effectively without formal counseling and medical supervision. - Simply advising to control blood sugar ignores the necessity of evaluating the severity of her **diabetic retinopathy** and potential **nephropathy**, which are critical pre-pregnancy assessment goals.

Q: Female in labor shows abrupt fetal bradycardia after spontaneous rupture of membrane. Cervix is 6cm dilated. 5/5 of the head is palpable. Diagnosis?

Cord prolapse. ***Cord prolapse*** - Sudden fetal bradycardia following rupture of membranes with a high, unengaged fetal head (5/5 palpable) is the classic presentation of **umbilical cord prolapse**, which causes acute cord compression and fetal hypoxia. - This is an **obstetric emergency** requiring immediate delivery, typically via **emergency cesarean section**, to alleviate the cord compression. *Abruption* - While **placental abruption** causes fetal compromise, the classic presentation includes **vaginal bleeding** and a firm, tender uterus, rather than the isolated fetal bradycardia seen here. - Abruption typically occurs over time or following trauma/hypertension, whereas the bradycardia here is temporally linked specifically to the rupture of membranes. *Uterine prolapse* - **Uterine prolapse** is unlikely during labor as the uterus is held in place by the cervix and supporting ligaments, and it does not present with acute fetal bradycardia. - It would present as a mass protruding through the introitus, which is not described in this acute clinical scenario of fetal distress. *Vasa previa* - **Vasa previa** is a condition where fetal vessels traverse the membranes near the cervix, which rupture upon membrane tear, leading to **painless vaginal bleeding** and rapid fetal exsanguination. - While it causes fetal bradycardia, it is classically associated with vaginal bleeding immediately following rupture of membranes, not noted in this case describing a high unengaged head.

Question 1

A patient with pain, heavy menstrual bleeding and symmetrically enlarged uterus of size corresponding to 10 -14 weeks. Diagnosis?

Accepted Answer

Adenomyosis

Answer

Endometrial cancer

Answer

Endometrial polyp

Answer

Endometrosis

Question 2

A 16-year-old girl presents with delayed and irregular menstrual cycles for the past year. On evaluation, ultrasound of the ovaries shows multiple small peripheral cysts giving a “string-of- pearls” appearance as shown below. What is the most likely diagnosis? Options

Accepted Answer

Polycystic ovary syndrome

Answer

Premature ovarian failure

Answer

Ovarian hyperstimulation syndrome

Answer

Endometriosis

Question 3

A pregnant female at 16th week of gestation is diagnosed with anemia. What is the most appropriate treatment?

Accepted Answer

100 mg iron, 500 mcg twice daily

Answer

100 mg iron, 500 mcg once daily

Answer

60 mg iron, 500 mcg twice daily

Answer

60 mg iron, 50 mcg once daily

Question 4

A woman with white and foul smelling vaginal discharge was subjected to PAP smear examination, which revealed clue cells. What is the appropriate treatment?

Accepted Answer

Metronidazole

Answer

Oral Itraconazole

Answer

Clotrimazole pessaries

Answer

Selenium sulphide

Question 5

What investigation should be done when a patient is presented with leiomyoma in the uterine wall?

Accepted Answer

MRI pelvis

Answer

CT pelvis

Answer

Hysterosalphingography

Answer

Plain Roentgenogram -pelvis

Question 6

A girl was brought to the clinic for primary evaluation. Physical examination: Tanner stage -4 breast. USG: blind vagina, no uterus, no ovaries. Lab: High testosterone levels. What is the most probable diagnosis?

Accepted Answer

Complete AIS

Answer

17 Alpha hydroxylase deficiency

Answer

Swyer syndrome

Answer

MRKH

Question 7

What is the next best step when a postmenopausal lady presents with complaints of irregular bleeding with endometrial thickness of 8mm?

Accepted Answer

Endometrial sampling

Answer

MRI pelvis

Answer

Diagnostic hysteroscopy

Answer

Dilatation and Curettage

Question 8

The maneuver shown in the image is done for which of the following conditions?

Accepted Answer

Second twin transverse lie

Answer

Face presentation

Answer

Shoulder presentation

Answer

Breech

Question 9

A diabetic female with HbA1c of 8 and retinopathy wants to get pregnant. What is the best advice?

Accepted Answer

Preconception counselling

Answer

Insulin

Answer

Metformin

Answer

Control blood sugar

Question 10

Female in labor shows abrupt fetal bradycardia after spontaneous rupture of membrane. Cervix is 6cm dilated. 5/5 of the head is palpable. Diagnosis?

Accepted Answer

Cord prolapse

Answer

Abruption

Answer

Uterine prolapse

Answer

Vasa previa

FMGE 2026 — Obstetrics and Gynecology