FMGE 2026 - Obstetrics and Gynecology Practice Questions

Q: A 28-year-old pregnant woman is found to be HBsAg positive with high HBV DNA levels during routine antenatal screening. She has no features of liver failure. What is the most appropriate treatment during pregnancy?

Tenofovir. ### ***Tenofovir*** - **Tenofovir** is the preferred antiviral agent for treating pregnant women with chronic hepatitis B infection who have high viral loads, as it is a pregnancy category B medication with a favorable safety profile. - It effectively reduces **HBV DNA levels**, significantly lowering the risk of **vertical transmission** (mother-to-child) when administered from the second or third trimester onward. *Pegylated interferon* - **Pegylated interferon** is generally contraindicated during pregnancy due to concerns regarding potential **teratogenicity** and anti-proliferative effects on fetal development. - It is typically avoided in women of childbearing age who are planning to conceive or are pregnant because of its known **adverse fetal outcomes**. *Zidovudine* - **Zidovudine** is a nucleoside reverse transcriptase inhibitor used specifically for the treatment of **HIV infection** to prevent vertical transmission. - While it has anti-viral properties, it is not an effective treatment for the **hepatitis B virus** and does not suppress **HBV DNA replication**. *Acyclovir* - **Acyclovir** is an antiviral medication indicated primarily for the treatment of **herpes simplex virus** (HSV) and **varicella-zoster virus** (VZV) infections. - It lacks efficacy against the **hepatitis B virus** and plays no role in the management of chronic HBV infection or the prevention of vertical transmission.

Q: A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Migraine with aura. ***Migraine with aura*** - Combined oral contraceptive pills are contraindicated in patients with migraine with aura due to a significant increase in the risk of **ischemic stroke**. - The use of **estrogen** in these patients is associated with vascular events, leading to a categorization of **Category 4 (unacceptable health risk)** by the CDC Medical Eligibility Criteria. *Iron deficiency anemia* - COCPs are often beneficial for patients with iron deficiency anemia because they reduce the duration and volume of **menstrual blood loss**. - This is not a contraindication; in fact, the **progestin component** helps to regulate and often decrease menses. *Polycystic ovarian syndrome* - COCPs are a first-line treatment for managing symptoms of PCOS, such as **menstrual irregularities**, acne, and hirsutism. - The estrogen component increases **sex hormone-binding globulin (SHBG)** levels, which helps lower free testosterone levels. *Dysmenorrhea* - COCPs are frequently prescribed as a therapeutic option for dysmenorrhea because they suppress **ovulation** and thin the **endometrial lining**. - By decreasing the production of **prostaglandins** in the endometrium, they effectively reduce uterine cramping during menses.

Q: A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Leiomyosarcoma. ***Leiomyosarcoma*** - Represents a **malignant smooth muscle tumor** arising from the uterine wall, typically presenting as a **rapidly enlarging mass** which is a hallmark clinical sign distinguishing it from benign lesions. - Histopathological diagnosis requires demonstrating high **mitotic activity**, cellular atypia, and **coagulative tumor cell necrosis**, which are classic features of this sarcoma. *Leiomyoma* - This is a **benign smooth muscle tumor** (fibroid) and is extremely common in perimenopausal women. - Unlike leiomyosarcoma, it grows slowly and lacks the criteria for high-grade malignancy, such as significant **cellular atypia** or extensive necrosis. *Endometrial carcinoma* - This cancer arises from the **glandular epithelium** of the endometrium rather than the smooth muscle of the uterine wall (myometrium). - While it presents with **postmenopausal or perimenopausal bleeding**, the mass effect is typically within the uterine cavity rather than an intramural smooth muscle malignancy. *Adenomyosis* - Characterized by the presence of **endometrial tissue** within the myometrium, leading to a uniformly enlarged, boggy uterus. - It is a **benign condition** and does not present as a discrete, rapidly growing malignant solid mass.

Question 1

A 28-year-old pregnant woman is found to be HBsAg positive with high HBV DNA levels during routine antenatal screening. She has no features of liver failure. What is the most appropriate treatment during pregnancy?

Accepted Answer

Tenofovir

Answer

Pegylated interferon

Answer

Zidovudine

Answer

Acyclovir

Question 2

A 32-year-old woman presents for contraception counseling. Which of the following is a contraindication to the use of combined oral contraceptive pills?

Accepted Answer

Migraine with aura

Answer

Iron deficiency anemia

Answer

Polycystic ovarian syndrome

Answer

Dysmenorrhea

Question 3

A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Accepted Answer

Leiomyosarcoma

Answer

Leiomyoma

Answer

Endometrial carcinoma

Answer

Adenomyosis

FMGE 2026 — Obstetrics and Gynecology