FMGE Obstetrics & Gynaecology questions

1. Q1. Which feature of a previous caesarean section carries the lowest risk of uterine rupture during a subsequent trial of labour?

   • A. A previous low transverse incision
   • B. A previous classical vertical incision
   • C. A previous inverted T incision
   • D. A previous low vertical incision extending into the upper segment

   Answer: A. A previous low transverse incision

2. Q2. After ovulation, which hormone converts proliferative endometrium into secretory endometrium capable of supporting implantation?

   • A. Oestradiol
   • B. Follicle stimulating hormone
   • C. Prolactin
   • D. Progesterone

   Answer: D. Progesterone

3. Q3. Haemolytic disease of the newborn from ABO incompatibility occurs almost exclusively when the mother is group O. Which antibody property explains this?

   • A. Anti-A and anti-B in group O mothers are largely IgM and cross the placenta
   • B. Anti-A and anti-B in group O mothers are largely IgG and cross the placenta
   • C. IgA antibodies are actively transported across the placenta
   • D. IgD antibodies fix complement on fetal red cells

   Answer: B. Anti-A and anti-B in group O mothers are largely IgG and cross the placenta

1. Q1. Exclusive breastfeeding means no other food or fluid, not even water. For how long is it recommended, and what follows?

   • A. 3 months, then complete weaning
   • B. 6 months, then complementary feeding with breastfeeding continued to 2 years or beyond
   • C. 9 months, then substitution with animal milk
   • D. 12 months, then complementary feeding

   Answer: B. 6 months, then complementary feeding with breastfeeding continued to 2 years or beyond

2. Q2. Which definition of puerperal pyrexia should prompt a sepsis screen after delivery?

   • A. Any temperature above 37.5 C within the first 6 hours
   • B. A single reading above 38 C in the first hour after delivery
   • C. A temperature of 38 C or more on any two of the first ten days postpartum, excluding the first 24 hours
   • D. A temperature above 39 C at any point during labour

   Answer: C. A temperature of 38 C or more on any two of the first ten days postpartum, excluding the first 24 hours

1. Q1. At what completed gestation is a pregnancy defined as post-term, and what is the principal fetal risk?

   • A. 40 weeks, with macrosomia alone
   • B. 42 weeks, with placental insufficiency and meconium aspiration
   • C. 37 weeks, with respiratory distress
   • D. 41 weeks, with neonatal jaundice

   Answer: B. 42 weeks, with placental insufficiency and meconium aspiration

2. Q2. A monozygotic twin pregnancy shows a single placenta with no dividing membrane between the fetuses. Around when did the zygote divide, and what is the principal risk?

   • A. Days 1 to 3, with no shared structures
   • B. Days 4 to 8, with twin-to-twin transfusion
   • C. Days 9 to 12, with cord entanglement
   • D. After day 13, with conjoined twins

   Answer: C. Days 9 to 12, with cord entanglement

1. Q1. A woman with newly diagnosed thyrotoxicosis is in her first trimester. Which antithyroid drug is preferred at this stage, and why?

   • A. Propylthiouracil, because methimazole and carbimazole carry a risk of embryopathy in the first trimester
   • B. Carbimazole, because it crosses the placenta less readily
   • C. Radioactive iodine, because it is a single definitive treatment
   • D. Methimazole, because it has a lower risk of hepatotoxicity

   Answer: A. Propylthiouracil, because methimazole and carbimazole carry a risk of embryopathy in the first trimester

2. Q2. A woman is six weeks post-delivery, breastfeeding, and wants reliable contraception for about three years before conceiving again. Which method best fits?

   • A. Combined oral contraceptive pills
   • B. Lactational amenorrhoea alone
   • C. An intrauterine device, which gives years of reversible protection and does not affect lactation
   • D. Barrier methods alone

   Answer: C. An intrauterine device, which gives years of reversible protection and does not affect lactation

1. Q1. Which combination of findings fulfils the Amsel criteria for bacterial vaginosis?

   • A. Curdy white discharge, pH below 4.5, budding yeasts and pruritus
   • B. Frothy green discharge, pH above 5, motile flagellates and a punctate cervix
   • C. Mucopurulent cervical discharge, normal pH, intracellular diplococci and contact bleeding
   • D. Thin homogeneous discharge, pH above 4.5, a positive amine test and clue cells on microscopy

   Answer: D. Thin homogeneous discharge, pH above 4.5, a positive amine test and clue cells on microscopy

2. Q2. Which statement about vasectomy is INCORRECT?

   • A. It is performed under local anaesthesia
   • B. The no-scalpel technique is widely used
   • C. The vas deferens is the structure divided
   • D. Sterility is immediate, so no additional contraception is required

   Answer: D. Sterility is immediate, so no additional contraception is required

1. Q1. A woman at 9 weeks has light vaginal bleeding and mild cramps. The cervical os is closed, the uterus is of appropriate size, and ultrasound shows a live intrauterine fetus. What is the diagnosis and the management?

   • A. Inevitable abortion, requiring evacuation
   • B. Threatened abortion, managed expectantly with reassurance
   • C. Incomplete abortion, requiring curettage
   • D. Missed abortion, requiring medical evacuation

   Answer: B. Threatened abortion, managed expectantly with reassurance

2. Q2. A woman develops secondary amenorrhoea after a vigorous curettage for retained products. Pregnancy test is negative and hysterosalpingography shows multiple filling defects in the cavity. What has occurred?

   • A. Sheehan syndrome, from pituitary infarction
   • B. Kallmann syndrome, from GnRH deficiency
   • C. Polycystic ovary syndrome, from anovulation
   • D. Asherman syndrome, from intrauterine adhesions after endometrial trauma

   Answer: D. Asherman syndrome, from intrauterine adhesions after endometrial trauma

1. Q1. A woman with eclampsia is on magnesium sulphate. Which finding means the next dose must be withheld?

   • A. Absent patellar reflexes
   • B. Sluggish but present patellar reflexes
   • C. A respiratory rate of 16 per minute
   • D. A urine output of 40 ml per hour

   Answer: A. Absent patellar reflexes

2. Q2. A 16-year-old has primary amenorrhoea with normal breast and pubic hair development, and ultrasound shows no uterus. What is the next investigation, and what is it distinguishing?

   • A. Serum prolactin, to exclude a pituitary adenoma
   • B. Karyotype with serum testosterone, to distinguish Mullerian agenesis from androgen insensitivity
   • C. LH and FSH, to confirm ovarian failure
   • D. Hysterosalpingography, to assess the cavity

   Answer: B. Karyotype with serum testosterone, to distinguish Mullerian agenesis from androgen insensitivity

1. Q1. Which organism is the commonest cause of pelvic inflammatory disease, and what makes it so damaging to fertility?

   • A. Neisseria gonorrhoeae, because it causes acute purulent salpingitis
   • B. Chlamydia trachomatis, because infection is often silent and causes tubal scarring before it is detected
   • C. Gardnerella vaginalis, because it alters vaginal flora
   • D. Bacteroides species, because they form abscesses

   Answer: B. Chlamydia trachomatis, because infection is often silent and causes tubal scarring before it is detected

2. Q2. Early transvaginal ultrasound shows two concentric echogenic rings around a small fluid collection in the uterus. What does this double decidual sign confirm?

   • A. A true intrauterine gestational sac, distinguishing it from the pseudosac of an ectopic pregnancy
   • B. An ectopic pregnancy
   • C. A complete hydatidiform mole
   • D. A missed abortion

   Answer: A. A true intrauterine gestational sac, distinguishing it from the pseudosac of an ectopic pregnancy

1. Q1. A 15-year-old has primary amenorrhoea with normally developed breasts and pubic hair and no other abnormality. What is the appropriate first investigation?

   • A. Reassurance and review in a year
   • B. Pelvic ultrasound, to establish whether a uterus is present
   • C. Hysterosalpingography
   • D. Immediate karyotyping

   Answer: B. Pelvic ultrasound, to establish whether a uterus is present

2. Q2. A woman at 8 weeks has light bleeding and pain, a closed os, a uterus matching dates, and ultrasound shows a single live intrauterine pregnancy. What is the management?

   • A. Dilatation and curettage
   • B. Combined oestrogen and progesterone therapy
   • C. Expectant management with rest and progesterone support if indicated
   • D. Immediate medical evacuation

   Answer: C. Expectant management with rest and progesterone support if indicated

1. Q1. Non-immune hydrops fetalis is detected at 26 weeks. Which fetal infection is classically responsible, and by what mechanism?

   • A. Epstein-Barr virus, through lymphoproliferation
   • B. Parvovirus B19, by infecting erythroid precursors and causing severe fetal anaemia and high-output failure
   • C. Human papillomavirus, through placental invasion
   • D. Influenza virus, through direct myocarditis

   Answer: B. Parvovirus B19, by infecting erythroid precursors and causing severe fetal anaemia and high-output failure

2. Q2. Which factor in an obstetric history does NOT predispose to uterovaginal prolapse?

   • A. Precipitate labour
   • B. Prolonged second stage
   • C. Bearing down before full dilatation
   • D. A timely mediolateral episiotomy

   Answer: D. A timely mediolateral episiotomy

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.