FMGE Obstetrics & Gynecology Syllabus

Obstetrics & Gynecology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Obstetrics & Gynecology in FMGE, not a summary of it.

1. 1

   Anatomy and Physiology

   2 topics

   • Anatomy of the female reproductive system
     • External genitalia
     • Internal genitalia (uterus, fallopian tubes, ovaries)
     • Pelvic floor muscles
   • Physiology of the menstrual cycle
     • Hormonal regulation (FSH, LH, estrogen, progesterone)
     • Follicular development
     • Ovulation
     • Endometrial changes
2. 2

   Normal Pregnancy

   3 topics

   • Antenatal care
     • Initial assessment
     • Risk assessment
     • Screening tests (ultrasound, biochemical markers)
     • Prenatal counseling
   • Physiological changes in pregnancy
     • Cardiovascular changes
     • Respiratory changes
     • Gastrointestinal changes
     • Renal changes
     • Endocrine changes
   • Fetal development and monitoring
     • Fetal growth and development
     • Fetal movements
     • Fetal heart rate monitoring (cardiotocography, Doppler ultrasound)
3. 3

   Obstetric Disorders

   4 topics

   • Hypertensive disorders of pregnancy
     • Gestational hypertension
     • Preeclampsia
     • Eclampsia
     • HELLP syndrome
   • Gestational diabetes mellitus
     • Diagnosis
     • Monitoring
     • Management (dietary modification, insulin therapy)
   • Preterm labor
     • Risk factors
     • Diagnosis
     • Prevention (progesterone supplementation)
     • Management (tocolysis, antenatal corticosteroids)
   • Multiple pregnancy
     • Diagnosis
     • Complications (preterm birth, twin-to-twin transfusion syndrome)
     • Management
4. 4

   Labor and Delivery

   4 topics

   • Normal labor
     • Stages of labor (first stage, second stage, third stage)
     • Mechanisms of labor
     • Assessment of progress
   • Intrapartum monitoring
     • Fetal heart rate monitoring (cardiotocography)
     • Assessment of fetal well-being
     • Partogram
   • Management of labor
     • Induction of labor
     • Augmentation of labor
     • Pain relief methods (analgesia, anesthesia)
     • Instrumental delivery (forceps, vacuum extraction)
   • Cesarean section
     • Indications
     • Preoperative preparation
     • Surgical techniques
     • Postoperative care
5. 5

   Postpartum Care

   3 topics

   • Physiological changes in the postpartum period
     • Uterine involution
     • Lochia
     • Breastfeeding
     • Maternal bonding
   • Postpartum complications
     • Postpartum hemorrhage
     • Puerperal sepsis
     • Postpartum blues
     • Postpartum depression
   • Contraception
     • Counseling on contraceptive methods (oral contraceptives, intrauterine devices, implants, sterilization)
     • Initiation of contraception in the postpartum period
6. 6

   Gynecological Disorders

   4 topics

   • Menstrual disorders
     • Dysmenorrhea
     • Menorrhagia
     • Oligomenorrhea
     • Amenorrhea
   • Benign gynecological conditions
     • Fibroids (leiomyomas)
     • Ovarian cysts
     • Endometriosis
     • Pelvic inflammatory disease (PID)
   • Gynecological cancers
     • Cervical cancer
     • Endometrial cancer
     • Ovarian cancer
     • Vulvar cancer
   • Reproductive endocrinology
     • Polycystic ovary syndrome (PCOS)
     • Premature ovarian insufficiency (POI)
     • Hyperprolactinemia
7. 7

   Reproductive Endocrinology and Infertility

   4 topics

   • Evaluation of Infertility
     • History taking
     • Physical examination
     • Investigations (hormonal assays, imaging studies)
     • Male factor evaluation
   • Assisted Reproductive Technologies (ART)
     • Intrauterine insemination (IUI)
     • In vitro fertilization (IVF)
     • Intracytoplasmic sperm injection (ICSI)
     • Gamete donation
   • Endocrine Disorders Causing Infertility
     • Hypothalamic-pituitary dysfunction
     • Thyroid disorders
     • Hyperprolactinemia
   • Ovulation Induction
     • Clomiphene citrate
     • Gonadotropins
     • Aromatase inhibitors for ovulation induction in women with anovulatory infertility
8. 8

   Urogynecology and Pelvic Floor Disorders

   3 topics

   • Urinary incontinence
     • Stress urinary incontinence
     • Urge urinary incontinence
     • Mixed urinary incontinence
     • Overflow incontinence
   • Pelvic organ prolapse
     • Anterior compartment prolapse (cystocele)
     • Posterior compartment prolapse (rectocele)
     • Uterine prolapse
   • Pelvic floor dysfunction
     • Pelvic floor muscle exercises (Kegel exercises)
     • Biofeedback therapy
     • Surgical management of pelvic organ prolapse
9. 9

   Sexual and Reproductive Health

   4 topics

   • Sexual health and contraception
     • Sexual history taking
     • Counseling on sexual health
     • Contraceptive counseling
   • Sexually transmitted infections (STIs)
     • Chlamydia
     • Gonorrhea
     • Syphilis
     • Genital herpes
     • Human papillomavirus (HPV)
     • HIV/AIDS
   • Menopause
     • Symptoms of menopause
     • Hormone replacement therapy (HRT)
     • Management of menopausal symptoms (hot flashes, vaginal dryness)
   • Sexual dysfunction
     • Female sexual dysfunction (hypoactive sexual desire disorder, dyspareunia, vaginismus)
     • Male sexual dysfunction (erectile dysfunction, premature ejaculation)
10. 10

    Gynecological Oncology

    4 topics

    • Cervical cancer
      • Screening (Pap smear, HPV testing)
      • Diagnosis
      • Staging
      • Management
    • Endometrial cancer
      • Clinical features
      • Diagnosis (endometrial biopsy)
      • Staging
      • Management
    • Ovarian cancer
      • Clinical features
      • Diagnosis (CA-125, imaging studies)
      • Staging
      • Management
    • Gestational trophoblastic disease
      • Hydatidiform mole
      • Invasive mole
      • Choriocarcinoma
      • Placental site trophoblastic tumor

Obstetrics & Gynecology flashcards for FMGE

24 of 50 cards from the Obstetrics & Gynecology deck — real questions with worked answers.

1. What are the four parts of the fallopian tube from the uterus outward, and which is the usual site of fertilization?

   Interstitial (intramural), isthmus, ampulla, and infundibulum (with fimbriae). The ampulla is the widest part and the usual site of fertilization (also the commonest site of ectopic pregnancy).

2. Name the three muscle layers of the myometrium and the four ligaments that support the uterus.

   Layers: outer longitudinal, middle oblique (interlacing, the 'living ligature' that controls bleeding), inner circular. Supports: uterosacral, transverse cervical (cardinal/Mackenrodt), pubocervical, and round ligaments (broad ligament is a peritoneal fold, not a true support).

3. What is the arterial blood supply of the uterus and how does the ureter relate to the uterine artery?

   The uterine artery (a branch of the anterior division of the internal iliac) supplies the uterus; the ureter passes BELOW the uterine artery about 1.5 cm lateral to the cervix ('water under the bridge'), a key landmark in hysterectomy.

4. Describe the hormonal and ovarian/endometrial events of the four phases of the menstrual cycle.

   Follicular (proliferative): rising FSH→follicle growth, estrogen rises→endometrial proliferation. Ovulation: LH surge (~day 14) triggered by estrogen positive feedback. Luteal (secretory): corpus luteum secretes progesterone→secretory endometrium. Menstruation: corpus luteum regresses, progesterone/estrogen fall→shedding.

5. What triggers ovulation and how long does the corpus luteum survive without pregnancy?

   The LH surge (driven by sustained high estrogen via positive feedback) triggers ovulation ~34–36 h after surge onset. The corpus luteum survives ~12–14 days then regresses unless rescued by hCG from a pregnancy.

6. Define Naegele's rule for estimating the expected date of delivery (EDD).

   EDD = first day of last menstrual period + 1 year − 3 months + 7 days (i.e., add 9 months and 7 days). Assumes a regular 28-day cycle; pregnancy lasts ~280 days/40 weeks from LMP.

7. What is the recommended antenatal visit schedule and the key first-trimester screening tests in antenatal care?

   Classic schedule: monthly to 28 wks, fortnightly 28–36 wks, weekly after 36 wks. Booking bloods: Hb, blood group & Rh, HIV, HBsAg, VDRL/syphilis, rubella, urine, blood sugar; first-trimester ultrasound for dating; combined screen (NT + PAPP-A + free β-hCG) at 11–13+6 wks.

8. What folic acid dose is recommended periconceptionally and for high-risk women to prevent neural tube defects?

   400 µg (0.4 mg) daily for low-risk women, started before conception through the first trimester; 4–5 mg daily for high-risk women (previous NTD, diabetes, on antiepileptics).

9. List the major cardiovascular and hematological physiological changes in pregnancy.

   Plasma volume rises ~40–50% and RBC mass ~20–30% → physiological (dilutional) anemia; cardiac output rises ~30–50% (increased HR and stroke volume); systemic vascular resistance and BP fall in mid-pregnancy; hypercoagulable state (increased fibrinogen and clotting factors).

10. What respiratory and renal changes occur in normal pregnancy?

    Respiratory: tidal volume and minute ventilation rise (progesterone-driven) causing a compensated respiratory alkalosis; functional residual capacity falls. Renal: GFR and renal plasma flow rise ~50% → lower serum creatinine/urea; mild glycosuria and increased frequency.

11. By what gestational ages is fetal cardiac activity first seen on ultrasound and quickening typically felt?

    Cardiac activity on transvaginal ultrasound by ~6 weeks (visible when crown-rump length ≥7 mm). Quickening (maternal perception of movements) ~18–20 weeks in primigravida, ~16–18 weeks in multigravida.

12. Describe the four components of the biophysical profile (BPP) plus the fifth, and the normal score.

    Ultrasound assesses: fetal breathing movements, gross body movements, fetal tone, and amniotic fluid volume; plus the non-stress test (NST). Each scores 0 or 2; total 8–10 is reassuring, 6 equivocal, ≤4 abnormal.

13. Define preeclampsia and list the criteria for severe features.

    Preeclampsia = new-onset hypertension (≥140/90 on two occasions) after 20 weeks with proteinuria (≥300 mg/24h or protein/creatinine ≥0.3) OR end-organ dysfunction. Severe features: BP ≥160/110, platelets <100,000, creatinine >1.1, raised transaminases, pulmonary edema, headache/visual symptoms.

14. What is the first-line anticonvulsant for eclampsia and the antidote for its toxicity?

    Magnesium sulfate is first-line for seizure prophylaxis and treatment of eclampsia. Calcium gluconate is the antidote for magnesium toxicity (signs: loss of deep tendon reflexes, respiratory depression, oliguria).

15. What defines HELLP syndrome?

    Hemolysis (low haptoglobin, raised LDH, schistocytes), Elevated Liver enzymes, and Low Platelets — a severe variant/complication of preeclampsia; definitive treatment is delivery.

16. How is gestational diabetes mellitus (GDM) screened and diagnosed using the 75 g OGTT?

    Universal/risk-based screening at 24–28 weeks. 75 g 2-hour OGTT (IADPSG/WHO) diagnostic if any value met: fasting ≥92 mg/dL, 1-hour ≥180 mg/dL, or 2-hour ≥153 mg/dL. (DIPSI uses 75 g non-fasting 2-h ≥140 mg/dL in India.)

17. What are the main maternal and fetal complications of poorly controlled GDM?

    Fetal: macrosomia, shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, polyhydramnios, congenital anomalies (if pregestational). Maternal: preeclampsia, increased cesarean rate, and future risk of type 2 diabetes.

18. Define preterm labor and name the antenatal interventions for fetal lung maturity and neuroprotection.

    Preterm labor = regular contractions with cervical change before 37 completed weeks. Antenatal corticosteroids (betamethasone/dexamethasone) between 24–34 weeks for fetal lung maturity; magnesium sulfate <32 weeks for fetal neuroprotection; tocolytics to delay delivery 48 h.

19. How are twin pregnancies classified by chorionicity and which type carries the highest risk?

    Dichorionic-diamniotic (DCDA), monochorionic-diamniotic (MCDA), and monochorionic-monoamniotic (MCMA). Monochorionic twins risk twin-to-twin transfusion syndrome; MCMA carries the highest risk (cord entanglement). Chorionicity is best determined by first-trimester ultrasound (lambda/twin-peak sign = DCDA, T-sign = MCDA).

20. List the cardinal movements of labor in order.

    Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion.

21. What are the three stages of labor and their definitions?

    First stage: onset of true labor to full cervical dilatation (10 cm) — latent (0–6 cm) and active phases. Second stage: full dilatation to delivery of the baby. Third stage: delivery of the baby to delivery of the placenta.

22. In intrapartum cardiotocography, what defines a normal/reassuring fetal heart rate trace?

    Baseline 110–160 bpm, moderate variability (6–25 bpm), presence of accelerations, and absence of decelerations (or only early decelerations). This is a Category I trace.

23. Differentiate early, variable, and late decelerations on CTG by mechanism.

    Early decelerations: mirror contractions, caused by head compression (benign). Variable decelerations: abrupt, variable timing/shape, caused by cord compression. Late decelerations: nadir after the contraction peak, caused by uteroplacental insufficiency (ominous, indicate fetal hypoxia).

24. What are the four components of active management of the third stage of labor (AMTSL)?

    Administration of a uterotonic (oxytocin 10 IU IM, within 1 min of delivery), controlled cord traction (Brandt-Andrews), and uterine massage after placental delivery; delayed cord clamping is also recommended. AMTSL reduces postpartum hemorrhage.

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