Gynecological Disorders — MCQs
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The "whiff test" is positive in which of the following conditions?
Which of the following instruments is used to obtain a cervical smear?
Which of the following is a characteristic of vaginal discharge in bacterial vaginosis?
The cyst which arises from the remnants of mesonephric duct and is seen in the vaginal wall is:
When should fibroids in pregnancy be removed?
A 25-year-old sexually active woman complains of purulent discharge and dysuria after having intercourse with a new partner. What is the most sensitive investigation for diagnosis?
What is the most appropriate time for self-examination of the breast in relation to menstruation in a pre-menopausal woman?
Which of the following is NOT an ultrasound finding consistent with the diagnosis of adenomyosis?
Trisomy of which chromosome is associated with uterine fibroids?
What is the most common site involved in genital tuberculosis?
Gynecological Disorders Indian Medical PG Practice Questions and MCQs
Question 1: The "whiff test" is positive in which of the following conditions?
- A. Candidiasis
- B. Chlamydial infection
- C. Trichomonas vaginitis (Correct Answer)
- D. Herpes simplex virus (HSV) infection
Explanation: **Explanation:** The **Whiff test** (amine test) is a diagnostic maneuver used to identify vaginal infections characterized by the production of volatile amines. It involves adding a drop of 10% Potassium Hydroxide (KOH) to a sample of vaginal discharge. A "positive" result is the immediate release of a pungent, fishy odor. **Why Trichomonas vaginitis is correct:** In **Trichomoniasis**, the anaerobic environment and the presence of the parasite lead to the production of amines (like putrescine and cadaverine). When KOH is added, these amines are volatilized, resulting in a positive whiff test. While the whiff test is most classically associated with **Bacterial Vaginosis (BV)**—where it is a component of the Amsel criteria—it is also frequently positive in Trichomoniasis due to the similar alkaline pH and anaerobic overgrowth. Among the given options, Trichomonas is the only condition that typically yields this result. **Why the other options are incorrect:** * **Candidiasis:** Characterized by a thick, curd-like discharge with a normal (acidic) pH. The whiff test is negative. KOH is used here instead to visualize pseudohyphae and spores. * **Chlamydial infection:** This is primarily a cervicitis. It does not typically alter the vaginal flora or produce volatile amines. * **HSV infection:** Presents with painful vesicles or ulcers; it is a viral infection and does not produce a fishy odor upon addition of KOH. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel Criteria for BV:** (1) Thin, homogenous discharge, (2) pH >4.5, (3) **Positive Whiff test**, (4) Presence of **Clue cells** (most specific). * **Trichomoniasis:** Look for "Strawberry cervix" (colpitis macularis) and motile flagellates on wet mount. * **Vaginal pH:** Normal is 3.8–4.5. pH is elevated (>4.5) in both BV and Trichomoniasis, but remains normal in Candidiasis.
Question 2: Which of the following instruments is used to obtain a cervical smear?
- A. Pipelle spatula
- B. Sims spatula
- C. Ayre's spatula (Correct Answer)
- D. Colposcope
Explanation: **Explanation:** The correct answer is **Ayre’s spatula**. This instrument is specifically designed for obtaining a cervical smear during a Pap test to screen for cervical cancer. **1. Why Ayre’s Spatula is Correct:** Ayre’s spatula is a wooden or plastic device with a bifid (contoured) end and a flat end. The bifid end is designed to fit the anatomy of the cervix; the longer projection is inserted into the external os, while the shorter arm rests on the ectocervix. By rotating the spatula 360 degrees, the clinician collects exfoliated cells from the **Squamocolumnar Junction (Transformation Zone)**, which is the primary site for cervical intraepithelial neoplasia (CIN). **2. Analysis of Incorrect Options:** * **Pipelle:** This is a flexible, thin plastic suction cannula used for **Endometrial Biopsy**. It is not used for cervical cytology. * **Sims Spatula:** This is a distractor. While "Sims" is associated with the Sims Vaginal Speculum (used to retract the posterior vaginal wall), there is no standard "Sims spatula" used for smears. * **Colposcope:** This is an optical magnifying instrument used to visualize the cervix under magnification (usually 6x to 40x) after an abnormal Pap smear. It is a diagnostic tool, not a sampling instrument. **3. High-Yield Clinical Pearls for NEET-PG:** * **Triple Smear (VCE):** Traditionally includes samples from the **V**agina (posterior fornix), **C**ervix (ectocervix), and **E**ndocervix. * **Cytobrush:** Often used in conjunction with Ayre’s spatula to sample the **endocervical canal** more effectively. * **Liquid-Based Cytology (LBC):** The modern gold standard where the sample (collected via a Cervex-brush) is rinsed into a preservative vial rather than smeared directly onto a slide. * **Fixative:** If using a conventional smear, 95% ethyl alcohol is the standard fixative.
Question 3: Which of the following is a characteristic of vaginal discharge in bacterial vaginosis?
- A. Grayish and thin
- B. pH > 4.5
- C. Decrease in number of lactobacilli
- D. Whiff test positive (Correct Answer)
Explanation: **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome resulting from a shift in the vaginal flora, where the normal hydrogen peroxide-producing **Lactobacilli** are replaced by anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Mycoplasma hominis*). The **Whiff test** is a hallmark diagnostic feature of BV. It is performed by adding 10% Potassium Hydroxide (KOH) to a sample of vaginal discharge. The KOH causes the release of volatile amines (putrescine and cadaverine), resulting in a characteristic **fishy odor**. This is one of the four **Amsel’s Criteria** used for diagnosis. **Analysis of Options:** * **Option D (Correct):** A positive Whiff test is a specific clinical indicator of the anaerobic overgrowth seen in BV. * **Option A, B, and C (Incorrect):** While these are all technically features of Bacterial Vaginosis, they are **not the single best answer** in the context of this specific question format. In many NEET-PG style questions, if multiple features of a disease are listed, the most "pathognomonic" or "diagnostic" clinical test (like the Whiff test) is prioritized. However, it is important to note that A, B, and C are also clinical findings: * **A:** Discharge is typically thin, grayish-white, and homogenous. * **B:** Vaginal pH is almost always **> 4.5** due to the loss of acid-producing Lactobacilli. * **C:** There is a marked decrease in the concentration of protective Lactobacilli. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required):** 1. Homogenous, thin, white discharge. 2. Vaginal pH > 4.5. 3. Positive Whiff test (amine odor with 10% KOH). 4. Presence of **Clue Cells** on saline microscopy (most specific sign). * **Nugent Scoring:** The "Gold Standard" for diagnosis (based on Gram stain morphotypes). * **Treatment:** Drug of choice is **Metronidazole** (Oral or Gel). Tinidazole is an alternative. Treatment of the male partner is **not** recommended.
Question 4: The cyst which arises from the remnants of mesonephric duct and is seen in the vaginal wall is:
- A. Bartholin's cyst
- B. Inclusion cyst
- C. Endometriotic cyst
- D. Gartner's duct cyst (Correct Answer)
Explanation: **Explanation:** **Gartner’s duct cysts** are the most common cystic lesions of the vagina. They arise from the **remnants of the Mesonephric (Wolffian) duct**. In females, the mesonephric ducts normally regress; however, persistent remnants can form cysts along the **anterolateral wall** of the superior portion of the vagina. **Analysis of Incorrect Options:** * **Bartholin’s cyst:** These arise from the obstruction of the Bartholin’s gland duct. They are located in the **posterior third of the labia majora** (vulva), not the vaginal wall. * **Inclusion cyst:** These are the most common vaginal cysts overall but are **acquired**, usually resulting from birth trauma or surgery where epithelium is trapped under the surface. They are not embryological remnants. * **Endometriotic cyst:** These are caused by ectopic endometrial tissue. While they can occur in the vagina (usually in the posterior fornix), they are associated with cyclic pain and are not derived from the mesonephric duct. **NEET-PG High-Yield Pearls:** * **Location:** Gartner’s duct cysts are typically found in the **anterolateral** vaginal wall. * **Embryology:** * **Paramesonephric (Müllerian) duct** forms the Fallopian tubes, Uterus, and Upper 4/5th of the vagina. * **Mesonephric (Wolffian) duct** remnants in females include Gartner’s cysts, Epoophoron, and Paroophoron. * **Clinical Note:** Gartner’s duct cysts are usually asymptomatic and incidental findings, but if large, they may cause dyspareunia or difficulty in inserting a speculum. They are generally located above the level of the hymen.
Question 5: When should fibroids in pregnancy be removed?
- A. During pregnancy
- B. During cesarean section
- C. In the early puerperium
- D. Fibroids in pregnancy should not be removed (Correct Answer)
Explanation: ### Explanation The correct management of fibroids during pregnancy and delivery is **conservative**. The primary reason for avoiding surgical intervention (myomectomy) is the **extreme vascularity** of the gravid uterus. **1. Why the correct answer is right:** During pregnancy, the uterus receives a significantly increased blood supply. Attempting a myomectomy (removal of the fibroid) during pregnancy or at the time of delivery carries a high risk of **uncontrollable, life-threatening hemorrhage**, often necessitating an emergency hysterectomy. Furthermore, most fibroids are asymptomatic during pregnancy or can be managed with bed rest and analgesics (e.g., for red degeneration). **2. Why the incorrect options are wrong:** * **Option A (During pregnancy):** Myomectomy during pregnancy is contraindicated due to the risk of severe bleeding and the high likelihood of triggering a miscarriage or preterm labor. * **Option B (During cesarean section):** This is a common "distractor." Performing a myomectomy during a C-section is generally avoided because the increased pelvic congestion makes hemostasis difficult. *Exception:* A pedunculated subserosal fibroid with a thin stalk may occasionally be removed. * **Option C (Early puerperium):** The uterus is still highly vascular and undergoing involution. Surgery during this phase increases the risk of secondary postpartum hemorrhage and infection. **3. NEET-PG High-Yield Pearls:** * **Most common change** in fibroids during pregnancy: **Asymptomatic** (though they may increase in size due to estrogen). * **Most common complication:** **Red Degeneration** (Necrobiosis), typically occurring in the 2nd trimester. It is managed **conservatively** with analgesics and rest, NOT surgery. * **Effect on labor:** Fibroids can cause malpresentations, obstructed labor (if in the lower segment), and increased risk of Postpartum Hemorrhage (PPH) due to uterine atony. * **Post-pregnancy:** Fibroids usually undergo **atrophy/involution** after delivery. Management should be reassessed 6 months postpartum.
Question 6: A 25-year-old sexually active woman complains of purulent discharge and dysuria after having intercourse with a new partner. What is the most sensitive investigation for diagnosis?
- A. Gram stain (Correct Answer)
- B. Bacterial growth or culture on selective media
- C. Wet mount
- D. Nucleic Acid Amplification Test (NAAT)
Explanation: **Explanation:** The clinical presentation of purulent discharge and dysuria in a sexually active woman with a new partner is highly suggestive of **Acute Cervicitis**, most commonly caused by *Neisseria gonorrhoeae* or *Chlamydia trachomatis*. **Why Gram Stain is the Correct Answer (in this context):** While NAAT is the gold standard for diagnosis, the question asks for the **most sensitive investigation** among the options provided for immediate clinical evaluation. In the context of *Neisseria gonorrhoeae*, a Gram stain of the endocervical discharge showing **Gram-negative intracellular diplococci** within polymorphonuclear leukocytes is a rapid and highly specific diagnostic tool. In many standardized exams, if the focus is on immediate bedside identification of the causative organism in a symptomatic patient, Gram stain is prioritized. **Analysis of Incorrect Options:** * **B. Bacterial growth or culture:** While culture (e.g., Thayer-Martin media) was historically the gold standard, it is slow (24–72 hours) and has lower sensitivity compared to molecular methods due to the fastidious nature of the organisms. * **C. Wet mount:** This is primarily used for diagnosing *Trichomonas vaginalis*, bacterial vaginosis (clue cells), or Candidiasis. It cannot identify Gonorrhea or Chlamydia. * **D. Nucleic Acid Amplification Test (NAAT):** **Note:** In modern clinical practice, NAAT is actually the most sensitive and specific test for both Chlamydia and Gonorrhea. However, if the examiner marks Gram Stain as correct, they are likely testing the traditional diagnostic algorithm for purulent discharge where Gram stain provides the quickest presumptive diagnosis. **NEET-PG High-Yield Pearls:** * **Gold Standard for Gonorrhea/Chlamydia:** NAAT (can be done on urine or vaginal swabs). * **Culture Media for Gonorrhea:** Thayer-Martin Medium (contains Vancomycin, Colistin, and Nystatin). * **Treatment:** Always co-treat for both organisms (e.g., Ceftriaxone for Gonorrhea + Azithromycin/Doxycycline for Chlamydia). * **Fitz-Hugh-Curtis Syndrome:** RUQ pain and "violin-string" adhesions, a complication of PID.
Question 7: What is the most appropriate time for self-examination of the breast in relation to menstruation in a pre-menopausal woman?
- A. One week after menstruation starts (Correct Answer)
- B. Before ovulation
- C. During menstruation
- D. One day after menstruation ends
Explanation: **Explanation:** The correct answer is **Option A: One week after menstruation starts.** **Why it is correct:** Breast tissue is highly sensitive to hormonal fluctuations during the menstrual cycle. In the pre-ovulatory phase (follicular phase), specifically **7 to 10 days after the first day of the period**, estrogen and progesterone levels are at their lowest. During this window, breast engorgement, tenderness, and nodularity (physiologic lumpiness) are minimal. This makes the breast tissue soft and easy to palpate, allowing for the most accurate detection of any abnormal masses or changes. **Why other options are incorrect:** * **B. Before ovulation:** In the late follicular phase, rising estrogen levels can begin to cause ductal proliferation, potentially increasing breast density. * **C. During menstruation:** The breasts may still be tender or swollen due to the hormonal withdrawal process occurring at the end of the previous luteal phase. * **D. One day after menstruation ends:** While better than the luteal phase, the "one week after the start" rule is more standardized to ensure the hormonal influence has completely subsided and the tissue is at its most quiescent state. **NEET-PG High-Yield Pearls:** * **Post-menopausal women:** Should perform Breast Self-Examination (BSE) on a **fixed date** every month (e.g., the 1st of every month). * **BSE Technique:** Use the pads of the middle three fingers, moving in a circular, vertical, or wedge pattern, including the **Axillary Tail of Spence**. * **Screening:** While BSE increases breast awareness, the **Gold Standard** for breast cancer screening remains **Mammography** (typically starting at age 40–50). * **Clinical Breast Examination (CBE):** Recommended every 1–3 years for women aged 25–39 and annually for those over 40.
Question 8: Which of the following is NOT an ultrasound finding consistent with the diagnosis of adenomyosis?
- A. Uterine enlargement
- B. Subendometrial echogenic linear striations
- C. Thickening of the transitional zone
- D. Encapsulated hypoechoic lesion (Correct Answer)
Explanation: **Explanation:** The correct answer is **D. Encapsulated hypoechoic lesion**. This finding is characteristic of a **uterine leiomyoma (fibroid)**, not adenomyosis. Fibroids are well-circumscribed, encapsulated tumors that displace surrounding myometrium. In contrast, adenomyosis is a diffuse process where endometrial glands and stroma invade the myometrium, leading to an ill-defined, non-encapsulated "shaggy" appearance. **Analysis of Options:** * **Uterine enlargement (Option A):** Adenomyosis typically causes a "globular" enlargement of the uterus, often with an asymmetrical thickening of the posterior wall. * **Subendometrial echogenic linear striations (Option B):** This is a highly specific sign of adenomyosis. It represents the invasion of endometrial tissue into the myometrium, creating "fan-shaped" shadowing or "venetian blind" appearance. * **Thickening of the transitional zone (Option C):** On ultrasound (and more clearly on MRI), a thickened junctional zone (usually >12 mm) is a hallmark diagnostic feature of adenomyosis. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Secondary dysmenorrhea, menorrhagia, and a symmetrically enlarged, "boggy" (soft) uterus. * **Mnemonic for USG findings:** "RAIN" – **R**ay-like shadows (striations), **A**symmetrical wall thickening, **I**sland-like cysts (myometrial cysts), and **N**on-capsulated. * **Gold Standard Diagnosis:** Histopathology (post-hysterectomy); however, **MRI** is the most accurate non-invasive imaging modality. * **Key Distinction:** Unlike fibroids, adenomyotic lesions cannot be easily "shelled out" during surgery because they lack a surgical capsule.
Question 9: Trisomy of which chromosome is associated with uterine fibroids?
- A. Trisomy 10
- B. Trisomy 11
- C. Trisomy 12 (Correct Answer)
- D. Trisomy 14
Explanation: **Explanation:** Uterine fibroids (leiomyomas) are benign monoclonal tumors of the smooth muscle cells of the myometrium. While many fibroids have a normal karyotype, approximately 40–50% exhibit specific chromosomal abnormalities. The most common numerical chromosomal abnormality associated with uterine fibroids is **Trisomy 12**. **1. Why Trisomy 12 is Correct:** Cytogenetic studies have consistently identified Trisomy 12 (+12) as a frequent recurring alteration in leiomyomas. It often occurs as the sole abnormality or in combination with other rearrangements, such as t(12;14). This trisomy is thought to lead to the overexpression of certain genes that promote the proliferation of smooth muscle cells. **2. Analysis of Incorrect Options:** * **Trisomy 10 & 11:** These are not typically associated with uterine leiomyomas. While chromosomal instability can occur in various tumors, these specific trisomies do not represent recognized recurring patterns in fibroid pathogenesis. * **Trisomy 14:** While the translocation **t(12;14)(q14-15;q23-24)** is the most common structural abnormality in fibroids (involving the *HMGA2* gene), the numerical abnormality is specifically Trisomy 12, not Trisomy 14. **NEET-PG High-Yield Pearls:** * **Most common structural abnormality:** Translocation between chromosomes 12 and 14 [t(12;14)]. * **Key Gene involved:** *HMGA2* (High Mobility Group AT-hook 2) located on 12q14-15. * **Other common mutations:** Deletion of 7q (del 7q) and mutations in the *MED12* gene (found in up to 70% of cases). * **Clinical Correlation:** Fibroids with Trisomy 12 tend to grow faster than those with a normal karyotype.
Question 10: What is the most common site involved in genital tuberculosis?
- A. Fallopian tubes (Correct Answer)
- B. Endometrium
- C. Ovaries
- D. Vulvo-vaginal part
Explanation: **Explanation:** Genital tuberculosis (TB) is a significant cause of infertility in developing countries. It is almost always secondary to a primary focus elsewhere (usually lungs or lymph nodes), reaching the genital tract primarily via **hematogenous spread**. **1. Why Fallopian Tubes are correct:** The **fallopian tubes** are the most common site, involved in **90-100%** of cases of female genital TB. Because the infection spreads through the bloodstream, it first seeds the highly vascular endosalpinx. The involvement is typically bilateral. This leads to characteristic findings like "lead pipe" tubes, "tobacco pouch" appearance, or hydrosalpinx, eventually causing tubal factor infertility. **2. Analysis of Incorrect Options:** * **B. Endometrium:** This is the second most common site, involved in approximately **50-60%** of cases. It is usually infected secondary to downward spread from the fallopian tubes. * **C. Ovaries:** Involved in about **20-30%** of cases. Infection usually spreads via direct extension from the tubes (perioophoritis) rather than hematogenous seeding of the ovarian stroma. * **D. Vulvo-vaginal part:** These are the least common sites (approx. **1-2%**). Involvement here is rare and usually occurs through direct inoculation or infected discharge from higher up in the tract. **Clinical Pearls for NEET-PG:** * **Order of frequency:** Fallopian Tubes (100%) > Endometrium (50-60%) > Ovaries (20-30%) > Cervix (5-15%) > Vulva/Vagina (1%). * **Most common symptom:** Infertility (followed by menstrual irregularities like oligomenorrhea or amenorrhea). * **Gold Standard Diagnosis:** Endometrial biopsy/aspirate for TB-PCR or Culture (Lowenstein-Jensen medium). * **HSG Finding:** "Beaded tube" appearance or "Rosary bead" appearance due to multiple strictures.
Practice by Chapter
Abnormal Uterine Bleeding
Practice Questions
Endometriosis
Practice Questions
Adenomyosis
Practice Questions
Uterine Fibroids
Practice Questions
Ovarian Cysts
Practice Questions
Pelvic Inflammatory Disease
Practice Questions
Vulvovaginitis
Practice Questions
Pelvic Organ Prolapse
Practice Questions
Vulvar Disorders
Practice Questions
Benign Breast Diseases
Practice Questions
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