Gynecological Disorders Practice Questions

Q: A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?

Pelvic inflammatory disease (PID). **Explanation:** The most common risk factor for ectopic pregnancy is **Pelvic Inflammatory Disease (PID)**. PID, often caused by *Chlamydia trachomatis* or *Neisseria gonorrhoeae*, leads to salpingitis. This inflammation results in the loss of ciliary action in the tubal epithelium and the formation of intratubal adhesions (endosalpingeal scarring). These structural and functional changes delay or prevent the transport of the fertilized ovum to the uterine cavity, leading to implantation within the fallopian tube. **Analysis of Options:** * **Previous tubal surgery (Option A):** While this carries the **highest relative risk** (Odds Ratio) for an ectopic pregnancy, PID is the more common predisposing factor in the general population due to its higher prevalence. * **Use of an IUD (Option C):** IUDs do not *cause* ectopic pregnancy; they are highly effective at preventing all pregnancies. However, if a woman becomes pregnant with an IUD in situ, the *proportion* of those pregnancies being ectopic is higher. * **Induction of ovulation (Option D):** While assisted reproductive technologies (ART) increase the risk of ectopic and heterotopic pregnancies due to hormonal changes and multiple embryos, it is a less frequent cause compared to the widespread incidence of PID. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of ectopic pregnancy:** Ampulla of the Fallopian tube (70%). * **Most common site of tubal rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) + Serial β-hCG (Discriminatory zone: 1500–2000 mIU/ml). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, characteristic of (but not pathognomonic for) ectopic pregnancy.

Q: What procedure is the instrument shown below typically used for?

Papanicolaou smear. ***Papanicolaou smear*** - The **Ayre's spatula** and **cervical cytobrush** are specifically designed to collect **exfoliated cervical cells** from the transformation zone for cytological examination. - This procedure is the gold standard for **cervical cancer screening** and detecting **precancerous lesions** (dysplasia). *Visual inspection with acetic acid* - Uses **3-5% acetic acid** applied directly to the cervix, causing abnormal areas to appear **acetowhite**. - Does not require specialized collection instruments like spatulas or brushes, only **visual examination**. *Visual inspection with Lugol's iodine* - Involves applying **Lugol's iodine solution** to the cervix, where normal tissue stains **mahogany brown** while abnormal areas remain **unstained**. - This is a **naked-eye examination** technique that doesn't involve cell collection instruments. *Colposcopy* - Utilizes a **colposcope** (binocular microscope) to magnify the cervix **6-40 times** for detailed visualization. - While **biopsy forceps** may be used during colposcopy for tissue sampling, the primary instrument is the colposcope, not collection spatulas.

Q: Which of the following hormones promotes the development of fibroids?

Estrogen and Progesterone. **Explanation:** Uterine fibroids (leiomyomas) are benign, monoclonal tumors of the myometrium. Their growth is strictly hormone-dependent, specifically requiring the synergistic action of both **Estrogen and Progesterone**. * **Why Estrogen and Progesterone is correct:** * **Estrogen** acts as the primary initiator of growth by increasing the expression of growth factors and inducing the synthesis of **progesterone receptors (PR)**. * **Progesterone** is now recognized as the key driver of tumor proliferation. It stimulates the production of extracellular matrix and inhibits apoptosis (cell death) within the fibroid. Clinical evidence shows that fibroids shrink after menopause (when both hormones drop) and during treatment with GnRH agonists or Progesterone receptor modulators (like Ulipristal). **Analysis of Incorrect Options:** * **A. Testosterone:** Androgens do not play a primary role in the pathogenesis of fibroids; in fact, high androgen states (like PCOS) are more closely linked to endometrial hyperplasia rather than myometrial tumors. * **B & D. Estrogen/Progesterone only:** While Estrogen was historically thought to be the sole driver, modern molecular studies prove that Estrogen alone is insufficient for sustained growth. Progesterone is essential for the mitotic activity of the leiomyoma cells. **NEET-PG High-Yield Pearls:** 1. **Risk Factors:** Early menarche, obesity (increased peripheral conversion to estrogen), and nulliparity. 2. **Protective Factors:** Multiparity, menopause, and smoking (due to decreased estrogen levels). 3. **Red Degeneration:** Most common during the **second trimester** of pregnancy due to rapid growth and venous thrombosis. 4. **Medical Management:** GnRH analogues are used pre-operatively to reduce fibroid volume and correct anemia.

Q: A woman diagnosed with Trichomoniasis should also be evaluated for which of the following?

Other venereal disease. **Explanation:** **Trichomoniasis**, caused by the flagellated protozoan *Trichomonas vaginalis*, is a classic **Sexually Transmitted Infection (STI)**. The fundamental medical principle here is that STIs rarely occur in isolation. Because the risk factors for acquiring one STI (unprotected intercourse, multiple partners) are identical for others, the presence of *T. vaginalis* serves as a clinical marker for high-risk sexual behavior. 1. **Why "Other venereal disease" is correct:** Patients diagnosed with Trichomoniasis have a significantly higher prevalence of co-infections. Standard clinical protocol dictates that any patient with a confirmed STI must be screened for other "venereal" (sexually transmitted) diseases, specifically **HIV, Syphilis, Gonorrhea, and Chlamydia**. Furthermore, Trichomoniasis causes local inflammation and "strawberry spots" (petechiae) on the cervix, which can increase the risk of HIV transmission and acquisition. 2. **Why other options are incorrect:** * **Functional bowel dysfunction:** There is no physiological link between a protozoal vaginal infection and IBS or other bowel motility disorders. * **Hypertension:** Trichomoniasis is a localized genitourinary infection and does not have a systemic vascular etiology. * **Ovarian malfunction:** The infection primarily affects the squamous epithelium of the vagina, cervix, and urethra; it does not impact endocrine ovarian function or ovulation. **NEET-PG High-Yield Pearls:** * **Clinical Feature:** Profuse, malodorous, **frothy yellowish-green discharge** and "Strawberry Cervix" (Colpitis Macularis). * **Diagnosis:** **Whiff test** may be positive; **Wet mount** shows motile pear-shaped flagellates; **Gold Standard** is NAAT (Nucleic Acid Amplification Test). * **Treatment:** **Metronidazole** 2g single dose (oral). **Crucial:** Always treat the partner simultaneously to prevent "ping-pong" reinfection.

Q: Diethylstilbestrol causes the following defects except?

Renal anomalies. **Explanation:** Diethylstilbestrol (DES) is a synthetic non-steroidal estrogen that was historically used to prevent miscarriages. However, it is a potent teratogen that affects the development of the **Müllerian ducts** (paramesonephric ducts) in female fetuses. **1. Why Renal Anomalies is the correct answer:** DES specifically targets the differentiation and development of the Müllerian system (uterus, cervix, and upper vagina). **Renal development** is associated with the **Wolffian (mesonephric) ducts**. While DES causes extensive structural changes in the reproductive tract, it is **not** associated with an increased incidence of renal anomalies. This distinguishes DES exposure from other Müllerian anomalies (like Mayer-Rokitansky-Küster-Hauser syndrome), where renal defects are common. **2. Analysis of Incorrect Options:** * **T-shaped uterus:** This is the classic uterine anomaly associated with DES exposure. Other defects include a small (hypoplastic) uterus and constricted segments. * **Vaginal adenosis:** This is the presence of glandular columnar epithelium in the vagina (which should normally be squamous). It is a precursor to **Clear Cell Adenocarcinoma** of the vagina, a hallmark malignancy in "DES daughters." * **Perifimbrial cysts:** DES exposure often leads to fallopian tube abnormalities, including accessory ostia, blunted fimbriae, and perifimbrial cysts, which contribute to increased rates of ectopic pregnancy and infertility. **High-Yield Clinical Pearls for NEET-PG:** * **Clear Cell Adenocarcinoma:** The most feared complication of DES exposure. * **Cervical findings:** "Coxcomb" cervix, cervical collars, and cervical hypoplasia. * **Obstetric risks:** Increased risk of spontaneous abortion, ectopic pregnancy, and preterm labor (due to cervical incompetence). * **Male offspring:** May show epididymal cysts, cryptorchidism, or microphallus, but no increased risk of cancer.

Question 1

A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?

Accepted Answer

Pelvic inflammatory disease (PID)

Answer

Previous tubal surgery

Answer

Use of a contraceptive uterine device (IUD)

Answer

Induction of ovulation

Question 2

A 30-year-old woman, para two, with two live children, has experienced menorrhagia for 2 years. She underwent tubal ligation 4 years ago. Investigations reveal a 2cm x 2cm submucous myoma. What is the best management option for her?

Accepted Answer

Total abdominal hysterectomy

Answer

Danazol 400mg twice daily for 3 months

Answer

GnRH analogues

Answer

Hysteroscopic myomectomy

Question 3

A 17-year-old unmarried girl presents with fever, nausea, vomiting, pallor, and pain abdomen. She is having foul-smelling, blood-stained discharge per vaginum. What is your most likely diagnosis?

Accepted Answer

Pelvic abscess with septic peritonitis

Answer

Twisted ovarian cyst

Answer

Typhoid with enteric perforation

Answer

Ruptured ectopic pregnancy

Question 4

What is the treatment of choice for perimenopausal adenomyosis?

Accepted Answer

Hysterectomy

Answer

Oral contraceptive pills (OCP)

Answer

Levonorgestrel-releasing intrauterine contraceptive device (LNG IUCD)

Answer

Gonadotropin-releasing hormone (GnRH) agonists

Question 5

What procedure is the instrument shown below typically used for?

Accepted Answer

Papanicolaou smear

Answer

Visual inspection with acetic acid

Answer

Visual inspection with Lugol's iodine

Answer

Colposcopy

Question 6

A 40-year-old primiparous woman with suspected endometriosis is undergoing diagnostic laparoscopy. Findings include a normal uterus, chocolate cysts in both ovaries, endometriotic deposits on the right round ligament, both fallopian tubes, and the pouch of Douglas, with moderately dense adhesions between the fallopian tubes and the pouch of Douglas. What is the treatment of choice in this case?

Accepted Answer

Fulguration of endometriotic deposits

Answer

Total hysterectomy with bilateral salpingo-oophorectomy

Answer

Danazol therapy

Answer

Progesterone therapy

Question 7

Which drug reduces the size of uterine myoma?

Accepted Answer

GnRH agonist

Answer

Danazol

Answer

Progesterone

Answer

Mifepristone

Question 8

Which of the following hormones promotes the development of fibroids?

Accepted Answer

Estrogen and Progesterone

Answer

Testosterone

Answer

Estrogen only

Answer

Progesterone only

Question 9

A woman diagnosed with Trichomoniasis should also be evaluated for which of the following?

Accepted Answer

Other venereal disease

Answer

Functional bowel dysfunction

Answer

Hypertension

Answer

Ovarian malfunction

Question 10

Diethylstilbestrol causes the following defects except?

Accepted Answer

Renal anomalies

Answer

Perifimbrial cysts

Answer

T-shaped uterus

Answer

Vaginal adenosis

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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