Gynecological Disorders Practice Questions

Q: A 25-year-old female presents with endometriosis. Diagnostic imaging reveals a 5 cm ovarian cyst. What is your treatment approach?

Laparoscopic cystectomy. **Explanation:** The patient presents with an **endometrioma** (chocolate cyst), a common manifestation of endometriosis. For an endometrioma larger than 3–4 cm, surgical intervention is the gold standard. **Why Laparoscopic Cystectomy is the Correct Choice:** Laparoscopic cystectomy involves the complete excision of the cyst wall. This is the preferred surgical approach because it is associated with a **lower rate of recurrence** and a higher spontaneous pregnancy rate compared to simple drainage or ablation. By removing the entire cyst lining, the source of ectopic endometrial tissue is eliminated, providing better long-term relief of symptoms like chronic pelvic pain and dysmenorrhea. **Analysis of Incorrect Options:** * **A. Laparoscopic drainage:** While this provides immediate relief, it has a very high recurrence rate (up to 80–100%) because the functional cyst lining remains intact. * **C. Laparoscopic adhesiolysis:** This is often performed *during* surgery for endometriosis to restore anatomy, but it does not treat the primary pathology (the 5 cm cyst) itself. * **D. Hormonal therapy:** While medical management (OCPs, GnRH agonists, Progestins) can manage pain, it is generally **ineffective** at resolving an endometrioma larger than 3 cm. Surgery is required for definitive management of large cysts. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy with biopsy (visualizing "powder-burn" or "mulberry" lesions). * **Tumor Marker:** CA-125 is often elevated in endometriosis but is non-specific. * **Infertility:** Cystectomy is preferred over drainage to improve fertility, though care must be taken to preserve the ovarian reserve (AMH levels may drop post-surgery). * **Ground Glass Appearance:** Classic finding on pelvic ultrasound for an endometrioma.

Q: Red degeneration of a fibroid is associated with which of the following conditions?

Pregnancy. **Explanation:** **Red degeneration** (also known as necrobiosis) is the most common form of degeneration seen in uterine fibroids during **pregnancy**, typically occurring in the second trimester. **Why Pregnancy is the Correct Answer:** The underlying mechanism is a **vascular accident**. During pregnancy, the fibroid undergoes rapid growth due to high estrogen levels. This growth outpaces its blood supply, leading to venous obstruction and congestion. This results in hemorrhage into the substance of the tumor and subsequent infarction. The characteristic "red" appearance is due to the diffusion of hemoglobin from hemolyzed red blood cells into the necrotic tissue. **Analysis of Incorrect Options:** * **B. Aseptic infection:** While red degeneration is a sterile (aseptic) necrotic process, it is not an "infection." It is an ischemic phenomenon. * **C. Thrombosis:** While venous thrombosis within the tumor's vessels is a *step* in the pathogenesis of red degeneration, the clinical condition most strongly and classically associated with this specific type of degeneration is pregnancy. * **D. Leukocytosis:** This is a clinical finding (raised white cell count) that may accompany the acute pain and fever of red degeneration, but it is a secondary sign, not the underlying associated condition. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Acute abdominal pain, localized tenderness over the fibroid, low-grade fever, and vomiting. * **Diagnosis:** Ultrasound is the first-line investigation; MRI shows a characteristic peripheral rim of high T1 signal. * **Management:** Always **conservative**. Treatment involves bed rest, hydration, and analgesics (NSAIDs). Surgery (myomectomy) is contraindicated during pregnancy due to the risk of uncontrollable hemorrhage. * **Most common degeneration overall:** Hyaline degeneration (seen in non-pregnant states).

Q: Which condition is characterized by a 'tobacco pouch' appearance?

Tuberculosis of fallopian tubes. **Explanation:** The **'tobacco pouch' appearance** is a classic laparoscopic finding in **Genital Tuberculosis (TB)** affecting the fallopian tubes. This appearance occurs when the fimbrial ends of the fallopian tubes are everted and the ostium remains open, but the tube itself is constricted by surrounding fibrosis and adhesions. This results in a shrunken, puckered look resembling an old-fashioned drawstring tobacco pouch. **Analysis of Options:** * **A. Tuberculosis of fallopian tubes (Correct):** In addition to the tobacco pouch appearance, TB is the most common cause of chronic Pelvic Inflammatory Disease (PID) in developing countries. It often leads to infertility due to tubal blockage or "Lead pipe" rigidity of the tubes. * **B. Endometriosis:** Characterized by "powder-burn" lesions, "chocolate cysts" (endometriomas) in the ovaries, and a "frozen pelvis" due to extensive adhesions, but not the tobacco pouch deformity. * **C. Ovarian carcinoma:** Typically presents with solid-cystic adnexal masses, ascites, and elevated CA-125. It does not produce this specific tubal morphology. * **D. Fallopian tube carcinoma:** Classically associated with **Latzko’s triad** (intermittent profuse watery vaginal discharge, pelvic pain, and a pelvic mass). The tubes usually appear sausage-shaped (hydrops tubae profluens). **High-Yield Clinical Pearls for NEET-PG:** * **Beaded Tube:** Another classic radiological/pathological finding in Genital TB due to multiple strictures. * **Schlamm’s Sign:** Calcified lymph nodes or pelvic calcifications seen on X-ray in TB. * **Gold Standard Diagnosis:** Endometrial biopsy/aspiration for Histopathology and TB Culture (taken in the pre-menstrual phase). * **Most common site of Genital TB:** Fallopian tubes (90-100%), followed by the Endometrium (50-60%).

Q: A 30-year-old female presents to the emergency department with a complaint of sudden, severe abdominal pain. An abdominal mass is palpable on examination. What is the most likely diagnosis?

Torsion of an ovarian cyst. **Explanation:** The clinical presentation of sudden-onset, severe abdominal pain associated with a palpable mass is a classic triad for **Adnexal (Ovarian) Torsion**. **1. Why Option B is Correct:** Ovarian torsion occurs when the ovary, often enlarged by a cyst (usually >5 cm), rotates around its pedicle (the infundibulopelvic and tubo-ovarian ligaments). This rotation compromises venous and lymphatic drainage, leading to congestion, edema, and eventually arterial ischemia. The presence of a **palpable mass** is a key distinguishing feature, as the cyst acts as the "lead point" for the torsion. **2. Why Other Options are Incorrect:** * **Option A (Torsion of a subserous fibroid):** While possible, it is significantly rarer than ovarian torsion. Fibroids are typically firm and often present with a history of menorrhagia or pressure symptoms rather than acute surgical emergencies. * **Option C (Rupture of ectopic pregnancy):** While this causes sudden severe pain, it is usually associated with a history of amenorrhea, positive pregnancy test (β-hCG), and signs of hemodynamic instability (shock). A large palpable mass is less common compared to ovarian torsion. * **Option D (Rupture of an ovarian cyst):** Rupture typically leads to sudden pain that may improve as the fluid disperses, but the **palpable mass usually disappears** or becomes less distinct upon rupture. **3. NEET-PG High-Yield Pearls:** * **Most common cyst to undergo torsion:** Dermoid cyst (Mature Cystic Teratoma) due to its heavy, sebaceous content. * **Investigation of Choice:** Color Doppler Ultrasound (shows "Whirlpool sign" and absent/decreased blood flow). * **Management:** Prompt laparoscopy. The current trend is **detorsion** (untwisting) and cystectomy, even if the ovary appears dusky, as many regain function. Salpingo-oophorectomy is reserved for necrotic/gangrenous tissue.

Q: Which of the following infections can cause Asherman syndrome?

Tuberculosis. **Explanation:** **Asherman Syndrome** refers to the presence of intrauterine adhesions (synechiae) that lead to menstrual irregularities (amenorrhea or oligomenorrhea) and infertility. **Why Tuberculosis is the correct answer:** In the context of infections, **Genital Tuberculosis** is the most common cause of Asherman syndrome in developing countries like India. Chronic infection by *Mycobacterium tuberculosis* leads to severe inflammation of the endometrium (endometritis), resulting in the destruction of the *stratum basalis* layer. This destruction prevents normal endometrial regeneration, leading to the formation of dense fibrous adhesions that obliterate the uterine cavity. This is often referred to as "Netter’s Syndrome" when the cavity is completely obliterated. **Why other options are incorrect:** * **Chlamydia & Staphylococcus:** These are common causes of Pelvic Inflammatory Disease (PID). While they primarily cause salpingitis (tubal damage) and pelvic adhesions, they rarely cause the extensive destruction of the endometrial basal layer required to produce Asherman syndrome. * **Candida:** This is a fungal infection typically limited to the vagina (vulvovaginal candidiasis). It does not ascend to the endometrium or cause intrauterine scarring. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause overall:** Over-vigorous curettage (D&C) of a pregnant or recently pregnant uterus (post-abortal or postpartum). * **Gold Standard Investigation:** Hysteroscopy (both diagnostic and therapeutic). * **HSG Finding:** Characterized by "filling defects" or a "jagged/irregular" uterine contour. * **Treatment:** Hysteroscopic adhesiolysis followed by estrogen therapy to promote endometrial regrowth and insertion of an IUCD or Foley catheter to prevent re-adhesion.

Q: A 39-year-old woman, para 3 live 3, complains of severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus of around 12 weeks pregnant size, with no adnexal tenderness. Results of endometrial biopsy are normal. What is the most likely diagnosis?

Adenomyosis. ### Explanation **Correct Answer: C. Adenomyosis** **Why it is correct:** Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. The classic clinical triad for adenomyosis is **multiparous women** (usually 35–50 years old) presenting with **progressive secondary dysmenorrhea** and **menorrhagia**. On physical examination, the hallmark finding is a **diffusely enlarged, "globular," and tender uterus**, typically not exceeding 12–14 weeks in size. The tenderness is often most prominent during the premenstrual phase. The diagnosis is clinical, supported by MRI or Transvaginal Ultrasound (showing "venetian blind" shadowing or asymmetrical myometrial thickening), and confirmed by histopathology. **Why the other options are incorrect:** * **A. Endometriosis:** While it causes secondary dysmenorrhea, the uterus is usually normal in size. Findings typically include fixed retroverted uterus, adnexal masses (endometriomas), or tender nodules in the pouch of Douglas. * **B. Endometritis:** This is an infection of the endometrium, usually presenting with acute pelvic pain, fever, and purulent vaginal discharge, rather than chronic progressive dysmenorrhea. * **D. Uterine Sarcoma:** This is a rare malignancy presenting with rapid uterine growth (often post-menopausal) and irregular bleeding. The uterus would be firm and irregular rather than diffusely globular and tender. **Clinical Pearls for NEET-PG:** * **Adenomyosis vs. Fibroids:** Fibroids cause an *asymmetrically* enlarged, firm, non-tender uterus. Adenomyosis causes a *symmetrically* enlarged, soft, tender uterus. * **Definitive Treatment:** Hysterectomy is the only definitive cure. * **Pathology:** Look for the "Halban’s sign" (tender uterus on examination during menstruation). * **Microscopy:** Endometrial islands must be at least 2.5 mm below the basalis layer to be termed adenomyosis.

Question 1

A 25-year-old female presents with endometriosis. Diagnostic imaging reveals a 5 cm ovarian cyst. What is your treatment approach?

Accepted Answer

Laparoscopic cystectomy

Answer

Laparoscopic drainage

Answer

Laparoscopic adhesiolysis

Answer

Hormonal therapy

Question 2

What is the most common complication after abdominal hysterectomy?

Accepted Answer

Ureteral injury

Answer

Intestinal injury

Answer

Urinary bladder atony

Answer

Vaginal vault prolapse

Question 3

Which versa point is used for hysteroscopic metroplasty?

Accepted Answer

Bipolar electrosurgical system that works with normal saline

Answer

Bipolar electrosurgical system that cannot be used with normal saline

Answer

Unipolar electrosurgical system that cannot be used with normal saline

Answer

Unipolar electrosurgical system that works with normal saline

Question 4

Red degeneration of a fibroid is associated with which of the following conditions?

Accepted Answer

Pregnancy

Answer

Aseptic infection

Answer

Thrombosis

Answer

Leukocytosis

Question 5

A 19-year-old sexually active female presents with abdominal pain and nausea. Her last menstrual period began seven days ago. Physical examination reveals fever and lower abdominal pain. Pelvic examination shows a mucopurulent discharge, adnexal tenderness, and tenderness with cervical motion. A pregnancy test is negative, and her white blood cell count is elevated. Which of the following complications is associated with this disorder?

Accepted Answer

Infertility

Answer

Ascites

Answer

Cervical carcinoma

Answer

Exsanguination

Question 6

Which condition is characterized by a 'tobacco pouch' appearance?

Accepted Answer

Tuberculosis of fallopian tubes

Answer

Endometriosis

Answer

Ovarian carcinoma

Answer

Fallopian tube carcinoma

Question 7

A 30-year-old female presents to the emergency department with a complaint of sudden, severe abdominal pain. An abdominal mass is palpable on examination. What is the most likely diagnosis?

Accepted Answer

Torsion of an ovarian cyst

Answer

Torsion of a subserous fibroid

Answer

Rupture of ectopic pregnancy

Answer

Rupture of an ovarian cyst

Question 8

Which of the following infections can cause Asherman syndrome?

Accepted Answer

Tuberculosis

Answer

Chlamydia

Answer

Staphylococcus

Answer

Candida

Question 9

Which drug reduces the size of a myoma?

Accepted Answer

All of the above

Answer

GnRH agonist

Answer

Danazol

Answer

Estrogen

Question 10

A 39-year-old woman, para 3 live 3, complains of severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus of around 12 weeks pregnant size, with no adnexal tenderness. Results of endometrial biopsy are normal. What is the most likely diagnosis?

Accepted Answer

Adenomyosis

Answer

Endometriosis

Answer

Endometritis

Answer

Uterine sarcoma

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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