Gynecological Disorders Practice Questions

Q: Bacterial vaginosis is also known by which of the following names?

Haemophilus vaginitis. **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome characterized by the replacement of normal hydrogen peroxide-producing *Lactobacillus* species with high concentrations of anaerobic bacteria. **Why Option B is Correct:** Historically, the organism most frequently associated with this condition was identified as *Haemophilus vaginalis*. Over time, the nomenclature evolved: it was renamed *Corynebacterium vaginale* and is currently known as **Gardnerella vaginalis**. Because of this historical classification, Bacterial Vaginosis is still synonymously referred to as **Haemophilus vaginitis** or Gardnerella vaginitis in medical literature and examinations. **Why Other Options are Incorrect:** * **Option A (Clostridium):** While some anaerobes like *Mobiluncus* are involved in BV, *Clostridium* species are not primary causative agents. * **Option C (Citrobacter):** This is a Gram-negative coliform bacterium typically associated with urinary tract infections or neonatal meningitis, not vaginal dysbiosis. * **Option D (Staphylococcal):** *Staphylococcus aureus* is associated with Toxic Shock Syndrome (TSS) but is not the etiology of the malodorous discharge seen in BV. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required):** 1. Homogeneous, thin, white-grey discharge. 2. Vaginal pH **> 4.5** (Most sensitive). 3. **Whiff Test:** Fishy odor on adding 10% KOH (due to release of amines). 4. **Clue Cells** on saline microscopy (Most specific). * **Nugent Scoring:** The "Gold Standard" for diagnosis based on Gram stain morphotypes. * **Treatment of Choice:** Oral **Metronidazole** (500 mg twice daily for 7 days). Clindamycin is an alternative. * **Note:** BV is a dysbiosis, not a true infection; therefore, treating the male partner is **not** recommended.

Q: Which of the following is least commonly seen in uterine fibroid?

Sarcomatous change. **Explanation:** Uterine fibroids (leiomyomas) are benign smooth muscle tumors that frequently undergo various types of degeneration due to an outgrown blood supply. **Why Sarcomatous Change is the Correct Answer:** Sarcomatous change (transformation into leiomyosarcoma) is the **least common** occurrence, seen in **less than 0.1%** (approximately 0.5% in some texts) of cases. It is typically suspected in postmenopausal women who present with a rapidly enlarging uterus and postmenopausal bleeding. Because it is a malignant transformation rather than a simple degenerative process, it is statistically the rarest outcome among the options provided. **Analysis of Incorrect Options:** * **Hyaline Degeneration (A):** This is the **most common** type of degeneration (seen in ~65% of cases). It occurs when the fibrous tissue replaces the smooth muscle, giving it a homogenous appearance. * **Red Degeneration (C):** Also known as carneous degeneration, this typically occurs during **pregnancy** (usually the 2nd trimester) due to aseptic infarction. It is characterized by severe pain and a "beefy red" appearance. * **Fatty Degeneration (D):** This is relatively common, especially in older women or following menopause, occurring after hyaline degeneration as the tissue further breaks down. **NEET-PG High-Yield Pearls:** * **Most common degeneration overall:** Hyaline degeneration. * **Most common degeneration during pregnancy:** Red degeneration. * **Calcific degeneration:** Most common in postmenopausal women (seen as "womb stones" on X-ray). * **Cystic degeneration:** Occurs when hyaline tissue liquefies; often mimics an ovarian cyst on ultrasound. * **Key Clinical Sign of Sarcoma:** Rapid growth of a fibroid in a **postmenopausal** woman.

Q: In which condition might a vulvectomy be indicated?

Granuloma inguinale. **Explanation:** **Granuloma Inguinale (Donovanosis)** is a chronic, progressive bacterial infection caused by *Klebsiella granulomatis*. While primarily treated with antibiotics (e.g., Azithromycin), it is characterized by extensive, painless, beefy-red "pseudobuboes" and significant tissue destruction. In chronic or neglected cases, the disease leads to severe **cicatrization (scarring), lymphatic obstruction, and vulvar elephantiasis**. In such instances of extensive tissue distortion or when there is a suspicion of malignant transformation (as chronic inflammation is a risk factor for squamous cell carcinoma), a **vulvectomy** may be indicated for functional and reconstructive purposes. **Why the other options are incorrect:** * **Chlamydia trachomatis:** Causes Lymphogranuloma Venereum (LGV) or cervicitis. While LGV can cause lymphatic obstruction (Esthiomene), the primary treatment is medical (Doxycycline). Vulvectomy is rarely the first-line surgical consideration compared to the extensive destruction seen in Donovanosis. * **Herpes Simplex (HSV):** A viral infection presenting with painful vesicles. It is managed with antiviral therapy (Acyclovir) and does not cause the structural destruction requiring radical surgery. * **Candidal Infection:** A common fungal vulvovaginitis treated with topical or oral antifungals (Fluconazole). It does not lead to permanent structural damage. **NEET-PG High-Yield Pearls:** * **Pathognomonic sign:** **Donovan Bodies** (safety-pin appearance) seen on Giemsa or Wright stain. * **Clinical feature:** "Beefy red" ulcers that bleed easily on touch; notably **painless**. * **Drug of Choice:** Azithromycin (1g once weekly or 500mg daily for at least 3 weeks). * **Surgical Note:** Surgery is reserved for late-stage complications like **pseudoelephantiasis** or secondary malignancy.

Question 1

Bacterial vaginosis is also known by which of the following names?

Accepted Answer

Haemophilus vaginitis

Answer

Clostridium vaginitis

Answer

Citrobacter vaginitis

Answer

Staphylococcal vaginitis

Question 2

Which of the following is least commonly seen in uterine fibroid?

Accepted Answer

Sarcomatous change

Answer

Hyaline degeneration

Answer

Red degeneration

Answer

Fatty degeneration

Question 3

What is the treatment of leukoplakia of the vulva?

Accepted Answer

Estrogen cream

Answer

Irradiation

Answer

Simple vulvectomy

Answer

Radical vulvectomy

Question 4

In which condition might a vulvectomy be indicated?

Accepted Answer

Granuloma inguinale

Answer

Chlamydia trachomatis infection

Answer

Herpes simplex infection

Answer

Candidal infection

Question 5

In women with ureterovaginal fistula, which of the following statements is FALSE?

Accepted Answer

Approximately 40% of cases heal spontaneously.

Answer

It may produce free fluid in the abdominal cavity.

Answer

It is often associated with hydronephrosis on the affected side.

Answer

None of the above statements is false.

Question 6

Ectopic pregnancy differs from threatened abortion by:

Accepted Answer

Manifests at an earlier gestational age

Answer

Minimal vaginal bleeding

Answer

Pain follows bleeding

Answer

Uterine size corresponds to gestational age

Question 7

All of the following are true about Doderlein's bacillus, EXCEPT?

Accepted Answer

Estrogen stimulates the growth of this bacillus

Answer

Gram-positive bacteria

Answer

Grows in acidic media

Answer

Converts glycogen into lactic acid

Question 8

Which condition of the genital organs may lead to lesions in surgical scars, rectum, lymph nodes, and lungs?

Accepted Answer

Endometriosis

Answer

Teratoma

Answer

Adenomyosis

Answer

Fibroid

Question 9

Which of the following pre-malignant conditions of the vulva presents with a "cake icing effect"?

Accepted Answer

Paget's disease of vulva

Answer

Vulvar intraepithelial neoplasia

Answer

Lichen sclerosis

Answer

Leukoplakia

Question 10

Histology of an endometriotic lesion represents its association with which of the following?

Accepted Answer

High estrogen

Answer

High progesterone

Answer

High cholesterol

Answer

High levels of prolactin

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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