Gynecological Disorders Practice Questions

Q: What is the investigation of choice in a 55-year-old postmenopausal woman who has presented with postmenopausal bleeding?

Fractional curettage. **Explanation:** In a postmenopausal woman presenting with vaginal bleeding, the primary clinical objective is to rule out **Endometrial Carcinoma**, which is present in approximately 10% of such cases. **Why Fractional Curettage is the Correct Answer:** Fractional curettage remains the traditional "gold standard" investigation of choice for definitive diagnosis. It involves separate sampling of the endocervical canal and the endometrial cavity. This process is crucial because it not only provides a tissue diagnosis (histopathology) but also helps in determining the extent of the disease (staging), specifically whether the malignancy involves the cervix. While Pipelle biopsy is often the first-line office procedure today, fractional curettage is the definitive diagnostic choice in the context of NEET-PG examinations. **Analysis of Incorrect Options:** * **A. Pap smear:** This is a screening tool for cervical cancer, not a diagnostic tool for endometrial pathology. It has very low sensitivity for detecting endometrial cancer. * **C. Transvaginal ultrasound (TVS):** TVS is the best **initial screening** modality. An endometrial thickness (ET) of $\leq$ 4 mm has a high negative predictive value for cancer. However, it cannot provide a tissue diagnosis, which is mandatory for confirmation. * **D. Ca-125 estimation:** This is a tumor marker primarily used for monitoring epithelial ovarian cancer. It is neither sensitive nor specific for diagnosing postmenopausal bleeding. **Clinical Pearls for NEET-PG:** * **Most common cause** of postmenopausal bleeding: Senile/Atrophic vaginitis. * **Most common malignancy** associated: Endometrial carcinoma. * **Endometrial Thickness (ET) Cut-off:** If ET is $>4$ mm in a postmenopausal woman, tissue biopsy is mandatory. * **Gold Standard:** Fractional curettage (or Hysteroscopy-guided biopsy for focal lesions).

Q: Ectopic pregnancy is associated with all of the following conditions EXCEPT:

None of the above. **Explanation:** The correct answer is **D (None of the above)** because all the conditions listed (Salpingitis, IUCD use, and tubal surgeries) are well-established risk factors for ectopic pregnancy. 1. **Salpingitis (Option A):** This is the most common risk factor. Pelvic Inflammatory Disease (PID), specifically salpingitis, causes endosalpingeal damage, loss of ciliary action, and structural adhesions. This hinders the transport of the fertilized ovum, leading to implantation within the fallopian tube. 2. **Intrauterine Contraceptive Device (Option B):** While IUCDs are highly effective at preventing pregnancy, if a pregnancy *does* occur with an IUCD in situ, the likelihood of it being ectopic is significantly higher. This is because the IUCD prevents intrauterine implantation more effectively than it prevents tubal implantation. 3. **Plastic procedure on the fallopian tube (Option C):** Any tubal surgery (reconstructive "plastic" procedures, tubal ligation, or salpingostomy) creates scarring or anatomical distortions. These alterations can trap the embryo or delay its passage to the uterus. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the fallopian tube (70%). * **Highest risk factor:** Previous history of ectopic pregnancy (increases risk by 10-fold). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy; it is suggestive of pregnancy but not specific to ectopic pregnancy. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (seen in only 50% of cases). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) combined with serial β-hCG levels (Discriminatory zone: 1500–2000 mIU/mL).

Q: Which of the following statements is NOT true regarding Endometriosis?

Endometriosis is common in low socio-economic groups.. **Explanation:** The correct answer is **D**. Endometriosis is traditionally known as a "disease of the modern woman" or a "career woman's disease." It is more frequently diagnosed in **high socio-economic groups**, likely due to factors such as delayed childbearing, lower parity, and better access to diagnostic facilities. **Analysis of Options:** * **Option A (Sampson’s Theory):** This is a true statement. John Sampson proposed the **Implantation Theory**, which suggests that endometriosis results from **retrograde menstruation**, where endometrial tissue flows through the fallopian tubes and implants on pelvic organs. * **Option B (Infertility):** This is true. Endometriosis is found in approximately 30–50% of women with infertility. It causes subfertility through pelvic adhesions, distorted anatomy, and an altered peritoneal microenvironment that affects oocyte quality and sperm motility. * **Option C (Laparoscopy):** This is true. **Diagnostic Laparoscopy with biopsy** is the "Gold Standard" for diagnosis. It allows for direct visualization of lesions (e.g., "powder-burn" or "gunshot" appearances) and histological confirmation. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Dysmenorrhea (congestive/secondary), Dyspareunia, and Infertility. * **Commonest Site:** The **Ovary** is the most common site of endometriosis. * **Chocolate Cyst:** An endometrioma of the ovary, filled with thick, dark, old blood. * **CA-125:** Often elevated in endometriosis but lacks specificity; used primarily for monitoring recurrence. * **Management:** Combined Oral Contraceptive Pills (OCPs) are first-line for pain; GnRH agonists create a "pseudomenopause" state.

Q: What is the investigation of choice for recurrent abortion in the first trimester?

Karyotyping. **Explanation:** Recurrent pregnancy loss (RPL) is defined as two or more consecutive spontaneous abortions. In the **first trimester**, the most common cause of sporadic miscarriage is chromosomal abnormalities. When these losses become recurrent, parental chromosomal anomalies (most commonly **balanced reciprocal translocations**) are a significant underlying factor. **1. Why Karyotyping is the Investigation of Choice:** Parental **Karyotyping** is the gold standard investigation to identify structural chromosomal rearrangements. If one parent carries a balanced translocation, they are phenotypically normal but produce unbalanced gametes, leading to recurrent embryonic aneuploidy and subsequent first-trimester loss. **2. Analysis of Incorrect Options:** * **SLE antibodies (Antiphospholipid Antibodies):** While Antiphospholipid Syndrome (APLAs) is a major cause of RPL, it is more classically associated with second-trimester losses or specific late-term complications (though it can cause early loss). Karyotyping remains the primary genetic screen for early-first-trimester recurrence. * **HIV testing:** HIV is not a recognized cause of recurrent pregnancy loss. * **TORCH infection screening:** This is a common misconception. TORCH infections (Toxoplasmosis, Rubella, CMV, Herpes) cause **sporadic** fetal loss or malformations, but they do **not** cause recurrent abortions because the mother develops immunity after the initial infection. **Clinical Pearls for NEET-PG:** * **Most common cause of 1st-trimester abortion:** Fetal chromosomal anomaly (Autosomal trisomy is the most common; specifically Trisomy 16). * **Most common parental anomaly in RPL:** Balanced reciprocal translocation. * **Uterine causes:** Septate uterus is the most common uterine anomaly associated with RPL. * **Investigation Timing:** Karyotyping should be performed on both parents and, if possible, the products of conception (POC).

Q: Which of the following is NOT typically seen in uterine fibroids?

Amenorrhea. **Explanation:** Uterine fibroids (leiomyomas) are benign monoclonal tumors of the myometrium. The hallmark of fibroids is **increased** uterine bleeding, not its absence. **Why Amenorrhea is the Correct Answer:** Amenorrhea (absence of menstruation) is **not** a feature of fibroids. In fact, fibroids typically cause the opposite: **Heavy Menstrual Bleeding (HMB/Menorrhagia)**. This occurs due to an increased endometrial surface area, increased vascularity of the uterus, and interference with normal myometrial contractions. If a patient with known fibroids presents with amenorrhea, the most likely cause is a coexisting pregnancy or menopause. **Analysis of Incorrect Options:** * **Pelvic Mass:** Large intramural or subserosal fibroids often present as a firm, non-tender, irregular mass felt on abdominal or bimanual examination. * **Infertility:** Fibroids can cause infertility by distorting the uterine cavity (submucosal type), obstructing the fallopian tube ostia, or causing chronic endometritis that prevents implantation. * **Menstrual Irregularity:** While HMB is most common, fibroids can lead to intermenstrual bleeding or metrorrhagia, especially if they are submucosal or pedunculated intracavitary types. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Heavy Menstrual Bleeding (Menorrhagia). * **Most common degeneration:** Hyaline degeneration. * **Degeneration during pregnancy:** Red degeneration (due to rapid growth and venous thrombosis). * **Most common type to cause infertility/miscarriage:** Submucosal fibroid (FIGO Type 0, 1, 2). * **Medical Management:** GnRH agonists are used pre-operatively to shrink fibroid volume and correct anemia.

Question 1

A 45-year-old lady presented with a Pap smear result showing atypical squamous cells of undetermined significance. What is the next line of management?

Accepted Answer

Repeat cervical cytology

Answer

Cervical biopsy

Answer

HPV DNA testing

Answer

Loop Electrosurgical Excision Procedure (LEEP)

Question 2

A young lady presents with acute abdominal pain and a history of 1 1/2 months of amenorrhea. On ultrasound examination, there is a collection of fluid in the pouch of Douglas and an empty gestational sac. What is the most likely diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Pelvic hematocele

Answer

Threatened abortion

Answer

Twisted ovarian cyst

Question 3

What is the investigation of choice in a 55-year-old postmenopausal woman who has presented with postmenopausal bleeding?

Accepted Answer

Fractional curettage

Answer

Pap smear

Answer

Transvaginal ultrasound (TVS)

Answer

Ca-125 estimation

Question 4

Sarcomatous change should be suspected in a uterine fibroid when there occurs:

Accepted Answer

All of the above

Answer

Increase in the size

Answer

Pain

Answer

Bleeding

Question 5

Ectopic pregnancy is associated with all of the following conditions EXCEPT:

Accepted Answer

None of the above

Answer

Salpingitis

Answer

Intrauterine contraceptive device (IUCD)

Answer

Plastic procedure on the fallopian tube

Question 6

Which of the following statements is NOT true regarding Endometriosis?

Accepted Answer

Endometriosis is common in low socio-economic groups.

Answer

Sampson proposed the implantation theory.

Answer

Endometriosis can cause infertility.

Answer

Laparoscopy is considered the gold standard for diagnosing endometriosis.

Question 7

What is the investigation of choice for recurrent abortion in the first trimester?

Accepted Answer

Karyotyping

Answer

Systemic Lupus Erythematosus (SLE) antibodies

Answer

Human Immunodeficiency Virus (HIV) testing

Answer

TORCH infection screening

Question 8

Which of the following is NOT typically seen in uterine fibroids?

Accepted Answer

Amenorrhea

Answer

Pelvic mass

Answer

Infertility

Answer

Menstrual irregularity

Question 9

Which of the following distension media used in hysteroscopy causes fluid overload and electrolyte disturbances?

Accepted Answer

Glycine

Answer

Carbon dioxide

Answer

Hyskon

Answer

Ringer Lactate

Question 10

Ectopic pregnancy occurs in all of the following situations EXCEPT?

Accepted Answer

Dysfunctional uterine bleeding (DUB)

Answer

Pelvic inflammatory disease (PID)

Answer

Intrauterine device (IUD) use

Answer

History of previous ectopic pregnancy

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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