Gynecological Disorders Practice Questions

Q: A girl presents with primary amenorrhea, normal ovaries, absent internal genitalia, and normal external genitalia. What is the most probable diagnosis?

Mayer-Rokitansky-Kuster-Hauser syndrome. ### Explanation **Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome** is the correct diagnosis based on the clinical triad of primary amenorrhea, absent internal genitalia (müllerian agenesis), and a female phenotype. **1. Why MRKH is Correct:** In MRKH syndrome, there is congenital aplasia of the Müllerian ducts. This results in the absence of the uterus, cervix, and upper two-thirds of the vagina. Because the ovaries develop from the primitive germ cells (not the Müllerian ducts), they are **normal and functional**, leading to normal secondary sexual characteristics (breast development/pubic hair) and a female 46,XX karyotype. **2. Why Other Options are Incorrect:** * **Turner’s Syndrome (45,XO):** Characterized by **streak ovaries** (gonadal dysgenesis). Patients have a uterus but lack secondary sexual characteristics due to estrogen deficiency. * **Noonan Syndrome:** Often called "male Turner’s," it presents with similar features to Turner’s (short stature, webbed neck) but usually involves fertile individuals with a 46,XX or 46,XY karyotype. Internal genitalia are typically present. * **Androgen Insensitivity Syndrome (46,XY):** While internal genitalia are absent (due to Anti-Müllerian Hormone from testes), the **ovaries are absent**. Instead, undescended testes are present, and there is usually scanty/absent pubic and axillary hair. **High-Yield Clinical Pearls for NEET-PG:** * **Karyotype:** MRKH is 46,XX; AIS is 46,XY. * **First Investigation:** Pelvic Ultrasound (to check for uterus/ovaries). * **Gold Standard Investigation:** MRI. * **Associated Anomalies:** 30–40% of MRKH patients have **Renal anomalies** (e.g., renal agenesis, ectopic kidney). Always screen with an ultrasound of the KUB region. * **Hormonal Profile:** In MRKH, FSH, LH, and Estrogen levels are **normal**.

Q: All of the following are causes of prolapse of the cervix EXCEPT:

Many MTP procedures. **Explanation:** Pelvic organ prolapse (POP) occurs when the pelvic floor muscles and ligaments (specifically the cardinal and uterosacral ligaments) are weakened or damaged, failing to support the uterus and cervix. **Why "Many MTP procedures" is the correct answer:** Medical Termination of Pregnancy (MTP) procedures, whether medical or surgical (suction evacuation), involve the cervix and the uterine cavity but do not involve the stretching or tearing of the primary pelvic supports (endopelvic fascia). Therefore, multiple MTPs do not contribute to the mechanical failure of the pelvic floor and are not a risk factor for prolapse. **Analysis of incorrect options:** * **Chronic cough:** This causes a repetitive, long-term increase in **intra-abdominal pressure**. This pressure is transmitted to the pelvic floor, eventually leading to the attenuation and herniation of pelvic organs. * **Menopause:** Estrogen is vital for maintaining the collagen content and strength of the pelvic ligaments. The **hypoestrogenic state** in menopause leads to atrophy and weakening of the pelvic diaphragm and ligaments (Urogenital atrophy). * **Delivery of a big baby:** Vaginal delivery of a macrosomic baby causes significant overstretching, nerve damage (pudendal nerve), and direct trauma to the **Levator ani muscles** and the cardinal/uterosacral ligament complex. **High-Yield Clinical Pearls for NEET-PG:** * **Most important support of the uterus:** Cardinal (Mackenrodt’s) ligaments. * **Main muscular support:** Levator ani muscle (specifically the Pubococcygeus). * **Nulliparous prolapse:** Usually occurs due to congenital weakness of connective tissue (e.g., Ehlers-Danlos syndrome) or chronic increase in intra-abdominal pressure. * **POP-Q System:** The gold standard for staging pelvic organ prolapse in modern clinical practice.

Q: A patient presents with primary amenorrhea. On examination, she has normal breast and pubic hair development but no visible vagina. Which of the following is the most probable diagnosis?

Mullerian agenesis. **Explanation:** The patient presents with **primary amenorrhea** despite having **normal secondary sexual characteristics** (breast and pubic hair development). This indicates a functioning hypothalamic-pituitary-ovarian axis and normal peripheral response to hormones, but a structural defect in the outflow tract. **1. Why Mullerian Agenesis (MRKH Syndrome) is correct:** In Mullerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome), the 46,XX female has normal ovaries producing estrogen (leading to **normal breast development**) and normal adrenal/ovarian androgens (leading to **normal pubic hair**). However, the Mullerian ducts fail to develop, resulting in the absence of the uterus, cervix, and the upper two-thirds of the vagina. **2. Why the other options are incorrect:** * **Turner’s Syndrome (45,XO):** Characterized by "streak ovaries." The lack of estrogen results in **absent breast development** and primary amenorrhea. * **Androgen Insensitivity Syndrome (46,XY):** While these patients have breast development (due to peripheral conversion of testosterone to estrogen), they have **absent or scanty pubic and axillary hair** because of end-organ insensitivity to androgens. * **Swyer Syndrome (46,XY pure gonadal dysgenesis):** These patients have streak gonads and lack estrogen, leading to **absent breast development**. **High-Yield Clinical Pearls for NEET-PG:** * **First investigation:** Pelvic Ultrasound (to confirm the presence/absence of the uterus). * **Gold standard investigation:** MRI. * **Karyotype:** 46,XX (distinguishes it from AIS). * **Associated anomalies:** Renal (40% - e.g., renal agenesis, ectopic kidney) and Skeletal (12% - e.g., Klippel-Feil syndrome). Always screen the renal system in these patients.

Q: A 34-week pregnant female presented with intense itching over the vulvar area and a white, cheesy vaginal discharge. On examination, vulvar erythema is noted. Which among the following is the causative organism in this patient?

Candida albicans. **Explanation:** The clinical presentation of **intense vulvar itching (pruritus)** and a **thick, white, "curdy" or "cheesy" vaginal discharge** is classic for **Vulvovaginal Candidiasis (VVC)**. In this case, the patient’s pregnancy (34 weeks) is a significant predisposing factor. High estrogen levels during pregnancy increase the glycogen content of the vaginal mucosa, providing an ideal environment for the overgrowth of *Candida*. **Why Candida albicans is correct:** * **Causative Agent:** *Candida albicans* is responsible for 80–90% of fungal vaginal infections. * **Clinical Features:** Characterized by "cottage-cheese" like discharge, vulvar erythema, edema, and intense itching. * **Diagnosis:** On microscopy (KOH mount), it shows pseudohyphae and budding yeast cells. The vaginal pH is typically **normal (<4.5)**, which helps distinguish it from Trichomoniasis or Bacterial Vaginosis. **Why other options are incorrect:** * **Epidermophyton & Tinea:** These are dermatophytes responsible for fungal infections of the skin (like Tinea cruris/jock itch). While they cause itching in the groin, they do not cause vaginal discharge. * **Aspergillus:** This is a filamentous fungus that typically causes respiratory infections or systemic opportunistic infections; it is not a standard cause of vaginitis. **NEET-PG High-Yield Pearls:** * **Risk Factors:** Pregnancy, Diabetes Mellitus, recent antibiotic use, and immunosuppression. * **Drug of Choice (Non-pregnant):** Oral Fluconazole (150 mg single dose). * **Drug of Choice (Pregnancy):** **Topical Azoles** (e.g., Clotrimazole) for 7 days are preferred; oral fluconazole is generally avoided in pregnancy. * **Gold Standard Diagnosis:** Culture on **Sabouraud’s Dextrose Agar (SDA)**.

Q: What is the definition of a satisfactory colposcopy?

Visualization of the entire transformation zone. ### Explanation **Why Option A is Correct:** A colposcopy is considered **satisfactory** (or "adequate") only when the **entire transformation zone (TZ)** and the full extent of any lesion are clearly visible. The transformation zone is the area between the original squamocolumnar junction (SCJ) and the new SCJ. This is the most critical region because over 90% of cervical neoplasias (CIN) and cancers originate here. If the upper limit of the TZ or the SCJ recedes into the endocervical canal and cannot be seen, the exam is "unsatisfactory," as a high-grade lesion could be hidden from view. **Why Other Options are Incorrect:** * **Option B & C:** Visualizing the endocervix or ectocervix alone is insufficient. While both are inspected during the procedure, the definition of adequacy specifically hinges on the visibility of the junction where these two epithelial types meet (the TZ). * **Option D:** The cervical os is a landmark, but seeing it does not guarantee that the SCJ is visible, especially in postmenopausal women where the SCJ often migrates deep into the canal. **High-Yield Clinical Pearls for NEET-PG:** * **Unsatisfactory Colposcopy:** If the TZ is not fully visualized, the next step is often an **Endocervical Curettage (ECC)** or a diagnostic excisional procedure (like LEEP or Cold Knife Conization). * **Green Filter:** Used during colposcopy to highlight **vascular patterns** (punctations, mosaicism, and atypical vessels), which are markers of high-grade lesions. * **Acetic Acid (3-5%):** Causes reversible dehydration of cells; areas with high nuclear density (cancer/dysplasia) appear **Acetowhite**. * **Schiller’s Test:** Uses Lugol’s Iodine. Normal squamous cells (rich in glycogen) turn mahogany brown. **Iodine-negative** (pale) areas are suspicious.

Q: Metroplasty is a plastic/reconstructive surgery on which of the following organs?

Uterus. **Explanation:** **Metroplasty** is a reconstructive surgical procedure performed on the **uterus** (Option C). The term is derived from the Greek words *"metra"* (uterus) and *"plassein"* (to shape). It is primarily indicated for correcting congenital structural anomalies, such as a septate uterus or a bicornuate uterus, to improve reproductive outcomes in women experiencing recurrent pregnancy loss or infertility. **Analysis of Options:** * **Fallopian tube (Option A):** Surgery to repair or reconstruct the fallopian tubes is called **Tuboplasty** or Salpingoplasty (e.g., Fimbrioplasty). * **Vagina (Option B):** Plastic surgery of the vagina is termed **Vaginoplasty** (often part of pelvic floor repair or gender affirmation surgery). * **Ovary (Option D):** Surgical procedures on the ovary include Oophorectomy (removal) or Ovarian Cystectomy. There is no standard "metroplasty" equivalent for the ovary. **Clinical Pearls for NEET-PG:** * **Strassman Operation:** A classic metroplasty technique used specifically for **bicornuate uteri** (unification of two horns). * **Jones and Tompkins Metroplasty:** Historically used for **septate uteri**, though these have largely been replaced by **Hysteroscopic Septal Resection**, which is now the gold standard due to its minimally invasive nature. * **Indication:** Metroplasty is generally not indicated for arcuate or unicornuate uteri; it is most beneficial for the **septate uterus** to reduce the risk of second-trimester miscarriages.

Q: Which of the following can cause urinary retention in obstetrics and gynecology?

All of the above. **Explanation:** Urinary retention in gynecology and obstetrics is primarily caused by **mechanical compression** or **displacement of the urethra and bladder neck**. This occurs when a pelvic mass fills the Pouch of Douglas (POD) and pushes the cervix anteriorly against the pubic symphysis, thereby elongating and compressing the urethra. * **Impacted Ovarian Tumor:** A large or dermoid cyst incarcerated in the Pouch of Douglas can exert direct pressure on the bladder neck or displace the cervix forward, leading to acute urinary retention. * **Retroversion (Incarcerated Gravid Uterus):** This is a classic high-yield cause. Between 12–16 weeks of gestation, a retroverted uterus may fail to rise into the abdominal cavity. As it enlarges, the cervix moves anteriorly, compressing the urethra against the back of the pubic bone. * **Hematocolpos:** In cases of imperforate hymen, the accumulation of menstrual blood (hematocolpos) causes the vagina to distend significantly. This distended vaginal wall exerts extrinsic pressure on the urethra, leading to retention (often the presenting symptom in adolescent girls). **Clinical Pearls for NEET-PG:** * **Most common cause of retention in pregnancy:** Incarcerated gravid uterus (typically occurs at 14 weeks). * **Red-flag symptom:** "Paradoxical incontinence" or "Overflow incontinence" where the patient leaks small amounts of urine despite a full bladder. * **Other causes to remember:** Fibroids (especially cervical or posterior wall), pelvic abscess, and postoperative pain/nerve injury (e.g., after radical hysterectomy).

Question 1

A girl presents with primary amenorrhea, normal ovaries, absent internal genitalia, and normal external genitalia. What is the most probable diagnosis?

Accepted Answer

Mayer-Rokitansky-Kuster-Hauser syndrome

Answer

Turner's syndrome

Answer

Noonan syndrome

Answer

Androgen insensitivity syndrome

Question 2

All of the following are causes of prolapse of the cervix EXCEPT:

Accepted Answer

Many MTP procedures

Answer

Chronic cough

Answer

Menopause

Answer

Delivery of a big baby

Question 3

A patient presents with primary amenorrhea. On examination, she has normal breast and pubic hair development but no visible vagina. Which of the following is the most probable diagnosis?

Accepted Answer

Mullerian agenesis

Answer

Turner's syndrome

Answer

Androgen insensitivity syndrome

Answer

Swyer syndrome

Question 4

A 34-week pregnant female presented with intense itching over the vulvar area and a white, cheesy vaginal discharge. On examination, vulvar erythema is noted. Which among the following is the causative organism in this patient?

Accepted Answer

Candida albicans

Answer

Epidermophyton

Answer

Aspergillus

Answer

Tinea

Question 5

Trans-Cervical Endometrial Resection (TCER) is used in which of the following conditions?

Accepted Answer

Dysfunctional Uterine Bleeding (DUB)

Answer

Endometriosis

Answer

Endometrial carcinoma

Answer

Submucous fibroid

Question 6

What is the definition of a satisfactory colposcopy?

Accepted Answer

Visualization of the entire transformation zone

Answer

Visualization of the endocervix

Answer

Visualization of the ectocervix

Answer

Visualization of the os (opening of the cervix)

Question 7

Metroplasty is a plastic/reconstructive surgery on which of the following organs?

Accepted Answer

Uterus

Answer

Fallopian tube

Answer

Vagina

Answer

Ovary

Question 8

Which of the following can cause urinary retention in obstetrics and gynecology?

Accepted Answer

All of the above

Answer

Impacted ovarian tumor

Answer

Retroversion

Answer

Hematocolpos

Question 9

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 10

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

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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