Gynecological Disorders Practice Questions

Q: A 32-year-old asymptomatic woman has a Pap's smear report of ASCUS. What are the possible management options, excluding one?

Repeat cytology at 3 years. **Explanation:** The management of **ASCUS (Atypical Squamous Cells of Undetermined Significance)** follows the ASCCP (American Society for Colposcopy and Cervical Pathology) guidelines. ASCUS is the most common abnormal Pap result, representing a borderline finding that requires further triage rather than immediate aggressive treatment or routine screening. **Why Option D is the Correct Answer (The Exception):** Routine screening (cytology every 3 years) is only appropriate for women with **normal** results. Once an abnormality like ASCUS is detected, the patient enters a "triage" or "surveillance" pathway. Extending the interval to 3 years is unsafe as it may miss a progressing CIN (Cervical Intraepithelial Neoplasia) lesion. **Analysis of Management Options (Incorrect Options):** * **A. High-risk HPV DNA testing:** This is the **preferred** management (Reflex HPV testing). If HPV is positive, the patient proceeds to colposcopy; if negative, she returns to routine screening. * **B. Repeat cytology at 1 year:** This is an acceptable alternative if HPV testing is unavailable. If the repeat Pap at 12 months is $\ge$ ASCUS, colposcopy is indicated. * **C. Colposcopy:** This is indicated if the reflex HPV test is positive or if the repeat cytology shows persistent abnormalities. **High-Yield Clinical Pearls for NEET-PG:** * **ASCUS Triage:** "Reflex HPV testing" is the most cost-effective and efficient strategy. * **Age Factor:** In women aged 21–24, the preferred management for ASCUS is **repeat cytology at 12 months** (not HPV testing), as HPV prevalence is high but often transient in this age group. * **Pregnancy:** Management of ASCUS in pregnancy is the same as in non-pregnant women, though endocervical curettage (ECC) is strictly contraindicated.

Q: Cervical incompetence is when the cervix measures less than?

2.5 cm. **Explanation:** Cervical incompetence (or cervical insufficiency) is the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions. The diagnosis is primarily based on a history of painless second-trimester miscarriages or via Transvaginal Ultrasound (TVS). **Why 2.5 cm is the correct answer:** In clinical practice and according to standard guidelines (ACOG/RCOG), a cervical length of **less than 2.5 cm (25 mm)** before 24 weeks of gestation is the established threshold for diagnosing a "short cervix." This measurement is a significant predictor of preterm birth, as a shorter cervix lacks the structural integrity to support the growing fetus and increasing intrauterine pressure. **Analysis of Incorrect Options:** * **A (1 cm) and B (1.5 cm):** While these measurements definitely indicate cervical shortening, they represent extreme cases. Waiting for the cervix to reach 1 cm or 1.5 cm before diagnosing incompetence would delay critical interventions like cerclage, increasing the risk of imminent pregnancy loss. * **C (2 cm):** Although 2 cm is clinically concerning, the standardized diagnostic cutoff for intervention and risk assessment in asymptomatic high-risk women is 2.5 cm. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS) is superior to transabdominal ultrasound for measuring cervical length. * **The "Funneling" Sign:** This refers to the protrusion of amniotic membranes into the internal os, often taking a 'T, Y, V, or U' shape (Mnemonic: **TRUST** - **T**hinning, **R**eaching **U** **S**haped **T**erminal). * **Treatment:** The definitive management is **Cervical Cerclage** (e.g., McDonald’s or Shirodkar’s technique), typically performed between 14–18 weeks of gestation. * **Best Time for Screening:** In women with a history of preterm birth, cervical length is monitored between 16 and 24 weeks.

Q: What is the best way to treat a decubitus ulcer in a case of genital prolapse?

Reduction with tampon. **Explanation:** A **decubitus ulcer** in genital prolapse is a pressure necrosis caused by venous congestion. When the uterus remains outside the introitus, the dependent position leads to impaired venous drainage and edema. The everted vaginal mucosa rubs against the thighs or clothing, resulting in ischemic ulceration. **Why "Reduction with tampon" is the correct answer:** The primary goal of treatment is to **relieve venous congestion**. By reducing the prolapse (pushing it back into the pelvic cavity) and holding it in place with a **glycerine-soaked gauze tampon**, the gravitational obstruction to venous return is removed. Glycerine, being hygroscopic, reduces local edema, while the reduction allows the ulcer to heal rapidly by restoring normal circulation. This is a mandatory preoperative step to ensure the vaginal tissue is healthy enough to hold sutures. **Analysis of Incorrect Options:** * **A. Bed rest:** While it reduces gravity's effect, it is insufficient to keep the prolapsed mass reduced and does not provide the necessary local decongestant effect. * **B. Antibiotics:** Decubitus ulcers are primarily **trophic/ischemic**, not infectious. Antibiotics are only required if there is secondary cellulitis. * **C. Antiseptic dressing:** Topical antiseptics do not address the underlying cause (venous congestion). Healing will not occur as long as the tissue remains prolapsed and edematous. **Clinical Pearls for NEET-PG:** * **Site:** Usually occurs on the dependent part of the prolapse (cervix or vaginal wall). * **Nature:** It is a **trophic ulcer**, not malignant. However, if it doesn't heal after reduction, a biopsy is mandatory to rule out malignancy. * **Pre-op management:** Surgery (e.g., Ward-Mayo’s) is contraindicated in the presence of an active ulcer. Reduction with glycerine tampons for 7–10 days is the standard pre-operative protocol.

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.

Question 1

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 2

A 32-year-old asymptomatic woman has a Pap's smear report of ASCUS. What are the possible management options, excluding one?

Accepted Answer

Repeat cytology at 3 years

Answer

High-risk HPV DNA testing

Answer

Repeat cytology at 1 year

Answer

Colposcopy

Question 3

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 4

Cervical incompetence is when the cervix measures less than?

Accepted Answer

2.5 cm

Answer

1 cm

Answer

1.5 cm

Answer

2 cm

Question 5

What is the first investigation to be done for postmenopausal bleeding?

Accepted Answer

Endometrial biopsy

Answer

Dilatation and curettage

Answer

Fractional curettage

Answer

Hysterosalpingography

Question 6

What is the best way to treat a decubitus ulcer in a case of genital prolapse?

Accepted Answer

Reduction with tampon

Answer

Bed rest

Answer

Antibiotics

Answer

Antiseptic dressing

Question 7

Which drug reduces the size of uterine myoma?

Accepted Answer

GnRH agonist

Answer

Danazol

Answer

Progesterone

Answer

Mifepristone

Question 8

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 9

Acute pyelonephritis in pregnancy most often complicates which trimester?

Accepted Answer

2nd trimester

Answer

1st trimester

Answer

3rd trimester

Answer

Puerperium

Question 10

What is the best treatment for senile vaginitis?

Accepted Answer

Hormone Replacement Therapy (HRT) + Local estrogen cream

Answer

Hormone Replacement Therapy (HRT)

Answer

Local estrogen cream

Answer

Surgery

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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