Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 221: Treatment of 'paner' is required in all infections except?

A. Candida (Correct Answer)
B. Herpes
C. Trichomonas
D. All

Explanation: **Explanation:** The term **'Partner'** (often misspelled as 'paner' in some question banks) refers to the clinical practice of treating the sexual partner of a patient diagnosed with a reproductive tract infection to prevent reinfection and break the chain of transmission. **Why Candida is the correct answer:** **Candidiasis (Moniliasis)** is primarily considered an opportunistic fungal overgrowth rather than a classic Sexually Transmitted Infection (STI). It is often triggered by changes in vaginal pH, antibiotic use, or pregnancy. Since it is not typically transmitted sexually, routine treatment of the male partner is **not recommended** unless the partner is symptomatic (e.g., presenting with balanitis). **Analysis of Incorrect Options:** * **Trichomonas:** This is a protozoal infection and a classic STI. The recurrence rate is extremely high if the partner is not treated simultaneously, as men often act as asymptomatic carriers. Partner treatment is **mandatory**. * **Herpes (HSV):** While treatment of an asymptomatic partner doesn't "cure" the virus, counseling and management of partners are standard components of STI protocols to prevent transmission during viral shedding. * **Bacterial Vaginosis (BV):** (Note for context) Similar to Candida, routine partner treatment is generally not required for BV, but in the context of this specific MCQ, Candida is the most definitive answer. **High-Yield Clinical Pearls for NEET-PG:** * **Statutory Partner Treatment:** Mandatory for *Trichomonas vaginalis*, *Chlamydia trachomatis*, and *Neisseria gonorrhoeae*. * **Drug of Choice (DOC):** For Trichomoniasis, the DOC is **Metronidazole** (2g single dose) for both the patient and the partner. * **Candida Diagnosis:** Look for "curdy white discharge" and "pseudohyphae" on KOH mount. Treatment is typically topical or oral Clotrimazole/Fluconazole.

Question 222: Hysteroscopic myomectomy scores over open myomectomy in all of the following except:

A. Less recurrence
B. Less post-operative pain
C. Less bleeding (Correct Answer)
D. Early ambulation

Explanation: **Explanation:** The core concept here lies in the comparison between **minimally invasive hysteroscopic surgery** and **open abdominal surgery (Laparotomy)** for fibroid removal. **Why "Less Bleeding" is the correct answer (The Exception):** While hysteroscopy is less invasive, it does not necessarily result in "less bleeding" compared to open surgery in a way that defines its superiority. In fact, during hysteroscopic myomectomy, the use of distension media and the resection of submucosal fibroids can sometimes lead to significant intraoperative bleeding that is harder to control than in open surgery (where primary hemostasis via sutures or tourniquets is easier). Therefore, "less bleeding" is not a definitive advantage of the hysteroscopic route over the open route. **Analysis of Incorrect Options:** * **Less Post-operative Pain (B) & Early Ambulation (D):** These are classic advantages of any endoscopic procedure. Since there is no abdominal incision (laparotomy), the patient experiences significantly less somatic pain, requires fewer analgesics, and can walk within hours of the procedure. * **Less Recurrence (A):** This is a nuanced point. Hysteroscopic myomectomy is specifically indicated for **FIGO Type 0, 1, and 2 (submucosal) fibroids**. By providing direct visualization of the uterine cavity, it ensures complete removal of the symptomatic lesion with minimal trauma to the myometrium, often leading to better long-term outcomes for that specific site compared to a blind or more traumatic open approach for small submucosal seeds. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Hysteroscopic myomectomy is the treatment of choice for **symptomatic submucosal fibroids** (<5 cm). * **Distension Media:** For monopolar cautery, use non-electrolytic media (Glycine 1.5%); for bipolar, use Normal Saline (to prevent hyponatremia). * **Fluid Overload:** The most critical complication of hysteroscopy is fluid overload (TURP-like syndrome). * **Pre-op Prep:** GnRH analogs are often given 3–6 months pre-operatively to reduce fibroid size and vascularity.

Question 223: In which of the following conditions do the ovaries function normally?

A. Turner's syndrome
B. Rokitansky-Kuster-Hauser syndrome (Correct Answer)
C. Androgen insensitivity syndrome
D. Swyer's syndrome

Explanation: **Explanation:** The core concept tested here is the embryological origin of the female reproductive system. The ovaries develop from the **primitive germ cells** (genital ridge), whereas the uterus, cervix, and upper vagina develop from the **Müllerian (paramesonephric) ducts**. **1. Why Rokitansky-Kuster-Hauser (MRKH) Syndrome is correct:** MRKH syndrome is characterized by **Müllerian Agenesis**. Because the defect is localized to the Müllerian ducts, the ovaries (which have a different embryological origin) develop and function perfectly. Patients have a **46, XX karyotype**, normal secondary sexual characteristics (due to intact estrogen production), and normal ovulation, but present with primary amenorrhea due to the absence of the uterus and upper vagina. **2. Why the other options are incorrect:** * **Turner’s Syndrome (45, X):** Accelerated oocyte atresia leads to **streak ovaries** and primary ovarian failure. Estrogen levels are low, and FSH is elevated. * **Androgen Insensitivity Syndrome (46, XY):** These individuals have **testes**, not ovaries. The testes produce testosterone (which peripherally converts to estrogen) and Anti-Müllerian Hormone (AMH), which causes the regression of Müllerian structures. * **Swyer’s Syndrome (46, XY Pure Gonadal Dysgenesis):** A mutation (often in the SRY gene) prevents the bipotential gonads from developing into testes. They remain as **non-functional streak gonads**, posing a high risk for gonadoblastoma. **Clinical Pearls for NEET-PG:** * **MRKH vs. AIS:** Both present with primary amenorrhea and a blind vaginal pouch. Differentiate by **axillary/pubic hair** (present in MRKH, absent/scant in AIS) and **testosterone levels** (female range in MRKH, male range in AIS). * **First investigation for MRKH:** Pelvic Ultrasound (to confirm absent uterus) followed by Karyotyping. * **Associated anomalies in MRKH:** Renal (40% - e.g., renal agenesis) and Skeletal (e.g., Klippel-Feil syndrome). Always screen the renal system.

Question 224: Which among the following is not known to cause hematocolpos?

A. Imperforate hymen
B. Cervical stenosis (Correct Answer)
C. Fused double vagina
D. Transverse septum in vagina

Explanation: **Explanation:** The core concept behind **hematocolpos** is the accumulation of menstrual blood within the **vagina** due to a distal outflow tract obstruction. **Why Cervical Stenosis is the correct answer:** Cervical stenosis occurs at the level of the cervix, which is proximal to the vagina. Obstruction at this level prevents blood from leaving the uterus, leading to **hematometra** (blood in the uterus) and potentially **hematosalpinx** (blood in the fallopian tubes). Since the obstruction is *above* the vaginal vault, blood does not collect in the vagina; therefore, it does not cause hematocolpos. **Analysis of incorrect options:** * **Imperforate Hymen:** This is the most common cause of hematocolpos. The obstruction is at the introitus, causing the entire vaginal canal to distend with blood. * **Transverse Vaginal Septum:** A septum (usually at the junction of the upper and middle third of the vagina) blocks the outflow, leading to blood accumulation in the vaginal space above the septum. * **Fused Double Vagina (Obstructed Hemivagina):** In conditions like OHVIRA syndrome (Uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis), one side of a double vagina is blind-ending, leading to unilateral hematocolpos. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Typically presents in a pubertal girl with **primary amenorrhea** and **cyclic pelvic pain**. * **Physical Exam:** Imperforate hymen shows a **tense, bulging, bluish membrane** at the vulva. * **Rectal Exam:** May reveal a large, cystic midline mass (the distended vagina). * **Sequence of Accumulation:** Hematocolpos (vagina) → Hematometra (uterus) → Hematosalpinx (tubes) → Hemoperitoneum (peritoneal cavity).

Question 225: A 35-year-old female presents with postcoital bleeding. What is the next appropriate step in management?

A. Pap smear along with clinical examination (Correct Answer)
B. Visual examination with Lugol's iodine
C. Visual examination with acetic acid
D. Colposcopy-directed biopsy

Explanation: **Explanation:** The primary concern in a patient presenting with **postcoital bleeding** is to rule out **Cervical Cancer**. In a 35-year-old woman, the initial management must involve a systematic approach to visualize the cervix and obtain a cytological sample. **Why Option A is Correct:** The standard protocol for any woman presenting with postcoital bleeding is a **Triple Assessment** approach: 1. **Clinical Examination:** A per-speculum (P/S) examination is vital to visualize the cervix for any gross lesions, polyps, or friability. 2. **Cytology (Pap Smear):** To screen for pre-malignant (CIN) or malignant changes. 3. **Digital Examination:** To assess the consistency and size of the cervix. Even if the Pap smear is negative, a suspicious-looking cervix on clinical examination warrants a biopsy. **Why Other Options are Incorrect:** * **Options B & C (VIA/VILI):** Visual Inspection with Acetic Acid (VIA) and Lugol’s Iodine (VILI) are primarily used as **screening tools in low-resource settings** where cytology is unavailable. They are not the definitive next step in a diagnostic workup for a symptomatic patient in a clinical setting. * **Option D (Colposcopy-directed biopsy):** This is a secondary investigation. It is indicated only if the Pap smear shows abnormalities (e.g., HSIL, LSIL) or if there is a **clinically suspicious lesion** seen during the initial examination. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause** of postcoital bleeding in India: **Cervical Cancer** (until proven otherwise). * **Most common benign cause**: Cervical ectropion or cervical polyps. * If a **gross growth** is visible on the cervix during the initial examination, do not wait for a Pap smear; proceed directly to a **punch biopsy**. * Postcoital bleeding is a "red flag" symptom that bypasses routine screening intervals.

Question 226: A 25-year-old female presents with endometriosis. Diagnostic imaging reveals a 5 cm ovarian cyst. What is your treatment approach?

A. Laparoscopic drainage
B. Laparoscopic cystectomy (Correct Answer)
C. Laparoscopic adhesiolysis
D. Hormonal therapy

Explanation: **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.

Question 227: Which of the following cannot be used for the medical management of adenomyosis in young women?

A. GnRH agonists
B. Aromatase inhibitors
C. Oral contraceptive pills (Correct Answer)
D. Progesterone pills

Explanation: **Explanation:** Adenomyosis is characterized by the presence of endometrial glands and stroma within the myometrium, leading to a hypertrophied, globular uterus. The medical management of adenomyosis aims to induce atrophy of this ectopic endometrial tissue by creating a hypoestrogenic or progestogenic environment. **Why Oral Contraceptive Pills (OCPs) are the correct answer:** While OCPs are frequently used to manage symptoms like dysmenorrhea and heavy menstrual bleeding, they are generally **not considered a definitive medical treatment** for the underlying pathology of adenomyosis. In fact, the **estrogen component** in combined OCPs can potentially stimulate the growth of adenomyotic lesions, as adenomyosis is an estrogen-dependent condition. Therefore, in the context of specific medical management aimed at regressing the disease, OCPs are the least appropriate choice compared to the other options. **Analysis of Incorrect Options:** * **GnRH Agonists:** These induce a state of "pseudomenopause" by downregulating the HPO axis, leading to profound hypoestrogenism. This causes significant shrinkage of adenomyotic lesions and symptomatic relief. * **Aromatase Inhibitors:** These block the peripheral conversion of androgens to estrogens. Since adenomyotic tissue expresses high levels of aromatase, these drugs effectively reduce local estrogen production within the myometrium. * **Progesterone Pills:** Progestins (like Dienogest) cause decidualization and subsequent atrophy of the endometrial tissue, making them a mainstay in conservative management. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Histopathology (post-hysterectomy). * **Investigation of Choice (IOC):** MRI (look for a "junctional zone" thickness >12 mm). * **First-line for symptoms:** Levonorgestrel-releasing intrauterine system (LNG-IUS/Mirena). * **Definitive Treatment:** Hysterectomy (for those who have completed their family).

Question 228: What is the most common complication after abdominal hysterectomy?

A. Ureteral injury (Correct Answer)
B. Intestinal injury
C. Urinary bladder atony
D. Vaginal vault prolapse

Explanation: **Explanation:** **Correct Answer: A. Ureteral injury** Ureteral injury is a classic and significant complication of major pelvic surgeries, particularly abdominal hysterectomy. The ureter is anatomically vulnerable due to its close proximity to the uterine artery and the cervix. The most common site of injury is at the level of the **infundibulopelvic ligament** or where the **uterine artery crosses the ureter** ("water under the bridge"). While the overall incidence is low (approx. 0.5–1.5%), it remains the most frequent major visceral injury cited in surgical literature for this procedure. **Analysis of Incorrect Options:** * **B. Intestinal injury:** While serious, bowel injuries are less common than urinary tract injuries during routine hysterectomy. They typically occur in cases involving dense adhesions from previous surgeries or severe endometriosis. * **C. Urinary bladder atony:** This is more commonly associated with radical hysterectomies (e.g., Wertheim’s) where the pelvic autonomic nerves are dissected, rather than a standard total abdominal hysterectomy. * **D. Vaginal vault prolapse:** This is a long-term/delayed complication resulting from inadequate support of the vaginal cuff (failure to attach the uterosacral-cardinal ligament complex), not an immediate surgical complication. **NEET-PG High-Yield Pearls:** * **Most common site of ureteral injury:** At the level of the uterine artery (distal ureter). * **Most common visceral injury overall:** Bladder injury is actually more frequent than ureteral injury in some series; however, in the context of standard MCQ patterns for NEET-PG, **Ureteral injury** is the traditionally tested "most common major complication" regarding specific anatomical structures. * **Prevention:** Intraoperative identification of the ureter and "skeletonization" of the uterine vessels are key. * **Diagnosis:** If suspected post-operatively, the first-line investigation is usually an **IVP (Intravenous Pyelogram)** or CT Urogram.

Question 229: Which of the following is not a risk factor for pelvic inflammatory disease?

A. N. gonorrhoeae
B. Bacterial vaginosis (Correct Answer)
C. Trichomonas vaginalis
D. Chlamydia trachomatis

Explanation: **Explanation:** Pelvic Inflammatory Disease (PID) is an ascending infection of the upper female genital tract. The distinction between **causative agents** and **risk factors** is crucial for NEET-PG. **Why Bacterial Vaginosis (BV) is the correct answer:** While *Bacterial vaginosis* is frequently associated with PID and can facilitate the ascent of pathogens by altering the vaginal flora and pH, it is technically considered a **causative/associated condition** rather than a primary risk factor in the same category as specific behavioral or demographic factors. However, in the context of this specific question, BV is often listed as a "condition associated with" rather than a "risk factor for" the acquisition of PID, which is primarily driven by sexually transmitted pathogens. **Analysis of Incorrect Options:** * **N. gonorrhoeae (Option A) & Chlamydia trachomatis (Option D):** These are the two most common **primary causative organisms** for PID. Their presence is the most significant risk factor for developing the disease. *C. trachomatis* is often associated with "silent PID," leading to tubal factor infertility. * **Trichomonas vaginalis (Option C):** This is a known risk factor and vector. *T. vaginalis* can carry bacteria on its surface into the upper genital tract, and its presence significantly increases the statistical risk of developing PID. **NEET-PG High-Yield Pearls:** * **Most common cause of PID:** *Chlamydia trachomatis* (followed by *N. gonorrhoeae*). * **Gold Standard Diagnosis:** Laparoscopy (shows tubal edema and erythema). * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving peri-hepatitis ("violin-string" adhesions). * **Protective Factor:** Combined Oral Contraceptive Pills (COCPs) are protective against PID as they thicken cervical mucus, preventing the ascent of bacteria. * **Risk Factor:** The highest risk period for IUD-related PID is the first 20 days post-insertion.

Question 230: Which versa point is used for hysteroscopic metroplasty?

A. Bipolar electrosurgical system that cannot be used with normal saline
B. Bipolar electrosurgical system that works with normal saline (Correct Answer)
C. Unipolar electrosurgical system that cannot be used with normal saline
D. Unipolar electrosurgical system that works with normal saline

Explanation: **Explanation:** The **Versapoint** system is a specialized **bipolar electrosurgical system** designed specifically for operative hysteroscopy (e.g., metroplasty for uterine septa, myomectomy, or polypectomy). **Why Option B is correct:** In traditional unipolar hysteroscopy, non-conducting distension media (like Glycine 1.5%) are required to prevent electrical current from dispersing. However, these media carry a high risk of hyponatremia and fluid overload (TURP syndrome). The Versapoint system utilizes **bipolar technology**, where the current travels only between two poles on the electrode tip. This allows the use of **Normal Saline (0.9% NaCl)** as the distension medium. Saline is isotonic, significantly reducing the risk of life-threatening electrolyte imbalances if systemic absorption occurs. **Why other options are incorrect:** * **Options A & C:** The primary advantage of the Versapoint system is its compatibility with normal saline; any system that "cannot be used with normal saline" defeats the clinical purpose of this specific technology. * **Options C & D:** Unipolar systems require a patient return electrode (grounding pad) and must use non-electrolytic media (Glycine, Sorbitol, or Mannitol) because saline, being an electrolyte, would cause the current to dissipate, leading to ineffective cutting and potential thermal injury. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Uterine Septum:** Hysteroscopic metroplasty (using Versapoint or cold scissors). * **Distension Media:** Use **Normal Saline** for Bipolar (Versapoint) and **1.5% Glycine** for Unipolar systems. * **Complication Watch:** The most feared complication of using Glycine is **dilutional hyponatremia** and cerebral edema. * **Versapoint Advantage:** It allows for simultaneous cutting and coagulation (hemostasis) with a superior safety profile regarding fluid management.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

Practice Questions

Pelvic Inflammatory Disease

Practice Questions

Vulvovaginitis

Practice Questions

Pelvic Organ Prolapse

Practice Questions

Vulvar Disorders

Practice Questions

Benign Breast Diseases

Practice Questions

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