Gynecological Disorders Practice Questions

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

Candida. **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.

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

Cervical stenosis. **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).

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

Pap smear along with clinical examination. **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.

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

Laparoscopic cystectomy. **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.

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

Oral contraceptive pills. **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).

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

Bacterial vaginosis. **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 1

Treatment of 'paner' is required in all infections except?

Accepted Answer

Candida

Answer

Herpes

Answer

Trichomonas

Answer

All

Question 2

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

Accepted Answer

Less bleeding

Answer

Less recurrence

Answer

Less post-operative pain

Answer

Early ambulation

Question 3

In which of the following conditions do the ovaries function normally?

Accepted Answer

Rokitansky-Kuster-Hauser syndrome

Answer

Turner's syndrome

Answer

Androgen insensitivity syndrome

Answer

Swyer's syndrome

Question 4

Which among the following is not known to cause hematocolpos?

Accepted Answer

Cervical stenosis

Answer

Imperforate hymen

Answer

Fused double vagina

Answer

Transverse septum in vagina

Question 5

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

Accepted Answer

Pap smear along with clinical examination

Answer

Visual examination with Lugol's iodine

Answer

Visual examination with acetic acid

Answer

Colposcopy-directed biopsy

Question 6

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

Accepted Answer

Laparoscopic cystectomy

Answer

Laparoscopic drainage

Answer

Laparoscopic adhesiolysis

Answer

Hormonal therapy

Question 7

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

Accepted Answer

Oral contraceptive pills

Answer

GnRH agonists

Answer

Aromatase inhibitors

Answer

Progesterone pills

Question 8

What is the most common complication after abdominal hysterectomy?

Accepted Answer

Ureteral injury

Answer

Intestinal injury

Answer

Urinary bladder atony

Answer

Vaginal vault prolapse

Question 9

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

Accepted Answer

Bacterial vaginosis

Answer

N. gonorrhoeae

Answer

Trichomonas vaginalis

Answer

Chlamydia trachomatis

Question 10

Which versa point is used for hysteroscopic metroplasty?

Accepted Answer

Bipolar electrosurgical system that works with normal saline

Answer

Bipolar electrosurgical system that cannot be used with normal saline

Answer

Unipolar electrosurgical system that cannot be used with normal saline

Answer

Unipolar electrosurgical system that works with normal saline

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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