Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 281: Strassman operation consists of:

A. Tightening of internal cervical os
B. Unification of a septate uterus (Correct Answer)
C. Sling operation for prolapse
D. None of the above

Explanation: **Explanation:** The **Strassman operation** (specifically the Strassman metroplasty) is a surgical procedure designed for the **unification of a double uterus**. While historically used for various anomalies, it is the classic procedure for correcting a **bicornuate uterus** or a **septate uterus** by unifying the two uterine cavities into one. 1. **Why Option B is correct:** The procedure involves a wedge-shaped incision at the fundus to remove the septum or the intervening tissue between two horns, followed by the reconstruction of a single uterine cavity. This improves reproductive outcomes by increasing the volume of the uterine cavity and improving vascularity. 2. **Why Option A is incorrect:** Tightening of the internal cervical os refers to **Cervical Cerclage** (e.g., McDonald or Shirodkar procedures), used to treat cervical incompetence. 3. **Why Option C is incorrect:** Sling operations for prolapse include procedures like **Shirodkar’s sling** or **Purandare’s sling**, which use synthetic or fascial grafts to provide support to the uterus. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** While Strassman is the classic open surgery, the current "Gold Standard" for a **septate uterus** is **Hysteroscopic Septal Resection** (minimally invasive). * **Strassman vs. Jones/Tompkins:** Strassman is typically used for bicornuate uteri (unification), whereas Jones and Tompkins metroplasties were historically used for septate uteri. * **Indication:** These surgeries are generally indicated only in cases of recurrent pregnancy loss (RPL) or infertility where no other cause is found. * **Contraindication:** Metroplasty is **not** indicated for an arcuate uterus.

Question 282: What is the ideal treatment for a 55-year-old female with endometrial hyperplasia with atypia?

A. Simple hysterectomy (Correct Answer)
B. Medroxyprogesterone acetate
C. Levonorgestrel-releasing intrauterine system
D. Intrauterine contraceptive device

Explanation: **Explanation:** The management of endometrial hyperplasia is determined by two factors: the presence of **atypia** and the patient's **reproductive status/age**. **1. Why Simple Hysterectomy is Correct:** Endometrial hyperplasia with atypia (Atypical Hyperplasia/Endometrioid Intraepithelial Neoplasia) is a **premalignant condition**. In postmenopausal women (like this 55-year-old patient), the risk of progression to endometrial carcinoma is high (approximately 30%), and there is a 40% chance of a coexisting occult malignancy. Therefore, **Total Simple Hysterectomy** (usually with bilateral salpingo-oophorectomy in this age group) is the definitive treatment of choice to eliminate the risk of cancer. **2. Why Other Options are Incorrect:** * **B & C (Progesterones):** Medroxyprogesterone acetate and the Levonorgestrel-releasing intrauterine system (LNG-IUS) are the treatments of choice for hyperplasia **without atypia**. While they can be used for atypical hyperplasia in patients who wish to preserve fertility or are unfit for surgery, they are not the "ideal" or definitive treatment for a postmenopausal woman. * **D (IUCD):** A standard non-medicated intrauterine contraceptive device (like Copper-T) has no therapeutic effect on the endometrium and is contraindicated in cases of abnormal uterine bleeding or hyperplasia. **Clinical Pearls for NEET-PG:** * **Classification:** The WHO 2014 classification simplifies it into: 1. Hyperplasia without atypia (Risk of cancer <3%), 2. Atypical hyperplasia (Risk of cancer ~30%). * **Management Rule:** * No atypia → Medical management (Progesterones). * With atypia → Surgical management (Hysterectomy). * **Gold Standard Diagnosis:** Endometrial biopsy or D&C. * **Postmenopausal Bleeding:** Always rule out endometrial carcinoma; the most common cause is actually atrophic vaginitis, but the most significant is malignancy.

Question 283: Which organ is NOT involved by endometriosis?

A. Liver
B. Lymph nodes
C. Brain
D. Spleen (Correct Answer)

Explanation: **Explanation:** Endometriosis is defined as the presence of functioning endometrial tissue (glands and stroma) outside the uterine cavity. While it is most commonly found in the pelvic peritoneum and ovaries, it is known for its "metastatic" behavior, allowing it to involve almost any organ in the body through hematogenous or lymphatic spread. **Why Spleen is the correct answer:** The **spleen** is considered the only organ in the human body that is **never** involved by endometriosis. While the exact reason remains a subject of research, it is hypothesized that the splenic microenvironment or its high immune surveillance prevents the implantation of endometrial cells. **Analysis of other options:** * **Liver:** Hepatic endometriosis is rare but documented. It usually presents as a cystic lesion in the right lobe of the liver and can mimic a hepatic tumor or abscess. * **Lymph nodes:** Involvement of pelvic and para-aortic lymph nodes is relatively common (found in up to 30% of cases during radical surgery). This supports the **Sampson’s theory** of lymphatic spread. * **Brain:** Though extremely rare, cerebral endometriosis has been reported. It typically presents with catamenial (cyclic) seizures or neurological deficits coinciding with menstruation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ovary (often forming "Chocolate cysts" or Endometriomas). * **Most common site in the bowel:** Sigmoid colon. * **Most common site in the urinary tract:** Bladder. * **Distant sites:** Lungs and pleura are the most common extra-abdominal sites, leading to **Catamenial Pneumothorax**. * **Gold Standard Diagnosis:** Laparoscopy with biopsy.

Question 284: Which of the following is NOT a complication of leiomyoma in pregnancy?

A. Red degeneration
B. Obstructed labour
C. Postpartum hemorrhage (PPH)
D. Placenta previa (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Placenta previa**. While leiomyomas (fibroids) can distort the uterine cavity, they do not cause the placenta to implant over the internal os. Placenta previa is primarily associated with previous uterine scarring (C-sections), multiparity, and advanced maternal age. However, fibroids *are* associated with **placental abruption** due to reduced decidual perfusion over the myoma. **Analysis of Incorrect Options:** * **A. Red Degeneration:** This is the most common complication of fibroid in pregnancy (usually in the 2nd trimester). It occurs due to rapid growth leading to venous thrombosis and interstitial hemorrhage, causing acute pain and fever. * **B. Obstructed Labour:** Large subserosal or intramural fibroids located in the lower uterine segment (cervical or isthmic) can act as a physical barrier, preventing the descent of the fetal head and leading to dystocia. * **C. Postpartum Hemorrhage (PPH):** Fibroids interfere with the "living ligatures" (myometrial contraction and retraction) after delivery, leading to uterine atony and significant PPH. **High-Yield Clinical Pearls for NEET-PG:** * **Most common change** in fibroid during pregnancy: **Asymptomatic** (most do not change size; if they do, they usually increase in the 1st trimester). * **Most common complication:** Red degeneration (Necrobiosis). * **Management of Red Degeneration:** Always **conservative** (bed rest, analgesics like NSAIDs). Surgery is contraindicated. * **Myomectomy during Pregnancy:** Generally contraindicated due to the risk of uncontrollable hemorrhage, except in cases of a pedunculated fibroid with torsion.

Question 285: What is the most common genetic cause of spontaneous abortion?

A. Triploidy
B. Monosomy
C. Trisomy (Correct Answer)
D. Single gene deletion

Explanation: **Explanation:** Genetic abnormalities are the most frequent cause of spontaneous abortion, accounting for approximately 50–60% of first-trimester miscarriages. **Why Trisomy is Correct:** Autosomal trisomy is the **most common** chromosomal abnormality found in spontaneous abortions, representing about 50% of all chromosomally abnormal fetuses. It results from non-disjunction during maternal meiosis. Among specific trisomies, **Trisomy 16** is the most common individual trisomy identified in miscarriages (though it is never seen in live births). **Analysis of Incorrect Options:** * **Monosomy (B):** Specifically Monosomy X (45,X or Turner Syndrome) is the **single most common specific chromosomal abnormality** (approx. 20%). However, as a *category*, trisomies are more frequent than monosomies. * **Triploidy (A):** This involves an extra set of chromosomes (69,XXX/XXY). While common (approx. 15%), it occurs less frequently than autosomal trisomies. It is often associated with partial hydatidiform moles. * **Single gene deletion (D):** These are rare causes of early spontaneous abortion compared to gross numerical chromosomal aberrations (aneuploidy). **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall cause of miscarriage:** Chromosomal abnormalities. * **Most common category of abnormality:** Autosomal Trisomy. * **Most common specific Trisomy:** Trisomy 16. * **Most common single specific karyotype:** 45,X (Turner Syndrome). * **Recurrent Pregnancy Loss (RPL):** While aneuploidy causes sporadic loss, the most common "treatable" cause of RPL is Antiphospholipid Antibody Syndrome (APS).

Question 286: What is a cochleate uterus?

A. Acute antiflexion (Correct Answer)
B. Acute retroflexion
C. Acute retroversion of the uterus
D. None of the above

Explanation: ### Explanation **Correct Answer: A. Acute anteflexion** **Understanding the Concept:** A **cochleate uterus** (also known as a "snail-shaped" uterus) is a developmental malformation where the body of the uterus is **acutely anteflexed** on the cervix. In this condition, the uterine body is disproportionately small compared to the cervix (often maintaining a prepubertal or infantile ratio), and the organ is sharply bent forward. This acute angulation can lead to a narrow internal os, which obstructs the free flow of menstrual blood. **Analysis of Options:** * **Option A (Correct):** Acute anteflexion is the defining anatomical feature of a cochleate uterus. The term "cochleate" is derived from the Latin word for snail shell, describing the extreme forward curvature. * **Option B (Incorrect):** Acute retroflexion refers to the uterus being bent backward at the level of the internal os. While this is a positional abnormality, it is not termed "cochleate." * **Option C (Incorrect):** Retroversion refers to the tilting of the entire uterus backward in relation to the vaginal axis. Version involves the whole organ, whereas "cochleate" specifically describes a flexion deformity (the angle between the cervix and the body). **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** The most common symptom associated with a cochleate uterus is **spasmodic (primary) dysmenorrhea** due to the obstruction caused by the acute bend. * **Infertility:** It is often associated with "hypoplasia of the uterus," which may contribute to primary infertility. * **Uterine Ratios:** Remember that in a normal adult, the Corpus:Cervix ratio is 2:1. In a cochleate/infantile uterus, this ratio is reversed or 1:1. * **Management:** Treatment usually involves cervical dilatation to ease menstrual flow, though the underlying hypoplasia may persist.

Question 287: Which of the following is not a treatment option for a 29-year-old patient with moderate to severe endometriosis?

A. Danazol 200-400mg per day
B. Levonorgestrel-releasing intrauterine device (LNG IUD)
C. Hysterectomy (Correct Answer)
D. Inj leuprolide 3.75 mg monthly

Explanation: **Explanation:** The management of endometriosis is guided by the patient's age, symptom severity, and desire for future fertility. In this case, the patient is **29 years old**, which is considered young and within the peak reproductive age. **1. Why Hysterectomy is the Correct Answer:** Hysterectomy (with or without bilateral salpingo-oophorectomy) is considered **definitive surgical management** for endometriosis. It is generally reserved for women who have completed their family or those with debilitating symptoms who have failed all conservative medical and surgical therapies. At age 29, a hysterectomy is inappropriate as a primary treatment option because it results in permanent sterility and does not align with the goal of conservative management in young patients. **2. Analysis of Incorrect Options (Medical Management):** * **Danazol (Option A):** An androgenic steroid that inhibits the LH/FSH surge and creates a "pseudomenopause" state, causing atrophy of ectopic endometrial tissue. * **LNG-IUD (Option B):** Provides local progestogenic effect, leading to decidualization and atrophy of the endometrium. It is highly effective for managing endometriosis-associated pelvic pain. * **GnRH Agonists (Inj. Leuprolide) (Option D):** These create a reversible hypogonadotropic hypogonadal state (pseudomenopause). Leuprolide is a gold-standard medical treatment for moderate to severe endometriosis to shrink lesions and relieve pain. **Clinical Pearls for NEET-PG:** * **First-line treatment** for symptomatic endometriosis is usually NSAIDs and Combined Oral Contraceptive Pills (COCPs). * **Gold Standard for Diagnosis:** Laparoscopy (visual confirmation with biopsy). * **Laparoscopic Cystectomy** is preferred over drainage for endometriomas >3 cm to reduce recurrence. * **Add-back therapy:** When using GnRH agonists for >6 months, low-dose estrogen/progestogen is added to prevent bone mineral density loss and vasomotor symptoms.

Question 288: Regarding adenomyosis, all of the following statements are true EXCEPT:

A. It is associated with dysmenorrhea and menorrhagia.
B. Total hysterectomy is considered the treatment of choice.
C. The uterus is asymmetrically enlarged and tender. (Correct Answer)
D. It is commonly seen in multiparous women.

Explanation: **Explanation:** Adenomyosis is a condition characterized by the presence of endometrial glands and stroma within the myometrium. Understanding its clinical presentation is crucial for NEET-PG. **Why Option C is the correct (false) statement:** In adenomyosis, the uterus is typically **symmetrically (globularly) enlarged**, not asymmetrical. While it is often tender (especially premenstrually), the enlargement rarely exceeds 12–14 weeks of gestational size. Asymmetrical enlargement is more characteristic of **uterine fibroids (leiomyomas)**. **Analysis of other options:** * **Option A:** Menorrhagia (heavy menstrual bleeding) and dysmenorrhea (typically secondary and progressive) are the classic clinical hallmarks, occurring in approximately 60% and 25% of cases, respectively. * **Option B:** Total hysterectomy is the **definitive treatment** for adenomyosis, especially in women who have completed their family, as medical management often provides only temporary relief. * **Option D:** Adenomyosis is classically seen in **multiparous women** in their 40s and 50s. This is a key demographic differentiator from endometriosis, which is more common in nulliparous women. **High-Yield Clinical Pearls for NEET-PG:** * **MRI Findings:** The "Gold Standard" for non-invasive diagnosis. Look for a **Junctional Zone (JZ) thickness >12 mm**. * **Ultrasound Signs:** "Venetian blind" appearance (linear shadowing), "Rain-in-the-forest" appearance on Doppler, and myometrial cysts. * **Pathology:** On gross examination, the cut surface shows a "trabeculated" or "whorled" appearance with small hemorrhagic spots, but unlike fibroids, there is **no false capsule**. * **Halban’s Sign:** A tender, softened uterus felt during the premenstrual phase.

Question 289: Which of the following statements about uterine fibroids is FALSE?

A. They are usually malignant. (Correct Answer)
B. They are rare before 20 years of age.
C. They are usually asymptomatic.
D. They are more common in nulliparous women.

Explanation: **Explanation:** **1. Why Option A is the correct (False) statement:** Uterine fibroids (leiomyomas) are **benign** monoclonal tumors of the smooth muscle cells of the myometrium. They are the most common benign tumors of the female pelvis. The risk of malignant transformation into a leiomyosarcoma is extremely low, estimated at approximately **0.1% to 0.5%**. Therefore, stating they are "usually malignant" is factually incorrect. **2. Why the other options are correct statements:** * **Option B:** Fibroids are estrogen-dependent. They are rarely seen before menarche and are **rare before age 20**, as they require prolonged exposure to reproductive hormones to grow. * **Option C:** Most women with fibroids are **asymptomatic**. They are often discovered incidentally during a routine pelvic examination or ultrasound. Symptoms (like AUB or pressure) typically depend on the size and location (e.g., submucosal fibroids are more likely to be symptomatic). * **Option D:** Fibroids are **more common in nulliparous women**. Pregnancy and parity are protective factors, likely due to the remodeling of the uterus postpartum and the interruption of cyclic estrogen exposure. **Clinical Pearls for NEET-PG:** * **Most common symptom:** Menorrhagia (Heavy Menstrual Bleeding). * **Most common degeneration:** Hyaline degeneration. * **Degeneration during pregnancy:** Red degeneration (due to rapid growth and venous thrombosis). * **Most common type:** Intramural; **Most symptomatic type:** Submucosal. * **Investigation of choice:** Transvaginal Ultrasound (TVS). * **Medical Management:** GnRH agonists (used pre-operatively to reduce size) or Ulipristal acetate.

Question 290: What is the most common site involved in tuberculosis of the genital organs?

A. Endometrium
B. Cervix
C. Tubes (Correct Answer)
D. Ovaries

Explanation: **Explanation:** Genital Tuberculosis (GTB) is a significant cause of infertility in developing countries. It is almost always a **secondary infection**, spreading most commonly via the **hematogenous route** from a primary focus (usually the lungs). **1. Why the Fallopian Tubes are the correct answer:** The **Fallopian tubes** are the most common site involved in GTB, affected in **90–100%** of cases. The infection typically starts in the endosalpinx and spreads to other pelvic organs. Because the tubes have a rich vascular supply and a narrow lumen, they provide an ideal environment for the tubercle bacilli to lodge and multiply. This often results in characteristic findings like "lead pipe" tubes or "tobacco pouch" appearances. **2. Analysis of Incorrect Options:** * **Endometrium (A):** This is the second most common site, involved in **50–60%** of cases. It is usually infected secondary to downward spread from the tubes. * **Ovaries (D):** Involved in about **20–30%** of cases. The infection typically affects the surface (perioophoritis) rather than the stroma. * **Cervix (B):** A rare site, involved in only **5–15%** of cases. It often mimics the appearance of cervical malignancy. **NEET-PG High-Yield Pearls:** * **Order of frequency:** Fallopian Tubes (100%) > Endometrium (50%) > Ovaries (25%) > Cervix (5%). * **Most common symptom:** Infertility (followed by pelvic pain and menstrual irregularities). * **Gold Standard Diagnosis:** Endometrial biopsy/aspirate for TB Culture or GeneXpert (taken in the pre-menstrual phase). * **Hysterosalpingography (HSG) findings:** "Beaded tube," "Golf-hole ostium," or "Shish-kebab" appearance. Note: HSG should be avoided in acute infection.

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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