Gynecological Disorders Practice Questions

Q: A young lady presents with a complaint of copious vaginal discharge. On per speculum examination, a 'strawberry vagina' is noted, with no cervical discharge. Which of the following should be given for management?

Metronidazole. **Explanation:** The clinical presentation of **copious vaginal discharge** and a characteristic **'strawberry vagina'** (punctate hemorrhages on the vaginal and cervical mucosa) is pathognomonic for **Trichomoniasis**, caused by the protozoan *Trichomonas vaginalis*. **1. Why Metronidazole is correct:** Metronidazole is the drug of choice for Trichomoniasis. It is a nitroimidazole that targets anaerobic bacteria and protozoa. According to current guidelines, both the patient and their sexual partner(s) must be treated simultaneously to prevent reinfection, as Trichomoniasis is a sexually transmitted infection (STI). **2. Analysis of Incorrect Options:** * **Metronidazole and Azithromycin/Doxycycline (Options B & C):** These combinations are used for Syndromic Management of Pelvic Inflammatory Disease (PID) or Cervicitis (targeting *N. gonorrhoeae* and *C. trachomatis*). Since the question specifies "no cervical discharge," the focus remains on the vaginal infection alone. * **Fluconazole (Option D):** This is an antifungal used for Vulvovaginal Candidiasis, which typically presents with a thick, "curdy-white" discharge and an inflamed (but not strawberry) vagina. **Clinical Pearls for NEET-PG:** * **Whiff Test:** Often positive (amine odor) in Trichomoniasis, similar to Bacterial Vaginosis. * **Microscopy:** Look for "pear-shaped, flagellated motile trophozoites" on a wet mount. * **pH:** The vaginal pH in Trichomoniasis is typically **>4.5**. * **Gold Standard Diagnosis:** Culture (Diamond’s Medium), though NAAT is now preferred for its high sensitivity. * **Pregnancy:** Metronidazole is safe to use in all trimesters of pregnancy for symptomatic Trichomoniasis.

Q: What is the definition of a unicornuate uterus?

Two uterine cavities with one cervix. ### Explanation The correct answer is **A: Two uterine cavities with one cervix**. A **Bicornuate Uterus** (specifically *Bicornuate Unicollis*) results from the partial failure of fusion of the Mullerian ducts at the level of the fundus. This leads to two separate uterine horns (cavities) that communicate at the level of the single cervix. #### Analysis of Options: * **Option B (Single vagina with a double uterus):** This describes **Uterus Didelphys** if there are also two cervices. If it refers to two horns with one cervix, it is a Bicornuate uterus, but "double uterus" is the classic terminology for Didelphys. * **Option C (Incomplete septum):** This defines a **Septate Uterus**, which occurs due to the failure of resorption of the midline septum after the Mullerian ducts have already fused. * **Option D (Double uterus with double cervix):** This is the classic definition of **Uterus Didelphys**, resulting from a complete failure of fusion of the two Mullerian ducts. #### High-Yield Clinical Pearls for NEET-PG: * **Mullerian Anomalies Classification:** Most commonly classified using the **AFS (American Fertility Society)** system. * **Bicornuate vs. Septate:** This is a frequent exam distinction. A **Bicornuate** uterus has a fundal cleft/indentation (>1 cm), whereas a **Septate** uterus has a flat or convex external fundal contour. * **Clinical Presentation:** Often associated with recurrent pregnancy loss (RPL), malpresentation (breech), and preterm labor. * **Gold Standard Diagnosis:** Combined **Laparoscopy and Hysteroscopy** (to visualize both the external contour and internal cavity). MRI is the best non-invasive modality. * **Treatment:** Bicornuate uteri usually do not require surgery unless there is obstetric failure (Strassman Metroplasty). In contrast, a Septate uterus is treated with Hysteroscopic Septal Resection.

Q: Which of the following is NOT characteristic of bacterial vaginosis?

Profuse creamy discharge. **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome resulting from a shift in the vaginal flora, where normal hydrogen peroxide-producing Lactobacilli are replaced by high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Mycoplasma hominis*). **Why Option A is the correct answer:** The discharge in BV is characteristically **thin, homogenous, and greyish-white**. It is typically non-viscous and coats the vaginal walls evenly. A "profuse creamy discharge" is more characteristic of **Candidiasis** (thick, curd-like) or certain stages of physiological discharge, but it does not fit the diagnostic criteria for BV. **Analysis of other options:** * **Option B (Clue cells):** These are vaginal epithelial cells coated with coccobacilli, giving them a "stippled" or "shaggy" appearance. They are the most specific microscopic finding for BV. * **Option C (Positive Whiff test):** Adding 10% KOH to the discharge releases volatile amines (putrescine and cadaverine), resulting in a characteristic "fishy odor." * **Option D (Absent leukocytes):** BV is a **malodorant dysbiosis**, not a true inflammatory condition (hence "vaginosis" rather than "vaginitis"). The absence of pus cells (leukocytes) on microscopy is a hallmark that distinguishes it from Trichomoniasis or Cervicitis. **NEET-PG High-Yield Pearls:** * **Amsel’s Criteria (3 out of 4 required):** 1. Thin, homogenous discharge. 2. Vaginal pH > 4.5 (Most sensitive). 3. Positive Whiff test. 4. Presence of Clue cells (Most specific). * **Gold Standard Diagnosis:** Nugent Scoring (Gram stain of vaginal secretions). * **Treatment of Choice:** Oral or topical Metronidazole (500 mg BD for 7 days). Note: Treatment of the male partner is **not** recommended.

Q: Which of the following is true about a complete hydatidiform mole?

Chromosome pattern is XX. **Explanation:** **1. Why Option A is Correct:** A complete hydatidiform mole (CHM) is characterized by the fertilization of an "empty" egg (lacking maternal chromosomes) by a sperm. The most common mechanism (90%) is **androgenesis**, where a single sperm (23,X) fertilizes the empty ovum and subsequently duplicates its DNA. This results in a **46,XX** diploid karyotype that is entirely paternal in origin. Less commonly (10%), it occurs via dispermy (46,XX or 46,XY). **2. Why Other Options are Incorrect:** * **Option B:** It is of **paternal origin**, not maternal. The maternal nuclear DNA is absent or inactivated. * **Option C:** While **Theca Lutein cysts** (bilateral ovarian enlargement) occur in about 25-30% of cases due to high hCG levels, the question asks for a definitive "true" statement. The chromosomal pattern (XX) is a defining genetic hallmark, whereas ovarian cysts are a clinical complication that does not occur in every case. * **Option D:** Hydatidiform moles are significantly **more common in developing countries** (especially Southeast Asia and Africa) compared to developed nations. **Clinical Pearls for NEET-PG:** * **Pathology:** "Bunch of grapes" appearance; histologically shows diffuse trophoblastic proliferation and hydropic villi with **no fetal parts**. * **Diagnosis:** "Snowstorm appearance" on USG; serum hCG levels are typically >100,000 mIU/ml. * **Marker:** **p57** is a paternally imprinted gene. Since CHM lacks maternal DNA, it is **p57 negative** (immunostaining), whereas partial moles are p57 positive. * **Risk:** CHM has a higher risk (15-20%) of progressing to Gestational Trophoblastic Neoplasia (Choriocarcinoma) compared to partial moles (1-5%).

Q: What is the best investigation for endometriosis?

Laparoscopy. **Explanation:** **Laparoscopy (Option A)** is the **Gold Standard** investigation for the diagnosis of endometriosis. This is because it allows for direct visualization of characteristic lesions (such as "powder-burn" or "mulberry" spots) on the pelvic peritoneum and ovaries. Furthermore, it provides the opportunity for **histopathological confirmation** via biopsy, which is the definitive diagnostic requirement. **Why other options are incorrect:** * **Ultrasound (USG) (Option B):** While Transvaginal Sonography (TVS) is the first-line screening tool and excellent for detecting **Endometriomas** ("chocolate cysts" with ground-glass echogenicity), it often fails to detect small peritoneal implants or deep infiltrating endometriosis. * **X-ray Pelvis (Option C):** This has no role in the diagnosis of endometriosis as soft tissue implants and adhesions are not radiopaque. * **CT Scan (Option D):** CT has poor soft-tissue resolution for the pelvis compared to MRI or USG and is not used for routine diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Laparoscopy + Biopsy. * **First-line Investigation:** Transvaginal Ultrasound (TVS). * **Investigation of choice for Deep Infiltrating Endometriosis (DIE):** MRI. * **Serum Marker:** **CA-125** may be elevated (usually >35 U/ml) but lacks specificity; it is primarily used for monitoring recurrence rather than primary diagnosis. * **Classic Triad:** Dysmenorrhea (congestive/secondary), Dyspareunia, and Infertility.

Q: What is the most common cause of vaginal discharge among reproductive-age females?

Bacterial vaginosis. **Explanation:** **Bacterial Vaginosis (BV)** is the most common cause of vaginal discharge in women of reproductive age worldwide, accounting for approximately 40–50% of cases. It is not a true infection but a **clinical dysbiosis** characterized by a shift in vaginal flora: a decrease in hydrogen peroxide-producing *Lactobacilli* and an overgrowth of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Atopobium vaginae*). **Analysis of Options:** * **Bacterial Vaginosis (Correct):** It is the leading cause of "fishy-smelling" discharge. Diagnosis is clinically confirmed using **Amsel’s Criteria** (requires 3 out of 4: thin homogenous discharge, pH >4.5, positive Whiff test, and presence of **Clue cells** on microscopy). * **Candida (Incorrect):** This is the second most common cause. It typically presents with thick, "curdy-white" (cottage cheese-like) discharge and intense pruritus. The vaginal pH remains normal (<4.5). * **Trichomonas (Incorrect):** This is a protozoal STI. While common, it is less frequent than BV. It presents with a malodorous, frothy, green-yellow discharge and a "strawberry cervix" (punctate hemorrhages). * **Gonorrhea (Incorrect):** This primarily causes cervicitis rather than vaginitis. While it can cause discharge, it is significantly less common than the aforementioned causes of vaginal symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis for BV:** Nugent Scoring (Gram stain of vaginal discharge). * **Drug of Choice:** Metronidazole (500 mg BID for 7 days). * **Key Distinction:** BV is the only one of the three major causes where the partner does **not** routinely require treatment. * **Whiff Test:** Addition of 10% KOH to discharge releases a fishy odor due to amines.

Q: Which of the following statements is false regarding the given specimen?

About 10% undergo malignant transformation.. ***About 10% undergo malignant transformation.*** - The actual **malignant transformation rate** for dermoid cysts (mature cystic teratomas) is only **1-2%**, not 10%. - **Squamous cell carcinoma** is the most common malignant transformation, typically occurring in postmenopausal women. *Bilateral in 10% to 15% of cases.* - Dermoid cysts are **bilateral** in approximately **10-15%** of cases, making this statement true. - **Bilateral occurrence** is more common in dermoid cysts compared to other ovarian cysts. *Typically presents as unilocular cysts.* - Dermoid cysts characteristically appear as **unilocular cysts** with mixed echogenicity on ultrasound. - They contain **ectodermal derivatives** like hair, teeth, and sebaceous material, giving them a characteristic appearance. *Common during the active reproductive years.* - Dermoid cysts are most frequently diagnosed during the **reproductive years**, particularly in women aged **20-40 years**. - They represent the most common **ovarian neoplasm** in women under 30 years of age.

Question 1

Which of the following is true regarding pain in endometriosis?

Accepted Answer

Dyspareunia is more common with peritoneal lesions in the pouch of Douglas.

Answer

Dysmenorrhea usually starts from day 2 of periods and subsides with the end of menstrual flow.

Answer

Dysmenorrhea is more common in ovarian endometriomas than peritoneal lesions.

Answer

Pelvic pain is usually unilateral.

Question 2

A young lady presents with a complaint of copious vaginal discharge. On per speculum examination, a 'strawberry vagina' is noted, with no cervical discharge. Which of the following should be given for management?

Accepted Answer

Metronidazole

Answer

Metronidazole and azithromycin

Answer

Metronidazole and doxycycline

Answer

Fluconazole only

Question 3

What is the definition of a unicornuate uterus?

Accepted Answer

Two uterine cavities with one cervix

Answer

Single vagina with a double uterus

Answer

An incomplete septum within the uterus

Answer

A double uterus with a double cervix

Question 4

Which of the following is NOT characteristic of bacterial vaginosis?

Accepted Answer

Profuse creamy discharge

Answer

Clue cells present

Answer

Positive whiff test

Answer

Absent leukocytes

Question 5

What is the best endometrial reaction in ectopic pregnancy?

Accepted Answer

Decidual reaction without chorionic villi

Answer

Arias-Stella reaction

Answer

Secretory phase

Answer

Decidual reaction with chorionic villi

Question 6

Which of the following is true about a complete hydatidiform mole?

Accepted Answer

Chromosome pattern is XX

Answer

It is of maternal origin

Answer

Enlarged ovarian cyst occurs

Answer

It is common in developed countries

Question 7

What is the best investigation for endometriosis?

Accepted Answer

Laparoscopy

Answer

Ultrasound (USG)

Answer

X-ray pelvis

Answer

CT Scan

Question 8

What is the most common cause of vaginal discharge among reproductive-age females?

Accepted Answer

Bacterial vaginosis

Answer

Trichomonas

Answer

Candida

Answer

Gonorrhea

Question 9

Hysteroscopic resection is indicated for submucosal myomas of which size?

Accepted Answer

Less than 4 cm

Answer

Any size

Answer

4-8 cm

Answer

Less than 10 cm

Question 10

Which of the following statements is false regarding the given specimen?

Accepted Answer

About 10% undergo malignant transformation.

Answer

Bilateral in 10% to 15% of cases.

Answer

Typically presents as unilocular cysts.

Answer

Common during the active reproductive years.

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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