Gynecological Disorders Practice Questions

Q: All of the following may be associated with a uterine fibroid except?

Amenorrhea. **Explanation:** Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. The correct answer is **Amenorrhea** because fibroids are typically associated with **increased** menstrual bleeding (menorrhagia) rather than the absence of menstruation. **1. Why Amenorrhea is the correct answer:** Fibroids increase the surface area of the endometrium, interfere with uterine contractility, and cause venous congestion. This leads to **heavy menstrual bleeding (menorrhagia)** or irregular bleeding (metrorrhagia). Amenorrhea is not a feature of fibroids unless they are associated with pregnancy or severe secondary anemia (rare). **2. Analysis of Incorrect Options:** * **Pseudo-Meig’s Syndrome:** This is a triad of benign ovarian tumors (other than fibroma), pleural effusion, and ascites. Large subserosal pedunculated fibroids can occasionally cause this syndrome, making it a known association. * **Polycythemia:** Rare "myomatous erythrocytosis" can occur due to the ectopic production of **Erythropoietin (EPO)** by the fibroid tissue itself. * **Dysmenorrhea:** Fibroids commonly cause **congestive dysmenorrhea** due to pelvic congestion or **spasmodic dysmenorrhea** if the uterus attempts to expel a submucosal fibroid (acting like a foreign body). **Clinical Pearls for NEET-PG:** * **Most common symptom:** Menorrhagia (Heavy Menstrual Bleeding). * **Most common type:** Intramural fibroid. * **Most symptomatic type:** Submucosal fibroid (causes infertility and heavy bleeding). * **Red Degeneration:** Most common during pregnancy (occurs in the 2nd trimester due to rapid growth and ischemia). * **Hyaline Degeneration:** The most common overall type of degeneration.

Q: Misoprostol is indicated in all of the following conditions except:

Menorrhagia. **Explanation:** Misoprostol is a synthetic **Prostaglandin E1 (PGE1) analogue**. Its primary mechanism of action involves stimulating uterine contractions (oxytocic effect) and causing cervical ripening. **Why Menorrhagia is the correct answer:** Menorrhagia (heavy menstrual bleeding) is primarily managed by reducing menstrual blood flow through antifibrinolytics (Tranexamic acid), NSAIDs, or hormonal therapy (OCPs, Progestogens, or the Levonorgestrel-releasing intrauterine system). Misoprostol causes uterine contractions but does not effectively reduce the volume of menstrual blood loss; therefore, it has **no clinical indication** in the management of menorrhagia. **Analysis of other options:** * **Postpartum Hemorrhage (PPH):** Misoprostol (600–800 mcg) is used for both prevention and treatment of PPH due to uterine atony, as it promotes sustained uterine contractions. * **Missed Abortion:** It is used to facilitate the expulsion of products of conception by softening the cervix and inducing contractions. * **Induction of Labor:** Low-dose Misoprostol (25 mcg) is a standard agent for cervical ripening and labor induction in patients with an unfavorable Bishop score. **High-Yield Clinical Pearls for NEET-PG:** * **Route of Administration:** Misoprostol can be given orally, sublingually, vaginally, or rectally. Sublingual has the fastest onset, while vaginal has the longest duration of action. * **Side Effects:** The most common side effects are **shivering and pyrexia** (fever). * **Contraindication:** It should be avoided for induction of labor in women with a previous cesarean section due to the increased risk of **uterine rupture**. * **Other Uses:** It is also used for medical termination of pregnancy (MTP) in combination with Mifepristone and for the prevention of NSAID-induced gastric ulcers.

Q: Which of the following surgical techniques for genitourinary fistula repair involves total excision of the fistulous tract?

Total excision of fistulous tract.. ### Explanation The surgical management of genitourinary fistulae (most commonly Vesicovaginal Fistula - VVF) aims to achieve a tension-free, watertight closure with well-vascularized tissue. **Correct Option: B. Total excision of fistulous tract** This technique, often associated with the **classic abdominal approach (O'Conor’s repair)**, involves the complete excision of the fibrotic fistulous tract. By removing the scarred edges until healthy, bleeding tissue is reached, the surgeon ensures optimal healing. The bladder and vagina are then closed in multiple layers, often with an interposition flap (like the Martius flap or omental flap) to prevent recurrence. **Analysis of Incorrect Options:** * **A. Partial excision:** This is characteristic of the **Latzko procedure** (a vaginal approach). In this technique, the fistula tract is *not* excised; instead, the vaginal mucosa around the fistula is denuded, and the layers are imbricated. It is highly successful for post-hysterectomy VVFs. * **C & D. Shortening of vagina / Approximating walls:** These are potential *complications* or side effects of certain repairs (like the Latzko procedure, which can slightly shorten the vaginal vault) rather than the intended surgical technique for tract management. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of VVF:** Globally, it is **obstructed labor**; in developed nations/urban centers, it is **iatrogenic (post-total abdominal hysterectomy)**. * **Gold Standard Investigation:** **Cystoscopy** to locate the fistula in relation to the ureteric orifices. * **Diagnostic Test:** **Three-swab test** (Methylene blue instilled in the bladder; if the top swab is blue, it confirms VVF). * **Timing of Repair:** Traditionally 3–6 months after the injury to allow inflammation to subside, though "early repair" is now gaining favor in non-radiated cases.

Q: What is the most likely cause of heavy menstrual bleeding in patients with uterine fibroids?

Dilated endometrial venules. **Explanation:** The primary mechanism for heavy menstrual bleeding (HMB) in patients with uterine fibroids (leiomyomas) is the **distortion and congestion of the overlying endometrial vasculature**. **1. Why "Dilated endometrial venules" is correct:** Fibroids increase the total surface area of the endometrium and exert pressure on the surrounding myometrial veins. This compression leads to venous stasis and the formation of **dilated, thin-walled endometrial venules** (ectasia) directly over the fibroid. During menstruation, as the functional layer of the endometrium sheds, these fragile, engorged vessels rupture, leading to significant blood loss that exceeds the normal hemostatic capacity of the uterus. Additionally, fibroids interfere with normal myometrial contractility, preventing the "physiologic ligatures" from effectively constricting vessels. **2. Why other options are incorrect:** * **Hormonal imbalance:** While fibroids are estrogen-dependent, HMB in these patients is primarily a structural and vascular issue rather than a primary hormonal dysfunction (like AUB-O). * **Ruptured fibroids:** This is an extremely rare clinical event, usually associated with pregnancy or trauma, and presents as an acute abdomen/hemoperitoneum, not cyclic HMB. * **Torsion of fibroids:** This occurs only in pedunculated subserosal fibroids. It causes acute pelvic pain and necrosis, not heavy menstrual bleeding. **High-Yield Clinical Pearls for NEET-PG:** * **Submucosal fibroids** (FIGO Type 0, 1, 2) are the most common type to cause HMB due to direct endometrial distortion. * **Most common symptom** of fibroids: Heavy Menstrual Bleeding (Menorrhagia). * **Most common site:** Intramural. * **Gold Standard Investigation:** Transvaginal Ultrasound (TVS); Saline Infusion Sonohysterography (SIS) is superior for evaluating submucosal types.

Q: The normal bacterial flora in the vagina makes its environment:

Acidic. **Explanation:** The vaginal environment in a healthy, reproductive-age woman is naturally **acidic**, typically maintaining a pH between **3.8 and 4.5**. This acidity is primarily maintained by **Döderlein’s bacilli** (Lactobacillus species). These bacteria utilize glycogen—stored in the vaginal squamous epithelium under the influence of estrogen—and convert it into **lactic acid**. This acidic environment serves as a critical innate immune mechanism, inhibiting the overgrowth of pathogenic bacteria and fungi. **Analysis of Options:** * **Option A (Correct):** Acidic. The production of lactic acid by Lactobacilli ensures a low pH, which is the physiological norm during reproductive years. * **Option B (Incorrect):** Alkaline. An alkaline pH (>4.5) is pathological in reproductive-age women and is often seen in conditions like Bacterial Vaginosis (BV) or Trichomoniasis. * **Option C (Incorrect):** Neutral. A neutral pH (around 7.0) is typically found in prepubertal girls and postmenopausal women due to low estrogen levels and a lack of glycogen/Lactobacilli. * **Option D (Incorrect):** The flora is the primary determinant of the vaginal pH; therefore, it significantly affects the environment. **High-Yield Clinical Pearls for NEET-PG:** * **Estrogen Connection:** High estrogen (reproductive age) = High glycogen = More Lactobacilli = **Acidic pH**. * **Life Cycle Changes:** The vaginal pH is alkaline/neutral at birth (due to maternal estrogens), becomes neutral during childhood, stays acidic during reproductive years, and returns to neutral/alkaline after menopause. * **Amniotic Fluid:** In cases of Premature Rupture of Membranes (PROM), the vaginal pH shifts from acidic to **alkaline** (pH 7.0–7.5), which is the basis for the Nitrazine paper test.

Q: Which of the following is considered a premalignant lesion of the vulva?

Leukoplakia. **Explanation:** **Leukoplakia** is a clinical term describing a "white patch" on the vulvar mucosa that cannot be scraped off. In the context of the vulva, it often represents **Vulvar Intraepithelial Neoplasia (VIN)** or hyperplastic dystrophy. Histologically, these lesions show cellular atypia, increased mitotic activity, and loss of polarity, making them significant **premalignant precursors** to squamous cell carcinoma of the vulva. **Analysis of Options:** * **Kraurosis (Option A):** This is an older clinical term describing the progressive atrophy, shriveling, and stenosis of the vulvar tissues (often seen in Lichen Sclerosus). While Lichen Sclerosus has a small associated risk of malignancy (approx. 3-5%), the term "Kraurosis" refers to the physical state of atrophy rather than a specific premalignant pathological lesion. * **Condyloma Acuminata (Option C):** These are genital warts caused by **HPV types 6 and 11** (low-risk types). While they are sexually transmitted, they are generally considered benign and do not typically progress to malignancy. (Note: High-risk HPV 16 and 18 are associated with VIN/Malignancy). * **Localized Scleroderma (Option D):** Also known as Morphea, this is a connective tissue disorder characterized by skin thickening. It is an inflammatory/autoimmune condition and is not considered a precursor to vulvar cancer. **High-Yield Clinical Pearls for NEET-PG:** * **VIN Classification:** Divided into **uVIN** (usual type, HPV-related, seen in younger women) and **dVIN** (differentiated type, non-HPV related, associated with Lichen Sclerosus, seen in older women). * **dVIN** has a higher potential for rapid progression to invasive squamous cell carcinoma compared to uVIN. * **Management:** Any suspicious "leukoplakic" or pigmented vulvar lesion must undergo a **Punch Biopsy** (using a Keyes punch) to rule out malignancy.

Q: Le Fort's operation is indicated for which of the following conditions?

Old post-menopausal women. **Explanation:** **Le Fort’s Operation** (also known as Partial Colpocleisis) is a "destructive" or obliterative surgical procedure used to treat **Pelvic Organ Prolapse (POP)**. **1. Why Option B is Correct:** The procedure involves denuding the anterior and posterior vaginal walls and suturing them together, effectively closing the vaginal canal to provide support for the prolapsed uterus. Because this procedure **obliterates the vagina**, it results in the loss of coital function. Therefore, it is strictly indicated for **elderly, post-menopausal women** who are no longer sexually active and are poor surgical candidates for more extensive procedures (like vaginal hysterectomy) due to medical comorbidities. **2. Why Other Options are Incorrect:** * **Option A:** It is contraindicated in young women or those desiring childbearing because it prevents sexual intercourse and makes vaginal delivery impossible. * **Option C:** Post-traumatic prolapse is rare and usually requires reconstructive surgery to restore anatomy, not an obliterative procedure that destroys vaginal function. **3. High-Yield Clinical Pearls for NEET-PG:** * **Prerequisites:** Before performing Le Fort’s, a **Pap smear** and **Endometrial biopsy** (if bleeding is present) must be done to rule out malignancy, as the cervix and uterus become inaccessible post-surgery. * **Key Feature:** Lateral channels (canals of Malpas) are left on both sides to allow for the drainage of cervical and uterine secretions. * **Advantage:** It can be performed quickly under local anesthesia or sedation, making it ideal for the frail elderly. * **Contraindication:** It should not be performed if there is a suspicion of uterine/cervical cancer or if the patient wishes to remain sexually active.

Q: Which drug is known to reduce the size of uterine fibroids?

Danazol. **Explanation:** Uterine fibroids (leiomyomas) are estrogen-dependent tumors. Therefore, medical management focuses on creating a hypoestrogenic environment to induce tumor shrinkage. **Why Danazol is correct:** Danazol is a synthetic androgen and a derivative of ethisterone. It acts by inhibiting the pituitary-ovarian axis (suppressing GnRH and gonadotropins) and directly inhibiting steroidogenic enzymes in the ovary. This results in a **high-androgen, low-estrogen state**, which leads to the atrophy of the endometrium and a significant reduction in the size of uterine fibroids. It is often used preoperatively to reduce tumor volume and blood loss. **Analysis of Incorrect Options:** * **Progesterone:** While some progestins are used to control bleeding (menorrhagia) associated with fibroids, they do not consistently reduce the size of the fibroid. In fact, progesterone can sometimes promote fibroid growth as it stimulates mitotic activity in the myometrium. * **Mifepristone (RU-486):** Although research shows that Selective Progesterone Receptor Modulators (SPRMs) like Mifepristone can reduce fibroid size, **Danazol** remains the classic textbook answer for this specific pharmacological mechanism in standard NEET-PG curricula. * **Estrogen:** Estrogen is the primary fuel for fibroid growth. Administering estrogen would likely increase the size of the fibroids and worsen symptoms. **NEET-PG High-Yield Pearls:** * **GnRH Agonists (e.g., Leuprolide):** These are the **most effective** drugs for reducing fibroid size (up to 50% reduction) by creating a temporary "pseudomenopause." * **Ulipristal Acetate:** A newer SPRM used specifically for preoperative shrinkage of fibroids. * **Definitive Treatment:** Hysterectomy remains the definitive treatment, while Myomectomy is the treatment of choice for women wishing to preserve fertility.

Question 1

All of the following may be associated with a uterine fibroid except?

Accepted Answer

Amenorrhea

Answer

Pseudo-Meig's syndrome

Answer

Polycythemia

Answer

Dysmenorrhea

Question 2

Misoprostol is indicated in all of the following conditions except:

Accepted Answer

Menorrhagia

Answer

Postpartum hemorrhage

Answer

Missed abortion

Answer

Induction of labor

Question 3

Which of the following surgical techniques for genitourinary fistula repair involves total excision of the fistulous tract?

Accepted Answer

Total excision of fistulous tract.

Answer

Partial excision of fistula.

Answer

Shortening of vagina.

Answer

Approximates anterior and posterior vaginal walls.

Question 4

What is the most likely cause of heavy menstrual bleeding in patients with uterine fibroids?

Accepted Answer

Dilated endometrial venules

Answer

Hormonal imbalance

Answer

Ruptured fibroids

Answer

Torsion of fibroids

Question 5

Which of the following malignancies is not found to have an increased risk in women with endometriosis?

Accepted Answer

Endometrial cancer

Answer

Ovarian cancers

Answer

Melanoma

Answer

Non-Hodgkin's lymphoma

Question 6

A 16-year-old female presents with primary amenorrhea. Examination shows a short, blind vagina with an absent uterus. What is the next investigation of choice?

Accepted Answer

Karyotyping

Answer

Intravenous pyelogram (IVP)

Answer

Gonadotropin levels

Answer

Serum prolactin

Question 7

The normal bacterial flora in the vagina makes its environment:

Accepted Answer

Acidic

Answer

Alkaline

Answer

Neutral

Answer

Does not affect the environment

Question 8

Which of the following is considered a premalignant lesion of the vulva?

Accepted Answer

Leukoplakia

Answer

Kraurosis

Answer

Condyloma acuminata

Answer

Localized scleroderma

Question 9

Le Fort's operation is indicated for which of the following conditions?

Accepted Answer

Old post-menopausal women

Answer

Young women desirous of child bearing

Answer

Post-traumatic prolapse

Answer

None of the above

Question 10

Which drug is known to reduce the size of uterine fibroids?

Accepted Answer

Danazol

Answer

Progesterone

Answer

Mifepristone (RU-486)

Answer

Estrogen

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?