Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 381: In the procedure of Laparoscopic myomectomy, an instrument is inserted into the exposed fibroid to help extract it from the muscular uterine bed. Which of the following is the instrument used?

A. Myoma Morcellator
B. Laparoscopic Myoma Screw (Correct Answer)
C. Myomectomy clamp
D. Bonneys elevator

Explanation: ### Explanation **Correct Answer: B. Laparoscopic Myoma Screw** In laparoscopic myomectomy, the **Myoma Screw** (also known as a corkscrew or tenaculum screw) is the primary instrument used for **traction and stabilization**. Once the uterine serosa and pseudocapsule are incised, the screw is bored into the center of the fibroid. This provides a firm grip, allowing the surgeon to pull, rotate, and manipulate the fibroid, creating the necessary tension to dissect it away from the surrounding myometrium (the muscular uterine bed). **Analysis of Incorrect Options:** * **A. Myoma Morcellator:** This is used at the *end* of the procedure to cut the already detached fibroid into smaller pieces for removal through small laparoscopic ports. It is not used to extract the fibroid from the uterine bed itself. * **C. Myomectomy Clamp:** These are typically used in *open* (laparotomy) myomectomy to provide traction or to compress the uterine arteries to reduce blood loss (e.g., Bonney’s Myomectomy Clamp). * **D. Bonney’s Elevator:** This is a specialized instrument used to lift the uterus out of the pelvis during open surgery to improve access to the posterior wall; it is not used for fibroid extraction. **High-Yield Clinical Pearls for NEET-PG:** * **Vasopressin (Pitressin):** Often injected into the myometrium before incision to minimize intraoperative bleeding. * **Layered Closure:** The uterine defect must be closed in multiple layers to prevent hematoma formation and ensure uterine integrity for future pregnancies (reducing the risk of uterine rupture). * **Morcellation Caution:** Power morcellation is contraindicated if there is any suspicion of uterine malignancy (leiomyosarcoma) due to the risk of peritoneal seeding. Use of an "endobag" is now standard practice.

Question 382: Which one of the following is not a complication of cervical cone biopsy?

A. Bleeding
B. Cervical stenosis
C. Sepsis
D. Spread of the cancer (Correct Answer)

Explanation: **Explanation:** Cervical cone biopsy (conization) is both a diagnostic and a therapeutic procedure used to manage cervical intraepithelial neoplasia (CIN) and early-stage cervical cancer. **Why "Spread of the cancer" is the correct answer:** Cervical conization involves the surgical removal of a cone-shaped wedge of the cervix. Unlike some other biopsies (like fine-needle aspiration of certain malignant tumors), a cone biopsy does not cause the "seeding" or mechanical spread of cancer cells to adjacent tissues. In fact, conization is the definitive treatment for Stage IA1 microinvasive cervical carcinoma, as it aims to remove the entire lesion with clear margins. **Analysis of Incorrect Options:** * **Bleeding:** This is the **most common** acute complication. It can occur intraoperatively or as secondary hemorrhage (usually 7–14 days later) when the surgical scab or sutures slough off. * **Cervical Stenosis:** A common long-term complication where the cervical canal narrows due to scarring. This can lead to dysmenorrhea, hematometra, or difficulty in future obstetric procedures and cytological sampling. * **Sepsis:** As with any surgical procedure involving a non-sterile field like the vagina, postoperative infection (cervicitis or pelvic inflammatory disease) leading to sepsis is a recognized, though less common, risk. **High-Yield Clinical Pearls for NEET-PG:** * **Obstetric Complications:** Conization increases the risk of **cervical insufficiency** (leading to mid-trimester miscarriages) and **preterm pre-labor rupture of membranes (PPROM)** in future pregnancies. * **Indications:** Performed when there is a discrepancy between cytology and biopsy, an unsatisfactory colposcopy, or suspicion of microinvasion. * **Cold Knife vs. LEEP:** Cold knife conization provides the best margins for pathology but has a higher risk of bleeding compared to the Loop Electrosurgical Excision Procedure (LEEP).

Question 383: A 24-year-old woman with a history of heavy and painful menstrual periods has been having difficulty conceiving. A bimanual pelvic examination and ultrasound demonstrate a mass in the uterus presumed to be a leiomyoma. This mass is a:

A. benign tumor of mesenchymal tissue (Correct Answer)
B. benign tumor of surface epithelium
C. malignant tumor of epithelial tissue
D. malignant tumor of mesenchymal tissue

Explanation: **Explanation:** **Leiomyoma** (commonly known as uterine fibroids) is the most common benign tumor of the female reproductive tract. 1. **Why Option A is correct:** Leiomyomas originate from the **smooth muscle cells** of the myometrium. In embryology and pathology, muscle, bone, and connective tissues are classified as **mesenchymal tissue**. Since fibroids are non-cancerous growths of smooth muscle (myocytes) and fibroblasts, they are defined as **benign tumors of mesenchymal origin**. 2. **Why Option B is incorrect:** Tumors of the surface epithelium in the female pelvis typically refer to ovarian epithelial tumors (e.g., serous cystadenoma). The uterine lining (endometrium) is epithelial, but a mass arising from it would be a polyp or carcinoma, not a leiomyoma. 3. **Why Option C is incorrect:** Malignant epithelial tumors are called **carcinomas** (e.g., Endometrial Adenocarcinoma). Leiomyomas are benign. 4. **Why Option D is incorrect:** A malignant tumor of mesenchymal (smooth muscle) tissue is a **Leiomyosarcoma**. These are rare, usually occur in older postmenopausal women, and typically arise *de novo* rather than from a pre-existing leiomyoma. **Clinical Pearls for NEET-PG:** * **Estrogen Dependency:** Leiomyomas are sensitive to estrogen and progesterone; they often enlarge during pregnancy and shrink after menopause. * **Degenerations:** The most common degeneration is **Hyaline** (asymptomatic). **Red degeneration** (necrobiosis) occurs during pregnancy due to rapid growth and venous thrombosis, presenting with acute pain. * **Symptoms:** Most are asymptomatic, but the most common symptom is **Heavy Menstrual Bleeding (HMB)**, specifically associated with intramural and submucosal types. * **Infertility:** Submucosal fibroids are most likely to cause infertility by distorting the uterine cavity and interfering with implantation.

Question 384: Genital infection in females presenting with thick curdy or flaky discharge may be:

A. Candidiasis (Correct Answer)
B. Trichomoniasis
C. Syphilis
D. Gonorrhoea

Explanation: **Explanation:** The correct answer is **Candidiasis (A)**. **1. Why Candidiasis is correct:** Vulvovaginal Candidiasis (VVC), most commonly caused by *Candida albicans*, is characterized by a classic **"thick, curdy, white, or cottage-cheese-like"** discharge. This discharge is typically non-malodorous and adheres to the vaginal walls. The underlying pathophysiology involves an overgrowth of yeast, leading to intense vulvar pruritus (itching), erythema, and dyspareunia. **2. Why other options are incorrect:** * **Trichomoniasis (B):** Caused by *Trichomonas vaginalis*, it typically presents with a **profuse, frothy, yellowish-green, malodorous** discharge. A "strawberry cervix" (punctate hemorrhages) is a classic clinical sign. * **Syphilis (C):** Primary syphilis presents with a **painless chancre** (ulcer), not a specific vaginal discharge. Secondary syphilis presents with rashes and condyloma lata. * **Gonorrhoea (D):** Caused by *Neisseria gonorrhoeae*, it usually presents as an endocervicitis with a **mucopurulent (yellowish-white)** discharge, often accompanied by pelvic pain or dysuria. **3. High-Yield Clinical Pearls for NEET-PG:** * **pH Factor:** In Candidiasis, the vaginal pH is usually **normal (< 4.5)**, whereas in Trichomoniasis and Bacterial Vaginosis, the pH is **elevated (> 4.5)**. * **Diagnosis:** Look for **pseudohyphae** and spores on a KOH (Potassium Hydroxide) mount. * **Risk Factors:** Pregnancy, uncontrolled Diabetes Mellitus, and recent use of broad-spectrum antibiotics are common triggers for Candidiasis. * **Treatment:** The drug of choice is **Fluconazole** (150 mg single dose) or topical Clotrimazole.

Question 385: A female presented with thick white discharge and pruritus. What is the etiological agent?

A. Gardnerella
B. Trichomonas vaginalis
C. Candida (Correct Answer)
D. Gonococci

Explanation: ### Explanation The clinical presentation of **thick, white, curd-like (cottage cheese) discharge** associated with intense **vulvovaginal pruritus** (itching) is the classic hallmark of **Vulvovaginal Candidiasis**, most commonly caused by *Candida albicans*. #### Why Candida is Correct: * **Clinical Features:** The hallmark is pruritus and a non-foul-smelling, thick, adherent discharge. * **Diagnosis:** On microscopy (KOH mount), it shows pseudohyphae and budding yeast cells. The vaginal pH is typically **normal (<4.5)**. #### Why Other Options are Incorrect: * **Gardnerella vaginalis:** Causes **Bacterial Vaginosis**. It presents with a thin, homogenous, grayish-white discharge with a characteristic **fishy odor** (positive Whiff test). Pruritus is usually absent, and "Clue cells" are seen on microscopy. * **Trichomonas vaginalis:** Causes **Trichomoniasis**, a sexually transmitted infection. It presents with a **profuse, frothy, greenish-yellow** discharge and a "strawberry cervix" (punctate hemorrhages). * **Gonococci:** Causes **Gonorrhea**, primarily resulting in cervicitis or Pelvic Inflammatory Disease (PID). It presents with a purulent endocervical discharge rather than isolated thick white vaginal discharge. #### NEET-PG High-Yield Pearls: 1. **Risk Factors for Candida:** Diabetes mellitus, pregnancy, recent broad-spectrum antibiotic use, and immunosuppression. 2. **Treatment:** Drug of choice is **Fluconazole** (150 mg single oral dose) or topical Clotrimazole. 3. **pH Differentiation:** In Candidiasis, pH is <4.5. In both Trichomoniasis and Bacterial Vaginosis, pH is **>4.5**. 4. **Recurrent Candidiasis:** Defined as $\geq$4 episodes per year; requires long-term maintenance therapy with Fluconazole.

Question 386: Which of the following antibiotics is NOT recommended for the treatment of bacterial vaginosis according to CDC guidelines?

A. Clindamycin
B. Erythromycin (Correct Answer)
C. Metronidazole
D. Tinidazole

Explanation: **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacillus* species in the vagina with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Prevotella* spp., and *Mobiluncus* spp.). **Why Erythromycin is the correct answer:** According to the **CDC Sexually Transmitted Infections Treatment Guidelines**, Erythromycin is **not** recommended for the treatment of BV. While it is a macrolide antibiotic used for other reproductive tract infections (like *Chlamydia*), it lacks sufficient efficacy against the complex polymicrobial anaerobic flora responsible for BV. **Analysis of Incorrect Options:** * **Metronidazole (Option C):** This is the **gold standard** and first-line treatment. It can be administered orally (500 mg twice daily for 7 days) or as a 0.75% intravaginal gel. * **Clindamycin (Option A):** This is a recommended alternative or first-line agent, especially useful in patients allergic to metronidazole. It is available as a 2% intravaginal cream or oral capsules. * **Tinidazole (Option D):** This is a second-generation nitroimidazole approved by the CDC as an alternative oral regimen for BV, often preferred for its shorter course or better tolerability compared to metronidazole. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Uses **Amsel’s Criteria** (requires 3 out of 4): 1. Homogeneous white discharge; 2. Vaginal pH >4.5; 3. Positive Whiff test (amine odor with KOH); 4. **Clue cells** on microscopy (most specific). * **Gold Standard Diagnosis:** **Nugent Scoring** (Gram stain of vaginal secretions). * **Pregnancy:** Symptomatic pregnant women should be treated with Metronidazole or Clindamycin to reduce the risk of preterm labor and PPROM. * **Partner Treatment:** Routine treatment of the male sexual partner is **not** recommended as it does not prevent recurrence.

Question 387: All of the following are indications for a Pap smear except?

A. Age 20 years or older
B. Pregnant female
C. Sexually active female
D. Menorrhagia (Correct Answer)

Explanation: **Explanation:** The **Pap smear** is a screening tool used primarily for the early detection of cervical pre-cancer (Cervical Intraepithelial Neoplasia) and cervical cancer. It is not a diagnostic tool for abnormal uterine bleeding. **Why Menorrhagia is the Correct Answer:** Menorrhagia (heavy menstrual bleeding) is a symptom related to the uterine cavity, myometrium, or hormonal axis (e.g., fibroids, adenomyosis, or endometrial hyperplasia). The primary investigation for menorrhagia is a **Transvaginal Ultrasound (TVS)** or an **Endometrial Biopsy**, not a Pap smear, which only samples cells from the ectocervix and transformation zone. **Analysis of Other Options:** * **Age 20 years or older:** According to most guidelines (including ACOG and FOGSI), screening typically begins at age 21, regardless of sexual debut. Therefore, being in this age bracket is a standard indication. * **Pregnant female:** Pregnancy is not a contraindication for a Pap smear. If a woman is due for her routine screening, it can be safely performed during the first prenatal visit. * **Sexually active female:** Since Human Papillomavirus (HPV) is the primary causative agent for cervical cancer and is sexually transmitted, sexual activity is the most significant risk factor necessitating screening. **High-Yield Clinical Pearls for NEET-PG:** * **Screening Age:** Start at 21 years. (Note: Screening <21 is avoided as HPV infections in teens are usually transient). * **Frequency:** Age 21–29 (Cytology every 3 years); Age 30–65 (Co-testing with Cytology + HPV DNA every 5 years is preferred). * **Discontinuation:** At age 65 if previous screenings were consistently negative. * **Post-Hysterectomy:** If the uterus was removed for benign reasons and there is no history of CIN 2/3, Pap smears can be discontinued.

Question 388: A 40-year-old female presents with a clinically detected pelvic mass. Which of the following investigations should NOT be performed?

A. CT scan
B. Laparoscopy (Correct Answer)
C. Pap smear
D. Ultrasound (USG)

Explanation: **Explanation:** The primary goal in evaluating a clinically detected pelvic mass is to differentiate between benign and malignant pathology and determine the organ of origin using non-invasive methods first. **Why Laparoscopy is the correct answer (NOT performed):** Laparoscopy is an invasive surgical procedure. In the context of a suspected ovarian or pelvic malignancy, performing a laparoscopy (or any percutaneous biopsy) is contraindicated if there is a risk of rupturing a cystic mass. If the mass is malignant, rupture can lead to **"spillage" of malignant cells** into the peritoneal cavity, upstaging the cancer (e.g., from FIGO Stage IA to IC) and significantly worsening the prognosis. Therefore, it is not a primary investigation for a newly detected mass. **Analysis of Incorrect Options:** * **Ultrasound (USG):** This is the **investigation of choice (IOC)** and the first-line imaging modality. It helps determine the size, consistency (cystic/solid), and origin of the mass. * **CT Scan:** Useful for evaluating the extent of the disease, detecting lymphadenopathy, and checking for metastasis or involvement of other pelvic organs (e.g., omentum, bowel). * **Pap Smear:** A routine part of the workup for any pelvic mass to rule out cervical pathology as a primary or co-existing condition. **NEET-PG High-Yield Pearls:** * **First-line investigation for pelvic mass:** Transvaginal Ultrasound (TVUS). * **Gold Standard for staging ovarian cancer:** Exploratory Laparotomy (not laparoscopy). * **Tumor Marker:** CA-125 is the most common marker for epithelial ovarian tumors, but it is non-specific in premenopausal women. * **Rule of Thumb:** Never biopsy a suspected ovarian mass; always perform a formal staging laparotomy if malignancy is suspected to avoid upstaging the disease.

Question 389: All of the following are features of pseudocyesis except?

A. Enlargement of abdomen
B. Amenorrhoea
C. Enlargement of uterus
D. Nausea and vomiting (Correct Answer)

Explanation: **Explanation:** **Pseudocyesis** (False Pregnancy) is a rare psychosomatic disorder where a non-pregnant woman firmly believes she is pregnant and exhibits objective signs of pregnancy. This condition is often rooted in an intense desire for, or a morbid fear of, conception. **Why "Nausea and Vomiting" is the correct answer:** While pseudocyesis can mimic many pregnancy symptoms, **nausea and vomiting (morning sickness)** are typically **absent**. Morning sickness is primarily driven by the physiological rise of Human Chorionic Gonadotropin (hCG) secreted by the syncytiotrophoblast. Since there is no actual conception or trophoblastic tissue in pseudocyesis, hCG levels remain normal, and the biochemical trigger for emesis is missing. **Analysis of Incorrect Options:** * **Enlargement of abdomen:** This is a hallmark feature. It is usually caused by aerophagia (swallowing air), lumbar lordosis, or deposition of abdominal fat. Interestingly, the abdominal distension often disappears under general anesthesia. * **Amenorrhoea:** Menstrual irregularities or complete cessation of menses are common due to the suppression of the hypothalamic-pituitary-ovarian axis caused by psychological stress or altered hormonal feedback. * **Enlargement of uterus:** While the uterus does not reach the size of a true gravid uterus, a **slight enlargement** can occur due to pelvic congestion or the influence of persistent hormonal imbalances (like elevated prolactin or persistent luteal phase). **NEET-PG High-Yield Pearls:** * **Hormonal Profile:** Patients may show elevated levels of Prolactin and LH, but **hCG is always negative**. * **Differential Diagnosis:** Must be distinguished from **Delusion of Pregnancy**, which is a fixed false belief without the physical manifestations (seen in schizophrenia). * **Key Sign:** The "inverted umbilicus" is often maintained in pseudocyesis, unlike the everted umbilicus seen in true advanced pregnancy.

Question 390: Which of the following is NOT considered a risk factor for endometriosis?

A. Short menstrual cycle length
B. Early age of menarche
C. Prior use of Intrauterine Contraceptive Device (IUCD) (Correct Answer)
D. Nulliparity

Explanation: **Explanation:** Endometriosis is an estrogen-dependent inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. Its pathogenesis is most widely explained by **Sampson’s Theory of Retrograde Menstruation**. Therefore, any factor that increases the total number of menstrual cycles or the volume of menstrual outflow increases the risk. **Why Option C is the Correct Answer:** Prior use of an **Intrauterine Contraceptive Device (IUCD)** is not a risk factor for endometriosis. In fact, the Levonorgestrel-releasing Intrauterine System (LNG-IUS) is a primary medical treatment for endometriosis-associated pain as it induces endometrial atrophy and reduces menstrual flow. While IUCDs are associated with Pelvic Inflammatory Disease (PID), they do not promote the ectopic implantation of endometrial tissue. **Analysis of Incorrect Options (Risk Factors):** * **Short Menstrual Cycle Length (<27 days):** Frequent cycles mean more episodes of menstruation per year, increasing the cumulative exposure to retrograde flow. * **Early Age of Menarche:** Starting periods early increases the total lifetime duration of exposure to menstruation and estrogen. * **Nulliparity:** Pregnancy and lactation provide a "physiological break" from menstruation (amenorrhea). Nulliparous women lack this protective interruption, leading to uninterrupted cyclic menstruation. **NEET-PG High-Yield Pearls:** * **Protective Factors:** Multiparity, late menarche, extended breastfeeding, and regular exercise (>4 hours/week). * **Common Site:** The **ovary** is the most common site for endometriosis. * **Classic Triad:** Dysmenorrhea (congestive/pre-menstrual), Dyspareunia, and Infertility. * **Gold Standard Diagnosis:** Laparoscopy with biopsy ("Powder-burn" or "Gunshot" lesions).

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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