Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 31: What is the treatment of Asherman's syndrome?

A. Dilatation and Curettage (D&C)
B. Dilatation and Curettage (D&C) with IUCD insertion (Correct Answer)
C. Hysterectomy
D. Hysterotomy

Explanation: **Explanation:** **Asherman’s Syndrome** is characterized by the presence of intrauterine adhesions (synechiae), usually resulting from trauma to the basal layer of the endometrium (often following post-abortal or postpartum curettage). **Why Option B is Correct:** The primary goal of treatment is to break the adhesions and prevent them from reforming. 1. **Adhesiolysis:** While hysteroscopic adhesiolysis is the modern gold standard, **Dilatation and Curettage (D&C)** or blunt dissection is the traditional method used to break synechiae. 2. **Prevention of Recurrence:** After the adhesions are cleared, the raw endometrial surfaces are prone to sticking together again. An **IUCD (Intrauterine Contraceptive Device)**, typically a Lippes Loop, acts as a physical spacer to keep the uterine walls apart during the healing phase. This is often supplemented with high-dose estrogen therapy to promote endometrial regeneration. **Why Other Options are Incorrect:** * **Option A (D&C alone):** Performing D&C without a spacer (IUCD) or hormonal support carries a high risk of the denuded surfaces re-adhering, leading to treatment failure. * **Option C (Hysterectomy):** This is an invasive, terminal procedure. Since Asherman’s often affects women of reproductive age desiring fertility, hysterectomy is contraindicated unless there is associated life-threatening pathology. * **Option D (Hysterotomy):** Opening the uterus surgically is excessively invasive for an endoluminal pathology and increases the risk of uterine rupture in future pregnancies. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Hysteroscopy (also the gold standard for treatment via hysteroscopic adhesiolysis). * **Most Common Cause:** Vigorous curettage following a miscarriage or secondary postpartum hemorrhage (PPH). * **Clinical Triad:** Secondary amenorrhea/hypomenorrhea, infertility, and recurrent pregnancy loss. * **Hormonal Add-on:** Post-procedure, patients are often given **Estrogen (2.5 mg/day for 21 days)** followed by Progesterone to "re-epithelialize" the endometrium.

Question 32: Nabothian follicles occur in which of the following conditions?

A. Erosion of the cervix (Correct Answer)
B. Endometrial carcinoma
C. Cervical carcinoma
D. Vaginal carcinoma

Explanation: **Explanation:** **Nabothian follicles** (also known as Nabothian cysts) are retention cysts that occur on the cervix. They are a hallmark feature of a healing **cervical erosion** (cervical ectopy). **Why Option A is Correct:** Cervical erosion occurs when the columnar epithelium of the endocervix replaces the squamous epithelium of the ectocervix. During the process of healing (epidermization), the squamous epithelium regrows over the columnar epithelium. This squamous metaplasia can block the openings of the mucus-secreting endocervical glands (crypts). As mucus continues to be produced but cannot escape, the glands become distended, forming small, translucent, yellowish-white vesicles known as Nabothian follicles. **Why Other Options are Incorrect:** * **Options B, C, and D:** Endometrial, cervical, and vaginal carcinomas are malignant processes characterized by uncontrolled cellular proliferation, invasion, and neovascularization. While a Nabothian cyst may incidentally coexist with cervical cancer, it is a **benign** physiological result of metaplasia and healing, not a feature of malignancy or neoplastic transformation. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** They are found in the **Transformation Zone** of the cervix. * **Clinical Significance:** They are benign and usually asymptomatic, requiring no treatment unless they become very large or cause symptoms. * **Colposcopy:** On colposcopic examination, they appear as opaque, ivory-white or yellowish elevations with prominent overlying branching vessels. * **Key Association:** Always associate Nabothian follicles with **chronic cervicitis** and the **healing phase of cervical erosion**.

Question 33: Pelvic Inflammatory Disease occurs least commonly with which contraceptive method?

A. Oral Contraceptive Pills (OCPs)
B. Condom (Correct Answer)
C. Intrauterine Contraceptive Device (IUCD)
D. Diaphragm

Explanation: **Explanation:** The correct answer is **Condom (Option B)**. Pelvic Inflammatory Disease (PID) is primarily caused by the ascending spread of sexually transmitted infections (STIs), most commonly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*. Condoms act as a **mechanical barrier** that prevents the transmission of these pathogens from the male urethra to the female genital tract. By preventing the initial infection, condoms provide the highest level of protection against PID compared to all other contraceptive methods. **Analysis of Incorrect Options:** * **Oral Contraceptive Pills (OCPs):** While OCPs provide a degree of protection against PID by thickening cervical mucus (making it harder for bacteria to ascend) and reducing menstrual flow (less medium for bacterial growth), they do not prevent the acquisition of STIs. * **Intrauterine Contraceptive Device (IUCD):** Historically, IUCDs were associated with an increased risk of PID, particularly during the first 20 days post-insertion due to the introduction of vaginal flora into the uterus. They offer no protection against STIs. * **Diaphragm:** While it provides some barrier protection to the cervix, its efficacy in preventing STIs and subsequent PID is significantly lower than that of male condoms. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis for PID:** Laparoscopy (shows tubal edema and exudates). * **Most Common Cause:** *Chlamydia trachomatis* (often subclinical/silent). * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions). * **OCP Benefit:** OCPs reduce the *severity* of PID but not the *incidence* of lower genital tract infections.

Question 34: Upon hysteroscopy, which of the following cannot be visualized?

A. Tubal ostia
B. Cervix
C. Endometrium
D. Tubal patency (Correct Answer)

Explanation: **Explanation:** Hysteroscopy is a diagnostic and therapeutic procedure that involves the endoscopic visualization of the **intrauterine cavity** and the **endocervical canal**. **Why "Tubal Patency" is the correct answer:** While a hysteroscope can visualize the **tubal ostia** (the openings of the fallopian tubes into the uterus), it cannot see *inside* the tubes or confirm if they are open (patent) throughout their length. To assess tubal patency, additional procedures are required, such as **Chromopertubation** (injecting methylene blue dye during laparoscopy) or **Hysterosalpingography (HSG)** (using radiopaque dye under X-ray). **Analysis of Incorrect Options:** * **A. Tubal ostia:** These are the anatomical landmarks located at the uterine cornua. Visualizing both ostia is a key requirement for a complete diagnostic hysteroscopy. * **B. Cervix:** The procedure begins by inserting the hysteroscope through the vagina into the **endocervical canal**. The lining and structure of the cervix are clearly visible during entry and withdrawal. * **C. Endometrium:** The primary purpose of hysteroscopy is to inspect the endometrial lining for pathologies like polyps, fibroids, adhesions (Asherman syndrome), or hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Distension Media:** CO2 was historically used, but **Normal Saline** is now the gold standard for diagnostic and mechanical operative hysteroscopy. For electrosurgery (monopolar), non-electrolytic fluids like **Glycine 1.5%** are used. * **Gold Standard:** Hysteroscopy is the "Gold Standard" for diagnosing intrauterine pathology (e.g., submucous fibroids, septate uterus). * **Contraindications:** Active pelvic inflammatory disease (PID), profuse uterine bleeding, and known pregnancy.

Question 35: A middle-aged woman presents with a fishy-smelling vaginal discharge and 'clue cells' are observed on a wet preparation. What is the most likely diagnosis?

A. Bacterial vaginosis (Correct Answer)
B. Chlamydia trachomatis infection
C. Neisseria gonorrhoeae infection
D. Trichomoniasis

Explanation: **Explanation:** The clinical presentation of a fishy-smelling vaginal discharge combined with the presence of **clue cells** is pathognomonic for **Bacterial Vaginosis (BV)**. BV is not a true infection but a clinical syndrome characterized by a shift in vaginal flora, where the protective *Lactobacillus* species (which maintain an acidic pH) are replaced by anaerobes like *Gardnerella vaginalis*, *Mobiluncus*, and *Mycoplasma hominis*. **Why the other options are incorrect:** * **Chlamydia trachomatis & Neisseria gonorrhoeae:** These typically cause cervicitis rather than vaginitis. They often present with mucopurulent cervical discharge and friability, but do not show clue cells on microscopy. * **Trichomoniasis:** This is caused by a protozoan and presents with a "strawberry cervix" and a frothy, greenish-yellow discharge. Microscopy would reveal motile, flagellated trichomonads, not clue cells. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required for diagnosis):** 1. Homogeneous, thin, white-grey discharge. 2. Vaginal pH **> 4.5** (most sensitive). 3. **Whiff Test:** Positive (fishy odor on adding 10% KOH). 4. **Clue Cells:** Vaginal epithelial cells coated with bacteria, giving them a "stippled" or "shaggy" appearance (most specific). * **Nugent Scoring:** The gold standard for diagnosis (based on Gram stain). * **Treatment:** Oral or topical **Metronidazole** (500 mg BID for 7 days) is the drug of choice. Treatment of the male partner is **not** recommended. * **Complications:** In pregnancy, BV is associated with Preterm Labor (PTL) and Premature Rupture of Membranes (PROM).

Question 36: Which of the following fibroids are not suitable for uterine artery embolization?

A. Intramural fibroid
B. Subserosal fibroid
C. Cervical fibroid
D. Pedunculated submucous fibroid (Correct Answer)

Explanation: **Explanation:** Uterine Artery Embolization (UAE) is a minimally invasive procedure that involves injecting embolic agents into the uterine arteries to cause ischemic necrosis and shrinkage of fibroids. **Why Pedunculated Submucous Fibroids are Contraindicated:** Pedunculated submucous fibroids (FIGO Type 0) are considered a major contraindication for UAE. When these fibroids undergo necrosis following embolization, they tend to detach from the uterine wall and become "sloughed" into the uterine cavity. This leads to **vaginal expulsion of the necrotic mass**, which can cause severe cramping, foul-smelling discharge, secondary infection (pyometra), and potentially life-threatening sepsis. For these fibroids, **hysteroscopic myomectomy** is the gold standard treatment. **Analysis of Other Options:** * **Intramural (A) and Subserosal (B):** These are the most common types treated with UAE. Since they are embedded within or on the surface of the myometrium, they undergo "in-situ" shrinkage and hyaline degeneration without the risk of being expelled through the cervix. * **Cervical Fibroid (C):** While technically challenging, cervical fibroids are not an absolute contraindication for UAE, although surgical management is often preferred depending on the size and symptoms. **NEET-PG High-Yield Pearls:** * **Ideal Candidate for UAE:** Premenopausal women with symptomatic fibroids who wish to avoid major surgery and do not desire future pregnancy (as UAE may impact ovarian reserve or placental perfusion). * **Absolute Contraindications:** Pregnancy, active pelvic inflammatory disease (PID), and suspected uterine malignancy. * **Post-Embolization Syndrome:** The most common complication post-UAE, characterized by pain, low-grade fever, nausea, and malaise due to tissue ischemia.

Question 37: A hysteroscope procedure is performed for which of the following organs?

A. Vagina
B. Cervix
C. Fallopian tubes
D. Uterus (Correct Answer)

Explanation: **Explanation:** **Hysteroscopy** is a minimally invasive clinical procedure used to visualize the interior of the **uterus**. The term is derived from the Greek words *"hystera"* (uterus) and *"skopeo"* (to look). A thin, lighted telescope called a hysteroscope is inserted through the vagina and cervix into the uterine cavity. To provide a clear view, the cavity is distended using a medium (such as Normal Saline or CO2). **Analysis of Options:** * **Uterus (Correct):** The primary goal of hysteroscopy is to examine the endometrial cavity and the tubal ostia. It is the gold standard for diagnosing intrauterine pathologies like submucosal fibroids, endometrial polyps, and uterine synechiae (Asherman’s syndrome). * **Vagina:** Visualization of the vagina is called **colposcopy** (specifically the vaginal walls) or **vaginoscopy** (often done in pediatric cases using a hysteroscope to avoid hymenal injury). * **Cervix:** While the hysteroscope passes through the cervical canal, the specific procedure to examine the cervix under magnification for dysplasia is **colposcopy**. * **Fallopian tubes:** Direct visualization of the interior of the fallopian tubes is called **falloposcopy**. While the *opening* of the tubes (ostia) is seen during hysteroscopy, the scope does not enter the tubes themselves. **NEET-PG High-Yield Pearls:** * **Distension Media:** Normal Saline is preferred for diagnostic and bipolar operative hysteroscopy. Glycine (1.5%) is used for monopolar electrosurgery but carries a risk of **hyponatremia** (TURP syndrome). * **Timing:** The best time for diagnostic hysteroscopy is the **early proliferative phase** (Day 6–10), as the endometrium is thin, allowing better visualization. * **Contraindications:** Absolute contraindications include **active pelvic infection** and **known pregnancy**. Profuse uterine bleeding is a relative contraindication as it obscures the view.

Question 38: What is the treatment for genital warts in pregnancy?

A. Podophyllin
B. Salicylic acid and lactic acid
C. Cryotherapy (Correct Answer)
D. Imiquimod

Explanation: **Explanation:** The management of genital warts (Condyloma acuminata) during pregnancy focuses on using modalities that are non-teratogenic and do not pose systemic risks to the fetus. **Why Cryotherapy is Correct:** **Cryotherapy** (using liquid nitrogen) is considered a first-line treatment in pregnancy. It is a **physical ablation** method that works by thermal-induced tissue necrosis. Since it acts locally and does not involve systemic absorption of chemicals, it is safe for both the mother and the fetus. Other safe physical methods include Trichloroacetic acid (TCA 80-90%), surgical excision, and CO2 laser. **Why Other Options are Incorrect:** * **Podophyllin (Option A):** It is strictly **contraindicated** in pregnancy. It is a cytotoxic agent that can be systemically absorbed, leading to fetal death, preterm labor, and teratogenic effects. * **Salicylic acid and Lactic acid (Option B):** These are keratolytic agents typically used for common skin warts. They are generally avoided in the sensitive anogenital area and are not the standard of care for genital warts in pregnancy. * **Imiquimod (Option C):** This is an immune response modifier. While some guidelines suggest it may be used with caution, it is generally **avoided** in pregnancy due to a lack of high-quality safety data compared to physical ablation. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Caused by HPV types **6 and 11** (low risk). * **Mode of Delivery:** Genital warts are **not** an absolute indication for Cesarean section. C-section is only indicated if the warts are so large they obstruct the birth canal or if vaginal delivery would result in massive hemorrhage. * **Neonatal Risk:** The primary concern for the neonate is **Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP)**, though the risk is low and not significantly reduced by C-section.

Question 39: Females with vaginal atresia are characterized by all of the following except?

A. Lack of the lower portion of the vagina.
B. Normal external genitalia.
C. Normal pubertal maturation.
D. Becomes apparent in the first decade. (Correct Answer)

Explanation: **Explanation:** **Vaginal atresia** is a congenital anomaly resulting from the failure of the urogenital sinus to form the lower portion of the vagina. **Why Option D is the correct answer:** Vaginal atresia typically remains asymptomatic during childhood (the first decade). It becomes clinically apparent only after **menarche** (usually in the second decade), when menstrual blood accumulates in the upper vagina and uterus, leading to **hematocolpos** and **hematometra**. This presents as primary amenorrhea and cyclical pelvic pain. **Analysis of incorrect options:** * **Option A:** This is a defining feature. In vaginal atresia, the lower vagina is replaced by fibrous tissue, while the upper structures (derived from Müllerian ducts) are usually present. * **Option B:** The external genitalia (vulva, clitoris, and labia) develop from the genital tubercle and swellings, which are independent of the urogenital sinus canalization. Thus, they appear normal. * **Option C:** Since the ovaries are present and functional, the hypothalamic-pituitary-ovarian axis is intact. Consequently, secondary sexual characteristics and pubertal maturation proceed normally. **High-Yield Clinical Pearls for NEET-PG:** * **Vaginal Atresia vs. MRKH Syndrome:** In vaginal atresia, the uterus is present and functional. In **Müllerian Agenesis (MRKH)**, the uterus and upper 2/3 of the vagina are absent. * **Physical Exam:** A "dimple" may be seen at the perineum, but unlike an imperforate hymen, there is no bulging membrane at the introitus. * **Management:** Surgical reconstruction (vaginoplasty) is required to create a functional outflow tract.

Question 40: Minimum criteria to diagnose Pelvic Inflammatory Disease (PID) includes all except:

A. Lower abdominal pain
B. Adnexal tenderness
C. Cervical motion tenderness
D. Leucocytosis (Correct Answer)

Explanation: To diagnose Pelvic Inflammatory Disease (PID), clinicians rely on the **CDC (Centers for Disease Control and Prevention) diagnostic criteria**. Because the clinical presentation of PID can be vague and the consequences of missing the diagnosis (such as infertility or ectopic pregnancy) are severe, the diagnostic threshold is kept low. ### Why Leucocytosis is the Correct Answer **Leucocytosis (Option D)** is an **additional/minor criterion**, not a minimum requirement. While an elevated white blood cell count supports the diagnosis, its absence does not rule out PID. In fact, many patients with laparoscopically proven PID have a normal peripheral WBC count. ### Explanation of Minimum (Core) Criteria According to the CDC, empiric treatment for PID should be initiated in sexually active young women (or those at risk for STIs) if they experience pelvic or lower abdominal pain and no other cause is identified, provided **one or more** of the following **minimum clinical criteria** are present on bimanual examination: * **Lower abdominal pain (Option A):** The primary presenting symptom. * **Adnexal tenderness (Option B):** Indicates inflammation of the fallopian tubes or ovaries. * **Cervical motion tenderness (Option C):** Also known as "Chandelier sign," indicating peritoneal irritation when the cervix is moved. ### High-Yield Clinical Pearls for NEET-PG * **Most Specific Criteria:** Endometrial biopsy showing endometritis, transvaginal ultrasound/MRI showing thickened fluid-filled tubes, or laparoscopic findings (the **Gold Standard**). * **Additional Criteria:** Fever (>38.3°C), abnormal cervical/vaginal mucopurulent discharge, elevated ESR/CRP, and laboratory documentation of *N. gonorrhoeae* or *C. trachomatis*. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions). * **Treatment:** Usually involves a combination of Ceftriaxone (IM), Doxycycline (Oral), and Metronidazole (Oral).

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

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