Gynecological Disorders Practice Questions

Q: An 18-year-old girl who has not attained menarche presents with acute retention of urine. What is the most likely diagnosis?

Hematocolpos. ### Explanation The clinical presentation of an 18-year-old girl with **primary amenorrhea** and **acute urinary retention** is a classic "textbook" description of **Hematocolpos** secondary to an **imperforate hymen**. **Why Hematocolpos is the correct answer:** In an imperforate hymen, menstrual blood accumulates in the vagina (hematocolpos) cycle after cycle. As the volume increases, the distended vagina creates significant extrinsic pressure on the adjacent **urethra and bladder neck**. This mechanical obstruction leads to acute urinary retention. Patients typically present during puberty with cyclical pelvic pain and a bulging, bluish membrane at the introitus on physical examination. **Analysis of Incorrect Options:** * **Twisted Ovarian Cyst:** While this causes acute pelvic pain and potentially a palpable mass, it rarely causes urinary retention. It is more likely to present with nausea, vomiting, and signs of peritonitis. * **Urinary Tract Infection (UTI):** UTIs cause frequency, urgency, and dysuria. While severe cases can cause voiding dysfunction, they do not explain the primary amenorrhea in an 18-year-old. * **Cervical Fibroid:** Although a central fibroid can compress the urethra, fibroids are extremely rare in the adolescent population (typically seen in women of reproductive age, 30–50 years). **NEET-PG High-Yield Pearls:** * **Initial Investigation:** Physical examination (inspection of the vulva). * **Gold Standard Investigation:** Pelvic Ultrasound (shows a hypoechoic collection in the vagina/uterus). * **Treatment:** Cruciate incision or stellate incision of the hymen to drain the "tarry" chocolate-colored blood. * **Sequence of Accumulation:** Hematocolpos (vagina) → Hematometra (uterus) → Hematosalpinx (fallopian tubes).

Q: Which of the following is NOT a cause of acute abdomen in pregnancy?

Placenta previa. **Explanation:** The core concept in evaluating an acute abdomen in pregnancy is the presence of **pain**. An "acute abdomen" refers to a sudden, severe abdominal pain that may require urgent surgical or medical intervention. **Why Placenta Previa is the correct answer:** Placenta previa is classically characterized by **painless, causeless, and recurrent** vaginal bleeding in the second half of pregnancy. Because the bleeding occurs from the separation of the placenta from the lower uterine segment without uterine contractions or concealed hemorrhage, it does not typically cause abdominal pain or peritoneal irritation. Therefore, it is not a cause of acute abdomen. **Analysis of incorrect options:** * **Abortion:** Threatened or inevitable abortions are associated with uterine contractions and cervical dilation, leading to significant pelvic pain and cramping. * **Preterm Labor:** This involves regular, painful uterine contractions leading to cervical changes before 37 weeks, presenting as acute abdominal/pelvic pain. * **Appendicitis:** This is the most common non-obstetric surgical emergency during pregnancy. It presents with acute right-sided abdominal pain (though the location may shift upward as the uterus grows). **NEET-PG High-Yield Pearls:** * **Abruptio Placentae vs. Placenta Previa:** Abruption is **painful** (due to retroplacental hematoma and uterine hypertonicity), whereas Previa is **painless**. * **Diagnosis:** Transvaginal Ultrasound (TVS) is the gold standard for diagnosing Placenta Previa. **Digital vaginal examination is strictly contraindicated** (the "Double Setup" rule) until previa is ruled out, as it can provoke torrential hemorrhage. * **Most common cause of acute abdomen in pregnancy:** Appendicitis. * **Most common obstetric cause of acute abdomen:** Ectopic pregnancy (1st trimester) or Abruptio placentae (3rd trimester).

Q: "Strawberry cervix" is a feature of which of the following conditions?

Trichomonas vaginitis. **Explanation:** **Trichomonas vaginitis** is the correct answer. The term **"Strawberry Cervix" (Colpitis Macularis)** refers to the presence of punctate, focal hemorrhages on the ectocervix and vaginal walls. These are caused by the protozoan *Trichomonas vaginalis*, which induces a localized inflammatory response and capillary dilation. While classic, this sign is clinically visible in only about 2–5% of cases but is highly specific for the infection. **Analysis of Incorrect Options:** * **Vaginal Candidiasis:** Characterized by a thick, "curd-like" or "cottage cheese" discharge and intense pruritus. The cervix usually appears normal or mildly erythematous, but not punctate. * **HSV Infection:** Typically presents with painful, shallow, multiple grouped vesicles or ulcers on the vulva or cervix. * **Bacterial Vaginosis (BV):** Caused by an overgrowth of *Gardnerella vaginalis*. It presents with a thin, homogenous, greyish-white "fishy-smelling" discharge. The cervix typically shows no signs of inflammation. **High-Yield Clinical Pearls for NEET-PG:** * **Discharge Profile:** Trichomoniasis features a **profuse, frothy, greenish-yellow** discharge with a pH > 4.5. * **Diagnosis:** The gold standard is **NAAT**, but the most common bedside test is **Wet Mount microscopy**, showing "pear-shaped" motile flagellates (jerky motility). * **Treatment:** The drug of choice is **Metronidazole** (2g single dose). **Crucial:** Always treat the partner to prevent "ping-pong" reinfection. * **Whiff Test:** Positive in both BV and Trichomoniasis (addition of 10% KOH releases amine odor).

Q: What is the key difference between ectopic pregnancy and threatened abortion?

Uterine size corresponds to gestational age. In the context of early pregnancy complications, differentiating between ectopic pregnancy and threatened abortion is a high-yield clinical skill for NEET-PG. **Explanation of the Correct Answer:** In a **threatened abortion**, the pregnancy is intrauterine. Therefore, the **uterine size corresponds to the period of amenorrhea (gestational age)**. In contrast, in an **ectopic pregnancy**, the uterus is typically **smaller** than the period of amenorrhea because the gestational sac is located extra-uterinely (most commonly in the fallopian tube), and the uterus only undergoes minor decidual changes. **Analysis of Incorrect Options:** * **A. Presence of minimal vaginal bleeding:** Both conditions present with spotting or minimal bleeding. In ectopic pregnancy, bleeding is usually dark brown and scanty; in threatened abortion, it is fresh and bright red. * **B. Pain typically follows bleeding:** This is a classic feature of **threatened abortion** (Bleeding → Pain). In **ectopic pregnancy**, the sequence is reversed: **Pain precedes bleeding** (Pain → Bleeding). * **D. Manifests at an early gestational age:** Both conditions typically manifest in the first trimester (6–10 weeks), making this a poor differentiating factor. **NEET-PG High-Yield Pearls:** * **The Classic Triad of Ectopic Pregnancy:** Amenorrhea, abdominal pain, and vaginal bleeding. * **Arias-Stella Reaction:** Hypersecretory endometrium seen on histology in ectopic pregnancy (not pathognomonic, but highly suggestive). * **Discriminatory Zone:** If Serum β-hCG is >1500–2000 mIU/mL and the gestational sac is not visible on Transvaginal Ultrasound (TVS), suspect ectopic pregnancy. * **Cervical Os:** In both threatened abortion and ectopic pregnancy, the internal os remains **closed**.

Q: Which one of the following is NOT a feature of Turner's syndrome?

Mental retardation. **Explanation:** **Turner’s Syndrome (45, XO)** is the most common sex chromosome abnormality in females, characterized by the absence of one X chromosome. 1. **Why "Mental Retardation" is the correct answer:** Most individuals with Turner’s syndrome have **normal intelligence**. While they may occasionally face specific learning disabilities (such as difficulties with visuospatial organization or mathematics), generalized intellectual disability (mental retardation) is **not** a characteristic feature. If a patient with Turner-like features presents with significant mental retardation, a different diagnosis or a more complex chromosomal mosaicism should be suspected. 2. **Analysis of Incorrect Options:** * **Short Stature (A):** This is the most consistent clinical finding (seen in >95% of cases) due to the loss of the *SHOX* gene on the X chromosome. * **Coarctation of Aorta (C):** This is the most common specific cardiac anomaly associated with Turner’s syndrome (occurring in about 15-20% of cases), followed by bicuspid aortic valve. * **Lymphedema (D):** Congenital lymphedema of the hands and feet is a classic neonatal sign caused by lymphatic hypoplasia. This often leads to the characteristic "webbed neck" (cystic hygroma) seen later in life. **High-Yield Clinical Pearls for NEET-PG:** * **Karyotype:** 45, XO is the most common, but 45, XO/46, XX mosaicism is also frequent. * **Gonads:** "Streak ovaries" lead to hypergonadotropic hypogonadism (high FSH/LH, low Estrogen) and primary amenorrhea. * **Renal:** Horseshoe kidney is the most common renal anomaly. * **Dermatology:** Multiple pigmented nevi are common. * **Treatment:** Growth hormone for height; Estrogen/Progesterone for secondary sexual characteristics and bone health.

Q: In Turner syndrome, which of the following clinical features is NOT typically seen?

Tall stature. **Explanation:** Turner Syndrome (45,XO) is the most common sex chromosome abnormality in females, characterized by the complete or partial absence of one X chromosome. **Why "Tall Stature" is the correct answer:** The hallmark clinical feature of Turner syndrome is **short stature**, not tall stature. This is primarily due to the haploinsufficiency of the **SHOX gene** (Short Stature Homeobox gene) located on the distal end of the X chromosome. Without two functional copies of this gene, longitudinal bone growth is severely impaired, leading to an average untreated adult height of approximately 143 cm. **Analysis of other options:** * **Webbed neck (Pterygium colli):** This is a classic phenotypic feature caused by lymphatic obstruction (cystic hygroma) during fetal development. * **Widening of long bones:** Patients often exhibit skeletal abnormalities such as a widened metaphysis of the long bones (especially the tibia), a short fourth metacarpal (Archibald’s sign), and cubitus valgus. * **XO inheritance:** While most cases are sporadic due to nondisjunction, 45,XO is the classic karyotype associated with the syndrome. **NEET-PG High-Yield Pearls:** * **Most common cause of primary amenorrhea:** Turner Syndrome (due to streak ovaries/gonadal dysgenesis). * **Cardiac association:** Bicuspid aortic valve (most common) and Coarctation of the aorta. * **Renal association:** Horseshoe kidney. * **Hormonal profile:** Hypergonadotropic hypogonadism (High FSH/LH, Low Estrogen). * **Treatment:** Growth Hormone (for height) and Estrogen/Progesterone (for secondary sexual characteristics and bone health).

Question 1

What is the treatment of choice in a multiparous female with 2nd-degree uterovaginal prolapse?

Accepted Answer

Fothergill's operation with tubal ligation

Answer

Fothergill's operation

Answer

Hysterectomy with pelvic floor repair

Answer

Hysterectomy only

Question 2

Which of the following is the drug of choice to treat endometriosis?

Accepted Answer

Medroxy progesterone

Answer

Testosterone propionate

Answer

Norethisterone

Answer

Danazol

Question 3

An 18-year-old girl who has not attained menarche presents with acute retention of urine. What is the most likely diagnosis?

Accepted Answer

Hematocolpos

Answer

Twisted ovarian cyst

Answer

Urinary tract infection

Answer

Cervical fibroid

Question 4

Which of the following is NOT a cause of acute abdomen in pregnancy?

Accepted Answer

Placenta previa

Answer

Abortion

Answer

Preterm labor

Answer

Appendicitis

Question 5

"Strawberry cervix" is a feature of which of the following conditions?

Accepted Answer

Trichomonas vaginitis

Answer

Vaginal candidiasis

Answer

HSV infection

Answer

Bacterial vaginosis

Question 6

What is the position used for bimanual examination in the out-patient department?

Accepted Answer

Dorsal position with thighs flexed

Answer

Lithotomy position

Answer

Sims position

Answer

Supine position

Question 7

What is the key difference between ectopic pregnancy and threatened abortion?

Accepted Answer

Uterine size corresponds to gestational age

Answer

Presence of minimal vaginal bleeding

Answer

Pain typically follows bleeding

Answer

Manifests at an early gestational age

Question 8

Which one of the following is NOT a feature of Turner's syndrome?

Accepted Answer

Mental retardation

Answer

Short stature

Answer

Coarctation of aorta

Answer

Lymphedema

Question 9

In Turner syndrome, which of the following clinical features is NOT typically seen?

Accepted Answer

Tall stature

Answer

Webbed neck

Answer

Widening of long bones of the leg

Answer

XO inheritance

Question 10

What does the karyopyknotic index represent?

Accepted Answer

Ratio of mature squamous cells to intermediate and basal cells.

Answer

Ratio of dysplastic squamous cells to normal squamous cells.

Answer

Ratio of Koilocytes to normal squamous cells.

Answer

Ratio of immature basal cells to the total number of cells.

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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