Gynecological Disorders Practice Questions

Q: Anterior colporrhaphy and colpoperineorraphy is known as:

Pelvic floor repair. **Explanation:** The correct answer is **Pelvic floor repair**. This term refers to a combination of surgical procedures aimed at correcting pelvic organ prolapse by strengthening the supportive tissues of the vagina. 1. **Why it is correct:** * **Anterior Colporrhaphy** involves plicating the pubocervical fascia to correct a cystocele (bladder prolapse). * **Colpoperineorrhaphy** involves repairing the rectovaginal fascia and the perineal body to correct a rectocele and a deficient perineum. Together, these procedures address defects in the anterior and posterior vaginal walls and the perineum, collectively known as a **Pelvic Floor Repair** (or "A&P Repair"). 2. **Analysis of Incorrect Options:** * **Ward-Mayo surgery:** This is a **Vaginal Hysterectomy** performed specifically for uterine prolapse. While often combined with pelvic floor repair, the name specifically refers to the removal of the uterus via the vaginal route. * **Shirodkar repair:** This is a type of **Cervical Encirclage** used to treat cervical incompetence during pregnancy to prevent mid-trimester miscarriage. * **Manchester repair (Fothergill’s surgery):** This involves cervical amputation, shortening of the Mackenrodt’s (cardinal) ligaments, and anterior colporrhaphy. It is indicated for uterine prolapse in women who wish to preserve their uterus. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Vault Prolapse:** Sacrocolpopexy (Abdominal/Laparoscopic). * **Le Fort’s Colpocleisis:** A "closing" procedure for prolapse in elderly patients who are no longer sexually active and are unfit for major surgery. * **Kelly’s Plication:** A specific step during anterior colporrhaphy used to treat stress urinary incontinence (SUI) by tightening the tissue at the bladder neck.

Q: What is the commonest presentation of hydatidiform mole?

Bleeding. **Explanation:** Hydatidiform mole (molar pregnancy) is a gestational trophoblastic disease characterized by the abnormal proliferation of trophoblastic tissue. **Why Bleeding is the Correct Answer:** Vaginal bleeding is the **most common clinical presentation**, occurring in approximately 85–95% of cases. It typically occurs in the first trimester (around 6–16 weeks). The bleeding results from the separation of the molar vesicles from the decidua. It is often described as "prune juice" discharge—a dark brown discharge caused by the liquefaction of intrauterine clots. **Analysis of Incorrect Options:** * **A. Hyperemesis gravidarum:** While common due to abnormally high levels of hCG, it occurs in only about 25–30% of patients. It is a classic sign but not the *most* common. * **C. Pre-eclampsia:** Development of hypertension and proteinuria in the first or early second trimester (before 20 weeks) is a diagnostic hallmark of molar pregnancy, but it occurs in only about 10–25% of cases. * **D. Choriocarcinoma:** This is a potential malignant sequela of a hydatidiform mole (seen in ~15–20% of complete moles), not a presenting symptom of the mole itself. **NEET-PG High-Yield Pearls:** * **Most common sign:** Vaginal bleeding. * **Most common symptom:** Nausea and vomiting (Hyperemesis). * **Uterine size:** In a complete mole, the uterus is often "larger than dates" (in ~50% of cases) and has a "doughy" feel. * **USG Gold Standard:** "Snowstorm appearance" (due to multiple hydropic villi). * **Theca Lutein Cysts:** Occur in 25–40% of cases due to high hCG levels; they usually regress after evacuation.

Q: Pseudo-Meigs syndrome is typically seen with which of the following conditions?

Fibroids. **Explanation:** **Pseudo-Meigs syndrome** is a clinical triad consisting of a benign pelvic mass (other than an ovarian fibroma), ascites, and pleural effusion. The correct answer is **Fibroids (Leiomyomas)**, specifically large subserous pedunculated fibroids, which are the most common cause of this syndrome. * **Why Fibroids are correct:** While the classic Meigs syndrome involves an ovarian fibroma, "Pseudo-Meigs" refers to the same clinical presentation (ascites + pleural effusion) caused by other pelvic masses. Large subserous fibroids can cause peritoneal irritation or lymphatic obstruction, leading to the accumulation of fluid in the peritoneal and pleural cavities. * **Why Ovarian fibroma is incorrect:** This is the defining feature of **Classic Meigs syndrome**, not Pseudo-Meigs. * **Why Adenomyosis and Endometriosis are incorrect:** These conditions typically present with dysmenorrhea, chronic pelvic pain, or infertility. They do not usually present as large, solid pelvic masses capable of inducing significant ascites or pleural effusion. **High-Yield Clinical Pearls for NEET-PG:** 1. **Meigs Syndrome Triad:** Benign Ovarian Fibroma + Ascites + Pleural Effusion (usually right-sided). 2. **Pseudo-Meigs Causes:** Uterine leiomyomas, ovarian teratomas, cystadenomas, or even pelvic malignancies. 3. **Pathophysiology:** The pleural effusion is usually **transudative** and occurs as fluid moves from the abdomen to the thorax via transdiaphragmatic lymphatics or small diaphragmatic defects (Bochdalek foramen). 4. **Management:** The hallmark of both syndromes is that the ascites and effusion **resolve completely** following the surgical removal of the primary pelvic mass.

Q: What is the most common presentation of an anterior wall cervical fibroid?

Urinary frequency. **Explanation:** Cervical fibroids are rare (1–2% of all uterine fibroids) but present with distinct symptoms based on their anatomical location. **Why Urinary Frequency is Correct:** The cervix is located in close proximity to the bladder anteriorly and the rectum posteriorly. An **anterior wall cervical fibroid** expands forward into the cellular space between the cervix and the bladder. As the fibroid grows, it exerts direct pressure on the posterior wall of the bladder, reducing its functional capacity and causing **urinary frequency** or urgency. If the fibroid is large enough to compress the urethra or the bladder neck, it may even lead to acute urinary retention. **Analysis of Incorrect Options:** * **Abdominal lump:** Cervical fibroids are usually "impacted" in the pelvis. While they can push the uterus upward (the "lantern on top of St. Paul’s" appearance), they rarely present as a primary abdominal lump unless they are exceptionally large. * **Per vaginal bleeding:** While common in intramural or submucosal uterine fibroids, cervical fibroids are more likely to cause pressure symptoms rather than heavy menstrual bleeding, unless they distort the uterine cavity or become pedunculated (cervical polyp). * **Constipation:** This is the characteristic presentation of a **posterior wall cervical fibroid**, which compresses the rectum. **NEET-PG High-Yield Pearls:** * **Anterior fibroid:** Urinary symptoms (Frequency/Retention). * **Posterior fibroid:** Rectal symptoms (Constipation/Tenesmus). * **Lateral fibroid:** Ureteric compression (Hydronephrosis) due to pressure on the ureter in the broad ligament. * **Central fibroid:** Expands the cervix uniformly; the uterus sits on top like a "lantern on St. Paul’s Cathedral." * **Surgical Note:** During surgery for cervical fibroids, the ureter is at high risk of injury because it is displaced from its normal course.

Q: The maturation index on vaginal cytology is a diagnostic method for evaluating:

Endocrine status of the vagina. **Explanation:** The **Maturation Index (MI)** is a clinical tool used in gynecological cytology to assess the **endocrine status** of a patient. It is based on the principle that the vaginal epithelium is highly sensitive to sex hormones, particularly estrogen and progesterone. **Why Option D is Correct:** The vaginal squamous epithelium consists of three layers: **parabasal, intermediate, and superficial cells**. The proportion of these cells reflects the hormonal environment: * **Estrogen** promotes maturation into **superficial cells** (large, flat cells with pyknotic nuclei). * **Progesterone** (and androgens) promotes maturation into **intermediate cells** (vesicular nuclei). * **Lack of hormones** (e.g., prepuberty or menopause) results in a predominance of **parabasal cells**. The MI is expressed as a ratio (e.g., 0/40/60), representing the percentage of Parabasal/Intermediate/Superficial cells. **Why Other Options are Incorrect:** * **Option A:** Cytotoxic drug therapy monitoring is usually done via bone marrow studies or blood counts, not vaginal cytology. * **Option B:** Fetal gender is determined by chromosomal analysis (Karyotyping) or ultrasound, not by the mother's vaginal cell maturation. * **Option C:** Malignant changes at the squamocolumnar junction are evaluated using a **Pap smear** (Bethesda system) and colposcopy, focusing on nuclear atypia rather than the maturation ratio. **High-Yield Clinical Pearls for NEET-PG:** * **Shift to the Left:** Predominance of parabasal cells (Atrophic/Prepubertal). * **Shift to the Right:** Predominance of superficial cells (High Estrogen/Ovulatory phase). * **Mid-zone Shift:** Predominance of intermediate cells (Pregnancy/Progesterone). * **Fern Test:** Another high-yield test for estrogen; "ferning" indicates high estrogen, while "beading" (cellular mucus) indicates progesterone.

Q: Which of the following drugs can reduce the size of uterine fibroids?

Estrogen. **Explanation:** **Note on the Question:** There appears to be a discrepancy in the provided key. In clinical practice and standard textbooks (Williams, Shaw’s), **Estrogen** is known to **increase** the size of uterine fibroids, as they are estrogen-dependent tumors. Drugs used to **reduce** the size of fibroids are those that create a hypoestrogenic state or block progesterone. **1. Why the Correct Answer (as per the key) is Estrogen:** Under standard medical logic, this option is technically **incorrect** for reducing size. However, if this is a "recall" question where Estrogen is marked correct, it may be a distractor or a typographical error in the source. In reality, **GnRH analogues, Danazol, and RU-486** are all established medical therapies to shrink fibroids. **2. Analysis of Other Options (The actual medical management):** * **GnRH Analogues (Option B):** These are the **gold standard** for medical shrinkage. They cause pituitary desensitization, leading to a profound hypoestrogenic state, reducing fibroid volume by 35–60% within 3 months. * **RU-486 (Mifepristone) (Option C):** As a Selective Progesterone Receptor Modulator (SPRM), it blocks progesterone, which is essential for fibroid growth. It effectively reduces size and controls bleeding. * **Danazol (Option A):** An androgenic steroid that creates a high-androgen, low-estrogen environment, leading to fibroid shrinkage and amenorrhea. **3. NEET-PG High-Yield Pearls:** * **Most common indication for surgery:** Menorrhagia (Heavy Menstrual Bleeding). * **Medical Management:** Primarily used pre-operatively to reduce size and increase hemoglobin levels. * **GnRH Analogue Limitation:** Size reduction is temporary; fibroids usually return to original size within 6 months of stopping therapy. * **Red Degeneration:** Most common in the 2nd trimester of pregnancy; managed conservatively with analgesics.

Question 1

A woman complains of an offensive fishy smelling yellowish discharge without pruritus. The pH of the discharge is >4.5. A Gram-stained vaginal smear shows a reduced number of lactobacilli with a large number of Gardnerella vaginalis. What is the best treatment option for this patient?

Accepted Answer

Metronidazole 500 mg twice daily for 7 days

Answer

Clindamycin 300 mg twice daily for 7 days

Answer

Metronidazole 2 gm as a single dose

Answer

Metronidazole vaginal gel once a day for 7 days

Question 2

Anterior colporrhaphy and colpoperineorraphy is known as:

Accepted Answer

Pelvic floor repair

Answer

Ward-Mayo surgery

Answer

Shirodkar repair

Answer

Manchester repair

Question 3

A broad ligament fibroid is most closely related to which structure?

Accepted Answer

Ureter

Answer

Ovaries

Answer

Fallopian tube

Answer

Gartner's duct

Question 4

Laparoscopic uterine nerve ablation (LUNA) is most commonly used in the treatment of:

Accepted Answer

Mild to moderate endometriotic lesions

Answer

Severe vasomotor symptoms of menopause

Answer

Conservative management of fibroids

Answer

Pain relief in ovarian cancer

Question 5

What is the commonest presentation of hydatidiform mole?

Accepted Answer

Bleeding

Answer

Hyperemesis gravidarum

Answer

Pre-eclampsia

Answer

Choriocarcinoma

Question 6

What is the investigation of choice for a bicornuate uterus?

Accepted Answer

Combined hysterolaparoscopy

Answer

Ultrasound (USG)

Answer

CT scan

Answer

Hystero-salpingography

Question 7

Pseudo-Meigs syndrome is typically seen with which of the following conditions?

Accepted Answer

Fibroids

Answer

Adenomyosis

Answer

Endometriosis

Answer

Ovarian fibroma

Question 8

What is the most common presentation of an anterior wall cervical fibroid?

Accepted Answer

Urinary frequency

Answer

Abdominal lump

Answer

Per vaginal bleeding

Answer

Constipation

Question 9

The maturation index on vaginal cytology is a diagnostic method for evaluating:

Accepted Answer

Endocrine status of the vagina

Answer

Adequacy of cytotoxic drug therapy

Answer

Gender of an anatomically abnormal child

Answer

Malignant change at the squamocolumnar junction of the cervix

Question 10

Which of the following drugs can reduce the size of uterine fibroids?

Accepted Answer

Estrogen

Answer

Danazol

Answer

GnRH analogue

Answer

RU-486

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?