Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 461: Scar endometriosis can occur following which surgical procedures?

A. Classical cesarean section
B. Hysterotomy
C. Episiotomy
D. All of the above (Correct Answer)

Explanation: **Explanation:** **Scar endometriosis** refers to the presence of endometrial tissue within a surgical scar. The underlying pathophysiology is the **iatrogenic transplantation** of viable endometrial cells into the incision site during surgery. When these cells are seeded into the wound, they respond to cyclical hormonal changes, leading to the classic presentation of a painful, palpable mass that swells and becomes tender during menstruation. * **Classical Cesarean Section:** Any C-section (Classical or LSCS) involves opening the uterine cavity. This allows endometrial cells to escape into the abdominal wall incision. It is the most common site for scar endometriosis. * **Hysterotomy:** This procedure involves an incision into the uterus (often for mid-trimester pregnancy termination or myomectomy). Similar to a C-section, it provides a direct pathway for endometrial cell seeding. * **Episiotomy:** During vaginal delivery, endometrial cells can be shed and implanted into the perineal repair site. While less common than abdominal scars, it is a well-documented site for the condition. **Clinical Pearls for NEET-PG:** * **Triad of Symptoms:** History of previous pelvic surgery, a palpable nodule near the scar, and **cyclical pain/swelling** (catamenial symptoms). * **Diagnosis:** Primarily clinical; however, **Fine Needle Aspiration Cytology (FNAC)** is the gold standard for confirmation, showing endometrial glands and stroma. * **Treatment of Choice:** Wide **surgical excision** with clear margins. Medical management (GnRH agonists or OCPs) provides only temporary relief and is generally ineffective for permanent cure. * **Differential Diagnosis:** Often misdiagnosed as an incisional hernia, suture granuloma, or desmoid tumor.

Question 462: In corpus luteum hematoma, where is the blood typically found?

A. Theca interna layer
B. Granulosa lutein layer
C. Cavity of the corpus luteum (Correct Answer)
D. All of the above

Explanation: **Explanation:** The **corpus luteum** is a temporary endocrine structure formed after ovulation. During the transformation of the collapsed follicle into the corpus luteum, there is an intense process of **neo-vascularization**. Capillaries from the theca interna layer invade the granulosa layer to provide nutrients for progesterone production. **Why Option C is correct:** A **corpus luteum hematoma** (or hemorrhagic corpus luteum) occurs when these fragile, newly formed thin-walled capillaries rupture. The resulting hemorrhage spills into the **central cystic cavity** of the corpus luteum. Because the corpus luteum is a closed structure, the blood is contained within this central space, often causing it to distend and become painful. **Why other options are incorrect:** * **Theca interna and Granulosa lutein layers (A & B):** While the bleeding originates from vessels in these layers, the blood does not typically pool within the cellular layers themselves. Instead, it follows the pressure gradient into the hollow central lumen (cavity). **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Typically presents as sudden-onset pelvic pain in the **luteal phase** (days 20–26 of the menstrual cycle). * **Ultrasonography (USG):** Characterized by a "complex cyst" with internal echoes (lace-like pattern or "spider-web" appearance) and a peripheral **"Ring of Fire"** on Doppler due to high vascularity. * **Complication:** If the hematoma ruptures into the peritoneal cavity, it can cause **hemoperitoneum**, mimicking the presentation of a ruptured ectopic pregnancy. * **Management:** Most cases are self-limiting and managed conservatively with analgesics unless hemodynamic instability occurs.

Question 463: Salpingitis / Endosalpingitis is best confirmed by:

A. Hysteroscopy and Laparoscopy (Correct Answer)
B. X-ray
C. Hysterosalpingography
D. Sonosalpingography

Explanation: **Explanation:** **Salpingitis** (inflammation of the fallopian tubes) and **Endosalpingitis** (inflammation of the tubal mucosa) are key components of Pelvic Inflammatory Disease (PID). **Why Option A is Correct:** **Laparoscopy** is considered the **gold standard** for diagnosing salpingitis. It allows for direct visualization of the fallopian tubes, where findings such as hyperaemia, edema of the tubal wall, and purulent exudate can be seen. **Hysteroscopy** complements this by allowing direct visualization of the uterine cavity and the tubal ostia to rule out concurrent endometritis or proximal tubal pathology. Together, they provide the most definitive evidence of active inflammation and structural changes. **Why Other Options are Incorrect:** * **B. X-ray:** Plain radiography has no role in diagnosing soft tissue inflammation like salpingitis. * **C. Hysterosalpingography (HSG):** HSG is used to assess tubal patency in infertility workups. It is **contraindicated** in acute salpingitis as the injection of contrast under pressure can disseminate the infection into the peritoneal cavity. * **D. Sonosalpingography:** While ultrasound can detect complications like a Tubo-ovarian abscess or "cogwheel sign" in chronic cases, it lacks the sensitivity and specificity of laparoscopy for confirming early or mild salpingitis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for PID:** Laparoscopy. * **Most common organism:** *Chlamydia trachomatis* (often subacute/silent) and *Neisseria gonorrhoeae* (acute). * **Fitz-Hugh-Curtis Syndrome:** A complication of salpingitis involving peri-hepatitis, characterized by "violin-string" adhesions between the liver capsule and the parietal peritoneum. * **Clinical Diagnosis:** Based on the CDC triad: Adnexal tenderness, Cervical motion tenderness (Chandelier sign), and Uterine tenderness.

Question 464: Frothy discharge with red ulceration in the vagina is seen with infection of:

A. Trichomoniasis (Correct Answer)
B. Moniliasis
C. Chlamydia
D. Bacterial vaginosis

Explanation: **Explanation:** The clinical presentation of **frothy discharge** and **red ulcerations** (punctate hemorrhages) is pathognomonic for **Trichomoniasis**, a common sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. 1. **Why Trichomoniasis is correct:** The discharge is typically profuse, malodorous, and greenish-yellow. The "frothy" nature is due to the gas produced by the organism. The "red ulcerations" refer to **Strawberry Cervix** (Colpitis Macularis), where the vaginal and cervical mucosa show punctate hemorrhages caused by the inflammatory response to the parasite. 2. **Why other options are incorrect:** * **Moniliasis (Candidiasis):** Characterized by a thick, white, "curd-like" or **cottage cheese** discharge. The underlying mucosa is usually erythematous but lacks the specific punctate hemorrhages of Trichomoniasis. * **Chlamydia:** Often asymptomatic or presents with mucopurulent cervicitis. It primarily affects the endocervix rather than causing generalized vaginal frothy discharge. * **Bacterial Vaginosis (BV):** Presents with a thin, homogenous, grayish-white discharge with a characteristic **fishy odor** (positive Whiff test). Crucially, BV is a non-inflammatory condition, so it does not cause redness or ulcerations. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** The gold standard is **Culture (Diamond’s medium)**, but the most common bedside test is **Wet Mount** showing motile pear-shaped flagellates. * **pH:** In Trichomoniasis, vaginal pH is typically **>4.5**. * **Treatment:** The drug of choice is **Metronidazole** (2g single dose or 400mg BD for 7 days). **Simultaneous treatment of the partner** is mandatory to prevent reinfection.

Question 465: Which is the most common uterine malformation seen in cases of recurrent abortions?

A. Mullerian fusion defects (Correct Answer)
B. Uterine syncytium
C. Unicornuate uterus
D. Uterine agenesis

Explanation: **Explanation:** **1. Why Mullerian Fusion Defects are Correct:** Mullerian duct anomalies (MDAs) are a significant cause of reproductive failure. Among these, **Mullerian fusion defects** (specifically **Septate** and **Bicornuate** uteri) are the most common malformations associated with recurrent pregnancy loss (RPL). * The **Septate uterus** (a failure of resorption) has the highest association with miscarriage (approx. 60% risk) because the septum is composed of fibroelastic tissue with poor vascularization, leading to defective implantation and placental insufficiency. * **Bicornuate and Didelphys uteri** (fusion defects) cause abortions primarily in the second trimester due to reduced intrauterine volume and cervical insufficiency. **2. Analysis of Incorrect Options:** * **B. Uterine syncytium:** This is a physiological term related to the placental structure (syncytiotrophoblast) or the arrangement of uterine muscle fibers; it is not a congenital malformation. * **C. Unicornuate uterus:** While associated with poor obstetric outcomes (preterm labor, ectopic pregnancy), it is a defect of **Mullerian agenesis/development** (one duct fails to form), not fusion. It is less common than fusion defects in the context of RPL. * **D. Uterine agenesis (Mayer-Rokitansky-Küster-Hauser syndrome):** This results in primary amenorrhea and absolute uterine factor infertility. Since pregnancy cannot occur, it is not a cause of recurrent abortion. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common MDA overall:** Septate Uterus (also most common cause of RPL). * **MDA with best obstetric outcome:** Arcuate Uterus (often considered a normal variant). * **Gold Standard Investigation for MDA:** Combined Laparoscopy and Hysteroscopy (to differentiate Septate from Bicornuate). * **Investigation of Choice (Non-invasive):** 3D Ultrasound or MRI. * **Treatment of choice for Septate Uterus:** Hysteroscopic Septal Resection.

Question 466: Clue cells are seen in which of the following conditions?

A. Gardnerella vaginitis (Correct Answer)
B. Trichomoniasis
C. Moniliasis
D. Pelvic inflammatory diseases

Explanation: **Explanation:** **Clue cells** are the pathognomonic hallmark of **Bacterial Vaginosis (BV)**, most commonly caused by *Gardnerella vaginalis*. These are vaginal epithelial cells that have acquired a "stippled" or "shaggy" appearance because they are heavily coated with coccobacilli. The bacteria obscure the sharp borders of the cell membrane, making the edges appear fuzzy under microscopic examination (Wet Mount). **Analysis of Options:** * **A. Gardnerella vaginitis (Correct):** BV is a polymicrobial syndrome resulting from a shift in vaginal flora (loss of *Lactobacilli* and overgrowth of anaerobes like *Gardnerella*). Clue cells are one of the four **Amsel Criteria** used for diagnosis. * **B. Trichomoniasis:** Caused by the protozoan *Trichomonas vaginalis*. Diagnosis is confirmed by seeing **pear-shaped, motile flagellates** on a wet mount. It typically presents with a "strawberry cervix." * **C. Moniliasis (Candidiasis):** Caused by *Candida albicans*. Microscopy reveals **pseudohyphae and spores** (budding yeast). It presents with a thick, curd-like discharge. * **D. Pelvic Inflammatory Disease (PID):** This is an upper genital tract infection. Diagnosis is clinical (cervical motion tenderness) or via ultrasound/laparoscopy; clue cells are not a diagnostic feature of PID itself. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required):** 1. Homogeneous, thin, white-grey discharge. 2. Vaginal pH **> 4.5**. 3. **Positive Whiff Test** (fishy odor on adding 10% KOH). 4. Presence of **Clue Cells** (>20% of epithelial cells). * **Nugent Scoring:** The "Gold Standard" for BV diagnosis (based on Gram stain morphotypes). * **Treatment of Choice:** Oral or topical **Metronidazole** (500 mg BD for 7 days). Note: Partner treatment is *not* routinely recommended for BV, unlike Trichomoniasis.

Question 467: Which of the following operations is NOT used for genital prolapse?

A. Fothergill's operation
B. Fenton's operation (Correct Answer)
C. Ward Mayo operation
D. Le Foe operation

Explanation: The correct answer is **B. Fenton’s operation**. ### **Explanation** **Fenton’s operation** is a reconstructive procedure (perineoplasty) used to treat **dyspareunia** caused by a narrow vaginal introitus or a scarred, tender perineum (often following a poorly healed episiotomy). It involves a longitudinal incision and transverse suturing to widen the vaginal opening. It has no role in correcting pelvic organ prolapse. ### **Analysis of Other Options** * **Fothergill’s operation (Manchester operation):** Used for **Uterovaginal (UV) prolapse** in women who wish to preserve their uterus. It involves cervical amputation, shortening of the Mackenrodt’s ligaments, and anterior colporrhaphy. * **Ward Mayo operation:** This is the eponym for **Vaginal Hysterectomy with Pelvic Floor Repair**. It is the gold standard treatment for 3rd or 4th-degree UV prolapse in post-menopausal women. * **Le Fort operation:** A type of **colpocleisis** (obliterative procedure) used for severe prolapse in elderly patients who are no longer sexually active and are medically unfit for major surgery. ### **High-Yield Clinical Pearls for NEET-PG** * **Shirodkar’s Sling:** Used for nulliparous prolapse (preserves fertility). * **Purandare’s Cervicopexy:** Uses the rectus sheath to support the cervix in cases of UV prolapse. * **Vault Prolapse:** Most common surgery is **Sacrocolpopexy** (abdominal) or **McCall’s Culdoplasty** (vaginal). * **Kelly’s Plication:** Specifically used for treating Stress Urinary Incontinence (SUI) during prolapse repair.

Question 468: Which organism commonly causes sterility in pelvic inflammatory disease?

A. Neisseria gonorrhoeae (Correct Answer)
B. Streptococcus species
C. Staphylococcus species
D. Haemophilus influenzae

Explanation: **Explanation:** Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper female genital tract. **Neisseria gonorrhoeae** and *Chlamydia trachomatis* are the most common primary pathogens. **Why Neisseria gonorrhoeae is the correct answer:** *N. gonorrhoeae* is highly virulent and causes intense inflammatory responses. It specifically targets the columnar epithelium of the fallopian tubes, leading to acute salpingitis. The resulting inflammatory exudate causes extensive endosalpingeal damage, leading to **tubal occlusion, fimbrial adhesion, and hydrosalpinx**. This structural damage to the tubes is the primary mechanism behind post-inflammatory sterility (infertility) and increased risk of ectopic pregnancy. **Why the other options are incorrect:** * **Streptococcus and Staphylococcus species:** While these can be part of the polymicrobial flora in PID (especially in cases related to post-abortal or puerperal sepsis), they are generally secondary invaders rather than the primary initiators of the tubal damage leading to classic PID-related sterility. * **Haemophilus influenzae:** This is a rare cause of PID, occasionally seen in respiratory-to-genital transmission, but it is not a "common" cause of sterility compared to the major STIs. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of PID:** *Chlamydia trachomatis* (often subclinical/silent). * **Most common cause of acute/symptomatic PID:** *Neisseria gonorrhoeae*. * **Fitz-Hugh-Curtis Syndrome:** Perihepatitis ("violin-string" adhesions) associated with PID, most commonly caused by Chlamydia. * **Gold Standard Diagnosis:** Laparoscopy (shows tubal erythema and edema). * **Infertility Risk:** The risk of sterility increases with each episode of PID (approx. 12% after one episode, 25% after two, and 50% after three).

Question 469: Acetic acid staining of the cervix shows the following findings, except:

A. Squamous dysplasia
B. Cervical carcinoma in situ
C. Cervical polyp (Correct Answer)
D. Cervical dysplasia

Explanation: **Explanation:** The use of **3-5% Acetic Acid** during colposcopy is a diagnostic technique used to identify abnormal cervical epithelium. The underlying principle is the **acetowhite reaction**: acetic acid causes reversible dehydration of cells and coagulation of nuclear proteins. **Why Cervical Polyp is the correct answer:** A cervical polyp is typically a benign growth arising from the endocervical mucosa. It is composed of vascularized stroma covered by columnar epithelium. Unlike dysplastic cells, polyps do not have a high nuclear-to-cytoplasmic (N/C) ratio or dense nuclear protein concentration. Therefore, they do not typically exhibit the characteristic opaque "acetowhite" change seen in premalignant or malignant lesions. **Analysis of incorrect options:** * **Squamous Dysplasia & Cervical Dysplasia (Options A & D):** These represent CIN (Cervical Intraepithelial Neoplasia). These cells have enlarged nuclei and increased DNA content. Acetic acid coagulates these proteins, preventing light from passing through to the vessels below, resulting in a distinct **acetowhite appearance**. * **Cervical Carcinoma in situ (Option B):** This is the most severe form of dysplasia. Due to the very high density of abnormal nuclei, these lesions turn rapidly and intensely white (dense acetowhite) and often take longer to fade. **NEET-PG High-Yield Pearls:** * **VIA (Visual Inspection with Acetic Acid):** A low-cost screening tool for cervical cancer in resource-limited settings. * **Acetowhite Appearance:** The intensity of the whiteness, the speed of appearance, and the borders (e.g., "geographic" vs. "sharp") help grade the severity of CIN. * **Schiller’s Test:** Uses **Lugol’s Iodine**. Normal cells (rich in glycogen) turn mahogany brown, while dysplastic cells (glycogen-deficient) remain **pale/yellow (Iodine negative)**. Remember: Acetic acid makes bad cells white; Iodine makes good cells brown.

Question 470: What are the symptoms of a retroverted uterus?

A. Dyspareunia
B. Backache
C. Dysmenorrhea and asymptomatic presentation
D. All of the above (Correct Answer)

Explanation: **Explanation:** A retroverted uterus is a common anatomical variation where the uterine fundus is tilted posteriorly toward the rectum instead of anteriorly over the bladder. It occurs in approximately 20–25% of healthy women. **Why "All of the above" is correct:** While most women with a retroverted uterus are **asymptomatic** (Option C), symptoms can arise if the retroversion is "fixed" due to underlying pathologies like endometriosis or pelvic inflammatory disease (PID). * **Dyspareunia (Option A):** Deep thrusting during intercourse can cause the penis to hit the retroverted fundus or ovaries (which often prolapse into the Pouch of Douglas), causing pain. * **Backache (Option B):** Chronic pelvic congestion or the stretching of uterosacral ligaments can manifest as a dull, sacral backache, especially during menstruation. * **Dysmenorrhea (Option C):** Congestion and difficulty in the drainage of menstrual blood through a sharply angled uterus can lead to painful periods. **Clinical Pearls for NEET-PG:** 1. **Mobile vs. Fixed:** A mobile retroverted uterus is usually a normal variant and asymptomatic. A **fixed retroverted uterus** is a classic sign of **Endometriosis** or chronic PID. 2. **Infertility:** Retroversion itself does not cause infertility, but the underlying cause (like adhesions) might. 3. **Pregnancy:** A retroverted uterus usually corrects itself (becomes anteverted) by the **12th week** of gestation. If it fails to do so, it may lead to **Uterine Incarceration**, causing acute urinary retention. 4. **Management:** Asymptomatic cases require no treatment. For symptomatic cases, the **Hodge Smith Pessary** can be used to maintain anteversion, or surgical **Plication of Uterosacral Ligaments** may be considered.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

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Pelvic Inflammatory Disease

Practice Questions

Vulvovaginitis

Practice Questions

Pelvic Organ Prolapse

Practice Questions

Vulvar Disorders

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Benign Breast Diseases

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