Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 481: All of the following are true about syphilis except?

A. A seropositive infant will not be treated at birth if the mother received penicillin in the 3rd trimester. (Correct Answer)
B. For neurosyphilis, FTA-ABS is sensitive, and VDRL is diagnostic, but CSF pleocytosis is the best guide for treatment response.
C. HIV patients are less likely to become VDRL nonreactive after treatment.
D. EIA positive and RPR positive indicate past or current infection.

Explanation: **Explanation** **1. Why Option A is the Correct Answer (The "Except" Statement):** In congenital syphilis management, maternal treatment in the 3rd trimester is often considered "inadequate" if it occurs within **30 days of delivery**. Even if the mother received Penicillin, a seropositive infant must be evaluated and treated if: * Maternal treatment was incomplete, undocumented, or not with Penicillin G. * Treatment was administered <4 weeks before delivery. * The infant’s RPR titer is fourfold higher than the mother’s. Therefore, the statement that an infant will *not* be treated simply because the mother received Penicillin in the 3rd trimester is false. **2. Analysis of Other Options:** * **Option B:** In Neurosyphilis, **CSF-VDRL** is highly specific (diagnostic) but lacks sensitivity. **FTA-ABS** is highly sensitive; a negative result helps rule out neurosyphilis. **CSF pleocytosis** (elevated WBC) is the most sensitive indicator of active disease and the most reliable marker for monitoring treatment efficacy. * **Option C:** HIV-infected patients often show an atypical serological response. They may have higher baseline titers and are significantly more likely to experience "serofast" states (failure of VDRL to become nonreactive) despite adequate therapy. * **Option D:** This describes the "Reverse Screening" algorithm. An **EIA/CIA** (Treponemal test) detects antibodies for life. If the **RPR** (Non-treponemal test) is also positive, it confirms an active or recently treated infection. **Clinical Pearls for NEET-PG:** * **Drug of Choice:** Penicillin G is the only recommended treatment for syphilis during pregnancy. If the mother is allergic, she must be **desensitized** and treated with Penicillin. * **Jarisch-Herxheimer Reaction:** An acute febrile response within 24 hours of treatment; in pregnancy, it can trigger preterm labor or fetal distress. * **Hutchinson’s Triad:** Interstitial keratitis, sensorineural hearing loss, and notched incisors (late congenital syphilis).

Question 482: A female patient presents with a reddish vagina and greenish vaginal discharge. What is the most probable diagnosis?

A. Herpes infection
B. Trichomonas vaginitis (Correct Answer)
C. Gonococcal infection
D. Candidiasis

Explanation: **Explanation:** The clinical presentation of a **reddish vagina** (erythema/inflammation) and **greenish vaginal discharge** is a classic hallmark of **Trichomonas vaginitis**, a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. 1. **Why Trichomonas vaginitis is correct:** The discharge in Trichomoniasis is typically profuse, **frothy (bubbly)**, and **yellow-green** in color. The "reddish vagina" refers to intense vaginal and cervical inflammation. A high-yield finding often associated with this is the **"Strawberry Cervix"** (punctate hemorrhages on the ectocervix). The vaginal pH is usually elevated (>4.5). 2. **Why other options are incorrect:** * **Herpes infection:** Presents with painful, fluid-filled vesicles or shallow ulcers and systemic symptoms (fever, malaise), rather than a characteristic greenish discharge. * **Gonococcal infection:** Primarily causes cervicitis. While it can cause a purulent discharge, it is typically associated with endocervical mucopurulent discharge and pelvic inflammatory disease (PID) symptoms. * **Candidiasis:** Characterized by intense pruritus and a thick, white, **"curdy" or "cottage-cheese"** like discharge. The vaginal mucosa may be red, but the discharge color is distinctively white, and the pH is usually normal (<4.5). **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 microscopy**, showing **motile pear-shaped flagellates**. * **Treatment:** The drug of choice is **Metronidazole** (2g single dose or 500mg BD for 7 days). * **Crucial Step:** Always **treat the partner** simultaneously to prevent ping-pong reinfection, as it is an STI.

Question 483: Which theory best explains Endometriosis?

A. Sampson's Implantation theory
B. Metastatic epithelium
C. Histogenesis by induction
D. All of the above (Correct Answer)

Explanation: Endometriosis is a complex, multifactorial disease where endometrial-like tissue grows outside the uterus. Because no single theory explains all clinical presentations (e.g., pelvic vs. distant sites like the lung), a combination of theories is accepted. **Explanation of Options:** * **Sampson’s Implantation Theory (Retrograde Menstruation):** This is the most widely accepted theory for **pelvic endometriosis**. It suggests that menstrual blood containing viable endometrial cells flows backward through the fallopian tubes and implants on peritoneal surfaces. * **Metastatic Epithelium (Lymphatic/Vascular Spread):** Proposed by Halban, this theory explains **extra-pelvic endometriosis** (e.g., in the lungs, brain, or lymph nodes) where retrograde menstruation cannot reach. Endometrial cells are transported via blood vessels or lymphatics. * **Histogenesis by Induction (Meyer’s Coelomic Metaplasia):** This theory suggests that the coelomic epithelium (the common precursor of endometrium and peritoneum) undergoes metaplastic transformation into endometrial tissue due to hormonal or inflammatory stimuli. This explains endometriosis in patients with **Müllerian agenesis** or in rare male cases. **Conclusion:** Since all three mechanisms contribute to the diverse manifestations of the disease, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ovary (often presenting as a "Chocolate Cyst" or Endometrioma). * **Most common symptom:** Secondary Dysmenorrhea (characteristically starts before menses). * **Gold Standard Diagnosis:** Laparoscopy with biopsy (Visualizes "powder-burn" or "gunshot" lesions). * **Powder-puff/Gunshot lesions:** Classic laparoscopic appearance of peritoneal endometriosis.

Question 484: The pH of the normal vagina is the lowest during which of the following phases?

A. Menstruation
B. Pregnancy (Correct Answer)
C. Puerperium
D. Infancy

Explanation: **Explanation:** The acidity of the vaginal environment is primarily determined by the presence of **Döderlein’s bacilli** (Lactobacilli), which convert glycogen from the vaginal epithelium into **lactic acid**. **Why Pregnancy is the correct answer:** During pregnancy, there is a significant increase in estrogen levels. Estrogen promotes the thickening of the vaginal epithelium and the deposition of high amounts of **glycogen**. This abundance of substrate allows Lactobacilli to produce maximal amounts of lactic acid, causing the vaginal pH to drop to its lowest levels (typically between **3.5 and 4.5**). This acidic environment serves as a protective mechanism against ascending infections. **Analysis of Incorrect Options:** * **Menstruation:** During menses, the presence of alkaline blood and the shedding of the epithelium raise the pH toward neutral or alkaline levels (approx. 7.0), increasing the risk of infections. * **Puerperium:** Following delivery, estrogen levels drop sharply and the presence of lochia (alkaline) raises the vaginal pH. * **Infancy:** In infants (after the initial influence of maternal estrogen fades) and prepubertal girls, the vaginal epithelium is thin and lacks glycogen. The pH is typically neutral or alkaline (around 7.0). **High-Yield Clinical Pearls for NEET-PG:** * **Normal Vaginal pH:** 3.8 to 4.5 (reproductive age). * **Bacterial Vaginosis:** pH > 4.5 (Key diagnostic feature in Amsel's criteria). * **Trichomoniasis:** pH > 4.5 to 5. * **Vulvovaginal Candidiasis:** pH is typically **normal** (< 4.5). * **Atrophic Vaginitis:** pH > 6.0 due to estrogen deficiency.

Question 485: A negative pregnancy test excludes the diagnosis of which type of abortion?

A. Threatened abortion (Correct Answer)
B. Ectopic pregnancy
C. Both
D. None

Explanation: ### Explanation **1. Why Threatened Abortion is the Correct Answer:** A **threatened abortion** is clinically defined as vaginal bleeding occurring in the presence of a **viable** intrauterine pregnancy before 20 weeks of gestation. For a pregnancy to be viable and ongoing, the trophoblastic tissue must be actively producing Human Chorionic Gonadotropin (hCG). Therefore, a **positive pregnancy test is a prerequisite** for the diagnosis. If the pregnancy test is negative, it implies there is no living trophoblastic tissue or active pregnancy, thereby excluding a "threatened" state. **2. Why the Other Options are Incorrect:** * **Ectopic Pregnancy:** While a pregnancy test is usually positive in ectopic pregnancies, it can occasionally be **false-negative** (especially with low-sensitivity urine tests) if the hCG levels are very low (e.g., in a chronic or ruptured ectopic pregnancy where trophoblastic activity has ceased). Thus, a negative test does not 100% exclude an ectopic pregnancy in a clinical emergency. * **Complete Abortion:** Though not an option here, it is important to note that in a complete abortion, the pregnancy test may remain positive for several days to weeks until hCG is cleared from the system. **3. NEET-PG High-Yield Pearls:** * **Definition:** In threatened abortion, the internal os remains **closed**, and fetal heart sound (FHS) is present on ultrasound. * **hCG Sensitivity:** Modern Urine Pregnancy Tests (UPT) can detect hCG levels as low as 20–25 mIU/ml. * **Management:** The mainstay of treatment for threatened abortion is **bed rest** and occasionally progestogens; however, 50% of these cases may progress to inevitable abortion. * **Rule of Thumb:** Any woman of reproductive age with amenorrhea and abdominal pain must be evaluated for pregnancy. If the test is negative but clinical suspicion is high for ectopic pregnancy, a **Serum β-hCG** (more sensitive) and Transvaginal Scan (TVS) are mandatory.

Question 486: Which of the following is a management option for unruptured tubal pregnancy?

A. Methotrexate (Correct Answer)
B. Prostaglandins
C. Hysterectomy
D. Laparoscopic salpingostomy

Explanation: **Explanation:** The management of unruptured tubal pregnancy is categorized into medical and surgical interventions. **Methotrexate (Option A)** is the primary medical management option. It is a folic acid antagonist that inhibits dihydrofolate reductase, thereby arresting DNA synthesis and cell proliferation in the rapidly dividing trophoblastic tissue. **Why the other options are incorrect:** * **Prostaglandins (Option B):** While historically researched for local injection into the gestational sac, they are not a standard or first-line management option due to lower efficacy and higher side effects compared to Methotrexate. * **Hysterectomy (Option C):** This is an overly invasive procedure involving the removal of the uterus. It is never indicated for a tubal pregnancy unless there are concurrent uterine pathologies or life-threatening hemorrhage that cannot be controlled otherwise. * **Laparoscopic Salpingostomy (Option D):** While this is a valid surgical treatment for unruptured ectopic pregnancy, the question asks for "a" management option, and in many standardized exams, Methotrexate is prioritized as the hallmark "medical" management for stable, unruptured cases. *(Note: If this were a "Multiple Select" context, D would also be correct, but Methotrexate is the classic pharmacological answer).* **High-Yield NEET-PG Pearls:** 1. **Selection Criteria for Methotrexate:** Hemodynamically stable, hCG <5000 mIU/mL, no fetal cardiac activity, and tubal mass <3.5–4 cm. 2. **Contraindications:** Breastfeeding, immunodeficiency, or hepatic/renal/pulmonary disease. 3. **Surgical Gold Standard:** Laparoscopic Salpingectomy is preferred if the contralateral tube is healthy; Salpingostomy is preferred if the other tube is damaged/absent to preserve fertility. 4. **Ruptured Ectopic:** Always requires immediate laparotomy/laparoscopy (Salpingectomy).

Question 487: What is the best treatment for endometriosis in a young girl?

A. Oestrogen
B. Gonadotropins
C. Surgery
D. Danazol (Correct Answer)

Explanation: **Explanation:** The primary goal in treating endometriosis is to induce a state of **"pseudomenopause"** or **"pseudopregnancy"** to cause atrophy of the ectopic endometrial tissue. **Why Danazol is the correct answer:** Danazol is a synthetic steroid (isoxazole derivative of 17-alpha-ethinyl testosterone). It acts by inhibiting the pituitary-ovarian axis, leading to a hypoestrogenic and hyperandrogenic state. It suppresses GnRH and gonadotropin secretion while directly inhibiting steroidogenic enzymes in the corpus luteum. This "pseudomenopause" environment causes the endometriotic implants to undergo atrophy, providing symptomatic relief and regression of the disease. In the context of traditional NEET-PG questions, Danazol remains a classic pharmacological choice for medical management. **Analysis of Incorrect Options:** * **A. Oestrogen:** Endometriosis is an estrogen-dependent condition. Administering estrogen would stimulate the growth and proliferation of ectopic endometrial tissue, worsening the disease. * **B. Gonadotropins:** While GnRH *agonists* (like Leuprolide) are used to treat endometriosis by causing pituitary desensitization, "Gonadotropins" (FSH/LH) would stimulate the ovaries to produce more estrogen, exacerbating the condition. * **C. Surgery:** In a young girl, conservative medical management is generally preferred first to preserve ovarian reserve and fertility. Surgery (Laparoscopic ablation/excision) is usually reserved for severe cases, presence of endometriomas, or when medical therapy fails. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy (Visual confirmation with "powder-burn" or "gunshot" lesions). * **Mechanism of Danazol:** Creates a "pseudomenopause" state. * **Side Effects of Danazol:** Weight gain, acne, hirsutism, and deepening of voice (due to androgenic properties). * **First-line for Pain:** NSAIDs and Combined Oral Contraceptive Pills (COCPs) are now often preferred in modern practice over Danazol due to fewer side effects.

Question 488: A 48-year-old woman, P2L2, with menorrhagia, diagnosed with adenomyosis, is not responding to medical management with NSAIDs and hormonal therapy. What is the next step in management?

A. Mirena (LNG IUD) insertion
B. GnRH analogues
C. Hysterectomy
D. Hysteroscopy biopsy (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Hysteroscopy biopsy**. **1. Why Hysteroscopy Biopsy is the Correct Next Step:** In a 48-year-old woman presenting with Abnormal Uterine Bleeding (AUB) that is refractory to medical management, the primary clinical priority is to **exclude endometrial hyperplasia or malignancy**. According to FIGO and ACOG guidelines, any woman over the age of 45 with AUB (or younger with risk factors) must undergo endometrial sampling. Even if a diagnosis of adenomyosis has been made clinically or via ultrasound, the failure of medical therapy necessitates a pathological evaluation of the endometrium before proceeding to definitive surgical interventions. **2. Why Other Options are Incorrect:** * **A. Mirena (LNG-IUD):** While Mirena is an excellent second-line medical treatment for adenomyosis, it should not be initiated in a perimenopausal woman with persistent bleeding until the endometrium has been sampled to rule out malignancy. * **B. GnRH Analogues:** These are generally used as a short-term "bridge" to surgery or to shrink the uterus; they do not provide a definitive diagnosis and are not the immediate next step when malignancy needs to be excluded. * **C. Hysterectomy:** This is the definitive treatment for adenomyosis. However, performing a major surgery without first ruling out endometrial cancer via biopsy is considered poor clinical practice, as the presence of malignancy would alter the surgical approach (e.g., staging, lymphadenectomy). **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis for Adenomyosis:** Histopathology (post-hysterectomy). * **Investigation of Choice (Imaging):** MRI (shows thickening of the Junctional Zone >12mm). * **Rule of Thumb:** In any perimenopausal/postmenopausal bleeding, **"Rule out Cancer first"** via Endometrial Biopsy or D&C. * **Definitive Treatment:** Hysterectomy is the only cure for adenomyosis.

Question 489: All of the following are associated with Turner's syndrome except?

A. Primary amenorrhea
B. Short stature
C. Cubitus varus (Correct Answer)
D. Aortic coarctation

Explanation: **Explanation:** Turner’s Syndrome (45, XO) is a common cause of primary amenorrhea and short stature due to the loss of genetic material on the X chromosome. **Why "Cubitus varus" is the correct answer:** The characteristic skeletal deformity in Turner’s syndrome is **Cubitus valgus** (an increased carrying angle of the elbow), not cubitus varus. Cubitus varus (gunstock deformity) is typically a late complication of a supracondylar fracture of the humerus, not a genetic feature of Turner’s. **Analysis of incorrect options:** * **Primary amenorrhea:** This is a hallmark feature. Patients have "streak ovaries" (gonadal dysgenesis) where ovarian follicles are replaced by fibrous tissue, leading to hypergonadotropic hypogonadism. * **Short stature:** This is the most consistent clinical finding in Turner’s syndrome, primarily due to the haploinsufficiency of the **SHOX gene**. * **Aortic coarctation:** This is the most classic cardiovascular association (found in ~10-20% of cases). Bicuspid aortic valve is actually the most common cardiac anomaly overall. **NEET-PG High-Yield Pearls:** * **Karyotype:** 45, XO is most common; however, mosaicism (45,X/46,XX) may present with secondary amenorrhea. * **Cardiac:** Bicuspid aortic valve (most common) > Coarctation of aorta. * **Renal:** Horseshoe kidney is the most common renal anomaly. * **Physical Signs:** Webbed neck (pterygium colli), low posterior hairline, shield chest (widely spaced nipples), and shortened 4th metacarpals. * **Management:** Growth hormone for height; Estrogen/Progesterone for secondary sexual characteristics; Oocyte donation for pregnancy.

Question 490: Non-gonococcal vaginal discharge, dysuria, and frequency of urine may be due to infection with:

A. Trichomonas vaginalis
B. Trichomonas vaginalis
C. Candida albicans
D. Chlamydia trachomatis (Correct Answer)

Explanation: **Explanation:** The clinical triad of **non-gonococcal vaginal discharge, dysuria, and urinary frequency** is highly characteristic of **Chlamydia trachomatis** infection. **Why Chlamydia trachomatis is correct:** Chlamydia is an obligate intracellular bacterium that primarily infects the columnar epithelium of the endocervix and the urethra. In women, it frequently causes **"Sterile Pyuria"** (presence of white blood cells in urine without bacterial growth on standard media) and **Urethritis**, leading to urinary symptoms like dysuria and frequency. The vaginal discharge associated with Chlamydia is typically mucopurulent and originates from the cervix (cervicitis) rather than the vaginal walls. **Analysis of Incorrect Options:** * **Trichomonas vaginalis:** While it causes profuse, frothy, greenish-yellow vaginal discharge and some dysuria, it is primarily a vaginal infection (vaginitis) rather than a primary cause of the urethral syndrome described. The classic sign is a "Strawberry Cervix." * **Candida albicans:** This presents with intense vulvar pruritus and a thick, "curd-like" or "cottage cheese" discharge. While it can cause external dysuria (due to urine touching inflamed vulvar skin), it does not typically cause urinary frequency or urethritis. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Nucleic Acid Amplification Test (NAAT) is the investigation of choice for Chlamydia. * **Treatment:** The current CDC recommendation is **Doxycycline** (100 mg BID for 7 days). Azithromycin (1g stat) is an alternative, especially in pregnancy. * **Co-infection:** Always screen for Neisseria gonorrhoeae when Chlamydia is suspected, as co-infection is common. * **Complications:** Untreated Chlamydia is a leading cause of Pelvic Inflammatory Disease (PID), tubal factor infertility, and ectopic pregnancy.

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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