Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 491: All are true regarding the medical treatment of endometriosis except?

A. Oral progestins cause decidualization of endometrial tissue.
B. Injectable progestagen is used once in 3 months in the management of pain of endometriosis.
C. Levonorgestrel releasing intrauterine system reduces dysmenorrhea in endometriosis.
D. Gestrinone is given orally 2.5 - 5 mg per day to induce endometrial atrophy. (Correct Answer)

Explanation: **Explanation:** The correct answer is **D** because the dosing regimen mentioned for Gestrinone is incorrect. Gestrinone is a synthetic tri-ethyl-19-nortestosterone derivative with anti-progestogenic and anti-estrogenic properties. While it does induce endometrial atrophy, it is administered **2.5 mg twice or thrice weekly**, not daily. Its long half-life allows for this intermittent dosing schedule, which helps in reducing side effects like weight gain and hirsutism. **Analysis of other options:** * **Option A:** Oral progestins (e.g., Norethisterone, Dienogest) work by causing **decidualization** of the ectopic endometrial tissue followed by eventual atrophy. This is a primary mechanism for pain relief. * **Option B:** Injectable progestagens, specifically **DMPA (Depot Medroxyprogesterone Acetate)** 150 mg, are administered intramuscularly once every 3 months. It is highly effective in managing endometriosis-associated pain by inducing a state of pseudopregnancy. * **Option C:** The **LNG-IUS (Mirena)** releases levonorgestrel directly into the uterine cavity. It is an evidence-based treatment that significantly reduces dysmenorrhea and pelvic pain by causing profound local decidualization and atrophy. **Clinical Pearls for NEET-PG:** * **Dienogest (2mg daily)** is currently considered the progestin of choice for long-term medical management of endometriosis. * **Danazol** (an isobarbiturate of ethisterone) creates a "pseudomenopause" state but is now less preferred due to androgenic side effects. * **GnRH agonists** (e.g., Leuprolide) are highly effective but require "add-back therapy" (estrogen + progestogen) if used for >6 months to prevent bone mineral density loss and vasomotor symptoms.

Question 492: Which is the LEAST likely feature of a fibroid?

A. Dysmenorrhoea (Correct Answer)
B. Infertility
C. Menorrhagia
D. Metrorrhagia

Explanation: Uterine fibroids (leiomyomas) are the most common benign tumors of the uterus. Understanding their clinical presentation is crucial for NEET-PG. **Why Dysmenorrhoea is the LEAST likely feature:** While fibroids can cause pain, **congestive dysmenorrhoea** is not a primary symptom of the fibroid itself. If dysmenorrhoea occurs, it is usually secondary to associated conditions like endometriosis or adenomyosis (found in 30-40% of cases). Pure fibroids are typically painless unless they undergo **red degeneration** (common in pregnancy), torsion of a pedunculated fibroid, or when a submucosal fibroid is being "expelled" by the uterus (acting like a foreign body). **Analysis of Incorrect Options:** * **Menorrhagia (C):** This is the **most common** symptom. It occurs due to an increased endometrial surface area, increased vascularity, and interference with uterine contractility. * **Infertility (B):** Fibroids can cause infertility by distorting the uterine cavity, obstructing the fallopian tubes, or creating an inflammatory environment that prevents implantation (especially submucosal types). * **Metrorrhagia (D):** Irregular intermenstrual bleeding can occur, particularly with submucosal fibroids that ulcerate the overlying endometrium or cause venous stasis. **Clinical Pearls for NEET-PG:** * **Most common symptom:** Menorrhagia. * **Most common site:** Intramural (interstitial). * **Most symptomatic type:** Submucosal (causes heavy bleeding and infertility). * **Degeneration during pregnancy:** Red degeneration (Carnous degeneration). * **Investigation of choice:** Transvaginal Ultrasound (TVS); MRI is the most accurate for mapping. * **Medical Management:** GnRH agonists (to shrink size pre-operatively) or Ulipristal acetate.

Question 493: Color Doppler Transvaginal Sonography (TVS) of an endometrioma demonstrates which of the following findings?

A. Intracystic flow
B. Pericystic flow (Correct Answer)
C. Diffuse blood flow
D. None of the above

Explanation: **Explanation:** The correct answer is **Pericystic flow**. **1. Why Pericystic flow is correct:** An endometrioma (chocolate cyst) is a pseudocyst formed by the accumulation of menstrual debris within the ovary. Unlike a true neoplasm, the contents of an endometrioma are **avascular** (consisting of old blood and debris). On Color Doppler, blood flow is characteristically restricted to the **periphery** of the cyst (the ovarian capsule/stroma), showing a "pericystic" pattern. This flow typically exhibits high resistance, which helps differentiate it from the low-resistance flow seen in malignant tumors. **2. Why other options are incorrect:** * **Intracystic flow:** This is absent in endometriomas because the internal contents are non-viable blood products. The presence of intracystic flow or vascularized solid components should raise suspicion for an ovarian malignancy or a different type of complex cyst. * **Diffuse blood flow:** This pattern is not seen in endometriomas. Diffuse or disorganized vascularity is a hallmark of inflammatory processes (like Tubo-ovarian abscess) or rapidly growing malignant lesions. **3. High-Yield Clinical Pearls for NEET-PG:** * **Classic TVS Appearance:** Endometriomas typically show a "Ground Glass" appearance (homogeneous, low-level internal echoes). * **The "Shifting" Sign:** Unlike a hemorrhagic cyst, the internal echoes of an endometrioma do not shift with patient movement or probe pressure. * **Resistance Index (RI):** Endometriomas usually have a high RI (> 0.45). A low RI (< 0.4) is more suggestive of malignancy. * **Management:** Medical management is often ineffective for large cysts; laparoscopic cystectomy is the gold standard treatment.

Question 494: Normal development of external genitalia in a female with absent uterus and vagina indicates?

A. Turner's syndrome
B. Testicular feminizing syndrome
C. Mullerian agenesis (Correct Answer)
D. Gonadal dysgenesis

Explanation: **Explanation:** The correct answer is **Mullerian agenesis** (Mayer-Rokitansky-Küster-Hauser or MRKH syndrome). **1. Why Mullerian Agenesis is correct:** In this condition, the Mullerian ducts fail to develop, leading to the absence of the uterus, cervix, and the upper two-thirds of the vagina. However, the **ovaries** develop normally (as they arise from the germ cells and genital ridge, not the Mullerian ducts). Because the ovaries are functional, they produce estrogen, which leads to the development of **normal female secondary sexual characteristics and normal external genitalia**. The karyotype is 46, XX. **2. Why other options are incorrect:** * **Testicular Feminizing Syndrome (Androgen Insensitivity Syndrome):** While these patients also have an absent uterus and a blind-ending vagina, they are genetically **46, XY**. They have undescended testes that produce Anti-Mullerian Hormone (AMH), causing Mullerian regression. A key differentiator is the **absence or scarcity of pubic and axillary hair**, unlike MRKH. * **Turner’s Syndrome (45, XO):** This is characterized by **gonadal dysgenesis (streak ovaries)**. Due to estrogen deficiency, there is a failure of secondary sexual characteristics (infantile genitalia and primary amenorrhea), though the uterus is present but prepubertal. * **Gonadal Dysgenesis:** Similar to Turner’s, the primary defect is in the ovaries. Without estrogen, there is a failure of secondary sexual development. The uterus is typically present but small. **Clinical Pearls for NEET-PG:** * **MRKH Syndrome:** Most common cause of primary amenorrhea with normal secondary sexual characteristics (after imperforate hymen). * **Association:** Always screen for **Renal anomalies** (40% cases, e.g., renal agenesis) and **Skeletal anomalies** (e.g., Klippel-Feil syndrome). * **Hormonal Profile:** In MRKH, FSH, LH, and Estrogen levels are **normal**. * **Differentiating MRKH vs. AIS:** Look for the karyotype (XX vs. XY) and the presence of pubic hair (Present in MRKH, Absent in AIS).

Question 495: Cryosurgery is effective in all of the following conditions except:

A. Chronic cervicitis
B. Squamous intraepithelial lesion
C. Condyloma acuminata
D. Treatment of carcinoma cervix (Correct Answer)

Explanation: **Explanation:** Cryosurgery is a destructive outpatient procedure that uses sub-freezing temperatures (typically using Nitrous Oxide or Carbon Dioxide) to induce cellular death through ice crystal formation and protein denaturation. **Why "Treatment of carcinoma cervix" is the correct answer:** Cryosurgery is strictly a **local destructive therapy**. It is contraindicated in invasive cervical cancer because it cannot achieve the necessary surgical margins or address potential lymph node involvement. Invasive carcinoma requires radical interventions (surgery or radiotherapy) to ensure complete oncological clearance. Using cryosurgery for malignancy would lead to incomplete treatment and poor prognosis. **Analysis of incorrect options:** * **Chronic cervicitis:** Cryosurgery is a standard treatment for symptomatic chronic cervicitis (e.g., persistent leucorrhea) as it destroys the diseased columnar epithelium, allowing healthy squamous epithelium to regrow. * **Squamous Intraepithelial Lesion (SIL):** It is highly effective for Low-grade SIL (LSIL/CIN 1) provided the lesion is small, entirely visible on the ectocervix, and the endocervical curettage (ECC) is negative. * **Condyloma acuminata:** Cryotherapy is a first-line treatment for genital warts caused by HPV, as it effectively freezes and destroys the viral-induced lesions. **NEET-PG High-Yield Pearls:** * **Mechanism:** Cryosurgery uses the **Joule-Thompson effect** (cooling of gas as it expands through a narrow aperture). * **The "Freeze-Thaw-Freeze" Technique:** This is the standard protocol to ensure maximum tissue destruction. * **Prerequisite:** Before performing cryosurgery for SIL, **invasive cancer must be ruled out** via colposcopy and biopsy. * **Side Effect:** Patients should be counseled about a profuse, watery vaginal discharge for 2–3 weeks post-procedure.

Question 496: Female pseudohermaphroditism is characterized by which of the following?

A. 46XX chromosomal pattern (Correct Answer)
B. Absent ovary
C. Absent uterus
D. Presence of testes

Explanation: **Explanation:** **1. Why Option A is Correct:** Female pseudohermaphroditism (now termed **46,XX Disorder of Sex Development**) is defined by the presence of a **46,XX karyotype** and **normal ovaries**, but with **virilized (ambiguous) external genitalia**. The underlying mechanism is the exposure of a female fetus to excessive androgens during the critical period of organogenesis. The most common cause is **Congenital Adrenal Hyperplasia (CAH)**, specifically 21-hydroxylase deficiency. **2. Why the Other Options are Incorrect:** * **B. Absent ovary:** In female pseudohermaphroditism, the gonads are always **ovaries**. If ovaries were absent or replaced by streaks, it would point toward Turner syndrome or Pure Gonadal Dysgenesis. * **C. Absent uterus:** Because there is no Anti-Müllerian Hormone (AMH) produced (as there are no testes), the Müllerian ducts develop normally into the **uterus, fallopian tubes, and upper vagina**. * **D. Presence of testes:** The presence of testicular tissue would define the condition as either Male Pseudohermaphroditism (46,XY) or True Hermaphroditism (presence of both ovarian and testicular tissue). **Clinical Pearls for NEET-PG:** * **Most Common Cause:** Congenital Adrenal Hyperplasia (CAH) is the #1 cause of female pseudohermaphroditism. * **Prader Staging:** Used to describe the degree of virilization of external genitalia in these patients. * **Key Diagnostic Feature:** Internal genitalia (uterus/ovaries) are **present and normal** because there is no Y chromosome to trigger SRY/AMH production. * **Maternal Causes:** Can also be caused by maternal ingestion of progestogens or androgen-secreting maternal tumors (e.g., Luteoma of pregnancy).

Question 497: Complications of benign ovarian tumors are all except:

A. Torsion
B. Bleeding
C. Pseudomyxoma
D. Metastasis (Correct Answer)

Explanation: ### Explanation The core concept differentiating benign from malignant tumors is the ability to invade surrounding tissues and spread to distant sites. **Why Metastasis is the Correct Answer:** **Metastasis** is a hallmark of malignancy. By definition, **benign tumors** remain localized to their site of origin. They may grow large and cause local pressure symptoms, but they do not possess the biological capability to invade lymphatics or blood vessels to form secondary deposits in distant organs. Therefore, metastasis is never a complication of a benign ovarian tumor. **Analysis of Incorrect Options:** * **Torsion (Option A):** This is the **most common complication** of benign ovarian tumors (especially dermoid cysts). The tumor acts as a pivot, causing the pedicle to twist, leading to vascular compromise and acute abdomen. * **Bleeding/Hemorrhage (Option B):** Intracystic hemorrhage is common, particularly in functional cysts or chocolate cysts (endometriomas), leading to sudden distension and pain. * **Pseudomyxoma Peritonei (Option C):** This occurs due to the rupture of a **Mucinous Cystadenoma** (even if histologically benign). The gelatinous material spills into the peritoneal cavity, leading to "jelly belly." While also associated with borderline and malignant tumors, it is a recognized complication of benign mucinous tumors. **NEET-PG High-Yield Pearls:** * **Most common complication:** Torsion. * **Most common tumor to undergo torsion:** Mature Cystic Teratoma (Dermoid cyst). * **Most common benign tumor of the ovary:** Serous Cystadenoma. * **Meigs’ Syndrome:** A triad of benign ovarian fibroma, ascites, and pleural effusion (usually right-sided). * **Rupture:** Can lead to chemical peritonitis (especially in dermoids due to sebaceous material).

Question 498: Which of the following is associated with an incarcerated gravid uterus?

A. Abortion
B. Anterior sacculation
C. Urinary retention
D. All of the above (Correct Answer)

Explanation: **Explanation:** An **incarcerated gravid uterus** occurs when a retroverted uterus fails to spontaneously correct into an upright position as it grows out of the pelvis (usually between 14–16 weeks of gestation). Instead, the fundus becomes trapped beneath the sacral promontory. **Why "All of the Above" is correct:** 1. **Urinary Retention (Option C):** This is the most common clinical presentation. As the fundus is trapped posteriorly, the cervix is displaced anteriorly and superiorly against the pubic symphysis. This stretches the urethra and compresses the bladder neck, leading to acute urinary retention and "overflow incontinence." 2. **Anterior Sacculation (Option B):** To accommodate the growing fetus while the fundus is trapped in the pouch of Douglas, the anterior wall of the lower uterine segment undergoes extreme stretching and thinning. This compensatory mechanism is known as anterior sacculation. 3. **Abortion (Option A):** If the incarceration is not relieved, the restricted space and compromised uterine circulation can lead to spontaneous abortion, intrauterine growth restriction (IUGR), or preterm labor. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Retroverted uterus + Pregnancy (12–16 weeks) + Acute urinary retention. * **Physical Exam:** A soft mass (the fundus) is felt in the Pouch of Douglas, and the cervix is high up, often difficult to reach behind the pubic symphysis. * **Management:** Initial management involves bladder catheterization and manual reduction (placing the patient in the knee-chest position). If unsuccessful, colonoscopic or surgical release may be required. * **Complication:** If unrecognized, it can lead to bladder rupture or uterine rupture during labor due to the thinned anterior sacculation.

Question 499: What is the commonest genital infection in females?

A. Candidiasis
B. Trichomoniasis (Correct Answer)
C. Syphilis
D. Gonorrhea

Explanation: **Explanation:** **Trichomoniasis** is recognized as the most common non-viral sexually transmitted infection (STI) and the most frequent genital infection in females worldwide. It is caused by the flagellated protozoan *Trichomonas vaginalis*. While many women remain asymptomatic, it typically presents with a profuse, thin, malodorous, frothy yellow-green vaginal discharge and a characteristic "strawberry cervix" (colpitis macularis) due to punctate hemorrhages. **Analysis of Options:** * **Candidiasis (Option A):** While extremely common (affecting 75% of women at least once), it is classified as a fungal overgrowth rather than a primary STI. It presents with a thick, "curdy-white" discharge and intense pruritus. * **Syphilis (Option C):** Caused by *Treponema pallidum*, this is a systemic bacterial STI. While significant, its prevalence is much lower than protozoal or fungal vaginal infections. * **Gonorrhea (Option D):** Caused by *Neisseria gonorrhoeae*, this is a common bacterial STI often leading to Pelvic Inflammatory Disease (PID), but its incidence rate is statistically lower than that of Trichomoniasis. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Culture (Diamond’s medium) is the gold standard, though NAAT is now preferred for its high sensitivity. * **Microscopy:** Look for "pear-shaped motile flagellates" on a wet mount. * **Vaginal pH:** In Trichomoniasis, the pH is typically **>4.5** (elevated), whereas in Candidiasis, the pH is usually normal (<4.5). * **Treatment:** The drug of choice is **Metronidazole** (2g single dose). Crucially, the **partner must be treated** simultaneously to prevent reinfection.

Question 500: All of the following are risk factors for bacterial vaginosis except?

A. Oral sex
B. Cigarette smoking
C. Sex during menses
D. Use of condoms during sex (Correct Answer)

Explanation: **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacillus* species with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Prevotella*, and *Mobiluncus*). **Why Option D is correct:** The **use of condoms** is a **protective factor**, not a risk factor. Condoms prevent the deposition of alkaline semen into the vagina. Since semen has a high pH (7.2–8.0), it can neutralize the acidic vaginal environment (normal pH <4.5), facilitating the overgrowth of anaerobes. Consistent condom use helps maintain the acidic pH and the dominance of *Lactobacillus*. **Why other options are incorrect:** * **Oral sex (Option A):** Saliva and the introduction of oropharyngeal flora can disrupt the delicate vaginal ecosystem, increasing the risk of BV. * **Cigarette smoking (Option B):** Smoking is a well-documented risk factor. Components like benzo[a]pyrene metabolites are toxic to *Lactobacilli* and can decrease their concentration, predisposing the patient to dysbiosis. * **Sex during menses (Option C):** Menstrual blood is alkaline. Frequent intercourse during menses further elevates the vaginal pH, creating an environment conducive to anaerobic proliferation. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required):** 1. Thin, homogenous discharge; 2. Vaginal pH >4.5; 3. Positive Whiff test (fishy odor with 10% KOH); 4. **Clue cells** on wet mount (Gold Standard for diagnosis). * **Nugent Scoring:** The "Gold Standard" for research, based on Gram stain morphotypes. * **Treatment:** Drug of choice is **Metronidazole** (500 mg BD for 7 days). Treatment of the male partner is **not** recommended. * **Complications:** Increased risk of Preterm Labor (PTL), PID, and acquisition of HIV/STIs.

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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