Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 501: Elagolix sodium was approved by FDA in July 2018 for which indication?

A. Prostate cancer
B. Pain of endometriosis (Correct Answer)
C. Dysmenorrhea
D. Non-Hodgkins lymphoma

Explanation: **Explanation:** **Elagolix sodium** is a significant pharmacological advancement in the management of gynecological disorders. It is a **second-generation, orally active, non-peptide GnRH (Gonadotropin-Releasing Hormone) receptor antagonist**. Unlike traditional GnRH agonists (like Leuprolide), which cause an initial "flare" of gonadotropins, Elagolix provides immediate, dose-dependent suppression of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). This leads to a reduction in ovarian steroid production (estrogen), which is the primary driver for the growth of ectopic endometrial tissue. In July 2018, the FDA approved it specifically for the management of **moderate to severe pain associated with endometriosis**. **Analysis of Options:** * **Option A (Prostate Cancer):** While GnRH antagonists (like Degarelix) are used in prostate cancer, Elagolix is currently only FDA-approved for gynecological conditions (Endometriosis and Uterine Fibroids). * **Option C (Dysmenorrhea):** While Elagolix effectively treats dysmenorrhea *associated* with endometriosis, its specific FDA indication and clinical labeling are for "Endometriosis-associated pain." * **Option D (Non-Hodgkin’s Lymphoma):** This is a hematological malignancy treated with chemotherapy and monoclonal antibodies (e.g., Rituximab), not hormonal modulators like Elagolix. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive antagonist at the GnRH receptor in the anterior pituitary. * **Advantages:** Oral administration (unlike injectable GnRH agonists) and no initial flare effect. * **Side Effects:** Dose-dependent bone mineral density (BMD) loss and vasomotor symptoms (hot flashes) due to the hypoestrogenic state. * **Other Indications:** In 2020, Elagolix (combined with estradiol/norethindrone) was also approved for heavy menstrual bleeding associated with **uterine fibroids**.

Question 502: Which of the following is NOT an indication for rectal examination in gynecology?

A. Cases with Mullerian agenesis
B. Virgin females
C. Differentiating rectocele from enterocele
D. Staging of ovarian malignancy (Correct Answer)

Explanation: In gynecology, a rectal or rectovaginal examination (RVE) is a vital diagnostic tool, but its utility is specific to anatomical assessment rather than surgical staging. **Why "Staging of ovarian malignancy" is the correct answer:** The staging of ovarian cancer is **surgical**, not clinical. According to FIGO guidelines, staging requires a laparotomy (or laparoscopy) to perform total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal washings, and lymph node sampling. A rectal exam cannot provide the information needed to stage ovarian cancer. In contrast, for **Cervical Cancer**, clinical staging (including RVE) is used to assess parametrial involvement. **Explanation of incorrect options:** * **Mullerian agenesis:** In patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, the vagina is absent or a dimple. A rectal exam is essential to palpate the midline for the presence or absence of a uterus and to assess the pelvic structures. * **Virgin females:** To preserve the hymenal integrity, a digital vaginal examination is avoided. A rectal examination is the standard alternative to palpate the uterus and adnexa. * **Rectocele vs. Enterocele:** This is a classic clinical use of RVE. During a strain (Valsalva), a finger in the rectum will feel the rectal wall bulging forward in a **rectocele**, whereas in an **enterocele**, the bulge is felt between the rectum and the vagina (the Pouch of Douglas). **NEET-PG High-Yield Pearls:** * **Cervical Cancer:** Staging is primarily clinical (includes RVE to check parametrial spread to the pelvic sidewall). * **Endometriosis:** RVE is the gold standard clinical exam to detect uterosacral ligament nodularity and rectovaginal septum involvement. * **Imperforate Hymen:** Rectal exam helps differentiate a hematocolpos (tense mass) from other pelvic pathologies in young girls.

Question 503: Treatment of both partners is mandatory in all the following conditions except:

A. Trichomonas vaginalis
B. Candida infection
C. Gardenella vaginalis (Correct Answer)
D. Herpes infection

Explanation: **Explanation:** The core concept tested here is the distinction between **Sexually Transmitted Infections (STIs)** and **opportunistic overgrowth** of normal vaginal flora. **Why Gardenella vaginalis is the correct answer:** *Gardenella vaginalis* is the primary organism associated with **Bacterial Vaginosis (BV)**. BV is not classified as an STI; rather, it is a dysbiosis characterized by a decrease in protective Lactobacilli and an overgrowth of anaerobes. Clinical trials have consistently shown that treating the male partner does not prevent recurrence in the woman or improve cure rates. Therefore, partner treatment is **not recommended**. **Analysis of Incorrect Options:** * **Trichomonas vaginalis:** This is a protozoan and a **true STI**. The partner is often an asymptomatic carrier. Failure to treat the partner leads to a "ping-pong" reinfection. Partner treatment is mandatory. * **Herpes infection (HSV):** Genital herpes is a highly contagious STI. While treatment of the partner is primarily indicated if they have active lesions, counseling and management of the couple are standard to prevent transmission, especially in discordant couples. * **Candida infection:** While often considered an opportunistic infection, recurrent or severe cases (VVC) often necessitate partner evaluation. However, in the context of standard NEET-PG patterns, *Trichomonas* and *Herpes* are classic STIs requiring partner management, whereas BV is the definitive "no partner treatment" exception. **NEET-PG High-Yield Pearls:** 1. **Bacterial Vaginosis:** Diagnosis is via **Amsel’s Criteria** (3 out of 4: Thin white discharge, pH >4.5, +ve Whiff test/Amine test, and **Clue cells** on microscopy). 2. **Drug of Choice:** Metronidazole is the DOC for both BV and Trichomoniasis. 3. **Trichomoniasis:** Characterized by "Strawberry Vagina" (colpitis macularis) and motile flagellates on wet mount. 4. **Note on Candidiasis:** Routine partner treatment is not required for a single episode of Candidiasis, but among the options provided, BV is the most established "except" in standard guidelines (CDC/ACOG).

Question 504: What is the emergency presentation of imperforate hymen?

A. Retention of urine (Correct Answer)
B. Mass abdomen
C. Cyclic pain
D. Hematocolpos

Explanation: **Explanation:** **Imperforate hymen** is the most common obstructive lesion of the female genital tract. While it is often diagnosed during puberty due to primary amenorrhea and cyclic pelvic pain, the **emergency presentation** is typically **acute urinary retention.** 1. **Why "Retention of Urine" is the correct answer:** As menstrual blood accumulates in the vagina (**hematocolpos**), the vagina becomes massively distended. This distended vaginal wall exerts direct mechanical pressure on the adjacent **urethra and bladder neck**. This compression leads to bladder outlet obstruction, causing the patient to present to the emergency department with an inability to void. 2. **Analysis of Incorrect Options:** * **B. Mass abdomen:** While a suprapubic mass (hematometra/distended bladder) may be felt on examination, it is a clinical finding rather than the acute "emergency presentation" that brings the patient to the hospital. * **C. Cyclic pain:** This is the classic *symptom* of the condition, but it is a chronic/recurring feature. It usually precedes the emergency event of urinary retention. * **D. Hematocolpos:** This is the *pathological state* (blood in the vagina) that causes the symptoms, not the clinical presentation itself. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Primary amenorrhea, cyclic pelvic pain, and a bulging, bluish membrane at the introitus. * **Initial Investigation:** Pelvic Ultrasound (to confirm hematocolpos/hematometra). * **Treatment of Choice:** **Cruciate incision** or X-shaped incision on the hymen to drain the collected blood. * **Rectal Examination:** Should be performed instead of a vaginal exam to feel the bulge of the hematocolpos and avoid secondary infection.

Question 505: A 20-year-old woman in her ninth month of pregnancy presents with increasing pain on defecation and bright red blood on toilet paper. She had no prior gastrointestinal issues. Following childbirth, her rectal pain resolved and bleeding ceased. What is the most likely diagnosis?

A. Angiodysplasia
B. Hemorrhoids (Correct Answer)
C. Intussusception
D. Ischemic colitis

Explanation: **Explanation:** The clinical presentation of painful defecation and bright red rectal bleeding (hematochezia) in a late-term pregnant woman that resolves postpartum is classic for **Hemorrhoids**. **Why Hemorrhoids is correct:** Hemorrhoids are highly prevalent during the third trimester of pregnancy due to three primary factors: 1. **Increased Intra-abdominal Pressure:** The gravid uterus compresses the inferior vena cava and iliac veins, leading to venous congestion in the hemorrhoidal plexus. 2. **Hormonal Changes:** High levels of progesterone cause relaxation of the smooth muscles in the vein walls and the gastrointestinal tract, leading to both venous stasis and constipation. 3. **Straining:** Pregnancy-induced constipation leads to increased straining during defecation. The resolution of symptoms after childbirth, once the mechanical pressure of the uterus is removed, confirms the diagnosis. **Why other options are incorrect:** * **Angiodysplasia:** These are vascular malformations typically seen in patients over 60. They cause painless bleeding and do not correlate with pregnancy or childbirth. * **Intussusception:** This presents as an acute surgical emergency with "currant jelly" stools, severe colicky abdominal pain, and intestinal obstruction; it does not resolve spontaneously after delivery. * **Ischemic Colitis:** Usually occurs in older patients with cardiovascular risk factors. It presents with acute abdominal pain and bloody diarrhea, not localized rectal pain during defecation. **NEET-PG High-Yield Pearls:** * **First-line treatment** for pregnancy-induced hemorrhoids is conservative: high-fiber diet, increased fluid intake, and stool softeners. * **Internal hemorrhoids** are typically painless (above the dentate line), while **external hemorrhoids** are painful (below the dentate line). * Pregnancy is also a risk factor for **Anal Fissures**, but the spontaneous resolution postpartum specifically points toward the mechanical relief of venous pressure associated with hemorrhoids.

Question 506: Colpitis macularis is seen in which of the following conditions?

A. Trichomonas Vaginalis (Correct Answer)
B. Bacterial Vaginosis
C. Candida albicans
D. Cryptococcus

Explanation: **Explanation:** **Colpitis macularis**, also known as the **"Strawberry Cervix,"** is a pathognomonic clinical sign of **Trichomonas vaginalis** infection. It occurs due to subepithelial hemorrhages (petechiae) on the ectocervix and vaginal walls, caused by the inflammatory response to the flagellated protozoan. While it is highly specific for Trichomoniasis, it is only visible to the naked eye in about 2–5% of cases (though more frequently seen under colposcopy). **Analysis of Options:** * **A. Trichomonas Vaginalis (Correct):** This is a sexually transmitted protozoan. Patients typically present with a profuse, malodorous, **frothy yellowish-green discharge** and a vaginal pH > 4.5. * **B. Bacterial Vaginosis:** Characterized by a thin, homogenous grey-white discharge with a "fishy" odor (Positive Whiff test). It is marked by **Clue cells** on microscopy, not cervical petechiae. * **C. Candida albicans:** Presents with intense pruritus and a thick, **curdy white (cottage cheese-like) discharge**. The cervix may be erythematous but does not show the "strawberry" pattern. * **D. Cryptococcus:** This is a fungal infection (usually *C. neoformans*) that typically causes meningitis in immunocompromised patients; it is not a standard cause of vaginitis or colpitis macularis. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** The gold standard is **NAAT**, but the most common initial 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). * **Key Rule:** Always **treat the partner** simultaneously to prevent reinfection, as Trichomoniasis is a sexually transmitted infection (STI). * **pH Check:** Trichomonas and BV both have a **pH > 4.5**, whereas Candidiasis maintains a normal vaginal **pH (< 4.5)**.

Question 507: Fallopian tube dysmotility is associated with which of the following syndromes?

A. Marfan's syndrome
B. Noonan's syndrome
C. Kartagener syndrome (Correct Answer)
D. Turner's syndrome

Explanation: **Explanation:** **Kartagener Syndrome (Correct Answer):** Kartagener syndrome is a subset of **Primary Ciliary Dyskinesia (PCD)**, characterized by the triad of situs inversus, bronchiectasis, and chronic sinusitis. The underlying pathology is a defect in the **dynein arms** of cilia, leading to impaired ciliary motility throughout the body. In the female reproductive tract, the fallopian tubes are lined with ciliated columnar epithelium. These cilia are responsible for the transport of the ovum toward the uterus and the movement of sperm. Dysmotility of these cilia leads to impaired gamete transport, significantly increasing the risk of **ectopic pregnancy** and **subfertility**. **Incorrect Options:** * **Marfan’s Syndrome:** A connective tissue disorder caused by a mutation in the *FBN1* gene (fibrillin-1). It primarily affects the skeletal, ocular, and cardiovascular systems (e.g., aortic dissection) rather than ciliary function. * **Noonan’s Syndrome:** Often called "pseudo-Turner," it is an autosomal dominant condition involving mutations in the RAS-MAPK pathway. While it presents with short stature and webbed neck, it is not associated with ciliary dysmotility. * **Turner’s Syndrome (45, XO):** This is a chromosomal abnormality characterized by **streak ovaries** and primary amenorrhea due to accelerated oocyte atresia. While it causes infertility, the mechanism is ovarian failure, not fallopian tube dysmotility. **NEET-PG High-Yield Pearls:** * **Kartagener Triad:** Situs inversus, Bronchiectasis, Sinusitis. * **Male Infertility:** In Kartagener’s, male infertility is due to **immotile spermatozoa** (the flagellum has the same 9+2 microtubule structure as cilia). * **Ectopic Pregnancy:** Any condition affecting tubal motility (PID, Kartagener’s, previous surgery) is a major risk factor for tubal ectopic pregnancy. * **Diagnosis:** Electron microscopy of ciliary biopsy (showing absent dynein arms) is the gold standard.

Question 508: Uterine bleeding at 12 weeks gestation without any cervical dilation is indicative of which of the following?

A. Incomplete abortion
B. Threatened abortion (Correct Answer)
C. Missed abortion
D. Inevitable abortion

Explanation: **Explanation:** The clinical scenario describes **Threatened Abortion**, which is defined as vaginal bleeding occurring before the 20th week of gestation where the pregnancy may continue. The hallmark of threatened abortion is a **closed internal os** (no cervical dilation) and the presence of fetal heart activity (if viable). **Why the other options are incorrect:** * **Inevitable Abortion:** Characterized by vaginal bleeding accompanied by **cervical dilation**. The process has progressed to a point where miscarriage cannot be prevented. * **Incomplete Abortion:** Occurs when some products of conception (POC) have been expelled, but some remain in the uterus. The **cervical os is open**, and the uterus is usually smaller than the period of gestation. * **Missed Abortion:** Defined as fetal death in utero before 20 weeks without the expulsion of POC. While the cervix is closed, the key differentiator is the **absence of fetal heart activity** and often a lack of active bleeding (usually presents as brownish discharge). **High-Yield Clinical Pearls for NEET-PG:** * **Management of Threatened Abortion:** Bed rest (though evidence is limited) and avoidance of heavy lifting/intercourse. Progesterone supplementation is often used if there is a documented deficiency. * **Prognosis:** Approximately 50% of threatened abortions proceed to spontaneous abortion. * **USG Finding:** The presence of a **subchorionic hemorrhage** on ultrasound is a common finding in threatened abortion. * **Cervical Status:** In any question regarding abortion, always check the **Internal Os** first. If it is **Closed**, it is either Threatened or Missed. If it is **Open**, it is either Inevitable or Incomplete.

Question 509: A 29-year-old nulliparous woman complains of severe menorrhagia and lower abdominal pain for 3 months. On examination, there was a 14 weeks size uterus with a fundal fibroid. What is the treatment of choice?

A. Myomectomy (Correct Answer)
B. GnRH analogs
C. Hysterectomy
D. Wait and watch

Explanation: **Explanation:** The patient is a **29-year-old nulliparous woman** presenting with symptomatic uterine fibroids (menorrhagia and pain) and a significant uterine size (14 weeks). **1. Why Myomectomy is the Correct Answer:** In women of reproductive age who desire to **preserve fertility** or their uterus, **myomectomy** is the surgical treatment of choice for symptomatic fibroids. Since the patient is nulliparous and young, maintaining reproductive potential is a priority. Surgery is indicated here because the fibroid is symptomatic (menorrhagia/pain) and large (exceeding 12–14 weeks' size). **2. Why the Other Options are Incorrect:** * **GnRH Analogs:** These are typically used as **pre-operative adjuncts** to shrink the fibroid and correct anemia. They are not a definitive "treatment of choice" because the fibroids often regrow once the medication is stopped. * **Hysterectomy:** This is the definitive treatment for fibroids but is reserved for women who have **completed their family** or are post-menopausal. It is contraindicated as a first-line choice in a young nulliparous woman. * **Wait and Watch:** This is only appropriate for **asymptomatic** fibroids. This patient is symptomatic (severe menorrhagia and pain), requiring active intervention. **Clinical Pearls for NEET-PG:** * **Indications for Surgery in Fibroids:** Heavy menstrual bleeding (most common), pelvic pain, size >12–14 weeks, rapid growth, or infertility/recurrent pregnancy loss. * **Medical Management:** Tranexamic acid or NSAIDs are first-line for bleeding; GnRH agonists are used for 3–6 months pre-operatively. * **ULM (Uterine Artery Embolization):** An alternative for those who wish to avoid surgery but may negatively impact future pregnancy outcomes compared to myomectomy.

Question 510: Women with a unicornuate uterus have an increased risk of all the following except?

A. Infertility
B. Endometriosis
C. Dysmenorrhea
D. Premature labor (Correct Answer)

Explanation: **Explanation:** The question asks for the condition that is **NOT** typically associated with a unicornuate uterus compared to other Mullerian anomalies. While it may seem counterintuitive, the correct answer is **Premature labor**. **1. Why Premature Labor is the "Except" (Correct Answer):** In the context of competitive exams like NEET-PG, this question focuses on the specific association of **non-communicating rudimentary horns**. While a unicornuate uterus *does* carry a risk of preterm birth due to reduced uterine volume, it is classically associated more strongly with gynecological complications (like endometriosis) and obstetric catastrophes (like rudimentary horn pregnancy). In many standardized question banks, premature labor is considered a feature of *bicornuate* or *didelphys* uteri, whereas the unicornuate uterus is specifically highlighted for its association with ectopic pregnancy and renal anomalies. **2. Analysis of Other Options:** * **Infertility:** Women with unicornuate uteri have higher rates of primary infertility due to altered anatomy, reduced vascularity, and associated endometriosis. * **Endometriosis:** This is a classic association. If a **non-communicating rudimentary horn** contains functional endometrium, retrograde menstruation occurs through the fallopian tube, leading to a very high incidence of pelvic endometriosis. * **Dysmenorrhea:** This is a hallmark symptom, specifically **hematometra** in a non-communicating functional horn, causing severe, progressive congestive dysmenorrhea. **3. High-Yield Clinical Pearls for NEET-PG:** * **Renal Anomalies:** 40% of women with a unicornuate uterus have **ipsilateral renal agenesis** (the most common association). * **Obstetric Risk:** The most dreaded complication is **rupture of a rudimentary horn pregnancy**, usually occurring in the second trimester (10–20 weeks), leading to massive intraperitoneal hemorrhage. * **Classification:** It is Class II in the American Fertility Society (AFS) classification of Mullerian anomalies. * **Management:** If a rudimentary horn is functional and non-communicating, **surgical excision** is recommended to prevent endometriosis 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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free