Gynecological Disorders Practice Questions

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

Pain of endometriosis. **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**.

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

Staging of ovarian malignancy. 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.

Q: What is the emergency presentation of imperforate hymen?

Retention of urine. **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.

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

Trichomonas Vaginalis. **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)**.

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

Threatened abortion. **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.

Q: 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?

Myomectomy. **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 1

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

Accepted Answer

Pain of endometriosis

Answer

Prostate cancer

Answer

Dysmenorrhea

Answer

Non-Hodgkins lymphoma

Question 2

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

Accepted Answer

Staging of ovarian malignancy

Answer

Cases with Mullerian agenesis

Answer

Virgin females

Answer

Differentiating rectocele from enterocele

Question 3

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

Accepted Answer

Gardenella vaginalis

Answer

Trichomonas vaginalis

Answer

Candida infection

Answer

Herpes infection

Question 4

What is the emergency presentation of imperforate hymen?

Accepted Answer

Retention of urine

Answer

Mass abdomen

Answer

Cyclic pain

Answer

Hematocolpos

Question 5

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?

Accepted Answer

Hemorrhoids

Answer

Angiodysplasia

Answer

Intussusception

Answer

Ischemic colitis

Question 6

Colpitis macularis is seen in which of the following conditions?

Accepted Answer

Trichomonas Vaginalis

Answer

Bacterial Vaginosis

Answer

Candida albicans

Answer

Cryptococcus

Question 7

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

Accepted Answer

Kartagener syndrome

Answer

Marfan's syndrome

Answer

Noonan's syndrome

Answer

Turner's syndrome

Question 8

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

Accepted Answer

Threatened abortion

Answer

Incomplete abortion

Answer

Missed abortion

Answer

Inevitable abortion

Question 9

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?

Accepted Answer

Myomectomy

Answer

GnRH analogs

Answer

Hysterectomy

Answer

Wait and watch

Question 10

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

Accepted Answer

Premature labor

Answer

Infertility

Answer

Endometriosis

Answer

Dysmenorrhea

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?