Gynecological Disorders Practice Questions

Q: Cervical incompetence is characterized by:

All of the above. **Explanation:** **Cervical Incompetence (Cervical Insufficiency)** is a clinical condition characterized by the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions, labor, or both. 1. **Why "All of the above" is correct:** * **Second Trimester Abortion (Option B):** This is the classic presentation. The cervix dilates painlessly under the weight of the growing fetus, leading to recurrent mid-trimester pregnancy losses (typically between 14–26 weeks). * **Premature Rupture of Membranes (Option C):** As the cervix dilates, the fetal membranes bulge into the vagina (funneling), making them vulnerable to infection and mechanical stress, which frequently leads to Preterm Premature Rupture of Membranes (PPROM). * **Cerclage Operation (Option A):** This is the definitive surgical management. Procedures like **McDonald’s** or **Shirodkar’s cerclage** involve placing a non-absorbable stitch around the cervix to provide mechanical support. 2. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Primarily clinical (history of painless spontaneous mid-trimester losses). Ultrasonography (TVS) is used to measure **cervical length**; a length **<25 mm** or "funneling" of the internal os before 24 weeks is diagnostic. * **Timing of Cerclage:** Usually performed electively between **12–14 weeks** of gestation (after confirming fetal viability and screening for chromosomal anomalies). * **Removal:** The stitch is typically removed at **37 completed weeks** or earlier if labor begins, to avoid cervical laceration. * **Gold Standard:** While McDonald is common, Shirodkar is technically superior as the stitch is placed higher (at the level of the internal os).

Q: Hematosalpinx is seen in:

All of the above. **Explanation:** Hematosalpinx refers to the accumulation of blood within the fallopian tubes. It is a clinical finding associated with various gynecological conditions where blood either originates in the tube or refluxes into it. **Why "All of the above" is correct:** 1. **Tubal Pregnancy (Option C):** This is the **most common cause** of hematosalpinx. As the ectopic pregnancy grows, it causes erosion of the tubal wall and vessels, leading to intratubal hemorrhage. 2. **Haematocolpos (Option A):** In cases of an imperforate hymen or vaginal atresia, menstrual blood accumulates in the vagina (hematocolpos), then the uterus (hematometra), and eventually refluxes into the fallopian tubes (hematosalpinx). 3. **Torsion of Hydrosalpinx (Option B):** When a pre-existing hydrosalpinx (fluid-filled tube) undergoes torsion, the venous return is obstructed first. This leads to intense congestion, rupture of small vessels, and subsequent hemorrhage into the lumen, converting a hydrosalpinx into a hematosalpinx. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause overall:** Ectopic pregnancy. * **Non-gestational causes:** Endometriosis (tubal endometriosis), pelvic inflammatory disease (PID), and cervical/vaginal stenosis. * **Triad of Ectopic Pregnancy:** Amenorrhea, abdominal pain, and vaginal bleeding (though hematosalpinx is a pathological finding, not a clinical symptom). * **Ultrasound Appearance:** A complex adnexal mass with low-level internal echoes (ground-glass appearance) if blood is old, or an "anechoic" tubular structure if acute. **Conclusion:** Since all three conditions can pathologically result in blood accumulation within the fallopian tubes, "All of the above" is the correct choice.

Q: A 30-year-old woman is examined for infertility. Hysterosalpingography reveals 'bead-like' fallopian tubes and clubbing of the ampulla. What is the most likely cause?

Mycobacterium tuberculosis. **Explanation:** The clinical presentation and hysterosalpingography (HSG) findings are classic for **Genital Tuberculosis**, caused by *Mycobacterium tuberculosis*. **1. Why Mycobacterium tuberculosis is correct:** Genital TB is a significant cause of tubal factor infertility in developing countries. It typically spreads hematogenously to the fallopian tubes (affected in 90-100% of cases). The chronic granulomatous inflammation leads to scarring and strictures. On HSG, these alternating areas of constriction and dilatation create the characteristic **"beaded" appearance**. As the disease progresses, the fimbrial end closes, and the ampulla becomes distended and blunt, known as **"clubbing."** Other HSG signs include a "lead pipe" appearance (rigid tubes) and "tobacco pouch" appearance. **2. Why other options are incorrect:** * **Gonococcus and Chlamydia:** These are the most common causes of Pelvic Inflammatory Disease (PID). While they cause tubal damage and infertility, they typically present with **hydrosalpinx** (thin-walled, fluid-filled tubes) or complete tubal occlusion with a "retort-shaped" appearance, rather than the specific beaded/calcified pattern seen in TB. * **Mycoplasma:** While associated with bacterial vaginosis and sometimes PID, it does not produce the specific chronic granulomatous changes or the "beaded" radiological morphology associated with tuberculosis. **Clinical Pearls for NEET-PG:** * **Most common site** of Genital TB: Fallopian tubes (1st), followed by Endometrium (2nd). * **Gold Standard Diagnosis:** Endometrial biopsy for histopathology (showing giant cells/tubercles) and TB culture (BACTEC). * **Schier's Sign:** A specific HSG finding in TB where there is calcification of the pelvic lymph nodes or the tubes themselves. * **Asherman’s Syndrome:** Genital TB is a leading cause of secondary amenorrhea due to extensive intrauterine synechiae.

Q: Clitoromegaly is defined if the clitoris is:

>10 mm. **Explanation:** Clitoromegaly (macroclitoris) is an abnormal enlargement of the clitoris, often serving as a clinical marker for hyperandrogenism or disorders of sexual development (DSD). **Why Option C is correct:** In clinical practice, the clitoris is measured by its **Clitoral Index**, which is the product of the longitudinal and transverse diameters. However, for a quick bedside assessment, the longitudinal diameter (length) is used. A clitoral length **>10 mm (1 cm)** in a newborn or an adult is considered the standard threshold for defining clitoromegaly. In newborns, a clitoral index >35 $mm^2$ is also diagnostic. **Analysis of Incorrect Options:** * **Option A (5 mm) & B (7 mm):** These values fall within the physiological range. The average clitoral length in a newborn is approximately 3–4 mm, and in an adult, it typically ranges from 4–7 mm. * **Option D (15 mm):** While 15 mm is certainly clitoromegaly, it is not the *defining* threshold. The definition starts at the point where the measurement exceeds the 97th percentile for the population, which is >10 mm. **High-Yield Clinical Pearls for NEET-PG:** 1. **Prader Staging:** Used to describe the degree of virilization of female genitalia; clitoromegaly is a key feature of Prader Stage 1 and above. 2. **Most Common Cause:** In newborns, the most common cause of clitoromegaly is **Congenital Adrenal Hyperplasia (CAH)** due to 21-hydroxylase deficiency. 3. **Adult Onset:** If clitoromegaly develops in an adult, clinicians must rule out **Androgen-secreting tumors** (e.g., Sertoli-Leydig cell tumors) or PCOS (though PCOS rarely causes significant clitoromegaly). 4. **Measurement:** It is measured using a sliding caliper, ensuring the glans is fully exposed.

Q: All of the following are characteristic features of genitourinary tuberculosis on imaging, EXCEPT?

Multiple nodular diverticula.. **Explanation:** Genitourinary Tuberculosis (GUTB) is a major cause of infertility in developing countries. The infection typically spreads hematogenously to the fallopian tubes, which are affected in nearly 90-100% of cases. **Why "Multiple nodular diverticula" is the correct answer:** Multiple nodular diverticula (Salpingitis Isthmica Nodosa) is a condition characterized by nodular thickening of the isthmic portion of the fallopian tube with diverticula of the endosalpinx into the muscularis layer. While it causes infertility, it is primarily associated with **chronic inflammation or endometriosis**, rather than being a classic imaging hallmark of tuberculosis. **Analysis of Incorrect Options (Characteristic Features of TB):** * **Rigid, lead pipe appearance:** Chronic TB causes fibrosis and scarring of the fallopian tubes, making them lose their peristaltic ability and appear straight and rigid on Hysterosalpingography (HSG). * **Tobacco pouch appearance:** This occurs when the fimbrial end of the tube is everted and phimotic (partially occluded) due to chronic inflammation, resembling a drawstring pouch. * **Bilateral cornual blockage:** TB often causes proximal tubal occlusion due to granulomatous lesions and fibrosis at the cornual end. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Endometrial biopsy/aspirate for Histopathology (showing granulomas) and GeneXpert/TB-PCR. * **HSG Findings:** Look for "Beaded tube" appearance (early stage) and "Golf hole" ureteric orifices on cystoscopy (urinary TB). * **Most common site of Female Genital TB:** Fallopian tubes (100%) > Endometrium (50%) > Ovaries (20%). * **Asherman’s Syndrome:** TB is a leading cause of secondary amenorrhea due to extensive intrauterine synechiae (Netter’s Syndrome).

Q: Which of the following statements regarding ectopic pregnancy is true?

Pregnancy test is positive.. **Explanation:** **1. Why Option A is Correct:** In an ectopic pregnancy, trophoblastic tissue is present and functional, which produces **human chorionic gonadotropin (hCG)**. Since the urine pregnancy test (UPT) detects the presence of the beta-subunit of hCG, it will be **positive** in almost all cases of ectopic pregnancy. While hCG levels may be lower than in a normal intrauterine pregnancy (IUP) of the same gestational age, they are still high enough to trigger a positive result. **2. Why the Other Options are Incorrect:** * **Options B & C:** These refer to the **"Discriminatory Zone."** For a Transvaginal Sonography (TVS), the standard discriminatory zone to visualize an intrauterine gestational sac is an hCG level between **1500–2000 mIU/ml**. If the level is above this threshold and no sac is seen in the uterus, an ectopic pregnancy is highly suspected. Levels of 1000 mIU/ml are generally too low for reliable detection. * **Option D:** While Methotrexate is indeed used in the medical management of ectopic pregnancy, it is **not a universal statement** for all cases. Its use is restricted to hemodynamically stable patients meeting specific criteria (e.g., hCG <5000 mIU/ml, no fetal heart activity, sac size <3.5–4 cm). In a multiple-choice format where one answer is "more" fundamentally true, the physiological fact that the pregnancy test is positive takes precedence over a conditional management strategy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, indicating a pregnancy response without chorionic villi in the uterus. * **Gold Standard Diagnosis:** Laparoscopy. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases).

Q: What is the percentage change of cystic glandular hyperplasia turning to malignancy?

1%. **Explanation:** The progression of endometrial hyperplasia to malignancy depends significantly on the presence of **cellular atypia**. **Cystic Glandular Hyperplasia (CGH)**, also known as Simple Hyperplasia without atypia, is characterized by an increase in the number of glands which may be dilated (cystic), but the cells lining them do not show nuclear abnormalities. 1. **Why 1% is correct:** According to the classic **Kurman’s classification**, simple hyperplasia without atypia (CGH) has a very low malignant potential, with only about **1%** of cases progressing to endometrial carcinoma over a period of 10–20 years. 2. **Why other options are incorrect:** * **0.1% and 0.2%:** These values are too low; while the risk is minimal, it is clinically documented at approximately 1%. * **10%:** This value is more characteristic of **Complex Hyperplasia without atypia** (approximately 3–5%) or is an underestimate for cases with atypia. **High-Yield Clinical Pearls for NEET-PG:** * **The Kurman Classification Risk Profile:** * Simple Hyperplasia (CGH): **1%** * Complex Hyperplasia: **3%** * Simple Atypical Hyperplasia: **8%** * Complex Atypical Hyperplasia: **29% (approx. 30%)** * **Key Concept:** The presence of **atypia** is the single most important prognostic factor for progression to cancer. * **Management:** CGH is usually treated with progestogens (to oppose estrogen) and periodic follow-up biopsies, rather than immediate hysterectomy.

Question 1

A 46-year-old lady has abnormal uterine bleeding with simple hyperplasia of the endometrium. What is the treatment of choice?

Accepted Answer

Total hysterectomy

Answer

Progesterone

Answer

Estrogen + progestogen

Answer

Estrogen

Question 2

Cervical incompetence is characterized by:

Accepted Answer

All of the above

Answer

Cerclage operation

Answer

Second trimester abortion

Answer

Premature rupture of membranes

Question 3

Retention of urine is most likely to be caused by which type of fibromyoma?

Accepted Answer

Posterior cervical fibromyoma

Answer

Subserous fibromyoma

Answer

Interstitial fibromyoma

Answer

Submucous fibromyoma

Question 4

Hematosalpinx is seen in:

Accepted Answer

All of the above

Answer

Haematocolpos

Answer

Torsion of hydrosalpinx

Answer

Tubal pregnancy

Question 5

A 30-year-old woman is examined for infertility. Hysterosalpingography reveals 'bead-like' fallopian tubes and clubbing of the ampulla. What is the most likely cause?

Accepted Answer

Mycobacterium tuberculosis

Answer

Gonococcus

Answer

Mycoplasma

Answer

Chlamydia

Question 6

Clitoromegaly is defined if the clitoris is:

Accepted Answer

>10 mm

Answer

>=5 mm

Answer

>=7 mm

Answer

15 mm

Question 7

All of the following are characteristic features of genitourinary tuberculosis on imaging, EXCEPT?

Accepted Answer

Multiple nodular diverticula.

Answer

Rigid, lead pipe appearance of fallopian tubes with nodulation.

Answer

Tobacco pouch appearance of the fallopian tube.

Answer

Bilateral cornual blockage.

Question 8

A 30-year-old multiparous woman is found to have a 5 to 6 cm cyst in one ovary. What is the most appropriate line of management?

Accepted Answer

Observation to see if it disappears by itself in three months

Answer

Laparotomy and cystectomy

Answer

Laparotomy and unilateral salpingo-oophorectomy

Answer

Laparoscopic aspiration of the cyst

Question 9

Which of the following statements regarding ectopic pregnancy is true?

Accepted Answer

Pregnancy test is positive.

Answer

hCG levels should be >1000 mlU/ml for the earliest detection of the gestational sac by TVS.

Answer

hCG levels should be <1000 mlU/ml for the earliest detection of the gestational sac by TVS.

Answer

Methotrexate is used in its management.

Question 10

What is the percentage change of cystic glandular hyperplasia turning to malignancy?

Accepted Answer

1%

Answer

0.10%

Answer

0.2%

Answer

10%

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?