Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 541: All of the following are abdominal sling surgeries done for uterine preservation in patients of uterine prolapse, EXCEPT?

A. Khanna
B. Shirodkar
C. Purandare
D. Manchester (Correct Answer)

Explanation: In the management of pelvic organ prolapse, surgeries are broadly classified into those that preserve the uterus and those that involve its removal. **Why Manchester is the Correct Answer:** The **Manchester (Fothergill) operation** is a vaginal surgery, not an abdominal sling procedure. It involves cervical amputation, shortening of the Mackenrodt’s (cardinal) ligaments, and anterior colporrhaphy. It is indicated for uterine prolapse in women who wish to preserve the uterus but do not desire future childbearing (due to the risk of cervical incompetence and mid-trimester abortion following cervical amputation). **Explanation of Incorrect Options (Abdominal Sling Surgeries):** Abdominal sling surgeries are performed to treat **nulliparous prolapse** or prolapse in young women who wish to preserve fertility. They involve using a synthetic mesh or a strip of rectus sheath to anchor the uterus/cervix to a fixed point. * **Shirodkar’s Sling:** The sling is attached to the **promontory of the sacrum** (Sacropexy). * **Khanna’s Sling:** The sling is attached to the **anterior superior iliac spine**. * **Purandare’s Sling:** The sling (rectus sheath) is attached to the **rectus sheath** itself, passing through the internal ring. **High-Yield Clinical Pearls for NEET-PG:** * **Virupaksha’s Sling:** Another abdominal sling where the attachment is to the **pectineal ligament**. * **Best Sling:** Shirodkar’s is often considered the most anatomical as it mimics the direction of the uterosacral ligaments. * **Contraindication:** Manchester operation is generally avoided in women desiring future pregnancy due to high obstetric morbidity. * **Lefort’s Operation:** A "colpocleisis" (obliteration of the vagina) used for frail, elderly patients who are not sexually active.

Question 542: A Pap smear is useful in the diagnosis of all the following EXCEPT:

A. Gonorrhoea (Correct Answer)
B. Trichomonas vaginalis
C. Human papilloma virus
D. Inflammatory changes

Explanation: **Explanation:** The **Pap smear (Papanicolaou test)** is primarily a screening tool for cervical cancer and its precursors. While it can incidentally detect certain infections and inflammatory states based on cellular morphology, it is **not** a diagnostic tool for **Gonorrhoea**. **1. Why Gonorrhoea is the correct answer:** *Neisseria gonorrhoeae* is an intracellular Gram-negative diplococcus that infects the columnar epithelium of the endocervix. It does not produce characteristic morphological changes on a routine Pap smear. Diagnosis requires **Gram staining, culture (Thayer-Martin medium), or Nucleic Acid Amplification Tests (NAAT)**, which is currently the gold standard. **2. Why the other options are incorrect:** * **Trichomonas vaginalis:** This parasite can be visualized on a Pap smear as pear-shaped, cyanophilic organisms with a faint nucleus ("strawberry spots" on the cervix clinically). * **Human Papilloma Virus (HPV):** HPV causes pathognomonic cellular changes known as **koilocytosis** (perinuclear halo with nuclear wrinkling/pyknosis), which are easily identified on cytology. * **Inflammatory changes:** Pap smears frequently show features of inflammation, such as the presence of polymorphonuclear leukocytes (neutrophils), cellular debris, and reactive changes in epithelial cells (e.g., nuclear enlargement or vacuolization). **NEET-PG High-Yield Pearls:** * **Koilocytes** = Hallmark of HPV infection on Pap smear. * **Clue Cells** = Characteristic of Bacterial Vaginosis (Gardnerella vaginalis) on Pap smear. * **Actinomyces** = Often seen in Pap smears of women using Intrauterine Devices (IUDs). * **Bethesda System** is the standard nomenclature used for reporting Pap smear results.

Question 543: Trachelorrhaphy is:

A. Repair of trachea
B. Suture of the uterine cervix (Correct Answer)
C. Care of tracheostomy tube
D. Removal of foreign body from trachea

Explanation: **Explanation:** The term **Trachelorrhaphy** is derived from the Greek words *trachelos* (neck) and *rhaphe* (suture). In medical terminology, "trachelo-" refers to the neck of the uterus, which is the **cervix**. Therefore, trachelorrhaphy refers to the surgical repair or suturing of a torn or lacerated cervix. **Why Option B is Correct:** This procedure is typically performed to repair old cervical lacerations resulting from childbirth trauma or to treat a hypertrophied, elongated, or chronically inflamed cervix (often as part of a Fothergill’s operation for uterine prolapse). It involves denuding the edges of the cervical tear and suturing them to restore the anatomical integrity of the cervical canal. **Analysis of Incorrect Options:** * **Option A & D:** These options confuse the prefix *trachelo-* (cervix) with *trachea* (windpipe). Procedures involving the trachea use the prefix "tracheo-" (e.g., Tracheoplasty for repair or Tracheotomy for incision). * **Option C:** Care of a tracheostomy tube is a nursing/clinical procedure, not a surgical "rhaphy" (suture/repair). **NEET-PG High-Yield Pearls:** * **Trachelectomy:** Surgical removal of the cervix (often performed in early-stage cervical cancer to preserve fertility). * **Tracheloplasty:** Plastic repair or reshaping of the cervix. * **Clinical Correlation:** Chronic cervical tears can lead to **cervical incompetence**, a leading cause of mid-trimester abortions. While trachelorrhaphy repairs the anatomy, **Cervical Encirclage** (e.g., McDonald or Shirodkar procedure) is the specific treatment for incompetence during pregnancy. * **Terminology Tip:** Always distinguish between *Trachelo-* (Cervix) and *Tracheo-* (Trachea) to avoid common traps in surgical nomenclature.

Question 544: What is the most frequent symptom of adenomyosis?

A. Amenorrhea
B. Dysmenorrhea
C. Menorrhagia (Correct Answer)
D. Metrorrhagia

Explanation: **Explanation:** **Adenomyosis** is a condition characterized by the presence of ectopic endometrial glands and stroma within the myometrium. This leads to reactive hypertrophy and hyperplasia of the surrounding smooth muscle, resulting in a diffusely enlarged, "globular" uterus. **Why Menorrhagia is the correct answer:** **Menorrhagia (heavy menstrual bleeding)** is the most frequent symptom, occurring in approximately **40–60%** of cases. The underlying pathophysiology involves: 1. **Increased Endometrial Surface Area:** The enlarged uterus provides more surface area for bleeding. 2. **Impaired Myometrial Contractility:** The presence of ectopic tissue disrupts the normal rhythmic contractions of the myometrium that usually compress spiral arteries to limit blood loss. 3. **Increased Vascularity:** Elevated levels of prostaglandins and angiogenic factors in the adenomyotic tissue lead to increased vascular congestion. **Analysis of Incorrect Options:** * **Dysmenorrhea (Option B):** While very common (approx. 30%), it is the second most frequent symptom. It is typically "secondary" and "congestive" in nature. * **Amenorrhea (Option A):** Adenomyosis involves an excess of endometrial tissue; therefore, it causes increased bleeding, not the absence of menstruation. * **Metrorrhagia (Option D):** Irregular bleeding between periods is less common than heavy cyclic bleeding (menorrhagia) in isolated adenomyosis. **NEET-PG High-Yield Pearls:** * **Classic Triad:** Middle-aged multiparous woman + Menorrhagia + Secondary Dysmenorrhea. * **Physical Exam:** A **symmetrically enlarged, globular, and soft (boggy) uterus**, which may be tender pre-menstrually. * **Investigation of Choice:** MRI is the gold standard (shows thickening of the **Junctional Zone >12mm**), though Transvaginal Ultrasound (TVUS) is the initial investigation. * **Definitive Treatment:** Hysterectomy.

Question 545: Which of the following is NOT true regarding Hyskon used as a distending medium in hysteroscopy?

A. It is a thick and sticky liquid medium.
B. Hyskon coalesces with blood into globules while the medium remains clear.
C. It is miscible with blood.
D. It provides poor optical quality. (Correct Answer)

Explanation: **Explanation** Hyskon (32% Dextran 70) is a high-viscosity, non-electrolytic distending medium used in hysteroscopy. The question asks for the statement that is **NOT true**. **Why Option D is the Correct Answer:** Option D is incorrect because Hyskon actually provides **excellent optical quality**. Due to its high refractive index and high viscosity, it does not mix with blood. Instead, blood forms discrete globules that sink to the dependent portion of the uterus, leaving the medium crystal clear. This allows for superior visualization even when minor bleeding occurs during operative procedures. **Analysis of Incorrect Options:** * **Option A:** True. Hyskon is a **thick, sticky, and viscous** liquid. While this provides good distension, it requires meticulous cleaning of instruments after use to prevent the valves from seizing as the liquid dries. * **Option B & C:** Option B is true, and Option C is false (making it a true statement about Hyskon's properties). Hyskon is **immiscible with blood**. It does not mix; rather, blood coalesces into globules, maintaining a clear field of vision. **High-Yield Clinical Pearls for NEET-PG:** * **Complications:** The most serious risk associated with Hyskon is **anaphylaxis** (rare but life-threatening). Other risks include fluid overload and **non-cardiogenic pulmonary edema** if more than 500 ml is absorbed. * **Volume Limit:** Absorption should be strictly monitored; the procedure should be stopped if the deficit exceeds **500 ml**. * **Contraindication:** It should not be used in patients with a known allergy to Dextran or in cases of active pelvic infection.

Question 546: A 26-year-old female with a history of tuberculosis underwent hysterosalpingogram for infertility investigation. If she had developed genital tuberculosis, which genital organ is most commonly affected?

A. Cervix
B. Ovary
C. Fallopian tube (Correct Answer)
D. Vagina

Explanation: **Explanation:** Genital tuberculosis (TB) is a significant cause of infertility in developing countries, typically occurring secondary to a primary focus elsewhere (usually pulmonary) via hematogenous spread. **1. Why the Fallopian Tube is Correct:** The **fallopian tube** is the most commonly affected organ in female genital tuberculosis, involved in **90-100% of cases**. The infection usually starts in the endosalpinx and leads to characteristic findings such as "beaded tubes," "tobacco pouch appearance," or "lead pipe" rigidity. Tubal involvement is almost always bilateral, leading to tubal factor infertility. **2. Why the Other Options are Incorrect:** * **Cervix (5-15%):** The cervix is less commonly involved. When affected, it may present with hypertrophic or ulcerative lesions that can mimic cervical malignancy. * **Ovary (20-30%):** Ovarian involvement is usually secondary to direct extension from the tubes (perioophoritis). Primary ovarian TB is rare. * **Vagina (1-2%):** The vagina and vulva are the least common sites for genital TB due to the protective acidic environment and stratified squamous epithelium. **High-Yield Clinical Pearls for NEET-PG:** * **Order of Frequency:** Fallopian Tubes (100%) > Endometrium (50-60%) > Ovaries (20-30%) > Cervix (5-15%) > Vagina/Vulva (1-2%). * **Gold Standard Diagnosis:** Endometrial biopsy/aspirate for Histopathology (showing acid-fast bacilli or caseating granulomas) and Culture (MGIT/Bactec). * **HSG Findings:** "Beaded tube" appearance, "Golf-hole" ostia, and "Lead pipe" tubes. * **Schiffer’s Sign:** A characteristic finding on HSG where there is calcification of the pelvic lymph nodes or tubes.

Question 547: Which of the following is LEAST likely to increase the risk for ectopic pregnancy?

A. Prior pelvic infection
B. Prior ectopic pregnancy
C. Prior hydatidiform mole (Correct Answer)
D. Current assisted reproductive technology use

Explanation: **Explanation:** The core pathophysiology of ectopic pregnancy involves factors that delay or prevent the passage of the fertilized ovum through the fallopian tube to the uterine cavity. **Why Option C is Correct:** A **prior hydatidiform mole** is a gestational trophoblastic disease characterized by abnormal proliferation of trophoblasts. While it increases the risk for recurrent moles or choriocarcinoma, it does **not** cause structural damage to the fallopian tubes or alter ciliary motility. Therefore, it has no established association with an increased risk of ectopic pregnancy. **Why Incorrect Options are Wrong:** * **Prior Pelvic Infection (Option A):** This is the most common risk factor. Pelvic Inflammatory Disease (PID), especially due to *Chlamydia trachomatis*, causes endosalpingeal scarring, loss of ciliary action, and tubal adhesions, physically obstructing the embryo's path. * **Prior Ectopic Pregnancy (Option B):** A history of ectopic pregnancy increases the risk of recurrence by approximately 10-fold (15% risk after one, 25% after two). This is due to underlying tubal pathology or damage from previous conservative surgery (salpingostomy). * **Assisted Reproductive Technology (Option C):** ART (IVF/ET) increases the risk of both ectopic and heterotopic pregnancies. Factors include the volume of transfer media, the technique of embryo placement, and the underlying tubal factor infertility often present in these patients. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla (70%). * **Most common risk factor:** Previous PID. * **Highest risk factor (Odds Ratio):** Previous tubal surgery. * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Arias-Stella Reaction:** Hypersecretory endometrium on biopsy, which can be seen in ectopic pregnancy (not diagnostic).

Question 548: What anatomical structure is visualized by a colposcope?

A. Vagina
B. Uterus
C. Cervix (Correct Answer)
D. Uterine tubes

Explanation: **Explanation:** A **colposcope** is a specialized binocular microscope with a light source used to provide a magnified and illuminated view of the **cervix**, vagina, and vulva. Its primary clinical utility lies in the screening and diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer following an abnormal Pap smear. **Why the Correct Answer is Right:** The cervix is the primary target of colposcopy. The procedure allows the clinician to visualize the **Transformation Zone (TZ)** and the **Squamocolumnar Junction (SCJ)**—the areas most susceptible to HPV-mediated oncogenesis. By applying 3–5% acetic acid (which turns dysplastic cells white) or Lugol’s iodine (Schiller’s test), clinicians can identify suspicious areas for targeted biopsy. **Why Other Options are Incorrect:** * **Vagina (A):** While the vagina is visualized during the process (vaginoscopy), the primary diagnostic intent of a standard colposcopic exam is the cervix. * **Uterus (B):** The internal cavity of the uterus is visualized using a **Hysteroscope**, not a colposcope. * **Uterine tubes (D):** The fallopian tubes are internal pelvic structures visualized via **Laparoscopy** or **Salpingoscopy**. **High-Yield Clinical Pearls for NEET-PG:** * **Magnification:** Typically ranges from 6x to 40x. * **Green Filter:** Used to enhance the visualization of abnormal vascular patterns (e.g., punctations, mosaicism, or atypical vessels) which indicate high-grade lesions. * **Indications:** Abnormal Pap smear, positive high-risk HPV DNA test, or a clinically suspicious-looking cervix. * **Reid Colposcopic Index:** A scoring system used to predict the histological severity of cervical lesions based on color, margins, vessels, and iodine staining.

Question 549: A 28-year-old female with a history of 8 weeks of amenorrhea complains of vaginal bleeding and lower abdominal pain. On ultrasound examination, there is a gestational sac with an absent fetal pole. What is the diagnosis?

A. Ectopic pregnancy
B. Incarcerated abortion (Correct Answer)
C. Threatened abortion
D. Corpus luteum cyst

Explanation: ### Explanation **Correct Answer: B. Incarcerated abortion** **Medical Concept:** The term **Incarcerated abortion** (also known as a **Missed abortion**) refers to a clinical scenario where the products of conception are retained within the uterus after the death of the embryo or fetus. In this case, the ultrasound finding of a **gestational sac with an absent fetal pole** (at 8 weeks) is diagnostic of an **anembryonic pregnancy** (blighted ovum), a subtype of missed abortion. The clinical presentation of vaginal bleeding and pain indicates that the body is beginning to recognize the non-viable pregnancy, but the products remain "incarcerated" or trapped within the closed cervical os. **Why other options are incorrect:** * **A. Ectopic pregnancy:** While it presents with pain and bleeding, ultrasound would typically show an empty uterus and an adnexal mass rather than an intrauterine gestational sac. * **C. Threatened abortion:** In a threatened abortion, the pregnancy is still viable. Ultrasound would demonstrate a fetal pole with cardiac activity. * **D. Corpus luteum cyst:** This is a physiological finding in early pregnancy. While it can cause pain if it ruptures or undergoes torsion, it does not explain the ultrasound finding of an empty gestational sac at 8 weeks. **NEET-PG High-Yield Pearls:** * **Blighted Ovum (Anembryonic Pregnancy):** Diagnosed when the Mean Sac Diameter (MSD) is **>25 mm** without a visible embryo on Transvaginal Scan (TVS). * **Missed Abortion Criteria:** Absence of cardiac activity in an embryo with a Crown-Rump Length (CRL) of **>7 mm**. * **Management:** Options include expectant management, medical evacuation (Misoprostol), or surgical Suction & Evacuation (S&E). * **Complication:** If a missed abortion is retained for >4 weeks, there is a risk of **Disseminated Intravascular Coagulation (DIC)** due to the release of thromboplastin from macerated fetal tissues.

Question 550: What is the clinical diagnosis when a pregnant woman presents with bloody vaginal discharge through a closed cervical os during the first 20 weeks?

A. Threatened abortion (Correct Answer)
B. Complete abortion
C. Incomplete abortion
D. Preterm labor

Explanation: ### Explanation **Correct Answer: A. Threatened Abortion** **Medical Concept:** Threatened abortion is defined as vaginal bleeding occurring before the 20th week of gestation where the **cervical os remains closed**. It is a clinical diagnosis indicating that the pregnancy is at risk, but the products of conception have not been expelled. The hallmark features are painless or mildly painful bleeding with a closed internal os and a viable fetus on ultrasound. **Why the other options are incorrect:** * **B. Complete Abortion:** In this case, all products of conception have been expelled. The cervix has usually closed *after* the event, the uterus is smaller than the period of gestation, and ultrasound shows an empty cavity. * **C. Incomplete Abortion:** This involves the partial expulsion of products. Crucially, the **cervical os is open**, and some tissue remains within the uterus, often leading to heavy bleeding and crampy pain. * **D. Preterm Labor:** This refers to the onset of labor (regular contractions and cervical changes) occurring after the age of viability (typically >20–24 weeks) but before 37 weeks. The question specifies the first 20 weeks. **NEET-PG High-Yield Pearls:** * **Management:** The mainstay of treatment for threatened abortion is **expectant management** and bed rest (though evidence for bed rest is limited). Progesterone supplementation is often used if a deficiency is suspected. * **Prognosis:** Approximately 50% of threatened abortions progress to actual loss; however, if fetal heart activity is seen on USG, there is a >90% chance of the pregnancy continuing. * **Cervical Os Status:** This is the "deciding factor" in abortion questions. * **Closed Os:** Threatened or Missed abortion. * **Open Os:** Inevitable or Incomplete abortion.

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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