Gynecological Disorders Practice Questions

Q: Pelvic inflammatory disease is caused by all except?

Leprosy. **Explanation:** Pelvic Inflammatory Disease (PID) is an infection-induced inflammation of the upper female reproductive tract. While most cases are caused by sexually transmitted pathogens (like *N. gonorrhoeae* and *C. trachomatis*), certain non-venereal and systemic conditions can also involve the pelvic organs. **Why Leprosy is the Correct Answer:** **Leprosy (*Mycobacterium leprae*)** primarily affects the skin, peripheral nerves, and upper respiratory tract mucosa. It does **not** involve the female internal genital tract or cause PID. Therefore, it is the "except" in this list. **Analysis of Other Options:** * **Schistosomiasis:** *Schistosoma haematobium* can cause "Female Genital Schistosomiasis." The parasite can lodge in the cervix, fallopian tubes, and ovaries, leading to chronic inflammation, granuloma formation, and clinical features indistinguishable from PID. * **Crohn’s Disease:** This is a common cause of **secondary PID**. Due to the proximity of the bowel to the adnexa, transmural inflammation or fistulous tracts from the intestines can spread directly to the fallopian tubes and ovaries. * **Syphilis:** While primarily known for chancres and systemic spread, *Treponema pallidum* can involve the pelvic organs during secondary or tertiary stages, and it is traditionally categorized among the infectious causes of pelvic inflammatory changes. **NEET-PG High-Yield Pearls:** * **Most common cause of PID:** *Chlamydia trachomatis* (often subclinical/silent) followed by *Neisseria gonorrhoeae* (more acute presentation). * **Actinomycosis:** Frequently associated with long-term **IUD use**. * **Tuberculous PID:** A major cause of infertility in developing countries; usually spreads via the **hematogenous route**. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving peri-hepatitis ("violin-string" adhesions).

Q: Simple hyperplasia of the endometrium is treated with progesterone for how many days?

21. **Explanation:** Endometrial hyperplasia without atypia (Simple Hyperplasia) is primarily caused by **unopposed estrogen** stimulation. The goal of treatment is to counteract this effect using progestogens, which induce secretory changes in the endometrium, leading to its thinning and eventual shedding. **Why 21 days is correct:** For the medical management of simple hyperplasia, the standard protocol involves cyclic progestogen therapy (e.g., Medroxyprogesterone acetate 10mg). It is typically administered for **21 days per month** (usually from Day 5 to Day 25 of the cycle) for a duration of 3 to 6 months. This extended duration is necessary to ensure adequate transformation of the proliferative endometrium and to prevent progression to atypia or malignancy. **Analysis of incorrect options:** * **10 & 14 days:** While a 10–14 day course of progesterone is often used to induce a withdrawal bleed in cases of secondary amenorrhea or PCOS, it is considered **insufficient** for the therapeutic reversal of established endometrial hyperplasia. * **5 days:** This duration is too short to achieve any significant histological change in the endometrial lining and is clinically ineffective for hyperplasia. **High-Yield NEET-PG Pearls:** * **Gold Standard Treatment:** For hyperplasia *without* atypia, the **Levonorgestrel Intrauterine System (LNG-IUS)** is now considered the first-line treatment due to higher regression rates compared to oral progestogens. * **Atypical Hyperplasia:** This is a premalignant condition. In postmenopausal women or those who have completed their family, the treatment of choice is **Total Abdominal Hysterectomy**. * **Follow-up:** Patients on medical management require a repeat endometrial biopsy every 3–6 months until two consecutive negative results are obtained.

Q: In which stage of Pelvic Inflammatory Disease (PID) is acute salpingitis with peritonitis considered?

Stage 2. The classification of Pelvic Inflammatory Disease (PID) is based on the **Monif Staging System**, which categorizes the severity and anatomical extent of the infection. ### **Explanation of the Correct Answer** * **Stage 2 (Acute Salpingitis with Peritonitis):** In this stage, the infection has progressed beyond the fallopian tubes (salpingitis) to involve the pelvic peritoneum. The presence of pelvic peritonitis indicates that inflammatory exudate has leaked from the fimbrial ends of the tubes, causing localized irritation of the peritoneal lining. ### **Analysis of Incorrect Options** * **Stage 1 (Acute Salpingitis without Peritonitis):** The infection is limited to the fallopian tubes. There is no spread to the pelvic peritoneum or surrounding structures. * **Stage 3 (Acute Salpingitis with Tubo-ovarian Abscess):** This stage is characterized by the formation of a palpable inflammatory mass involving the tube and ovary (Tubo-ovarian Abscess or TOA). * **Stage 4 (Ruptured Tubo-ovarian Abscess):** This is a surgical emergency where the abscess ruptures, leading to generalized peritonitis and potential septic shock. * **Stage 5:** There is no Stage 5 in the standard Monif classification for PID. ### **NEET-PG High-Yield Pearls** * **Gold Standard Diagnosis:** Laparoscopy (shows tubal edema and purulent exudate). * **Most Common Organisms:** *Chlamydia trachomatis* (most common overall) and *Neisseria gonorrhoeae*. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving peri-hepatitis ("violin-string" adhesions between the liver capsule and parietal peritoneum). * **Treatment:** CDC guidelines recommend Ceftriaxone (IM) + Doxycycline (Oral) + Metronidazole (Oral) for outpatient management.

Q: What is the most important structure preventing uterine prolapse?

Cardinal ligament. **Explanation:** The pelvic organs are supported by a complex network of ligaments and the pelvic floor musculature. The primary support of the uterus is divided into three tiers, with the **Cardinal ligament (Mackenrodt’s ligament)** being the most critical. **1. Why Cardinal Ligament is Correct:** The Cardinal ligaments are thick bands of connective tissue located at the base of the broad ligament, extending from the supravaginal portion of the cervix and lateral vaginal fornices to the pelvic side walls. They provide the **primary lateral support** to the uterus, keeping the cervix in a central position and preventing downward protrusion (prolapse). **2. Analysis of Incorrect Options:** * **Round Ligament:** Its primary function is to maintain the uterus in an **anteverted (AV)** and **anteflexed (AF)** position. It does not provide significant vertical support; hence, its laxity leads to retroversion, not prolapse. * **Broad Ligament:** This is a double fold of peritoneum. It is a weak structure that primarily acts as a "cloak" for the adnexa and does not contribute significantly to uterine support. * **Uterosacral Ligament:** While these provide important **posterior support** and pull the cervix backward to maintain anteversion, they are considered secondary to the cardinal ligaments in preventing descent. **NEET-PG High-Yield Pearls:** * **Primary Support (Level 1):** Cardinal and Uterosacral ligaments. * **Secondary Support (Level 2):** Levator ani muscle (specifically the Pubococcygeus part) and pelvic fascia. * **Most important muscular support:** Levator ani. * **Most important ligamentous support:** Cardinal ligament. * **Uterine Position:** Maintained by the Round ligament (AV/AF).

Q: A 31-year-old woman presents to the emergency department because of two days of abdominal pain without vaginal bleeding. Pelvic examination reveals a closed cervical os and right adnexal pain. The serum beta hCG level is 9,000 mIU/mL. An endovaginal ultrasound demonstrates no intrauterine gestational sac. Which of the following is the most likely diagnosis?

Ectopic pregnancy. **Explanation:** The diagnosis of **Ectopic Pregnancy** is established based on the concept of the **Discriminatory Zone**. This is the serum $\beta$-hCG level above which a gestational sac should be visible on ultrasound in a normal intrauterine pregnancy (IUP). 1. **Why it is correct:** For transvaginal sonography (TVS), the discriminatory zone is typically **1,500–2,000 mIU/mL**. In this patient, the $\beta$-hCG is significantly elevated at **9,000 mIU/mL**, yet the ultrasound shows an empty uterus. The combination of a positive pregnancy test, abdominal pain, adnexal tenderness, and the absence of an intrauterine sac despite high $\beta$-hCG levels is pathognomonic for an ectopic pregnancy. 2. **Why other options are incorrect:** * **Incomplete Abortion:** This would typically present with vaginal bleeding and an **open cervical os** on examination. Ultrasound would show retained products of conception within the uterus. * **Ovarian Torsion:** While it causes acute pelvic pain and adnexal tenderness, it does not explain the elevated $\beta$-hCG level. * **Ruptured Ovarian Cyst:** This can cause sudden pain and peritoneal irritation, but like torsion, it is unrelated to a positive pregnancy test unless it is a ruptured corpus luteum of pregnancy (which would usually still show an IUP). **NEET-PG High-Yield Pearls:** * **Most common site:** Ampulla of the Fallopian tube. * **Most common site for rupture:** Isthmus (due to narrow lumen). * **Gold Standard Diagnosis:** Laparoscopy. * **Medical Management (Methotrexate) Criteria:** Hemodynamically stable, $\beta$-hCG < 5,000 mIU/mL, mass < 3.5–4 cm, and no fetal heart activity.

Question 1

What is the definitive treatment of choice for adenomyosis?

Accepted Answer

Hysterectomy

Answer

Hormone therapy

Answer

Cryotherapy

Answer

Curettage

Question 2

Endometrial hyperplasia is caused by:

Accepted Answer

Estrogen

Answer

Smoking

Answer

Ovulation-inducing drugs

Answer

Asherman's syndrome

Question 3

Pelvic inflammatory disease is caused by all except?

Accepted Answer

Leprosy

Answer

Schistosomiasis

Answer

Crohn's disease

Answer

Syphilis

Question 4

A patient in shock is diagnosed with ectopic pregnancy in the right fallopian tube. What is the postulated cause of fetal death in ectopic pregnancy?

Accepted Answer

Vascular accident

Answer

Nutritional adequacy

Answer

Endocrine insufficiency

Answer

Immune response of mother

Question 5

Simple hyperplasia of the endometrium is treated with progesterone for how many days?

Accepted Answer

21

Answer

14

Answer

5

Answer

10

Question 6

In which stage of Pelvic Inflammatory Disease (PID) is acute salpingitis with peritonitis considered?

Accepted Answer

Stage 2

Answer

Stage 3

Answer

Stage 4

Answer

Stage 5

Question 7

What is the most important structure preventing uterine prolapse?

Accepted Answer

Cardinal ligament

Answer

Round ligament

Answer

Broad ligaments

Answer

Uterosacral ligament

Question 8

In a newborn, the vagina is lined by which epithelium?

Accepted Answer

Transitional

Answer

Squamous

Answer

Columnar

Answer

Stratified

Question 9

A 31-year-old woman presents to the emergency department because of two days of abdominal pain without vaginal bleeding. Pelvic examination reveals a closed cervical os and right adnexal pain. The serum beta hCG level is 9,000 mIU/mL. An endovaginal ultrasound demonstrates no intrauterine gestational sac. Which of the following is the most likely diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

Incomplete abortion

Answer

Ovarian torsion

Answer

Ruptured ovarian cyst

Question 10

What is the procedure of choice for diagnosing uterus didelphys?

Accepted Answer

Ultrasonography (USG)

Answer

Laparoscopy

Answer

Intravenous pyelography (IVP)

Answer

Hysterosalpingography (HSG)

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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