Gynecological Disorders Practice Questions

Q: Which of the following is NOT true regarding adenomyosis?

Progestins are the treatment of choice.. **Explanation** Adenomyosis is a condition characterized by the presence of endometrial glands and stroma within the myometrium, leading to reactive hypertrophy of the surrounding muscle. **Why Option C is the correct answer (The "Not True" statement):** While progestins (like the LNG-IUS) can help alleviate symptoms, they are **not the treatment of choice**. The definitive treatment for adenomyosis is **hysterectomy**. Unlike endometriosis, adenomyosis is often diffuse and deep within the myometrium, making medical management or conservative surgery (like adenomyomectomy) less effective. **Analysis of Incorrect Options:** * **Option A:** This is the classic clinical triad. Menorrhagia occurs due to increased endometrial surface area and impaired uterine contractility; dysmenorrhea is typically "secondary" and congestive; the uterus is characteristically **globular and symmetrically enlarged** (rarely exceeding 12–14 weeks size). * **Option B:** Adenomyosis is classically seen in **multiparous women** in their 40s and 50s. It is hypothesized that pregnancy and labor facilitate the invagination of the basal endometrium into the myometrium. * **Option D:** On Transvaginal Ultrasound (TVS), "lakes" or anechoic lacunae represent small areas of hemorrhage or glandular secretions within the myometrium. Other findings include an asymmetrical myometrial wall and "venetian blind" shadowing. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Histopathology (after hysterectomy). * **MRI Findings:** Thickening of the **Junctional Zone (JZ) >12 mm** is diagnostic. * **Physical Exam:** The uterus is often described as "soft" or "boggy" and tender during menstruation (Halban’s sign). * **Distinction:** Unlike fibroids, adenomyosis has ill-defined margins and no true capsule.

Q: What is the commonest manifestation of endometriosis?

Pain. **Explanation:** Endometriosis is defined as the presence of functional endometrial tissue (stroma and glands) outside the uterine cavity. **Why Pain is the Correct Answer:** Pain is the **most common clinical manifestation** of endometriosis, affecting approximately 70–80% of symptomatic patients. The pain is typically chronic and cyclic, mediated by the inflammatory response of ectopic tissue to hormonal fluctuations. It classically presents as a "triad" of symptoms: 1. **Dysmenorrhea:** Specifically secondary, congestive dysmenorrhea (starts before menses). 2. **Dyspareunia:** Deep-seated pain during intercourse, often due to involvement of the pouch of Douglas or uterosacral ligaments. 3. **Chronic Pelvic Pain:** Non-cyclic pain lasting >6 months. **Analysis of Incorrect Options:** * **Infertility (A):** While endometriosis is a leading cause of infertility (found in 30–50% of infertile women), it is not as frequent a presenting complaint as pain. * **Bleeding (C):** Abnormal uterine bleeding (AUB) or menorrhagia occurs in about 15–20% of cases, often due to associated adenomyosis or ovarian dysfunction, but it is not the hallmark symptom. * **Leukorrhea (D):** This refers to excessive white vaginal discharge, which is typically associated with infections (vaginitis) or physiological changes, not endometriosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Diagnostic Laparoscopy (Visual confirmation + Biopsy). * **Commonest Site:** Ovary (often presenting as a "Chocolate Cyst" or Endometrioma). * **Classic Sign:** Fixed retroverted uterus and tender nodules in the Pouch of Douglas (POD). * **Serum Marker:** CA-125 (used for monitoring recurrence, not for primary diagnosis).

Q: What is the most common route of transmission of endometrial tuberculosis?

Retrograde spread. **Explanation:** Genital tuberculosis (TB) is almost always secondary to a primary focus elsewhere in the body (usually the lungs). Understanding the sequence of spread is crucial for NEET-PG: 1. **The Correct Answer (C):** While the initial spread from the lungs to the pelvic organs (specifically the fallopian tubes) occurs via the **hematogenous route**, the transmission to the **endometrium** specifically occurs via **retrograde spread** (descending spread) from the fallopian tubes. In 90-100% of cases, the fallopian tubes are affected first. The infection then tracks down the mucosa to involve the endometrium in about 50-60% of cases. 2. **Why other options are incorrect:** * **Hematogenous spread (D):** This is the most common route for the *initial* infection of the genital tract (seeding the fallopian tubes from the lungs), but not the specific route for endometrial involvement. * **Lymphatic spread (B):** This is less common and usually occurs from abdominal nodes or the primary intestinal complex. * **Direct local spread (A):** This occurs rarely from adjacent infected organs like the bladder or bowel (e.g., tuberculous peritonitis). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site** of Genital TB: Fallopian Tubes (90-100%), followed by Endometrium (50-60%), and Ovaries (20-30%). * **Classic Presentation:** Infertility (most common symptom) and menstrual irregularities (amenorrhea or oligomenorrhea due to endometrial synechiae/Asherman’s syndrome). * **Hysterosalpingography (HSG) findings:** "Beaded tube," "Lead pipe appearance," or "Tobacco pouch" appearance. * **Gold Standard Diagnosis:** Endometrial biopsy/histopathology showing caseating granulomas or TB-PCR/Culture.

Q: Lichen sclerosus lesions are typically limited by which anatomical structure?

Labia majora. **Explanation:** Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that primarily affects the anogenital skin. The hallmark of this condition is that it **only involves keratinized squamous epithelium**. **Why Labia Majora is the correct answer:** Lichen sclerosus typically presents in a "figure-of-eight" or "hourglass" distribution, involving the vulva and the perianal area. The lesions are anatomically restricted to the **keratinized skin** of the vulva, which includes the labia majora, labia minora, and clitoral hood. It characteristically stops at the transition zone where the skin meets the non-keratinized mucous membranes. **Analysis of Incorrect Options:** * **Vagina & Cervix (Options A & B):** These structures are lined by **non-keratinized stratified squamous epithelium** (vagina) and columnar/squamous epithelium (cervix). Lichen sclerosus **never** involves the vagina. This is a crucial clinical differentiator from Lichen Planus, which frequently involves the vaginal mucosa. * **Labia Minora (Option C):** While the labia minora are frequently affected (often leading to resorption or "agglutination"), they do not represent the anatomical limit of the disease. The disease extends laterally to the labia majora and posteriorly to the anus. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** "Parchment-like" or "Cigarette paper" skin, pruritus, and porcelain-white plaques. * **Key Histology:** Hyperkeratosis, thinning of the epidermis (atrophy), and subepithelial **hyalinization** (homogenization of collagen). * **Treatment:** First-line therapy is **High-potency topical steroids** (e.g., Clobetasol propionate). * **Malignancy Risk:** There is a 3–5% lifetime risk of progression to **Squamous Cell Carcinoma (SCC)** of the vulva. Regular follow-up is mandatory.

Q: What is the classic mode of spread of gonococcus infection in pelvic inflammatory disease (PID)?

Direct spread (continuity). ### Explanation **Correct Answer: A. Direct spread (continuity)** The classic mode of spread for *Neisseria gonorrhoeae* in Pelvic Inflammatory Disease (PID) is **mucosal or canalicular spread**. The bacteria ascend from the lower genital tract (cervix) to the upper genital tract (endometrium, fallopian tubes, and pelvic peritoneum) by traveling along the continuous mucosal surfaces. This is often facilitated by the breakdown of the cervical mucus barrier during menstruation or by attaching to sperm, which act as vehicles for transport. **Why the other options are incorrect:** * **Option B:** While the infection eventually involves adjacent organs (like the ovaries), this is a consequence of the initial direct mucosal ascent rather than the primary "mode of spread." * **Option C:** Hematogenous spread is rare for PID. It is characteristic of **Genital Tuberculosis**, which typically reaches the fallopian tubes via the bloodstream from a primary pulmonary focus. * **Option D:** Lymphatic spread and spread via pelvic veins are the hallmark of **Puerperal Sepsis** (post-abortal or postpartum infections). In these cases, the infection spreads through the parametrium and pelvic cellular tissues rather than the mucosal lining. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of PID:** Fallopian tubes (Salpingitis). * **Gold Standard Diagnosis:** Laparoscopy (shows tubal erythema and edema). * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving peri-hepatitis, characterized by "violin-string" adhesions between the liver capsule and the parietal peritoneum. * **Chlamydia vs. Gonorrhea:** *Chlamydia trachomatis* is the most common cause of PID overall, but *N. gonorrhoeae* typically presents with more acute and severe clinical symptoms.

Q: All of the following are true about Bacterial vaginosis except?

Vaginal pH is typically less than 4.5.. **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacillus* species with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Prevotella*). **1. Why Option A is the Correct Answer (False Statement):** In a healthy vaginal ecosystem, *Lactobacilli* maintain an acidic environment with a **pH 4.5)**. Therefore, a pH less than 4.5 is inconsistent with a diagnosis of BV. **2. Analysis of Other Options:** * **Option B (Nugent Scoring):** This is the **gold standard** for diagnosing BV. It is a Gram stain scoring system (0–10) that quantifies the relative concentration of *Lactobacilli* (large Gram-positive rods) versus *Gardnerella/Bacteroides* (small Gram-variable/negative rods). * **Option C (Whiff Test):** When 10% KOH is added to the discharge, it volatilizes amines (putrescine and cadaverine) produced by anaerobes, resulting in a characteristic "fishy odor." * **Option D (Clue Cells):** These are vaginal epithelial cells coated with coccobacilli, giving them a "stippled" or "shaggy" appearance. They are the most reliable microscopic predictor of BV. **Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (Need 3 out of 4 for diagnosis):** 1. Homogeneous, thin, white-grey discharge. 2. Vaginal pH > 4.5. 3. Positive Whiff test (amine odor). 4. Presence of Clue cells (> 20% of epithelial cells). * **Treatment:** Oral or topical **Metronidazole** is the drug of choice (safe in pregnancy). * **Note:** BV is not considered a classic STI; therefore, routine treatment of the male partner is not recommended.

Question 1

A 30-year-old female presents to the gynecology OPD with complaints of recurrent abortions and menorrhagia. Her USG showed two subserosal fibroids of 3 x 4 cm each on the anterior wall of the uterus and fundus. What is the best line of management?

Accepted Answer

Myomectomy

Answer

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Answer

Myolysis

Answer

Uterine artery embolisation

Question 2

Regarding the use of lasers in gynecology, all are true EXCEPT:

Accepted Answer

Laser hysteroscopy for presacral neurectomy

Answer

Management of CIN, VIN, VAIN

Answer

Laser laparoscopy for ectopic pregnancy

Answer

It acts by tissue cutting, vaporization, or coagulation

Question 3

Which of the following is NOT true regarding adenomyosis?

Accepted Answer

Progestins are the treatment of choice.

Answer

Presents with menorrhagia, dysmenorrhea, and an enlarged uterus.

Answer

More common in multiparous women.

Answer

'Lakes' of endometrial collection are seen in the myometrium on ultrasound.

Question 4

All of the following are advantages of laparoscope assisted vaginal hysterectomy (LAVH) over abdominal hysterectomy except?

Accepted Answer

Scope for wide exploration of the abdominal and pelvic organs

Answer

Less peritoneal adhesions postoperatively

Answer

Shorter hospital stay

Answer

Less postoperative pain

Question 5

What is the commonest manifestation of endometriosis?

Accepted Answer

Pain

Answer

Infertility

Answer

Bleeding

Answer

Leukorrhea

Question 6

What is the most common route of transmission of endometrial tuberculosis?

Accepted Answer

Retrograde spread

Answer

Direct local spread

Answer

Lymphatic spread

Answer

Hematogenous spread

Question 7

Lichen sclerosus lesions are typically limited by which anatomical structure?

Accepted Answer

Labia majora

Answer

Vagina

Answer

Cervix

Answer

Labia minora

Question 8

What is the classic mode of spread of gonococcus infection in pelvic inflammatory disease (PID)?

Accepted Answer

Direct spread (continuity)

Answer

Spread to adjacent organs

Answer

Hematogenous spread (bloodstream)

Answer

Lymphatic spread and via pelvic veins

Question 9

All of the following are true about Bacterial vaginosis except?

Accepted Answer

Vaginal pH is typically less than 4.5.

Answer

Nugent scoring can be used for diagnosis.

Answer

A fishy odor is noted after the addition of potassium hydroxide (KOH) to vaginal discharge.

Answer

The presence of clue cells is pathognomic.

Question 10

A 26-year-old woman experiences the sudden onset of left-sided lower abdominal pain with radiation to the back, pelvis, and thigh. Following a negative test for pregnancy, abdominal radiography shows an enlarged left ovary with multiple calcifications. Laparoscopy reveals adnexal torsion and an ovarian tumor. Ovariectomy is performed. The tumor is most likely?

Accepted Answer

Dermoid cyst.

Answer

Granulosa cell tumor.

Answer

Brenner tumor.

Answer

Serous cystadenoma.

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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