Gynecological Disorders Practice Questions

Q: Lutein cysts are associated with all except?

Use of oral contraceptive pills. **Explanation:** The correct answer is **D. Use of oral contraceptive pills.** **Medical Concept:** Lutein cysts (specifically **Theca Lutein Cysts**) are functional ovarian cysts caused by **excessive stimulation of the ovaries by high levels of Human Chorionic Gonadotropin (hCG)** or hypersensitivity to gonadotropins. Oral contraceptive pills (OCPs) actually **suppress** the hypothalamic-pituitary-ovarian axis, reducing FSH and LH levels and preventing ovulation. Therefore, OCPs are used to *prevent* functional cysts rather than cause them. **Analysis of Options:** * **A. Gestational Trophoblastic Tumors:** Conditions like Hydatidiform mole or Choriocarcinoma produce massive amounts of hCG, which leads to the hyperplasia of theca interna cells and the formation of multiple theca lutein cysts. * **B. Clomiphene Administration:** Clomiphene citrate is an ovulation-inducing agent. It increases endogenous gonadotropins, which can lead to ovarian hyperstimulation and the development of lutein cysts. * **C. Bilaterality:** A hallmark feature of theca lutein cysts is that they are almost always **bilateral and multiple**. They give the ovary a "soap bubble" appearance on ultrasound. **Clinical Pearls for NEET-PG:** * **Hyperreactio Luteinalis:** This is a benign condition where bilateral theca lutein cysts occur during a normal singleton pregnancy (usually in the third trimester) due to increased sensitivity to hCG. * **Management:** Theca lutein cysts are physiological. They usually **regress spontaneously** once the source of hCG is removed (e.g., evacuation of a mole or delivery). Surgery is only indicated in cases of torsion or rupture. * **Triad of Ovarian Hyperstimulation Syndrome (OHSS):** Bilateral theca lutein cysts, ascites, and hemoconcentration.

Q: What is the management of choice for a 30-year-old multipara presenting with uterine prolapse?

Fothergill's repair with tubal ligation. **Explanation:** The management of uterine prolapse depends on three key factors: the patient's age, her desire for future fertility, and the completion of her family. **Why Option B is Correct:** The patient is a **30-year-old multipara**. In young women who wish to preserve their uterus (avoid hysterectomy), the **Fothergill’s operation** (Manchester operation) is the treatment of choice. It involves cervical amputation and plication of the Mackenrodt’s (cardinal) ligaments to provide support. Since she is a multipara and likely has completed her family, **tubal ligation** is added to prevent future pregnancies. This is crucial because cervical amputation increases the risk of mid-trimester abortions and cervical dystocia in subsequent pregnancies. **Analysis of Incorrect Options:** * **A. Fothergill's repair:** While correct in technique, in a multipara who has completed her family, concurrent sterilization (tubal ligation) is the standard of care to avoid obstetric complications. * **C. Sling operation:** These (e.g., Shirodkar or Purandare sling) are preferred for **nulliparous** women or young women who specifically desire **future childbearing**, as they do not involve cervical amputation. * **D. Vaginal hysterectomy:** This is the treatment of choice for women **above 40 years** or those who have completed their family and do not wish to preserve the uterus (Ward-Mayo’s operation). **NEET-PG High-Yield Pearls:** * **Manchester Operation Components:** Dilatation and Curettage (D&C), Amputation of the cervix, Plication of Mackenrodt’s ligaments, and Anterior/Posterior Colporrhaphy. * **Contraindication:** Fothergill’s is contraindicated in cases of procidentia (4th-degree prolapse) or if there is suspected uterine pathology. * **Key Landmark:** The cardinal ligaments (Mackenrodt’s) are the primary support of the uterus.

Q: A "beaded" appearance of the fallopian tube on hysterosalpingography (HSG) is typically seen in which condition?

Tuberculosis (TB). **Explanation:** The correct answer is **Tuberculosis (TB)**. Genital Tuberculosis is a major cause of infertility in developing countries, and the fallopian tubes are affected in almost 90-100% of cases. **Why Tuberculosis is correct:** The "beaded" appearance on HSG is a classic radiological sign of **Tuberculous Salpingitis**. It occurs due to multiple strictures and segments of scarring along the fallopian tube, interspersed with small pockets of contrast. As the disease progresses, the tubes may also show a "lead pipe" appearance (rigid tubes) or a "tobacco pouch" appearance (due to fimbrial phimosis). **Why other options are incorrect:** * **Chlamydia and Gonococcal infections:** These are common causes of Pelvic Inflammatory Disease (PID). While they lead to tubal damage, they typically present on HSG as **hydrosalpinx** (dilated, fluid-filled tubes) or complete tubal occlusion, rather than the specific beaded pattern of granulomatous inflammation. * **Syphilis:** This is primarily a systemic and ulcerative disease. It rarely involves the fallopian tubes and does not produce the characteristic scarring seen in TB. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site** of Genital TB: Fallopian Tubes (1st), followed by Endometrium (2nd). * **Gold Standard Diagnosis:** Endometrial biopsy/aspirate for TB-PCR or Culture (Lowenstein-Jensen medium). * **Other HSG Signs of TB:** "Golf-hole" appearance of the ostia, calcified lymph nodes in the pelvis, and Asherman’s syndrome (due to endometrial destruction). * **Key Symptom:** Infertility and menstrual irregularities (most commonly oligomenorrhea or amenorrhea).

Q: A 30-year-old multiparous hypertensive woman complains of menorrhagia. What is the best treatment for her?

Levonorgestrel-releasing intrauterine system (Mirena). **Explanation:** The patient is a 30-year-old multiparous woman with **menorrhagia** (Heavy Menstrual Bleeding) and a co-morbidity of **hypertension**. **Why Option B is Correct:** The **Levonorgestrel-releasing intrauterine system (LNG-IUS/Mirena)** is currently the first-line medical management for heavy menstrual bleeding (NICE guidelines). It works by releasing progestogen locally, causing endometrial atrophy and reducing menstrual blood loss by up to 90%. In this specific case, the patient is **hypertensive**; LNG-IUS is safe as it lacks the systemic estrogenic effects that can worsen blood pressure. Being multiparous, she is also an ideal candidate for an intrauterine device. **Why Other Options are Incorrect:** * **Option A (COCPs):** Combined oral contraceptive pills are generally **contraindicated** in women with hypertension (especially if poorly controlled) due to the risk of stroke, myocardial infarction, and further elevation of blood pressure caused by the estrogen component. * **Option C (Hysterectomy):** This is a major surgical intervention. It is reserved for patients who have completed their family and failed medical management. At age 30, conservative medical management is preferred first. * **Option D (TCRE):** Endometrial ablation/resection is a second-line surgical option for those who fail medical therapy. It is generally avoided in younger women due to higher failure and regeneration rates. **Clinical Pearls for NEET-PG:** * **First-line for Menorrhagia:** LNG-IUS (Mirena). * **Mechanism of LNG-IUS:** Local endometrial decidualization and atrophy. * **Hypertension & Contraception:** Avoid Estrogen (COCPs); Progesterone-only methods (LNG-IUS, POPs, DMPA) are preferred. * **Non-hormonal first-line:** Tranexamic acid (antifibrinolytic) is the preferred non-hormonal treatment for menorrhagia.

Q: A 45-year-old lady presented with dysfunctional uterine bleeding. On transvaginal ultrasound, the thickness of the endometrium was found to be 8 mm. What should be the next step in the management of this patient?

Histopathology. **Explanation:** The primary concern in a perimenopausal woman (age >40–45 years) presenting with Abnormal Uterine Bleeding (AUB) is excluding **Endometrial Hyperplasia or Malignancy**. **1. Why Histopathology is Correct:** In women over 45 years, any case of dysfunctional uterine bleeding (now classified under AUB) requires a tissue diagnosis as the first-line investigation. While Transvaginal Ultrasound (TVUS) is a screening tool, an endometrial thickness (ET) of **>4 mm** in postmenopausal women or persistent bleeding in perimenopausal women (regardless of ET, though 8 mm is significantly thickened) necessitates **Endometrial Biopsy** or Fractional Curettage for histopathological examination. This is the "Gold Standard" to rule out premalignant or malignant lesions before starting medical or surgical therapy. **2. Why Other Options are Incorrect:** * **Hysterectomy:** This is a definitive surgical treatment, not a diagnostic step. It should only be performed after a confirmed diagnosis and if medical management fails or malignancy is detected. * **Progesterone / Oral Contraceptive Pills (OCPs):** These are medical management options for hormonal regulation. Starting these without a biopsy in a 45-year-old is dangerous, as they may temporarily mask the symptoms of an underlying endometrial carcinoma, leading to a delayed diagnosis. **Clinical Pearls for NEET-PG:** * **Cut-off for Postmenopausal bleeding:** ET >4 mm requires biopsy. * **Age Factor:** Any woman **>45 years** with AUB needs histopathology. * **AUB in <45 years:** Biopsy is indicated only if there are risk factors (obesity, PCOS, family history) or failure of medical management. * **Gold Standard for AUB diagnosis:** Hysteroscopy-guided biopsy (more accurate than blind D&C).

Question 1

A 29-year-old nulliparous woman complains of severe menorrhagia and lower abdominal pain for the past 3 months. On examination, her uterus is enlarged to 14 weeks' size with a fundal fibroid. What is the treatment of choice?

Accepted Answer

Myomectomy

Answer

GnRH analogues

Answer

Hysterectomy

Answer

Wait and watch

Question 2

Lutein cysts are associated with all except?

Accepted Answer

Use of oral contraceptive pills

Answer

Gestational trophoblastic tumors

Answer

Clomiphene administration

Answer

Bilaterality

Question 3

What is the management of choice for a 30-year-old multipara presenting with uterine prolapse?

Accepted Answer

Fothergill's repair with tubal ligation

Answer

Fothergill's repair

Answer

Sling operation

Answer

Vaginal hysterectomy

Question 4

A "beaded" appearance of the fallopian tube on hysterosalpingography (HSG) is typically seen in which condition?

Accepted Answer

Tuberculosis (TB)

Answer

Chlamydia infection

Answer

Gonococcal infection

Answer

Syphilis

Question 5

A 65-year-old female presents with postmenopausal bleeding. On examination, senile vaginitis is noted. The patient requires immediate:

Accepted Answer

Estrogen therapy and colposcopy

Answer

Cytology and colposcopy

Answer

Cytology and fractional curettage

Answer

Fractional curettage

Question 6

What is the most common type of genital tuberculosis?

Accepted Answer

Endosalpingitis

Answer

Exosalpingitis

Answer

Endometritis

Answer

Interstitial salpingitis

Question 7

A 30-year-old multiparous hypertensive woman complains of menorrhagia. What is the best treatment for her?

Accepted Answer

Levonorgestrel-releasing intrauterine system (Mirena)

Answer

Combined oral contraceptive pills

Answer

Hysterectomy

Answer

Transcervical resection of the endometrium

Question 8

What is the treatment for intrahepatic cholestasis of pregnancy?

Accepted Answer

Ursodiol

Answer

Cholestyramine

Answer

Steroids

Answer

Antihistamines

Question 9

In a non-pregnant uterus, which of the following is the treatment for cervical incompetence?

Accepted Answer

Counselling

Answer

Shirodkar cerclage suture

Answer

McDonald cerclage suture

Answer

Abdominal cerclage

Question 10

A 45-year-old lady presented with dysfunctional uterine bleeding. On transvaginal ultrasound, the thickness of the endometrium was found to be 8 mm. What should be the next step in the management of this patient?

Accepted Answer

Histopathology

Answer

Hysterectomy

Answer

Progesterone

Answer

Oral contraceptive pills

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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