Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 641: Which of the following is a contraindication for dilatation and curettage?

A. Tuberculous endometrium
B. Acute pelvic inflammatory disease (Correct Answer)
C. Post-menopausal bleeding
D. Endometrial carcinoma

Explanation: **Explanation:** **Dilatation and Curettage (D&C)** is a common gynecological procedure used for both diagnostic and therapeutic purposes. However, it is strictly contraindicated in certain clinical scenarios to prevent severe complications. **Why Acute Pelvic Inflammatory Disease (PID) is the correct answer:** In the presence of **Acute PID**, the pelvic organs are highly inflamed, friable, and often harbor virulent pathogens. Performing a D&C during the acute phase can lead to the **dissemination of infection** into the peritoneal cavity or the bloodstream, potentially causing generalized peritonitis, pelvic abscess formation, or septicemia. Furthermore, the risk of uterine perforation is significantly increased due to the softened, inflamed myometrium. **Analysis of Incorrect Options:** * **Tuberculous Endometrium:** D&C is actually a **diagnostic tool** here. Histopathological examination of the endometrium (looking for granulomas) is essential for confirming genital tuberculosis. * **Post-menopausal Bleeding:** This is a **primary indication** for D&C. It is mandatory to rule out endometrial hyperplasia or malignancy in any patient presenting with bleeding after menopause. * **Endometrial Carcinoma:** While fractional curettage is being replaced by office biopsies (like Pipelle), D&C remains a standard method for obtaining tissue for **diagnosis and staging** of endometrial cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications for D&C:** Acute PID and viable intrauterine pregnancy (unless performing an MTP). * **Fractional Curettage:** This is the specific technique used when malignancy is suspected; the endocervical canal is sampled *before* the uterine cavity to determine the extent of the disease. * **Complications:** The most common immediate complication of D&C is **uterine perforation**, while the most common late complication is **Asherman Syndrome** (intrauterine adhesions).

Question 642: What is the shape of the nulliparous cervical canal?

A. Circular
B. Transverse (Correct Answer)
C. Spherical
D. Longitudinal

Explanation: **Explanation:** The shape of the cervical canal and the external os is a classic high-yield anatomical detail in gynecology, as it helps clinicians distinguish between a nulliparous and a multiparous cervix. **Why "Transverse" is correct:** In a **nulliparous** woman (one who has never given birth vaginally), the external os of the cervix is a small, **transverse slit**. While the canal itself is fusiform (spindle-shaped), its horizontal orientation at the opening is described as transverse. Following a vaginal delivery, the cervix undergoes significant stretching and often sustains minor bilateral lacerations. Consequently, in a **multiparous** woman, the os becomes a wider, irregular, or **stellate** (star-shaped) transverse slit. **Analysis of Incorrect Options:** * **A. Circular:** While the cervix itself is cylindrical, the opening (os) is not a perfect circle. A "pinpoint" circular os is sometimes seen in nulliparous women, but "transverse" is the standard anatomical description. * **C. Spherical:** This describes a 3D ball shape. Neither the cervical canal nor the os is spherical; the cervix is a cylindrical structure. * **D. Longitudinal:** A longitudinal (vertical) slit is not the normal anatomical presentation of the cervical os. **NEET-PG Clinical Pearls:** * **Nulliparous Os:** Small, smooth, and transverse slit-like. * **Multiparous Os:** Large, irregular, and often described as "fissured" or "stellate." * **Ectocervix Lining:** Stratified squamous epithelium. * **Endocervix Lining:** Single layer of tall columnar epithelium (ciliated). * **The Squamocolumnar Junction (SCJ):** This is the most common site for cervical intraepithelial neoplasia (CIN) and is the target area for Pap smear screening.

Question 643: A young female presents with recurrent abortions, deep vein thrombosis, thrombocytopenia, and a recent myocardial infarction. What is the most likely diagnosis?

A. Catastrophic antiphospholipid antibody syndrome
B. Primary antiphospholipid antibody syndrome (Correct Answer)
C. Thrombotic thrombocytopenic purpura (TTP)
D. Protein C deficiency

Explanation: ### **Explanation** **Correct Answer: B. Primary antiphospholipid antibody syndrome (APS)** **Medical Concept:** Antiphospholipid Antibody Syndrome (APS) is an autoimmune prothrombotic state characterized by the presence of antiphospholipid antibodies (Lupus anticoagulant, Anticardiolipin, or Anti-β2 glycoprotein I). The clinical hallmark is the "classic triad" of **recurrent pregnancy loss** (due to placental infarction), **venous or arterial thrombosis** (DVT and MI), and **thrombocytopenia**. When these features occur in the absence of an underlying connective tissue disease like SLE, it is termed **Primary APS**. **Why other options are incorrect:** * **A. Catastrophic APS:** This is an extreme, life-threatening form of APS involving **multiorgan failure** (at least 3 organ systems) developing simultaneously or within a week, often with microangiopathy. While the patient has multiple issues, the presentation suggests a chronic/recurrent history rather than an acute multi-organ collapse. * **C. Thrombotic thrombocytopenic purpura (TTP):** Characterized by the pentad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, neurological symptoms, fever, and renal failure. It does not typically cause recurrent abortions or large-vessel DVT. * **D. Protein C deficiency:** While it causes venous thromboembolism and skin necrosis, it is less commonly associated with arterial events (like MI) or the specific pattern of recurrent pregnancy loss seen in APS. **NEET-PG High-Yield Pearls:** * **Sapporo Criteria:** Diagnosis requires at least one clinical (vascular thrombosis or pregnancy morbidity) and one laboratory criterion (positive antibodies on two occasions 12 weeks apart). * **Pregnancy Morbidity:** Defined as ≥3 unexplained consecutive abortions before 10th week, ≥1 premature birth (<34 weeks) due to eclampsia/placental insufficiency, or ≥1 fetal death (>10 weeks). * **Drug of Choice in Pregnancy:** Low Molecular Weight Heparin (LMWH) + Low-dose Aspirin. **Warfarin is contraindicated** due to teratogenicity. * **Most specific test:** Anti-β2 glycoprotein I antibody.

Question 644: All of the following are reasons for the sudden onset of pain in an asymptomatic case of uterine fibroid, EXCEPT?

A. Torsion
B. Infection
C. Red degeneration
D. Hyaline degeneration (Correct Answer)

Explanation: **Explanation:** Uterine fibroids (leiomyomas) are typically asymptomatic or present with chronic symptoms like menorrhagia. Sudden, acute pain in a fibroid indicates a complication. **Why Hyaline Degeneration is the Correct Answer:** Hyaline degeneration is the **most common** type of fibroid degeneration (occurring in ~65% of cases). It is a **chronic, slow process** where smooth muscle is replaced by homogenous hyaline tissue due to a gradual decrease in blood supply. Because it is a slow, progressive replacement rather than an acute event, it does **not** cause sudden pain. **Why the other options are incorrect (Reasons for Acute Pain):** * **Torsion:** Occurs in pedunculated subserous fibroids. The twisting of the pedicle leads to acute ischemia and venous congestion, causing sudden, severe abdominal pain (an emergency). * **Infection:** Usually occurs post-delivery or post-abortion (especially in submucous fibroids). It leads to acute inflammation, fever, and sharp pain. * **Red Degeneration (Necrobiosis):** Most common during the **second trimester of pregnancy**. It is caused by rapid growth leading to venous obstruction and infarction. It presents with sudden, localized pain, tenderness, and low-grade fever. **Clinical Pearls for NEET-PG:** * **Most common degeneration overall:** Hyaline degeneration. * **Most common degeneration in pregnancy:** Red degeneration. * **Degeneration with highest malignant potential:** None (Cystic/Calcareous are benign), but **Sarcomatous transformation** (<0.5%) is the malignant change (usually post-menopausal). * **Calcific (Calcareous) degeneration:** Most common in post-menopausal women (womb stone).

Question 645: Which of the following factors is not an important risk factor for tubal ectopic pregnancy?

A. A history of tubal surgery
B. Intrauterine device (IUD) use (Correct Answer)
C. In utero diethylstilbestrol (DES) exposure
D. History of pelvic inflammatory disease

Explanation: **Explanation:** The correct answer is **B. Intrauterine device (IUD) use.** While it is a common misconception that IUDs cause ectopic pregnancies, they are actually highly effective contraceptives that significantly reduce the **absolute risk** of any pregnancy, including ectopic ones. However, if a woman *does* become pregnant with an IUD in situ, the **relative risk** (proportion) of that pregnancy being ectopic is higher. Because the question asks for an "important risk factor," IUD use is the outlier; it is a protective factor against pregnancy in general. **Analysis of other options:** * **A. History of tubal surgery:** This is the **strongest risk factor** for ectopic pregnancy (highest Odds Ratio). Procedures like tubal ligation or re-anastomosis cause structural damage and scarring, hindering the transport of the fertilized ovum. * **C. In utero DES exposure:** Diethylstilbestrol exposure in utero is associated with structural uterine anomalies (T-shaped uterus) and fallopian tube abnormalities (ciliary dysfunction), which significantly increase ectopic risk. * **D. History of Pelvic Inflammatory Disease (PID):** PID (often due to *Chlamydia trachomatis*) causes salpingitis, leading to the loss of endosalpingeal cilia and the formation of intratubal adhesions (plicae), which trap the embryo. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of ectopic pregnancy:** Ampulla of the Fallopian tube (70-80%). * **Most common site of rupture:** Isthmus (occurs early, around 6-8 weeks). * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy; it is suggestive of pregnancy but not specific to ectopic pregnancy.

Question 646: Which of the following is NOT true about genital infection in bacterial vaginosis?

A. Clue cells are present
B. Gardnerella is the causative agent
C. Pruritus is seen (Correct Answer)
D. Grey and foul-smelling discharge is present

Explanation: **Explanation:** Bacterial Vaginosis (BV) is a clinical syndrome characterized by a shift in the vaginal flora from dominant *Lactobacillus* species to an overgrowth of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Prevotella*). **Why "Pruritus is seen" is the correct answer (NOT true):** Pruritus (itching) and vaginal inflammation are typically **absent** in Bacterial Vaginosis. BV is a non-inflammatory condition (hence "vaginosis" rather than "vaginitis"). If a patient presents with significant pruritus and erythema, clinicians should suspect *Candidiasis* or *Trichomoniasis* instead. **Analysis of other options:** * **Clue cells are present:** These are vaginal epithelial cells coated with coccobacilli, giving them a "stippled" or "shaggy" appearance. They are the most specific diagnostic criterion for BV. * **Gardnerella is the causative agent:** While BV is polymicrobial, *Gardnerella vaginalis* is the hallmark organism associated with the condition. * **Grey and foul-smelling discharge:** A thin, homogenous, milky-white or grey discharge with a "fishy" odor (due to the release of amines) is a classic clinical feature. **NEET-PG High-Yield Pearls (Amsel’s Criteria):** To diagnose BV, 3 out of 4 of the following must be present: 1. **Homogenous discharge** (thin, white/grey). 2. **Vaginal pH > 4.5** (Most sensitive). 3. **Positive Whiff Test:** Fishy odor on adding 10% KOH. 4. **Clue Cells** on wet mount (Most specific). * **Gold Standard Diagnosis:** Nugent Scoring (Gram stain). * **Treatment of Choice:** Oral or topical Metronidazole (safe in pregnancy).

Question 647: Gartner duct cyst is the remnant of which embryological structure?

A. Mullerian duct
B. Wolffian duct (Correct Answer)
C. Cloacal duct
D. Epoophoron

Explanation: **Explanation:** **Gartner duct cysts** are common benign vaginal cysts that arise from the vestigial remnants of the **Wolffian duct (Mesonephric duct)** in females. 1. **Why Wolffian duct is correct:** In the female fetus, the absence of testosterone leads to the regression of the Wolffian ducts. However, remnants can persist as vestigial structures. When these remnants occur within the anterolateral wall of the proximal vagina and become secretory or cystic, they are termed Gartner duct cysts. 2. **Why other options are incorrect:** * **Mullerian duct (Paramesonephric duct):** In females, these ducts develop into the Fallopian tubes, uterus, and the upper 4/5th of the vagina. Cysts derived from these are called Mullerian cysts (usually found in the posterior or lateral vaginal walls). * **Cloacal duct:** The cloaca is the common precursor for the urinary, genital, and digestive tracts. It divides into the urogenital sinus and the rectum; it is not the direct precursor to Gartner cysts. * **Epoophoron:** While the Epoophoron is also a Wolffian remnant, it is specifically located in the **mesosalpinx** (between the ovary and the fallopian tube), not the vaginal wall. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Gartner duct cysts are characteristically found in the **anterolateral wall** of the vagina, above the level of the hymen. * **Other Wolffian Remnants in Females:** * **Epoophoron & Paroophoron** (in the broad ligament/mesosalpinx). * **Kobelt’s cysts.** * **Association:** Gartner duct cysts are occasionally associated with **renal agenesis** or ectopic ureters; if a large or complex cyst is found, renal imaging (USG) may be indicated.

Question 648: A 20-year-old female presents for a routine antenatal checkup in her first trimester and is diagnosed with an ovarian cyst. What is the most appropriate next step?

A. Immediate surgical removal of the cyst
B. Surgical removal of the cyst after delivery
C. Termination of pregnancy followed by cyst removal
D. Observation and surgical removal in the second trimester (Correct Answer)

Explanation: ### Explanation The management of an adnexal mass in pregnancy depends on the gestational age, the size of the cyst, and its clinical features. **Why Option D is Correct:** Most ovarian cysts discovered in the first trimester are functional (e.g., **Corpus Luteum cysts**), which typically regress spontaneously by 14–16 weeks of gestation. Therefore, the initial step is **observation**. If the cyst persists, is >6 cm, or shows suspicious features, surgical intervention is indicated. The **second trimester (14–22 weeks)** is the "golden period" for surgery because: 1. Organogenesis is complete (reducing teratogenic risk). 2. The placenta has taken over progesterone production (reducing the risk of miscarriage from corpus luteum removal). 3. The uterus is not yet large enough to obstruct the surgical field, making laparoscopy safer. **Why Other Options are Incorrect:** * **Option A:** Surgery in the first trimester carries a high risk of miscarriage due to potential interference with the corpus luteum and the effects of anesthesia during organogenesis. * **Option B:** Waiting until after delivery increases the risk of complications such as **torsion** (most common in the 2nd trimester or puerperium), rupture, or labor dystocia. * **Option C:** An asymptomatic ovarian cyst is never an indication for termination of pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common ovarian cyst in pregnancy:** Corpus Luteum cyst. * **Most common benign tumor in pregnancy:** Mature Cystic Teratoma (Dermoid). * **Most common complication:** Torsion (occurs most frequently when the uterus rises out of the pelvis or during rapid involution postpartum). * **Emergency Indication:** If torsion or rupture occurs, immediate surgery is required regardless of the trimester.

Question 649: Which of the following causes torsion of an ovarian tumor?

A. Trauma (Correct Answer)
B. Uterine contraction
C. Physical movements
D. All of the above

Explanation: **Explanation:** Ovarian torsion occurs when an ovarian tumor or cyst rotates on its pedicle, compromising its blood supply. This is a surgical emergency. **Why Trauma is the Correct Answer:** Sudden mechanical forces, such as **trauma** or a blow to the abdomen, can provide the necessary momentum to displace the tumor from its pelvic position. This abrupt displacement causes the tumor to rotate around its infundibulopelvic and tubo-ovarian ligaments. Once the rotation exceeds a certain degree, the venous drainage is obstructed first (due to lower pressure), leading to congestion, followed by arterial occlusion and eventual gangrene. **Analysis of Other Options:** * **Uterine Contractions:** While the pregnant uterus can displace an ovary, contractions themselves are rhythmic and internal; they do not typically provide the sudden, external directional force required to initiate a 180–360 degree twist of the pedicle. * **Physical Movements:** While vigorous exercise or sudden changes in body position (like jumping or twisting) are common *precipitating* factors, in the context of standardized NEET-PG questions, **trauma** is recognized as a classic, direct external cause that forcefully initiates the torsion. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Tumor:** The **Dermoid cyst (Mature Cystic Teratoma)** is the most common tumor to undergo torsion because of its weight and long pedicle. * **Risk Factors:** Torsion is more common in tumors sized **5–10 cm**. Very large tumors are less likely to undergo torsion as they are "wedged" in the pelvis or abdomen with no room to rotate. * **Pregnancy:** The most common time for torsion during pregnancy is the **first trimester** (when the uterus rises out of the pelvis) or the **puerperium** (due to the sudden laxity of the abdominal walls and ligaments). * **Clinical Presentation:** Sudden onset of sharp, unilateral lower abdominal pain, often accompanied by nausea and vomiting.

Question 650: Which of the following patient positions is NOT typically used for the described procedure?

A. Diagnostic laparoscopy - Trendelenburg with about 30° tilt
B. Colposcopy - Lithotomy
C. Transvaginal sonography in gynecology - Lithotomy with a full bladder (Correct Answer)
D. Hysteroscopy - Lithotomy

Explanation: **Explanation:** The correct answer is **C (Transvaginal sonography in gynecology - Lithotomy with a full bladder)** because it contains a fundamental clinical error regarding bladder preparation. 1. **Why Option C is correct (The Error):** Transvaginal sonography (TVS) requires an **empty bladder**. A full bladder pushes the uterus and ovaries further away from the vaginal vault, creating an acoustic barrier and displacing the pelvic organs out of the probe's optimal focal range. In contrast, **Transabdominal sonography (TAS)** requires a **full bladder** to act as an acoustic window and to displace gas-filled bowel loops. 2. **Analysis of Other Options:** * **Diagnostic Laparoscopy (Trendelenburg 30°):** This position uses gravity to shift the bowel cranially (toward the head), providing a clear view of the pelvic organs (uterus, tubes, and ovaries). * **Colposcopy (Lithotomy):** This is the standard position to allow the colposcopist an unobstructed view of the cervix through the speculum. * **Hysteroscopy (Lithotomy):** This position is essential for vaginal access, cervical dilatation, and the manipulation of the hysteroscope into the uterine cavity. **High-Yield Clinical Pearls for NEET-PG:** * **TVS vs. TAS:** TVS offers higher resolution (uses higher frequency probes) but less depth; TAS offers better "big picture" views but lower resolution. * **Steep Trendelenburg:** While 30° is standard for laparoscopy, be aware of physiological changes like decreased lung compliance and increased intracranial/intraocular pressure. * **Empty Bladder Rule:** Always ensure the patient voids before TVS, pelvic examinations, or performing a D&C to avoid accidental bladder injury and improve palpatory accuracy.

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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