Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 651: What is the most common manifestation of ectopic pregnancy?

A. Vomiting
B. Bleeding
C. Pain in abdomen (Correct Answer)
D. Shock

Explanation: **Explanation:** Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube (95%). **Why "Pain in abdomen" is correct:** Abdominal pain is the **most common and earliest clinical manifestation**, occurring in approximately **95-100%** of cases. The pain is typically caused by tubal distension, localized peritoneal irritation, or tubal rupture. It is often sudden, sharp, and may be lateralized to the side of the ectopic pregnancy before becoming generalized. **Analysis of Incorrect Options:** * **Bleeding (Option B):** While vaginal bleeding (spotting) is common (occurring in about 60-80% of cases), it is less frequent than abdominal pain. It usually occurs after the onset of pain due to the sloughing of the decidua as hCG levels fail to rise normally. * **Shock (Option D):** This is a late-stage manifestation indicating a **ruptured** ectopic pregnancy with significant hemoperitoneum. While life-threatening, it is not the most common presentation across all cases (stable and unstable). * **Vomiting (Option A):** This is a non-specific symptom of early pregnancy or peritoneal irritation and is not a primary diagnostic feature of ectopic pregnancy. **NEET-PG High-Yield Pearls:** * **Classic Triad:** Amenorrhea (75%), Abdominal Pain (95-100%), and Vaginal Bleeding (60-80%). Note that the complete triad is present in only about 50% of patients. * **Most common site:** Ampulla of the fallopian tube. * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) combined with serial β-hCG levels (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy, characteristic of (but not pathognomonic for) ectopic pregnancy.

Question 652: Where does Neisseria gonorrhoeae initially infect the female reproductive tract?

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

Explanation: **Explanation:** The correct answer is **B. Cervix**. *Neisseria gonorrhoeae* is a Gram-negative diplococcus that specifically targets **columnar and cuboidal epithelium**. In the female reproductive tract, the **endocervix** is the primary site of initial infection because it is lined by simple columnar epithelium, which provides the necessary receptors (pili and Opa proteins) for bacterial attachment and invasion. **Why other options are incorrect:** * **A. Vagina:** In adult females, the vagina is lined by **stratified squamous epithelium**. This thick, multi-layered surface is resistant to gonococcal invasion. (Note: In pre-pubertal girls, the vaginal mucosa is thin and can be infected, leading to vulvovaginitis). * **C. Uterus & D. Fallopian tubes:** While the infection can ascend to the endometrium and fallopian tubes causing Pelvic Inflammatory Disease (PID), these are **secondary sites** of infection. The bacteria must first establish a colony in the cervix before ascending. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of asymptomatic infection:** The cervix (up to 50-70% of women are asymptomatic). * **Gold Standard Diagnosis:** Nucleic Acid Amplification Test (NAAT). Culture on **Thayer-Martin medium** is used for sensitivity testing. * **Fitz-Hugh-Curtis Syndrome:** A complication where the infection spreads to the liver capsule, causing "string-bread" adhesions. * **Treatment:** Due to increasing resistance, the current recommendation is often a combination therapy (e.g., Ceftriaxone IM + Azithromycin/Doxycycline) to cover co-infection with *Chlamydia trachomatis*.

Question 653: Chassar Moir surgery is indicated in which of the following conditions?

A. Uterine inversion
B. Vesicovaginal fistula repair (Correct Answer)
C. Ureterovesical fistula repair
D. Retroverted uterus

Explanation: **Explanation:** **Chassar Moir surgery** (also known as the Moir technique) is a classic surgical procedure used for the repair of a **Vesicovaginal Fistula (VVF)**. It involves a vaginal approach where the edges of the fistula are denuded and the bladder and vaginal walls are separated (flap-splitting technique). The layers are then closed separately without tension to ensure a watertight seal. **Analysis of Options:** * **Option B (Correct):** Chassar Moir is the gold standard vaginal repair for VVF, particularly for those located at the supratrigonal or trigonal areas. * **Option A:** **Uterine inversion** is managed by the **O'Sullivan’s hydrostatic method** (acute) or surgical procedures like **Huntington’s** or **Haultain’s** (chronic). * **Option C:** **Ureterovesical fistula** repair usually requires an abdominal approach (ureteroneocystostomy) rather than the vaginal approach associated with Moir. * **Option D:** **Retroverted uterus** was historically treated with "ventrosuspension" procedures like the **Gilliam’s surgery**, though it is rarely performed today. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of VVF:** In developing countries, it is **obstructed labor**; in developed countries, it is **iatrogenic (post-hysterectomy)**. * **Diagnostic Test:** The **Three-swab test** (Moir’s test) is used to differentiate between VVF and Ureterovaginal fistula. * **Timing of Repair:** Traditionally, a waiting period of **3–6 months** is advised after the injury to allow inflammation to subside, though early repair is gaining favor in non-infected cases. * **Latzko’s Procedure:** Another vaginal repair technique specifically used for post-hysterectomy VVFs (partial colpocleisis).

Question 654: Which of the following infections does NOT require treatment with Paner?

A. Candida
B. Herpes
C. Trichomonas
D. Gardnerella (Correct Answer)

Explanation: The question focuses on the management of common vaginal and vulvar infections. The term **"Partner treatment"** (often misspelled as 'Paner' in some question banks) refers to the necessity of treating the sexual partner to prevent reinfection or "ping-pong" transmission. ### **Explanation of the Correct Answer** **D. Gardnerella (Bacterial Vaginosis - BV):** Bacterial Vaginosis is characterized by a polymicrobial overgrowth (primarily *Gardnerella vaginalis* and anaerobes) due to a shift in vaginal flora (loss of Lactobacilli). It is **not** classified as a sexually transmitted infection (STI). Clinical trials have consistently shown that treating the male partner does not reduce the recurrence rate in the woman. Therefore, partner treatment is **not recommended**. ### **Analysis of Incorrect Options** * **A. Candida:** While Candidiasis is usually not an STI, partner treatment is indicated if the partner is symptomatic (e.g., Balanitis). However, in the context of standard NEET-PG questions, Trichomonas is the most "mandatory" STI for partner treatment, making Gardnerella the most definitive "No." * **B. Herpes:** Genital Herpes (HSV-2) is a highly contagious STI. Management involves counseling and treating partners if they show symptoms or to reduce transmission risk. * **C. Trichomonas:** This is a **protozoal STI**. Treatment of the sexual partner is **mandatory**, regardless of symptoms, because the recurrence rate is extremely high if the partner remains an asymptomatic carrier. ### **NEET-PG High-Yield Pearls** * **Amsel’s Criteria (for BV):** Need 3 out of 4: (1) Thin, homogenous discharge, (2) pH > 4.5, (3) Positive Whiff test (KOH), (4) **Clue cells** on microscopy. * **Drug of Choice:** Metronidazole is the DOC for both Bacterial Vaginosis and Trichomoniasis. * **Trichomoniasis:** Characterized by "Strawberry Cervix" (colpitis macularis) and motile flagellates on wet mount. * **Candidiasis:** Characterized by "Curdy white" discharge and pseudohyphae; pH is typically **normal (<4.5)**.

Question 655: Pelvic Inflammatory Disease (PID) is most commonly caused by which of the following?

A. Chlamydia trachomatis (Correct Answer)
B. Mycoplasma genitalium
C. Mycobacterium tuberculosis
D. Escherichia coli

Explanation: **Explanation:** Pelvic Inflammatory Disease (PID) is an ascending infection of the female upper genital tract. Globally and in the context of competitive exams like NEET-PG, **Chlamydia trachomatis** is recognized as the most common causative organism, followed closely by *Neisseria gonorrhoeae*. **Why Chlamydia trachomatis is correct:** Chlamydia is an obligate intracellular bacterium that often causes "silent" or subclinical infections. Because it frequently presents with minimal symptoms, it often goes untreated, allowing the pathogen to ascend from the endocervix to the endometrium and fallopian tubes, leading to chronic inflammation, scarring, and tubal factor infertility. **Analysis of Incorrect Options:** * **Mycoplasma genitalium:** While an emerging cause of PID and cervicitis, it is statistically less common than Chlamydia. * **Mycobacterium tuberculosis:** This is the leading cause of **Chronic PID** (specifically Granulomatous Salpingitis) in developing countries like India, but it is not the most common cause of acute PID overall. * **Escherichia coli:** This is a common cause of urinary tract infections and can be part of the polymicrobial flora in late-stage PID or Tubo-ovarian abscesses, but it is rarely the primary initiating pathogen. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Lower abdominal pain (Dull aching). * **Most specific sign:** Cervical Motion Tenderness (Chandelier sign). * **Gold Standard Investigation:** Laparoscopy (shows "violin-string" adhesions in Fitz-Hugh-Curtis Syndrome). * **CDC Treatment Regimen:** Ceftriaxone (IM) + Doxycycline (Oral) + Metronidazole (Oral). * **Risk Factor:** The highest risk period for PID is the first 3 weeks after IUD insertion.

Question 656: What is the treatment of choice for Gardenella vaginalis vaginitis in pregnancy?

A. Clindamycin
B. Metronidazole (Correct Answer)
C. Erythromycin
D. Tetracycline

Explanation: **Explanation:** **Bacterial Vaginosis (BV)**, caused by *Gardnerella vaginalis*, is the most common cause of vaginal discharge in women of childbearing age. In pregnancy, BV is associated with adverse outcomes such as preterm labor, premature rupture of membranes (PROM), and postpartum endometritis. **Why Metronidazole is the Correct Choice:** According to the CDC and ACOG guidelines, **Metronidazole (500 mg orally twice daily for 7 days)** is the treatment of choice for symptomatic pregnant women. It is highly effective against anaerobic bacteria. Extensive meta-analyses have shown that Metronidazole is **safe in all trimesters** of pregnancy and is not associated with teratogenic or mutagenic effects in humans, despite older concerns. **Analysis of Incorrect Options:** * **A. Clindamycin:** While Clindamycin (oral or cream) is an alternative treatment for BV, it is generally reserved for patients allergic to Metronidazole. * **C. Erythromycin:** This macrolide is ineffective against the anaerobic environment of *Gardnerella vaginalis* and is not a standard treatment for BV. * **D. Tetracycline:** These are **contraindicated** in pregnancy (Category D) because they cross the placenta and cause permanent discoloration of teeth and inhibition of bone growth in the fetus. **High-Yield NEET-PG Pearls:** 1. **Diagnosis:** Based on **Amsel’s Criteria** (3 out of 4): Homogeneous white discharge, Vaginal pH >4.5, Positive Whiff test (fishy odor with KOH), and **Clue cells** on microscopy (Most reliable sign). 2. **Gold Standard:** **Nugent Scoring** (based on Gram stain morphotypes). 3. **Treatment Goal:** In pregnancy, the primary goal is to alleviate symptoms and reduce the risk of infectious complications. 4. **Partner Treatment:** Unlike Trichomoniasis, treating the male partner in BV does **not** prevent recurrence.

Question 657: Which of the following is NOT true regarding endometriosis-associated dysmenorrhea?

A. It is often more severe than primary dysmenorrhea.
B. It typically occurs 24 to 48 hours after the start of menses. (Correct Answer)
C. It may be less responsive to NSAIDs compared to primary dysmenorrhea.
D. Deep infiltrating endometriosis often correlates with the severity of dysmenorrhea.

Explanation: **Explanation:** The hallmark of **endometriosis-associated dysmenorrhea** (secondary dysmenorrhea) is that it typically **precedes** the onset of menstrual flow. Unlike primary dysmenorrhea, which starts just before or at the onset of bleeding and lasts 24–48 hours, endometriosis pain often begins **2 to 7 days before menses**, intensifies during flow, and may persist after the period ends. Therefore, Option B is incorrect (and the right answer) because it describes the timing of primary dysmenorrhea, not endometriosis. **Analysis of other options:** * **Option A:** Endometriosis pain is generally more severe, progressive, and chronic compared to the self-limiting nature of primary dysmenorrhea. * **Option C:** Primary dysmenorrhea is caused by prostaglandin release and responds well to NSAIDs. Endometriosis involves complex inflammatory pathways and structural lesions, making it frequently less responsive to standard analgesics. * **Option D:** While the total "stage" of endometriosis (ASRM) does not always correlate with pain, the **depth of infiltration** (Deep Infiltrating Endometriosis - DIE) and involvement of the uterosacral ligaments are strongly associated with the severity of dysmenorrhea and dyspareunia. **High-Yield NEET-PG Pearls:** * **Classic Triad:** Dysmenorrhea, Dyspareunia (deep), and Dyschezia. * **Gold Standard Diagnosis:** Laparoscopy with biopsy (visualizing "powder-burn" or "mulberry" lesions). * **First-line Medical Management:** Combined Oral Contraceptive Pills (COCPs) or Progestins. * **Sampson’s Theory:** Retrograde menstruation is the most widely accepted theory for its pathogenesis.

Question 658: Which site is most commonly infected in the female genitalia?

A. Vulva (Correct Answer)
B. Cervix
C. Vagina
D. Anus

Explanation: **Explanation:** The **vulva** is the most common site of infection in the female genitalia. This is primarily due to its anatomical location and physiological characteristics. The vulva is a cutaneous surface that is constantly exposed to moisture, friction, and warmth. It is frequently contaminated by intestinal flora (from the anus) and urogenital secretions. Unlike the vagina, which has a protective acidic pH (3.8–4.5) maintained by *Lactobacillus*, the vulvar skin is more susceptible to a wide range of pathogens, including bacteria, fungi (Candidiasis), and viruses (HPV, HSV). **Analysis of Options:** * **Cervix (Option B):** While the cervix is a frequent site for specific infections like *Chlamydia* and *Gonorrhea*, it is less commonly infected overall compared to the external genitalia. * **Vagina (Option C):** Although vaginitis is a common clinical complaint, the vagina possesses a robust self-cleansing mechanism and an acidic environment that inhibits the growth of many pathogenic organisms. Most "vaginal" symptoms often involve the vulva (vulvovaginitis). * **Anus (Option D):** While the perianal area is prone to infection, it is considered part of the gastrointestinal/perineal tract rather than the primary female genitalia in this clinical context. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Vulvovaginitis:** *Candida albicans* (presents with curd-like discharge and intense pruritus). * **Most common cause of Vaginitis:** Bacterial Vaginosis (characterized by "clue cells" and a positive Whiff test). * **Protective Factor:** The acidic pH of the vagina is the primary defense mechanism against ascending infections. Any disruption (menses, antibiotics, douching) increases infection risk. * **Vulvar Hygiene:** Poor hygiene or excessive use of irritants (soaps/detergents) are leading predisposing factors for vulvar dermatitis and secondary infections.

Question 659: A 19-year-old patient presents with primary amenorrhea. She has well-developed breasts and pubic hair, but there is an absence of the vagina and uterus. What is the likely diagnosis?

A. XYY syndrome
B. Mullerian agenesis (Correct Answer)
C. Gonadal dysgenesis
D. Klinefelter's syndrome

Explanation: ### Explanation **Mullerian Agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome)** is the correct diagnosis. This condition is characterized by the congenital absence of the uterus and the upper two-thirds of the vagina due to the failure of the Mullerian ducts to develop. 1. **Why it is correct:** In MRKH, the ovaries are functional and the karyotype is **46, XX**. Because the ovaries are intact, estrogen production is normal, leading to **normal secondary sexual characteristics** (well-developed breasts and pubic hair). However, the absence of the uterus results in primary amenorrhea. 2. **Why the others are wrong:** * **XYY Syndrome:** These individuals are phenotypically male, often tall, with normal internal and external male genitalia. * **Gonadal Dysgenesis (e.g., Turner Syndrome):** Patients typically have "streak ovaries," leading to estrogen deficiency. This results in **delayed or absent breast development**, which contradicts this patient’s presentation. * **Klinefelter’s Syndrome (47, XXY):** This affects males, presenting with small testes, gynecomastia, and infertility. ### High-Yield Clinical Pearls for NEET-PG: * **Differential Diagnosis:** Always differentiate MRKH from **Androgen Insensitivity Syndrome (AIS)**. In AIS (46, XY), there is absent/scanty pubic hair and present testes, whereas in MRKH, pubic hair is normal and ovaries are present. * **Associated Anomalies:** 30-40% of patients with Mullerian agenesis have **renal anomalies** (e.g., renal agenesis, pelvic kidney). Always perform a renal ultrasound. * **Hormonal Profile:** FSH, LH, and Estrogen levels are **normal** in MRKH. * **Treatment:** Non-surgical (Frank’s dilators) or surgical (McIndoe vaginoplasty) creation of a neovagina.

Question 660: Which of the following statements is/are true regarding androgen insensitivity syndrome?

A. Absent vagina (Correct Answer)
B. Karyotype is XX
C. Karyotype is XO
D. Pubic hair is normally present

Explanation: **Explanation:** **Androgen Insensitivity Syndrome (AIS)**, formerly known as Testicular Feminization Syndrome, is an X-linked recessive condition where a genetic male (46, XY) has a functional loss of androgen receptors. 1. **Why Option A is Correct:** In AIS, the testes develop normally (due to the SRY gene) and produce **Anti-Müllerian Hormone (AMH)**. AMH causes the regression of Müllerian structures (uterus, fallopian tubes, and the upper 2/3rd of the vagina). Consequently, the patient has an **absent or short, blind-ending vagina** and no uterus. 2. **Why Option B & C are Incorrect:** The karyotype in AIS is **46, XY** (genetically male). 46, XX is a normal female or seen in Müllerian Agenesis (MRKH), while 45, XO is characteristic of Turner Syndrome. 3. **Why Option D is Incorrect:** Because the body is resistant to androgens, **pubic and axillary hair are absent or very sparse**. This is a key clinical differentiator from MRKH syndrome, where hair growth is normal. **High-Yield Clinical Pearls for NEET-PG:** * **Phenotype:** Phenotypically female with well-developed breasts (due to peripheral conversion of testosterone to estrogen). * **Gonads:** Undescended testes are present (often in the inguinal canal or abdomen). These should be removed **after puberty** to prevent gonadoblastoma, allowing for natural completion of breast development. * **Laboratory Findings:** High Testosterone levels (for a female range), high LH, and normal to high FSH. * **Differential Diagnosis:** Always differentiate from **MRKH Syndrome** (46, XX, normal ovaries, normal hair) and **5-alpha reductase deficiency** (virilization at puberty).

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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