Gynecological Disorders Practice Questions

Q: Clue cells are seen in which of the following conditions?

Bacterial vaginosis. **Explanation:** **Bacterial Vaginosis (BV)** is the correct answer. It is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacillus* species in the vagina with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Mycoplasma hominis*). **Clue Cells** are the pathognomonic microscopic finding for BV. These are vaginal epithelial cells that have a "stippled" or "shaggy" appearance because their borders are obscured by numerous coccobacilli adhering to them. Under a saline wet mount, these cells must comprise at least 20% of the total epithelial cells to be diagnostically significant. **Why other options are incorrect:** * **Moniliasis (Candidiasis):** Characterized by the presence of pseudohyphae and budding yeast cells on a KOH mount. * **Trichomoniasis:** Characterized by the presence of pear-shaped, flagellated, motile protozoa (*Trichomonas vaginalis*) on a wet mount. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required for diagnosis):** 1. Homogeneous, thin, white-grey discharge. 2. Vaginal pH > 4.5 (Most sensitive). 3. **Positive Whiff Test:** Fishy odor on adding 10% KOH. 4. **Clue cells** on microscopy (Most specific). * **Nugent Scoring:** The "Gold Standard" for diagnosis based on Gram stain morphotypes. * **Treatment:** Drug of choice is **Metronidazole** (500 mg BID for 7 days). Treatment of the male partner is NOT recommended. * **Complications:** Increased risk of Preterm Labor (PTL) and Pelvic Inflammatory Disease (PID).

Q: Which of the following is true about tubal pregnancy?

All of the above.. **Explanation:** The correct answer is **D. All of the above.** Tubal pregnancy, the most common form of ectopic pregnancy, occurs when a fertilized ovum implants outside the uterine cavity, usually due to factors that delay or prevent its passage into the uterus. 1. **Prior Tubal Pregnancy (Option B):** This is the **strongest risk factor** for a recurrence. Once a patient has had one ectopic pregnancy, the risk of another increases by approximately 10-fold (roughly a 15% recurrence rate) due to underlying tubal damage or surgical scarring. 2. **History of PID/Chlamydia (Option C):** Pelvic Inflammatory Disease, particularly caused by *Chlamydia trachomatis*, leads to salpingitis. This results in the destruction of endosalpingeal cilia and the formation of intratubal adhesions (folds), which physically trap the embryo. 3. **IUCD Use (Option A):** While IUCDs are highly effective at preventing all pregnancies, if a woman *does* conceive with an IUCD in situ, the pregnancy is statistically more likely to be ectopic. This is because the IUCD prevents intrauterine implantation more effectively than it prevents tubal implantation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla (70%), followed by the Isthmus. * **Most common cause:** Chronic Salpingitis (PID). * **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serial β-hCG levels (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage, indicating pregnancy but not necessarily its location.

Q: Ectopic pregnancy is most commonly associated with:

Tubal inflammatory diseases. **Explanation:** The most common site for ectopic pregnancy is the fallopian tube (95%), and the primary risk factor is any condition that causes **structural or functional damage** to the tubal cilia and mucosa. **1. Why Tubal Inflammatory Diseases (TID/PID) is correct:** Pelvic Inflammatory Disease (PID), often caused by *Chlamydia trachomatis* or *Neisseria gonorrhoeae*, leads to endosalpingitis. This results in the loss of ciliary action and the formation of intratubal adhesions (plicae). These changes physically obstruct or delay the transport of the fertilized ovum to the uterine cavity, leading to implantation within the tube. It is the single most common identifiable risk factor. **2. Why other options are incorrect:** * **Endometriosis:** While it can cause pelvic adhesions and distort anatomy, it is a much less frequent cause of ectopic pregnancy compared to infection. * **Congenital tubal anomalies:** Conditions like accessory ostia or tubal hypoplasia are rare occurrences in the general population. * **Tuberculosis:** Genital TB is a significant cause of infertility in developing countries because it often leads to complete tubal occlusion (e.g., "lead pipe" tubes). While it can cause ectopic pregnancy, the incidence of PID-related ectopic cases is statistically much higher. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Strongest risk factor:** Previous history of ectopic pregnancy (increases risk by 10-fold). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serum β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage, characteristic of (but not diagnostic for) ectopic pregnancy.

Q: Corpus luteum cyst occurs due to:

HCG. **Explanation:** The **Corpus Luteum (CL)** is a temporary endocrine structure formed from the ovarian follicle after ovulation. Its primary role is to secrete progesterone to support a potential pregnancy. **Why HCG is the correct answer:** The maintenance and growth of the corpus luteum are directly dependent on **Human Chorionic Gonadotropin (HCG)**. In a normal menstrual cycle, the CL regresses (becomes corpus albicans) due to the lack of LH/HCG. However, if fertilization occurs, the syncytiotrophoblast secretes HCG, which acts on the LH receptors of the CL. This "rescues" the corpus luteum, causing it to enlarge and continue producing progesterone. When this stimulation is excessive or prolonged, it can lead to the formation of a **Corpus Luteum Cyst** (often seen in early pregnancy or gestational trophoblastic disease). **Analysis of Incorrect Options:** * **B. HPL (Human Placental Lactogen):** This hormone is involved in maternal metabolism and insulin resistance; it has no luteotrophic effect on the ovary. * **C. Estrogen:** While the CL secretes some estrogen, estrogen itself does not stimulate the formation or maintenance of the cyst; it actually provides negative feedback to the pituitary. * **D. Progesterone:** This is the *product* of the corpus luteum, not the cause of its formation. High levels of progesterone actually inhibit the gonadotropins required for follicular development. **NEET-PG High-Yield Pearls:** * **Theca Lutein Cysts:** These are bilateral cysts caused by **hypersensitivity to HCG**, commonly associated with Molar Pregnancy, Multiple Gestation, or Ovulation Induction. * **Luteoma of Pregnancy:** A rare, non-neoplastic virilizing tumor of the ovary that regresses spontaneously postpartum. * **Corpus Luteum of Pregnancy:** It is most active during the first **7–10 weeks** of gestation, after which the "Luteo-placental shift" occurs, and the placenta takes over progesterone production.

Q: Which of the following treatments is not indicated in ectopic pregnancy?

Salpingo-oophorectomy. ### Explanation The primary goal in the surgical management of ectopic pregnancy is to remove the conceptus while preserving as much healthy tissue as possible, particularly the ovary, to maintain the patient’s future fertility and hormonal balance. **Why Salpingo-oophorectomy is the correct answer:** In a tubal ectopic pregnancy, the pathology is confined to the fallopian tube. The ovary is rarely involved and has its own independent blood supply (ovarian artery). Therefore, removing the ovary (**Salpingo-oophorectomy**) along with the tube is unnecessary and considered over-treatment. It is **not indicated** unless there is a specific reason like a concomitant ovarian torsion, malignancy, or a rare tubo-ovarian abscess. **Analysis of Incorrect Options:** * **Salpingectomy:** This is the standard **radical** surgical treatment. It is indicated when the tube is ruptured, there is severe hemorrhage, or the tube is extensively damaged. * **Salpingostomy:** This is a **conservative** surgical procedure where a longitudinal incision is made on the tube to remove the products of conception, leaving the tube intact. It is preferred in hemodynamically stable patients who desire future fertility. * **Resection of involved segment:** This is specifically indicated for **isthmic pregnancies**. Since the isthmus has a narrow lumen, a salpingostomy often leads to scarring and occlusion; therefore, segmental resection followed by delayed re-anastomosis is preferred. **NEET-PG High-Yield Pearls:** * **Most common site of Ectopic Pregnancy:** Ampulla (Fallopian tube). * **Most common site of Rupture:** Isthmus (due to narrow lumen). * **Gold Standard Investigation:** Transvaginal Ultrasound (TVUS) + Serial β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Medical Management:** Methotrexate (50 mg/m²) is the drug of choice in hemodynamically stable patients with a small sac (<3.5–4 cm) and no fetal heart activity.

Q: A 55-year-old woman presents with post-menopausal bleeding. Pelvic examination reveals a normal cervix, and a Pap smear performed one month prior was normal. Her ultrasound shows an endometrial thickness of 1 mm and atrophic ovaries. What is the most probable diagnosis?

Senile endometritis. **Explanation:** The patient presents with post-menopausal bleeding (PMB), which is a "red flag" symptom requiring immediate evaluation. However, the diagnostic findings point towards a benign, atrophic etiology rather than malignancy. **Why Senile Endometritis is correct:** In post-menopausal women, the lack of estrogen leads to thinning (atrophy) of the endometrial lining and the vaginal mucosa. **Senile endometritis** occurs when this thin, friable lining becomes inflamed or infected, leading to spotting or bleeding. The key diagnostic clue here is the **endometrial thickness (ET) of 1 mm**. In PMB, an ET of **≤ 4 mm** has a high negative predictive value for endometrial cancer, making atrophy or senile endometritis the most likely cause. **Why the other options are incorrect:** * **Cervical Cancer:** Ruled out by the normal pelvic examination of the cervix and the recent normal Pap smear. * **Endometrial Cancer:** While PMB is the classic presentation, an ET of 1 mm is extremely unlikely for malignancy. Endometrial cancer typically presents with a thickened, irregular endometrium (usually >5 mm in post-menopausal women). * **Ovarian Cancer:** Usually presents with vague abdominal symptoms, adnexal masses, or ascites. Atrophic ovaries on ultrasound are a normal physiological finding in a 55-year-old and argue against ovarian malignancy. **NEET-PG High-Yield Pearls:** * **Most common cause of PMB:** Atrophic vaginitis/endometritis (Senile endometritis). * **Most common "malignant" cause of PMB:** Endometrial carcinoma. * **Cut-off for ET in PMB:** If ET is **≤ 4 mm**, the risk of malignancy is 4 mm).

Q: Which drug is used for the management of ectopic pregnancy?

Methotrexate. **Explanation:** **Methotrexate (Option A)** is the drug of choice for the medical management of unruptured ectopic pregnancy. It is a folic acid antagonist that inhibits the enzyme **dihydrofolate reductase**, thereby preventing the synthesis of DNA, RNA, and proteins. Since trophoblastic tissue is rapidly dividing, it is highly sensitive to methotrexate, which effectively halts the growth of the ectopic pregnancy and allows for gradual resorption. **Why other options are incorrect:** * **Mifepristone (Option B):** While it is an anti-progestogen used for medical abortion (in combination with Misoprostol), it is not the primary treatment for ectopic pregnancy. It acts on the decidua but is insufficient to reliably terminate a tubal pregnancy. * **Procarbazine (Option C):** This is an alkylating agent primarily used in the treatment of Hodgkin’s lymphoma, not in obstetric practice. * **Cytosine arabinoside (Option D):** Also known as Cytarabine, this is a chemotherapy agent used for leukemias and has no role in managing ectopic pregnancies. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Methotrexate:** Hemodynamically stable patient, unruptured mass <3.5–4 cm, no fetal cardiac activity, and baseline serum β-hCG <5000 mIU/mL. * **Contraindications:** Breastfeeding, immunodeficiency, ruptured ectopic pregnancy, or hepatic/renal dysfunction. * **Dosing:** Most commonly administered as a single intramuscular dose (50 mg/m²). * **Monitoring:** Success is defined by a ≥15% drop in β-hCG levels between Day 4 and Day 7 after administration.

Question 1

Clue cells are seen in which of the following conditions?

Accepted Answer

Bacterial vaginosis

Answer

Moniliasis

Answer

Trichomoniasis

Answer

All of the above

Question 2

A 35-year-old female who has completed her family presents with an asymptomatic 10-week size fibroid. What is the most appropriate management?

Accepted Answer

Observation only

Answer

Hysterectomy with bilateral salpingo-oophorectomy

Answer

Hysteroscopic myomectomy

Answer

Myomectomy

Question 3

Which of the following is true about tubal pregnancy?

Accepted Answer

All of the above.

Answer

Intrauterine contraceptive device (IUCD) use predisposes to tubal pregnancy.

Answer

A prior tubal pregnancy is a predisposing factor.

Answer

A history of pelvic inflammatory disease (PID) or Chlamydia infection is a predisposing factor.

Question 4

Ectopic pregnancy is most commonly associated with:

Accepted Answer

Tubal inflammatory diseases

Answer

Endometriosis

Answer

Congenital tubal anomalies

Answer

Tuberculosis

Question 5

Corpus luteum cyst occurs due to:

Accepted Answer

HCG

Answer

HPL

Answer

Estrogen

Answer

Progesterone

Question 6

Which of the following treatments is not indicated in ectopic pregnancy?

Accepted Answer

Salpingo-oophorectomy

Answer

Salpingectomy

Answer

Salpingostomy

Answer

Resection of involved segment

Question 7

A 55-year-old woman presents with post-menopausal bleeding. Pelvic examination reveals a normal cervix, and a Pap smear performed one month prior was normal. Her ultrasound shows an endometrial thickness of 1 mm and atrophic ovaries. What is the most probable diagnosis?

Accepted Answer

Senile endometritis

Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Question 8

In gynecologic surgery, what is the most common procedure associated with ureter injury and where is the typical site of injury?

Accepted Answer

Simple abdominal hysterectomy, pelvic brim near the infundibulopelvic ligament

Answer

Vaginal hysterectomy, tunnel of Weheim

Answer

Bladder neck suspension, tunnel of Weheim

Answer

Laparoscopic oophorectomy, pelvic brim near the infundibulopelvic ligament

Question 9

Mayer-Rokitansky-Kuster-Hauser syndrome is characterized by which of the following findings?

Accepted Answer

Absence of the uterus, but presence of fallopian tubes and ovaries

Answer

Presence of ovaries, uterus, and fallopian tubes

Answer

Absence of all reproductive organs

Answer

Presence of the uterus, but absence of tubes and ovaries

Question 10

Which drug is used for the management of ectopic pregnancy?

Accepted Answer

Methotrexate

Answer

Mifepristone

Answer

Procarbazine

Answer

Cytosine arabinoside

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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