Gynecological Disorders Practice Questions

Q: Leiomyomatosis is:

An extrauterine tumor. **Explanation:** **Leiomyomatosis** refers to a group of rare conditions characterized by the growth of benign smooth muscle tumors in locations **outside the uterine cavity**. While histologically identical to common uterine fibroids (leiomyomas), these tumors exhibit unusual growth patterns, spreading to extrauterine sites such as the pelvic peritoneum, lungs, or even within the vascular system. * **Why Option C is Correct:** The defining feature of leiomyomatosis is its **extrauterine** presence. Examples include *Intravenous Leiomyomatosis* (growth into venous channels) and *Leiomyomatosis Peritonealis Disseminata* (multiple nodules on the peritoneal surfaces), both of which occur outside the confines of the uterus. * **Why Option A is Incorrect:** Despite their aggressive-sounding name and ability to spread, these tumors are **benign**. They lack the cellular atypia, high mitotic index, and coagulative necrosis characteristic of Leiomyosarcoma (malignant). * **Why Option B is Incorrect:** Certain forms, like Intravenous Leiomyomatosis, are highly **infiltrative**, extending into the internal iliac veins, vena cava, and sometimes reaching the right chambers of the heart. * **Why Option D is Incorrect:** A standard "uterine fibroid" is a localized, intramural, subserosal, or submucosal tumor. Leiomyomatosis represents a systemic or disseminated variant rather than a simple localized fibroid. **High-Yield NEET-PG Pearls:** * **Leiomyomatosis Peritonealis Disseminata (LPD):** Often associated with high estrogen states (pregnancy or OCP use) and can mimic peritoneal carcinomatosis laparoscopically. * **Benign Metastasizing Leiomyoma:** A variant where histologically benign uterine fibroids "metastasize" most commonly to the **lungs**. * **Management:** Treatment usually involves surgical excision and hormonal suppression (GnRH agonists), as these tumors are often estrogen-dependent.

Q: Following an ectopic pregnancy, what is the approximate recurrence rate?

15%. **Explanation:** The risk of a repeat ectopic pregnancy is significantly higher in women who have already experienced one, primarily due to underlying tubal damage or dysfunction (e.g., chronic salpingitis or scarring from surgery). **1. Why 15% is correct:** Statistically, after one ectopic pregnancy, the recurrence rate is approximately **15%**. This risk increases dramatically after two or more ectopic pregnancies, rising to about **25-30%**. The underlying medical concept is that the factors which predisposed the patient to the first ectopic (such as Pelvic Inflammatory Disease, smoking, or previous tubal surgery) often persist or are exacerbated by the initial event, leading to a higher likelihood of future implantation outside the uterine cavity. **2. Analysis of Incorrect Options:** * **A (5%):** This is too low. The risk in the general population is approximately 1-2%; a previous ectopic increases this baseline risk by nearly tenfold. * **B (10%):** While some older texts cite 10%, standard contemporary textbooks (like Williams Obstetrics and Dutta) generally point toward the 15% mark as the most accurate representative figure for a single prior event. * **D (20%):** This figure is slightly higher than the average for a single recurrence, though it may be seen in specific high-risk cohorts (e.g., those with bilateral tubal disease). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serum β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Management:** Methotrexate is the medical treatment of choice in hemodynamically stable patients with a small sac (<3.5-4 cm) and no fetal cardiac activity. Salpingectomy is preferred over salpingostomy if the contralateral tube is healthy.

Q: A 50-year-old diabetic female presents with intense pruritus and discharge from the vagina. A smear of the discharge shows budding yeast cells. What is the most likely causative agent?

Candida albicans. ### Explanation The correct answer is **Candida albicans**. **1. Why Candida albicans is correct:** The clinical presentation of intense pruritus, vaginal discharge, and the presence of **budding yeast cells** (and/or pseudohyphae) on a smear is pathognomonic for **Vulvovaginal Candidiasis (VVC)**. * **Risk Factors:** Diabetes mellitus is a major predisposing factor because hyperglycemia increases glycogen levels in vaginal secretions, promoting fungal growth. * **Microscopy:** Budding yeast cells and pseudohyphae are typically seen on a KOH mount or Gram stain. **2. Why the other options are incorrect:** * **Trichomonas vaginalis:** Presents with a profuse, frothy, greenish-yellow discharge and a "strawberry cervix." Microscopy would show motile, flagellated pear-shaped organisms, not yeast. * **Mobiluncus:** This is an anaerobic organism associated with **Bacterial Vaginosis (BV)**. BV is characterized by a "fishy" odor and "clue cells" on microscopy, not budding yeast. * **Chlamydia trachomatis:** Typically causes cervicitis or Pelvic Inflammatory Disease (PID). It is an obligate intracellular bacterium and would not appear as budding yeast on a smear. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Culture on **Sabouraud’s Dextrose Agar (SDA)**. * **Clinical Sign:** "Curdy white" or "cottage cheese" like discharge. * **pH Factor:** Unlike Trichomonas and BV (where pH > 4.5), the vaginal pH in Candidiasis is usually **normal (< 4.5)**. * **Treatment:** Fluconazole (oral) or Clotrimazole (topical). In pregnancy, only topical azoles are recommended.

Q: Intermenstrual bleeding (metrorrhagia) arises typically when the fibroid tumour is:

Submucous. ### Explanation **Correct Option: A (Submucous)** The primary reason for abnormal uterine bleeding in fibroids is the distortion and increased surface area of the endometrial lining. **Submucous fibroids** (Type 0, 1, and 2 according to FIGO classification) are located directly beneath the endometrium. They cause **metrorrhagia (intermenstrual bleeding)** because they lead to: 1. **Ulceration and necrosis** of the overlying thinned-out endometrium. 2. **Venous congestion** and stasis within the endometrial plexuses. 3. Interference with normal uterine contractility, preventing effective hemostasis. **Incorrect Options:** * **B. Subserous:** These fibroids grow toward the peritoneal cavity. They are usually asymptomatic regarding menstruation but may cause pressure symptoms (e.g., frequency of micturition) or torsion. * **C. Interstitial (Intramural):** These are the most common type and typically present with **menorrhagia** (heavy cyclic bleeding) due to increased uterine surface area and vascularity, rather than irregular intermenstrual bleeding. * **D. Broad ligament myoma:** These are a type of subserous fibroid that grows between the layers of the broad ligament. They do not involve the endometrium and thus do not cause metrorrhagia. **NEET-PG High-Yield Pearls:** * **Most common symptom of fibroid:** Menorrhagia (Heavy Menstrual Bleeding). * **Most common type of fibroid:** Intramural (Interstitial). * **Fibroid most likely to cause infertility/abortion:** Submucous. * **Degeneration most common in pregnancy:** Red degeneration (due to rapid growth and venous thrombosis). * **Investigation of choice:** Transvaginal Ultrasound (TVS). Saline Infusion Sonohysterography (SIS) is superior for diagnosing submucous fibroids.

Q: Which is not a feature of pseudocyesis?

Fetal heart sounds are audible. **Explanation:** **Pseudocyesis** (False Pregnancy) is a rare psychosomatic disorder where a non-pregnant woman exhibits classic signs and symptoms of pregnancy. It is often driven by an intense desire to conceive or a fear of pregnancy, leading to a complex neuroendocrine feedback loop. **Why Option C is the correct answer:** The hallmark of pseudocyesis is that despite the physical manifestations, there is **no actual fetus**. Therefore, objective signs of pregnancy such as **fetal heart sounds (FHS)**, fetal movements (palpated by a clinician), or fetal parts on imaging are **always absent**. The presence of audible fetal heart sounds would indicate a true pregnancy, making it incompatible with a diagnosis of pseudocyesis. **Analysis of incorrect options:** * **Option A (Amenorrhoea):** This is a common feature. Stress and psychological factors can disrupt the hypothalamic-pituitary-ovarian axis, leading to hormonal changes (like elevated prolactin or persistent luteal phase) that result in the cessation of menses. * **Option B (Abdominal distension):** This is frequently observed and is usually caused by aerophagia (swallowing air), abdominal muscle contraction (lordosis), or excess omental fat. Interestingly, the distension often disappears under general anesthesia. **High-Yield Clinical Pearls for NEET-PG:** * **Hormonal Profile:** Patients may show elevated levels of prolactin and LH, but **hCG levels are always negative**. * **Differential Diagnosis:** Must be distinguished from **Delusion of Pregnancy**, which is a fixed false belief without the physical symptoms, and **Malingering**, where the patient is consciously faking symptoms. * **Management:** The primary treatment is psychological counseling and ultrasound demonstration of an empty uterus to the patient.

Q: A young lady presents with a complaint of copious vaginal discharge. On per speculum examination, a 'strawberry vagina' is noted, with no cervical discharge. Which of the following should be given for management?

Metronidazole. **Explanation:** The clinical presentation of **copious vaginal discharge** and a characteristic **'strawberry vagina'** (punctate hemorrhages on the vaginal and cervical mucosa) is pathognomonic for **Trichomoniasis**, caused by the protozoan *Trichomonas vaginalis*. **1. Why Metronidazole is correct:** Metronidazole is the drug of choice for Trichomoniasis. It is a nitroimidazole that targets anaerobic bacteria and protozoa. According to current guidelines, both the patient and their sexual partner(s) must be treated simultaneously to prevent reinfection, as Trichomoniasis is a sexually transmitted infection (STI). **2. Analysis of Incorrect Options:** * **Metronidazole and Azithromycin/Doxycycline (Options B & C):** These combinations are used for Syndromic Management of Pelvic Inflammatory Disease (PID) or Cervicitis (targeting *N. gonorrhoeae* and *C. trachomatis*). Since the question specifies "no cervical discharge," the focus remains on the vaginal infection alone. * **Fluconazole (Option D):** This is an antifungal used for Vulvovaginal Candidiasis, which typically presents with a thick, "curdy-white" discharge and an inflamed (but not strawberry) vagina. **Clinical Pearls for NEET-PG:** * **Whiff Test:** Often positive (amine odor) in Trichomoniasis, similar to Bacterial Vaginosis. * **Microscopy:** Look for "pear-shaped, flagellated motile trophozoites" on a wet mount. * **pH:** The vaginal pH in Trichomoniasis is typically **>4.5**. * **Gold Standard Diagnosis:** Culture (Diamond’s Medium), though NAAT is now preferred for its high sensitivity. * **Pregnancy:** Metronidazole is safe to use in all trimesters of pregnancy for symptomatic Trichomoniasis.

Q: All are true regarding endometriosis, except?

Endometriotic cysts typically contain clear fluid.. **Explanation:** **Why Option C is the correct answer:** Endometriotic cysts, commonly known as **Chocolate Cysts**, do not contain clear fluid. Instead, they are filled with thick, dark, chocolate-colored material. This characteristic appearance is due to repeated cyclical bleeding into the cyst cavity; over time, the blood undergoes hemolysis and degradation, resulting in a viscous, brownish fluid. Clear fluid is more characteristic of simple follicular or serous cysts. **Analysis of other options:** * **Option A (Hormone-dependent):** This is true. Endometriosis is an **estrogen-dependent** inflammatory condition. It primarily affects women of reproductive age and typically regresses after menopause or during pregnancy when estrogen levels are low or counteracted. * **Option B (Lung and pleura involvement):** This is true. While most common in the pelvis, "extra-pelvic endometriosis" can occur. The **thoracic cavity** is the most common site outside the abdomen, leading to conditions like catamenial pneumothorax (collapsed lung during menstruation). * **Option D (Ovary as the most common site):** This is true. The **ovary** is statistically the most frequent site of endometriotic implants, followed by the Pouch of Douglas (POD) and the broad ligaments. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy with biopsy (visual confirmation of "powder-burn" or "gunshot" lesions). * **Classic Triad:** Dysmenorrhea (congestive), Dyspareunia, and Infertility. * **CA-125:** Often elevated in endometriosis, but it is non-specific and used more for monitoring than diagnosis. * **Sampson’s Theory:** Retrograde menstruation is the most widely accepted theory for its pathogenesis.

Question 1

Leiomyomatosis is:

Accepted Answer

An extrauterine tumor

Answer

A malignant tumor

Answer

A non-infiltrative tumor

Answer

A uterine fibroid

Question 2

Following an ectopic pregnancy, what is the approximate recurrence rate?

Accepted Answer

15%

Answer

5%

Answer

10%

Answer

20%

Question 3

A 50-year-old diabetic female presents with intense pruritus and discharge from the vagina. A smear of the discharge shows budding yeast cells. What is the most likely causative agent?

Accepted Answer

Candida albicans

Answer

Trichomonas vaginalis

Answer

Mobiluncus

Answer

Chlamydia trachomatis

Question 4

Intermenstrual bleeding (metrorrhagia) arises typically when the fibroid tumour is:

Accepted Answer

Submucous

Answer

Subserous

Answer

Interstitial

Answer

Broad ligament myoma

Question 5

Which is not a feature of pseudocyesis?

Accepted Answer

Fetal heart sounds are audible

Answer

Amenorrhoea

Answer

Abdominal distension

Answer

None of the above

Question 6

A woman with a history of recurrent abortions presents with an isolated increase in aPTT. What is the most likely cause?

Accepted Answer

Lupus anticoagulant

Answer

Factor VII deficiency

Answer

Von Willebrand's disease

Answer

Hemophilia A

Question 7

A patient with a long-standing intrauterine contraceptive device (IUCD) develops chronic pelvic pain. The device is removed, and a biopsy of the endometrium is performed. The biopsy specimen shows a prominent infiltrate composed of lymphocytes, plasma cells, and histiocytes. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic endometritis

Answer

Acute endometritis

Answer

Adenomyosis

Answer

Endometriosis

Question 8

Which of the following is true regarding pain in endometriosis?

Accepted Answer

Dyspareunia is more common with peritoneal lesions in the pouch of Douglas.

Answer

Dysmenorrhea usually starts from day 2 of periods and subsides with the end of menstrual flow.

Answer

Dysmenorrhea is more common in ovarian endometriomas than peritoneal lesions.

Answer

Pelvic pain is usually unilateral.

Question 9

A young lady presents with a complaint of copious vaginal discharge. On per speculum examination, a 'strawberry vagina' is noted, with no cervical discharge. Which of the following should be given for management?

Accepted Answer

Metronidazole

Answer

Metronidazole and azithromycin

Answer

Metronidazole and doxycycline

Answer

Fluconazole only

Question 10

All are true regarding endometriosis, except?

Accepted Answer

Endometriotic cysts typically contain clear fluid.

Answer

It is a hormone-dependent condition.

Answer

It can involve the lung and pleura.

Answer

The ovary is the most common site for endometriosis.

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?