Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 691: What is the most common cause of vaginal discharge among reproductive-age females?

A. Trichomonas
B. Candida
C. Bacterial vaginosis (Correct Answer)
D. Gonorrhea

Explanation: **Explanation:** **Bacterial Vaginosis (BV)** is the most common cause of vaginal discharge in women of reproductive age worldwide, accounting for approximately 40–50% of cases. It is not a true infection but a **clinical dysbiosis** characterized by a shift in vaginal flora: a decrease in hydrogen peroxide-producing *Lactobacilli* and an overgrowth of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*, and *Atopobium vaginae*). **Analysis of Options:** * **Bacterial Vaginosis (Correct):** It is the leading cause of "fishy-smelling" discharge. Diagnosis is clinically confirmed using **Amsel’s Criteria** (requires 3 out of 4: thin homogenous discharge, pH >4.5, positive Whiff test, and presence of **Clue cells** on microscopy). * **Candida (Incorrect):** This is the second most common cause. It typically presents with thick, "curdy-white" (cottage cheese-like) discharge and intense pruritus. The vaginal pH remains normal (<4.5). * **Trichomonas (Incorrect):** This is a protozoal STI. While common, it is less frequent than BV. It presents with a malodorous, frothy, green-yellow discharge and a "strawberry cervix" (punctate hemorrhages). * **Gonorrhea (Incorrect):** This primarily causes cervicitis rather than vaginitis. While it can cause discharge, it is significantly less common than the aforementioned causes of vaginal symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis for BV:** Nugent Scoring (Gram stain of vaginal discharge). * **Drug of Choice:** Metronidazole (500 mg BID for 7 days). * **Key Distinction:** BV is the only one of the three major causes where the partner does **not** routinely require treatment. * **Whiff Test:** Addition of 10% KOH to discharge releases a fishy odor due to amines.

Question 692: Hysteroscopic resection is indicated for submucosal myomas of which size?

A. Any size
B. Less than 4 cm (Correct Answer)
C. 4-8 cm
D. Less than 10 cm

Explanation: ### Explanation **Correct Answer: B. Less than 4 cm** Hysteroscopic myomectomy is the gold standard for treating symptomatic submucosal myomas (FIGO Type 0, 1, and 2). The primary limiting factor for a safe and successful hysteroscopic resection is the size of the fibroid. **Why < 4 cm is correct:** The consensus in gynecological surgery (supported by AAGL and ESGE guidelines) is that submucosal myomas **less than 4 cm** are most suitable for hysteroscopic resection. When a fibroid exceeds 4 cm, the procedure becomes technically challenging, significantly increasing the risk of: * **Fluid Overload:** Longer operative time leads to excessive absorption of distension media (Glycine or Saline), causing electrolyte imbalances or pulmonary edema. * **Incomplete Resection:** Large fibroids often require a two-stage procedure. * **Uterine Perforation:** Difficulty in maneuvering the resectoscope in a cavity crowded by a large mass. **Analysis of Incorrect Options:** * **A. Any size:** Incorrect. Large fibroids (e.g., >5 cm) pose a high risk of "TURP syndrome-like" fluid shifts and surgical complications. * **C. 4-8 cm:** Incorrect. While some expert surgeons may attempt resection of 4-5 cm fibroids, it is not the standard recommendation due to the high risk-to-benefit ratio. * **D. Less than 10 cm:** Incorrect. A 10 cm fibroid would likely occupy the entire uterine cavity, making hysteroscopic visualization impossible. Such cases require abdominal or laparoscopic myomectomy. **High-Yield Clinical Pearls for NEET-PG:** * **FIGO Classification:** Type 0 (completely intracavitary), Type 1 (<50% intramural), Type 2 (≥50% intramural). Type 0 and 1 are the best candidates for hysteroscopy. * **Pre-operative GnRH Analogues:** Often used for 2–3 months before surgery for fibroids >3 cm to reduce vascularity and size, making resection easier. * **Distension Media:** If using a monopolar resectoscope, use **1.5% Glycine** (non-electrolytic). If using bipolar, use **Normal Saline** (safer, reduces risk of hyponatremia). * **Fluid Limit:** Stop the procedure if the fluid deficit exceeds **1000 ml (for hypotonic solutions)** or **2500 ml (for isotonic solutions)** in a healthy patient.

Question 693: Which of the following statements is false regarding the given specimen?

A. Bilateral in 10% to 15% of cases.
B. About 10% undergo malignant transformation. (Correct Answer)
C. Typically presents as unilocular cysts.
D. Common during the active reproductive years.

Explanation: ***About 10% undergo malignant transformation.*** - The actual **malignant transformation rate** for dermoid cysts (mature cystic teratomas) is only **1-2%**, not 10%. - **Squamous cell carcinoma** is the most common malignant transformation, typically occurring in postmenopausal women. *Bilateral in 10% to 15% of cases.* - Dermoid cysts are **bilateral** in approximately **10-15%** of cases, making this statement true. - **Bilateral occurrence** is more common in dermoid cysts compared to other ovarian cysts. *Typically presents as unilocular cysts.* - Dermoid cysts characteristically appear as **unilocular cysts** with mixed echogenicity on ultrasound. - They contain **ectodermal derivatives** like hair, teeth, and sebaceous material, giving them a characteristic appearance. *Common during the active reproductive years.* - Dermoid cysts are most frequently diagnosed during the **reproductive years**, particularly in women aged **20-40 years**. - They represent the most common **ovarian neoplasm** in women under 30 years of age.

Question 694: Most common type of uterine polyp is:

A. Mucous polyp (Correct Answer)
B. Fibroid
C. Placental polyp
D. None of the above

Explanation: **Explanation:** **1. Why Mucous Polyp is Correct:** Uterine polyps are localized overgrowths of the lining of the uterus. The **Mucous polyp** (specifically the **Endometrial polyp**) is the most common type encountered in clinical practice. These are focal protrusions of the endometrial stroma and glands covered by epithelium. They are most frequently seen in women aged 40–50 years and are a common cause of Abnormal Uterine Bleeding (AUB-P in the FIGO classification). While most are benign, they require evaluation to rule out malignancy, especially in postmenopausal women. **2. Why Other Options are Incorrect:** * **Fibroid (Leiomyoma):** While fibroids are the most common benign *tumors* of the uterus, they are composed of smooth muscle cells and connective tissue. A "fibroid polyp" (pedunculated submucosal fibroid) is a specific subtype, but it is less common than the simple mucous/endometrial polyp. * **Placental Polyp:** This is a rare condition where retained products of conception (placental tissue) become organized and polypoid. It only occurs following a pregnancy, miscarriage, or abortion, making it far less common than general mucous polyps. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Intermenstrual bleeding (spotting between periods). * **Gold Standard Investigation:** Hysteroscopy (allows for both diagnosis and "see-and-treat" polypectomy). * **Investigation of Choice (Screening):** Transvaginal Sonography (TVS) or Saline Infusion Sonohysterography (SIS). * **Histology:** Look for "thick-walled blood vessels" in the stroma, which is a characteristic feature of endometrial polyps. * **Association:** Increased risk is associated with **Tamoxifen** therapy (used in breast cancer).

Question 695: What is true about galactorrhea?

A. Found in pregnancy and lactation
B. Always bilateral
C. Surgery is performed (Correct Answer)
D. Associated with adrenal gland tumor

Explanation: **Explanation:** Galactorrhea is defined as the spontaneous, non-puerperal secretion of milk-like fluid from the breast, occurring at least six months postpartum in a non-nursing woman. **Why Option C is Correct:** While most cases of galactorrhea are managed medically (e.g., Dopamine agonists like Bromocriptine or Cabergoline), **surgery is indicated** when the underlying cause is a **Macroadenoma** (Prolactinoma >10mm) that is refractory to medical treatment or causing compressive symptoms like visual field defects (bitemporal hemianopia). In such cases, a **Transsphenoidal Resection** is the procedure of choice. **Analysis of Incorrect Options:** * **Option A:** By definition, galactorrhea is **non-puerperal**. Milk secretion during pregnancy and lactation is considered physiological and is not termed galactorrhea. * **Option B:** While often bilateral, galactorrhea can be **unilateral** depending on the underlying cause (e.g., local chest wall stimulation or idiopathic cases). * **Option D:** Galactorrhea is primarily associated with **Pituitary tumors** (Prolactinomas), not adrenal gland tumors. Adrenal tumors typically present with virilization or Cushingoid features. **NEET-PG High-Yield Pearls:** * **Most common cause:** Idiopathic, followed by Pituitary Adenoma. * **Drug-induced causes:** Antipsychotics (Haloperidol), Metoclopramide, and Methyldopa (due to dopamine antagonism). * **Gold Standard Investigation:** Serum Prolactin levels and MRI of the Sella Turcica. * **First-line Medical Treatment:** **Cabergoline** (preferred over Bromocriptine due to better tolerability and longer half-life).

Question 696: Which of the following is NOT an indication for myomectomy in a case of fibroid uterus?

A. Associated infertility
B. Recurrent pregnancy loss
C. Pressure symptoms
D. Red degeneration (Correct Answer)

Explanation: **Explanation:** The correct answer is **Red degeneration (Option D)**. **Why Red Degeneration is NOT an indication:** Red degeneration (carneous degeneration) is an aseptic necrosis of a fibroid, typically occurring during the second half of pregnancy or the puerperium due to rapid growth and venous obstruction. It is a **self-limiting medical condition** characterized by acute pain, fever, and leukocytosis. The management is strictly **conservative** (bed rest, analgesics, and hydration). Surgery (myomectomy) is contraindicated during pregnancy due to the high risk of uncontrollable hemorrhage and miscarriage. **Analysis of Incorrect Options:** * **A. Associated Infertility:** Submucosal or intramural fibroids that distort the endometrial cavity can interfere with implantation or sperm transport. Myomectomy is indicated if no other cause of infertility is found. * **B. Recurrent Pregnancy Loss (RPL):** Fibroids can cause RPL by compromising the blood supply to the developing placenta or reducing uterine space. Removing these fibroids improves pregnancy outcomes. * **C. Pressure Symptoms:** Large fibroids can compress the bladder (frequency/urgency) or rectum (constipation). These mechanical symptoms are definitive indications for surgical intervention. **NEET-PG High-Yield Pearls:** * **Most common degeneration of fibroid:** Hyaline degeneration. * **Most common degeneration in pregnancy:** Red degeneration. * **Best time for myomectomy:** In the non-pregnant state. If required during a C-section, it is generally avoided unless the fibroid is pedunculated, due to the risk of hemorrhage. * **Medical Management of Red Degeneration:** Injection Pentazocine or other analgesics are the mainstays of treatment.

Question 697: Which of the following is a cystic remnant of the Wolffian duct?

A. Bartholin's cyst
B. Gartner's cyst (Correct Answer)
C. Nabothian cyst
D. Parovarian cyst

Explanation: ### Explanation **Correct Answer: B. Gartner’s cyst** **1. Why Gartner’s cyst is correct:** Gartner’s cysts are vestigial remnants of the **Wolffian (Mesonephric) duct**. In females, the Wolffian ducts normally regress due to the absence of testosterone. However, if portions persist, they can form cysts along the **anterolateral wall of the proximal vagina**. These are typically asymptomatic and found incidentally during pelvic examinations. **2. Why the other options are incorrect:** * **A. Bartholin’s cyst:** These are caused by the obstruction of the Bartholin’s gland duct, located in the **posterior third of the labia majora**. They are secretory glands (homologous to Cowper’s glands in males) and not embryological remnants. * **C. Nabothian cyst:** These are **mucous-filled retention cysts** on the surface of the cervix. They occur when the squamous epithelium of the ectocervix grows over the columnar epithelium of the endocervix, trapping mucus. * **D. Parovarian cyst:** These are cysts arising from the broad ligament, usually between the ovary and the fallopian tube. While some may be Wolffian in origin (e.g., Kobelt’s cysts), the term "Parovarian" is a broad anatomical classification that most commonly refers to **paramesonephric (Mullerian)** origins or simple mesothelial inclusions. Gartner’s cyst is the classic, specific answer for a Wolffian remnant in the vaginal wall. **3. Clinical Pearls for NEET-PG:** * **Mnemonic:** **W**olffian = **W**ay out (regresses in females); **M**ullerian = **M**akes female organs (Uterus, Tubes, Upper Vagina). * **Location:** Gartner’s cysts are always found **above the level of the hymen** on the anterolateral vaginal wall. * **Differential Diagnosis:** Always differentiate a Gartner’s cyst from a **Urethral Diverticulum** (which presents with the 3 D’s: Dysuria, Dribbling, and Dyspareunia). * **Associated Anomalies:** Large or multiple Gartner’s cysts may be associated with **renal agenesis** or ectopic ureters (ipsilateral).

Question 698: What is the most common etiology of abnormal uterine bleeding in the childhood age group?

A. Vulvovaginitis (Correct Answer)
B. Anovulation
C. Endometrial polyp
D. Endometrial cancer

Explanation: **Explanation:** Abnormal uterine bleeding (AUB) in the pediatric population requires a high index of suspicion for non-uterine causes, as the hypothalamic-pituitary-ovarian (HPO) axis is quiescent during this period. **1. Why Vulvovaginitis is Correct:** In the childhood age group (pre-pubertal), the vaginal mucosa is thin, atrophic, and has a neutral-to-alkaline pH due to low estrogen levels. This makes the area highly susceptible to infections and irritation. **Vulvovaginitis** is the most common cause of genital tract bleeding in children. It often presents as blood-tinged discharge resulting from localized inflammation, scratching, or secondary infection. Other common pediatric causes include foreign bodies and lichen sclerosus. **2. Why the Other Options are Incorrect:** * **Anovulation (Option B):** This is the most common cause of AUB in **adolescents** (post-menarche) due to an immature HPO axis, but it does not occur in pre-pubertal children. * **Endometrial Polyp (Option C):** These are benign growths typically seen in the **reproductive age group** or perimenopausal women; they are extremely rare in children. * **Endometrial Cancer (Option D):** This is a malignancy of the **postmenopausal** period. In children, while rare, the most common genital malignancy is Sarcoma botryoides (Embryonal rhabdomyosarcoma), not endometrial cancer. **Clinical Pearls for NEET-PG:** * **Most common cause of AUB by age:** * **Childhood:** Vulvovaginitis / Foreign body. * **Adolescence:** Anovulation (Dysfunctional Uterine Bleeding). * **Reproductive age:** Pregnancy-related complications, followed by PALM-COEIN causes (e.g., Leiomyoma, PCOS). * **Postmenopausal:** Endometrial atrophy (most common), but one must always rule out Endometrial Carcinoma. * **High-Yield Tip:** If a child presents with foul-smelling, bloody vaginal discharge, always suspect a **retained foreign body** (e.g., toilet paper).

Question 699: Classically, salpingitis is associated with which organism?

A. Neisseria gonorrhoeae
B. Chlamydia trachomatis (Correct Answer)
C. Trichomonas vaginalis
D. Mycoplasma hominis

Explanation: **Explanation:** Salpingitis, a key component of Pelvic Inflammatory Disease (PID), is most commonly caused by sexually transmitted infections. While multiple organisms can be involved, **Chlamydia trachomatis** is classically considered the most common cause of salpingitis worldwide. * **Why Chlamydia trachomatis is correct:** It is the leading cause of "silent" or subclinical salpingitis. Unlike other pathogens, Chlamydia often causes an insidious, low-grade infection that leads to significant tubal scarring, permanent damage to the endosalpinx, and subsequent infertility or ectopic pregnancy. In modern clinical practice, it is isolated more frequently than Gonorrhea in cases of PID. **Analysis of Incorrect Options:** * **Neisseria gonorrhoeae:** Historically, this was the most common cause. It typically presents more acutely with high fever and overt symptoms. While still a major cause, it is now second to Chlamydia in many epidemiological studies. * **Trichomonas vaginalis:** This is a protozoan that primarily causes vaginitis (strawberry cervix). While it can coexist with PID pathogens, it is not a primary cause of salpingitis. * **Mycoplasma hominis:** This is an opportunistic inhabitant of the lower genital tract. While it can be isolated in polymicrobial PID, it is rarely the primary "classical" causative agent. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy (shows hyperemic, edematous tubes with purulent exudate). * **Fitz-Hugh-Curtis Syndrome:** Peri-hepatitis (violin-string adhesions) associated with Chlamydial or Gonococcal salpingitis. * **Most common site of PID:** Fallopian tubes (Salpingitis). * **Treatment:** Always cover both *C. trachomatis* (Doxycycline/Azithromycin) and *N. gonorrhoeae* (Ceftriaxone) empirically.

Question 700: What is the gold standard investigation for a septate uterus?

A. Hysterosalpingography (HSG)
B. Hysteroscopy (Correct Answer)
C. Magnetic Resonance Imaging (MRI)
D. Ultrasonography (USG)

Explanation: **Explanation:** The **septate uterus** is the most common congenital uterine anomaly, resulting from the failure of resorption of the midline Müllerian duct septum. **Why Hysteroscopy is the Gold Standard:** Hysteroscopy is considered the gold standard because it allows for **direct visualization** of the uterine cavity. It can definitively identify the presence, extent, and nature of the septum. More importantly, it serves a dual purpose: it is both **diagnostic and therapeutic**, as hysteroscopic septoplasty (resection of the septum) is the definitive treatment to improve reproductive outcomes. **Analysis of Incorrect Options:** * **Hysterosalpingography (HSG):** While often the initial screening test, HSG cannot differentiate between a septate and a bicornuate uterus because it only shows the internal contour of the cavity, not the external fundal notch. * **Magnetic Resonance Imaging (MRI):** MRI is highly accurate and the best **non-invasive** modality to differentiate between septate and bicornuate uteri (by visualizing the external fundal contour), but it remains secondary to the direct visualization and surgical capability of hysteroscopy. * **Ultrasonography (USG):** 2D-USG has low sensitivity. While **3D-USG** is now highly regarded for its accuracy in mapping the fundal notch, it is not yet classified as the "gold standard" over the surgical visualization provided by hysteroscopy. **NEET-PG High-Yield Pearls:** * **Most common Müllerian anomaly:** Septate uterus. * **Anomaly with worst reproductive outcome:** Septate uterus (highest risk of miscarriage). * **Differentiating factor:** A **septate** uterus has a flat or convex external fundal contour, whereas a **bicornuate** uterus has a fundal indentation >1 cm. * **Combined Gold Standard:** Often, the combination of **Hysteroscopy + Laparoscopy** is cited to perfectly visualize both the internal cavity and external contour simultaneously.

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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