Gynecological Disorders — MCQs

A 30-year-old female presents with lower abdominal pain and purulent vaginal discharge. Her pulse rate is 98/min, temperature is 101°F, and WBC and ESR are elevated. Pelvic examination reveals lower abdominal tenderness and cervical motion tenderness. What is the most appropriate treatment for this patient?

Q717Easy

A creamy, fishy odor is characteristic of which of the following conditions?

Q718Medium

In procidentia, which of the following statements is true?

Q719Easy

What is the most common cause of first-trimester abortion?

Q720Easy

Which of the following best describes a cervical myoma?

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 711: What is the commonest chromosomal abnormality in early spontaneous abortions?

A. Monosomy
B. Autosomal trisomy (Correct Answer)
C. Triploidy
D. Tetraploidy

Explanation: **Explanation:** Chromosomal abnormalities are responsible for approximately 50–60% of first-trimester spontaneous abortions. Among these, numerical aberrations are the most frequent cause. **1. Why Autosomal Trisomy is Correct:** Autosomal trisomy is the **single most common** chromosomal abnormality found in early miscarriages, accounting for about **50%** of all chromosomally abnormal abortuses. It occurs due to non-disjunction during meiosis (usually maternal). * **Trisomy 16** is the most common specific trisomy identified in these cases (though it is never seen in live births). * **Trisomy 21, 18, and 13** are also frequent but have higher rates of survival to term compared to Trisomy 16. **2. Analysis of Incorrect Options:** * **Monosomy (Option A):** Specifically, **45,X (Turner Syndrome)** is the **single most common specific chromosomal pattern** (karyotype) found in spontaneous abortions (approx. 20%). However, as a *group*, autosomal trisomies are more common than monosomies. * **Triploidy (Option C):** This involves 69 chromosomes (often due to dispermy). It accounts for about 15% of cases and is frequently associated with hydatidiform changes (Partial Mole). * **Tetraploidy (Option D):** This involves 92 chromosomes. It is rare (approx. 5%) and usually results in very early pregnancy loss (blighted ovum). **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of 1st-trimester abortion:** Chromosomal abnormalities. * **Most common group of abnormalities:** Autosomal Trisomy. * **Most common specific Trisomy:** Trisomy 16. * **Most common specific Karyotype:** 45,X (Turner Syndrome). * **Most common cause of 2nd-trimester abortion:** Maternal factors (e.g., Cervical incompetence, uterine anomalies).

Question 712: What is the treatment for acute Pelvic Inflammatory Disease (PID)?

A. Intravenous antibiotics (broad spectrum)
B. Drainage of a tubo-ovarian abscess
C. Laparoscopic exploration
D. All of the above (Correct Answer)

Explanation: **Explanation:** Acute Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper female genital tract. The management strategy is multifaceted, depending on the severity of the clinical presentation. * **Intravenous Antibiotics (Option A):** This is the cornerstone of treatment for acute PID, especially in hospitalized patients. Regimens (e.g., Ceftriaxone + Doxycycline + Metronidazole) must provide broad-spectrum coverage against *N. gonorrhoeae*, *C. trachomatis*, anaerobes, and Gram-negative rods to prevent long-term sequelae like infertility. * **Drainage of Tubo-ovarian Abscess (TOA) (Option B):** If PID progresses to a TOA and fails to respond to medical therapy, or if the abscess is large/ruptured, surgical or image-guided (ultrasound/CT) drainage is indicated. * **Laparoscopic Exploration (Option C):** Laparoscopy is the **gold standard** for the diagnosis of PID. It allows for direct visualization of inflamed tubes and purulent exudate, and it can be therapeutic for adhesiolysis or drainage of collections. Since all three modalities—medical, surgical drainage, and diagnostic/therapeutic laparoscopy—play a role in the comprehensive management of acute PID, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Laparoscopy (shows tubal edema and hyperemia). * **Most Common Organism:** *Chlamydia trachomatis* (overall), though *N. gonorrhoeae* is more common in acute, symptomatic presentations. * **CDC Criteria for Hospitalization:** Pregnancy, failure of outpatient therapy, high fever/vomiting, presence of TOA, or inability to exclude surgical emergencies like appendicitis. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions).

Question 713: Which type of ovarian cyst is least likely to undergo malignant transformation?

A. Mucinous cystadenoma
B. Serous cystadenoma
C. Dermoid cyst
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because all three types of ovarian cysts mentioned—Serous cystadenoma, Mucinous cystadenoma, and Dermoid cysts—possess a documented potential for malignant transformation. In the context of NEET-PG, it is crucial to understand that while these are primarily benign, they are precursors or have associated malignant counterparts. * **Serous Cystadenoma:** This is the most common benign epithelial tumor. However, it has a significant risk of malignant transformation into **Serous Cystadenocarcinoma**, which is the most common malignant ovarian tumor. * **Mucinous Cystadenoma:** These can grow to massive sizes. About 10% undergo malignant change into **Mucinous Cystadenocarcinoma**. They are also associated with *Pseudomyxoma peritonei* if they rupture. * **Dermoid Cyst (Mature Cystic Teratoma):** While 98% are benign, approximately **1-2%** undergo malignant transformation, most commonly into **Squamous Cell Carcinoma** (arising from the ectodermal component). Since all three options carry a risk of malignancy, none can be classified as "least likely" in a way that excludes the others; rather, the question highlights that malignancy is a potential complication for all common benign ovarian neoplasms. **High-Yield NEET-PG Pearls:** * **Most common malignant change in a Dermoid:** Squamous Cell Carcinoma. * **Most common ovarian neoplasm overall:** Serous Cystadenoma. * **Psammoma bodies:** Characteristically seen in Serous tumors (both benign and malignant). * **Tumor Marker for Epithelial Ovarian Cancer:** CA-125.

Question 714: Koilocytes with dyskeratosis and perinuclear halo on Pap smear is pathognomonic of which of the following?

A. HPV infection (Correct Answer)
B. Metaplasia
C. Dysplasia
D. Bacterial vaginosis

Explanation: **Explanation:** **Correct Option: A (HPV infection)** The presence of **koilocytes** is the hallmark cytological feature of Human Papillomavirus (HPV) infection. A koilocyte is a squamous epithelial cell that has undergone specific structural changes due to the HPV E6 and E7 oncoproteins. The pathognomonic features include: * **Perinuclear halo:** A large, sharply demarcated clear zone around the nucleus. * **Nuclear atypia:** Enlarged, hyperchromatic (dark) nucleus with an irregular "raisinoid" appearance. * **Dyskeratosis:** Premature or abnormal keratinization of the cytoplasm. **Why other options are incorrect:** * **B. Metaplasia:** Squamous metaplasia is a physiological process (common at the transformation zone) where columnar epithelium changes to squamous epithelium. It lacks the specific nuclear atypia and halos seen in koilocytosis. * **C. Dysplasia:** While HPV can lead to dysplasia (CIN), "dysplasia" is a broader term for disordered growth. Koilocytosis specifically indicates the *viral effect* (LSIL), whereas high-grade dysplasia is characterized by a high nuclear-to-cytoplasmic ratio and loss of polarity without prominent halos. * **D. Bacterial Vaginosis:** This is characterized by **"Clue Cells"** (squamous cells covered in *Gardnerella vaginalis* bacilli, giving a "shaggy" border appearance), not koilocytes. **High-Yield NEET-PG Pearls:** * **Koilocytes** are primarily found in **LSIL** (Low-grade Squamous Intraepithelial Lesion). * HPV types **16 and 18** are high-risk (linked to cervical cancer); types **6 and 11** are low-risk (linked to genital warts/condyloma acuminatum). * The **transformation zone** is the most common site for HPV-related neoplasia. * On biopsy, koilocytosis is seen in the **superficial and intermediate** layers of the epithelium.

Question 715: True about endometriosis is/are:

A. Most common in 3rd or 4th decade (Correct Answer)
B. Premenstrual spotting absent
C. Endometrial sarcoma is most common
D. True cyst

Explanation: **Explanation:** **1. Why Option A is Correct:** Endometriosis is an estrogen-dependent inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. It primarily affects women of reproductive age, most commonly diagnosed in the **3rd and 4th decades (ages 25–35)**. This is because the growth and proliferation of ectopic tissue rely on cyclic ovarian hormonal stimulation, which is at its peak during these years. **2. Why Other Options are Incorrect:** * **Option B:** Premenstrual spotting is a **known clinical feature** of endometriosis. It often occurs due to luteal phase deficiency or the breakdown of ectopic implants just before the onset of menstruation. * **Option C:** While endometriosis increases the risk of certain cancers, the most common associated malignancies are **Clear Cell Carcinoma** and **Endometrioid Adenocarcinoma** of the ovary, not endometrial sarcoma. * **Option D:** An endometrioma (chocolate cyst) is a **pseudocyst**. Unlike a true cyst, it lacks an epithelial lining; its wall is composed of compressed ovarian stroma and fibrous tissue containing hemosiderin-laden macrophages (siderophages). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ovary (followed by the Pouch of Douglas). * **Classic Triad:** Dysmenorrhea (congestive/secondary), Dyspareunia, and Infertility. * **Gold Standard Diagnosis:** Laparoscopy with biopsy (visualized as "powder-burn" or "gunshot" lesions). * **Sampson’s Theory:** Retrograde menstruation is the most widely accepted theory of pathogenesis. * **CA-125:** May be elevated but is non-specific; used primarily for monitoring recurrence.

Question 716: A 30-year-old female presents with lower abdominal pain and purulent vaginal discharge. Her pulse rate is 98/min, temperature is 101°F, and WBC and ESR are elevated. Pelvic examination reveals lower abdominal tenderness and cervical motion tenderness. What is the most appropriate treatment for this patient?

A. Single intramuscular injection of Ceftriaxone with oral doxycycline and oral metronidazole for 14 days (Correct Answer)
B. Single dose of Ceftriaxone injection with oral Azithromycin for 14 days
C. Oral Metronidazole for 14 days
D. Oral Ofloxacin and oral Metronidazole for 14 days

Explanation: ### Explanation **Diagnosis:** The patient presents with the classic triad of Pelvic Inflammatory Disease (PID): lower abdominal pain, cervical motion tenderness (Chandelier sign), and fever/purulent discharge. **1. Why Option A is Correct:** According to the latest **CDC and WHO guidelines** for the outpatient management of mild-to-moderate PID, the regimen must provide broad-spectrum coverage against *Neisseria gonorrhoeae*, *Chlamydia trachomatis*, and anaerobes. * **Ceftriaxone (500mg IM single dose):** Covers *N. gonorrhoeae*. * **Doxycycline (100mg BID for 14 days):** Covers *C. trachomatis*. * **Metronidazole (500mg BID for 14 days):** Added to provide robust coverage against anaerobes, which are frequently associated with PID and tubo-ovarian abscesses. **2. Why Other Options are Incorrect:** * **Option B:** Azithromycin is no longer the preferred agent for PID because Doxycycline has shown superior efficacy in eradicating *Chlamydia* in the upper genital tract. * **Option C:** Metronidazole alone lacks coverage for the primary causative organisms (*Gonorrhea* and *Chlamydia*). * **Option D:** Fluoroquinolones (Ofloxacin) are no longer recommended as first-line therapy due to the high prevalence of quinolone-resistant *N. gonorrhoeae*. **3. High-Yield Clinical Pearls for NEET-PG:** * **Minimum Clinical Criteria for PID:** Cervical motion tenderness OR Uterine tenderness OR Adnexal tenderness. * **Most Common Organism:** *Chlamydia trachomatis* (most common overall), though *N. gonorrhoeae* is often more acute. * **Gold Standard Diagnosis:** Laparoscopy (shows "violin-string" adhesions in Fitz-Hugh-Curtis Syndrome). * **Indications for Hospitalization:** Pregnancy, failure of outpatient therapy, severe nausea/vomiting, or suspected tubo-ovarian abscess.

Question 717: A creamy, fishy odor is characteristic of which of the following conditions?

A. Trichomonas vaginalis infection
B. Bacterial vaginosis (Gardnerella vaginalis) (Correct Answer)
C. Candida albicans infection (Vaginal candidiasis)
D. Chlamydia trachomatis infection

Explanation: **Explanation:** The correct answer is **Bacterial vaginosis (BV)**, primarily caused by *Gardnerella vaginalis*. BV is not a true infection but a clinical syndrome characterized by a shift in vaginal flora from protective Lactobacilli to anaerobic bacteria. 1. **Why it is correct:** The hallmark of BV is a **thin, homogenous, creamy-white discharge** that adheres to the vaginal walls. The "fishy odor" is due to the production of volatile amines (putrescine and cadaverine) by anaerobes. This odor becomes more pronounced after adding 10% KOH (the **Whiff test**) or after intercourse, as the alkaline nature of semen volatilizes the amines. 2. **Why other options are incorrect:** * **Trichomonas vaginalis:** Presents with a **profuse, frothy, greenish-yellow** discharge and a "strawberry cervix" (punctate hemorrhages). * **Candida albicans:** Characterized by a thick, **curdy, "cottage-cheese" like** discharge. It is typically odorless and associated with intense pruritus and an acidic pH (<4.5). * **Chlamydia trachomatis:** Often asymptomatic or presents as mucopurulent cervicitis with post-coital bleeding, rather than a specific malodorous vaginal discharge. **High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (3 out of 4 required for BV diagnosis):** 1. Homogenous, thin, white discharge. 2. Vaginal pH **> 4.5** (Most sensitive). 3. Positive **Whiff test** (amine odor). 4. Presence of **Clue cells** on saline microscopy (Most specific). * **Treatment of Choice:** Oral or topical **Metronidazole** (500 mg BD for 7 days). * **Note:** Partner treatment is *not* recommended for BV, unlike Trichomoniasis.

Question 718: In procidentia, which of the following statements is true?

A. Uterus and cervix are within the vagina.
B. Uterus is within the vagina, and the cervix is outside the introitus.
C. Both the uterus and cervix are outside the introitus. (Correct Answer)
D. None of the above.

Explanation: **Explanation:** **Procidentia** (also known as Grade 4 Uterine Prolapse) represents the most severe form of pelvic organ prolapse. The term is derived from the Latin *procidere*, meaning "to fall forward." **Why Option C is Correct:** In procidentia, there is a complete failure of the pelvic support system (primarily the cardinal and uterosacral ligaments). As a result, the entire uterus, including the cervix, descends completely through the vaginal canal and lies **outside the introitus**. The vaginal walls are completely everted, and the pelvic floor defect is maximal. **Why Other Options are Incorrect:** * **Option A:** This describes **First-degree prolapse** (where the cervix remains within the vagina but descends below its normal level) or **Second-degree prolapse** (where the cervix reaches the introitus but the uterine body remains internal). * **Option B:** This is anatomically impossible in the context of uterine prolapse. If the cervix is outside the introitus, the uterus (which is superior to the cervix) must also have descended significantly. While the entire uterine body might not be fully external in some third-degree cases, "procidentia" specifically refers to the total herniation described in Option C. **High-Yield Clinical Pearls for NEET-PG:** * **Keratinization:** In procidentia, the vaginal mucosa is exposed to the external environment, leading to thickening and keratinization (skin-like appearance). * **Decubitus Ulcer:** This is a common complication of procidentia, caused by venous congestion and friction against clothing. It is typically found at the dependent part of the prolapse (the cervix). * **Treatment of Choice:** For postmenopausal women with procidentia, the definitive treatment is **Vaginal Hysterectomy with Pelvic Floor Repair**. * **Measurement:** On the POP-Q (Pelvic Organ Prolapse Quantification) scale, procidentia corresponds to **Stage IV**.

Question 719: What is the most common cause of first-trimester abortion?

A. Chromosomal abnormalities (Correct Answer)
B. Syphilis
C. Rhesus isoimmunization
D. Cervical incompetence

Explanation: **Explanation:** **1. Why Chromosomal Abnormalities is Correct:** Chromosomal abnormalities are the single most common cause of spontaneous abortion in the first trimester, accounting for approximately **50–60%** of all early pregnancy losses. Among these, **Autosomal Trisomy** is the most frequent (Trisomy 16 being the most common specific trisomy), followed by Monosomy X (Turner Syndrome) and Polyploidy. These genetic errors usually occur de novo during gametogenesis or early fertilization, leading to non-viable embryos that the body naturally expels. **2. Why the Other Options are Incorrect:** * **Syphilis:** While infections can cause pregnancy loss, Syphilis is typically associated with **late second-trimester abortions**, stillbirths, or congenital syphilis, rather than early first-trimester loss. * **Rhesus (Rh) Isoimmunization:** This condition leads to fetal hemolysis and hydrops fetalis. It rarely causes abortion in the first trimester; its effects are usually manifested in the **second or third trimester**. * **Cervical Incompetence:** This is a classic cause of **painless, mid-trimester (second trimester)** habitual abortions, typically occurring between 16–24 weeks of gestation. **Clinical Pearls for NEET-PG:** * **Most common trisomy in abortuses:** Trisomy 16. * **Most common single chromosomal anomaly:** Monosomy X (45,X). * **Second-trimester abortions:** More commonly due to maternal factors (e.g., uterine anomalies, cervical incompetence, systemic diseases). * **Recurrent Pregnancy Loss (RPL):** While chromosomal issues are common in sporadic cases, in RPL, always rule out **Antiphospholipid Antibody Syndrome (APLA)**, which is the most common treatable cause.

Question 720: Which of the following best describes a cervical myoma?

A. Multiple growths
B. Solitary growth (Correct Answer)
C. Mostly large always
D. Mainly arise from cervical stroma

Explanation: **Explanation:** Cervical myomas (fibroids) are relatively rare, accounting for only **1–2%** of all uterine leiomyomas. The defining characteristic of a cervical myoma is that it is almost always a **solitary growth**. * **Why Option B is correct:** Unlike corporal (body) fibroids, which are frequently multiple, cervical fibroids typically occur as a single, isolated mass. They arise from the smooth muscle of the cervix and can be classified as interstitial, subperitoneal, or polypoid (submucous). * **Why Option A is incorrect:** Multiple growths are the hallmark of corporal fibroids, not cervical ones. * **Why Option C is incorrect:** While cervical myomas can become large enough to fill the pelvic cavity, they are not "always" large. However, even a small cervical myoma can cause significant symptoms due to the limited space in the pelvis. * **Why Option D is incorrect:** Myomas arise from the **smooth muscle fibers** (myometrium) of the cervix, not the fibrous stroma. **Clinical Pearls for NEET-PG:** 1. **Classification:** They are categorized as Anterior, Posterior, Lateral, or Central (the most common type, which expands the cervix uniformly). 2. **Clinical Features:** They often present with **pressure symptoms** (urinary retention due to pressure on the urethra/bladder) or menstrual irregularities. 3. **Surgical Challenge:** During a hysterectomy for cervical myoma, the **ureter** is at high risk of injury because it is displaced laterally and stretched over the surface of the tumor. 4. **Sign:** A central cervical myoma gives a characteristic **"Lantern on top of St. Paul’s Cathedral"** appearance, where the small uterus sits atop the massive cervical expansion.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

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Adenomyosis

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Uterine Fibroids

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Ovarian Cysts

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Pelvic Inflammatory Disease

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Vulvovaginitis

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Pelvic Organ Prolapse

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Vulvar Disorders

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Benign Breast Diseases

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