Gynecological Disorders Practice Questions

Q: What is the chromosomal complement of a normal female?

46XX. **Explanation:** The human somatic cell contains **46 chromosomes**, organized into 23 pairs. Of these, 22 pairs are autosomes, and one pair consists of sex chromosomes (gonosomes) which determine the biological sex of the individual. * **Why 46,XX is correct:** In a normal female, the sex chromosome pair consists of two X chromosomes. Therefore, the standard karyotype is represented as **46,XX**. During embryonic development, the absence of the Y chromosome (and specifically the SRY gene) allows the bipotential gonad to develop into an ovary, leading to female phenotypic differentiation. **Analysis of Incorrect Options:** * **46,XY (Option A):** This is the chromosomal complement of a normal **male**. The presence of the Y chromosome triggers testis determination. * **45,XY and 45,XX (Options C & D):** These represent **monosomy**, which is a numerical chromosomal abnormality. A 45,X karyotype (missing one sex chromosome) results in **Turner Syndrome**, the most common cause of primary amenorrhea. A 45,Y complement is non-viable and results in early spontaneous abortion. **NEET-PG Clinical Pearls:** * **Barr Body:** In females, one X chromosome undergoes inactivation (Lyonization) to balance gene dosage. This inactivated X chromosome is visible as a **Barr body** in the nucleus of somatic cells (e.g., buccal smear). The number of Barr bodies = (Total X chromosomes - 1). * **Swyer Syndrome:** A high-yield condition where an individual has a **46,XY** karyotype but presents as a phenotypic female due to a mutation in the SRY gene. * **Mullerian Agenesis (MRKH Syndrome):** These patients have a normal female karyotype (**46,XX**) and normal ovaries but are born without a uterus and upper vagina.

Q: Which of the following criteria is used for the diagnosis of abdominal pregnancy?

Studiford criteria. **Explanation:** **1. Why Studiford Criteria is Correct:** Abdominal pregnancy is a rare form of ectopic pregnancy where the fetus develops within the peritoneal cavity. To diagnose a **Primary Abdominal Pregnancy**, the **Studiford Criteria** must be met: * Both fallopian tubes and ovaries must be normal (no evidence of recent or remote injury). * There is no evidence of a uteroperitoneal fistula. * The pregnancy is related exclusively to the peritoneal surface and is early enough to eliminate the possibility of secondary implantation after primary tubal rupture. **2. Analysis of Incorrect Options:** * **Speigelberg Criteria:** These are used for the diagnosis of **Ovarian Pregnancy**. They require the tube on the affected side to be intact, the fetal sac to occupy the position of the ovary, and ovarian tissue to be present in the sac wall. * **Rubins Criteria:** These are used for the diagnosis of **Cervical Pregnancy**. Criteria include the presence of cervical glands opposite the placental attachment and the placenta being below the level of the internal os. * **Rotterdam Criteria:** These are used for the diagnosis of **Polycystic Ovary Syndrome (PCOS)**, requiring two out of three: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound. **3. Clinical Pearls for NEET-PG:** * **Secondary Abdominal Pregnancy** is more common than primary, usually occurring after tubal abortion or rupture. * **Management:** Surgical intervention is usually required. A high-yield point is **not to remove the placenta** if it is attached to vital organs (like the bowel or major vessels) to avoid massive hemorrhage; instead, leave it in situ and treat with Methotrexate. * **Arias-Stella Reaction:** Can be seen in the endometrium of any ectopic pregnancy (decidual change without chorionic villi).

Q: All are the criteria for medical management of ectopic pregnancy except?

Gestational sac diameter <5 cm.. **Explanation:** The medical management of ectopic pregnancy (primarily using **Methotrexate**) is reserved for hemodynamically stable patients who meet specific criteria to ensure a high success rate and minimize the risk of tubal rupture. **Why Option C is the correct answer (The Exception):** The standard criterion for the size of the gestational sac in medical management is **<3.5 cm or <4 cm** (depending on the guideline, e.g., RCOG/ACOG). A diameter of **<5 cm is too large**; as the sac size increases, the risk of treatment failure and tubal rupture rises significantly. Therefore, "Gestational sac <5 cm" is not a standard criterion. **Analysis of Incorrect Options:** * **A. Asymptomatic patient:** Medical management is only indicated in hemodynamically stable patients with minimal or no symptoms (no signs of hemoperitoneum or acute abdomen). * **B. Serum β-hCG level <2000 IU/L:** While some guidelines allow up to 5000 IU/L, a level <2000 IU/L is a classic criterion associated with the highest success rates (up to 95%). Higher levels are relative contraindications. * **D. Unruptured tube:** This is an absolute prerequisite. If the tube has ruptured, the patient requires emergency surgical intervention (Laparoscopy/Laparotomy). **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Methotrexate (Folic acid antagonist). * **Dose:** 50 mg/m² (Single-dose regimen is most common). * **Absolute Contraindications:** Ruptured ectopic, hemodynamic instability, breastfeeding, and presence of **fetal cardiac activity** (relative/absolute depending on size). * **Monitoring:** β-hCG levels are measured on Day 4 and Day 7. A drop of **>15%** between Day 4 and 7 indicates successful treatment.

Q: Which of the following drugs is NOT used in the treatment of a pregnant woman with SLE who is at >35 weeks gestation?

Methotrexate. **Explanation:** The management of Systemic Lupus Erythematosus (SLE) during pregnancy requires a careful balance between controlling maternal disease activity and ensuring fetal safety. **Why Methotrexate is the Correct Answer:** **Methotrexate** is strictly **contraindicated** throughout pregnancy (FDA Category X). It is a folic acid antagonist that interferes with DNA synthesis. If used in the first trimester, it is a potent teratogen (causing "Methotrexate-aminopterin syndrome"). Even at **>35 weeks gestation**, it is avoided because it is an antimetabolite that can cause fetal myelosuppression and growth restriction. Furthermore, it is not used for acute flares in late pregnancy when safer alternatives exist. **Why the other options are incorrect:** * **Prednisolone:** This is the mainstay for treating SLE flares in pregnancy. It is metabolized by the placental enzyme **11β-hydroxysteroid dehydrogenase 2**, which converts it into inactive prednisone, ensuring minimal fetal exposure. * **Chloroquine/Hydroxychloroquine:** These are considered safe and are often continued throughout pregnancy to prevent maternal flares and reduce the risk of neonatal congenital heart block. * **Sulfasalazine:** This is considered safe in pregnancy. It does not increase the risk of congenital anomalies, though supplemental folic acid (5mg) is recommended for the mother. **NEET-PG High-Yield Pearls:** * **Safe SLE Drugs in Pregnancy:** Hydroxychloroquine (HCQ), Prednisolone, Azathioprine, and Sulfasalazine. * **Contraindicated SLE Drugs:** Methotrexate, Cyclophosphamide, and Mycophenolate Mofetil (MMF). * **Neonatal Lupus:** Associated with **Anti-Ro (SS-A)** and **Anti-La (SS-B)** antibodies; the most serious complication is irreversible **congenital complete heart block**. * **Flare vs. Preeclampsia:** Low complement levels (C3, C4) suggest an SLE flare, whereas normal complement levels with high uric acid suggest preeclampsia.

Q: What is the drug of choice for bacterial vaginosis?

Metronidazole. **Explanation:** **Bacterial Vaginosis (BV)** is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacilli* with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Prevotella* spp., and *Mobiluncus* spp.). **Why Metronidazole is the Correct Answer:** Metronidazole is the **Drug of Choice (DOC)** because it is highly effective against anaerobic bacteria while sparing the protective *Lactobacilli*. It works by inhibiting nucleic acid synthesis. According to CDC and ACOG guidelines, the standard regimen is **500 mg orally twice daily for 7 days**. Alternatively, 0.75% Metronidazole gel or 2% Clindamycin cream can be used intravaginally. **Analysis of Incorrect Options:** * **B. Ampicillin:** While it has some activity against *G. vaginalis*, it is significantly less effective than Metronidazole and is not recommended for treatment. * **C. Ciprofloxacin:** This is a fluoroquinolone used for urinary tract infections and some aerobic infections; it lacks the necessary anaerobic coverage for BV. * **D. Fluconazole:** This is an antifungal agent used to treat **Vulvovaginal Candidiasis**, not bacterial infections. **High-Yield Clinical Pearls for NEET-PG:** 1. **Amsel’s Criteria (3 out of 4 required):** Homogeneous white discharge, pH > 4.5, Positive "Whiff test" (KOH 10%), and presence of **Clue Cells** on microscopy. 2. **Nugent Score:** The "Gold Standard" for diagnosis based on Gram stain of vaginal discharge. 3. **Treatment in Pregnancy:** Symptomatic pregnant women should be treated with oral Metronidazole to reduce the risk of preterm labor and PPROM. 4. **Partner Treatment:** Routine treatment of the male partner is **not recommended** as it does not prevent recurrence. 5. **Counseling:** Advise patients to avoid alcohol during Metronidazole therapy due to the **Disulfiram-like reaction**.

Q: Which of the following is the most common site of bladder injury during abdominal hysterectomy?

Posterior wall. **Explanation:** The bladder is the most frequently injured organ during a hysterectomy, occurring in approximately 1–2% of cases. **Why the Posterior Wall is the Correct Answer:** During an abdominal hysterectomy, the bladder must be separated from the lower uterine segment and cervix. This is achieved by incising the vesicouterine peritoneum and developing the **vesicovaginal space**. The **posterior wall (base)** of the bladder is anatomically adjacent to the anterior surface of the uterus and cervix. Injury most commonly occurs during the **dissection of the bladder flap** or while reflecting the bladder inferiorly, especially if there are adhesions from previous surgeries (like a C-section) or endometriosis. **Analysis of Incorrect Options:** * **Anterior Wall:** This surface faces the pubic symphysis and is generally away from the primary surgical field of a hysterectomy. * **Medial Wall:** The bladder is a midline structure; it does not have a distinct "medial" wall in the context of surgical anatomy. * **Lateral Walls:** While the ureters enter the bladder at the posterolateral angles (trigone), the lateral walls themselves are not the primary site of dissection during the mobilization of the uterus. **NEET-PG High-Yield Pearls:** * **Most common site of injury:** Posterior wall (base). * **Most common timing of injury:** During the dissection of the bladder flap or during the clamping of the vaginal vault. * **Diagnosis:** Intraoperatively, injury is identified by the appearance of urine in the field or by filling the bladder with **methylene blue** or sterile milk. * **Management:** Small injuries (<1 cm) may heal with catheterization; larger injuries require a two-layer closure with absorbable sutures. * **Ureteric Injury:** The most common site for ureteric injury is at the level of the **infundibulopelvic ligament** or where the ureter passes under the **uterine artery** ("water under the bridge").

Question 1

Which drug is commonly used in the treatment of endometriosis?

Accepted Answer

GnRH analogues

Answer

LH

Answer

MPA

Answer

FSH

Question 2

Endometriosis is common in:

Accepted Answer

Nulliparity

Answer

Multiple parity

Answer

Perimenopausal age

Answer

Virgins

Question 3

What is the chromosomal complement of a normal female?

Accepted Answer

46XX

Answer

46XY

Answer

45XY

Answer

45XX

Question 4

Which of the following criteria is used for the diagnosis of abdominal pregnancy?

Accepted Answer

Studiford criteria

Answer

Speigelberg criteria

Answer

Rubins criteria

Answer

Rotterdam criteria

Question 5

What is the drug of choice in bacterial vaginosis?

Accepted Answer

Metronidazole

Answer

Doxycycline

Answer

Clindamycin

Answer

Ciprofloxacin

Question 6

All are the criteria for medical management of ectopic pregnancy except?

Accepted Answer

Gestational sac diameter <5 cm.

Answer

Asymptomatic patient.

Answer

Serum β-hCG level <2000 IU/L.

Answer

Unruptured tube.

Question 7

Which of the following drugs is NOT used in the treatment of a pregnant woman with SLE who is at >35 weeks gestation?

Accepted Answer

Methotrexate

Answer

Sulfasalazine

Answer

Prednisolone

Answer

Chloroquine

Question 8

What is the drug of choice for bacterial vaginosis?

Accepted Answer

Metronidazole

Answer

Ampicillin

Answer

Ciprofloxacin

Answer

Fluconazole

Question 9

A 36-year-old female presents with heavy menstrual bleeding. She has one child of 7 years. USG shows a single 3x3 cm submucosal fibroid. Hemoglobin is 10.5 gm/dl. What is the best treatment option for her?

Accepted Answer

Hysteroscopic myomectomy

Answer

GnRH injection

Answer

Uterine Artery Embolization (UAE)

Answer

Laparoscopic myomectomy

Question 10

Which of the following is the most common site of bladder injury during abdominal hysterectomy?

Accepted Answer

Posterior wall

Answer

Anterior wall

Answer

Medial wall

Answer

Lateral wall

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?