Gynecological Disorders Practice Questions

Q: All of the following are true regarding menstrual regulation except:

It can be performed up to 12 weeks of gestation.. **Explanation:** **Menstrual Regulation (MR)** is a procedure used to terminate a suspected pregnancy before it is clinically confirmed by a pregnancy test or ultrasound. It involves the aspiration of the endometrial lining using a Karman’s cannula and a syringe (Manual Vacuum Aspiration). **1. Why Option C is the correct answer (The Exception):** Menstrual Regulation is strictly performed within **14 days of a missed period** (i.e., up to 6 weeks of gestation). It cannot be performed up to 12 weeks. Beyond 6–7 weeks, the procedure is classified as a standard MTP (Manual or Electric Vacuum Aspiration), as the products of conception become too large for the small-gauge cannulas used in MR. **2. Analysis of other options:** * **Option A:** In India, MR is legally governed by the **MTP Act**. Even though a pregnancy test might not be performed, the procedure must be documented and conducted by a registered medical practitioner at an approved center. * **Option B:** Because the procedure is done very early (within 2 weeks of a missed period), the gestational sac is tiny and the vascularity of the uterus is minimal, leading to **significantly less blood loss** compared to later-term abortions. * **Option D:** MR is a quick, outpatient procedure (taking 5–10 minutes). It is usually performed under **local anesthesia (paracervical block)** or no anesthesia at all; general anesthesia is not required. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** MR is done within 42 days from the Last Menstrual Period (LMP). * **Equipment:** Uses a **Karman’s Cannula** (usually 4–6 mm) and a 60cc syringe. * **Complication:** The most common complication is **incomplete evacuation** due to the very early stage of pregnancy. * **MTP Act Update:** Remember that under the 2021 amendment, the upper limit for MTP in specific categories is 24 weeks, but MR remains an early-intervention technique.

Q: What is the drug of choice to treat Chlamydia infection in pregnancy?

Erythromycin. **Explanation:** The drug of choice for treating *Chlamydia trachomatis* infection in pregnancy is **Erythromycin** (or alternatively, Azithromycin). Chlamydia is an obligate intracellular bacterium, and treatment during pregnancy is crucial to prevent neonatal complications like ophthalmia neonatorum and chlamydial pneumonia. **Why Erythromycin is Correct:** Erythromycin is a macrolide that inhibits protein synthesis by binding to the 50S ribosomal subunit. It has a long-standing safety profile in pregnancy (Category B). While Azithromycin (1g single dose) is now often preferred due to better compliance, Erythromycin remains a classic, correct answer in many standardized exams based on traditional guidelines. **Why Other Options are Incorrect:** * **Tetracycline & Doxycycline:** These are contraindicated in pregnancy (Category D). They cross the placenta and can cause permanent discoloration of deciduous teeth and inhibit fetal bone growth (skeletal hypoplasia). * **Penicillin:** Chlamydia lacks a typical peptidoglycan cell wall; therefore, beta-lactam antibiotics like Penicillin, which act on cell wall synthesis, are ineffective. **NEET-PG High-Yield Pearls:** * **Drug of Choice (Non-pregnant):** Doxycycline (100 mg BID for 7 days). * **Drug of Choice (Pregnant):** Azithromycin (1g stat) is currently the first-line recommendation by the CDC, but Erythromycin is the traditional alternative. * **Neonatal Prophylaxis:** Erythromycin eye ointment is used to prevent gonococcal ophthalmia, but it is **not** effective in preventing chlamydial conjunctivitis; oral therapy is required if the neonate is infected. * **Partner Treatment:** Always treat the partner to prevent "ping-pong" reinfection.

Q: The most common site of implantation in ectopic pregnancy is?

Ampulla. **Explanation:** An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. The **Fallopian tube** is the most frequent site of ectopic pregnancy, accounting for approximately **95–97%** of all cases. **Why Ampulla is Correct:** The **Ampulla** is the widest and longest part of the fallopian tube, and it is the physiological site where fertilization typically occurs. Because the zygote spends a significant amount of time traversing this section, it is the most common site for abnormal implantation, accounting for **70–80%** of all tubal pregnancies. **Analysis of Incorrect Options:** * **Fimbriae:** This is the finger-like distal end of the tube. Implantation here is rare (approx. 5%) as the cilia usually sweep the ovum quickly into the infundibulum. * **Body (Uterus):** This is the site of a normal intrauterine pregnancy. If implantation occurs in the muscular wall (intramural) or a previous scar, it is considered ectopic, but these are statistically rare. * **Infundibulum:** This is the funnel-shaped portion near the ovary. It accounts for only about **10–15%** of tubal pregnancies. **High-Yield Clinical Pearls for NEET-PG:** 1. **Order of frequency in the tube:** Ampulla (80%) > Isthmus (12%) > Infundibulum/Fimbriae (5%) > Interstitial (2%). 2. **Most Dangerous Site:** The **Interstitial (intramural) portion** is the most dangerous because it is highly vascular; rupture here occurs late (12–14 weeks) and can lead to massive, life-threatening hemorrhage. 3. **Classic Triad:** Amenorrhea, abdominal pain, and vaginal bleeding (present in only 50% of cases). 4. **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVS) combined with quantitative β-hCG levels.

Q: Recurrent abortion occurs in a woman. USG abdomen shows a non-echoic region in the central part of the uterus. What is the probable diagnosis?

Septate uterus. **Explanation:** The clinical presentation of recurrent abortion combined with specific ultrasonographic findings points toward a Mullerian duct anomaly. **1. Why Septate Uterus is Correct:** A **septate uterus** occurs due to the failure of resorption of the midline uterovaginal septum after the fusion of the Mullerian ducts. On a 2D Ultrasound (USG), the septum appears as a **non-echoic (hypoechoic) or linear region** dividing the central part of the uterine cavity. Because the septum is composed of fibroelastic tissue with poor vascularization, it is the most common Mullerian anomaly associated with **recurrent pregnancy loss (RPL)**, as the embryo cannot implant or sustain growth on poorly vascularized tissue. **2. Why Other Options are Incorrect:** * **Arcuate Uterus:** This is a mild variation where the fundus has a small midline indentation. It is generally considered a normal variant and is not typically associated with recurrent abortions. * **Bicornuate Uterus:** This results from partial failure of fusion of the Mullerian ducts. While it shows two horns, the key diagnostic feature is a **deep fundal cleft (>1cm)**, which distinguishes it from a septate uterus (where the external fundal contour is straight or convex). * **Unicornuate Uterus:** This results from the failure of one Mullerian duct to develop. USG would show a small, laterally displaced uterus ("banana-shaped") rather than a central non-echoic division. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Combined Laparoscopy and Hysteroscopy (to differentiate Septate from Bicornuate by viewing the external fundal contour). * **Best Non-invasive Investigation:** 3D Ultrasound or MRI. * **Treatment of Choice:** Hysteroscopic Septal Resection (Metzenbaum procedure). * **Highest Risk of Miscarriage:** Septate uterus (approx. 60-90% risk).

Q: Red degeneration most commonly occurs in which period?

2nd trimester. **Explanation:** **Red Degeneration (Carneous Degeneration)** is a form of aseptic necrosis of a uterine fibroid (leiomyoma). It occurs when a rapidly growing fibroid outstrips its blood supply, leading to venous thrombosis and interstitial hemorrhage within the tumor. **Why the 2nd Trimester is Correct:** Red degeneration is most frequently associated with pregnancy, specifically the **second trimester**. During this period, high levels of estrogen and progesterone cause rapid hypertrophy of the fibroid. The blood supply cannot keep pace with this growth, leading to infarction. The characteristic "red" color is due to the diffusion of hemoglobin into the necrotic tissue. **Analysis of Incorrect Options:** * **1st Trimester:** While fibroids can grow in the first trimester, they rarely reach the critical size or growth velocity required to trigger massive ischemic necrosis compared to the second trimester. * **3rd Trimester:** By the third trimester, the growth rate of fibroids typically plateaus or slows down, making acute degeneration less common than in mid-pregnancy. * **Puerperium:** Although red degeneration can occur in the puerperium due to sudden changes in uterine blood flow after delivery, it is statistically less common than the second-trimester occurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Acute onset of localized abdominal pain, low-grade fever, and leukocytosis. * **Diagnosis:** Primarily clinical; Ultrasound may show a "cystic" appearance or a "whorled" pattern with internal echoes. MRI is the most sensitive imaging modality. * **Management:** Always **conservative**. Treatment involves bed rest, hydration, and analgesics (NSAIDs like Ibuprofen are the first line). Surgery (Myomectomy) is contraindicated during pregnancy due to the risk of massive hemorrhage. * **Key Association:** It is the most common complication of fibroids during pregnancy.

Q: What are the definitive criteria for Pelvic Inflammatory Disease (PID)?

Tubo-ovarian abscess on ultrasound. **Explanation:** Pelvic Inflammatory Disease (PID) is a clinical diagnosis, but because its symptoms are often non-specific, the CDC classifies diagnostic criteria into three categories: Minimum (Clinical), Additional (Supporting), and **Definitive (Elaborate)**. **Why Option A is Correct:** Definitive criteria are those that provide objective, histopathological, or radiological proof of upper genital tract inflammation. According to the CDC, definitive criteria include: 1. **Transvaginal Ultrasound (TVS) or MRI** showing thickened, fluid-filled tubes (hydrosalpinx/pyosalpinx) with or without free pelvic fluid or a **Tubo-ovarian abscess (TOA)**. 2. **Laparoscopic findings** consistent with PID (e.g., tubal erythema, edema, or purulent exudate). 3. **Endometrial biopsy** showing histopathological evidence of endometritis. **Why the other options are incorrect:** * **B. Cervical erosion:** This is a common physiological finding (ectopy) and is not a marker for upper tract infection. * **C. Temperature > 37.5°C:** While fever is an "Additional Criterion" for PID, the threshold is typically **>38.3°C (101°F)**. It is not definitive as it can occur in many other conditions. * **D. Infertility:** This is a long-term *sequela* or complication of PID (due to tubal scarring), not a diagnostic criterion for the acute infection. **High-Yield Clinical Pearls for NEET-PG:** * **Minimum (Clinical) Criteria:** Cervical motion tenderness, Uterine tenderness, or Adnexal tenderness. (Treatment is started if any one of these is present in a sexually active woman). * **Gold Standard Investigation:** Laparoscopy (though TVS is often the first-line imaging). * **Most Common Organisms:** *Chlamydia trachomatis* (most common overall) and *Neisseria gonorrhoeae*. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions).

Q: Which of the following is NOT a risk factor for gonococcal infection?

Age greater than 25 years. **Explanation:** The correct answer is **A. Age greater than 25 years**. **1. Why Option A is correct:** Gonococcal infection (*Neisseria gonorrhoeae*) is primarily a disease of the young. **Young age (specifically <25 years)** is a well-established risk factor. This is due to both behavioral factors (higher likelihood of new partners) and biological factors, such as **cervical ectopy** (the presence of columnar epithelium on the ectocervix), which is more common in younger women and more susceptible to infection by *N. gonorrhoeae* and *C. trachomatis*. Therefore, being older than 25 is considered a protective factor rather than a risk factor. **2. Why other options are incorrect:** * **B. Prior or current STDs:** A history of STDs indicates high-risk sexual behavior and potential mucosal damage, increasing the susceptibility to new infections. * **C. New or multiple sexual partners:** This increases the statistical probability of exposure to an infected individual, which is the primary driver of STD transmission. * **D. Lack of barrier protection:** Consistent use of condoms acts as a physical barrier against the transmission of infected secretions. Lack of such protection is a major risk factor for all bacterial STDs. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Nucleic Acid Amplification Test (NAAT). * **Culture Medium:** Thayer-Martin Media (selective for *Neisseria*). * **Treatment:** Due to rising resistance, the current CDC recommendation is a single dose of **Ceftriaxone 500 mg IM**. If Chlamydia is not ruled out, add Doxycycline. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID (often gonococcal) involving perihepatitis and "violin-string" adhesions.

Q: Which of the following lesions is most likely to pursue a benign course?

Adenomyosis. **Explanation:** The question asks to identify the lesion with the most benign course among the given options. **Correct Option: B. Adenomyosis** Adenomyosis is a common, benign gynecological condition characterized by the presence of ectopic endometrial glands and stroma within the myometrium, leading to reactive hypertrophy of the surrounding muscle. While it causes significant morbidity (menorrhagia and dysmenorrhea), it is **not a premalignant condition** and does not carry a risk of malignant transformation. It typically regresses after menopause. **Incorrect Options:** * **A. Vaginal adenosis:** While benign in itself (replacement of squamous epithelium by columnar epithelium), it is a known precursor to **Clear Cell Adenocarcinoma** of the vagina, particularly in women exposed to Diethylstilbestrol (DES) in utero. * **C. Extramammary Paget's disease (Vulva):** This is a rare intraepithelial neoplasia. Unlike mammary Paget’s, it is often a primary lesion, but in approximately 20-30% of cases, it is associated with an underlying invasive adenocarcinoma (vulvar, rectal, or bladder). * **D. Endometrial hyperplasia:** This is a spectrum of lesions. Specifically, **Atypical Endometrial Hyperplasia** (Endometrial Intraepithelial Neoplasia) is a direct precursor to Type I Endometrioid Adenocarcinoma, with a progression risk of nearly 30% if left untreated. **High-Yield Clinical Pearls for NEET-PG:** * **Adenomyosis:** Classically presents as a "globular, symmetrically enlarged, soft/boggy uterus." * **MRI** is the most accurate imaging modality (look for a junctional zone thickness >12 mm). * **Definitive treatment:** Hysterectomy; however, Levonorgestrel-IUS (Mirena) is an effective medical management option. * **Distinction:** Unlike Endometriosis, Adenomyosis is more common in multiparous women in their 40s.

Question 1

Anti-phospholipid Antibody syndrome is characterized by all of the following except:

Accepted Answer

Central nervous system involvement is the least common manifestation.

Answer

Antibodies directed against phospholipid-binding proteins.

Answer

Inhibition of syncytiotrophoblast differentiation.

Answer

High risk of placental infarction and early-onset pre-eclampsia.

Question 2

All of the following are true regarding menstrual regulation except:

Accepted Answer

It can be performed up to 12 weeks of gestation.

Answer

It comes under the Medical Termination of Pregnancy (MTP) Act.

Answer

Blood loss is typically less compared to other methods.

Answer

General anesthesia is generally not required.

Question 3

What is the drug of choice to treat Chlamydia infection in pregnancy?

Accepted Answer

Erythromycin

Answer

Tetracycline

Answer

Doxycycline

Answer

Penicillin

Question 4

The most common site of implantation in ectopic pregnancy is?

Accepted Answer

Ampulla

Answer

Fimbriae

Answer

Body

Answer

Infundibulum

Question 5

What is the treatment of choice in a postmenopausal lady with atypical endometrial hyperplasia?

Accepted Answer

Hysterectomy

Answer

Estrogens

Answer

Progestogens

Answer

Radiotherapy

Question 6

Recurrent abortion occurs in a woman. USG abdomen shows a non-echoic region in the central part of the uterus. What is the probable diagnosis?

Accepted Answer

Septate uterus

Answer

Arcuate uterus

Answer

Bicornuate uterus

Answer

Unicornuate uterus

Question 7

Red degeneration most commonly occurs in which period?

Accepted Answer

2nd trimester

Answer

1st trimester

Answer

3rd trimester

Answer

Puerperium

Question 8

What are the definitive criteria for Pelvic Inflammatory Disease (PID)?

Accepted Answer

Tubo-ovarian abscess on ultrasound

Answer

Cervical erosion

Answer

Temperature > 37.5 degrees Celsius

Answer

Infertility

Question 9

Which of the following is NOT a risk factor for gonococcal infection?

Accepted Answer

Age greater than 25 years

Answer

Prior or current sexually transmitted diseases

Answer

New or multiple sexual partners

Answer

Lack of barrier modes of protection

Question 10

Which of the following lesions is most likely to pursue a benign course?

Accepted Answer

Adenomyosis

Answer

Vaginal adenosis

Answer

Extramammary Paget's disease

Answer

Endometrial hyperplasia

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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