Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 851: Anti-phospholipid Antibody syndrome is characterized by all of the following except:

A. Antibodies directed against phospholipid-binding proteins.
B. Inhibition of syncytiotrophoblast differentiation.
C. Central nervous system involvement is the least common manifestation. (Correct Answer)
D. High risk of placental infarction and early-onset pre-eclampsia.

Explanation: **Explanation:** Antiphospholipid Antibody Syndrome (APS) is an autoimmune prothrombotic state characterized by recurrent arterial or venous thrombosis and/or pregnancy complications. **Why Option C is the correct answer (The "Except"):** Contrary to the statement, **Central Nervous System (CNS) involvement is actually one of the most common and significant clinical manifestations** of APS. It frequently presents as strokes, Transient Ischemic Attacks (TIAs), or Sneddon’s syndrome. In the context of systemic lupus erythematosus (SLE), CNS involvement is a hallmark of secondary APS. **Analysis of Incorrect Options:** * **Option A:** APS is characterized by antibodies (Lupus anticoagulant, Anticardiolipin, Anti-β2 glycoprotein I) directed against **phospholipid-binding proteins** rather than the phospholipids themselves. * **Option B:** Pathophysiologically, these antibodies bind to the trophoblast surface, leading to **inhibition of syncytiotrophoblast differentiation**, impaired invasion, and increased apoptosis, which directly causes pregnancy loss. * **Option D:** APS causes a hypercoagulable state at the uteroplacental interface, leading to **placental infarction**, placental insufficiency, and a significantly increased risk of **early-onset pre-eclampsia** (<34 weeks). **NEET-PG High-Yield Pearls:** * **Revised Sapporo Criteria:** Diagnosis requires at least one clinical (thrombosis or pregnancy morbidity) and one laboratory criterion (positive tests 12 weeks apart). * **Pregnancy Morbidity:** Defined as ≥1 death of a normal fetus >10 weeks, OR ≥3 consecutive spontaneous abortions <10 weeks, OR ≥1 preterm birth <34 weeks due to eclampsia/pre-eclampsia/placental insufficiency. * **Treatment in Pregnancy:** Low-dose Aspirin (LDA) + Low Molecular Weight Heparin (LMWH). Warfarin is contraindicated due to teratogenicity.

Question 852: All of the following are true regarding menstrual regulation except:

A. It comes under the Medical Termination of Pregnancy (MTP) Act.
B. Blood loss is typically less compared to other methods.
C. It can be performed up to 12 weeks of gestation. (Correct Answer)
D. General anesthesia is generally not required.

Explanation: **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.

Question 853: What is the drug of choice to treat Chlamydia infection in pregnancy?

A. Tetracycline
B. Doxycycline
C. Erythromycin (Correct Answer)
D. Penicillin

Explanation: **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.

Question 854: The most common site of implantation in ectopic pregnancy is?

A. Ampulla (Correct Answer)
B. Fimbriae
C. Body
D. Infundibulum

Explanation: **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.

Question 855: What is the treatment of choice in a postmenopausal lady with atypical endometrial hyperplasia?

A. Estrogens
B. Hysterectomy (Correct Answer)
C. Progestogens
D. Radiotherapy

Explanation: **Explanation:** The management of endometrial hyperplasia is determined by the presence of **cellular atypia**, as this is the most significant predictor of progression to malignancy. **1. Why Hysterectomy is the Correct Choice:** Atypical endometrial hyperplasia (AEH), also known as Endometrial Intraepithelial Neoplasia (EIN), is a **premalignant condition**. In postmenopausal women, the risk of progression to endometrial carcinoma is as high as 30-40%. Furthermore, up to 40-50% of women diagnosed with AEH on a biopsy are found to have a **concurrent occult invasive carcinoma** in the final hysterectomy specimen. Therefore, **Total Laparoscopic or Abdominal Hysterectomy** (usually with Bilateral Salpingo-oophorectomy in postmenopausal patients) is the definitive treatment of choice. **2. Why Other Options are Incorrect:** * **A. Estrogens:** Estrogens cause endometrial proliferation and are a primary risk factor for hyperplasia. Administering them would worsen the condition. * **C. Progestogens:** While high-dose progestogens (e.g., Megestrol acetate or Levonorgestrel-IUS) are used for hyperplasia *without* atypia, or for AEH in women wishing to preserve fertility, they are not the "treatment of choice" for postmenopausal women due to the high risk of underlying malignancy. * **D. Radiotherapy:** This is reserved for confirmed endometrial cancer in patients who are medically unfit for surgery; it has no role in the primary management of hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Hyperplasia WITHOUT atypia:** Risk of malignancy is <3%; treat medically with Progestogens. * **Hyperplasia WITH atypia:** Risk of malignancy is ~30%; treat with Hysterectomy. * **Most common symptom:** Abnormal Uterine Bleeding (AUB) or Postmenopausal Bleeding (PMB). * **Investigation of Choice:** Endometrial Biopsy (Pipelle) or D&C. Transvaginal Ultrasound (TVS) showing an endometrial thickness **>4mm** in a postmenopausal woman warrants further evaluation.

Question 856: 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?

A. Arcuate uterus
B. Septate uterus (Correct Answer)
C. Bicornuate uterus
D. Unicornuate uterus

Explanation: **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).

Question 857: Red degeneration most commonly occurs in which period?

A. 1st trimester
B. 2nd trimester (Correct Answer)
C. 3rd trimester
D. Puerperium

Explanation: **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.

Question 858: What are the definitive criteria for Pelvic Inflammatory Disease (PID)?

A. Tubo-ovarian abscess on ultrasound (Correct Answer)
B. Cervical erosion
C. Temperature > 37.5 degrees Celsius
D. Infertility

Explanation: **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).

Question 859: Which of the following is NOT a risk factor for gonococcal infection?

A. Age greater than 25 years (Correct Answer)
B. Prior or current sexually transmitted diseases
C. New or multiple sexual partners
D. Lack of barrier modes of protection

Explanation: **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.

Question 860: Which of the following lesions is most likely to pursue a benign course?

A. Vaginal adenosis
B. Adenomyosis (Correct Answer)
C. Extramammary Paget's disease
D. Endometrial hyperplasia

Explanation: **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.

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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