Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 861: Criteria to diagnose Pelvic Inflammatory Disease (PID) include all of the following except:

A. Uterine tenderness
B. Cervical motion tenderness
C. Nausea and Vomiting (Correct Answer)
D. Adnexal tenderness

Explanation: **Explanation:** Pelvic Inflammatory Disease (PID) is a clinical diagnosis based on the **CDC (Centers for Disease Control and Prevention) criteria**. Because the consequences of missing a diagnosis are severe (infertility, ectopic pregnancy, chronic pain), the diagnostic threshold is kept low. **1. Why Nausea and Vomiting is the correct answer:** Nausea and vomiting are **not** part of the minimum clinical criteria for diagnosing PID. While they may occur in severe cases or if peritonitis develops (e.g., Fitz-Hugh-Curtis syndrome), they are non-specific symptoms. In the context of pelvic pain, nausea and vomiting are more classically associated with **acute appendicitis** or **ovarian torsion**, making them a point of differential diagnosis rather than a diagnostic criterion for PID. **2. Why the other options are incorrect:** According to the CDC, PID is diagnosed if **one or more** of the following **Minimum Clinical Criteria** are present on pelvic examination in a sexually active young woman experiencing pelvic or lower abdominal pain: * **Cervical Motion Tenderness (Option B):** Also known as "Chandelier sign." * **Uterine Tenderness (Option A):** Pain on palpation of the uterus. * **Adnexal Tenderness (Option D):** Pain in the region of the ovaries and fallopian tubes. **Clinical Pearls for NEET-PG:** * **Additional Criteria (to increase specificity):** Oral temperature >101°F (>38.3°C), abnormal cervical/vaginal mucopurulent discharge, presence of abundant WBCs on saline microscopy of vaginal fluid, and elevated ESR/CRP. * **Definitive Criteria:** Histopathologic evidence of endometritis, imaging (USG/MRI) showing thickened fluid-filled tubes, or laparoscopic findings consistent with PID. * **Gold Standard Investigation:** Laparoscopy (though not required for routine diagnosis). * **Most Common Organisms:** *Chlamydia trachomatis* (most common) and *Neisseria gonorrhoeae*.

Question 862: What is true about genital infections?

A. Thin frothy secretions are associated with candidal infection.
B. Patients and partners are given metronidazole for candidal infection.
C. Tetracycline is the drug of choice for Trichomonas vaginalis.
D. Clue cells are associated with Gardnerella vaginalis. (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Clue cells are associated with Gardnerella vaginalis.** **1. Why the Correct Answer is Right:** Clue cells are the pathognomonic microscopic finding for **Bacterial Vaginosis (BV)**, primarily caused by *Gardnerella vaginalis*. These are vaginal epithelial cells covered with so many coccobacilli that their borders appear stippled or "shaggy." Their presence is one of the four **Amsel’s Criteria** used for diagnosing BV. **2. Why the Other Options are Wrong:** * **Option A:** Thin, frothy, malodorous, greenish-yellow discharge is characteristic of **Trichomoniasis**. In contrast, *Candidal* infection presents with thick, white, "curd-like" or "cottage cheese" discharge. * **Option B:** Metronidazole is the treatment for BV and Trichomoniasis. For **Candidal infection** (a fungal infection), the treatment of choice is antifungal agents like **Fluconazole** or Clotrimazole. Furthermore, partner treatment is not routinely required for Candidiasis as it is not strictly considered an STI. * **Option C:** The drug of choice for *Trichomonas vaginalis* is **Metronidazole** (2g single dose or 500mg BD for 7 days). Tetracyclines are used for infections like Chlamydia or Syphilis (if penicillin-allergic). **3. High-Yield Clinical Pearls for NEET-PG:** * **Amsel’s Criteria (Need 3 out of 4):** 1. Thin homogenous discharge, 2. pH > 4.5, 3. Positive Whiff test (fishy odor with 10% KOH), 4. Clue cells on wet mount. * **Nugent Scoring:** The "Gold Standard" for diagnosing BV (based on Gram stain morphotypes). * **Strawberry Cervix:** Seen in 10% of cases of *Trichomonas vaginalis* due to punctate hemorrhages. * **pH Check:** Vaginal pH is **normal (<4.5)** in Candidiasis but **elevated (>4.5)** in BV and Trichomoniasis.

Question 863: A female presents with a 3 cm painless ulcer with raised edges on the labia majora. What is the most common cause?

A. Syphilis (Correct Answer)
B. Gonorrhea
C. Herpes
D. Chlamydia trachomatis

Explanation: **Explanation:** The clinical presentation of a **painless ulcer with raised, indurated edges** (often described as a "button-like" consistency) on the genitalia is the classic hallmark of a **Chancre**, which is the primary stage of **Syphilis**, caused by the spirochete *Treponema pallidum*. **Why Syphilis is correct:** Primary syphilis typically presents as a solitary, painless, and firm ulcer (chancre) with a clean base and raised, everted borders. It is usually associated with painless, non-suppurative regional (inguinal) lymphadenopathy. The lack of pain is a key diagnostic differentiator. **Why the other options are incorrect:** * **Gonorrhea:** Primarily causes endocervicitis or urethritis characterized by purulent discharge; it does not typically present with genital ulcers. * **Herpes (HSV-2):** Presents as multiple, shallow, **exquisitely painful** vesicles or ulcers on an erythematous base. It is the most common cause of painful genital ulcers. * **Chlamydia trachomatis:** While Serotypes L1-L3 cause *Lymphogranuloma Venereum (LGV)*, the initial ulcer is usually small, transient, and often goes unnoticed. The dominant feature of LGV is painful, suppurative inguinal lymphadenopathy (the "Bubo" and the "Groove sign"). **NEET-PG High-Yield Pearls:** * **Painful Ulcers:** Chancroid (*Haemophilus ducreyi* - "You cry with ducreyi") and Herpes. * **Painless Ulcers:** Syphilis and Granuloma Inguinale (Donovanosis - presents as beefy red, velvety ulcers). * **Investigation of Choice:** Dark-field microscopy is used for primary syphilis (visualizing spirochetes); VDRL/RPR are screening tests but may be negative in the very early stages of a chancre. * **Treatment:** Benzathine Penicillin G (2.4 million units IM) remains the gold standard.

Question 864: Which of the following is NOT true about red degeneration of myomas?

A. It occurs commonly during pregnancy
B. Immediate surgical intervention is needed (Correct Answer)
C. It is due to interference with blood supply
D. It is treated with analgesics

Explanation: **Explanation:** Red degeneration (also known as **carneous degeneration**) is a specific type of aseptic necrosis of a uterine fibroid. It is most commonly seen during the **second trimester of pregnancy** or the puerperium. **1. Why Option B is the Correct Answer (The "False" Statement):** Red degeneration is a **self-limiting medical condition**, not a surgical emergency. Immediate surgical intervention (like myomectomy) is strictly contraindicated during pregnancy due to the high risk of uncontrollable hemorrhage and miscarriage. The management is always **conservative**, focusing on bed rest, intravenous fluids, and analgesia. **2. Analysis of Other Options:** * **Option A:** It occurs in approximately 5–10% of pregnancies. The rapid enlargement of the uterus causes the fibroid to grow quickly, outstripping its blood supply. * **Option C:** The underlying pathology is an **infarction**. Rapid growth leads to venous obstruction and thrombosis within the tumor, causing congestion, interstitial hemorrhage, and the characteristic "beefy red" appearance (due to hemolysis). * **Option D:** Since the primary symptom is acute, localized abdominal pain and low-grade fever, the mainstay of treatment is **analgesics** (usually NSAIDs or narcotics) to manage the pain until the episode resolves (typically within 4–7 days). **Clinical Pearls for NEET-PG:** * **Characteristic Smell:** On gross examination, the fibroid has a "stale fish" odor. * **Diagnosis:** Primarily clinical, but Ultrasound/MRI may show a cystic center or peripheral echoes. * **Differential Diagnosis:** Must be distinguished from acute appendicitis, abruptio placentae, or twisted ovarian cyst. * **Key Management Rule:** "Wait and watch" with medical management; surgery is reserved only for rare cases of failed conservative therapy or peritonitis.

Question 865: Danazol is not used in which of the following conditions?

A. Precocious puberty
B. Endometrial carcinoma (Correct Answer)
C. Endometriosis
D. Dysfunctional uterine bleeding (DUB)

Explanation: **Explanation:** **Danazol** is a synthetic ethisterone derivative with mild androgenic and strong anti-gonadotropic properties. It acts primarily by inhibiting the pituitary-ovarian axis (suppressing LH and FSH surges) and creating a hypoestrogenic, hyperandrogenic environment. **Why Endometrial Carcinoma is the correct answer:** Danazol has no role in the management of **Endometrial Carcinoma**. The primary hormonal treatment for advanced or recurrent endometrial carcinoma involves high-dose **progestogens** (like Megestrol acetate) or GnRH agonists, which counteract the estrogen-driven growth of the tumor. Danazol’s androgenic profile does not provide the necessary therapeutic effect for malignant transformation of the endometrium. **Analysis of Incorrect Options:** * **Precocious Puberty:** Danazol can be used to suppress the premature surge of gonadotropins, thereby delaying the onset of puberty and preventing premature epiphyseal closure. * **Endometriosis:** This is the classic indication for Danazol. It induces "pseudomenopause" by inhibiting ovulation and directly suppressing endometrial tissue growth, leading to atrophy of ectopic implants. * **Dysfunctional Uterine Bleeding (DUB):** Danazol is effective in reducing menstrual blood loss by causing endometrial atrophy. It is often used as a second-line medical therapy when NSAIDs or antifibrinolytics fail. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It creates a "pseudomenopause" state. * **Other Indications:** Fibrocystic breast disease, Hereditary Angioneurotic Edema (increases C4 component of complement), and Autoimmune Hemolytic Anemia. * **Side Effects:** Weight gain, acne, hirsutism, deepening of voice (often irreversible), and oiliness of skin. * **Contraindications:** Pregnancy (teratogenic—causes virilization of female fetus), breastfeeding, and severe hepatic impairment.

Question 866: Which of the following is NOT true about Molluscum contagiosum?

A. It is caused by a poxvirus.
B. It is commonly seen in HIV-infected and immunocompromised individuals.
C. Treatment can include cryotherapy.
D. It is treated with metronidazole and doxycycline. (Correct Answer)

Explanation: **Explanation:** **Molluscum Contagiosum** is a common viral skin infection caused by a **Poxvirus** (specifically a double-stranded DNA virus). In adults, it is often transmitted sexually and presents as small, firm, pearly, umbilicated papules on the lower abdomen, thighs, or genitalia. **Why Option D is the correct answer (False statement):** Molluscum contagiosum is a **viral infection**, not a bacterial or protozoal one. **Metronidazole** is used for anaerobic bacteria and protozoa (like *Trichomonas vaginalis*), while **Doxycycline** is used for Chlamydia, Syphilis, or PID. These antibiotics have no efficacy against the poxvirus. Treatment for Molluscum is typically destructive (cryotherapy, curettage) or expectant, as it is often self-limiting. **Analysis of other options:** * **Option A:** Correct. It is caused by the *Molluscipoxvirus*, a member of the Poxviridae family. * **Option B:** Correct. While common in children, extensive or giant lesions in adults are a hallmark of **immunocompromised states**, particularly **HIV/AIDS**. * **Option C:** Correct. Management includes physical destruction of the lesions via **cryotherapy** (liquid nitrogen), curettage, or topical agents like podophyllotoxin or potassium hydroxide. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic Feature:** Central umbilication (dimple) on a pearly papule. * **Histopathology:** Presence of **Henderson-Paterson bodies** (large, intracytoplasmic eosinophilic inclusion bodies) is a classic exam finding. * **Transmission:** Skin-to-skin contact or fomites. In children, it is non-sexual; in adults, it is considered an STI. * **HIV Correlation:** If a patient presents with extensive facial molluscum, always screen for HIV.

Question 867: Per Rectal palpation of the uterus is indicated in which of the following patients?

A. Primigravida
B. Virgins (Correct Answer)
C. Grand multipara
D. Placenta previa

Explanation: **Explanation:** In gynecological practice, the primary method of pelvic assessment is the **Bimanual Vaginal Examination (P/V)**. However, in specific clinical scenarios where a vaginal examination is contraindicated or impossible, a **Per Rectal (P/R) examination** serves as the standard alternative to assess the pelvic organs (uterus and adnexa). **Why "Virgins" is the Correct Answer:** In patients who have not had sexual intercourse (virgins), the **hymen is intact**. Performing a per-vaginal examination would cause hymeneal rupture and significant physical/psychological distress. Therefore, a per-rectal examination is indicated to palpate the uterus, check for pelvic masses, or assess the pouch of Douglas while maintaining the integrity of the hymen. **Analysis of Incorrect Options:** * **Primigravida (A) & Grand Multipara (C):** These are pregnant or parous women. In these cases, the vaginal introitus is patulous enough to allow a standard per-vaginal examination, which provides superior tactile information compared to a rectal exam. * **Placenta Previa (D):** This is a **strict contraindication** for both P/V and P/R examinations. Any digital examination (vaginal or rectal) can provoke massive, life-threatening hemorrhage by disturbing the placental site. Diagnosis is strictly via ultrasound (Double Setup Examination is now obsolete). **NEET-PG High-Yield Pearls:** * **Indications for P/R in Gynae:** Virgins, vaginal atresia/stenosis, and staging of **Cervical Cancer** (to assess parametrial involvement). * **Mullerian Agenesis (MRKH):** P/R examination is the initial clinical step to confirm the absence of the uterus in a young girl presenting with primary amenorrhea. * **Rectovaginal Examination:** The gold standard for evaluating the **Pouch of Douglas** and rectovaginal septum in suspected endometriosis.

Question 868: Which type of fibroid typically presents with a "Lantern on top of St Paul's Cathedral" appearance?

A. Submucosal fibroid
B. Subserosal fibroid
C. Cervical fibroid (Correct Answer)
D. Interstitial fibroid

Explanation: ### Explanation **Correct Answer: C. Cervical fibroid** The "Lantern on top of St Paul's Cathedral" is a classic clinical description for a **cervical fibroid**. In this condition, the fibroid originates from the cervix and expands significantly, while the relatively smaller, unaffected body of the uterus (corpus) sits perched on top of the enlarged cervical mass. This anatomical configuration mimics the architecture of St Paul’s Cathedral in London, where the small dome (the uterus) sits atop the large, expansive base (the cervical fibroid). **Why the other options are incorrect:** * **Submucosal fibroid (A):** These grow just beneath the endometrium and project into the uterine cavity. They typically present with heavy menstrual bleeding (menorrhagia) or infertility, but do not alter the external uterine contour in this specific "lantern" fashion. * **Subserosal fibroid (B):** These grow on the outer surface of the uterus. While they can become large and pedunculated, they do not create the specific relationship of a small uterus sitting atop a massive cervical base. * **Interstitial (Intramural) fibroid (D):** These are located within the muscular wall of the uterus. They cause symmetrical or asymmetrical enlargement of the uterine body itself, rather than a distinct separation between the corpus and the cervix. **Clinical Pearls for NEET-PG:** * **Types of Cervical Fibroids:** Can be anterior, posterior, lateral, or central. Central fibroids are the ones most likely to produce the "Lantern" appearance. * **Surgical Risk:** During a hysterectomy for cervical fibroids, the **ureters** are at high risk of injury because they are displaced and often lie directly over the surface of the fibroid. * **Clinical Presentation:** Cervical fibroids often present with pressure symptoms (urinary frequency or retention due to bladder compression) rather than just menstrual irregularities. * **Other Sign:** Cervical fibroids can also cause the "cup and saucer" appearance during a vaginal examination if the cervix is thinned out over the tumor.

Question 869: Which part of the broad ligament gives attachment and support to the uterine tube?

A. Mesometrium
B. Mesovarium
C. Mesosalpinx (Correct Answer)
D. Round ligament

Explanation: **Explanation:** The **broad ligament** is a double fold of peritoneum that extends from the lateral aspects of the uterus to the pelvic sidewalls. It is divided into three distinct anatomical regions based on the structures they support: 1. **Mesosalpinx (Correct Answer):** This is the most superior portion of the broad ligament. It drapes over the **fallopian (uterine) tubes**, providing them with attachment and support. It is located between the attachment of the mesovarium and the fallopian tube itself. 2. **Mesometrium (Incorrect):** This is the largest component of the broad ligament. it extends from the pelvic floor to the body of the uterus, supporting the **uterine body**. 3. **Mesovarium (Incorrect):** This is a posterior extension of the broad ligament that attaches to the **ovary**, carrying the ovarian vessels and nerves. 4. **Round Ligament (Incorrect):** This is a fibromuscular band (a remnant of the gubernaculum) that maintains the **anteverted position** of the uterus. It is not a subdivision of the broad ligament, though it travels within its folds. **High-Yield NEET-PG Pearls:** * **Contents of the Broad Ligament:** Uterine tube, Round ligament, Ligament of the ovary, Uterine and Ovarian arteries/veins, Ureter (at the base), and vestigial remnants (Epoophoron and Paraoophoron). * **Water Under the Bridge:** This classic mnemonic refers to the **Ureter** passing inferior to the **Uterine Artery** within the base of the broad ligament (cardinal ligament area)—a critical landmark during hysterectomy to avoid ureteric injury. * **Suspensory Ligament of Ovary (Infundibulopelvic ligament):** Contains the **Ovarian artery**, which is the primary blood supply to the ovaries.

Question 870: The duct of Bartholin's gland opens where?

A. On the outer side of the labia minora
B. On the inner side of the labia majora
C. On the outer side of the labia majora
D. On the inner side of the labia minora (Correct Answer)

Explanation: **Explanation:** The Bartholin’s glands (greater vestibular glands) are a pair of pea-sized structures located posteriorly in the vaginal introitus. They are the female homologs of the bulbourethral (Cowper’s) glands in males. **Why the correct answer is right:** The duct of each Bartholin’s gland is approximately 2 cm long and opens into the **vestibule** (the space between the labia minora). Specifically, the opening is located on the **inner side of the labia minora**, at the 4 o'clock and 8 o'clock positions, just outside the hymenal ring. Its primary function is to secrete mucus for vaginal lubrication during sexual arousal. **Analysis of incorrect options:** * **Options A & C (Outer sides):** The duct opens into the vestibule, which is an internal mucosal surface. Openings on the "outer side" of the labia would place them on keratinized skin, which is anatomically incorrect for a mucosal secretory gland. * **Option B (Inner side of labia majora):** While the gland *body* is located deep to the posterior end of the labia majora, the *duct* travels medially to open into the vestibule, which is bounded laterally by the labia minora. **High-Yield Clinical Pearls for NEET-PG:** * **Bartholin Cyst/Abscess:** Occurs due to duct obstruction. The most common causative organism for an abscess is *E. coli* (though traditionally associated with *N. gonorrhoeae*). * **Treatment:** The gold standard for a recurrent cyst/abscess is **Marsupialization**. Simple incision and drainage (I&D) have high recurrence rates. * **Histology:** The gland itself is lined by **columnar epithelium**, while the duct is lined by **transitional epithelium** (near the gland) and **stratified squamous epithelium** (near the opening). * **Malignancy:** Bartholin gland carcinoma is rare; any new solid mass in this region in a postmenopausal woman must be biopsied.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

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Pelvic Inflammatory Disease

Practice Questions

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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