Gynecological Disorders — MCQs

A 38-year-old woman complains of chronic pelvic pain, significantly worse during her menstrual periods. Pelvic examination reveals an enlarged uterus with multiple palpable masses. Ultrasound shows numerous ball-like masses up to 6 cm in diameter within the uterus. In which location are most cases of this type of tumor typically found?

Q874Medium

A 26-year-old G2P1L1 at 10 weeks complains of abdominal pain and bleeding per vaginum. On examination, products of conception are seen partially extruding through the cervix. What is your diagnosis?

Q875Medium

A 40-year-old man presented with acute onset pain and swelling of the left great toe. On X-ray, a punched-out lytic lesion is seen on the phalanx with sclerotic margins and overhanging bony edges. What is the diagnosis?

Q876Easy

What is the treatment of choice for an endocervical polyp?

Q877Easy

What is the typical size of a non-pregnant uterus in inches?

Q878Easy

Which of the following conditions is caused by HSV 2?

Q879Easy

Asherman syndrome is typically caused by which of the following?

Q880Medium

Which statement is true regarding the ovary?

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 871: What is the classical symptom of an endocervical polyp?

A. Cervical prolapse
B. Dyspareunia
C. Intermenstrual bleeding (Correct Answer)
D. Dysmenorrhea

Explanation: **Explanation:** **Endocervical polyps** are the most common benign neoplasms of the cervix. They are focal pedunculated protrusions of the endocervical mucosa, often resulting from chronic inflammation or localized vascular congestion. **Why Intermenstrual Bleeding is Correct:** The hallmark clinical presentation of an endocervical polyp is **intermenstrual bleeding** or **post-coital spotting**. The polyp is highly vascular and covered by a thin, fragile columnar epithelium. Because it often protrudes through the external os, it is susceptible to minor trauma (such as intercourse) or spontaneous capillary rupture, leading to irregular spotting between normal menstrual cycles. **Analysis of Incorrect Options:** * **A. Cervical prolapse:** This refers to the descent of the cervix into the vaginal canal due to weakened pelvic floor support (level I/II suspension). While a large pedunculated polyp may "prolapse" through the os, it does not cause uterine or cervical descent. * **B. Dyspareunia:** While post-coital bleeding occurs, actual pain during intercourse (dyspareunia) is uncommon unless the polyp is associated with significant pelvic inflammatory disease or is extremely large and necrotic. * **C. Dysmenorrhea:** Painful menstruation is typically associated with uterine conditions like endometriosis, adenomyosis, or intramural fibroids, rather than superficial cervical growths. **NEET-PG High-Yield Pearls:** * **Demographics:** Most common in multigravida women in their 40s and 50s. * **Diagnosis:** Usually made via speculum examination; they appear as smooth, red/purple, finger-like projections. * **Management:** The treatment of choice is **polypectomy** (avulsion) followed by histopathological examination to rule out rare malignancy (found in <1% of cases). * **Key Differential:** Always differentiate from a "prolapsed pedunculated submucosal fibroid," which is usually firmer and associated with heavy menstrual bleeding (menorrhagia).

Question 872: Spiegelberg criteria is used in which type of pregnancy?

A. Ovarian pregnancy (Correct Answer)
B. Abdominal pregnancy
C. Cervical pregnancy
D. Tubal pregnancy

Explanation: **Explanation:** The **Spiegelberg criteria** are a set of four clinical and pathological requirements used to diagnose a primary **ovarian pregnancy**, which is a rare form of ectopic pregnancy (occurring in approximately 0.5% to 3% of all ectopic cases). **Why Option A is correct:** To distinguish a primary ovarian pregnancy from a distal tubal pregnancy that has involved the ovary secondarily, Spiegelberg established the following criteria: 1. The gestational sac must be located on the ovary. 2. The ovary and the gestational sac must be connected to the uterus by the ovarian ligament. 3. Ovarian tissue must be present in the wall of the gestational sac (histopathological confirmation). 4. The fallopian tube on the affected side must be intact and separate from the ovary. **Why other options are incorrect:** * **Abdominal pregnancy:** Diagnosed using **Studdiford’s criteria**. It involves implantation within the peritoneal cavity. * **Cervical pregnancy:** Diagnosed using **Rubin’s criteria**. It involves implantation in the endocervical canal below the internal os. * **Tubal pregnancy:** The most common type of ectopic pregnancy (95%+). It does not have a specific named eponym for diagnostic criteria like Spiegelberg, as it is usually identified by its anatomical location in the ampulla, isthmus, or fimbria. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Unlike tubal pregnancies, ovarian pregnancies are **not** strongly associated with Pelvic Inflammatory Disease (PID) but are frequently associated with **IUD use**. * **Management:** Surgical (wedge resection or cystectomy) is preferred over oophorectomy to preserve fertility. * **Mnemonic:** Remember **"S"** for **S**piegelberg and **O**varian (The 'S' looks like an 'O' if you close it).

Question 873: A 38-year-old woman complains of chronic pelvic pain, significantly worse during her menstrual periods. Pelvic examination reveals an enlarged uterus with multiple palpable masses. Ultrasound shows numerous ball-like masses up to 6 cm in diameter within the uterus. In which location are most cases of this type of tumor typically found?

A. Intramural location within the cervix of the uterus
B. Intramural location within the fundus or body of the uterus (Correct Answer)
C. Submucosal location within the cervix of the uterus
D. Submucosal location within the fundus or body of the uterus

Explanation: ### Explanation **1. Understanding the Diagnosis** The clinical presentation of a 38-year-old woman with chronic pelvic pain, dysmenorrhea, an enlarged uterus, and "ball-like masses" on ultrasound is classic for **Uterine Leiomyomas (Fibroids)**. These are benign monoclonal tumors of smooth muscle cells. **2. Why Option B is Correct** Leiomyomas are the most common pelvic tumors in women. Based on their anatomical location, they are classified as intramural, submucosal, or subserosal. * **Intramural fibroids**, located within the thick muscular wall of the uterus, are the **most common type** overall. * The majority of these tumors (approx. 95%) occur in the **corpus (fundus or body)** of the uterus because this area contains the highest concentration of smooth muscle fibers. **3. Why Other Options are Incorrect** * **Options A & C (Cervix):** Cervical fibroids are relatively rare, accounting for only about 1–2% of all uterine leiomyomas. * **Option D (Submucosal):** While submucosal fibroids are clinically significant because they cause heavy menstrual bleeding (menorrhagia) and infertility, they are less common than the intramural variety. **4. NEET-PG High-Yield Pearls** * **Most common symptom:** Menorrhagia (heavy menstrual bleeding). * **Most common type:** Intramural. * **Most symptomatic type:** Submucosal (even small ones cause significant bleeding). * **Degenerations:** **Red degeneration** (carneous degeneration) is most common during pregnancy due to rapid growth and ischemia. **Hyaline degeneration** is the most common overall. * **Investigation of choice:** Transvaginal Ultrasound (TVS). Saline Infusion Sonography (SIS) is superior for submucosal types. * **Medical Management:** GnRH agonists (used pre-operatively to reduce tumor size).

Question 874: A 26-year-old G2P1L1 at 10 weeks complains of abdominal pain and bleeding per vaginum. On examination, products of conception are seen partially extruding through the cervix. What is your diagnosis?

A. Inevitable abortion
B. Threatened abortion
C. Complete abortion
D. Incomplete abortion (Correct Answer)

Explanation: **Explanation:** The clinical presentation of a patient with abdominal pain, vaginal bleeding, and **products of conception partially extruding through the cervix** is the hallmark of an **Incomplete Abortion**. In this condition, the cervical os is open, but only a portion of the products of conception has been expelled, while some remain within the uterine cavity. **Analysis of Options:** * **Incomplete Abortion (Correct):** Defined by the partial expulsion of products. The cervical os is open, and tissue is often visible at the os or on ultrasound. * **Inevitable Abortion:** The cervical os is open and bleeding is present, but **no products of conception have been expelled yet**. The process is in progress but remains "internal." * **Threatened Abortion:** Characterized by vaginal bleeding with a **closed cervical os** and a viable fetus. The pregnancy may still continue. * **Complete Abortion:** All products of conception have been expelled. The cervical os typically closes afterward, and the uterus is firm and contracted. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** Incomplete abortion requires evacuation of the remaining products via **Surgical Evacuation (D&C/MVA)** or medical management (Misoprostol) to prevent complications like hemorrhage or sepsis. * **Cervical Os Status:** This is the primary clinical differentiator. If the os is **closed**, it is either Threatened, Complete, or Missed abortion. If the os is **open**, it is either Inevitable or Incomplete abortion. * **Ultrasound Finding:** In an incomplete abortion, the endometrial stripe is typically thickened (>15 mm) or shows irregular echogenic masses.

Question 875: A 40-year-old man presented with acute onset pain and swelling of the left great toe. On X-ray, a punched-out lytic lesion is seen on the phalanx with sclerotic margins and overhanging bony edges. What is the diagnosis?

A. Gout (Correct Answer)
B. Rheumatoid arthritis
C. Psoriatic arthritis
D. Reiter's syndrome

Explanation: **Explanation** The clinical presentation and radiographic findings are classic for **Gouty Arthritis**. **Why Gout is Correct:** The patient presents with **Podagra** (acute pain and swelling of the first metatarsophalangeal joint), which is the most common initial manifestation of gout. The X-ray findings described—**punched-out lytic lesions** with **sclerotic margins** and **overhanging bony edges** (Martel’s sign)—are pathognomonic for chronic tophaceous gout. These lesions result from the deposition of monosodium urate crystals in the bone, leading to localized bone resorption. **Why Other Options are Incorrect:** * **Rheumatoid Arthritis:** Typically presents with symmetrical small joint involvement (PIP, MCP) and shows **periarticular osteopenia** and marginal erosions on X-ray, rather than sclerotic punched-out lesions. * **Psoriatic Arthritis:** Characterized by "pencil-in-cup" deformities, dactylitis (sausage digits), and asymmetric involvement. It often involves the DIP joints. * **Reiter’s Syndrome (Reactive Arthritis):** Usually follows a urogenital or enteric infection. Radiographic features include fluffy periosteal reactions and calcaneal spurs, not the classic "overhanging edges" of gout. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Polarized light microscopy of synovial fluid showing **needle-shaped, negatively birefringent** crystals. * **Martel’s Sign:** The radiographic "overhanging edge" created by the bony cortex extending over a tophus. * **Acute Management:** NSAIDs (first-line), Colchicine, or Corticosteroids. * **Chronic Management:** Xanthine oxidase inhibitors like **Allopurinol** or Febuxostat (do not start during an acute attack).

Question 876: What is the treatment of choice for an endocervical polyp?

A. Vaginal hysterectomy
B. Conisation
C. Polypectomy (Correct Answer)
D. Radiotherapy

Explanation: **Explanation:** **1. Why Polypectomy is the Correct Answer:** An endocervical polyp is a benign, focal overgrowth of the endocervical stroma covered by epithelium. Most polyps are asymptomatic or present with intermenstrual/post-coital bleeding. **Polypectomy** is the treatment of choice because it is a simple, effective, and minimally invasive procedure. It involves grasping the polyp with a Ring or Sponge forceps and twisting it until the pedicle avulses. If the base is thick, it may be excised with a cautery loop or scissors. Following removal, the base is usually cauterized to prevent recurrence and control bleeding. **2. Why Other Options are Incorrect:** * **Vaginal Hysterectomy:** This is a major surgery involving the removal of the entire uterus. It is gross overtreatment for a localized, typically benign lesion like a polyp. * **Conisation:** This involves removing a cone-shaped wedge of the cervix. It is indicated for Cervical Intraepithelial Neoplasia (CIN) or suspected microinvasive carcinoma, not for simple benign polyps. * **Radiotherapy:** This is reserved for malignant conditions (e.g., Cervical Cancer). Using radiation for a benign polyp would cause unnecessary morbidity and ovarian failure. **3. High-Yield Clinical Pearls for NEET-PG:** * **Histopathology:** All removed polyps **must** be sent for histopathological examination to rule out rare focal malignancy (incidence <0.5%). * **Association:** Endocervical polyps are often associated with **endometrial hyperplasia or endometrial polyps**; therefore, if a patient is peri- or post-menopausal, an ultrasound or endometrial sampling may be warranted. * **Recurrence:** If polyps recur frequently, a fractional curettage is indicated to check for pathology higher up in the endocervical canal or endometrium.

Question 877: What is the typical size of a non-pregnant uterus in inches?

A. 5x4x2
B. 4x3x1
C. 3x2x1 (Correct Answer)
D. 4x2x1

Explanation: **Explanation:** The dimensions of a non-pregnant, nulliparous uterus are a classic high-yield fact in pelvic anatomy. The correct answer is **3x2x1 inches** (Length x Breadth x Thickness). **1. Why the Correct Answer is Right:** In the reproductive age group, the uterus is a pear-shaped, hollow muscular organ. Its standard dimensions are approximately **7.5 cm long, 5 cm wide, and 2.5 cm thick**. When converted to inches (where 1 inch ≈ 2.5 cm), this translates precisely to **3 x 2 x 1 inches**. These dimensions represent the average size of a nulliparous uterus; in multiparous women, the uterus may be slightly larger due to permanent structural changes following pregnancy. **2. Why Incorrect Options are Wrong:** * **A (5x4x2) & B (4x3x1):** These dimensions are significantly larger than the physiological norm. Such measurements would typically indicate uterine enlargement, seen in conditions like uterine leiomyomas (fibroids), adenomyosis, or early pregnancy. * **D (4x2x1):** While the thickness and breadth are close, a 4-inch length is longer than the average non-pregnant state. **3. Clinical Pearls for NEET-PG:** * **Weight:** The non-pregnant uterus weighs approximately **50–80 grams**. * **Volume:** The uterine cavity volume is roughly **5–10 mL**. * **Post-menopause:** The uterus undergoes atrophy, significantly decreasing in size and weight. * **Position:** The most common position is **Anteverted and Anteflexed (AVAF)**. * **Ratio:** In a nulliparous adult, the ratio of the corpus (body) to the cervix is **2:1**. In a prepubertal child, this ratio is reversed (1:2).

Question 878: Which of the following conditions is caused by HSV 2?

A. Genital herpes (Correct Answer)
B. Genital warts
C. Herpes zoster
D. Genital ulcer

Explanation: **Explanation:** **Correct Answer: A. Genital herpes** Genital herpes is primarily caused by **Herpes Simplex Virus Type 2 (HSV-2)**, although Type 1 (HSV-1) is increasingly implicated due to changing sexual practices. HSV-2 is a double-stranded DNA virus that establishes latency in the **sacral ganglia**. It typically presents as painful, fluid-filled vesicles on an erythematous base ("dewdrops on a rose petal" appearance), which rupture to form shallow, exquisitely tender ulcers. **Analysis of Incorrect Options:** * **B. Genital warts:** These are caused by **Human Papillomavirus (HPV)**, most commonly low-risk strains **6 and 11** (Condyloma acuminata). * **C. Herpes zoster:** Also known as "shingles," this is caused by the reactivation of the **Varicella-Zoster Virus (VZV)**, which belongs to the same *Herpesviridae* family but is distinct from HSV-2. * **D. Genital ulcer:** This is a broad clinical symptom, not a specific disease. While HSV-2 causes ulcers, other pathogens like *Treponema pallidum* (Syphilis) and *Haemophilus ducreyi* (Chancroid) are also major causes. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Viral culture or PCR (PCR is more sensitive). * **Cytology (Tzanck Smear):** Look for **multinucleated giant cells** and **Cowdry Type A** intranuclear inclusion bodies. * **Management:** Acyclovir, Valacyclovir, or Famciclovir. These drugs do not cure the infection but reduce viral shedding and symptom duration. * **Pregnancy:** If active lesions are present at the time of labor, a **Cesarean section** is indicated to prevent neonatal herpes.

Question 879: Asherman syndrome is typically caused by which of the following?

A. Adverse reaction to overdose drugs
B. Post-abortion curettage (Correct Answer)
C. Systemic septicemia
D. Long-term use of contraceptive pills

Explanation: **Asherman Syndrome** (intrauterine synechiae) refers to the formation of scar tissue (adhesions) within the uterine cavity, leading to the partial or complete obliteration of the endometrial space. ### **Explanation of the Correct Option** **B. Post-abortion curettage:** This is the most common cause of Asherman syndrome. Vigorous or repeated **Dilatation and Curettage (D&C)**, especially following a missed abortion, incomplete abortion, or postpartum hemorrhage, causes trauma to the **basalis layer** of the endometrium. When the basal layer is denuded, the opposing raw surfaces of the myometrium heal by forming fibrous bridges (adhesions). ### **Explanation of Incorrect Options** * **A. Adverse reaction to overdose drugs:** Drug toxicity does not cause mechanical trauma or scarring of the uterine lining. * **C. Systemic septicemia:** While severe pelvic infections (like Pelvic Inflammatory Disease) can lead to adhesions, systemic septicemia alone does not typically target the endometrial lining to cause synechiae unless it leads to localized tuberculous endometritis. * **D. Long-term use of contraceptive pills:** OCPs cause reversible endometrial atrophy but do not cause permanent scarring or adhesion formation. ### **NEET-PG High-Yield Clinical Pearls** * **Clinical Triad:** Secondary amenorrhea (or hypomenorrhea), cyclic pelvic pain, and infertility/recurrent pregnancy loss. * **Gold Standard Diagnosis:** **Hysteroscopy** (allows for both visualization and grading of adhesions). * **Hysterosalpingography (HSG) Finding:** Characteristic "filling defects" or a "honeycomb appearance." * **Most Common Infective Cause:** In developing countries like India, **Genital Tuberculosis** is a significant non-traumatic cause of Asherman syndrome. * **Management:** Hysteroscopic adhesiolysis followed by the placement of an IUCD or Foley catheter and high-dose estrogen therapy to promote endometrial regrowth.

Question 880: Which statement is true regarding the ovary?

A. The mesovarium contains ovarian vessels.
B. The ovarian ligament connects the ovary to the uterus. (Correct Answer)
C. The ovarian fossa is related to the ilioinguinal nerve.
D. The suspensory ligament of the ovary connects the ovary to the uterus.

Explanation: **Explanation:** The ovary is a vital pelvic organ with complex ligamentous attachments. Understanding its anatomical relations is high-yield for NEET-PG. **Why Option B is Correct:** The **ovarian ligament** (also known as the proper ligament of the ovary) is a fibrous band that connects the lower (uterine) pole of the ovary to the lateral wall of the uterus, just below the entry of the fallopian tube. It is a remnant of the **gubernaculum**. **Analysis of Incorrect Options:** * **Option A:** The **mesovarium** is a fold of peritoneum that attaches the ovary to the posterior layer of the broad ligament. While it carries small vessels to the hilum, the main **ovarian artery and vein** travel within the suspensory ligament of the ovary. * **Option C:** The **ovarian fossa** (Waldeyer’s fossa) is a depression in the lateral pelvic wall. Its most important neural relation is the **obturator nerve**, not the ilioinguinal nerve. Irritation of this nerve by ovarian masses can cause referred pain to the medial thigh. * **Option D:** The **suspensory ligament of the ovary** (infundibulopelvic ligament) connects the ovary to the **lateral pelvic wall**, not the uterus. It is the structure that must be ligated during an oophorectomy to control the ovarian vessels. **NEET-PG High-Yield Pearls:** 1. **Blood Supply:** The ovarian artery is a direct branch of the **Abdominal Aorta** (L2 level). 2. **Venous Drainage:** The right ovarian vein drains into the IVC, while the **left ovarian vein** drains into the **left renal vein** (similar to testicular veins). 3. **Lymphatics:** Lymphatic drainage of the ovary follows the vessels back to the **Para-aortic lymph nodes**. 4. **Ureter Relation:** The ureter lies just posterior/medial to the infundibulopelvic ligament; it is at high risk of injury during ligation of ovarian vessels.

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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