Gynecological Disorders Practice Questions

Q: A 20-year-old female presented with vaginal discharge which is non-irritating and malodorous. Saline wet preparation reveals clue cells. Clue cells are used to detect which type of vaginitis?

Bacterial vaginosis. ### Explanation **Correct Option: A. Bacterial vaginosis** Bacterial vaginosis (BV) is a clinical syndrome resulting from the replacement of normal hydrogen peroxide-producing *Lactobacillus* species with high concentrations of anaerobic bacteria (e.g., *Gardnerella vaginalis*, *Mobiluncus*). **Clue cells** are the pathognomonic microscopic finding for BV. These are vaginal epithelial cells that have a "stippled" or "shaggy" appearance because their borders are obscured by numerous coccobacilli adhering to them. For a diagnosis of BV, clue cells must constitute at least 20% of the epithelial cells on a saline wet mount. **Why the other options are incorrect:** * **B. Candidal vaginitis:** Characterized by a thick, "curd-like" or "cottage cheese" discharge. Microscopic examination typically shows pseudohyphae and budding yeast (best seen with 10% KOH). * **C & D. Primary and Secondary Syphilis:** Caused by *Treponema pallidum*. Primary syphilis presents with a painless chancre, while secondary syphilis presents with a maculopapular rash and condyloma lata. Diagnosis is made via dark-field microscopy or serology (VDRL/RPR), not clue cells. ### High-Yield Clinical Pearls for NEET-PG * **Amsel’s Criteria (3 out of 4 required for BV diagnosis):** 1. Homogeneous, thin, grayish-white discharge. 2. Vaginal pH > 4.5 (Most sensitive). 3. Positive **Whiff test** (fishy odor on adding 10% KOH). 4. Presence of **Clue cells** on wet mount (Most specific). * **Treatment of Choice:** Oral Metronidazole (500 mg twice daily for 7 days). * **Nugent Scoring:** The "gold standard" for BV diagnosis, based on a Gram stain of vaginal secretions. * **Note:** BV is not considered a traditional STI; therefore, routine treatment of the male partner is not recommended.

Q: During which phase of the menstrual cycle is colposcopy best performed?

Proliferative phase. **Explanation:** The **Proliferative phase** (Days 5–14) is the ideal time to perform a colposcopy because of the physiological changes driven by estrogen. During this phase, the cervical mucus is thin, clear, and watery, which allows for optimal visualization of the transformation zone and the squamocolumnar junction (SCJ). Furthermore, the cervical os is slightly more dilated, and the vaginal epithelium is mature, making it easier to identify abnormal vascular patterns or acetowhite changes. **Analysis of Incorrect Options:** * **Secretory Phase:** Under the influence of progesterone, the cervical mucus becomes thick, opaque, and tenacious. This "plugs" the cervix and obscures the view of the transformation zone. Additionally, the vaginal epithelium may become more friable or congested, leading to minor bleeding that interferes with the examination. * **Menstrual Phase:** Menstrual blood and debris physically obstruct the view of the cervix. Blood also reacts with acetic acid, making it impossible to interpret acetowhite changes or perform accurate biopsies. * **Any day of the cycle:** While colposcopy can be performed at various times in an emergency, it is not "best" performed at any time due to the aforementioned hormonal influences on mucus and visibility. **NEET-PG High-Yield Pearls:** * **Ideal Timing:** Post-menstrual (Days 7–12) is the "sweet spot." * **Acetic Acid (3-5%):** Used to identify acetowhite lesions (areas of high nuclear density). * **Schiller’s Test:** Uses Lugol’s Iodine. Normal squamous epithelium turns mahogany brown (iodine-positive); suspicious areas remain pale/yellow (iodine-negative). * **Contraindication:** Acute pelvic inflammatory disease (PID) or active cervicitis. * **Pregnancy:** Colposcopy is safe, but endocervical curettage (ECC) is strictly contraindicated.

Q: All the following are features of the classic triad of ectopic pregnancy except?

Mass per abdomen. ### Explanation The **classic clinical triad** of ectopic pregnancy consists of **Amenorrhea, Abdominal Pain, and Vaginal Bleeding**. This triad is a hallmark of the condition, though it is present in only about 50% of patients. **1. Why "Mass per abdomen" is the correct answer:** While a pelvic mass may be felt on bimanual examination (adnexal tenderness or mass), a **palpable mass per abdomen** is not part of the classic triad. In most cases of ectopic pregnancy, the fallopian tube ruptures or the pregnancy is too small to be felt through the abdominal wall. A palpable abdominal mass is more characteristic of large uterine fibroids, ovarian tumors, or advanced intrauterine pregnancy. **2. Analysis of the Incorrect Options (The Triad):** * **Amenorrhea (Option A):** Occurs in 75–90% of cases. It usually lasts 6–8 weeks from the last menstrual period before symptoms begin. * **Abdominal Pain (Option B):** The most common symptom (95–100%). It is typically unilateral and pelvic, but can become generalized if rupture occurs (due to hemoperitoneum). * **Vaginal Bleeding (Option C):** Seen in 70–80% of cases. It is usually "spotting" or dark brown bleeding caused by the sloughing of the decidua due to falling progesterone levels. **Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube. * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serial β-hCG levels (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on biopsy; it is suggestive but not diagnostic of ectopic pregnancy. * **Kehr’s Sign:** Referred shoulder pain due to diaphragmatic irritation by blood (hemoperitoneum).

Q: Fibroid uterus is the neoplasm that arises from which layer of the uterus?

Myometrium. **Explanation:** **1. Why Myometrium is Correct:** Uterine fibroids, medically known as **leiomyomas**, are the most common benign tumors of the female reproductive tract. They are monoclonal tumors that arise specifically from the **smooth muscle cells (myocytes)** of the **myometrium**. The growth of these tumors is highly dependent on the hormones estrogen and progesterone, which is why they typically enlarge during reproductive years and regress after menopause. **2. Why Other Options are Incorrect:** * **Endometrium:** This is the innermost mucosal lining of the uterus. Neoplasms arising here include endometrial polyps or endometrial carcinoma (adenocarcinoma), not fibroids. * **Perimetrium:** This is the outer serous layer of the uterus. While "subserosal" fibroids may bulge toward this layer, they do not originate from it. * **Visceral Peritoneum:** This is the thin membrane covering the pelvic organs. It is histologically distinct from the muscular wall where leiomyomas originate. **3. NEET-PG High-Yield Clinical Pearls:** * **Most Common Site:** The most common location is **intramural** (within the myometrium), but the most symptomatic (causing heavy menstrual bleeding) is **submucosal**. * **Degenerations:** The most common degeneration is **hyaline degeneration**. **Red degeneration** (carneous degeneration) is a classic exam favorite, occurring typically during the mid-trimester of pregnancy due to rapid growth and venous thrombosis. * **Genetic Association:** Often associated with **MED12** gene mutations. * **Key Feature:** Fibroids are characterized by a "pseudocapsule" formed by compressed myometrium, which allows for easy shelling out during a myomectomy.

Q: All of the following changes occur in a fibroid uterus EXCEPT:

Squamous metaplasia. **Explanation:** The correct answer is **B. Squamous metaplasia.** Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the myometrium. **Squamous metaplasia** is a change typically seen in the **columnar epithelium of the cervix** or the **endometrium** (often associated with chronic irritation or vitamin A deficiency), but it does not occur within the smooth muscle tissue of a fibroid itself. **Why the other options are incorrect (Changes that DO occur in fibroids):** * **Hyaline Degeneration (D):** This is the **most common** type of degeneration (65%). The smooth muscle is replaced by homogenous eosinophilic hyaline tissue. It occurs due to a gradual decrease in blood supply. * **Calcification (C):** Often follows hyaline or fatty degeneration, particularly in postmenopausal women (subserosal fibroids). It is known as a "womb stone" and appears as a popcorn-like calcification on X-ray. * **Atrophy (A):** Fibroids are estrogen-dependent. Following menopause or during treatment with GnRH agonists, the size of the fibroid decreases due to the loss of hormonal support, leading to atrophy. **High-Yield Clinical Pearls for NEET-PG:** * **Red Degeneration:** Occurs most commonly during the **second trimester of pregnancy** due to aseptic infarction. It presents with acute pain and fever. * **Cystic Degeneration:** Occurs when hyaline tissue liquefies; it can mimic an ovarian cyst on ultrasound. * **Sarcomatous Change:** The rarest but most serious change (<0.5%), where a leiomyoma transforms into a leiomyosarcoma. * **Most common symptom:** Menorrhagia (specifically for intramural and submucosal types).

Q: A 19-year-old female presents with a 2-month history of progressively worsening left lower quadrant pain. She denies changes in bowel or bladder function, fevers, chills, nausea, vomiting, or diarrhea. The pain is intermittent and described as a dull pressure. Pelvic examination reveals a mildly tender left adnexal mass. Urine hCG is negative, and pelvic ultrasound shows a 6 cm complex left adnexal mass with features consistent with a benign cystic teratoma. What is the most appropriate next step in management?

Perform laparotomy. **Explanation:** The patient presents with a symptomatic, 6 cm complex adnexal mass consistent with a **mature cystic teratoma (dermoid cyst)**. In a young female, the primary management goal for a symptomatic dermoid cyst is surgical intervention to alleviate pain and prevent complications such as **ovarian torsion** (the most common complication) or rupture. **Why Laparotomy (or Laparoscopy) is Correct:** Surgical removal (cystectomy) is indicated for symptomatic teratomas or those >5 cm due to the increased risk of torsion. While laparoscopy is often preferred in modern practice, **laparotomy** remains a standard definitive management option in many clinical scenarios and exams to ensure complete removal of the cyst while preserving as much healthy ovarian tissue as possible (ovarian cystectomy). **Why Other Options are Incorrect:** * **A & B (Observation/Repeat Ultrasound):** Dermoid cysts are germ cell tumors; they do not regress spontaneously. Observation is only reserved for asymptomatic cysts <5 cm. This patient is symptomatic with a 6 cm mass, necessitating intervention. * **C (Oral Contraceptive Pills):** OCPs can suppress functional (physiologic) cysts like follicular or corpus luteum cysts by inhibiting ovulation. They have no effect on the size or progression of neoplastic cysts like teratomas. **Clinical Pearls for NEET-PG:** * **Most common ovarian tumor in young women:** Mature cystic teratoma. * **Pathognomonic USG signs:** Rokitansky protuberance (dermoid plug), "tip of the iceberg" sign, and "dermoid mesh" (hair fibers). * **Complications:** Torsion (15%), Rupture (leading to chemical peritonitis), and Malignant transformation (1-2%, usually Squamous Cell Carcinoma in older women). * **Management:** Cystectomy is preferred over oophorectomy in reproductive-age women to preserve fertility.

Q: All of the following are risk factors for Pelvic Inflammatory Disease (PID) except:

Pregnancy. **Explanation:** Pelvic Inflammatory Disease (PID) is an ascending infection of the female upper genital tract. The correct answer is **Pregnancy** because it acts as a physiological barrier against ascending infections. **1. Why Pregnancy is the Correct Answer:** Pregnancy is considered protective against PID for two primary reasons: * **Mucus Plug:** The formation of a thick, tenacious cervical mucus plug (under the influence of progesterone) physically obstructs the ascent of bacteria from the vagina into the uterine cavity. * **Obliteration of Uterine Cavity:** As the pregnancy progresses, the decidua capsularis fuses with the decidua parietalis, effectively obliterating the uterine cavity and preventing the spread of pathogens to the fallopian tubes. **2. Analysis of Other Options:** * **Females not using OCPs:** OCP users have a *decreased* risk of PID because progestin thickens cervical mucus (mimicking the pregnancy effect) and reduces menstrual flow, which otherwise acts as a culture medium for bacteria. Therefore, **not** using OCPs is a relative risk factor. * **Intrauterine Device (IUD) users:** The risk of PID is slightly increased, primarily during the first 21 days following insertion due to the introduction of vaginal flora into the sterile uterus during the procedure. * **Previous history of PID:** This is one of the strongest risk factors. Prior infection causes mucosal damage, loss of ciliary function in the tubes, and scarring, making the tract more susceptible to reinfection. **High-Yield Clinical Pearls for NEET-PG:** * **Most common causative organism:** *Chlamydia trachomatis* (subacute) and *Neisseria gonorrhoeae* (acute). * **Barrier Contraceptives:** Condoms provide the best protection against PID. * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions). * **Gold Standard Diagnosis:** Laparoscopy (though clinical diagnosis is preferred in practice).

Q: A young lady presents with a complaint of copious vaginal discharge, but there is no cervical discharge on per speculum examination. Which of the following should be given for management?

Metronidazole and fluconazole. ### Explanation **1. Understanding the Clinical Presentation** The patient presents with **copious vaginal discharge** but **no cervical discharge** on speculum examination. This distinction is crucial for NEET-PG. * **Vaginal discharge without cervicitis** typically points toward **Vaginitis** (Bacterial Vaginosis, Trichomoniasis, or Candidiasis). * **Cervical discharge** (mucopurulent) would suggest **Cervicitis** (Chlamydia or Gonorrhea). According to the **Syndromic Management of STI/RTI** (NACO guidelines), a patient with vaginal discharge and no evidence of cervical infection is treated using **Kit 2 (Green Kit)**. **2. Why Option A is Correct** Kit 2 is designed to cover the most common causes of vaginitis: * **Bacterial Vaginosis & Trichomoniasis:** Covered by **Metronidazole** (2g single dose). * **Candidiasis (Yeast infection):** Covered by **Fluconazole** (150mg single dose). Since the question describes a purely vaginal pathology, this combination is the standard of care. **3. Why Other Options are Incorrect** * **Options B & C:** These include Azithromycin or Doxycycline, which are used to treat **Chlamydia**. These drugs are part of **Kit 1 (Grey Kit)**, used when there is visible cervical discharge or cervical motion tenderness (Cervicitis/PID). * **Option D:** Fluconazole alone only treats Candidiasis, failing to address Bacterial Vaginosis or Trichomoniasis, which also cause copious discharge. **4. High-Yield Clinical Pearls for NEET-PG** * **Kit 1 (Grey):** Azithromycin + Cefixime (for Cervicitis/Urethritis). * **Kit 2 (Green):** Metronidazole + Fluconazole (for Vaginitis). * **Whiff Test:** Positive (fishy odor) in Bacterial Vaginosis (KOH mount). * **Strawberry Cervix:** Classic sign of *Trichomonas vaginalis*. * **Curdy White Discharge:** Classic for *Candida albicans*.

Q: What is the common mode of transmission in pyogenic TB salpingitis?

Hematogenous. **Explanation:** Genital tuberculosis is almost always a **secondary infection** resulting from a primary focus elsewhere in the body, most commonly the lungs. **1. Why Hematogenous is Correct:** The fallopian tubes are the most frequently affected organ in female genital TB (90-100% of cases). The primary mode of spread is **hematogenous (blood-borne)**. Mycobacteria travel from the primary pulmonary focus via the bloodstream and lodge in the subepithelial layers of the fallopian tubes. From the tubes, the infection typically spreads downwards to the endometrium (50-60%) and ovaries (20-30%). **2. Why Other Options are Incorrect:** * **Ascending Infection:** This is the common route for most Pelvic Inflammatory Diseases (PID) caused by *Chlamydia* or *Gonorrhea*, but it is extremely rare for TB. * **Direct Invasion:** This occurs only rarely via lymphatic spread from an infected adjacent organ, such as the intestines (tuberculous peritonitis) or mesenteric nodes. * **Sexually Transmitted:** While theoretically possible if a partner has active genitourinary TB, it is not the standard or common mode of transmission. **Clinical Pearls for NEET-PG:** * **Most common site:** Fallopian tubes (bilateral involvement is the rule). * **Infertility:** TB salpingitis is a major cause of tubal factor infertility in endemic regions. * **Hysterosalpingography (HSG) findings:** Look for "Lead pipe" tubes, "Beaded" appearance, or "Tobacco pouch" appearance. * **Gold Standard Diagnosis:** Endometrial biopsy/aspirate for Histopathology (showing granulomas) and Culture (Lowenstein-Jensen medium) or GeneXpert.

Question 1

A 20-year-old female presented with vaginal discharge which is non-irritating and malodorous. Saline wet preparation reveals clue cells. Clue cells are used to detect which type of vaginitis?

Accepted Answer

Bacterial vaginosis

Answer

Candidal vaginitis

Answer

Primary syphilis

Answer

Secondary syphilis

Question 2

During which phase of the menstrual cycle is colposcopy best performed?

Accepted Answer

Proliferative phase

Answer

Secretory phase

Answer

Menstrual phase

Answer

Any day of the cycle

Question 3

All the following are features of the classic triad of ectopic pregnancy except?

Accepted Answer

Mass per abdomen

Answer

Amenorrhea

Answer

Pain

Answer

Bleeding

Question 4

A 58-year-old woman presents with a mildly tender, fluctuant mass in the right vulva, located just outside the introitus in the region of the Bartholin's gland. She reports pain in the area during walking and coitus. What is the most appropriate treatment?

Accepted Answer

Surgical excision

Answer

Marsupialization

Answer

Administration of antibiotics

Answer

Incision and drainage

Question 5

Fibroid uterus is the neoplasm that arises from which layer of the uterus?

Accepted Answer

Myometrium

Answer

Endometrium

Answer

Perimetrium

Answer

Visceral peritoneum

Question 6

All of the following changes occur in a fibroid uterus EXCEPT:

Accepted Answer

Squamous metaplasia

Answer

Atrophy

Answer

Calcification

Answer

Hyaline degeneration

Question 7

A 19-year-old female presents with a 2-month history of progressively worsening left lower quadrant pain. She denies changes in bowel or bladder function, fevers, chills, nausea, vomiting, or diarrhea. The pain is intermittent and described as a dull pressure. Pelvic examination reveals a mildly tender left adnexal mass. Urine hCG is negative, and pelvic ultrasound shows a 6 cm complex left adnexal mass with features consistent with a benign cystic teratoma. What is the most appropriate next step in management?

Accepted Answer

Perform laparotomy

Answer

Repeat pelvic examination in 1 year

Answer

Repeat pelvic ultrasound in 6 weeks

Answer

Prescribe oral contraceptive pills

Question 8

All of the following are risk factors for Pelvic Inflammatory Disease (PID) except:

Accepted Answer

Pregnancy

Answer

Females not using oral contraceptive pills (OCP)

Answer

Intrauterine device (IUD) users

Answer

Previous history of acute PID

Question 9

A young lady presents with a complaint of copious vaginal discharge, but there is no cervical discharge on per speculum examination. Which of the following should be given for management?

Accepted Answer

Metronidazole and fluconazole

Answer

Metronidazole and azithromycin

Answer

Metronidazole and doxycycline

Answer

Fluconazole only

Question 10

What is the common mode of transmission in pyogenic TB salpingitis?

Accepted Answer

Hematogenous

Answer

Ascending infection

Answer

Direct invasion

Answer

Sexually transmitted

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?