Gynecological Disorders Practice Questions

Q: What is the most common symptom of uterine retroversion?

Dyspareunia. **Explanation:** Uterine retroversion refers to the posterior tilting of the uterus toward the rectum. While it is often an asymptomatic anatomical variant (found in approximately 20% of healthy women), when symptoms do occur, **deep dyspareunia** is the most common and characteristic presentation. **1. Why Dyspareunia is Correct:** In a retroverted uterus, the cervix is displaced anteriorly, and the uterine body, along with the ovaries (which often prolapse into the Pouch of Douglas), lies in a dependent posterior position. During sexual intercourse, mechanical thrusting causes direct pressure or impact on the retroverted fundus and the prolapsed ovaries, leading to deep pelvic pain. **2. Analysis of Incorrect Options:** * **Backache:** Historically, retroversion was blamed for chronic backache. However, modern evidence shows that simple retroversion rarely causes back pain unless it is fixed due to underlying pathology like endometriosis or Pelvic Inflammatory Disease (PID). * **Infertility:** Retroversion itself does not cause infertility. While the anterior displacement of the cervix might theoretically affect sperm deposition, clinical studies show no significant difference in conception rates compared to anteverted uteri. * **Diarrhea:** There is no direct physiological link between uterine position and bowel motility. While a retroverted uterus may press against the rectum, it typically causes constipation or tenesmus rather than diarrhea. **NEET-PG High-Yield Pearls:** * **Most common cause of "Fixed" Retroversion:** Endometriosis and PID (due to adhesions). * **Pessary Test (Hodge Test):** Used to determine if symptoms (like backache) are truly due to retroversion. If symptoms disappear after correcting the position with a pessary, the test is positive. * **Management:** Asymptomatic cases require no treatment. Symptomatic cases may require pelvic floor exercises or, rarely, surgical ventrosuspension.

Q: An 18-year-old girl who has not attained menarche presents with acute retention of urine. What is the most likely diagnosis?

Hematocolpos. ### Explanation The clinical presentation of an 18-year-old girl with **primary amenorrhea** and **acute urinary retention** is a classic "textbook" description of **Hematocolpos** secondary to an **imperforate hymen**. **Why Hematocolpos is the correct answer:** In an imperforate hymen, menstrual blood accumulates in the vagina (hematocolpos) cycle after cycle. As the volume increases, the distended vagina creates significant extrinsic pressure on the adjacent **urethra and bladder neck**. This mechanical obstruction leads to acute urinary retention. Patients typically present during puberty with cyclical pelvic pain and a bulging, bluish membrane at the introitus on physical examination. **Analysis of Incorrect Options:** * **Twisted Ovarian Cyst:** While this causes acute pelvic pain and potentially a palpable mass, it rarely causes urinary retention. It is more likely to present with nausea, vomiting, and signs of peritonitis. * **Urinary Tract Infection (UTI):** UTIs cause frequency, urgency, and dysuria. While severe cases can cause voiding dysfunction, they do not explain the primary amenorrhea in an 18-year-old. * **Cervical Fibroid:** Although a central fibroid can compress the urethra, fibroids are extremely rare in the adolescent population (typically seen in women of reproductive age, 30–50 years). **NEET-PG High-Yield Pearls:** * **Initial Investigation:** Physical examination (inspection of the vulva). * **Gold Standard Investigation:** Pelvic Ultrasound (shows a hypoechoic collection in the vagina/uterus). * **Treatment:** Cruciate incision or stellate incision of the hymen to drain the "tarry" chocolate-colored blood. * **Sequence of Accumulation:** Hematocolpos (vagina) → Hematometra (uterus) → Hematosalpinx (fallopian tubes).

Q: What is the most common presentation of an anterior wall cervical fibroid?

Urinary frequency. **Explanation:** Cervical fibroids are rare (1–2% of all uterine fibroids) but present with distinct symptoms based on their anatomical location. **Why Urinary Frequency is Correct:** The cervix is located in close proximity to the bladder anteriorly and the rectum posteriorly. An **anterior wall cervical fibroid** expands forward into the cellular space between the cervix and the bladder. As the fibroid grows, it exerts direct pressure on the posterior wall of the bladder, reducing its functional capacity and causing **urinary frequency** or urgency. If the fibroid is large enough to compress the urethra or the bladder neck, it may even lead to acute urinary retention. **Analysis of Incorrect Options:** * **Abdominal lump:** Cervical fibroids are usually "impacted" in the pelvis. While they can push the uterus upward (the "lantern on top of St. Paul’s" appearance), they rarely present as a primary abdominal lump unless they are exceptionally large. * **Per vaginal bleeding:** While common in intramural or submucosal uterine fibroids, cervical fibroids are more likely to cause pressure symptoms rather than heavy menstrual bleeding, unless they distort the uterine cavity or become pedunculated (cervical polyp). * **Constipation:** This is the characteristic presentation of a **posterior wall cervical fibroid**, which compresses the rectum. **NEET-PG High-Yield Pearls:** * **Anterior fibroid:** Urinary symptoms (Frequency/Retention). * **Posterior fibroid:** Rectal symptoms (Constipation/Tenesmus). * **Lateral fibroid:** Ureteric compression (Hydronephrosis) due to pressure on the ureter in the broad ligament. * **Central fibroid:** Expands the cervix uniformly; the uterus sits on top like a "lantern on St. Paul’s Cathedral." * **Surgical Note:** During surgery for cervical fibroids, the ureter is at high risk of injury because it is displaced from its normal course.

Q: Which of the following drugs can reduce the size of uterine fibroids?

Estrogen. **Explanation:** **Note on the Question:** There appears to be a discrepancy in the provided key. In clinical practice and standard textbooks (Williams, Shaw’s), **Estrogen** is known to **increase** the size of uterine fibroids, as they are estrogen-dependent tumors. Drugs used to **reduce** the size of fibroids are those that create a hypoestrogenic state or block progesterone. **1. Why the Correct Answer (as per the key) is Estrogen:** Under standard medical logic, this option is technically **incorrect** for reducing size. However, if this is a "recall" question where Estrogen is marked correct, it may be a distractor or a typographical error in the source. In reality, **GnRH analogues, Danazol, and RU-486** are all established medical therapies to shrink fibroids. **2. Analysis of Other Options (The actual medical management):** * **GnRH Analogues (Option B):** These are the **gold standard** for medical shrinkage. They cause pituitary desensitization, leading to a profound hypoestrogenic state, reducing fibroid volume by 35–60% within 3 months. * **RU-486 (Mifepristone) (Option C):** As a Selective Progesterone Receptor Modulator (SPRM), it blocks progesterone, which is essential for fibroid growth. It effectively reduces size and controls bleeding. * **Danazol (Option A):** An androgenic steroid that creates a high-androgen, low-estrogen environment, leading to fibroid shrinkage and amenorrhea. **3. NEET-PG High-Yield Pearls:** * **Most common indication for surgery:** Menorrhagia (Heavy Menstrual Bleeding). * **Medical Management:** Primarily used pre-operatively to reduce size and increase hemoglobin levels. * **GnRH Analogue Limitation:** Size reduction is temporary; fibroids usually return to original size within 6 months of stopping therapy. * **Red Degeneration:** Most common in the 2nd trimester of pregnancy; managed conservatively with analgesics.

Q: A patient presents with pain and swelling in the vagina. On examination, a bluish bulge is found on the posterior vaginal wall behind the cervix. The swelling enlarges and becomes more painful with approaching menses. What is your diagnosis?

Endometriotic cyst. ### Explanation The correct diagnosis is **Endometriotic cyst** (Option D). **Why it is correct:** The clinical hallmark of endometriosis is the presence of ectopic endometrial tissue that responds to hormonal fluctuations. The **"bluish bulge"** is a classic sign of a "powder-burn" or "mulberry" lesion, representing old hemorrhage trapped within the tissue. The most pathognomonic feature in this case is the **cyclical nature of the symptoms**—the swelling enlarges and becomes more painful with approaching menses (premenstrual congestion and intramural bleeding). When located in the posterior vaginal fornix or the rectovaginal septum, it presents as a painful, bluish vaginal mass. **Why the other options are incorrect:** * **Gartner’s duct cyst:** These are remnants of the Wolffian duct. They are typically found on the **anterolateral** wall of the vagina and are asymptomatic and non-cyclical. * **Inclusion cyst:** These usually occur due to birth trauma or surgery (episiotomy scars) where the epithelium is buried. They are found in the **posterior lower third** of the vagina and do not change with the menstrual cycle. * **Bartholin’s cyst:** These occur due to duct obstruction of the Bartholin gland, located at the **4 o'clock or 8 o'clock position of the vulva** (posterior third of the labia majora), not behind the cervix on the vaginal wall. **Clinical Pearls for NEET-PG:** * **Triad of Endometriosis:** Dysmenorrhea, Dyspareunia, and Infertility. * **Commonest site:** Ovary (Chocolate cyst). * **Rectovaginal Endometriosis:** Often presents with "deep-seated" dyspareunia and painful defecation (dyschezia). * **Gold Standard Diagnosis:** Laparoscopy with biopsy.

Question 1

What is the most common symptom of uterine retroversion?

Accepted Answer

Dyspareunia

Answer

Backache

Answer

Infertility

Answer

Diarrhea

Question 2

A patient presents to the gynecology outpatient department with complaints of foul-smelling frothy vaginal discharge and intense itching. On examination, a 'strawberry cervix' is noted. Which of the following statements is false regarding the causative organism?

Accepted Answer

It is a flagellated protozoan.

Answer

It is transmitted sexually.

Answer

Metronidazole is the drug of choice for treatment.

Answer

It is associated with bacterial vaginosis.

Question 3

Which of the following is the drug of choice to treat endometriosis?

Accepted Answer

Medroxy progesterone

Answer

Testosterone propionate

Answer

Norethisterone

Answer

Danazol

Question 4

An 18-year-old girl who has not attained menarche presents with acute retention of urine. What is the most likely diagnosis?

Accepted Answer

Hematocolpos

Answer

Twisted ovarian cyst

Answer

Urinary tract infection

Answer

Cervical fibroid

Question 5

A woman complains of an offensive fishy smelling yellowish discharge without pruritus. The pH of the discharge is >4.5. A Gram-stained vaginal smear shows a reduced number of lactobacilli with a large number of Gardnerella vaginalis. What is the best treatment option for this patient?

Accepted Answer

Metronidazole 500 mg twice daily for 7 days

Answer

Clindamycin 300 mg twice daily for 7 days

Answer

Metronidazole 2 gm as a single dose

Answer

Metronidazole vaginal gel once a day for 7 days

Question 6

A broad ligament fibroid is most closely related to which structure?

Accepted Answer

Ureter

Answer

Ovaries

Answer

Fallopian tube

Answer

Gartner's duct

Question 7

What is the investigation of choice for a bicornuate uterus?

Accepted Answer

Combined hysterolaparoscopy

Answer

Ultrasound (USG)

Answer

CT scan

Answer

Hystero-salpingography

Question 8

What is the most common presentation of an anterior wall cervical fibroid?

Accepted Answer

Urinary frequency

Answer

Abdominal lump

Answer

Per vaginal bleeding

Answer

Constipation

Question 9

Which of the following drugs can reduce the size of uterine fibroids?

Accepted Answer

Estrogen

Answer

Danazol

Answer

GnRH analogue

Answer

RU-486

Question 10

A patient presents with pain and swelling in the vagina. On examination, a bluish bulge is found on the posterior vaginal wall behind the cervix. The swelling enlarges and becomes more painful with approaching menses. What is your diagnosis?

Accepted Answer

Endometriotic cyst

Answer

Gartner's duct cyst

Answer

Inclusion cyst

Answer

Bartholin's cyst

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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