Gynecological Disorders Practice Questions

Q: A 20-year-old female presents for a routine antenatal checkup in her first trimester and is diagnosed with an ovarian cyst. What is the most appropriate next step?

Observation and surgical removal in the second trimester. ### Explanation The management of an adnexal mass in pregnancy depends on the gestational age, the size of the cyst, and its clinical features. **Why Option D is Correct:** Most ovarian cysts discovered in the first trimester are functional (e.g., **Corpus Luteum cysts**), which typically regress spontaneously by 14–16 weeks of gestation. Therefore, the initial step is **observation**. If the cyst persists, is >6 cm, or shows suspicious features, surgical intervention is indicated. The **second trimester (14–22 weeks)** is the "golden period" for surgery because: 1. Organogenesis is complete (reducing teratogenic risk). 2. The placenta has taken over progesterone production (reducing the risk of miscarriage from corpus luteum removal). 3. The uterus is not yet large enough to obstruct the surgical field, making laparoscopy safer. **Why Other Options are Incorrect:** * **Option A:** Surgery in the first trimester carries a high risk of miscarriage due to potential interference with the corpus luteum and the effects of anesthesia during organogenesis. * **Option B:** Waiting until after delivery increases the risk of complications such as **torsion** (most common in the 2nd trimester or puerperium), rupture, or labor dystocia. * **Option C:** An asymptomatic ovarian cyst is never an indication for termination of pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common ovarian cyst in pregnancy:** Corpus Luteum cyst. * **Most common benign tumor in pregnancy:** Mature Cystic Teratoma (Dermoid). * **Most common complication:** Torsion (occurs most frequently when the uterus rises out of the pelvis or during rapid involution postpartum). * **Emergency Indication:** If torsion or rupture occurs, immediate surgery is required regardless of the trimester.

Q: Pelvic Inflammatory Disease (PID) is most commonly caused by which of the following?

Chlamydia trachomatis. **Explanation:** Pelvic Inflammatory Disease (PID) is an ascending infection of the female upper genital tract. Globally and in the context of competitive exams like NEET-PG, **Chlamydia trachomatis** is recognized as the most common causative organism, followed closely by *Neisseria gonorrhoeae*. **Why Chlamydia trachomatis is correct:** Chlamydia is an obligate intracellular bacterium that often causes "silent" or subclinical infections. Because it frequently presents with minimal symptoms, it often goes untreated, allowing the pathogen to ascend from the endocervix to the endometrium and fallopian tubes, leading to chronic inflammation, scarring, and tubal factor infertility. **Analysis of Incorrect Options:** * **Mycoplasma genitalium:** While an emerging cause of PID and cervicitis, it is statistically less common than Chlamydia. * **Mycobacterium tuberculosis:** This is the leading cause of **Chronic PID** (specifically Granulomatous Salpingitis) in developing countries like India, but it is not the most common cause of acute PID overall. * **Escherichia coli:** This is a common cause of urinary tract infections and can be part of the polymicrobial flora in late-stage PID or Tubo-ovarian abscesses, but it is rarely the primary initiating pathogen. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Lower abdominal pain (Dull aching). * **Most specific sign:** Cervical Motion Tenderness (Chandelier sign). * **Gold Standard Investigation:** Laparoscopy (shows "violin-string" adhesions in Fitz-Hugh-Curtis Syndrome). * **CDC Treatment Regimen:** Ceftriaxone (IM) + Doxycycline (Oral) + Metronidazole (Oral). * **Risk Factor:** The highest risk period for PID is the first 3 weeks after IUD insertion.

Q: Ectopic pregnancy is most commonly associated with:

Tubal inflammatory diseases. **Explanation:** The most common site for ectopic pregnancy is the fallopian tube (95%), and the primary risk factor is any condition that causes **structural or functional damage** to the tubal cilia and mucosa. **1. Why Tubal Inflammatory Diseases (TID/PID) is correct:** Pelvic Inflammatory Disease (PID), often caused by *Chlamydia trachomatis* or *Neisseria gonorrhoeae*, leads to endosalpingitis. This results in the loss of ciliary action and the formation of intratubal adhesions (plicae). These changes physically obstruct or delay the transport of the fertilized ovum to the uterine cavity, leading to implantation within the tube. It is the single most common identifiable risk factor. **2. Why other options are incorrect:** * **Endometriosis:** While it can cause pelvic adhesions and distort anatomy, it is a much less frequent cause of ectopic pregnancy compared to infection. * **Congenital tubal anomalies:** Conditions like accessory ostia or tubal hypoplasia are rare occurrences in the general population. * **Tuberculosis:** Genital TB is a significant cause of infertility in developing countries because it often leads to complete tubal occlusion (e.g., "lead pipe" tubes). While it can cause ectopic pregnancy, the incidence of PID-related ectopic cases is statistically much higher. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to its narrow lumen). * **Strongest risk factor:** Previous history of ectopic pregnancy (increases risk by 10-fold). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serum β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Arias-Stella Reaction:** Hypersecretory endometrium seen on curettage, characteristic of (but not diagnostic for) ectopic pregnancy.

Q: Following an ectopic pregnancy, what is the approximate recurrence rate?

15%. **Explanation:** The risk of a repeat ectopic pregnancy is significantly higher in women who have already experienced one, primarily due to underlying tubal damage or dysfunction (e.g., chronic salpingitis or scarring from surgery). **1. Why 15% is correct:** Statistically, after one ectopic pregnancy, the recurrence rate is approximately **15%**. This risk increases dramatically after two or more ectopic pregnancies, rising to about **25-30%**. The underlying medical concept is that the factors which predisposed the patient to the first ectopic (such as Pelvic Inflammatory Disease, smoking, or previous tubal surgery) often persist or are exacerbated by the initial event, leading to a higher likelihood of future implantation outside the uterine cavity. **2. Analysis of Incorrect Options:** * **A (5%):** This is too low. The risk in the general population is approximately 1-2%; a previous ectopic increases this baseline risk by nearly tenfold. * **B (10%):** While some older texts cite 10%, standard contemporary textbooks (like Williams Obstetrics and Dutta) generally point toward the 15% mark as the most accurate representative figure for a single prior event. * **D (20%):** This figure is slightly higher than the average for a single recurrence, though it may be seen in specific high-risk cohorts (e.g., those with bilateral tubal disease). **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Ampulla of the Fallopian tube (70%). * **Most common site for rupture:** Isthmus (due to narrow lumen). * **Gold Standard Diagnosis:** Transvaginal Ultrasound (TVUS) + Serum β-hCG (Discriminatory zone: 1500–2000 mIU/mL). * **Management:** Methotrexate is the medical treatment of choice in hemodynamically stable patients with a small sac (<3.5-4 cm) and no fetal cardiac activity. Salpingectomy is preferred over salpingostomy if the contralateral tube is healthy.

Q: Intermenstrual bleeding (metrorrhagia) arises typically when the fibroid tumour is:

Submucous. ### Explanation **Correct Option: A (Submucous)** The primary reason for abnormal uterine bleeding in fibroids is the distortion and increased surface area of the endometrial lining. **Submucous fibroids** (Type 0, 1, and 2 according to FIGO classification) are located directly beneath the endometrium. They cause **metrorrhagia (intermenstrual bleeding)** because they lead to: 1. **Ulceration and necrosis** of the overlying thinned-out endometrium. 2. **Venous congestion** and stasis within the endometrial plexuses. 3. Interference with normal uterine contractility, preventing effective hemostasis. **Incorrect Options:** * **B. Subserous:** These fibroids grow toward the peritoneal cavity. They are usually asymptomatic regarding menstruation but may cause pressure symptoms (e.g., frequency of micturition) or torsion. * **C. Interstitial (Intramural):** These are the most common type and typically present with **menorrhagia** (heavy cyclic bleeding) due to increased uterine surface area and vascularity, rather than irregular intermenstrual bleeding. * **D. Broad ligament myoma:** These are a type of subserous fibroid that grows between the layers of the broad ligament. They do not involve the endometrium and thus do not cause metrorrhagia. **NEET-PG High-Yield Pearls:** * **Most common symptom of fibroid:** Menorrhagia (Heavy Menstrual Bleeding). * **Most common type of fibroid:** Intramural (Interstitial). * **Fibroid most likely to cause infertility/abortion:** Submucous. * **Degeneration most common in pregnancy:** Red degeneration (due to rapid growth and venous thrombosis). * **Investigation of choice:** Transvaginal Ultrasound (TVS). Saline Infusion Sonohysterography (SIS) is superior for diagnosing submucous fibroids.

Question 1

A 20-year-old female presents for a routine antenatal checkup in her first trimester and is diagnosed with an ovarian cyst. What is the most appropriate next step?

Accepted Answer

Observation and surgical removal in the second trimester

Answer

Immediate surgical removal of the cyst

Answer

Surgical removal of the cyst after delivery

Answer

Termination of pregnancy followed by cyst removal

Question 2

Which of the following patient positions is NOT typically used for the described procedure?

Accepted Answer

Transvaginal sonography in gynecology - Lithotomy with a full bladder

Answer

Diagnostic laparoscopy - Trendelenburg with about 30° tilt

Answer

Colposcopy - Lithotomy

Answer

Hysteroscopy - Lithotomy

Question 3

Pelvic Inflammatory Disease (PID) is most commonly caused by which of the following?

Accepted Answer

Chlamydia trachomatis

Answer

Mycoplasma genitalium

Answer

Mycobacterium tuberculosis

Answer

Escherichia coli

Question 4

Which of the following is NOT true regarding endometriosis-associated dysmenorrhea?

Accepted Answer

It typically occurs 24 to 48 hours after the start of menses.

Answer

It is often more severe than primary dysmenorrhea.

Answer

It may be less responsive to NSAIDs compared to primary dysmenorrhea.

Answer

Deep infiltrating endometriosis often correlates with the severity of dysmenorrhea.

Question 5

A 35-year-old female who has completed her family presents with an asymptomatic 10-week size fibroid. What is the most appropriate management?

Accepted Answer

Observation only

Answer

Hysterectomy with bilateral salpingo-oophorectomy

Answer

Hysteroscopic myomectomy

Answer

Myomectomy

Question 6

Ectopic pregnancy is most commonly associated with:

Accepted Answer

Tubal inflammatory diseases

Answer

Endometriosis

Answer

Congenital tubal anomalies

Answer

Tuberculosis

Question 7

In gynecologic surgery, what is the most common procedure associated with ureter injury and where is the typical site of injury?

Accepted Answer

Simple abdominal hysterectomy, pelvic brim near the infundibulopelvic ligament

Answer

Vaginal hysterectomy, tunnel of Weheim

Answer

Bladder neck suspension, tunnel of Weheim

Answer

Laparoscopic oophorectomy, pelvic brim near the infundibulopelvic ligament

Question 8

Following an ectopic pregnancy, what is the approximate recurrence rate?

Accepted Answer

15%

Answer

5%

Answer

10%

Answer

20%

Question 9

Intermenstrual bleeding (metrorrhagia) arises typically when the fibroid tumour is:

Accepted Answer

Submucous

Answer

Subserous

Answer

Interstitial

Answer

Broad ligament myoma

Question 10

Which of the following is true regarding pain in endometriosis?

Accepted Answer

Dyspareunia is more common with peritoneal lesions in the pouch of Douglas.

Answer

Dysmenorrhea usually starts from day 2 of periods and subsides with the end of menstrual flow.

Answer

Dysmenorrhea is more common in ovarian endometriomas than peritoneal lesions.

Answer

Pelvic pain is usually unilateral.

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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