12 Self Assessment & Review: Gynecology

FIGURE BASED QUESTIONS

F1. Identify the structure ‘X’ shown in figure F1: F2. Identify the structure ‘X’ marked on the figure F1:
a. Fallopian tube b. Round ligament a. Fossa navicularis b. Fourchette
c. Ovarian ligament d. Broad ligament c. Posterior commissure d. Vestibule

Fig. F1 Fig. F2

QUESTIONS

1. All of the following pelvic structures support the vagina, 10. Nabothian follicles occur in: [TN 91]
except: [AIIMS May 04] a. Erosion of cervix b. Ca endometrium
a. Perineal body c. Ca cervix d. Ca vagina
b. Pelvic diaphragm
11. Bartholin’s duct opens into: [DNB 99]
c. Levator ani muscle
a. Labia majora and minora
d. Infundibulopelvic ligament
b. A groove between labia minora and hymen
2. All are related to lateral vaginal fornix except:
c. The lower vagina
[JIPMER 90]
d. The upper vagina
a. Ureters b. Mackenrodt’s
c. Inferior vesical artery d. Uterine artery 12. A woman presents with a fluctuant non tender swelling
3. The pH of vagina in adults is: [Delhi 98, DNB 00 95] at the introitus. The best treatment is: [AI 08]
a. 3.5 – 4.5 b. 4.5 – 5.5 a. Marsupilization b. Incision and drainage
c. 5.5 – 6.5 d. 6.5 – 7.5 c. Surgical resection d. Aspiration
4. Protective bacterium in normal vagina is: [J and K 01] 13. Bartholin’s cyst is caused by: [DNB 04]
a. Peptostreptococcus b. Lactobacillus a. Candida b. Anaerobes
c. Gardenella vaginalis d. E. coli c. Gonococcus d. Trichomonas
5. The main source of physiological secretion found in the 14. Narrowest part of fallopian tube is: [Delhi 93]
vagina is: [AIIMS 98] a. Interstitial portion b. Isthmus
a. Bartholin’s glands b. Gartner’s duct c. Infundibulum d. Ampulla
c. Vagina d. Cervix
15. ‘Peg cells’ are seen in: [DNB 00]
6. With reference to vagina which of the following state-
a. Vagina b. Vulva
ment is not correct: [UPSC 07]
a. It has mucus secreting gland c. Ovary d. Tubes
b. It is supplied by uterine artery 16. The length of fallopian tube is: [DNB 95]
c. It is lined by stratified squamous epithelium a. 8 – 10 cm b. 10 – 12 cm
d. Its posterior wall is covered by peritoneum c. 15 – 18 cm d. 18 – 20 cm
7. Which of the following about lymphatics of vulva is 17. Uterine artery is a branch of: [DNB 00, 95]
true: [AI 98] a. Aorta b. Common iliac
a. Do not cross the labiocrural fold c. Internal iliac d. External iliac
b. Traverse labia from medial to lateral
18. Vaginal epithelium is derived from: [AIIMS Nov 13]
c. Drain directly into deep femoral glands
d. Do not freely communicate with each other a. Endoderm of urogenital sinus
b. Mesoderm of urogenital sinus
8. Uterine-cervix ratio upto 10 years of age: [PGI 89]
a. 3:2 b. 2:1 c. Endoderm of genital ridge
c. 3:1 d. 1:2 d. Mesoderm of genital ridge
9. The epithelial lining of cervical canal is: [TN 90] 19. Anatomical sphincter of fallopian tubes? [AIIMS Nov 13]
a. Low columnar b. High columnar a. Ampulla b. Isthums
c. Stratified squamous d. Ciliated columnar c. Intramural d. Infundibulum
 Chapter 1  Anatomy of the Female Genital Tract 13

NEW PATTERN QUESTIONS 27. With regards to the nerve supply of pelvis all are correct
except
20. With regards to labia majora all are correct except: a. The sensory component of pudendal nerve supp­lies
a. Is homologus to scrotum in males the skin of vulva, clitoris, perineum and lower va-
b. Is supplied by branches of internal and external gina
pudendal arteries b. The motor component of pudendal nerve supplies
c. Drains into superficial inguinal lymph nodes all the muscles of pelvic floor
d. The broad ligament terminates at its anterior end c. The anterior half of the vulva is supplied by ilio­
21. With regards to vagina all are correct except inguinal and genitofemoral nerves
a. Makes an angle of 45° with the horizontal in erect d. The posterior half of vulva is supplied by ilioinguinal
posture nerve only
b. Looks like letter ‘H’ on cross section 28. The triangular area bounded by clitoris, fourchette and
c. Vaginal axis lies parallel to the uterus and at right labia minora is:
angles to the plane axis of inlet a. Fossa navicularis b. Fourchette
d. Is lined by stratified squamous epithelium c. Vestibule d. Vulva
22. Vaginal defence is lost: 29. Fourchette is where:
a. Within 10 days of birth a. Both labia minora meet posteriorly
b. After 10 days of birth b. Both labia minora meet posteriorly
c. During pregnancy c. Labia mionra and majora meet
d. At puberty d. Distance between vulva and labia minora
23. Ovary is: 30. Glands of littre are homologous to:
a. Is attached to the posterior layer of the broad liga- a. Bartholin gland b. Cowper’s gland
ment by mesovarium c. Skene glands d. Glands on labia
b. Has hilus cells in the cortex 31. For hormonal study, sample should be taken from
c. Ovarian veins drain into inferior vena cava which wall of vagina:
d. Is connected to the uterus by infundibulopelvic a. Anterior b. Posterior
ligament c. Lateral d. Any wall
24. The fallopian tube: 32. Theoretically, Gonococcal vaginitis can be seen:
a. Is lined entirely by ciliated columnar epithelium a. In puberty
b. Has a submucous layer b. In newborn females
c. Undergoes shedding during menstrual cycle c. In reproductive age females
d. Surrounded by peritoneum on all sides except along d. Sex workers
the line of attachment of mesosalpinx 33. Cervix: corpus ratio before puberty is:
25. All are true about the round ligament except: a. 1:2 b. 2:1
a. Measures 12 cm in length c. 1:3 d. 3:1
b. Is homologous to the gubernaculum testes 34. Which ligament carries ovarian A in lateral wall:
c. Lies anterior to the obturator artery along its course a. Ovarian ligament
d. Contains smooth muscles b. Suspensory ligament of ovary
26. All of the following are true with respect to ligation of c. Broad ligament
internal iliac artery except: d. Round ligament
a. For hemostasis, anterior division is to be ligated 35. M/C site of ureteric injury during hysterectomy:
b. Collateral circulation is established later between a. Pelvic brin
middle sacral and lateral sacral arteries b. Where it is crossed by uterine artery.
c. Bleeding is always controlled with it c. Where it enters the bsadder
d. The artery should be ligated and not transected d. Where it is over obturator vessels
 Chapter 2  Reproductive Physiology and Hormones in Females 33

QUESTIONS

Ovarian cycle c. Right handedness is more common in

population
1. Which of the following is seen in the ovulatory phase?
d. Some embryological basis
(AIIMS May 11) 10. Ovulation occurs [AIIMS May 2013]
a. Stimulation of continuation of reduction a. Before LH surge
division of oocytes b. After biphasic rise in body temperature
b. Inhibin A is increased c. After ripening of follicle by FSH
c. FSH increases steroid synthesis in granulosa d. Before estrogen peak
cells 11. True about timing of LH surge: [PGI May 2013]
d. Activin causes FSH to act on granulosa cells a. Occur 12 hour before ovulation
2. In ovarian cycle increased levels of LH are due to: b. Occur 24 hour before ovulation
c. Occur 12 hour after ovulation
(AIIMS May 11)
d. Occur 24 hour after ovulation
a. Increased Progesterone
e. Occur at time or ovulation
b. Increased Estrogen
12. Which of the following is not related with menstrual
c. Increased FSH
cycle? [AI 2011]
d. Increased Androgens
a. Hormonal changes b. Vaginal cytology
3. In 40 days of menstrual cycle the ovulation occurs at: c. Estrous cycle d. Endometrial sampling
[UP 03]
a. 14th day b. 20th day Hormones – Estrogen/Progesterone
c. 26th day d. 30th day
4. The ovarian cycle is initiated by: [DNB 96] 13. Naturally occurring estrogens are: [PGI Dec 08]
a. FSH b. Estrogen a. Estrone b. Estradiol
c. LH d. Progesterone c. Estriol d. Diethylstilbestrol
e. Pregnanediol
5. The corpus luteum secretes: [DNB 04]
14. The production of cervical mucus is stimulated by:
a. Estrogens b. Progesterone
[AIIMS Nov 02]
c. Both d. None
a. Progesterone b. Estradiol
6. Apoptosis can occur by change in hormone levels in the c. Estriol d. Pregnenolone
ovarian cycle. When there is no fertilization of the ovum, 15. Ferning of cervical mucus depends on: [DNB 96]
the endometrial cells die because: a. Estrogen b. Progesterone
[AIIMS Nov 03] c. LH d. FSH
a. The involution of corpus luteum causes estradiol 16. In an infertile woman, endometrial biopsy reveals
and progesterone levels to fall dramatically proliferative changes. Which hormone should be
b. LH levels rise after ovulation preferred ? [AI 01]
c. Estradiol levels are not involved in the LH surge a. MDPA b. Desogestrel
phenomenon c. Norethisterone d. None of the above
d. Estradiol inhibits the induction of the progesterone 17. End product of progesterone metabolism found in urine
receptor in the endometrium is: [AIIMS May 2013]
7. Corpus luteum functions maximally without an a. Pregnenolone
implantation for …… days: [PGI June 00] b. 17-OH pregnanelone exerected in urine
a. 9 b. 12 c. Pregnanediol
c. 6 d. 15 d. Pregnanetriol

8. Maximum function of corpus luteum occurs:

Clomiphene
a. At ovulation
b. Before ovulation 18. Clomiphene citrate is: [AP 97]
c. 3 days after ovulation a. Antiandrogen b. Synthetic steroid
d. 8–9 days after ovulation c. Antiestrogen d. GnRH analogue
9. In a study it is observed that the right ovary ovulates 19. Clomiphene citrate is indicated in: [AI 98]
more than the left, all are possible explanations for the a. Stein–Leventhal syndrome
cause except: [AIIMS Nov 2010, AIIMS Nov 2012] b. Ovarian cyst
a. Anatomical asymmetry c. Asherman’s syndrome
b. Difference in blood supply to both sides d. Carcinoma endometrium
34 Self Assessment & Review: Gynecology

20. True about Clomiphene citrate : [PGI June 07] Inhibin/Relaxin

a. Commonly causes hyperstimulation syndrome
b. Used for ovulation induction 29. Following are the features of inhibin except:
c. Multiple pregnancies seen in 3–8% cases [Karnataka 06]
21. True about clomiphene citrate is: a. Non steroidal water soluble protein
[AIIMS May 09/May 10] b. Secreted by Graafian follicle
a. Enclomiphene has antiestrogenic affect c. Stimulates FSH secretion
b. Chance of pregnancy is three fold as compared d. Increased secretion of inhibin occurs in polycystic
to placebo ovarian disease
c. Risk of multiple pregnancy is 2–4% 30. The probable source of relaxin is: [JIPMER 91; DNB 98]
d. It can also be used for male infertility with oligozoo­ a. Ovary b. Adrenal cortex
spermia c. Liver d. Bartholin’s gland
22. Side effect of clomephene citrate includes all except: e. Anterior pituitary
a. Multiple pregnancy [AIIMS Nov 07]
b. Increase risk of ovarian cancer NEW PATTERN QUESTIONS
c. Multiple polycystic ovary
d. Teratogenic effect on off springs 31. All are true regarding folliculogenesis and ovulation
23. A patient treated for infertility with clomiphene citrate except:
presents with sudden onset of abdominal pain and dis- a. Follicular development and differentiation takes
tension with ascites, the probable cause is: about 85 days
a. Uterine repture b. AMH supports monofollicular development
b. Ectopic pregnancy rupture c. First phase of follicular growth is gonadotropin
c. Multifetal pregnancy insensitive
d. Elevated and static level of estradiol is essential for
d. Hyperstimulation syndrome
ovulation.
32. The following are related to granulosa cells except:
GnRH a. It has got no blood supply
24. GnRH analogue may be given in all of the following b. In the first half of the cycle, it has no steroidogenic
function
except: [AI 99]
c. Granulosa cells produce activin and inhibin
a. Prostate Ca
d. Estrogen stimulates the proliferation of granulosa
b. Endometrial Ca
cells
c. Fibromyoma – uterus
d. Precocious puberty 33. The following are related to corpus luteum except:
a. Luteinised granulosa cells produce progesterone
25. GnRH analogues are useful in all except : [AP 97]
b. Estrogen continues to be produced by the luteinised
a. Endometriosis b. Hyperprolactinemia
theca cells
c. Precocious puberty d. Menstrual disturbances c. Luteolysis is due to estrogen, PGF2α and endothelin
d. The peak steroid production is between 23 and 25th
Danazol day
26. Danazol is used in the treatment of: [AIIMS May 02] 34. Granulosa cells produces estrogen with the help of the
a. Cyclical mastalgia enzyme:
b. Breast cyst a. Alkaline phosphatase
c. Noncyclical mastalgia b. Aromatase
d. Epithelial changes in breast c. Acid phosphatase
27. Danazol is used in all except : [JIPMER 91] d. Glucuronidase
a. Hirsutism 35. Peak level of plasma progesterone in the luteal phase:
b. Endometriosis a. 5 ng/ml b. 10 ng/ml
c. Dysfunctional uterine bleeding c. 15 ng/ml d. 30 ng/ml
d. Fibroid 36. The earliest morphological evidence of ovulation on
endometrial biopsy is:
Mifepristone a. Pseudostratification
b. Basal vacuolation
28. Which of the following statements are true about c. Decrease in glycogen content
mifepristone? [PGI Dec 01] d. Predecidual reaction
a. Also called RU – 486
37. The most serious complication of clomiphene therapy
b. It is a 19 – norsteroid
for induction of ovulation is:
c. Acts on receptors a. Bone marrow depression
d. Given only intravenously b. Hyperstimulation syndrome
e. Used for menstrual regulation
 Chapter 2  Reproductive Physiology and Hormones in Females 35

c. Secondary amenorrhea 41. The maturation index on vaginal cytology is a diagnos-

d. Multiple pregnancy tic method for evaluating the:
38. Major sources of androgen in females are all except: a. Adequacy of cytotoxic drag therapy
a. Adrenals b. Gender of an anatomically abnormal child
b. Ovaries c. Malignant change at squamocolumnar junction of
c. Peripheral conversion to androgen precursors in the cervix
liver, gastro-intestinal tract and adipose tissue d. Enocrine status of cervix
d. Corpus luterm 42. Vaginal cytology for hormonal change in best taken from:
39. The side effect of clomiphene because of which its use a. Posterior wall
should be immediately stopped: b. Anterior wall
a. Hotflashes b. Multiple pregnancy c. Lateral wall
c. Terato genecity d. Visual symptoms d. Any wall
40. Vaginal smear in old lady shows: 43. Cornification index or eosinophilic index indicates:
a. Atropic cells on smear a. Progesterone effect
b. Basel and parabasal cells b. Estrogenic effect
c. Superficial cells c. Effect of LH
d. Few intermediate cells seen d. All of the above
 Chapter 3  Menopause and HRT 49

QUESTIONS

1. HRT is helpful in all of the following except: a. Reduces fracture rates

(AIIMS Nov 06, AIIMS May 2013) b. Avoids endometrial hyperplasia
a. Vaginal atrophy c. Reduces the incidence of venous thrombosis
b. Flushing d. No increase in incidence of breast carcinoma
c. Osteoporosis 8. A 48-year-old female suffering from severe
d. Coronary heart disease menorrhagia (DUB) underwent hysterectomy.
2. Hormone replacement therapy (HRT) is indicated She wishes to take hormone replacement therapy.
in: (PGI Nov 2012) Physical examination and breast are normal but
a. Cardiovascular disease X-ray shows osteoporosis. The treatment of choice
b. Osteoporosis is: (AIIMS May 01)
c. Hot flushes a. Progesterone
d. Atrophic vaginitis b. Estrogen and progesterone
3. Estrogen replacement for postmenopausal symp­ c. Estrogen
toms causes an increase in: (AIIMS May 02) d. None
a. LDL b. Cholesterol 9. Basanti devi, 45 years old women presents with hot
c. VLDL d. Triglycerides flushes after stopping of menstruation. ‘Hot Flush’
4. Estrogen administration in a menopausal woman can be relieved by administration of following
increases the: (AIIMS May 06) agents: (AI 02)
a. Gonadotropin secretion a. Ethinyl estradiol
b. LDL – cholesterol b. Testosterone
c. Bone mass c. Fluoxymesteron
d. Muscle mass d. Danazol
5. True regarding postmenopausal osteoporosis is: 10. All of the following appear to decrease hot flushes
(PGI May 00) in menopausal women except: (AI 05)
a. Decreased vitamin D a. Androgens b. Raloxifene
b. Decreased serum calcium c. Isoflavones d. Tibolone
c. Normal serum chemistries 11. Absolute contraindication of hormone replacement
d. Decreased vitamin C therapy is: (AIIMS Dec 98)
e. Amenorrhea a. Thrombosis b. Fibrocystic disease
6. Non-hormonal drug to prevent post menopausal c. Fibroadenoma d. Hemorrhage
osteoporosis is: (Delhi 99)
a. Alendronate b. Estrogen NEW PATTERN QUESTION
c. Raloxifene d. Parathyroid
12. The cut-off point of serum estrogen level for the
7. All of the following are the advantages of using
diagnosis of ovarian failure:
Raloxifene over estrogen in postmenopausal
a. 10 pg/mL b. 20 pg/mL
women except: (AI 04)
c. 30 pg/mL d. 40 pg/mL
58 Self Assessment & Review: Gynecology

FIGURE BASED QUESTION

F1. Figure F1 shows a 22-year female complaining of irregu-
lar cycles, weight gain and discoloration of neck. USG
revealed multiple cysts in both the ovaries. The meta-
bolic abnormalities which need to be ruled out in this
patient are:
a. Hyper insulinism
b. Hyper androgenism
c. Diabetes mellitus
d. Diabetes insipidus Fig. F1

QUESTIONS

1. Which of the following statements is incorrect regarding c. Innumerate cysts in ovary

polycystic ovarian disease? (AI 06) d. BRCA – 1 is associated
a. Elevated LH hormone e. Theca cell hypertrophy
b. Can cause infertility 9. PCOD which of the following is seen: (PGI Dec 02)
c. May be associated with abnormal glucose a. Hirsutism b. Secondary amenorrhoea
tolerance test c. Streak ovaries d. ↑ FSH / LH
d. Results in postdated pregnancy e. ­Oestrogen (E2)
2. The following hormone is raised in polycystic ovarian 10. In Polycystic ovarian diseases, all of the following are
syndrome: (AI 06) seen except: (PGI Dec 01)
a. 17 – OH progesterone a. Endometrial carcinoma
b. Follicular stimulating hormone b. Increased FSH c. Streak ovaries
c. Luteinizing hormone d. Insulin resistance e. Hirsutism
d. Thyroid stimulating hormone 11. All are true about polycystic ovarian disease except:
3. PCOD- Hormonal Status: (PGI Dec 08) a. Persistently elevated LH (AIIMS Nov 08)
a. LH decreased b. Increased LH/FSH ratio
b. LH increased, FSH normal to low c. Increased Dheas d. Increased prolactin
c. FSH increased 12. The first step in the management of hirsutism due to
d. 17 OH progesterone normal Stein-Leventhal syndrome is: (PGI June 99)
e. Testosterone increased a. OCP b. HMG
4. True about PCOD: (PGI June 09) c. Spironolactone d. Bromocriptine
a. ↑ LH & ↓ FSH b. ↑ FSH & ↓ LH 13. Treatment of Hirsutism in PCOD, drugs used are:
c. ↑ LH & ↓ FSH d. Hyperinsulinemia a. Menopausal Gonadotropin (PGI Dec 08)
e. ↑ TSH b. GnRH c. Spironolactone
5. Which of the following is the most likely diagnosis in a d. Hcg
27-year-old obese woman presenting with Oligomenor- 14. A hirsuite lady with PCOD treatment is: (Kolkata 2009)
rhea, infertility and hirsutism? (AI 04) a. Ethinyl estradiol + Levonorgestrel
a. Polycystic ovaries b. Endometriosis b. Ethinyl estradiol + Desogestrel
c. Pelvic inflammatory disease c. Levonorgestrel
d. Turner’s syndrome d. None
6. In PCOD symptoms and signs seen are: (PGI June 07) 15. Most common cause of hirsutism: (AIIMS Dec 97)
a. Amenorrhoea b. Alopecia a. Polycystic ovary disease
c. Theca cell hyperplasia b. Arrhenoblastoma
d. Hyperandrogenism c. Cushing syndrome
e. Anovulation d. Congenital adrenal hyperplasia
7. A 28-year-old lady, Rani, is suspected to have polycystic 16. Most common cause of hirsutism in a teenage girl:
ovarian disease. Sample for testing LH & FSH are best (AIIMS June 97)
taken on the following days of menstrual cycle: (AI 02) a. Ovarian disease b. Pheochromocytoma
a. 1–4 b. 8–10 c. Obesity d. Adrenogenital syndrome
c. 13–15 d. 24–26 17. A 16-year-old girl presents with rapid onset hirsutism
8. True about Stein-Leventhal syndrome is/are: and amenorrhea. Best investigation is: (AIIMS June)
a. Oligomenorrhea and amenorrhea (PGI June 03) a. Testosterone estimation
b. Seen in postmenopausal women b. Dihydroepiandrosterone
 Chapter 4  PCOD, Hirsutism and Galactorrhea 59

c. Adrenocorticoids
d. LH and FSH estimation NEW PATTERN QUESTIONS
18. Kali Rani, a 20-year-old girl presents with history of rap- 25. The biochemical changes in established cases of Stein-
idly developing hirsutism and amenorrhea. To establish Leventhal syndrome are as mentioned except:
the diagnosis you would like to proceed with which of a. Marked elevation of LH in contrast to FSH
the following tests in blood: (AI 02)
b. Insulin resistance
a. 17 – OH progesterone b. DHEA
c. Elevation of plasma testosterone
c. Testosterone d. LH: FSH ratio
d. Elevation in the level of sex hormone binding
19. A 22-year-old woman comes for treatment of hirsutism. globulin (SHBG) level
She is obese and has facial acne and hirsutism on her
26. As regard the PCOS and hyperinsulinaemia:
face. Serum LH level is 36 mIU/mL and FSH is 9 mIU/
a. Hyperinsulinaemia is observed in about 40% to
mL. Androstenedione and testosterone levels are mildly
80% of women with PCOS
elevated, but serum DHEAS is normal. The patient does
b. Hyperinsulinaemia stimulates hepatic synthesis of
not wish to conceive at this time. Which of the following
SHBG
is the most appropriate treatment of her condition?
c. Metformin causes hypoglycaemia in normoglycae-
a. Oral contraceptives pills (All India 2002)
mic women
b. Corticosteroids
c. GnRH analog d. Metformin has many other health benefits
d. Wedge resection of ovary 27. The following are related to bromocriptine therapy except:
20. Persistent anovulation not treated leads to all except: a. It is used to inhibit inappropriate lactation with
a. Hirsutism (PGI June 99) secondary amenorrhoea
b. Ovarian carcinoma b. It is specific in suppressing only the prolactin secretion
c. Endometrial carcinoma c. If pregnancy occurs, there is increased incidence
d. Increased risk of CVS disease of multiple pregnancy
21. A 20-year average weight female presented with d. Its teratogenic effect on the fetus is inconclusive
oligomenorrhea and abnormal facial hair growth along 28. According to Ferriman Gallwey scoring system—her-
with high serum free testosterone level. On USG the sutism is diagnosed when score is more than:
ovaries are normal. The diagnosis: a. 8 b. 12
(AIIMS Nov 2010, AIIMS Nov 2012) c. 16 d. 20
a. Idiopathic hirsutism 29. A 24-year-old comes with a chief complaint of hair
b. PCOD growth all over body. She reports that her menses
c. Testosterone secreting tumor began at the age of 13 years and has always been very
d. Adrenal hyperplasia irregular. She also complains of acne. On physical
22. All of the following are associated with polycystic examination there is hair around the nipples, chin and
ovarian syndrome except: (AI 2010) upper lip. There is no galactorrhea, thyromegaly, or
a. Ovarian carcinoma b. Endometrial carcinoma temporal balding on examination. Pelvic examination is
c. Insulin resistance d. Osteoporosis normal, and there is not evidence of clitoromegaly. All
23. True about PCOS: (PGI May 2010) of the following should be included in the differential
a. High FSH/LH ratio diagnosis based on the patient’s history and physical
b. Unilateral large ovarian cyst examination, except:
c. Hirsutism a. Idiopathic hirsutism
d. Increased risk of diabetes mellitus b. Stein-Leventhal syndrome
e. OCP is given for treatment c. Late-onset congenital adrenal hyperplasia
24. In PCOD, which of the following drugs is not used for d. Sertoli-Leydig cell tumor
infertility? (AIIMS Nov 2013) 30. BMI of an overweight female is:
a. Spironolactone b. Tamoxifen a. 19–24 b. 25–29
c. Clomiphene d. OC pill c. 30–34 d. Less than 19
 Chapter 5  Congenital Malformations 75

FIGURE BASED QUESTIONS

F1. Identify the condition shown in HSG:- F1 shows F3. Identify the condition shown in Figure F3
a. Septate uterus b. Bicornuate uterus a. Ambiguous genitalia b. Bifid clitoric
c. Didelphys uterus d. Unicornuate uterus c. Clitoromegaly
d. Normal genitalia of females

Fig. F1
F2. Hysteroscopic view shown in figure F2: shows Fig. F3
a. Normal uterine cavity
F4. Identify the condition shown in HSG:-F4
b. Asherman syndrome
a. Biconuate uterus b. Normal uterus
c. Septate uterus
c. Arcuate uterus d. Septate uterus
d. Uterus perforation

Fig. F2 Fig. F4

QUESTIONS
1. To diagnose uterus didelphys, procedure of choice is: 8. Transverse vaginal septum corresponds to:
a. Laparoscopy b. IVP [AIIMS 92, Al 95] [PGI Dec 04; June 04]
c. HSG d. USG a. External os b. Vesical neck
2. The most important indication for surgical repair of a c. Bladder base d. Hymen
bicornuate uterus is: [AIIMS Nov. 05] e. Above the external meatus
a. Infertility b. Dysmenorrhoea 9. All of the following are features of mullerian agenesis
c. Menorrhagia d. Habitual abortion except: [PGI Dec 04]
3. Vaginal atresia is associated with: [AIIMS June 98] a. 46 XX karyotype
a. Uterine atresia b. Exstrophy of bladder b. Normal breast development
c. Imperforate hymen d. Ovarian atrophy c. Absent vagina d. Ovarian agenesis
4. Ideal age for repair of vaginal agenesis is: [AIIMS 92] 10. True about MRKH syndrome: [PGI May 2010]
a. 6 months b. 3 years a Absent uterus b. Absent ovary
c. At puberty d. Before marriage c. Absent vagina d. XX phenotype
5. Ovary develop from: [PGI June 02] e. XY phenotype
a. Mullerian duct b. Genital ridge
c. Genital tubercle d. Mesonephric duct 11. Characteristic features of Rokitansky Kuster Hauser
e. Sinovaginal bulbs syndrome are all of the following except: [AI 99; Delhi 05]
a. Absent uterus b. Absent vagina
6. Diagnosis of septate uterus done by: [PGI Dec 04]
c. Anovulation d. 46 – XX
a. USG b. Uterine sound
c. Hysteroscopy d. Hysterosalpingography 12. Rokitansky Kuster Hauser syndrome is associated with:
e. Laparoscopy [AI 01]
7. MC congenital abnormality of uterus is: [PGI Dec 05] a. Ovarian agenesis b. Absent fallopian tube
a. Uterus didelphys b. Arcuate c. Vaginal atresia d. Bicornuate uterus
c. Unicornuate d. Septate 13. In complete mullerian duct aplasia all of the following
e. Bicornuate are likely to be absent except: [AI 07]
76 Self Assessment & Review: Gynecology

a. Ovaries b. Fallopian tubes c. Incomplete septum of uterus

c. Uterus d. Vagina d. Double uterus and double cervix
14. Mayer Rokitansky Kuster Hauser syndrome consists of: 20. SRY gene is located on:
[AIIMS May 09] a. Short arm of Y chromosome
a. Ovaries, uterus fallopian tubes present b. Long arm of Y chromosome
b. Uterus absent, fallopian tube ovaries present c. Short arm of X chromosome
c. All absent d. Long arm of X chromosome
d. Uterus present tubes and ovaries absent 21. All of the following structures are homologous except:
15. Which of the following condition does not present with a. Labia majora and scrotum
both mullerian and wolffian duct structures? b. Labia minora and penile urethra
a. Antimullerian hormone deficiency [AI 2010] c. Epoophoron and caudal end of wolffian duct
b. FSH receptor mutation d. Clitoris and glans penis
c. Ovotesticular syndrome 22. All are derivatives of paramesonephric duct except:
d. Mixed gonadal dysgenesis a. Appendix of testis b. Hydatid of morgagni
16. Vaginal epithelium is derived from: (AIIMS May, Nov 2013) c. Uterus d. Gartner’s duct
a. Endoderm of urogenital sinus 23. Diethylstilbesterol causes the following defects except:
b. Mesoderm of urogenital sinus a. Renal anomalies b. Perifimbrial cysts
c. Endoderm of genital ridge c. T shaped uterus d. Vaginal adenosis
d. Mesoderm of genital ridge 24. Gartner’s cyst can be differentiated from cystocele by
17. Complete failure of mullerian duct fusion will result in: all except:
[AI 02; UP 04] a. Not reducible b. No impulse on coughing
a. Uterus didelphys b. Arcuate uterus c. Presence of rugosities of overlying vaginal mucosa
c. Subseptate uterus d. Bicornuate uterus d. None of above
18. Bicornuate uterus is due to: [PGI Dec. 98] 25. All of the following take part in male genital tract deve­
a. Incomplete fusion of uterine cavity lopment except:
b. Incomplete fusion of paramesonephric duct a. SRY b. SOX-9
c. Incomplete fusion of mesonephric duct c. FGF-9 d. WNT-4
d. Incomplete formation of vagina 26. M/C uterine malformation associated with renal anom-
alies:
NEW PATTERN QUESTIONS a. Bicornuate b. Unicornuate
c. Septate d. Didelphys
19. Unicollis bicornis means: 27. M/C uterine malformation associated with infertility:
a. Two uterine cavity with one cervix a. Bicornuate b. Unicornuate
b. Single vagina with double uterus c. Septate d. Didelphys
90 Self Assessment & Review: Gynecology

QUESTIONS
1. The sequence of development of puberty in girls is: 10. During sexual differentiation in males: (Karnataka 05)
a. Thelarche, Pubarche, Menarche (AI 00) a. Leydig cells produce Mullerian Inhibiting Substance
b. Pubarche, Thelarche, Menarche b. Primitive Gonads differentiate into testis due to the
c. Pubarche, Menarche, Thelarche presence of SRY gene
d. Menarche, Thelarche, Pubarche c. Androgen binding protein is responsible for the
2. The first sign of puberty in girls is: (AI 08) development of male external Genitalia
a. Breast budding b. Peak height velocity d. Wolffian duct regresses
c. Menarche 11. Most common cause of ambigious genitalia in a female
d. Pubic and axillary hair growth child is: (AI 2011)
3. Which of the following pubertal events in girls is not a. Placenta steroid sulfatase deficiency
estrogen dependant? b. Fetal aromatase deficiency
a. Menstruation c. Wnt4 mutation
d. Congenital adrenal hyperplasia
b. Vaginal cornification
c. Height spurt 12. Most common cause of female pseudoherma-phrodit-
d. Hair growth ism is: (AI 02)
a. Virlizing ovarian tumor
4. Which of the following Is responsible for pubertal
b. Ovarian dysgenesis
growth in females? (AIIMS May 2014)
c. Exogenous androgen
a. Decreased level of adrenal androgens at puberty
d. Congenital adrenal hyperplasia
b. High level of estrogen at puberty
c. Pulsatile release of GnRH during sleep 13. Female pseudohermaphroditism true is: (PGI Dec 04)
d. Increased sensitivity of HPO axis to estrogen a. 46XX chromosomal pattern
b. Absent ovary
5. One of the following forms the basis for sex chromatin
c. Absent uterus
testing: (AIIMS May 2014)
d. Presence of testis
a. Barr body
e. Clitoromegaly
b. Testosterone receptors
14. The treatment for a case of virilizing adrenal hyperplasia
c. Hormone levels
is: (AI 06)
d. Phenotypic features
a. Estrogens
6. A 9-year-old girl presents with menarche. History re- b. Antiandrogens
veals thelarche at the age of 7 years and adrenarche at c. ACTh
the age of 8 years- the M/C cause of this condition in d. Cortisone
girls is:
15. Best prenatal treatment for CAH is: (AIIMS Nov 2011)
a. Idiopathic
a. Dexamethasone b. Betamethasone
b. Gonadal tumor
c. Prednisolone d. Hydrocortisone
c. Mc cure albright syndrome
16. A newborn with 46XX has external genitalia of male. All
d. Hypothyroidism
the following are the possible causes except:
7. Medication used in treatment of idiopathic central pre-
a. Placental aromatase deficiency
colcious puberty is: b. Maternal androgen adrenal tumor
a. Exogenous gonadotrophins c. Anti mullerian hormone deficiency
b. Ethinyl estradiol c. GnRH analogues d. Wnt 4 mutation
d. Ethinyl estradiol
17. C/F of Turner’s syndrome: (PGI Dec 06, 09)
8. Gynaecomastia is seen in: (PGI June 07, Dec. 02) a. Secondary amenorrhea
a. Secondary syphilis b. Edema of hands and feet
b. Lepromatous leprosy c. XO genotype
c. HIV d. Mental retardation common
d. Klinefelter’s syndrome e. Streak ovaries
9. Gynaecomastia is seen in all of the following conditions 18. All are features of Turner’s syndrome except:
except: (AI 2012) a. Karyotype is 46 XO (PGI May 2013)
a. Prolactinoma b. Normal breast
b. TSH secreting adenoma c. Underdeveloped uterus
c. HCG secreting tumor d. Normal secondary sexual characters
d. estrogen secreting tumor e. Primary amenorrhoea
 Chapter 6  Sexuality and Intersexuality 91

19. A girl presents with primary amenorrhea, short stature, d. Ovaries are absent
widely spaced nipple. Karyotype of the girl would be: 29. 16-year-old female presents with primary amenorrhoea
(AIIMS May 2013) with B/L inguinal hernia. She has normal sexual devel-
a. 45 XO b. 46 XXY opment with no pubic hair. USG shows no uterus and
c. 46 xy d. 46 xx ovaries and a blind vagina. Diagnosis is: (AIIMS May 07)
20. A 16-year-old girl with it 58 inches present with prima- a. Turner’s syndrome
ry amenorrhea and rising FSH. The histological finding b. Mullerian agenesis
most consistent with her conditions is: (AIIMS Nov 2013) c. STAR syndrome
a. Low oocyte in ovary d. Androgen insensitivity syndrome
b. Corpus luteum hemorrhage 30. Among the following which is a feature of testicular
c. Marfan syndrome feminization syndrome: (PGI June 99)
d. Pituitary appolexy a. XX pattern
21. A 17-year-old girl with amenorrhea, atrophied breast, b. Commonly reared as male
hypoplastic uterus: (AIIMS Nov 09) c. Well formed female internal genitalia
a. Turner’s syndrome b. Gonadal dysgenesis d. High testosterone levels
c. Androgen insensitivity syndrome 31. In Testicular Feminization syndrome Gonadectomy is
d. Klinefelter’s syndrome indicated: (UPSC 04)
22. A 15-year-old female presents with primary amenor- a. As soon as it is diagnosed.
rhea. Her breasts are Tanner 4 but she has no axillary or b. At puberty
pubic hair. The most likely diagnosis is: (AI 06) c. Only when malignancy develops in it
a. Turner’s syndrome d. When hirsutism is evident
b. Mullerian agenesis
32. Pure gonadal dysgenesis will be diagnosed in the pres-
c. Testicular feminization syndrome
ence of: (AI 03)
d. Premature ovarian failure
a. Bilateral streak gonads
23. Androgen insensitivity syndrome true is: b. Bilateral dysgenetic gonads
(AIIMS May 08) c. One side steak and other dysgenetic gonads
a. Phenotype may be completely female d. One side streak and other normal looking gonad
b. Predominantly ovarian component in gonads
33. A 16-year-old female presents with Primary Amenor-
c. Always in female
d. Testes formed abnormlly and receptors are normal rhea. Examination shows a Short Blind Vagina, with ab-
sent Uterus. The Next Investigation of choice is: (AI 00)
24. Which of the following statement is/are true regarding
a. Karyotyping b. IVP
androgen insensitivity syndrome? (PGI Nov 2012)
c. Gonadotrophin levels d. Serum Prolactin
a. Absent vagina b. Karyotype is XX
c. Karyotype is XY 34. True about klinefelter syndrome: (PGI May 2010)
d. Pubic hair is normlly present a. XXY b. XO
e. Breast development is normal c. Male hypogonadism d. Female hypogonadism
25. Regarding androgen insensitivity syndrome, which e.­ FSH
statement is/are true: (PGI May 2013) 35. A patient of 47 XXY karyotype presents with features of
a. Genotype is 46 XX b. Scanty pubic hair hypogonadism; likely diagnosis is: (AI 01)
c. Well developed female external genitalia a. Turners syndrome
d. Uterus absent b. Klinefelters syndrome
e. Breast development is adequate c. Edwards syndrome
26. All are seen in testicular feminization syndrome except: d. Down syndrome
(PGI June 99) 36. A girl has primary amenorrhea with normal ovaries, ab-
a. 46XY b. Primary amenorrhea sent internal genitalia but normal external genitalia. Most
c. Short stature d. Vagina may be present probable diagnosis?: (AI 10)
27. A girl presents with; primary amenorrhea; grade V a. Mayer-Rokitansky-Kuster-Hauser syndrome
thelarche, grade II pubarche; no axillary hair; likely di- b. Turner’s syndrome
agnosis is: (AI 01) c. Noonan’s
a. Testicular feminisation syndrome d. Androgen insensitivity syndrome
b. Mullerian agenesis 37. A 19-year-old patient came with C/o primary amenor-
c. Turners syndrome rhea. she had well developed breasts and pubic hair.
d. Gonadal dysgenesis However there was absence of vagina and uterus. Likely
28. All of the following statements about Androgen Insensi- diagnosis is: (AIIMS May 2013)
tivity Syndrome are true except: (AI 08) a. Turners syndrome
a. Patients have an XY genotype b. Mullerian agenesis
b. Pubic hair are abundant c. Kinefelter’s syndrome–XXY
c. Short vagina may be present d. Gonadal agenesis
92 Self Assessment & Review: Gynecology

38. Young male presents with delayed puberty with de-

42. Exposure of a female fetus to androgen in early embry-
creased FSH, LH, and testosterone. Which of the follow-
ogenesis may arrest differenitation of:
ing is NOT possible? (AI 2012)
a. Mullerian ducts b. Ovary
a. Kallmann syndrome b. Klinefelter’s sydnrome
c. Urogenital sinus d. Mesonephric ducts
c. Constitutional delay d. Dax-1 gene mutation
43. Destruction of ovaries prior to 7th week following ferti-
39. In which of the following conditions do the ovaries func-
lization results in:
tions normally? (AIIMS Nov 2011)
a. Pseudohermaphroditism
a. Turner’s syndrome
b. Uterine agenesis
b. Rokitansky-Kuster-Hauser syndrome
c. Masculinisation
c. Androgen insensitivity syndrome
d. None of the above
d. Swyer’s syndrome
44. In testicular feminisation syndrome:
40. A girl with normal stature and minimal or absent puber-
a. Buccal smear is chromatin positive
tal development is seen in: (AIIMS Nov 2014)
b. Normal breast size is observed
a. Kallmann syndrome
c. Menstruation is scanty and infrequent
b. Turner syndrome
d. Familial incidence is recognised
c. Testicular feminization syndrome
45. Precocious puberty may be seen in all of the following
d. Pure gonadal dysgenesis
conditions except:
a. Granulosa – cell tumour
NEW PATTERN QUESTIONS b. Head – injury
c. Corticosteroid intake
41. Normal size but non functioning uterus is usually d. Hyperthyroidism
associated with: 46. Precocious puberty associated with bony dysplasia and
a. Stenosis of the external os café au lait spots in skin is seen in:
b. Uterine synechiae a. Frohlichs syndrome b. Alports syndrome
c. Partial agenesis of the vagina c. McCune-Albright syndrome
d. Complete absence of vagina d. Laurence-Moon-Biedl syndrome
112 Self Assessment & Review: Gynecology

FIGURE BASED QUESTIONS

F1. Figure 6 shows phthirus pubis. The pathogen was F2. Identify the lesion in the figure. All of the following
seen in pubic hair of a pregnant female complaining of drugs can be used in this condition except:
genital itching. a. Imiquimod
DOC for pubic lice in pregnant females is: b. Podophyllin
a. Premetharin cream 1% c. Methotrexate
b. Malathion 0.5% d. Trichlorocetic acid
c. Overnectin
d. Petroleum jelly

Fig. F1 Fig. F2

QUESTIONS
1. Which of the following is not sexually transmitted? The diagnosis of bacterial vaginosis was made based
a. Echinococcus (AIIMS June 00) upon all of the following findings on microscopy except:
b. Candida (AIIMS 06)
c. Molluscum contagiosum a. Abundance of gram variable coccobacilli
d. Group B. Streptococcus b. Absence of lactobacilli
2. A patient with discharge per vagina was evaluated c. Abundance of polymorphs
and on endocervical biopsy Chlamydia was found. d. Present of clue cells
Treatment to be given in this case is: (AIIMS June 00) 7. In hysterosalpingography, fallopian tubes are seen
a. Azithromycin and contact tracing beaded in appearance with clubbing of fimbrial end and
b. Metronidazole only ampulla. Most likely cause is:
c. Doxycycline and metronidazole (AIIMS June 00)
d. Azithromycin a. Tuberculosis
3. Strawberry vagina is seen in: (AIIMS June 98) b. Candidiasis
a. Candida albicans c. Chlamydia
b. H. vaginalis d. Gonococcus
c. Syphilis 8. A lady approaches a physician for contraceptive advice.
d. Trichomonas vaginalis On examination, there were two symmetrical ulcers on
4. All are risk factors for vaginal candidiasis except: vulva, which were well-defined with firm base. Which
(AIIMS Nov 10) of the following is the most likely cause?
a. HIV (AIIMS Nov 00)
b. Hypertension a. Chancre b. Herpes
c. Pregnancy c. Syphilis d. Malignancy
d. Diabetes mellitus 9. A 25-year-old female with history of multiple contacts
5. Clue cells are seen in: (AIIMS May 08) presenting with growth on vulva, the probable diagnosis
a. Bacterial vaginosis b. Candidasis is: (AIIMS June 98)
c. Trichomoniasis d. Gonorrhoea a. Condyloma accuminata
6. A 40-year-old woman presented to the gynecologist with b. Verruca plana
complaints of profuse vaginal discharge. There was no c. Verruca vulgaris
discharge from the cervix on the speculum examination. d. Condyloma lata
 Chapter 7  Infections of the Genital Tract 113

10. A young lady presents to your office with complain 19. True about bacterial vaginosis: (PGI June 05)
of copious vaginal discharge, but there is no cervical a. Itching
discharge on per speculum examination. Which of the b. Gray discharge
following should be given for the management? c. Clue cells found
a. Metronidazole and fluconazole (AIIMS Nov 2012) d. Fishy odor discharge
b. Metronidazole and azithromycin e. Caused by Gardnerella vaginalis
c. Metronidazole and doxycycline 20. True about bacterial vaginosis: (PGI Dec 04)
d. Fluconazole only a. Intense pruritis
11. Cervicitis is caused by: (PGI June 03) b. Gray and white discharge
a. Pseudomonus c. Associated with vaginal pH
b. Staphylococcus d. Commonly associated with intensive mucosal
c. Chlamydia inflammation
d. Trichomonas e. Oral metronidazole is the drug of choice
e. N. gonorrhoea 21. Not true about bacterial vaginosis: (PGI Nov 2012)
12. Minimum criteria to diagnose PID include(s): a. Clue cells present
a. Lower abdominal pain (PGI May 2013) b. With KOH gives amine smell
b. Fever c. pH < 4.5
c. Cervical motion tenderness d. Yellow green discharge
d. Adnexal tenderness e. Whiff test postive
e. Leucocytosis 22. In a patient with pelvic inflammatory disease due to
13. Acute PID is treated by: (PGI June 03) tuberculosis, which of the following statements is true?
a. IV antibiotics (broad spectrum) (PGI Dec 01)
b. Drainage of TO mass a. Mycobacterium can be grown from menstrual
c. Abdominal hysterectomy blood
d. Laparoscopic exploration b. Associated with infertility
c. Ectopic pregnancy is common
14. Nongonococcal urethritis is caused by: (PGI Dec 99)
d. Dysmenorrhea is a common presentation
a. Chlamydia
23. All are clinical features of PID except:
b. LGV
a. Temp>38°C
c. Syphilis
b. WBC count of 15,000
d. Gardnerella vaginalis
c. ESR – 10 mm/hour
15. Gonorrhoea—which is not a presenting feature? d. Tenderness on movement of cervix
a. Discharge (PGI Dec 08)
24. During laparoscopy, the preferred site for obtaining
b. Acute febrile episodes
cultures in a patient with acute PID is:
c. Hematuria
a. Endocervix
d. Reddened lips of vulva and vagina
b. Endometrium
16. Which of the following statements about clinical features c. Pouch of Douglas
in a female suffering from Gonorrhoea is correct? d. Fallopian tubes
a. 50% patients are asymptomatic
25. Asymptomatic carriage of gonococcal infection in
b. Excessive vaginal discharge is seen female is commonly seen in: (AI 97)
c. Vaginal discharge is purulent a. Endocervix b. Vagina
d. Features of perihepatitis present c. Urethra d. Fornix
e. All of the above statements are correct
26. Gonococcal vaginitis occurs in: (TN 2007)
17. True about Trichomonas vaginalis: (PGI June 05) a. Adults b. Children
a. Flagellated parasite c. Infants d. Adolescents
b. Fungal infection
27. Which of the following cannot be detected by wet film?
c. Curdy white discharge
(Delhi 08)
d. Pruritus
a. Candida b. Trichomonas
e. Sexually transmitted disease
c. Chlamydia d. Bacterial vaginosis
18. Trichomonas—which of the following true is?
28. The most sensitive method for detecting cervical
a. Foul smelling vaginal discharge (PGI June 08) chlamydia trachomatis infection is: (AI 04)
b. Vaginal pH is 4 a. Direct fluorescent antibody test
c. Strawberry vagina b. Enzyme immunoassay
d. Infertility c. Polymerase chain reaction
e. Abortion d. Culture on irradiated McConkey cells
114 Self Assessment & Review: Gynecology

29. 45-year-old female complains of lower abdominal NEW PATTERN QUESTIONS

pain and vaginal discharge. On examination, there is
cervicitis along with a mucopurulent cervical discharge. 39. Which of the following is true with regards to genital
The Gram smear of the discharge shows presence of tuberculosis?
abundant pus cells, but no bacteria. The best approach a. Ovarian involvement can occur without tubal
to isolate the possible causative agent would be: (AI 05) affection
a. Culture on chocholate agar supplemented with b. Infertility is mainly due to anovulation
hemin c. Acid fast bacilli is identified in 100% cases of
b. Culture on McCoy cells tubercular endometritis
c. Culture on a bilayer human blood agar
d. A negative Mantoux test reasonably excludes
d. Culture on Vero cell lines
tuberculosis
30. Drug of choice for Chlamydia in pregnancy: (AI 10)
40. The following statements are related to tubercular
a. Doxycycline
b. Tetracycline salpingitis except:
c. Erythromycin a. The abdominal ostium may be patent with eversion
d. Penicillin of fimbriae
31. A woman presents with a thick curdy-white vaginal b. The early lesion may be confused with adenocarci-
discharge. The best treatment for her is: noma on histology
(AI 00) c. Genital tuberculosis is always secondary and the
a. Miconazole b. Metronidazole tubes are invariably the primary sites
c. Nystatin d. Doxycycline d. Salpingitis isthmica nodosa is the exclusive
32. Creamy fishy odor is caused by: (AI 09) pathology to tuberculosis
a. Trichomonas b. Gardnerella 41. True statement about female genital tuberculosis:
c. Candida d. Chlamydia a. Genital tract involvement results from lymphatic
33. A lady presented with creamy white vaginal discharge spread
with fishy odor, drug of choice is: (AIIMS May 09) b. Premenstrual histopathological examination is
a. Doxycycline diagnostic
b. Ofloxacine c. Polymerase chain reaction (PCR) techniques have
c. Metronidazole got higher sensitivity in detection
d. Clindamycin d. Reproductive outcome following antituberculous
34. Most common site for genital tuberculosis is: (AI 98) chemotherapy is satisfactory
a. Ovary b. Uterus 42. The risk factors of acute pelvic inflammatory disease
c. Cervix d. Fallopian tube (PID) are the following except:
35. Most common route of transmission of endometrial a. Menstruating teenagers who have multiple sex
tuberculosis is: (AIIMS June 98) partners
a. Direct local spread b. IUD users
b. Lymphatic spread c. Women with monogamous partner who had
c. Retrograde spread vasectomy
d. Hematogenous d. Previous history of acute PID
36. The most common cause of tubal block in India is: 43. The following are the primary sites of acute gonococcal
a. Gonorrhoea infection  (AI 06) infection except:
b. Chlamydia infection a. Urethra
c. Tuberculosis b. Bartholin’s gland
d. Bacterial vaginosis c. Skene’s gland (paraurethral glands)
37. Salpingitis/Endosalpingitis is best confirmed by: d. Ectocervix
a. Hysteroscopy and laparoscopy (AI 08) 44. Ulceration of the vulva is commonly seen in all except:
b. X-ray a. Bacterial vaginosis
c. Hysterosalpingography b. Syphilis
d. Sonosalpingography c. Chancroid
38. A 19-year-old girl with painless ulcer in labia majora d. Behçet’s disease
with everted margins: (AIIMS May 2013) 45. Regarding bacterial vaginosis, all are true except:
a. Treponema pallidum a. Homogeneous vaginal discharge with pH 5.0 to 6.0
b. Chalmydia b. Positive KOH — With fishy odour
c. Gonorrhoea c. Positive clue cells in 100% of cases
d. Herpes genital ulcer disease d. It is due to Gardnerella vaginalis
136 Self Assessment & Review: Gynecology

FIGURE BASED QUESTIONS

F1. The instrument used in figure F1 is used to measure:
a. Urethrovesical angle
b. Angle of arteflexion
c. Angle of Anteversion
d. Angle of vagina with horizontal

Fig. F2
F3. The pessary shown in Figure F3 is used for:
a. Prolapse of uterus b. Stress urinary incontinence
c. Retroversion of uterus d. Inversion of uterus

Fig. F1
F2. The instrument shown in figure F2 is used for:
a. Kegel’s exercise
b. Retroversion
c. Prolapse
d. Measuring rectal pressure
Fig. F3

QUESTIONS
1. A 30 years old multipara has uterine prolapse, the 6. Kamla, a 48-years-old lady underwent hysterec-tomy.
management of choice is: (AIIMS Nov 99) On the seventh day, she developed fever, burning
a. Fothergill’s repair micturation and continuous urinary dribbling. She can
b. Fothergill’s repair with tubal ligation also pass urine voluntarily. The diagnosis is:
c. Sling operation (AIIMS May 01)
d. Vaginal hysterectomy a. Vesico vaginal fistula
b. Urge incontinence
2. A 28-year-old female P3, has IInd degree of utero- c. Stress incontinence d. Uretero-vaginal fistula
vaginal prolapse. The management of choice is:
7. Post partum VVF is best repaired after: (AIIMS 87)
a. Fothergill’s repair (AIIMS Dec 97) a. 6 weeks b. 8 weeks
b. Wertheim’s hysterectomy c. 3 months d. 6 months
c. Perineal exercises x 3 month 8. Ureter is identified at operation by: (AIIMS 96)
d. Vaginal hysterectomy with vault repair a. Rich arterial plexus
3. A lady with prolapsed uterus after Fothergill’s repair b. Peristaltic movement
will complain of following except: (AIIMS Nov 00) c. Relation to lumber plexus
a. First trimester abortion d. Accompanied by renal vein
b. Cervical dystocia 9. Version I
c. Premature labour Most important structure preventing uterine prolapse
d. Premature rupture of membrane is: (PGI 88)
a. Round ligament b. Broad ligament
4. Fourteen weeks pregnancy with third degree prolapse.
c. Cardinal ligament d. Uterosacral ligament
Best management will be: (AIIMS Dec 98)
Version II
a. Sling surgery b. Foot end elevation
All of the following are classified as primary supports of
c. Ring Pessary d. No treatment uterus except:
5. Most common cause of vesicovaginal fistula in India is: a. Transcervical ligament
(AIIMS Nov 02) b. Pubocervical ligament
a. Gynae surgery b. Irradiation c. Uterosacral ligament
c. Obstructed labour d. Trauma d. Broad ligament
 Chapter 8 Urogynecology 137

10. Cause of decubitus ulcer in uterine prolapse is: c. Shirodkar’s abdominal sling
(PGI Dec 99) d. Fothergill’s operation
a. Friction b. Venous congestion 20. Shirodkar sling operation may be associated with all
c. Intercourse d. Trauma complications except:
11. Indication of Manchester operation in prolapse: a. Enterocele
a. Nulliparous (PGI Dec 03) b. Subacute intesteral abstructions
b. Women of < 35 years age c. Clreteral injury
c. Patient who wants child bearing function d. Parasthesia over inner aspect.
d. Congenital elongation of cervix 21. Version 1
12. Most common site of obstetric injury leading to uretero Kegel’s exercise should begin:
vaginal fistula: (PGI 96) a. immediately after delivery
a. Infundibulo pelvic ligament b. 24 hrs after delivery
b. Vaginal vault c. 3 weeks after delivery
c. Ureteric tunnel d. 6 weeks after delivery
d. Below cardinal ligament where uterine artery Version 2
crosses Kegel’s exercise should begin:
13. Treatment of genuine stress incontinence: (PGI Dec 04) a. immediately after delivery
a. Anterior colporrhaphy b. 3 weeks after delivery
b. Posterior colporrhaphy c. Only after LSCS
c. Colposuspension d. During third trimester of pregnancy
d. Pelvic floor exercise 22. A 65-year-old P3+0 female complains of procidentia.
e. Sling operation She has past history sugnificant of MI and is diabetic
14. Cause(s) of retention of urine in reproductive age and hypertensive. Ideal management of prolapse in the
group: (PGI Dec 00) patient is:
a. Cervical fibroid a. Cervicopexy b. Vaginal hysterectomy
b. Retroverted gravid uterus c. Wait and watch d. Le forts repair
c. Unilateral hydronephrosis 23. Best management of vault prolapse is:
d. Severe UTI a. Sacral colpopexy
e. Posterior urethral valve b. Sacrospinous ligament fixation
15. Which is true regarding retroverted uterus: (PGI Dec 01) c. Le forts repair
a. May present congenitally d. Anterior colporapphy
b. Associated with endometriosis 24. The most appropriate method for collecting urine for
c. It is a cause of infertility culture in case of vesicovaginal fistula is: (AI 04)
d. Causes menorrhagia a. Suprapubic needle aspiration
e. Associated with PID b. Midstream clean catch
16. Most common genital prolapse is: (AI 02) c. Foley’s catheterisation d. Sterile speculum
a. Cystocoele b. Procidentia 25. Most useful investigation for VVF is: (AI 10)
c. Rectocoele d. Enterocoele a. Three swab test b. Cystoscopy
17. Birth trauma is a risk factor for: (MAHE 07) c. Urine culture d. IVP
a. Prolapse uterus b. Endometriosis 26. Chassar Moir technique is used in: (AMU 05)
c. PID d. Abortions a. VVF b. Stress incontinence
18. Which of the following is true: (Delhi 98) c. Urethrocoele d. Enterocoele
a. Pregnancy with prolapse : Pessary treatment 27. In a case of incontinence of urine, dye filled into the
b. Uterine prolapse in a nulliparous: Shirodkar urinary bladder does not stain the pad in the vagina, yet
sling operation the pad is soaked with clear urine. Most likely diagnosis
c. Prolapsed pouch of Douglas: Posterior is: (UPSC 00)
colpoperineorrhaphy a. VVF
d. All of the above b. Uretero – vaginal fistula
19. A young nulliparous woman has 3rd degree uterovaginal c. Urinary stress incontinence
prolapse without any cystocele or rectocele. There is no d. Urethero – vaginal fistula
stress incontinence. Uterocervical length is 3 inches. All 28. A case of obstructed labor which was delivered by
other symptoms are normal. The best treatment plan for Cesarean section complains of cyclical passage of
her will be: (UPSC 00) menstrual blood in urine. Which is the most likely site
a. Observation and reassurance till child bearing of fistula: (AI 04)
is over a. Uretherovaginal b. Vesico-vaginal
b. Shirodkar’s vaginal repair c. Vesico-uterine d. Uretero-uterine
138 Self Assessment & Review: Gynecology

29. Multipara With LSCS, Presents With Cyclical Hematuria,

Diagnosis can be: (PGI Dec 08) NEW PATTERN QUESTIONS
a. VVF b. UVF
c. Bladder Endometriosis d. Ca. Cervix 38. Childbirth trauma leading to urine incontinence is seen
least in females with:
30. Patient of rectovaginal fistula should be initially treated
a. Android pelvis b. Anthropoid pelvis
with: (AI 05)
c. Gyncoid pelvis d. Platypelloid pelvis
a. Colostomy b. Primary repair
c. Colporrhaphy d. Anterior resection 39. Ureterovaginal fistula should best be treated by:
a. Ureteroneocystostomy
31. The recommended non surgical treatment of stress
b. End-to-end anastomosis through an
incontinence is: (AI 09)
ureteric catheter
a. Pelvic Floor Muscle Exercises
c. Implantation into colon
b. Bladder Training
d. Ileal conduit
c. Electrical stimulation
d. Vaginal cone/weights 40. Accidental injury of the ureter during abdominal
operation should be managed by all except:
32. Kelly’s plication operation is done in: (PGI June 05)
a. Deligation
a. Stress incontinence b. Vault prolapse
b. End-to-end anastomosis through an ureteric catheter
c. Rectal prolapse d. Uterine prolapse
c. Implantation into the bladder
e. Cervical incontinence
d. Colonic implantation
33. Bonney’s test demonstrates:
41. In anterior colporrhaphy, the best method of suture
a. Stress urinary incontinence
apposing the vaginal flaps is:
b. Urge incontinence
a. Interrupted b. Continuous
c. Overflow
c. Interlocking d. Interrupted mattress
d. All of the above
42. Regarding the sling procedure for Urodynamic Stress
34. Version I
Incontinence (USI):
Which of the following surgeries for stress incontinence
a. Tension-free vaginal tape (TVT) elevates the bladder
has highest success rate: (AI 2011)
neck to a retropubic position
a. Bursch colposuspension
b. TVT is an autologous sling material
b. Pereyra sling
c. Intrinsic sphincter deficiency is an indication
c. Kelly’s stitch
d. Success rate of TVT is low than other retropubic
d. Tension free vaginal tape (TVT)
procedures
Version II
43. Complications of sling procedures (TVT) for USI are all
Among the surgeries to correct SUI, the long-term
except:
success rate is maximum with: (AI 2002, 2011)
a. Injury to bladder and wound haematoma
a. Burch’s colposuspension
b. Sling erosion particularly with polytetrafluoroethyl-
b. Stamey’s repair
ene (Goretex)
c. Kelly’s stitch
c. Overactive bladder in about 7% cases
d. Aldridge surgery
d. Obturator nerve injury is about 10%
35. Site of placement of tension free vaginal tapes in stress
44. Urinary symptoms of procidentia:
urinary incontinence: (PGI May 2013)
a. Frequency of micturition
a. At ureterovaginal junction
b. Retention of urine
b. At urethrovaginal junction
c. Stress incontinence
c. At upper part of urethra
d. All of the above
d. At middle part of urethra
e. At lower part of urethra 45. Enterocele formation is a common complication of:
a. Suburethral sling surgery
36. The disadvantage of Marshall marchetti Krantz
b. TVT
procedure compared with other surgical alternatives for
c. Bursch colposuspension
treatment of stress urinary incontinence includes?
d. TOT
a. Urinary retention
b. Increased incidence of urinary tract infections 46. Baldy webster operation is done in case of:
c. High failure rate In case of:
d. Osteitis pubis a. Congenital prolapse
37. A woman treated for infertility, presents with 6 week b. Retroversion of uterus
amenorrhea with urinary retention. The most likely c. Inversion of uterus
etiology is: (AI 00) d. Prolapse in females < 40 yrs of age.
a. Retroverted uterus 47. In Baden Walker Halfway system of classification of
b. Pelvic hematocoele prolapse, the reference point is:
c. Impacted Cervical Fibroid a. Hymen b. Introitus
d. Carcinoma Cervix c. Internal os d. External os
 Chapter 9 Infertility 161

QUESTIONS

General Infertility a. 12 – 14 days b. 17 – 19 days

c. 20 – 22 days d. 3 – 5 days
1. In the perspective of the busy life schedule in the 10. Fern test is due to: (SGPGI 05)
modern society, the accepted minimum period of sexual a. Presence of NaCl under progesterone effect
cohabitation resulting in no offspring for a couple to be b. Presence of NaCl under estrogenic effect
declared infertile is: (AIIMS May 05) c. LH/FSH
a. One year b. One and a half - year d. Mucus secretion by Glands
c. Two years d. Three years 11. Drugs used for ovulation induction are:
2. Infertility is seen in: (PGI Dec 02) (PGI Nov 10)
a. Fibroid uterus b. Endometriosis a. Gn RH b. Clomiphene citrate
c. Adenomyosis d. PID c. Gonadotropins d. Letrozole
e. Danazol
3. Common causes of infertility are: (PGI Dec 00)
12. Antihormonal substance used to induce ovulation:
a. Chlamydia b. Gonorrhea
(AI 07)
c. Mycoplasma d. Pneumococcus
a. Mifepristone b. Clomiphene citrate
4. Best prognosis in infertile women is seen in/most c. Tamoxifen d. Raloxifen
reversible form of infertility is: (PGI June 98, Dec 97)
13. A patient treated for infertility with clomiphence citrate
a. Tubal block b. Anovulation presents with sudden onset of abdominal pain and
c. Oligospermia d. Endometritis distension with ascites, the probable cause is
5. TB endometritis causes infertility by: (PGI Dec 98) (AIIMS May 01)
a. Causing anovulation a. Uterine rupture
b. Destroying endometrium b. Ectopic pregnancy rupture
c. Tubal blockage c. Multifetal pregnancy
d. Ciliary dysmotility d. Hyperstimulation syndrome

6. Kamla, a 30 yrs old lady examined for infertility by

hysterosalpingography, reveals ‘Bead – like’ fallopian Female Infertility: Tubal Cause
tube and clubbing of ampulla. Most likely cause is:
14. Fallopian tube dysmotility is seen: (AIIMS Nov 09, 08)
(AI 02)
a. Noonan syndrome
a. Gonococcus b. Mycoplasma
b. Turner syndrome
c. Chlamydia c. Kartagener syndrome
d. Mycobacterium tuberculosis d. Marfan syndrome
7. The risk of Asherman syndrome is the highest if 15. Best Investigation to assess tubal patency: (TN 95)
Dilatation and Curettage (D and C) is done for the a. Rubin’s test
following condition: (AIIMS May 06) b. HSG
a. Medical termination of pregnancy c. Laparotomy
b. Missed abortion d. Laparoscopic chromotubation
c. Dysfunctional uterine bleeding 16. Fallopian tube patency is checked by:
d. Postpartum haemorrhage (PGI Dec 02)
8. What is the cause for luteal phase defect? a. Hysterosalpingography
b. Laparoscopy
(PGI Dec 05)
c. Hysteroscopy
a. Progesterone is inadequately secreted
d. USG
b. Excess estrogen is secreted
e. CT scan
c. Excess progesterone is secreted
17. Lady with infertility with bilateral tubal block at cornual
best method of management is: (AIIMS Nov 06)
Female Infertility: Ovarian Cause
a. Laparoscopy and hysteroscopy

9. Smita is a case of infertility. What is the right time in her b. Hydrotubation
menstrual cycle to do endometrial biopsy: c. IVF
(AIIMS Nov 00) d. Tuboplasty
162 Self Assessment & Review: Gynecology

18. An infertile women has bilateral tubal block at cornua 27. WHO definition of normal sperm count:
diagnosed on hysterosalpingography. Next step in (PGI Dec 05)
treatment is: (AIIMS Nov 2011) a. 10 million/ml b. 20 million/ml
a. IVF c. 40 million/ml d. 50 million/ml
b. Laparoscopy and hysteroscopy e. 60 million/ml
c. Tuboplasty 28. Aspermia is the term used to describe: (AI 05)
d. Hydrotubation a. Absence of semen
b. Absence of sperm in ejaculate
Female Infertility: Cervical Cause c. Absence of sperm motility
d. Occurrence of abnormal sperm
19. Post coital test detects all of the following except: 29. A 25 year old infertile male underwent semen analysis.
a. Fallopian tube block (AIIMS May 01) Results show: sperm count – 15 million/ml; pH – 7.5;
b. Cervical factor abnormality volume – 2 ml; no agglutination is seen. Morphology
c. Sperm count shows 60% normal and 60% motile sperms. Most likely
d. Sperm abnormality diagnosis is: (AI 02)
20. Postcoital test (PCT) is done for: (PGI June 05) a. Normospermia b. Oligospermia
a. Cervical receptivity c. Azoospermia d. Aspermia
b. Sperm motility c. Absolute sperm count 30. Which of the following is true about obstructive
d. Viable sperm count e. Endometrial function azoospermia: (AI 09)
21. Cervical hostility is tested by following except: a. ↑ FSH and ↑ LH
(PGI Dec 97) b. Normal FSH and normal LH
a. Spinnbarkeit b. Postcoital test c. ↑ LH, Normal FSH
c. Miller kuzrole test d. Keller test d. ↑ FSH, Normal LH
22. Postcoital test showing non motile sperms in the cervical 31. A male with azoospermia. On examination size of testis
smear and Motile sperms from the posterior fornix normal FSH normal testosterone normal. Most probable
suggests: (UPSC 97) cause is: (AIIMS Nov 09)
a. Faulty coital practice b. Immunological defect a. MAL descended testis
c. Hypospadias d. Azoospermia b. Klinefelter’s syndrome
23. Treatment for Cervical infertility can be all except: c. Kallmann’s syndrome
a. Condom for 3 month (Delhi 99) d. VAS obstruction
b. IUI 32. In azoospermia, the diagnostic test which can distin­
c. Gamete Intrafallopian transfer guish between testicular failure and obstruction of Vas
d. Clomiphene citrate deferens is: (UPSC 04)
24. If the life style factor that is causing infertility in a young a. Estimation of FSH level
male is identified. Which of the following life style b. Estimation of testosterone level
modification will have no effect (AIIMS Nov 2014) c. Karyotyping
a. Weight gain b. Less exercise d. FNAC of testes
c. Vegetarian diet d. Weight loss
33. Semen analysis of a male of an infertile couple. shows
absence of spermatozoa but presence of fructose. The
Male Infertility most probable diagnosis is:
a. Prostatic infection
25. According to WHO criteria, the minimum normal sperm b. Mumps orchitis
count is: (AIIMS May 03) c. Block in efferent duct system
a. 10 million/ml b. 20 million/ml d. All of the above
c. 40 million/ml d. 60 million/ml 34. A couple complains of primary infertility inspite of
26. Which is a not an essential criteria according to WHO staying together for 4 year and having unprotected
for normal semen analysis: intercourse, all tests in wife are normal. Semen analysis
shows a volume of 0.8 ml/sperm count is 0, fructose is
a. Sperm count > 20 million/ml (AIIMS Nov 07)
absent what is done next? (AIIMS Nov 2013)
b. Volume > 1 ml
a. Testicular FNAC
c. Sperm with normal morphology (strict criteria) b. Ultrasound for obstruction
> 15% c. Local palpation of vas
d. Motility > 25% with rapidly progressive motility d. Karyotyping
 Chapter 9 Infertility 163

IUI 41. Indications of intrauterine insemination (IUI) are all

except:
35. Intrauterine insemination means implantation of:
a. Hostile cervical mucus
(PGI June 05)
a. Semen b. Washed semen b. Unexplained infertility
c. Million of sperm d. Fertilized ova c. Oligoasthenospermia
d. Luteal Phase defect
IVF 42. In which case homologous artificial insemination is used
in females:
36. In vitro fertilization is indicated in: (AIIMS Dec 97) a. Hormonal disturbance
a. Tubal pathology b. Uterine dysfunction b. Tubal block
c. Ovarian pathology d. Azoospermia c. Cervical factor
37. Aspiration of sperms from testes is done in: d. All of the above
a. TESA b. MESA (AI 07)
43. Artificial insemination with husband’s semen is indicated
c. ZIFT d. GIFT
in all the following situations, except:
38. In semen banks, semen is preserved at low temperature a. Oligospermia
using: (JIPMER 81; DNB 90) b. Impotency
a. Dry ice b. Deep freeze c. Antisperm antibodies in the cervical mucous
c. Liquid nitrogen d. Liquid air d. Azoospermia
39. Which is not an assisted reproduction technique:
44. The major contribution to the human seminal fluid is
a. GIFT b. ZIFT (AI 95)
c. IVF and ET d. Artificial insemination from:
a. Testes
NEW PATTERN QUESTIONS b. Seminal vesicles
c. Prostate
40. Ovulation can be diagnosed by all except: d. Bulbourethral and urethral glands
a. Measuring day 14 serum progesterone 45. Absent fructose content in the seminal fluid suggests:
b. Rise in basal body temperature in the second a. Congenital absence of seminal vesicle
half of cycle b. Partial duct obstruction
c. Study of cervical mucus c. None
d. Endometrial histology d. Both
 Chapter 10 Contraception 197

FIGURE BASED QUESTIONS

F1. Figure F1 shows a transdermal patch used for contra- F2. Figure F2 shows a popular method of performing steri-
ceptive purpose. The patch is not yet available in India. lization. Regarding this technique true statements is:
The following statement is incorrect about the patch: a. Is performed with absorbable suture material
a. It contains norelgestromin and ethyl estradiol. b. Is performed using permanent suture
b. A single patch to be used for 3 weeks c. Includes crushing the fallopian tube
c. A single patch to be used for 1 week d. Is irreversible
d. Compliance is good with the patch

Fig. F1 Fig. F2

QUESTIONS

General Natural methods of family planning

1. Which of the following is correct for the calculation of 6. Which natural family planning method is based on
pearl index: (AIIMS Nov 03) ogino knauss theory: (Neet Pattern)
No. of accidental pregnancies × 1200 a. BBT method
a. b. Rhythm method
No. of patient observed × months of use
c. Lactational anerorrhea
No. of accidental pregnancies × 1200 d. Withdrawl method
b.
No. of patient observed × 2400 7. Which of the folowing statements about calendar
No. of patients observed × months of use method (Rhythm method) is false: (Neet Pattern)
c.
No. of accidental pregnancies a. Abstinence is needed for only a few days in a month
No. of patient observed × 2400 b. It is associated with no costs
d. c. Safe period can also be observed using
No. of accidental pregnancies × 1200
temperature rhythm or mucous method
2. Pearl’s index indicates: (PGI June 05) d. Ectopic pregnancy is a reported complication of
a. Malnutrition calendar method
b. Population 8. Rise in body temperature after ovulation is due to:
c. Contraceptive failure a. Estrogen (Neet Pattern)
d. LBW e. IUGR b. Progesterone
3. Contraceptive methods with failure rate <5: c. LH
(Neet Pattern) d. FSH
a. Copper - T b. Vaginal sponge 9. Billing’s method of contraception refers to:
c. Condom d. OCP (UPSC 99)
e. Tubectomy a. Monitoring BBT
4. Reversible methods of contraception are: b. Cervical mucus method
c. Rhythm method
(PGI June 05)
d. Coitus interruptus method
a. Female sterilization b. OCP
c. IUCD d. Barrier
e. Depot injection Barrier methods
5. Date of birth of billionth baby is: (Neet Pattern) 10. Not a barrier contraceptive: (UP 2008)
a. May 11, 2011 b. May 11, 2000 a. Diaphragm b. Centchroman
c. April 11,2000 d. April 11, 2011 c. Condom d. Today
198 Self Assessment & Review: Gynecology

11. Which one of the following is not a correct statement 20. Third generation oral contraceptive pills containing
regarding the use of condom: (UPSC 07) norgestimate and gestodene along with estrogens:
a. Air should be squeezed out of tip a. Are more lipid friendly
b. It should be tested by inflating b. Decreases the risk of venous thromboembolism
c. It should be unrolled on erect penis c. Increase the risk of breakthrough bleeding
d. K-Y jellly may be used for lubrication d. Are not used for emergency contraception
12. Which one of the following is the most common problem 21. Norgestimate OCP’s have the following advantage
associated with the use of condom: except:
(UPSC 02) a. Reduces venous thrombosis
a. Increased monilial infection of vagina b. Is cheaper than standard OCP’s
b. Premature ejaculation c. Reduces acne and hirsutism
c. Contact dermatitis d. Useful in heart disease
d. Retention of urine 22. The progesterone component of OCP acts by:
13. All are contraindications of diaphragm except: (UP 05) a. Preventing ovulation
a. Multiple sex partners b. Inhibiting implantation
b. Recurrent UTI c. Bringing about alterations in cervical mucus
c. Uterine prolapse d. All of the above
d. Herpes vaginitis 23. Amount of estrogen in Mala D is: (UP 00)
14. Contraceptive vaginal foam tablet “today “contains: a. 30 µg b. 50 µg
a. Nonoxynol 9 b. Octoxynol 9 c. 10 µg d. 80 µg
c. Menfegol d. None of the above 24. Which of the following OCP’s have the least amount of
15. Spermicidal jelly acts through: (AIIMS Dec 98) estrogen:
a. Acrosomal enzyme a. Mala N b. Triquilar
b. Cervical enzyme alteration c. Femilon d. Novelon
c. Glucose uptake inhibition by sperms
d. Disruption of cell membrane Benefits of OCP’s
16. Spermicidal agents are: (PGI June 06)
a. Nonoxynol 25. Oral contraceptive pills decrease incidence of all of the
b. Menfegol following conditions except: (AI 99)
c. Progestasert a. Salpingitis b. Hepatic adenoma
c. Ovary CA d. Fibroadenosis
OCPs 26. Use of OCP’s are known to protect against following
malignancies except: (AIIMS Nov 02)
17. All of the following mechanisms of action of oral a. Ovarian carcinoma b. Endometrial carcinoma
contraceptive pills are true, except: (AI 06) c. Uterine sarcoma d. Carcinoma cervix
a. Inhibition of ovulation 27. Use of oral contraceptives decreases the incidence of all
b. Prevention of fertilization of the following except: (AIIMS May 05)
c. Interference with implantation of fertilized a. Ectopic pregnancy
ovum b. Epithelial ovarian malignancy
d. Interference with placental functioning c. Hepatic adenoma
d. Pelvic inflammatory disease
Composition 28. Non contraceptive use of OCPs are all except:
(AI 07)
18. Version I a. Ca endometrium b. Ca breast
Amount of estrogen in low dose oral contraceptive c. Rheumatoid arthritis d. Endometriosis
pills: (AIIMS Nov 01)
29. OCP gives protection against following cancers:
a. 30 µg b. 40 µg
(PGI June 06)
c. 50 µg d. 20 µg
a. Endometrial b. Ovary
Version II c. Cervix d. Breast
Minimum effective dose of ethinyl estradiol in e. Liver
combination oral pills is: (AIIMS May 04)
a. 20 µg b. 35 µg
c. 50 µg d. 75 µg
Side Effects of OCPs
19. Low dose OCP’s contain: 30. OCP’s cause all except: (AIIMS Dec 98)
a. Levonorgestrel b. Desogestrel a. Dysmenorrhea b. Mastalgia
c. Norgestrel d. Norethisterone c. Nausea d. Chloasma
 Chapter 10 Contraception 199

31. Adverse effects combined OCPs: (PGI Dec 09) 41. OCPs are C/I in pts receiving: (AIIMS Nov 07)
a. Liver disorders a. Rifampicin b. Ethambutol
b. PID c. Weight gain c. Streptomycin d. Pyrazinamide
d. Acne e. Endometriosis 42. Hypokalemic paralysis is a side effect of:
32. OCP’s intake causes all Except: (AIIMS June 98) a. Gossypol
a. Decreased risk of ovarian tumour b. DMPA
b. Increased risk of fibroadenosis c. Testosterone enanthate
c. Increased risk of liver adenoma d. Cyproterone acetate
d. Increased risk of fibroadenoma
33. The use of combined OCPs is associated with an Progesterone only Pills/Implants/Injections
increased incidence of: (AIIMS Nov 03)
a. Bacterial vaginosis 43. Newer progestational contraceptives primarily act by:
b. Chlamydial endocervicitis (AIIMS May 03)
c. Vaginal warts a. Oviductal motility b. Uterine endometrium
d. Genital herpes c. Cervix d. Inhibiting ovulation
44. True statement about Minipill is: (AI 99)
Contraindications of OCPs a. Irregular vaginal bleeding may be a side effect
b. Used in with combination with oral
34. In a young female of reproductive age an absolute contraceptive pills
contraindication for prescribing OCP’s is: c. Cannot be used in lactation
(AIIMS May 05) d. Prevents ectopic pregnancy
a. Diabetes b. Hypertension 45. DMPA-True: (PGI Dec 09)
c. Obesity d. Impaired liver function a. Failure @ 0.3/100 WY
35. Absolute contraindication of OCP’s is: b. 150 mg/3 monthly
(PGI June 02) delivered
a. Breast cancer b. Mentally ill c. Weight gain
c. Migraine d. Fibroid d. Glucose intolerance occur
e. Hyperlipidemia e. Anemia improves
36. Contraindications to OC pills: (PGI June 01) 46. True regarding DMPA including the following except:
a. Heart disease b. Uterine malformations (AI 09)
c. Menorrhagia d. Liver failure a. 3% failure rate
e. Epilepsy b. Does not have protective effect on Ca
37. OCP’s are contraindicated in all except: (PGI Dec 99) endometrium
a. Smoking 35 years c. Can be given in seizures
b. Coronary occlusion d. Useful in treatmen of menohorrhegia
c. Polycystic ovarian disease 47. Side effect of depot MPA are all, EXCEPT: (AI 00)
d. Cerebrovascular disease a. Weight gain
38. OCP’s intake cause psychiatric symptoms, and abdominal b. Irregular bleeding
pain. Diagnosis is: (PGI Dec 98) c. Amenorrhea
a. Acute intermittent porphyria d. Hepatitis
b. Systemic lupus 48. To avoid contraception, DMPA is given: (HP 05)
c. Thrombosis a. Monthly b. 3 Monthly
d. Anemia c. 6 Monthly d. Yearly
49. Characteristic problem in females taking nor-ethisterone
Drug Interaction is: (AI 00)
a. Irregular bleeding b. Thromboembolism
39. A 20-years old nulliparous women is on oral contra­ c. Hirsutism d. Weight gain
ceptives pills. She is currently diagnosed as having 50. In a woman on subdermal progesterone implant, the
pulmonary tuberculosis. Which anti-tubercular drug menstrual abnormality seen is: (AIIMS May 01)
decreases the effect of OCP: (AIIMS May 01) a. Menorrhagia b. Metrorrhagia
a. INH b. Pyrazinamide c. Polymenorrhea d. Amenorrhea
c. Ethambutol d. Rifampicin
51. Mirena is: (AIIMS May 05)
40. OCP’s efficiency is reduced by simultaneous use of: a. Used in abortions
(PGI Dec 98) b. Antiprogesterone
a. Rifampicin b. Carbamazepine c. Progesterone IUCD
c. Propranolol d. Tricyclic antidepressants d. Hormonal implant
200 Self Assessment & Review: Gynecology

52. Use of Levo-Norgestrel releasing, IUCD is helpful in all 62. Composition of Nova - T: (PGI June 05)
of the following conditions except: (AIIMS Nov 02) a. Copper and silver
a. Menorrhagia b. Copper and aluminium
b. Dysmenorrhea c. Copper only
c. Premenstrual symptoms d. Copper and selenium
d. Pelvic inflammatory disease e. Copper and molybdenum
53. Benefits of LNG IUCD: (PGI Dec 09) 63. A lady with IUCD becomes pregnant with tail of IUCD
a. Endometriosis b. Fibroid uterus being seen, next course of action is: (PGI Dec 98)
c. PID d. Contraception a. MTP
e. Extauterine endometriosis b. Remove the IUCD
c. Continue the pregnancy
54. True about Mirena: (PGI Nov 2012)
d. Remove IUCD and terminate pregnancy
a. Progestrone containing IUCD
b. Contain desogestrol 64. An intrauterine pregnancy of approximately 10 weeks
c. Causes endometrial hypeplasia gestation is confirmed in a 30 year old, gravida 5, para
d. Decreases menstural blood flow 4 woman with an IUD in place. The patient expresses
a strong desire for the pregnancy to be continued.
55. Which of the following statements is incorrect regarding
On examination, the string of the IUD is noted to be
levonorgestrel releasing intrauterine contraceptive protruding from the cervical os. The most appropriate
devices: (AI 06) course of action is to:
a. There is increased incidence of menorrhagia a. Leave the IUD in place without any other
b. This system can be used as hormone treatment
replacement therapy b. Remove the IUD to decrease the risk of
c. This method is useful for the treatment of endome- malformations
trial hyperplasia c. Remove the IUD to decrease the risk of infection
d. Irregular uterine bleeding can be a problem initially d. Terminate the pregnancy because of the high
56. All of the following mechanisms might account for a risk of malformations.
reduce-risk of upper genital tract infection in users of 65. A 28-year-old P1L1 had Cu T inserted 2 years back, on
progestin – releasing IUDs, except: (AI 06) examination Cu T threads are not seen. USG shows Cu
a. Reduced retrograde menstruation T partly in abdominal cavity. Method of removal is:
b. Decreased ovulation a. Hysteroscopy
c. Thickened cervical mucus b. No need of removal (wait and watch)
d. Decidual changes in the endometrium c. IUCD hook
57. Contraceptive LNG–IUD (levonorgesterel intra–uterine d. Laparoscopy
device) has the cumulative pregnancy rate at 5 years of: 66. Absolute contraindication for IUCD includes all of the
a. 0.5 b. 1.0 (AI 02) following except: (AI 97)
c. 1.5 d. 2.0 a. Undiagnosed vaginal bleeding
b. Suspected pregnancy
IUCDs c. Congenital malformation of uterus
d. PID
58. Characteristics of an ideal candidate for copper-T
insertion include all of the following except: 67. Absolute contraindication of IUCD is: (AIIMS Dec 97)
a. Endometriosis
a. Has born at least one child (AIIMS May 05)
b. Iron deficiency anemia
b. Is willing to check IUD tail
c. Dysmenorrhea
c. Has a history of ectopic pregnancy
d. Pelvic tuberculosis
d. Has normal menstrual periods
68. Contraindications of IUCD:
59. Mechanism by which IUCD does not act: (AIIMS Dec 98)
a. Undiagnosed vaginal bleeding
a. Chronic endometrial inflammation
b. PID c. Smoking
b. Increase the motility of tubes
d. Obesity e. Diabetes
c. Inducing endometrial atrophy
69. Contraindication of IUCD: (PGI Dec 04)
d. Inhibition of ovulation
a. Oligomenorrhea b. PID
60. All ICUD’s are changed every 4–5 year except: c. Uterine malformation d. Controlled diabetes
(AIIMS Dec 97) e. Previous cesarean section
a. Cu 280 b. Cu 320
70. Contraindication of IUCD: (PGI Dec 04)
c. Multiload devices d. Progestasert
a. Oligomenorrhea
61. Among of following IUCD’s which has life span for 10 b. PID
years: c. Uterine malformation
a. CuT380A b. CuT200 d. Controlled diabetese.
c. Nova T d. Multiload e. Previous ectopic pregnancy
 Chapter 10 Contraception 201

71. The most common complication of IUCD is: (AI 95) 81. Sterilization procedure with maximum chances of
a. Ectopic pregnancy b. Bleeding reversal is: (AIIMS May 02)
c. Backache d. Cervical stenosis a. Pomeroy’s tubal ligation
b. Irwing’s technique
Emergency Contraception c. Laparoscopic tubal ligation with silastic bands
d. Laparoscopic tubal ligation with clips
72. Emergency contraception prevents pregnancy by all of 82. During Pomeroy’s method of female sterilization, which
the following mechanisms, except: (AI 06) portion of the tube is ligated? (UPSC 07)
a. Delaying/inhibiting ovulation a. Isthmus b. Ampullary
b. Inhibiting fertilization c. Isthmo-ampullary d. Cornual
c. Preventing implantation of the fertilized egg 83. Sterilization is commonly performed at which site of
d. Interrupting an early pregnancy fallopian tube: (AI 07)
73. Emergency contraception is required in: a. Ampulla b. Infundibulum
(AIIMS Nov 99) c. Isthmus d. Cornua
a. Partner not willing to use any contraceptive 84. Best prognosis for reversibility is seen in: (AI 97)
b. In emergency, where sexual intercourse is a. Isthmo – isthmic type
done in camps in emergency like floods b. Isthmic – ampullary type
c. Contraception failure c. Ampullary – interstitial type
d. Unprotected sex d. Ampullary – fimbrial type
74. Drugs used in emergency contraception are all except: 85. Which of the following procedure isassociated with
(PGI Dec 06) maximum chance of recanalization during surgery for
a. Levonorgestrel b. Estrogen + progesterone reversal of tubal ligation:
c. Danazol d. Mifepristone a. Isthumo-isthmic anastomosis
e. Misoprostol b. Isthumo-ampullary anastomosis
c. Ampullo-ampullary anastomosis
75. Which is not an emergency contraceptive:
d. Cornual obstruction
(PGI Nov 2012)
86. All of the following are features of post-tubal ligation
a. Combined oral pills b. Estrogen
syndrome except:
c. Desogestrel d. Levonorgestrel
a. Abnormal menstrual bleeding
e. Medoxy progesterone acetate
b. Dysmenorrhea
76. Emergency contraceptive of choice is: c. Pelvic pain
(PGI Dec 09) d. Dysperunia
a. OCP b. Danazol 87. Failure rate of vasectomy is:
c. Levonorgestrel d. Mifepristone a. 0.2% b. 0.1%
77. Emergency contraceptives are effective if administered c. 3% d. 10%
within following period after unprotected intercourse: 88. A couple is advised to use barrier methods after
(AIIMS May 04) vasectomy till:
a. 24 hours b. 48 hours a. 3 months b. No sperms in ejaculate
c. 72 hours d. 120 hours c. Next 15 ejaculations d. None of the above

Permanent Method Contraceptive of Choice

78. Permanent sterilization is all except? (PGI Dec 05) 89. Which one of the following is the ideal contraceptive for
a. Electrocoagulation b. Vasectomy a patient with heart disease: (AI 05)
c. Clipping d. Tube ligation a. IUCD b. Depoprovera
e. Medroxy progesterone c. Diaphragm d. Oral contraceptive pills
79. Which of the following is not an abdominal laparoscopic 90. Best mode of contraception for a newly married lady
technique for tubal ligation? with rheumatic heart disease: (AIIMS Nov 99)
a. Pomeroy b. Parkland a. Oral pills b. Norplant
c. Essure d. Irving c. IUCD d. Condom
80. Method of sterilization which is least effective is: 91. PID occurs least common with: (AI 00)
(AIIMS Dec 98) a. OCPs b. Condom
a. Pomeroy’s technique c. IUCD d. Diaphragm
b. Laparoscopy 92. Ideal contraceptive for newly married couple is:
c. Vaginal fimbriectomy (AIIMS May 2011)
d. Hysteroscopic tubal occlusion a. Barrier method b. Combined OCP
c. IUCD d. Progesterone only pill
202 Self Assessment & Review: Gynecology

93. Ideal contraceptive for a couple living in different cities 99. The intra-abdominal pressure during laparoscopy
meeting only occasionally: (AIIMS May 2011) should be set between:
a. Barrier method b. IUCD
a. 5–8 mm Hg b. 10–15 mm Hg
c. OCP d. DMPA
c. 20–25 mm Hg d. 30–35 mm Hg
94. Ideal contraceptive for lactating mother is:
a. Barrier method (AIIMS May 2011) 100. A 30-year-old P1L1 wants contraception for 6 months.
b. Combined OCP She has dhymenorrhea and is a known case of
c. Lactational amenorrhoea complicated migraine. On USG, uterus has multiple
d. Progesterone only pill fibroids. Contraception of choice is:
95. Peritoneum is opened in all of the following sterilization a. Cu T 200 b. OC pills
procedures except: (AP 97) c. Vaginal diaphragm d. Tubal sterilization
a. Mini lap 101. A 28-year-old P1L1 had Cu T inserted 2 years back. O/E-
b. Laparoscopy Cu-T threads are not seen. USG shows Cu T partly in
c. Vasectomy abdominal cavity. Method of removal is:
d. Transvaginal tubectomy a. Hysteroscopy
96. Contraceptive to be avoided in epilepsy: b. No need removal (wait and watch)
(AIIMS May 2011) c. IUCD hook
a. OCP b. Condom d. Laparoscopy
c. IUCD d. Mirena 102. All of the following are contraceptive implants except:
a. Norplant b. Implanon
NEW PATTERN QUESTIONS c. Jadelle d. Mesigyna
103. Least failure in sterilization occurs with:
97. The following are true related with regards to
a. Falope ring
vasectomy except
b. Bipolar cautery
a. Leads to immediate sterility
c. Unipolar cauterisation
b. Failure rate is 0.1%
d. Hulka clip
c. Involves ligation and division of spermatic cord
d. Partner (wife may be given DMPA for 3 months 104. All of the following are LARC methods except:
a. IUCD b. DMPA
98. The following are the contraindications of tubal
c. POPs d. Implanon
reconstructive surgery except
a. Length of tube <4 cms 105. Preferred method of contraception in family for a female
b. Patients over 30 years of age with H/O ovarian cancer:
c. Pelvic tuberculosis a. POP b. Cu IUCD
d. Reversal done after 5 years of sterilization c. OCP d. Barrier method
228 Self Assessment & Review: Gynecology

FIGURE BASED QUESTIONS

F1. Identify the fibroid based on FIGO classification:
a. Type 3
b. Type 4
c. Type 5
d. Type 7
Fig. F2
F3. Identify the instrument shown in Figure F3
a. Bonneys myoma screw
b. Bonneys myoma clamp
c. Cervical occlusion clamp
d. Uterus holding forcep
Fig. F1
F2. Identify the instrument:
a. Myoma clamp
b. Myoma screw
c. Uterine manipulator
d. IUCD removing hook Fig. F3

QUESTIONS

1. All changes occur in fibroid uterus except: c. Hysterectomy

(AIIMS June 97) d. Wait and watch
a. Atrophy b. Squamous metaplasia 7. To start with all fibroids are: (PGI Dec 98)
c. Hyaline degeneration d. Calcification a. Interstitial b. Submucous
2. A pregnant woman with fibroid uterus develops c. Subserous d. Ovarian
acute pain in abdomen with low-grade fever and mild 8. Calcareous degeneration occurs most commonly in
leukocytosis at 28 week. The most likely diagnosis is: which type of fibroids: (PGI 97)
a. Preterm labor (AIIMS Nov 03) a. Submucous b. Subserous
b. Torsion of fibroid c. Interstitial d. Cervical
c. Red degeneration of fibroid 9. Uterine fibromyoma is associated with: (PGI June 02)
d. Infection in fibroid a. Endometriosis
3. Not true about red degeneration of myomas is: b. Pelvic inflammatory disease
(AIIMS May 02) c. Ovarian Ca
a. It occurs commonly during pregnancy d. Amenorrhea
b. Immediate surgical intervention is needed e. Tamoxifen
c. Due to interference with blood supply 10. Treatment of red degeneration of fibroid during
d. Treated with analgesics pregnancy: (PGI Dec 03)
4. Red degeneration in uterine fibroid is most common in: a. Analgesics
(AI 99; AIIMS June 97) b. Laparotomy
a. Second trimester b. Third trimester c. Termination of pregnancy
c. Puerperium d. First trimester d. Removal at cesarean section
5. All are methods of managing fibroid uterus except: 11. Submucosal fibroid is detected by: (PGI Dec 05, 02)
a. Myomectomy (AIIMS Nov 99) a. Hysteroscopy b. Hysterosalpingography
b. Radiofrequency ablation c. USG (Transabdominal) d. Laparoscopy
c. Embolization of uterine artery 12. The drug which reduces the size of myoma includes:
d. Laser myomectomy (PGI Dec 05)
6. Sucheta, a 29-year-old nulliparous women complains a. GnRH agonist
of severe menorrhagia and lower abdominal pain since b. Danazol
3 months. On examination there was a 14 weeks size c. Progesterone
uterus with fundal fibroid. The treatment of choice is:
d. Mifepristone
a. Myomectomy (AIIMS May 01)
e. Estrogen
b. GnRH analogs
 Chapter 11  Uterine Fibroid 229

13. Drugs that reduce the size of fibroid are: (PGI June 03) 22. All are prerequisites for myomectomy except:
a. Danazol b. GnRH analog a. Husbands semen analysis
c. RU-486 d. Estrogen b. D and C report
e. Progesterone c. Hysterectomy consent
14. Decreased vascularity of fibroid is seen with: d. None of the above
a. GnRH agonist (PGI Dec 06) 23. All are complications of fibroid in pregnancy except:
b. Danazol a. Red degeneration
c. Mifepristone b. Obstructed labor
d. Clomiphene citrate c. PPH
15. Management options in a 26-year-old women with 7 × 8 cm d. Placenta previa
size fibroid: (PGI June 09) 24. Most common type of uterine polyp is:
a. Follow-up b. OCP a. Mucous polyp b. Fibroid
c. Myomectomy d. Hysterectomy c. Placental polyp d. None
e. Danazol
25. All of the following measures reduce bleeding during
16. True regarding fibroid uteri: (PGI June 02) myomectomy except: (DNB 08)
a. Estrogen dependant tumor
a. Preoperative correction of anemia
b. Capsulated
b. Preop oc pills
c. Can lead to red degeneration in pregnancy for
c. Ligation of pedicle
which urgent surgery is required
d. GNRH analogues
d. Danazol used in treatment
e. Local injection of vasoconstrictive agents
17. Malignant prevalence in fibroid is: (UP 99)
26. Regarding imaging of uterine fibroids all are correct
a. 0.5% b. 1%
except:
c. 5% d. 10%
a. Ultrasound is ideal to confirm the diagnosis
18. Least common complication of fibroid is: (AI 98) b. Saline Infusion Sonography (SIS) is more sensitive to
a. Menstrual disorder b. Malignancy
detect any submucous fibroid
c. Urinary retention d. Degeneration
c. MRI is superior to USG to identify the exact location
19. In fibroid which is not seen: (AI 07)
of myoma
a. Amenorrhea b. Pelvic mass
d. CT scanning is an alternative to MRI
c. Infertility d. Menstrual irregularity
20. What is the earliest most common presenting feature of 27. Concerning fibroids:
anterior cervical fibroid? a. Use of GnRH analogues cause permanent reduction
a. Frequency of urine b. Bleeding in size
c. Acute abdomen d. Constipation b. Pregnancy following myomectomy is about 80%
c. Recurrence rate following myomectomy is about
NEW PATTERN QUESTIONS 30%
d. Growth factors (IGF-1, EGF) stimulates myoma to
21. All of the following are the indications for myomectomy grow
in a case of fibroid uterus except: 28. The surgical treatment of uterine polyp includes:
a. Associated infertility a. Removal by twisting
b. Recurrent pregnancy loss b. Removal by morcellement
c. Pressure symptoms
c. Hysteroscopy
d. Red degeneration
d. All of the above
 Chapter 12  Endometriosis and Dysmenorrhea 243

QUESTIONS

1. All are true regarding endometriosis, except: NEW PATTERN QUESTIONS

(AIIMS Dec 94)
a. Hormone dependent condition 10. Scar endometriosis can occur following:
b. Can involve lung, pleura a. Classical Cesarean Section
c. Contains clear fluid b. Hysterotomy
d. Ovary is the most common site c. Episiotomy
2. True about endometriosis is/are: (PGI June 06) d. All of the above
a. MC in 3rd or 4th decade 11. Endometriosis is explained by:
b. Premenstrual spotting a. Sampson’s Implantation theory
c. Endometrial sarcoma is most common b. Metastatic epithelium
malignancy associated with it
c. Histogenesis by induction
d. True cyst
d. Coelomic metaplasia theory
e. Ist degree relative seen
e. All of the above
3. Endometriosis is commonly associated with:
12. Best investigation to establish the diagnosis of
(PGI Dec 02)
endometriosis is:
a. B/L chocolate cyst of ovary
a. Laparoscopy
b. Adenomyosis
b. USG
c. Fibroid
d. Luteal cyst c. X-ray pelvis
e. Endometritis d. CT Scan
4. Pain in endometriosis correlates with: (PGI June 00) 13. A 40-year-old primiparous woman suspected to be
a. Depth of invasion b. Multiple sites suffering from endometriosis is subjected to diagnostic
c. ­CA 125 d. Stage of disease laparoscopy. Findings indicate - uterus normal,
5. A 35-year-old woman presents with infertility and both the ovaries show presence of chocolate cysts;
palpable pelvic mass. Her CA-125 level is 90 mIU/mL endometriotic deposits are seen on the round ligament
diagnosis is: (AIIMS May 2010) right side, both the fallopian tubes and the pouch of
a. Ovarian Ca Douglas; moderately dense adhesions are present
b. Endometrioma between the fallopian tubes and the pouch of Douglas.
c. Tuberculosis The treatment of choice in this case is:
d. Borderline ovarian tumor a. Total hysterectomy with bilateral salpingo-
6. All are used in treatment of endometriosis except: oophorectomy
a. Medroxyprogesterone acetate (AIIMS Dec 97) b. Danazol therapy
b. Tibolone c. Progesterone therapy
c. OCP d. Fulguration of endometriotic deposits
d. Danazol 14. True regarding adenomyosis is:
7. Treatment of endometriosis include: (PGI Dec 02) a. Most common in nullipara
a. Estrogen b. Progesterone b. Progestin are agents of choice for medical
c. OCP d. Danazol management
e. GnRH c. Presents with menorrhagia, dysmenorrhea, and an
8. Drugs used in endometriosis are: (PGI Dec 01) enlarged uterus
a. Testosterone b. Danazol d. More common in young women
c. GnRH d. Progesterone 15. False statement regarding spasmodic dysmenorrhea
e. Estrogen is:
9. Cause of secondary dysmenorrhea in a young female: a. Often cured by delivery of a child
(PGI June 05)
b. Pain usually appears on the first day of menstruation
a. Tuberculosis b. Adenomyosis
c. Pain persists for 2–3 days
c. CIN d. Endometriosis
e. Subserous fibroid d. Rare above age of 35 years
244 Self Assessment & Review: Gynecology

16. All are used in treating spasmodic dysmenorrhea 18. Which of the following is NOT to be given in cyclic
except: (DNB 02) mastalgia is: (UP 01)
a. Bromocriptine a. Evening primrose oil
b. Ibuprofen b. Danazol
c. Mefenamic acid c. Tamoxifen
d. Norethisterone and ethinyl estradiol d. Estrogen
17. A 20-year-old woman gives a history of sharp pain 19. Which of the following modalities have shown best
in the lower abdomen for 2–3 days every month
result for pre menstrual syndrome?
approximately 2 weeks before the menses. The most
(AIIMS Nov 02)
probable etiology for her pain is: (AI 03)
a. SSRI b. Progesterone
a. Endometriosis b. Dysmenorrhea
c. Pelvic tuberculosis d. Mittelschmerz c. Oestrogen d. Anxiolyties
 Chapter 13 Disorders of Menstruation 263

FIGURE BASED QUESTION

26$ A 16-year-old girl was brought to gynae OPD by
her parents with C/O primary amenorrhea. The
  
 

 -
sented in the Fig. F1. The patient was diagnosed
as having complete vaginal agenesis. Congenital
vaginal agenesis is associated with all except:
a. Non-functioning uterus
b. Non-functioning ovaries
c. Normal female karyotype
d. Normal secondary sexual characteristics
Fig. F1

QUESTIONS

6$ J@%%

   !0##1234%
with acute pain in the lower abdomen. She has a. Cortisol b. Insulin
history of cyclical pain for last 6 months and she c. Ethinyl estradiol d. Thyroid extract
has not attained her menarche yet. On local genital 8$ Hypothalamic amenorrhea is seen in:
examination, a tense bulge in the region of hymen a. Asherman syndrome !0##1234%
was seen. The most probable diagnosis is: b. Stein-leventhal syndrome
!0##11
3%
c. Kallmann syndrome
a. Mayer Rockitansky Kuster Hauser syndrome
d. Sheehan’s syndrome
 *   3


c. Imperforate hymen 9$ Primary amenorrhoea with anosmia is seen in:
d. Asherman’s syndrome a. Kallmann syndrome !0##1533%
4$ The commonest cause of primary amenorrhoea is: b. Laurence Moon Biedl syndrome
a. Genital tuberculosis !0##123% c. Foster – Kennedy syndrome
b. Ovarian dysgenesis d. Sheehan’s syndrome
c. Mullerian duct anomalies :$ A 19-year-old patient complains of primary amen-
d. Hypothyroidism orrhea. She had well developed breast and pub-
<$ Which is not primary amenorrhea? lic hair but on examination there was absence of
!0#3780#634480##11
6343% uterus and vagina. Likely diagnosis is:
a. Sheehan’s syndrome a. XYY (0##126343
b. Kallmann’s syndrome b. Mullerian agenesis
c. Mayer Rokitansky Koster Hauser syndrome c. Gonadal dysgenesis
d. Turner syndrome d. Klinefelter syndrome
=$ A woman has 2 kids. She presents with galactorrhea ;$  @{%%
   
     

and amenorrhea for 1 year. The most probable  > 
 !     !"  #"
diagnosis is: !0##11
36% level with low estradiol. The likely cause is:
a. Pregnancy a. Panhypopituitarism !0##1277%
b. Pituitary tumor b. Polycystic ovarian disease
c. Sheehan’s syndrome
c. Exogenous estrogen administration
d. Metastasis to pituitary from other carcinoma
d. Premature menopause
>$ Mrs. Sinha having her youngest child of 6
65$ @?%%

QŒ?2

years age presents to her family physician with
menorrhagia. Which is best treatment for her?
complaints of pruritis vulvae and amenorrhea. On
examination she is found to have loss of pubic and !0##11
6344%
axillary hairs, patch of vitiligo and hypotension. a. Combined pills
She is lethargic and has cold intolerance. She has b. Mirena
got multiple skin infections and anemia. All of the c. Hysterectomy
following should be used to treat her, except: d. Transcervical resection of endometrium
264 Self Assessment & Review: Gynecology

66$ >{
 

6;$
A patient with amenorrhea had bleeding after
uterine bleeding. On transvaginal USG thickness giving a trial of progesterone. This implies:
of endometrium was found to be 8 mm. What !9:#+34%
should be the nest step in the management of this   ! 

patient? !0##123=80###126344%   ! 


a. Histopathology b. Hysterectomy c. Normal ovarian function
c. Progesterone d. OCP d. Intact endometrium
64$ 0‚& >{

  
 e. Intact pituitary axis

 
%
 
   † 
 * 
45$ Positive progesterone challenge test in a patient of
line of management is: !0#36% secondary amenorrhea, seen in: !9:#53;%
a. Hysterectomy a. Asherman Syndrome
  5


@ b. Endometrial TB
c. Dilatation and curettage c. Hypopituitarism
  4
 
@ d. Premature ovarian failure
6<$ :  >{ 
    &Y 
 „ 
 e. PCOD
duration best line of management is:
46$ Withdrawal bleeding with progesterone seen in
!0##1533% otherwise amenorrheic woman due to:
a. Progesterone for 6 months !9:#+7<%
b. OCP for 6 months a. Hypogonadotrophic hypogonadism
c. Dilation and curettage b. Anovulation
d. Hysterectomy c. Ovarian failure
6=$ Commonest cause of post menopausal bleeding in d. TB endometritis
India is: !0#3<>0##11
3<%
44$ In a case of secondary amenorrhea who fails to get
a. Ca endometrium b. Ca cervix withdrawl bleeding after taking E and P, the fault
c. Ca vulva d. Ovarian tumour lies at the level of: !9:#53%
6>$ A teenage girl presented in OPD with moderate a. Pituitary b. Hypothalamus
acne and history of irregular menses. What c. Ovary d. Endometrium
treatment will you give? !0##126343%

4<$ Child with primary amenorrhea with negative
a. Oral isotretinoin b. Oral acitretin
progesterone challenge test but positive combined
c. Oral minocycline d. Cyproterone acetate
progesterone and estrogen test. Diagnosis may be:
68$ Primary Amenorrhea: !9:#+3=% a. Mullerian agenesis !9:#53<%
   
 +  J>   
 b. PCOD
secondary sexual characters c. Asherman syndrome
b. Absence of Menarche by 16 years with second- d. Prolactinoma
ary sexual characters
4=$ Average blood loss in normal menstruation:
c. Absence of secondary sexual characters by years
  {?#  K?# !9:#53%

69$
Causes of secondary amenorrhea are:   J??#  JQ?#
!9:#534%
  J?#
a. Turner’s syndrome

4>$ +
     

 
   
b. Endometriosis
c. Asherman’s syndrome more than: !0##1277%
d. Thyroiditis   K?#  JJ?#
e. PCOD   J{?#  {?#

6:$
Lady recovered from severe PPH, complains of
48$
Polymenorrhoea Means: !9:#+3=%
failure of lactation and menstruation, which of the   +`QJ  +Ž@{
following can be seen: !9:#+3=% c. Painful menses d. DUB
a. Increased Excretion of NaΠ49$ Initial evaluation in adolescent with abnormal
b. Retention of Water uterine bleeding: !9:#53%
c. Increased Prolactin a. Haemogram b. Platelet count
d. Increased GnRH c. USG d. D & C
e. Increased TSH e. Examination under anesthesia
 Chapter 13 Disorders of Menstruation 265

4:$ Most common cause of puberty menorrhagia: <:$ Evaluation of a patient with post menopausal
!9:#53<% bleeding is done by: !9:#53%
a. Anovulation b. Malignancy a. Pap smear b. USG
c. Endometriosis d. Bleeding disorder c. Endometrial biopsy d. Dilatation & curettage
4;$ Puberty menorrhagia is treated by: !9:#536% <;$ Cryptomenorrhea occurs due to: !0#7%
a. Progesterone a. Imperforate hymen b. Asherman’s syndrome
b. Progesterone and estrogen c. Mullerian agenesis d. All
c. GnRH analogues =5$ @{%%



   
  &3
  ! from amenorrhea from last 12 month. She has
<5$ Causes of dysfunctional uterine bleeding can be: a history of failure of lactation following second
!9:#+34% delivery but remained asymptomatic thereafter.
a. Uterine polyp b. Fibroid Skull X-ray shows empty sella diagnosis is: !0#36%
c. Granulosa cell tumour a. Menopause
d. Irregular ripening of endometrium b. Pituitary tumor
e. Irregular shedding of endometrium c. Sheehan’s syndrome
d. Intraductal papilloma of breast

<6$ *


 

  

-
trium in DUB is: !9:#577% =6$ @{%%
 0  
a. Hypertrophic b. Hyperplastic aged 5 and 6 years has history of amenorrhea and
galactorrhea. Blood examination reveals increased
c. Cystic glandular hyperplasia
prolactin. CT of head is likely to reveal: !0#36%
d. Dysplastic
a. Pituitary adenoma

<4$
Treatment of DUB in young female is: !9:#7% b. Craniopharyngioma
a. Hormones b. Radiotherapy c. Sheehan’s syndrome
c. D & C d. Hysterectomy d. Pinealoma
<<$ * 
 @Q 
     =4$ In a woman presenting with amenorrhea headache,

   $&Y V blurred vision and galactorrhea appropriate
!9:#+33% investigation: !0#7<%
  5

  &3
 a. Prolactin levels b. LH
c. Prostaglandins d. Endometrial ablation c. FSH d. HCG
e. Hysterectomy =<$ A middle aged female presents with increasing
<=$  >{%%
      
- visual loss, breast enlargement and irregular
rhoea and menorrhagia most probably has: menses. Investigation of choice would be: !0#7<%
!9:#+7<% a. S. calcitonin
a. DUB b. Endometriosis b. S. prolactin
c. Fibroid d. Endometrial Ca c. S. hemoglobin concentration
<>$ All are causes of postmenopausal bleeding except: d. S. calcium
a. Carcinoma in situ of cervix !9:#+33% ==$ Primary amenorrhea with absent uterus, normal
b. Ca. endometrium breasts and scanty pubic hair is seen in: !0#6343%
c. Ca. ovary a. Mayer Rokitansky Kuster hauser Syndrome
d. Ca. fallopian tube b. Turner Syndrome
<8$ Post–menopausal bleeding is associated with all c. Noonan Syndrome
except: (9:#+3;   *   3 

a. Ca cervix b. CIN
=>$ A patient had a spontaneous abortion, then she
c. Ca ovary d. Endometrial Ca came with amenorrhea and FSH 6 pm IU/mL.
e. Ca fallopian tube What the most probably diagnosis? !0#43%
<9$  

 {?  
   
2 a. Ovarian failure b. Uterine Synechiae
coming with one episode of bleeding P/V. Which c. Pregnancy d. Pituitary failure
of the following to be done: !9:#537% =8$ Lactational amenorrhea is due to:
a. Assess for H/o HRT b. Hysterectomy a. Prolactin induced inhibition of GnRH
c. PAPs smear d. Endometrial biopsy b. Prolactin induced inhibition of FSH
e. DUB c. Oxytocin induced inhibition of GnRH
266 Self Assessment & Review: Gynecology

=9$ All of the following conditions are associated with c. Nonsecretory

primary amenorrhea except: !0#7<% d. Atrophic
  *   3


>:$ Most common cause of menorrhagia in childbear-
b. Stein-Leventhal syndrome
ing period:
c. Turner’s syndrome
a. Fibroid
d Mayer Rockitansky Kuster Hauser Syndrome
b. Dysfunctional uterine bleeding
=:$ The most common cause of secondary amenorrhea c. Pelvic endometriosis
in India is: !0#3% d. Adenomyosis
a. Endometrial tuberculosis
b. Premature ovarian failure
>;$ Primary amenorrhoea is most commonly associ-
c. Polycystic ovarian syndrome ated with:
d. Sheehan’s syndrome a. Developmental defect of the genital tract
b. Tuberculosis
=;$ Evidence based treatment for menorrhagia is all
c. Endocrine disorders
except: !0#3780##11
6343%
a. OCPS d. Chromosomal abnormality
b. Progesterone for three months cyclically
85$ Dysfunctional uterine bleeding is commonly met
c. Tranexamic acid in all except:
d. Ethamsylate a. Adolescence
>5$ Which of the following is not indicated in menor- b. Following childbirth
rhagia: !0#36% c. Premenopausal period
a. NSAID’s b. Clomiphene d. Postmenopausal period
c. Norethisterone d. Tranexamic acid
86$ Withdrawal bleeding following administration of
progestogen in a case of secondary amenorrhoea
NEW PATTERN QUESTIONS indicates all except:
a. Absence of pregnancy
>6$ Abnormal uterine bleeding is/are: !9:#1
634% b. Production of endogenous estrogen
a. Bl




K? c. Endometrium is responsive to estrogen
 ' 
  
  @{ 
 
d. Defect in pituitary gonadal axis
than 21 days
c. Bleeding period lasting 7 days or more
84$ The following are the features of anovular men-
d. Irregular bleeding during a regular cycle struation except:
a. The only symptom may be failure of conception
>4$ Metrorrhagia is produced by the following
except: b. It is usually associated with painless periods
a. Fibroid polyp b. CA endometrium c. May be associated with premenstrual syndrome
  :Y&  : 
 d. May be associated with DUB

><$ In DUB, there is:
8<$ Anita 15-year-old, complains of heavy periods
a. Increased estrogen   Q 
 4‰ZV  >? _  5 JQ?‰K?
b. Decreased receptors of progesterone mmHg. All of the following investigations are
c. Decreased receptors of estrogen indicated, except:
d. Pituitary imbalance of hormones a. S. TSH
>=$ Halban’s disease is due to: b. Platelet count
a. Persistent corpus luteum c. Bleeding and clotting time
  & 
 d. Estradiol levels
c. Persistent trophoblast
8=$ Period of amenorrhea followed by massive bleed-
  & 

 ing is seen in premenopausal women with:
>>$ Metropathica hemorrhagica is best treated by: a. Irregular ripening
a. Curettage of uterus b. Progestogen b. Irregular shedding
c. Estrogen d. Clomiphene c. Metropathia hemorrhagica
>8$ The most common source of vicarious menstrua- d. All of the above
tion is:
8>$ The investigation of choice in a 55-year-old post-
a. Heart b. Lungs menopausal women who has presented with
c. Nose d. Kidney postmenopausal bleeding is:
>9$ Most common endometrial pattern in dysfunc- a. Pap smear
tional uterine bleeding: b. Fractional curettage
a. Normal c. Transvaginal ultrasound
b. Hyperplastic with Swiss-Cheese pattern d. CA-125
 Chapter 14A  Gynecological Oncology: Uterine Cancer 293

QUESTIONS

1. The risk of endometrial cancer is highest with 9. Long-term tamoxifen therapy may cause:
the following histological pattern of endometrial (AI 99, 98; PGI 99)
hyperplasia: (AIMS May 06) a. Endometrium Ca b. Ovary Ca
a. Simple hyperplasia without atypia c. Cervix Ca d. Vagina Ca
b. Simple hyperplasia with atypia 10. Which of the following is not seen with corpus
c. Complex hyperplasia without atypia cancer syndrome in cancer endometrium?
d. Complex hyperplasia with atypia (AIIMS Nov 2010)
a. Multiparity b. Diabetes mellitus
2. The risk of complex hyperplasia of endometrium
c. Hypertension d. Obesity
with atypia progressing to malignancy in a
11. A 50-year-old woman, nulliparous, diabetic and
postmenopausal woman is: (AIIMS 04, 05)
obese presenting with post-menopausal bleeding
a. 3% b. 8%
likely diagnosis is: (PGI 99)
c. 15% d. 28%
a. Carcinoma in situ of cervix
3. Percentage change of cystic glandular hyperplasia b. Carcinoma endometrium
turning to malignancy: (PGI June 05) c. DUB
a. 0.1% b. 2% d. None of the above
c. 1% d. 10% 12. True about endometrial carcinoma: (PGI 01)
e. 15% a. Predisposed by diabetes mellitus, hypertension
4. Endometrial hyperplasia is seen in: (AI 04) and obesity
a. Endodermal sinus tumor b. Adenosquamous type is most common
b. Dysgerminoma c. Commonly associated with Ca cervix
c. PCOD d. Common age group affected is between 20 and 40
d. Ca cervix years
13. The most malignant endometrial carcinoma is:
5. What is the ideal treatment for a 55-years-female
a. Adenocarcinoma (JIPMER 03)
with Simple hyperplasia of endometrium with
b. Adenoacanthoma
Atypia? (AI 08) c. Mixed adenosquamous carcinoma
a. Simple hysterectomy d. Clear cell carcinoma
b. Medroxy progesterone acetate (MPA)
14. Investigation of choice in a 55-year-old post
c. Levonorgesterol (LNG) menopausal woman who has presented with
d. IUCD postmenopausal bleeding: (AI 06, 98)
6. All of the following are known risk factors for a. Pap smear
development of endometrial carcinoma except: b. Fractional curettage
a. Obesity (AI 03, 02) c. Transvaginal ultrasound
b. Family history d. CA - 125 estimation
c. Use of hormone replacement therapy 15. The stage of cancer endometrium with invasion of
d. Early menopause 10 mm of myometrium is: (AI 00)
7. Risk for endometrial cancer is: (PGI 04, 00) a. Ia b. Ib
a. Obesity c. IIb d. IIa
b. Pregnancy before 20 years age 16. Carcinoma endometrium with positive superficial
c. PCOD inguinal lymph node status is classified as stage:
(AI 99)
d. Combined OC pills
a. I b. II
e. Artificial menopause
c. III d. IV
8. All are the risk factors for endometrial carcinoma
17. True about endometrial carcinoma in clinical stage
except: (PGI June 09) III: (PGI June 09)
a. Multiparity a. Vaginal metastasis
b. Obesity b. Para aortic lymph node involvement
c. Early menopause c. Pelvic lymph node involvement
d. Unopposed estrogen therapy d. Peritoneal involvement
e. Hypertension e. Inguinal lymph node involvement
294 Self Assessment & Review: Gynecology

18. Lymph nodes not involved in Ca endometrium is: c. Carcinoma in situ

(AIIMS 97) d. Papillary serous tumor
a. Para-aortic b. Presaral e. Estrogen receptor positive
c. Inferior mesenteric d. Inguinal 27. Which of the following direct lymph node
19. A perimenopausal lady with well differentiated dissections in endometrial carcinoma?
adenocarcinoma of uterus has more than half a. Penetration into half of myometrium
myometrial invasion, vaginal metastasis and b. Clear cell carcinoma
inguinal lymph node metastasis. She is staged as: c. Fundal involvement d. Peritoneal metastasis
(AIIMS 96, 03) e. Papillary serous carcinoma
a. Stage IIIB b. Stage IIIC 28. An 80-year-old female who has never taken
c. Stage IVA d. Stage IVB estrogen, develops pink vaginal discharge. An
20. A lady presented with carcinoma endometrium endometrial biopsy shows an adenocarcinoma of
involving >50% of myometrium extending to the endometrium. Papanicolaou smear is negative.
vagina and positive peritoneal cytology but no Of the following what is the most important
involvements of para aortic and pre aortic nodes. indicator of prognosis? (AI 04)
What is the stage of disease? (AIIMS Nov 2010) a. Body habitus b. Level of CA–125
a. III A b. III B (May 2012) c. Nutritional status d. Histologic type of tumor
c. III C1 d. III C2 29. Following can cause endometrial cancer: (AP 2008)
21. Stage III B endometrial Ca-true is: a. Metropathia hemorrhagica
a. Vaginal metastasis (PGI June 08, Dec. 06) b. Gynandroblastoma
b. Lymph node metastasis c. Dysgerminoma d. All of the above
c. Bowel involvement 30. A female patient has adenocarcinoma uterus along
d. Lung metastasis with sarcoma of uterus. It is known as:
e. Serosa involved a. Homologous sarcoma (AIIMS June 00)
22. Stage-IIIB endometrial carcinoma true is/are: b. Sarcoma uterus
a. Vaginal metastasis (PGI June 09) c. Mixed Mullerian carcinogenesis
b. Lymph node metastasis (paraaortic) d. Heterologous sarcoma
c. Pelvic lymph node involvement 31. All are true regarding sarcoma botryoides except:
d. Positive peritoneal cytology a. Seen in vagina (PGI 01)
e. Rectal invasion b. Grape like clusters are seen
c. Seen in elderly women
23. Choice of adjuvant treatment for endometrial
d. It is an adenocarcinoma
carcinoma stage I A grade I is: (AI 04)
e. Familial incidence is common
a. Radiotherapy b. Chemotherapy
c. Chemotherapy + Radiotherapy 32. True statement regarding sarcoma botryoides:
d. No treatment a. Involvement of vagina (PGI May 2010)
b. Grape like growth seen
24. The following are indications for postoperative
c. Common in old age
radiotherapy in a case of carcinoma endometrium
d. Malignant
except: (AIIMS 04, 05)
a. Myometrial invasion of more than half thickness
b. Positive lymph nodes NEW PATTERN QUESTIONS
c. Endocervical involvement
33. Primary carcinoma body of the uterus may be of
d. Tumor positive for estrogen receptors
following types except:
25. Indication for radioterhapy in carcinoma a. Adenocarcinoma
endometrium include all except: (AIIMS Nov. 07) b. Adenosquamous carcinoma
a. Pelvic node involvement c. Clear cell type
b. Deep myometrial involvement d. Large cell keratinising type
c. Enlarged uterine cavity 34. The following are precursors of endometrial
d. Poor differentiation carcinoma except:
26. Indication of adjuvant radiotherapy in Ca a. Atypical adenomatous hyperplasia
endometrium is/are: (PGI 05) b. Atrophic endometrium
a. Cervical involvement c. Adenocarcinoma in situ
b. Lymph node involvement d. Cystic hyperplasia
 Chapter 14B  Gynecological Oncology: CIN Cancer Cervix 319

QUESTIONS

CIN 8. Pap smear of Lelawati 45 years female shows CIN

grade III. Which of the following is the next step in
1. True about CIN: (PGI Dec 04) management: (AIIMS 00)
a. Premalignant lesion a. Punch biopsy
b. HPV predisposes b. Large loop excision
c. Pap smear can detect it c. Colposcopy directed biopsy
d. Chlamydia infection can predispose d. Cone biopsy
e. Occurs at squamocolumnar junction 9. Cone biopsy is indicated in all the following conditions
2. A patient is diagnosed to have CIN II. She approaches except: (AIIMS 00)
you for advice. You can definitely tell her the risk of a. Indefinite diagnosis on colposcopy
malignancy as: (AI 98; AIIMS 01) b. CIN-III
a. 15% b. 60% c. Cervical metaplasia
c. 30% d. 5% d. Microinvasive carcinoma
3. All of the following changes are seen in dysplasia of 10. Cone biopsy of cervix is indicated in all cases showing:
squamocolumnar junction, except: (AIIMS 97) (PGI 04)
a. Breaking of basement membrane a. Parametrial invasion
b. Change of epithelium b. Abnormal pap smear
c. Hyperchromatic nuclei c. Endometrial Ca
d. Increased mitotic figure d. Endocervical curettage positive
e. Clear cell Ca
4. In a cervix low grade squamous intraepithelial leison
(LSIL) in Bethseda system includes: (PGI May 2010) 11. Therapeutic conisation is indicated in: (AIIMS 00)
a. CIN 1 b. CIN 2 a. Microinvasive carcinoma
c. CIN 3 d. Squamous metaplasia b. CIN (III)
c. Unsatisfactory colposcopy with cervical dysplasia
5. Pap smear is useful in the diagnosis of all EXCEPT:
d. Cervical metaplasia
a. Gonorrhea (AIIMS May 02)
12. Young lady comes with mild erosion of cervix and pap
b. Trichomonas vaginalis
smear shows dysplasia, next step is: (PGI Dec 98)
c. Human papilloma virus
a. Antibiotics b. Colposcopy
d. Inflammatory changes
c. Cryosurgery d. Conization
6A. Acetic acid staining of cervix shows following except:
13. A 45 years old lady complains of contact bleeding. She
(AIIMS May 02)
has positive pap smear. The next line of management
a. Squamous dysplasia
is: (AIIMS 99)
b. Cervical carcinoma in situ
a. Colposcopy directed biopsy
c. Cervical polyp
b. Cone biopsy
d. Cervical dysplasia c. Repeat pap smear
6B. Colposcopic features suggestive of malignancy are all d. Hysterectomy
except: (PGI 99) 14. A 35-year-old lady with post coital bleeding management
a. Condyloma b. Vascular atypyia is: (AIIMS Nov 09; May 08)
c. Punctation d. White epithelium a. Clinical examination and pap smear
6C. In colposcopy following are visualised except: b. Visual examination with lugol iodine
a. Upper 2/3rd endocervix c. Visual examination with acetic acid
b. Cervical carinoma in situ d. Colposcopy
c. Cervical polyp 15. Treatment of choice of stage III CIN in 40-year-old
d. Cervical dysplasia female is: (AIIMS 97; PGI 96)
6D. All of the following are indications of colposcopy: a. Hysterectomy
a. Suspicious pap smear (PGI Dec 05) b. Laser coagulation
b. Obvious mass seen c. Cryocoagulation
c. Suspected invasive carcinoma d. Cone excision
d. Patient who refuse biopsy 16. A 40-year-old woman presents with abnormal cervical
7. Rekha a 45-year-old woman has negative pap smear cytology on PAP smear suggestive of CIN (III). The next
with +ve endocervical curretage. Next step in manage- best step in management is: (AI 2010)
ment will be: (AI 01) a. Hysterectomy
a. Colposcopy b. Vaginal hysterectomy b. Colposcopy and LEEP
c. Conization d. Wertheim’s hysterectomy c. Colposcopy and cryothereapy
d. Conization
320 Self Assessment & Review: Gynecology

17. A female 35 years P3 L3 with CIN III on colposcopic 28. M/C agent responsible for Ca cervix is: (Al 07)
biopsy what would you do? (AI 09) a. HPV 16 b. HPV 18
a. LEEP b. Conization c. HPV 31 d. HPV 36
c. Hysterectomy d. Cryotherapy 29. HPV associated with adenocarcinoma of cervix:
18. A 55-year-old lady presenting to out patient department (PGI 05)
(OPD) with postcoital bleeding for 3 months has a 1 a. Type 6 b. Type 18
× 1 cm nodule on the anterior lip of cervix. The most c. Type 11 d. Type 42
appropriate investigation to be done subsequently is: 30. Most common type of human papilloma virus causing
(AI 03) Ca cervix are: (PGI 03)
a. Pap smear b. Punch biopsy a. 16 and 18 b. 1 and 33
c. Endocervical curettage d. Colposcopy c. 6 and 11 d. 2 and 14
19. A 50-year-old women present’s with post coital bleeding. e. 2 and 5
A visible growth on cervix is detected on per speculum 31. High risk HPV includes: (PGI 02)
examination. Next investigation is: (AI 01) a. Type 16 b. Type 18
a. Punch biopsy b. Colposcopic biopsy c. Type 11 d. Type 12
c. Pap smear d. Cone Biopsy
32. HPV type teast commonly associated with carcinoma
20. Meena 45-years-old female presents with post coi-
cervix: (PGI Nov 2012)
tal bleeding. On per speculum examination a friable
a. 6 b. 11
mass is found in cervix. Next step in management is:
c. 16 d. 18
(AIIMS Nov 00)
e. 33
a. Colposcopy directed biopsy
b. 6 monthly pap smear 33. Cervix carcinoma arises from: (PGI Dec 08)
c. Only observation a. Squamocolumnar junction
d. Punch biopsy b. Isthmus
21. A patient complaints of post coital bleed; no growth is c. Cervical lip
seen, on per speculum examination; next step should d. Internal os
be: (AI 01) 34. Earliest symptom of carcinoma cervix is:
a. Colposcopy biopsy b. Conisation a. Irregular vaginal bleeding (PGI 99)
c. Repeat pap smear d. Culdoscopy b. Post coital bleed
22. Investigation of choice in postcoital bleeding in a c. Foul smelling discharge
60-year-old lady is: (AIIMS 96, 97; AI 96) d. Pain
a. Pap smear b. Colposcopy and biopsy 35. A case of carcinoma cervix is found in altered sensorium
c. Pelvic ultrasound d. Cone excision of cervix and is having hiccups. Likely cause is: (AI 01)
a. Septicemia b. Uremia
CARCINOMA CERVIX c. Raised ICT d. None of the above
23. True about Ca cervix: (PGI Dec 06) 36. Which investigation is not done in FIGO staging of CA
a. 90% associated with HPV cervix: (AIIMS 96)
b. Nulliparity a. Cystoscopy b. Chest X-ray
c. OCP c. Pelvic ultrasound d. IVP
d. Immunocompromised patients 37. All of the following investigations are used in FIGO
24. Predisposing factors for Ca cervix: (PGI Dec 08) staging of carcinoma cervix except: (AIIMS Nov 08)
a. Multiple sex partners b. Genital warts a. CECT b. Intravenous pyelography
c. HPV 16, 18 d. Virginity c. Cystoscopy d. Proctoscopy
e. Late menarche 38. Carcinoma cervix extends upto lateral pelvic wall. The
25. Risk factor for Ca Cervix: (PGI Dec 04) stage would be: (AI 97)
a. HPV b. Smoking a. Stage I b. Stage II
c. Late Menarche d. Nulliparity c. Stage III d. Stage IV
e. Early sexual intercourse
39. Which is/are feature(s) of stage lb2 cancer cervix:
26. Carcinoma cervix is more common in: (PGI 01) (PGI Nov 12)
a. HIV patient b. Multiparity a. Microinvasive carcinoma with stromal invasion < 3
c. Smoking d. Nulliparity mm
e. Family history b. Microinvasie carcinoma with stromal invasion < 5
27. Which of the following is not a risk factor for CA cervix? mm
a. Low parity (AIIMS Nov 2013) c. Microinvasive carcinoma with 6mm carcinoma with
b. Multiple sexual partner stromal invasion > 5 mm
c. Early sexual intercourse (< 16 years) d. Size of lesion ≤ 4 cm
d. Smoking e. Size of lesion > 4 cm
 Chapter 14B  Gynecological Oncology: CIN Cancer Cervix 321

40. Which of the following statements about squamous cell 50. Treatment of stage III B carcinoma cervix is:
carcinoma of cervix is false: (AI 08) (AIIMS Nov 2010/AIIMS May 2012 Nov 2012)
a. Common at squamocolumnar junction a. Wertheim procedure
b. CT scan is mandatory for staging b. Schauta’s procedure
c. Post coital bleeding is a common symptom c. Chemotherapy
d. HPV 16 and 18 are associated with high risk of d. Intracavitary brachytherapy followed by external
carcinogenesis beam RT
41. In Ca cervix lymphatic spread involve which of the 51. True statement regarding Ca cervix involving parame-
following lymph node/nodes: (PGI 02) trium but not pelvic involvement: (PGI May 2010)
a. Obturator LN b. External iliac LN a. Stage II A
c. Inguinal LN d. Femoral LN b. Stage II B
e. Hypogastric LN c. Radiotherapy should be given
42. LN involved in cervical cancer: (PGI Dec. 05) d. Hysterectomy can be useful
a. Inguinal LN b. Obturator LN e. Staging should be done after cystoscopy
c. Hypogastric LN d. External Iliac LN 52. Cervical cone biopsy in a case of carcinoma cervix causes
e. Femoral LN all, except: (AIIMS May 94)
43. Best treatment of carcinoma in situ of cervix: (PGI 98) a. Bleeding
a. Simple hysterectomy b. Cervical stenosis
c. Infection
b. Conization c. Laser
d. Spread of malignancy
d. Cryosurgery e. All

53. A 55-year-old woman was found to have Ca cervix,
44. A 42-year-old female P3 + 0 + 0 + 3 is found to have
FIGO stage 2–3, locally advanced. What would be the
carcinoma in situ. Best treatment would be: (Al 97)
management?: (AIIMS May 2012)
a. Hysterectomy
a. Surgery plus chemotherapy
b. Wertheim’s hysterectomy
b. Radiotherapy plus chemotherapy
c. Conisation d. Wait and watch
c. Chemotherapy
45. In microinvasive cervical cancer, most common treat­ d. Rediotherapy plus HPV vaccine
ment is: (PGI 97)
a. Conization b. Laser NEW PATTERN QUESTIONS
c. Simple hysterectomy d. Radical hysterectomy
46. False statement about treatment of Ca cervix: 54. All are signs of inoperabilty of carciroma of cervix
(PGI June 05) except
a. Radiotherapy is helpful in all stages a. Cervix of cervix and parametrum to lateral peliac wall
b. Prognosis of surgery good if done in early stages b. Presence of extgrapelvic metastasis
c. When radiotherapy is given, para-aortic LNs should c. Involvement of bladder
be included d. Extensive infiltration of vagina
d. Chemotherapy is reserved for late stages 55. If stage Ib cervical cancer is diagnosed in a young
e. From stage Ib onwards same prognosis with surgery woman, while performing radical hysterectomy which
and RT structure would you not remove:
47. A lady undergoes radical hysterectomy for stage Ib ca a. Uteroseval and uterovesical ligament
cervix. It was found that cancer extends to lower part b. Pelvic LN
of body of uterus and upper part of cervix next step of c. Both ovaries
management will be: (AIIMS May 2010) d. Upper third of vagina
a. Chemotherapy b. Radiotherapy 56. Point B in the treatment of carcinoma cervix receives
c. Chemoradiation d. Follow-up the dose of:
48. Treatment of Ca cervix stage IB includes: (PGI Nov 10) a. 7000 cGy
a. Surgery b. Chemotherapy b. 6000 cGy
c. Radiotherapy d. Cryotherapy c. 5000 cGy
e. Leep d. 10,000 cGy
49. Treatment of stage lla cervical cancer includes: 57. HPV triage strategy includes all except:
(PGI Nov 12) a. Conventional pap smear
a. Radical hystrectomy b. Liquid based cytology
c. Hybrid capture 2 for HPV DNA
b. Radical hystrectomy with pelvic lymph node dissec-
d. Colposcopy
tion
c. Total abdominal hysterectomy with B/L salphingo 58. M/C site of metastasis of Ca cervix is
oopherectomy a. Lymph node b. Lungs
d. Chemoradiation c. Bone d. Abdominal cavity
322 Self Assessment & Review: Gynecology

59. A 55-year-old woman is diagnosed with invasive 61. Concerning invasive cervical carcinoma all are correct
cervical carcinoma by cone biopsy. Pelvic examination except:
and rectal examination reveal the parametrium is free a. Radical hysterectomy is not indicated for stage Ia
of disease but upper part of vagina is involved with disease, if the excision margins are
tumor .IVP and sigmoidoscopy are negative but CT free of the disease
b. MRI imaging is safe for staging even during
S can of abdomen and pelvis shows grossly enlarged
pregnancy
pelvic and para aortic nodes. Thus patient is classified
c. Radical trachelectomy and pelvic lymphadenec­
as stage: tomy can be done for stage IIa disease
a. IIa b. IIb d. Pregnancy rate is about 35% within 1 year following
c. IIIa d. IIIb radical trachelectomy
e. IV 62. The following statements are related to the treatment of
60. An intravenous pyelogram (IVP) showing hydrone- carcinoma cervix stage 1B except:
phrosis in the work up of a patient with cervical cancer a. Surgery and radiotherapy have got almost equal
otherwise confined to a cervix of normal size would in- 5-year-survival rate
dicate stage: b. Surgery has got higher morbidity than radiotherapy
a. I b. II c. Radiotherapy has got few limitations
c. III d. IV d. In younger age group, radiotherapy is preferred
 Chapter 14C  Gynecological Oncology: Ovarian Tumors 347

FIGURE BASED QUESTION

F1. Figure 1 shows specimen of ‘Para ovarian cyst’. All of
the following are true in relation to para ovarian cyst
except:
a. It is a true broad ligament cyst
b. It usually arises from epoophoron
c. Malignant transformation is frequent
d. More chances of ureteric injury during surgical
removal Fig. F1

QUESTIONS

General Epithelial Cell Tumors

1. All of the following are known risk factors for the 8. Ovarian tumours are commonly arise from: (UP 05)
development of ovarian carcinoma except: (AIIMS 03) a. Stroma b. Surface epithelium
a. Family history of ovarian carcinoma c. Germinal epithelium d. Endoderm
b. Use of oral pills 9. True about Brenner tumor: (PGI 03)
c. Use of Clomiphene a. Usually bilateral
d. BRCA - 1 positive individual b. Resembles fibroma
c. Accounts for 20% of all ovarian tumors
2. Which of the following strategy has been recommended
d. Common in postmenopausal age group
to reduce the heredity risk for ovarian cancer in women
with BRCA - 1 and BRCA - 2 mutations? (AIIMS 05) 10. A 25-year-old married nullipara undergoes laparoscopic
a. Use of oral contraceptive pills cystectomy for ovarian cyst which on histopath reveals
ovarian serous cisadenocarcinoma. What should be the
b. Screening with transvaginal ultrasound
c. Screening with CA - 125
next management? (AIIMS Nov 08)
a. Serial Ca-125 measurement and follow-up
d. Prophylactic oophorectomy
b. Hysterectomy and bilateral pingo oophorectomy
3. Most common ovarian tumor in less than 20 years is: c. Hysterectomy + Radiotherapy
(AIIMS 97) d. Radiotherapy
a. Epithelial tumour b. Germ cell tumour
11. Chemotherapeutic drug effective in the treatment of
c. Metastatic tumour d. Sexcord stromal tumour
epithelial ovarian cancer is: (Karn 02)
4. Which of the following is the most radiosensitive a. Carboplatin b. Paclitaxel
ovarian tumors? (AIIMS 97) c. Cyclophosphamide d. Methotrexate karnataka
a. Dysgerminoma b. Dermoid cyst
c. Serous cystadenoma d. Endodermal sinus tumour Sex Cord Tumors
5. MC ovarian tumour in younger age group or M/C
12. Which of the following are masculinizing tumors of the
malignant Tm in young age group: (PGI June 05/04)
ovary? (AI 97)
a. Dysgerminoma
a. Granulosa cell tumor
b. Dermoid
b. Dysgerminoma
c. Mucinous cystadenoma
c. Dermoid Cyst
d. Fibroma
d. Arrhenoblastoma
e. Granulosa cell tumour
13. Which of the following is correct regarding granulosa
6. All of the following are true about Borderline tumors cell tumour of ovary? (AIIMS 96)
except: a. Common in puberty
a. 10% of all epithelial tumours are borderline. b. Associated with Ca endometrium
b. they have a good prognosis. c. Malignant change occur rarely
c. Metastases are common d. It is bilateral
d. Absence of stromal invasion 14. True about granulosa cell tumours: (PGI Dec 05)
7. According to WHO classification of ovarian tumours, a. MC malignant tumour of ovary
Brenner tumor of ovary belongs to: b. It secretes hormones
a. Epithelial tumours b. Sex cord stromal tumours c. Associated with endometrial hyperplasia
c. Germ cell tumours d. Metastatic tumours d. Chemotherapy sensitive
348 Self Assessment & Review: Gynecology

Germ Cell Tumor 25. True about endodermal sinus tumors: (PGI Dec 05)
a. Schiller duval bodies seen
15. The most common pure germ cell tumour of the ovary: b. It is a benign tumour
a. Choriocarcinoma b. Dysgerminoma  (AI 05) c. ↑ HCG
c. Embryonal cell tumor d. Malignant Teratoma d. It is seen in young individuals
16. Which of the following is the most common pure e. It is a malignant tumour
malignant germ cell tumor of the ovary?
(AIIMS 04, 05) Krukenberg Tumor
a. Choriocarcinoma b. Gonadoblastoma
c. Dysgerminoma d. Malignant teratoma 26. All of the following are true about Krukenberg’s tumor
except: (AI 96)
17. Malignant germ cell tumours of ovary includes all of the
a. Has a rough surface
following except: (PGI 04) b. Shape of ovary is maintained
a. Choriocarcinoma b. Arrhenoblastoma
c. Usually bilateral
c. Brenner’s tumor d. Serous cystadenoma
d. Arises usually form stomach carcinoma
e. Teratoma
27. Smt. Pushpa is a suspected case of ovarian tumors. On
18. Features of dysgerminoma are: (PGI June 06) laparotomy bilaterally enlarged ovaries with smooth
a. Unilateral b. Post-menopausal surface was seen: (AIIMS 00)
c. Virilising d. Cut section gritty a. Granulosa cell tumor
e. ↑ AFP b. Krukenberg tumor
19. True about dysgerminoma: (PGI June 09) c. Dysgerminoma
a. Radiosensitive d. Primary adenocarcinoma
b. Most common malignant germ cell tumor 28. The following tumours commonly metastasise to the
c. Bilateral ovary, except: (J & K 05)
d. ↑ AFP a. Malignant melanoma b. Stomach
e. Common in postmenopause c. Oesophagus d. Lymphoma
20. True about dysgerminoma of ovary: (PGI Dec. 04)
a. Blood spread seen Presentation/Complication
b. Schiller-Duval bodies seen
c. Increase alfa fetoprotein 29. A 55-year-old female presents with abdominal pain,
d. Bleomycin, etoposide and cisplatin given distension, ascites and dyspnea. Her CA 125 levels are
e. Radiosensitive elevated. The most likely diagnosis is: (AI 2012)
21. Chemotherapy for dysgerminoma is: (AP 05) a. Ca ovary b. Ca cervix
a. Cisplatin, etoposide, bleomycin c. Ca lung d. Symphoma
b. Cyclophophamide, vincristine, prednisolone 30. Pain of ovarian carcinoma is referred to:
c. Adriamycin, cyclophophamide, cisplatin a. Back of thigh (AIIMS May 2010)
d. Methotrexate, oncovin, cyclophosphamide b. Cervical region
22. A 12 years old female is admitted as a patient of dys- c. Anterior surface of thigh
germinoma of right ovary 4 x 5 cm in size with intact d. Medial surface of thigh
capsule. Best treatment will be: (AIIMS 01) 31. True about Meig’s syndrome: (PGI Dec 06)
a. Ovarian cystectomy a. Lymphatic dysplasia
b. Oophorectomy on the involved side b. 2–30 years age
c. Bilateral oophorectomy c. Associated with ascites and pleural effusion
d. Hysterectomy with bilateral salpingo oophorec-tomy d. No treatment required
23. True about dermoid cyst of ovary: (PGI 03) 32. All are components of Meig’s syndrome, except:
a. It is teratoma a. Pleural effusion (AIIMS 97; AI 95)
b. Frequently undergo torsion b. Ovarian tumour
c. X-ray is diagnostic c. Ascites
d. Invariably turns to malignancy d. Pericardial effusion
e. Contains sebaceous material and hairs
33. Meig’s syndrome is associated with: (PGI 95, 99)
24. True about Yolk sac tumor: (PGI 02) a. Teratoma b. Brenner tumour
a. Also called endodermal sinus tumour c. Theca cell tumour d. Fibroma
b. Always have elevated AFP level 34. The most common complication of an ovarian tumor is:
c. Schiller Duval bodies seen
(AI 95)
d. Highly malignant
a. Torsion b. Hemorrhage
e. Arise from epithelial cells of ovary
c. Infection d. Hyaline change
 Chapter 14C  Gynecological Oncology: Ovarian Tumors 349

35. Most common ovarian cyst to undergo torsion: (AI 07) 44. A lady has ovarian mass, X-ray pelvis shows a radio-
a. Benign cystic teratoma b. Dysgerminoma opaque shadow. The probable diagnosis is: (AIIMS 98)
c. Ovarian fibroma d. Brenner’s tumour a. Mucinous cyst adenoma
36. Pseudomyxoma peritonei is seen in: (PGI 98) b. Serous cyst adenoma
a. Serous cystadenoma c. Dysgerminoma
b. Pseudomucinous cyst d. Dermoid cyst
c. Mucinous cystadenoma 45. A 20-year female presents with a ovarian mass 6× 6 ×
d. Teratoma 6 cm in size. Ultrasonography reveals solid structures in
37. The pseudomyxoma peritonei occurs as a complication the mass. Her serum biomarkers such as AFP. ƒÒ-hCG
and CA 125 are normal, however, her serum alkaline
of the following ovarian tumours: (AIIMS May 06)
phosphatase was found to be elevated. The most likely
a. Serous cystadenoma b. Mucinous cystadenoma
c. Dysgerminoma d. Gonadoblastoma diagnosis is: (AIIMS Nov 2011)
a. Dysgerminoma
38. Attacks of flushing and cyanosis occur in which type of
b. Endodermal sinus tumor
ovarian tumors: (AIIMS 79; AMU 82) c. Malignant teratoma
a. Struma ovarii d. Mucinous cystadenocarcinoma
b. Krukenberg’s tumor
46. Smt. Pushpa is a suspected case of ovarian tumors. On
c. Arrhenoblastoma
laparotomy bilaterally enlarged ovaries with smooth
d. Carcinoid tumors of ovary
e. Granulosa cell tumor surface was seen: (AIIMS 00)
a. Granulosa cell tumor b. Krukenberg tumor
(Ref. Shaw 15th/ed p 378)
c. Dysgerminoma d. Primary adenocarcinoma

Diagnosis 47. Reinke’s crystals are found in: (AIIMS 95)

a. Arrhenoblastoma b. Granulosa cell tumor
39. In a suspected case of ovarian cancer, imaging work up c. Dysgerminoma d. Hilus cell tumor
is required for all of the following except: (AI 06) 48. Which are seen in endodermal sinus tumor?
a. Detection of adnexal lesion a. Schiller-duval bodies b. Reed-Sternberg cells
b. Characterization of lesion c. Reinke’s crystals d. Russell bodies
c. Staging
d. Asses resectability Tumor Markers
40. A 45-year-old female is having bilateral ovarian mass,
ascites and omental caking on CT scan. There is high 49. In a case of Dysgerminoma of ovary one of the following
possibility that patient is having: (AI 03) tumor markers is likely to be raised: (AI 05)
a. Benign ovarian tumor a. Serum HCG
b. Malignant epithelial ovarian tumor b. Serum alpha fetoprotein
c. Dysgerminoma of ovary c. Serum lactic dehydrogenase
d. Lymphoma of ovary d. Serum inhibin
41. Feature in USG suggestive of ovarian malignancy is: 50. Which is raised in dysgerminoma? (AI 09)
(PGI 99) a. AFP b. LDH
a. Papillary pattern b. Septations c. HCG d. CA-A 19-9
c. Bilaterality d. Clear fluid 51. All of the following are the markers for malignant germ
42. A 24-year-old woman presents with new onset right cell tumors of ovary except: (AIIMS 05)
lower quadrant pain, and you palpate an enlarged, a. CA - 125 b. Alpha fetoprotein
tender right adnexa. Which of the following sonographic c. β HCG d. LDH
characteristics of the cyst in this patient suggests the 52. CA - 125 is a tumor marker for: (AIIMS 97, 98)
need for surgical exploration now instead to observation a. Carcinoma ovary b. Carcinoma endometrium
for one menstrual cycle? c. Carcinoma vagina d. Carcinoma cervix
a. Lack of ascites b. Unilocularity
53. CA - 125 is specifically associated with: (PGI 02)
c. Papillary vegetation d. Diameter of 3 cm
a. Colon Ca b. Breast Ca
43. A 20-year-old young girl, presents with history of c. Ovarian Ca d. Bronchogenic Ca
rapidly developing hirsutism and amenorrhea with e. Pancreatic Ca
change in voice. To establish a diagnosis you would like
to proceed with which of the following tests in blood? 54. CA - 125 is specific marker of: (PGI 99)
a. Choriocarcinoma
(AI 02)
b. Teratoma
a. 17 OH progesterone b. DHEA
c. Epithelial cell carcinoma of ovary
c. Testosterone d. LH + FSH estimation
d. Seminoma
350 Self Assessment & Review: Gynecology

55. A lady with CA ovary in follow-up with raised CA 125 65. What is the stage of ovarian Ca with superficial liver
level, next step: (AIIMS May 08) metastasis with B/L ovarian mass? (PGI Dec 06)
a. CT a. Stage I b. Stage II
b. PET c. Stage III d. Stage IV
c. MRI e. Ca in situ
d. Clinical exam and serial follow up of CA 125
56. Placental alkaline phosphatase is marker of: (PGI 96) Ovarian Cysts and Their Management
a. Theca cell tumor b. Teratoma
c. Choriocarcinoma d. Dysgerminoma 66. Which ovarian cyst does not undergo malignancy:
57. Marker for granulosa cell tumor: (AIIMS May 08) (AIIMS 92)
a. CA 19-9 b. Ca 50 a. Mucinous b. Papillary
c. Inhibin d. Teratoma c. Dermoid d. Granulosa Theca
(Ref. Shaw 15th/ed pg -377 for option c, 379 for
Unilateral/Bilateral option d, 375 for option a, 374 for option b)
67. All are true about serous cystadenoma of the ovary
58. All of the following ovarian tumours usually occur except: (UP 04)
bilaterally, except: (AIIMS 95) a. Bilateral
a. Metastatic mass b. Unilateral
b. Dysgerminoma c. Concentric calcification
c. Cyst adenoma of ovary d. Multiloculated, sticky, gelatinous fluid
d. Dermoid cyst (Ref. Shaw 15th/ed pg -374; Dutta Gynae 5th/ed p 282)
59. Bilateral germ cell tumour is: (AIIMS May 07) 68. A 35-year-old patient on USG shows 3 × 4 cm clear
a. Dysgerminoma ovarian cyst on right side. Next line of management is:
b. Immature teratoma
(PGI Dec 08)
c. Embryonal cell carcinoma
a. Laparoscopy b. OC pills
d. Endodermal sinus tumour
c. Wait and watch d. Ca-125 estimation
60. Which ovarian tumor is likely to involve the opposite
69. Kruti, 56 years old, complained of pain in abdomen,
ovary by metastasis? (AI 96)
a. Granulosa cell tumor with USG showing 4 cm bilateral ovarian mass with
b. Dysgerminoma increased vascularity. Next line of managements:
c. Gynandroblastoma a. USG guided ovarian tapping (AI 2007)
d. Endodermal sinus tumor b. Wait and watch
c. Surgery
Staging d. OC pills x three cycles.

61. Surgical staging of ovarian Ca all done except: (AI 09) Pregnancy and Cysts
a. Peritoneal washing b. Peritoneal biopsy
c. Omental biopsy d. Palpation of organs 70. Most common ovarian tumour in pregnancy is:
62. Laparotomy performed in a case of ovarian tumor (AIIMS 96)
revealed unilateral ovarian tumor with ascites positive a. Mucinous cyst adenoma
for malignant cells and positive pelvic lymph nodes. All b. Dermoid cyst
other structures were free of disease. What is stage of the c. Metastasis
disease? (AI 03) d. Dysgerminoma
a. Stage II b b. Stage III a 71. Which of the following ovarian tumor is most prone to
c. Stage III b d. Stage III c undergo torsion during pregnancy? (AI 06)
63. Bilateral ovarian cancer with; capsule breached; ascites a. Serous cystadenoma b. Mucinous cystadenoma
positive for malignant cells. Stage is: (AI 01; AIIMS 07) c. Dermoid cyst d. Theca lutein cyst
a. I b. II 72. A 15 cms X 15 cms ovarian cyst has been diagnosed in an
c. III d. IV 8 weeks pregnant lady. Further Management includes:
64. A 55-year-old female patient has carcinoma ovary with (PGI Nov 10)
bilateral involvement with ascitic fluid in the abdomen. a. Only follow up without surgical intervention
The stage is: (AIIMS 99) b. Laparotomy at 14–16 weeks
a. II b. III c. Cesarean delivery and ovariotomy at term
c. IV d. IC d. Surgery after delivery
e. Dysgerminoma
e. Immediate operation
 Chapter 14C  Gynecological Oncology: Ovarian Tumors 351

73. Which is/are used in management of stage III ovarian 76. Sex cord stromal tumours of the ovary include all
cancer: except:
a. Debulking a. Luteomas
b. Mantle field irradiation b. Gynandroblastomas
c. Abdomino-pelvic radiotherapy is very effective c. Sertoli-Leydig cell tumours of the ovary
d. Chemotherapy d. Theca-fibroma
e. Cytoreduction 77. True regarding neoplasms of the ovary are:
a. Stromal invasion is commonly present in ovarian
NEW PATTERN QUESTIONS tumours of borderline malignancy
b. Lymphocytic infiltration is characteristic to dysger-
74. Lutein cysts are associated with all except: minoma
a. Gestational trophoblastic tumours c. Presence of ascites and pleural effusion in Brenner
b. Clomiphene administration tumour indicates poor prognosis
c. Bilaterality d. Endometrioid carcinoma of the ovary may coexist
d. Use of OCP’s with endometrial adenocarcinoma
75. The following statements are related to Krukenberg 78. A 52 years postmenopausal female presents unilocular
tumour except: with a ovarian cyst of 6 cms with normal Ca125 levels
a. It is always secondary management is:
b. The most common primary site is pylorus of the a. USG guided ovarian tapping
stomach b. Wait and watch
c. The tumour is bilateral c. Surgery
d. ‘Signet ring’ looking cells are characteristic d. OCP
 Chapter 14D  Gynecological Oncology: Miscellaneous Tumors 371

QUESTIONS

1. Most common vaginal carcinoma is: (PGI 99) 11. Pyometra is a complication associated with all of the
a. Squamous cell carcinoma following conditions except: (AI 03)
b. Adenocarcinoma a. Carcinoma vulva
c. Botryoid’s tumor b. Carcinoma cervix
d. Columnar hyperplasia c. Carcinoma endometrium
2. Involvement of pelvis in a case of vaginal carcinoma of d. Pelvic radiotherapy
stage: (AI 97) 12. Characteristic feature of carcinoma fallopian tube:
a. I b. II  (MAHE 01)
c. III d. IV a. Watery discharge P/V
3. Common differential diagnosis of verrucous carcinoma b. Hemorrhage
is: (AIIMS 96) c. Pain
a. Condylomata lata d. Sepsis
b. Condylomata acuminata 13. Patient diagnosed as squamous cell intraepithelial
c. Adenocarcinoma lesion which of the following has the highest risk for
d. Tuberculosis progression to carcinoma: (AIIMS Nov 07)
4. Which is most comonly implicated in genital (vulval) a. Low grade squamous intraepithelial neoplasia
warts ? (AIIMS May 08) b. High grade squamous intraepithelial neoplasia
a. HPV 16 b. HPV 18 c. Squamous intraepithelial associated with HPV 16
c. HPV 31 d. HPV 6 d. Squamous intraepithelial neoplasia associated with
5. True about Ca vulva associated/predisposed by: HIV
(PGI 02) 14. Sentinel biopsy most effective in: (AI 2010)
a. Paget’s disease a. Cervix cancer b. Endometrium ca
b. Vulval intraepithelial neoplasia c. Vulval ca e. Vaginal ca
c. Bowen’s disease 15. The treatment of leukoplakia of vulva is:
6. Vulval Ca, True statements: (PGI Dec 09) (UPSC 85; PGI 86)
a. Squamous hyperplasia predisposes a. Irradiation b. Simple vulvectomy
b. Paget’s disease of vulva predisposes c. Radical vulvectomy d. Estrogen cream
c. Lichen sclerosis 16. All of the following are used for screening cancers in
d. Condylomata acuminata females except: (AIIMS Nov 2014)
e. Dystrophy a. CA-125: Ovarian cancer
7. True about carcinoma vulva: (PGI 04) b. Office endometrial aspirate: Endometrial carcinoma
a. Spreads to superficial inguinal nodes c. Pap smear: Cervical cancer
b. Spreads to iliac nodes d. Mammography: Breast cancer
c. Seen after menopause 17. Which of the following most commonly causes
d. Viral predisposition intraorbital metastasis in female? (AIIMS Nov 13)
e. Radiotherapy given a. Breast cancer b. Cervical cancer
8. Brachytherapy is used in: (PGI 00) c. Ovarian cancer d. Endometrial cancer
a. Stage Ib Ca cervix
b. Ovarian Ca NEW PATTERN QUESTIONS
c. Stage IV Ca vagina
d. Stage II fallopian tube Ca 18. Most common recurrence sites or metastatic sites of
9. All of these secrete hormone, except: malignancy following pelvic surgery are all except:
a. Granulosa cell tumor  (AIIMS May 93) a. Carcinoma cervix — Lateral pelvic wall and central
b. Dysgerminoma pelvis
c. Hilus cell tumor b. Carcinoma ovary — Lung
d. Theca cell tumor c. Chorionepithelioma — Suburethral region in
anterior vaginal wall
10. Pyometra commonly occurs following:
d. Carcinoma body — Vault of vagina
(AIIMS Dec 94)
a. Carcinoma endometrium 19. The most common site of vulval cancer:
b. Carcinoma cervix a. Labia majora
c. Carcinoma urethra b. Labia minora
d. Senile endometritis c. Prepuce of the clitoris
d. Bartholin’s gland
372 Self Assessment & Review: Gynecology

20. The following statements are related to clear cell a. Adenocarcinoma

carcinoma of the vagina except: b. Basal cell carcinoma
a. Common to those whose mothers were given c. Choriocarcinoma
diethylstilbestrol during early pregnancy d. Squamous cell carcinoma
b. Vaginal adenosis may progress to this conditions 22. All of the following statements hold true for melanoma
c. The middle one-third is the commonest site of vulva except:
d. May be multicentric and may involve even the a. It is the 2nd M/C vulval cancer
cervix as well b. M/C site is labia majora
21. The following primary tumours are common in the c. May arise from junctional nevus
vulva except: d. Has a poor prognosis
380 Self Assessment & Review: Gynecology

19. Maximum chances of ureteric injury are with: (AI 06) 24. Indications of rectal examination in gynecology are all
a. TAH except:
b. Wertheims hysterectomy a. In cases with müllerian agenesis
c. Anterior colporrhaphy b. In virgin females
d. Vaginal hysterectomy
c. To differentiate rectocele from enterocele
20. Transcervical endometrial resection (TCRE) is used in:
d. For staging of ovarian malignancy
a. Endometriosis (PGI June 99)
b. DUB 25. The advantages of cryosurgery over electrocauteriza-
c. Carcinoma endometrium tion are all except:
d. Submucous fibroid a. Less discomfort to the patient
b. Postoperative bleeding is much less
NEW PATTERN QUESTIONS c. Postoperative vaginal discharge is also much less
d. Cervical stenosis is extremely rare
21. Cryosurgery is effective in all except:
26. Position of the patient should be as described except:
a. Chronic cervicitis
b. Squamous intraepithelial lesion (SIL) a. Diagnostic laparoscopy—Trendelenburg with about
c. Condyloma accuminata 30° tilt
d. Cases with severe dysplasia or CIS lesion b. Colposcopy—Lithotomy
22. Regarding outpatient hysteroscopy all are correct c. Transvaginal sonography in gynecology—Lithoto-
except: my with full bladder
a. Abnormal uterine bleeding is an indication d. Hysteroscopy—Lithotomy
b. Normal saline as distension medium can be used
27. Absolute contraindications of laparoscopy are:
c. It is less accurate than saline infusion sonography
a. Diaphragmatic hernia
(SIS)
d. It is not reliable to exclude endometrial carcinoma b. Generalized peritonitis
23. To minimize ureteric damage, the following preopera- c. Patient on anticoagulant therapy
tive and operative precautions may be taken except: d. Previous incomplete laparoscopy
a. Cystoscopy 28. As regard the use of laser in gynecology, all are correct
b. Direct visualization during surgery except:
c. Ureter should not be dissected off the peritoneum a. Management of CIN, VIN, VAIN
for a long distance
b. Laser laparoscopy for ectopic pregnancy
d. Bladder should be pushed downwards and out-
c. Laser hysteroscopy for presacral neurectomy
wards while the clamps are placed near the angles
of vagina d. It acts by tissue cutting, vapourization or coagulation
 Chapter

16 QUESTIONS
Miscellaneous
Question Bank

1. CA 125 is elevated in all except : (AIIMS June 98) a. CT b. Laparoscopy (PGI 00)
a. Tuberculosis b. Endometriosis c. Pap smear d. USG
c. Ovarian tumor d. Polycystic ovarian disease 10. A female presents to gynecological OPD with complain
2. A 21-year-old unmarried woman has premenstrual of cyclical pain, dyspareunia and infertility. The best
fullness of breast and pain, the likely diagnosis is: investigation to establish the diagnosis would be-
(AIIMS June 98) (AIIMS Nov 2012)
a. Galactocele b. Fibroadenosis a. TVS
b. Diagnostic laparoscopy
c. Fibroadenoma d. Mastitis
c. Hormonal study
3. Corpus luteum cyst occurs due to: (AIIMS Nov 99)
d. Aspirate from the pouch of douglas
a. HCG b. HPL
c. Estrogen d. Progesterone
NEW PATTERN QUESTIONS
4. In those mammals which are seasonal breeder, the
females are receptive only once in a year ; the cycle is
11. These are the names with associated conditions—match
termed as: (AIIMS May 06) the following:
a. Follicular b. Estrous a. Henry Turner 1. Repair of bladder fistula
c. Menstrual d. Luteal b. John Tanner 2. Primary amenorrhoea
5. Which of the following is true regarding precocious with delayed secondary
puberty? (AI 94) sex characters
a. Sexual maturity is attained early c. Marion Sims 3. Surgery for carcinoma
b. Mental function is increased cervix
c. No reproductive function d. Joe Meige 4. Staging of puberty changes
d. Body proportions are enlarged 12. Causes of vulval pain are due to all except:
a. Neuralgia of the genitofemoral nerve
6. Menstruation is defined as precocious if it starts before
b. Herpes
the child reaches the age of: (AIIMS Nov 04)
c. Vulval vestibulitis syndrome
a. 8 years b. 10 years
d. Lichen sclerosus
c. 14 years d. 20 years
13. Match the names associated in the treatment of stress
7. Primary peritonitis is more common in females incontinence:
because: (AI 01) a. Osteitis pubis 1. Raj and Stamey
a. Ostia of fallopian tubes communicate with abdominal b. Rectus sheath 2. Marshall-Marchetti
cavity Krantz
b. Peritoneum overlies the uterus c. Cystoscopy 3. Aldridge sling
c. Rupture of functional ovarian cysts d. Cystourethroplasty
d. None of the above 4. Howard Kelly
8. Post menopausal estrogen production is due to : 14. Match the following appropriately:
a. Peripheral aromatization of androstenedione a. Asherman’s syndrome 1. Chronic pelvic pain
b. Adrenal – direct production (PGI June 00) b. Rokitansky–Küster- 2. Secondary
c. Ovarian tumor Hauser syndrome amenorrhoea
c. Toxic shock syndrome 3. Primary
d. Ovary testosterone secretion
amenorrhoea
9. 40 years female, mass in pelvis detected clinically, d. Ovarian remnant 4. Menstruation and
following investigations should be done except : syndrome use of tampons
 Latest Papers 399

AIIMS MAY 2015

1. A 18-year-old girl presented to the gynecology OPD b. Mesenteric cyst
with amenorhea. On examination she was found to have c. Omental cyst
Tanner's Stage V breasts and no pubic and axillary hairs. d. Ovarian cyst
Ultrasound revealed absent uterus and nondeveloped 5. A lady with abdominal mass was investigated. On sur-
gonads. What is the likely diagnosis? gery, she was found to have bilateral ovarian masses
a. Androgen insensitivity Syndrome with smooth surface. On microscopy they revealed mucin
b. Turner's syndrome secreting cells with signet ring shapes. Diagnosis?
c. Cryptomenorrhea a. Dysgerminoma
d. Mayer Rokitansky kuster hauser syndrome b. Krukenberg tumor
2. A lady underwent vaginal hysterectomy for Carcinoma c. Mucinous adenocarcinoma of the varies
cervix. Following the surgery after her urethral catheter d. Dermoid cyst
was removed, she complained of urinary incontinence. 6. Drug not given in PCOD in a 30-year-old lady with
On examination she has normal voiding as well as con- infertility?
tinuous incontinence. Methylene blue dye was instilled a. Tamoxifen
in her bladder through her urethra and she was given b. Clomiphene
oral Phenazopyridine dye. After some time her pads were c. Oral contraceptive
checked and it showed yellow staining at the top most d. Spironolactone
pad, while the middle or bottom pads were unstained. 7. A 32-year-old P2L2 lady comes five days after unpro-
She is likely to have: tected sexual intercourse. What will be your advice for
a. Ureterovaginal fistula contraception in this lady?
b. Vesicovaginal fistula a. Levonorgestrol 0.75 mg
c. Urethrovaginal fistula b. Copper IUD
d. Vesicouterine fistula c. Two tablets of high dose OCP, repeated after 24 hours
3. Which of these is not a support of the uterus? d. Laparoscopic tubectomy
a. Urogenital diaphragm 8. According to the 2010 WHO criteria what are the charac-
b. Pelvic diaphragm teristics of normal semen analysis.
c. Perineal body a. Volume 1.5 ml, count 15 million, morphology 4% progres-
d. Rectovaginal septum sive motility 32%
4. A 10-year-old girl presents with a mass in lower abdomen b. Volume 2.0 ml, count 20 million, morphology 4% progres-
involving umbilical and the hypogastrium. On examina- sive motility 32%
tion it is cystic and mobile and the examiner is unable to c. Volume 1.5 ml, count 20 million, morphology 4% progres-
insinuate fingers between the mass and the pelvic bone. sive motility 32%
What is the likely diagnosis? d. Volume 2.0 ml, count 15 million, morphology 40% pro-
a. Duplication of small intestine gressive motility 32%

EXPLANATIONS
1. Ans. is a i.e. Androgen insensitivity syndrome Ref. Williams Obstetrics 24/e p149
See Ans. 22, Chapter 6 of the guide
2. Ans. is a i.e. Ureterovaginal fistula Ref. Shaw's Textbook of Gynecology 15/e, p186
The site of the fistula can be determined by the complaint and also by Methylene Blue 3 Swab test.
Complaint Urogenital fistula
yyH/O normal voiding + Continuous dribbling of urine from vagina Ureterovaginal fistula
yyContinuous dribbling of urine from vagina but no normal voiding Vesicovaginal fistula
yyNo continuous leakage but when patient urinates, urine comes out from urethra and vagina Urethrovaginal fistula

For details of methylene blue 3 swab test-Refer chapter 8 of the guide.
Observation Interpretation
Upper most swab soared with urine (yellow) but not with dye. Remaining 2 swabs unstained Ureterovaginal fistula
Upper and lower remain dry but middle swab soaked with dye. The upper two swabs remain dry Vesicovaginal fistula
but lower soared with dye
 Latest Papers 401

PGI MAY 2015

1. All are true about polycystic ovarian disease (PCOD) 7. Appropriate time of IUCD insertion is/are:
except: a. Immediately after delivery
a. Testosetrone>2 ng/ml b. 1 week after delivery
b. Infertility c. Post-puerperal period
c. High FSH/LH ratio d. Before menstruation
d. ↑ Insulin level e. Any time during lactation period
d. ↑E2/oestrone(E1)ratio 8. True about combined oral contraceptive:
2. Not true about Endometriosis: a. Pelvic examination is mandatory before prescribing COC
a. Sampson gave implantation theory b. Pregnancy resumes soon after discontinuation of pill
b. Cause infertility c. Protect from endometrial cancer, & ovarian cancer
c. Laproscopy is gold standard for diagnosis d. HIV antiviral drugs reduce effectivencess of COC
d. Common in low socio-economic group e. Pregnancy rate equal to non-hormonal contraceptive
3. A young lady can be counselled for sterilization operation after discontinuation
in all except: 9. True abot implanon:
a. A woman having no child may undergo sterilization a. Releases > 76 mg/day of drug
b. Women with HIV either taking or not ART can go for b. Prevent STD
sterilization c. Life span is 3 years
c. Husband consent is present d. Contains LNG
d. Young lactating women more than 25 years can go for e. Has 6 implants
sterilization 10. True about progestogen only pili:
e. If the couple has 3 or more living children, the lower a. Weight gain occurs
limit of age of the husband or wife may be relaxed at the b. Cause irregular bleeding
discretion of the operating surgeon c. It can be given to lactating mother
d. Should not be given to women over 35 years
4. Nulliparous women have high risk of following cancer:
e. Protect from breast cancer
a. Cervical cancer
11. True about Dysgerminoma:
b. Vaginal cancer
c. Breast cancer
a. Rare tumor in pregnancy
b. Always b/l
d. Ovarian cancer
c. Total abdominal hysterectomy is usually done
e. Endometrial Ca
d. Unilateral salpingo-oophorectomy is generally done
5. True about testosterone in female: e. Constitute 30% of all malignant germ cell tumour
a. > 50% testosterone secreted from ovary 12. True about Klinefelter syndrome:
b. > 80% testosterone secreted from ovary a. Leg are more in length than trunk
c. ~ .05% ng/ml is plasma concentration b. Intrauterine fertilization can not be successful even with
d. Slight decrease in the secretion at time 0/5 ovulation TESA & ICSI
e. Daily production of testosterone is 0.2–0.3% mg c. Gynecomastia
6. True about Nonoxynol-9: d. FSH and luteinizing hormone (LH) are decreased
a. Decrease risk of HIV 13. Diagnosis of Endometrial carcinoma can be made from:
b. Prevent STD infection a. Papanicolaou smear
c. Remain effective for 1–2 hours after application b. Fractional curettage
d. Spermicidal action c. Aspiration cytology from uterine
e. Causes itching of vagina in female and itching of penis d. Hysteroscopy & biopsy
in male e. Colposcopy
406 Latest Papers

PGI NOVEMBER 2014

1. Which of the following is true about endometrial carci- c. Cause endometrial hyperplasia
noma: d. Suppression of endometrium
a. Less aggressive in post menopausal women e. No significant effect on ovaries
b. More common in diabetes 4. All are true about LNG except:
c. Common after 40 year of age a. Cause Endometrial suppression
d. Associated with PCOD b. Can be used in emergency contraception
e. Associated with hereditary nonpolyposis colorectal can- c. Can not be given to lactating women
cer syndrome (HNPCC) d. Devoid of estrogenic side-effects
2. True about Trichomonas vaginitis: 5. IUCD is absolutely contraindicated in:
a. Important cause of recurrent abortion a. HIV positive women
b. T.vaginalis is a flagellated protozoa b. Previous ectopic tubal pregnancy
c. Metronidazole is used for treatment c. Mild anaemia
d. Strawberry cervix d. Undiagnosed vaginal bleeding
e. Curdy discharge 6. True about ovulation and menstruation:
3. True about Mirena: a. Temperature decrease at time of ovulation
a. Effective life is 2 year b. Estrogen have a role in proliferative phase
b. LNG containing IUD c. LH surge occurs before ovulation
d. 80 ml blood loss is normal

EXPLANATIONS

1. Ans. is. b, c, d and e i.e. More common in diabetes, common after 40 years of age, associated with PCOD and associated with
hereditary nonpolyposis colorectal cancer syndrome (HNPCC) Ref. Novars Gyne 4/e p1251, 1256
For details see chapter 14A of the guide
2. Ans. is b, c and d i.e T. Vaginals is a flagellated protozoa, metronidazole is used for treatment, and strawberry cervix.
 Ref. Dutta obs 7/e p167
Infection in genital tract may be responsible for sporadic abortion but its relation to recurrent abortion is inconclusive.
Rest all options- have been explained earlier in the book.
3. Ans. is b, d and e i.e. LNG containing IUD, suppression of endometrium and no significant effect on ovaries
 Ref. Leon Speroff 8/e p1102
For all options see chapter 10 of guide
4. Ans. is c i.e. cannot be given to lactating women.
For explanation see chapter 10 of guide
5. Ans. is d i.e. Undiagnosed vaginal bleeding
Absolute-WHO-category 4 contraindications for IUCD

Please- Periperal Sepsis, pregnancy

Don’t- DUB
Try to- Gestational Trophoplastic disease
Put- current PID/STD or within 3 months, known pelvic TB
Condom- Ca Cervix
Ca endometrium

Relative C/I:-
Wilson disease
Breast CA for miera
Distortions of uterine cavity due to congenital malformations or fibroid
Note: Ectopic pregnancy is not a C/I for use of IUCD
Undiagnosed vaginal bleeding is a C/I for IUCD  Ref. JB Sharma 1/e, page 682
6. Ans. is b, c, and d i.e Estrogen has a role in proliferative phase, LH surge occurs before ovulation and 80ml blood loss is
normal  Ref. Shaw 15/e p46,32
All the options have been explained earlier in the guide