A 25-year-old nulliparous woman, married a year ago, has a uterine prolapse with the cervix reaching the introitus on straining, without cervical elongation. Six months of pelvic floor exercises have not helped. She strongly wishes to have children. Which operation is most suitable?

Abdominal sling operation (cervicopexy)

Vaginal hysterectomy with pelvic floor repair

Manchester (Fothergill) operation

A 79-year-old widow with heart failure and COPD has a complete procidentia that keeps falling out despite ring and Gellhorn pessaries. She is not sexually active and does not intend to be. Her cervical screening is normal and ultrasound shows a thin endometrium. Which operation is most appropriate?

Manchester (Fothergill) operation

Vaginal hysterectomy with sacrospinous fixation

Fibroids, prolapse and benign gynaecology

24 NEET-PG practice questions on Fibroids, prolapse and benign gynaecology, part of Obstetrics & Gynaecology. The first 24 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 25-year-old nulliparous woman, married a year ago, has a uterine prolapse with the cervix reaching the introitus on straining, without cervical elongation. Six months of pelvic floor exercises have not helped. She strongly wishes to have children. Which operation is most suitable?
1. AVaginal hysterectomy with pelvic floor repair
2. BManchester (Fothergill) operation
3. CAbdominal sling operation (cervicopexy)
4. DLe Fort colpocleisis
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Answer: C · Abdominal sling operation (cervicopexy)
A young woman who wants children needs the uterus and an intact cervix preserved, so abdominal sling operations (such as Purandare's or Shirodkar's cervicopexy, or sacrohysteropexy) are used to suspend the uterus without amputating the cervix. The Manchester operation amputates the cervix, risking cervical incompetence, stenosis and preterm labour, so it suits women who have completed their families but wish to keep the uterus. Hysterectomy ends fertility and colpocleisis closes the vagina. Prolapse in a nulliparous woman also suggests a connective tissue weakness, which is asked about.
- A: Hysterectomy ends her fertility.
- B: Cervical amputation risks preterm birth and cervical stenosis.
- D: Colpocleisis closes the vagina and suits only women not wanting intercourse.
Question 2 · Easy
A 24-year-old woman being treated for pelvic inflammatory disease develops sharp right upper quadrant pain that is worse on deep breathing. Liver function tests are normal. At laparoscopy, fine 'violin-string' adhesions are seen between the liver capsule and the anterior abdominal wall. What is this condition called?
1. AAsherman syndrome
2. BBudd-Chiari syndrome
3. CFitz-Hugh-Curtis syndrome
4. DMeigs syndrome
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Answer: C · Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis syndrome is perihepatitis complicating PID, caused by Chlamydia trachomatis or Neisseria gonorrhoeae spreading along the paracolic gutter to the liver capsule. It causes pleuritic right upper quadrant pain with normal liver enzymes, because the liver itself is spared, and is often mistaken for cholecystitis. It responds to the standard PID antibiotic regimen. Meigs syndrome is an ovarian fibroma with ascites and hydrothorax, Asherman is intrauterine adhesions and Budd-Chiari is hepatic vein obstruction.
- A: Asherman syndrome is adhesions inside the uterine cavity.
- B: Budd-Chiari is hepatic venous outflow obstruction with deranged liver function.
- D: Meigs syndrome is a benign ovarian tumour with ascites and pleural effusion.
Question 3 · Easy
A 34-year-old with heavy periods has a hysteroscopy that shows a 2 cm fibroid attached to the uterine wall by a thin stalk and lying entirely within the cavity. What is its type in the FIGO leiomyoma classification?
1. AType 3
2. BType 2
3. CType 0
4. DType 1
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Answer: C · Type 0
FIGO type 0 is a pedunculated intracavitary fibroid; type 1 is submucous with less than half its bulk in the wall, type 2 is submucous with half or more in the wall, and type 3 is wholly intramural but touches the endometrium. Types 0-2 are the submucous group, which cause heavy bleeding and subfertility even when small. A type 0 fibroid is the easiest to remove by hysteroscopic myomectomy, and the operation becomes harder as the intramural part grows. Types 4-7 are intramural, subserous and pedunculated subserous, and type 8 includes cervical and parasitic fibroids.
- A: Type 3 lies wholly in the wall, touching the endometrium.
- B: Type 2 has half or more of its bulk in the wall.
- D: Type 1 is sessile, with less than half its bulk in the wall.
Question 4 · Medium
A 79-year-old widow with heart failure and COPD has a complete procidentia that keeps falling out despite ring and Gellhorn pessaries. She is not sexually active and does not intend to be. Her cervical screening is normal and ultrasound shows a thin endometrium. Which operation is most appropriate?
1. ALe Fort partial colpocleisis
2. BManchester (Fothergill) operation
3. CAbdominal sacrohysteropexy
4. DVaginal hysterectomy with sacrospinous fixation
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Answer: A · Le Fort partial colpocleisis
Colpocleisis closes the vagina; it is a quick, low-risk vaginal operation with a very high success rate, suited to frail elderly women who no longer want vaginal intercourse. In Le Fort's operation the uterus stays in place, so the cervix and endometrium cannot be examined later, and malignancy must be excluded beforehand, as here. Abdominal or long reconstructive operations carry more anaesthetic risk in a woman with heart and lung disease. Her consent must include the understanding that vaginal intercourse will no longer be possible.
- B: The Manchester operation is for younger women with cervical elongation.
- C: Abdominal surgery is longer and riskier for a frail woman.
- D: A long reconstructive operation is unnecessary when she does not need a functional vagina.
Question 5 · Hard
A 35-year-old woman with fibroids asks about her condition, and the doctor considers four statements: 1. Each fibroid is a monoclonal tumour of smooth muscle cells. 2. Fibroids grow in response to both oestrogen and progesterone. 3. Red degeneration is the commonest degenerative change. 4. Malignant change into leiomyosarcoma occurs in fewer than 1% of fibroids. Which statements are correct?
1. A1, 2 and 4 only
2. B1, 2 and 3 only
3. C1, 2, 3 and 4
4. D2, 3 and 4 only
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Answer: A · 1, 2 and 4 only
Each fibroid arises from a single smooth muscle cell (monoclonal), often with a MED12 mutation, and grows under the influence of both oestrogen and progesterone, which is why progesterone receptor modulators shrink fibroids. Hyaline degeneration is the commonest degeneration, while red degeneration is typical of pregnancy. Sarcomatous change is rare, well under 1%, and most leiomyosarcomas arise on their own. Fibroids shrink after menopause as hormone levels fall.
- B: Includes statement 3; hyaline degeneration is commoner.
- C: Includes statement 3, which is false.
- D: Leaves out statement 1 and includes the false statement 3.
Question 6 · Hard
Ten days after a difficult abdominal hysterectomy for a broad-ligament fibroid, a 44-year-old woman reports continuous vaginal leakage, although she still passes urine normally. Three cotton swabs are placed in the vagina and methylene blue is instilled into the bladder by catheter. After 30 minutes the upper swab is wet with clear fluid and none of the swabs is stained blue. Where is the fistula most likely to be?
1. ABetween the bladder base and the vault
2. BBetween the bladder and the cervix
3. CBetween the ureter and the vagina
4. DBetween the urethra and the vagina
Answer and explanation in LearnFree account
Question 7 · Easy
A 58-year-old woman who feels something coming down is examined in the gynae OPD, and her prolapse is recorded with the POP-Q system. Which fixed landmark is the zero reference point for all measurements?
1. AIschial spines
2. BFourchette of the introitus
3. CHymen
4. DExternal cervical os
Answer and explanation in LearnFree account
Question 8 · Hard
A 56-year-old woman, 5 years after menopause and not on hormone therapy, has a fibroid that has grown from 6 cm to 10 cm in a year, with new pelvic pain. Ultrasound shows a heterogeneous mass with irregular vascularity and central necrosis, and serum LDH is raised. She is booked for a laparoscopic hysterectomy. What is the most important change to the surgical plan?
1. AChange to laparoscopic myomectomy alone
2. BGive a GnRH agonist for 3 months before surgery
3. CAvoid power morcellation and remove the uterus intact
4. DProceed as planned with tissue morcellation
Answer and explanation in LearnFree account
Question 9 · Medium
A 29-year-old woman attends the gynae OPD with a thin grey vaginal discharge and a fishy odour that is worse after intercourse. The doctor applies Amsel's criteria. Consider four findings: 1. Thin, homogeneous discharge coating the vaginal walls. 2. Vaginal pH above 4.5. 3. Fishy odour when 10% KOH is added. 4. Clue cells on a wet mount. Which of these are Amsel's criteria?
1. A2 and 4 only
2. B1, 2, 3 and 4
3. C1, 2 and 3 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 10 · Easy
A 22-year-old woman from a remote village, who delivered a stillborn baby at home after 3 days of labour 6 weeks ago, now leaks urine through the vagina continuously, day and night. What is the most likely mechanism of her fistula?
1. APressure necrosis of the bladder base by the impacted head
2. BDirect injury during a forceps delivery
3. CBladder injury at caesarean section
4. DRadiation damage to the bladder wall
Answer and explanation in LearnFree account
Question 11 · Easy
A 27-year-old primigravida at 22 weeks with a known 7 cm intramural fibroid comes to casualty with severe pain over the fibroid, vomiting and a temperature of 37.9 °C. The fibroid is tender, the fetal heart is normal and the total leucocyte count is 12,500/µL. What is the most likely diagnosis?
1. ATorsion of a pedunculated fibroid
2. BSarcomatous change in the fibroid
3. CRed degeneration of the fibroid
4. DAbruptio placentae
Answer and explanation in LearnFree account
Question 12 · Medium
A 64-year-old para 4 has a POP-Q examination at maximal straining: Aa +2, Ba +3, C -4, D -6, Ap -2, Bp -2; genital hiatus 4 cm, perineal body 3 cm and total vaginal length 9 cm. What is the stage of her prolapse?
1. AStage II, anterior compartment
2. BStage III, anterior compartment
3. CStage III, apical compartment
4. DStage IV, anterior compartment
Answer and explanation in LearnFree account
Question 13 · Medium
During an elective caesarean at 39 weeks for breech, the surgeon finds a 5 cm intramural fibroid on the posterior uterine wall, away from the incision. The baby and placenta are delivered and the uterus is contracting well. What is the most appropriate action regarding the fibroid?
1. ACaesarean hysterectomy
2. BEnucleate it after vasopressin
3. CMyomectomy at the same sitting
4. DLeave the fibroid alone
Answer and explanation in LearnFree account
Question 14 · Medium
A 38-year-old para 2 with adenomyosis on ultrasound has heavy, painful periods despite NSAIDs and tranexamic acid. She wants to avoid surgery and may want another child in a few years. What is the most suitable next treatment?
1. AEndometrial ablation
2. BBilateral uterine artery embolisation
3. CLevonorgestrel intrauterine system
4. DTotal hysterectomy
Answer and explanation in LearnFree account
Question 15 · Medium
A 28-year-old with a copper-T inserted 2 years ago is diagnosed with mild pelvic inflammatory disease at the gynae OPD. She has no abscess, is not pregnant and wishes to keep the device. What is the best advice regarding the copper-T?
1. ARemove it after completing 14 days of antibiotics
2. BReplace it with a new device at once
3. CLeave it in place and start antibiotics
4. DRemove it before starting antibiotics
Answer and explanation in LearnFree account
Question 16 · Medium
A 58-year-old woman who had a vaginal hysterectomy 6 years ago now has a vaginal vault prolapse reaching 3 cm beyond the hymen. She is fit, sexually active and wants the most durable repair. Which operation is most suitable?
1. AAnterior colporrhaphy alone
2. BAbdominal or laparoscopic sacrocolpopexy
3. CManchester (Fothergill) operation
4. DLe Fort colpocleisis
Answer and explanation in LearnFree account
Question 17 · Medium
A 26-year-old woman from Bihar, married for 4 years, has primary infertility and scanty periods. HSG shows rigid tubes with multiple constrictions giving a beaded appearance, and calcified shadows in the pelvis. Her husband's semen analysis is normal. Which test on a premenstrual endometrial biopsy is most useful to confirm the likely diagnosis?
1. AGram stain for intracellular diplococci
2. BHistology for a decidual reaction
3. CNucleic acid amplification (CBNAAT) and culture
4. DZiehl-Neelsen smear alone
Answer and explanation in LearnFree account
Question 18 · Medium
Five days after an abdominal hysterectomy for fibroids, a 45-year-old woman notices continuous leakage of urine through the vagina. A dye test and examination show a 3 mm fistula in the bladder base just above the vault, with healthy surrounding tissue. What is the best initial management?
1. AContinuous catheter drainage of the bladder
2. BImmediate transabdominal repair
3. CUrinary diversion into the sigmoid colon
4. DRepair only after waiting 6 months
Answer and explanation in LearnFree account
Question 19 · Hard
A 32-year-old woman with a copper-T is admitted with fever, severe lower abdominal pain and a tender left adnexal mass. Ultrasound shows a 7 cm multiloculated, thick-walled left tubo-ovarian abscess. After 72 hours of IV ceftriaxone, doxycycline and metronidazole she still has a fever of 38.8 °C, a rising leucocyte count and increasing pain, but she is haemodynamically stable with no signs of rupture. What is the most appropriate next step?
1. ARemove the copper-T and stop the antibiotics
2. BContinue the same antibiotics for another week
3. CImage-guided or laparoscopic drainage of the abscess
4. DTotal hysterectomy with bilateral salpingo-oophorectomy
Answer and explanation in LearnFree account
Question 20 · Medium
A 31-year-old woman, trying to conceive for 2 years, has heavy periods. Saline infusion sonography shows a 2.5 cm submucous fibroid with about 30% of its bulk in the myometrium (FIGO type 1). Her tubes are patent and her husband's semen analysis is normal. What is the best treatment?
1. AHysteroscopic myomectomy
2. BUterine artery embolisation
3. CUlipristal acetate for 6 months
4. DLaparoscopic myomectomy
Answer and explanation in LearnFree account
Question 21 · Medium
A 23-year-old woman has had lower abdominal pain and vaginal discharge for 4 days. Temperature is 38.1 °C; there is cervical motion tenderness and bilateral adnexal tenderness, with no mass on ultrasound. She is not pregnant, is not vomiting and can take oral drugs. Which treatment is most appropriate?
1. ASingle-dose oral azithromycin alone
2. BIM ceftriaxone, oral doxycycline and metronidazole
3. COral amoxicillin-clavulanate for 5 days
4. DOral fluconazole with metronidazole
Answer and explanation in LearnFree account
Question 22 · Medium
A 41-year-old para 2 with a 16-week-size fibroid uterus and heavy periods is listed for abdominal hysterectomy in 3 months. Her Hb is 7.8 g/dL with a microcytic picture. Which preoperative drug, given with iron, best raises her haemoglobin and shrinks the uterus before surgery?
1. ATranexamic acid alone
2. BMifepristone for 2 weeks
3. CCombined oral contraceptive pill
4. DDepot GnRH agonist for 3 months
Answer and explanation in LearnFree account
Question 23 · Hard
A 70-year-old para 6 has had a procidentia for 3 years. The whole uterus lies outside the introitus, the vaginal skin is thickened and keratinised, and there is a shallow 2 cm ulcer with a clean base on the most dependent part of the cervix. She is fit and listed for vaginal hysterectomy with pelvic floor repair. What should be done first?
1. ACauterise the ulcer and operate the next day
2. BRefer for radiotherapy to the ulcerated cervix
3. CReduce the prolapse and pack the vagina daily until the ulcer heals
4. DProceed directly with vaginal hysterectomy and repair
Answer and explanation in LearnFree account
Question 24 · Medium
A 43-year-old para 3 has had heavy periods and worsening dysmenorrhoea for 2 years. The uterus is uniformly enlarged to 12 weeks' size, globular, firm and tender just before menses. MRI shows a junctional zone of 15 mm with small high-signal foci and no discrete mass. What is the most likely diagnosis?
1. AMultiple intramural fibroids
2. BChronic endometritis
3. CAdenomyosis
4. DEndometrial carcinoma
Answer and explanation in LearnFree account

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Fibroids, prolapse and benign gynaecology

A 25-year-old nulliparous woman, married a year ago, has a uterine prolapse with the cervix reaching the introitus on straining, without cervical elongation. Six months of pelvic floor exercises have not helped. She strongly wishes to have children. Which operation is most suitable?

A 34-year-old with heavy periods has a hysteroscopy that shows a 2 cm fibroid attached to the uterine wall by a thin stalk and lying entirely within the cavity. What is its type in the FIGO leiomyoma classification?

A 79-year-old widow with heart failure and COPD has a complete procidentia that keeps falling out despite ring and Gellhorn pessaries. She is not sexually active and does not intend to be. Her cervical screening is normal and ultrasound shows a thin endometrium. Which operation is most appropriate?

A 58-year-old woman who feels something coming down is examined in the gynae OPD, and her prolapse is recorded with the POP-Q system. Which fixed landmark is the zero reference point for all measurements?

A 22-year-old woman from a remote village, who delivered a stillborn baby at home after 3 days of labour 6 weeks ago, now leaks urine through the vagina continuously, day and night. What is the most likely mechanism of her fistula?

A 27-year-old primigravida at 22 weeks with a known 7 cm intramural fibroid comes to casualty with severe pain over the fibroid, vomiting and a temperature of 37.9 °C. The fibroid is tender, the fetal heart is normal and the total leucocyte count is 12,500/µL. What is the most likely diagnosis?

A 64-year-old para 4 has a POP-Q examination at maximal straining: Aa +2, Ba +3, C -4, D -6, Ap -2, Bp -2; genital hiatus 4 cm, perineal body 3 cm and total vaginal length 9 cm. What is the stage of her prolapse?

During an elective caesarean at 39 weeks for breech, the surgeon finds a 5 cm intramural fibroid on the posterior uterine wall, away from the incision. The baby and placenta are delivered and the uterus is contracting well. What is the most appropriate action regarding the fibroid?

A 38-year-old para 2 with adenomyosis on ultrasound has heavy, painful periods despite NSAIDs and tranexamic acid. She wants to avoid surgery and may want another child in a few years. What is the most suitable next treatment?

A 28-year-old with a copper-T inserted 2 years ago is diagnosed with mild pelvic inflammatory disease at the gynae OPD. She has no abscess, is not pregnant and wishes to keep the device. What is the best advice regarding the copper-T?

A 58-year-old woman who had a vaginal hysterectomy 6 years ago now has a vaginal vault prolapse reaching 3 cm beyond the hymen. She is fit, sexually active and wants the most durable repair. Which operation is most suitable?

Five days after an abdominal hysterectomy for fibroids, a 45-year-old woman notices continuous leakage of urine through the vagina. A dye test and examination show a 3 mm fistula in the bladder base just above the vault, with healthy surrounding tissue. What is the best initial management?

A 31-year-old woman, trying to conceive for 2 years, has heavy periods. Saline infusion sonography shows a 2.5 cm submucous fibroid with about 30% of its bulk in the myometrium (FIGO type 1). Her tubes are patent and her husband's semen analysis is normal. What is the best treatment?

A 41-year-old para 2 with a 16-week-size fibroid uterus and heavy periods is listed for abdominal hysterectomy in 3 months. Her Hb is 7.8 g/dL with a microcytic picture. Which preoperative drug, given with iron, best raises her haemoglobin and shrinks the uterus before surgery?