Six hours after a vaginal delivery under epidural analgesia, a primipara has not passed urine. The uterus is pushed up to the right and a tender suprapubic swelling is felt. What is the next step?

Catheterise and measure the volume drained

Encourage oral fluids and wait 6 more hours

On the gynaecology ward of a district hospital, a woman of 70 from a fishing village is admitted with third-degree uterine prolapse that has stayed outside the introitus for months. The cervix shows a shallow 2 cm ulcer with clean, granulating edges on its most dependent part, and the cervix and vaginal walls are thick and keratinised. She has diabetes, with fasting glucose 118 mg/dL on metformin, and her Pap smear and a biopsy of the ulcer edge are benign. She is listed for vaginal hysterectomy with repair, and her family wants the operation done the next morning. What should be done before surgery?

Reduce it and pack daily until the ulcer heals

Silver nitrate cautery, then surgery in 48 hours

Operate next morning as planned

Excise the ulcer under local anaesthesia first

Gynaecological classifications, urogynaecology and surgery

52 NEET-PG practice questions on Gynaecological classifications, urogynaecology and surgery, part of Obstetrics & Gynaecology. The first 25 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 · Easy
On hysteroscopy, a fibroid hangs on a narrow stalk and lies wholly within the uterine cavity. What is its FIGO leiomyoma type?
1. AType 3
2. BType 7
3. CType 1
4. DType 0
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Answer: D · Type 0
The FIGO leiomyoma subclassification runs from type 0 (pedunculated, entirely intracavitary) through types 1 and 2 (submucous with less than or at least 50% intramural) to type 7 (pedunculated subserous) and type 8 (cervical or parasitic). Type 0 fibroids are ideal for hysteroscopic resection.
- A: Type 3 is fully intramural but touches the endometrium.
- B: Type 7 is pedunculated but on the serosal surface.
- C: Type 1 is sessile submucous with less than half of it in the myometrium.
Remember this
FIGO type 0 is a pedunculated, wholly intracavitary submucous fibroid.
Question 2 · Medium
Six hours after a vaginal delivery under epidural analgesia, a primipara has not passed urine. The uterus is pushed up to the right and a tender suprapubic swelling is felt. What is the next step?
1. ACatheterise and measure the volume drained
2. BUltrasound of both kidneys
3. CEncourage oral fluids and wait 6 more hours
4. DStart oral bethanechol
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Answer: A · Catheterise and measure the volume drained
Postpartum urinary retention is common after epidural analgesia, instrumental delivery and perineal trauma. A distended bladder displaces the uterus and can cause atony and haemorrhage, so the bladder is emptied by catheter and the residual measured; a large volume means an indwelling catheter for a period. Untreated overdistension can damage the detrusor permanently.
- B: Kidney imaging is not needed; the bladder is clearly full.
- C: Waiting longer risks overdistension injury to the detrusor.
- D: Bethanechol is not effective in postpartum retention.
Remember this
No void within 6 hours after delivery with a palpable bladder: catheterise and measure the volume.
Question 3 · Medium
When POP-Q is recorded in a woman who has had a total hysterectomy, which measurement is left out?
1. ATotal vaginal length
2. BPoint D
3. CPoint C
4. DPoint Ba
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Answer: B · Point D
Point D marks the posterior fornix, at the level where the uterosacral ligaments attach to the back of the cervix, so it exists only when the cervix is present. After total hysterectomy point C represents the vaginal cuff and D is omitted. Point D is also used to tell cervical elongation from true uterine descent.
- A: Total vaginal length is always measured.
- C: Point C is still recorded; it becomes the vaginal cuff.
- D: Point Ba measures the anterior wall and is always recorded.
Remember this
After total hysterectomy, POP-Q point D is omitted and point C marks the vaginal cuff.
Question 4 · Medium
On the gynaecology ward of a district hospital, a woman of 70 from a fishing village is admitted with third-degree uterine prolapse that has stayed outside the introitus for months. The cervix shows a shallow 2 cm ulcer with clean, granulating edges on its most dependent part, and the cervix and vaginal walls are thick and keratinised. She has diabetes, with fasting glucose 118 mg/dL on metformin, and her Pap smear and a biopsy of the ulcer edge are benign. She is listed for vaginal hysterectomy with repair, and her family wants the operation done the next morning. What should be done before surgery?
1. AReduce it and pack daily until the ulcer heals
2. BSilver nitrate cautery, then surgery in 48 hours
3. COperate next morning as planned
4. DExcise the ulcer under local anaesthesia first
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Answer: A · Reduce it and pack daily until the ulcer heals
A decubitus ulcer forms from congestion and friction on the exposed, dependent cervix. Once malignancy has been excluded, the prolapse is reduced and the vagina packed daily, often with glycerine or oestrogen cream, so that congestion settles and the ulcer heals within 1-2 weeks; surgery through an ulcerated, oedematous field risks infection and poor healing.
- B: Cautery does not treat the underlying congestion, and 48 hours is too short.
- C: Surgery through an ulcerated field raises infection and wound breakdown.
- D: Excising the ulcer is unnecessary; it heals once the prolapse is reduced.
Remember this
Decubitus ulcer on a prolapse: biopsy, then reduce and pack until it heals before surgery.
Question 5 · Medium
After a fourth-degree tear in the labour room, the plan reads: 1. Repair in the operating theatre under regional or general anaesthesia. 2. Repair a torn external anal sphincter by an overlapping or end-to-end method. 3. Identify and repair a torn internal anal sphincter separately. 4. Avoid antibiotics and laxatives after repair. Which steps are correct?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C1, 2 and 3 only
4. D1 and 2 only
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Answer: C · 1, 2 and 3 only
Obstetric anal sphincter injuries are repaired in theatre with good light and anaesthesia that relaxes the sphincter. For a full-thickness external sphincter tear either an overlapping or end-to-end method may be used, and the internal sphincter is repaired separately. Broad-spectrum antibiotics and stool softeners are recommended afterwards, so step 4 is wrong.
- A: Step 1 is correct and step 4 is wrong.
- B: Antibiotics and laxatives are recommended, so step 4 is wrong.
- D: Step 3 is also correct; the internal sphincter is repaired separately.
Remember this
OASIS repair: in theatre, separate sphincter repair, then antibiotics and laxatives.
Question 6 · Medium
LEEP cone specimen from a nulligravida shows squamous carcinoma with stromal invasion of 2 mm, no lymphovascular space invasion and clear margins of 4 mm. She wants children. What is the appropriate management?
1. ARadical trachelectomy with bilateral pelvic lymphadenectomy
2. BSimple hysterectomy
3. CRadical hysterectomy with node dissection
4. DNo further surgery; follow-up with cytology and HPV tests
Answer and explanation in LearnFree account
Question 7 · Hard
Ten days after a difficult total abdominal hysterectomy for a broad-ligament fibroid, a teacher from Kollam has constant watery leakage per vaginum day and night, yet she still passes normal amounts of urine at intervals. A three-swab test with methylene blue in the bladder leaves the swabs wet but unstained. CT urography shows contrast leaking from the lower left ureter into the vagina, with mild left hydroureteronephrosis; the right side is normal. Her creatinine is 1.0 mg/dL, her urine output is normal and she is afebrile. What is the most appropriate next step?
1. ALeft nephrectomy
2. BCystoscopy and retrograde left ureteric stenting
3. CWait 3 months, then Latzko partial colpocleisis repair
4. DTransvaginal fistula repair now
Answer and explanation in LearnFree account
Question 8 · Medium
Thoracocentesis of a right pleural effusion in a woman with bilateral ovarian masses and an omental cake shows malignant cells. CT shows no liver or splenic parenchymal metastases. What is the FIGO 2014 stage?
1. AIIIB
2. BIVA
3. CIIIC
4. DIVB
Answer and explanation in LearnFree account
Question 9 · Hard
Urgency and urge leakage several times a day trouble a retired headmistress of 76 who has mild Alzheimer disease and takes donepezil. Six weeks of bladder training has helped only partly. Urine culture is sterile, post-void residual is 40 mL and BP is 132/80 mmHg. Which drug is the best choice?
1. ADesmopressin
2. BOxybutynin
3. CImipramine
4. DMirabegron
Answer and explanation in LearnFree account
Question 10 · Medium
Continuous leakage of urine began on day 8 after vaginal hysterectomy in a woman at a CHC. Cystoscopy shows a 3 mm fistula in the bladder base above the trigone, with healthy surrounding tissue. What is the most appropriate initial management?
1. AContinuous bladder drainage for 4-6 weeks
2. BWait 3 months, then repair by the abdominal route
3. CImmediate transvaginal repair
4. DIleal conduit urinary diversion
Answer and explanation in LearnFree account
Question 11 · Medium
Wide local excision is planned for a 1.5 cm squamous carcinoma on the right labium majus of a woman of 68. Biopsy shows stromal invasion of 0.8 mm. What should be done about the groin nodes?
1. ABilateral inguinofemoral lymphadenectomy
2. BRight-sided sentinel node biopsy
3. CNo groin node assessment is needed
4. DGroin irradiation
Answer and explanation in LearnFree account
Question 12 · Hard
At the regional cancer centre, a mother of four from a village near Madurai has had postcoital bleeding for 3 months. Biopsy shows squamous cell carcinoma. Examination under anaesthesia finds a 4 cm cervical growth with nodular thickening of the right parametrium that does not reach the pelvic wall; the vagina is free. MRI confirms parametrial invasion, with no hydronephrosis and no enlarged nodes, and her creatinine is 0.8 mg/dL. Her husband asks whether an operation to remove the womb would be the surest cure. What is the recommended primary treatment?
1. ANeoadjuvant chemotherapy, then a radical hysterectomy
2. BExternal beam radiotherapy alone
3. CRadical hysterectomy with pelvic lymphadenectomy
4. DConcurrent cisplatin chemoradiation with brachytherapy
Answer and explanation in LearnFree account
Question 13 · Medium
On the basis of FIGO staging of gynaecological cancers: 1. Cervical cancer (2018) may be staged using imaging and pathology findings. 2. Endometrial cancer is staged surgically and pathologically. 3. Ovarian cancer is staged surgically. 4. Vulvar cancer is staged clinically, without surgery. Which statements are correct?
1. A1, 2 and 3 only
2. B1, 2, 3 and 4
3. C1 and 2 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 14 · Medium
Filling cystometry: at 150 mL there are phasic rises in detrusor pressure of 25 cm H2O with urgency and leakage, abdominal pressure does not change, and there is no leakage on coughing. What is the urodynamic diagnosis?
1. AUrodynamic stress incontinence
2. BDetrusor underactivity
3. CDetrusor overactivity
4. DLow-compliance bladder
Answer and explanation in LearnFree account
Question 15 · Medium
Nerve injuries after gynaecological surgery: 1. Femoral nerve: lateral blades of a self-retaining retractor; weak knee extension. 2. Genitofemoral nerve: external iliac node dissection; numbness of the labium majus. 3. Obturator nerve: pelvic lymphadenectomy; weak thigh adduction. 4. Ilioinguinal nerve: Pfannenstiel incision; weak hip flexion. Which pairs are correct?
1. A1 and 2 only
2. B1, 2 and 3 only
3. C1, 3 and 4 only
4. D2 and 4 only
Answer and explanation in LearnFree account
Question 16 · Medium
Colour Doppler shows a tangle of high-velocity, low-resistance vessels in the myometrium of a woman with sudden heavy bleeding 6 weeks after a suction evacuation; serum beta-hCG is negative. Which category fits, and what is the preferred treatment?
1. AAUB-N; uterine artery embolisation
2. BAUB-E; dilatation and curettage
3. CAUB-P; hysteroscopic resection
4. DAUB-M; hysterectomy
Answer and explanation in LearnFree account
Question 17 · Hard
About PALM-COEIN: 1. PALM causes are structural and can be confirmed by imaging or histology. 2. Atypical endometrial hyperplasia is coded AUB-M. 3. Bleeding caused by a copper IUD is coded AUB-E. 4. One patient may have more than one category coded at the same time. Which statements are correct?
1. A1, 2 and 4 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1 and 3 only
Answer and explanation in LearnFree account
Question 18 · Hard
MRI for heavy bleeding and pressure symptoms shows a 9 cm fibroid that indents the endometrial cavity and also bulges from the serosa; less than half of its diameter lies in the cavity and less than half beyond the serosa. How is it coded, and which route of removal suits her if she wants to keep her uterus?
1. AType 6; vaginal myomectomy
2. BType 2-5; staged two-step hysteroscopic myomectomy
3. CType 2-5; abdominal or laparoscopic myomectomy
4. DType 3; hysteroscopic myomectomy
Answer and explanation in LearnFree account
Question 19 · Medium
While opening the vesicouterine fold during a difficult abdominal hysterectomy after two caesareans, the surgeon sees a 2 cm tear in the bladder dome; the ureteric orifices are well away from it. What is the correct management?
1. ALeave it to heal with a catheter for 48 hours
2. BSuprapubic cystostomy without repair
3. CDelayed repair after 3 months
4. DTwo-layer repair and catheter for 7-10 days
Answer and explanation in LearnFree account
Question 20 · Medium
POP-Q record: Aa +2, Ba +2, C -6, D -8, Ap -2, Bp -2; gh 4 cm, pb 3 cm, tvl 9 cm. What is the stage, and which compartment is mainly involved?
1. AStage II, anterior
2. BStage IV, anterior
3. CStage III, anterior
4. DStage III, apical
Answer and explanation in LearnFree account
Question 21 · Medium
Three months after insertion of a levonorgestrel intrauterine system for contraception, a nurse has light, irregular spotting most weeks. Ultrasound shows the device in place and no structural lesion. In PALM-COEIN, this bleeding is:
1. AAUB-O
2. BAUB-E
3. CAUB-L
4. DAUB-I
Answer and explanation in LearnFree account
Question 22 · Easy
During abdominal hysterectomy, the ureter is most often injured where it:
1. AEnters the bladder wall at the trigone
2. BPasses under the uterine artery beside the cervix
3. CCrosses the pelvic brim over the common iliac bifurcation
4. DRuns beside the infundibulopelvic ligament
Answer and explanation in LearnFree account
Question 23 · Easy
Leakage of urine on coughing and sneezing troubles a mother of three; her bladder diary shows no urgency and urine culture is sterile. What is the first-line treatment?
1. ARetropubic midurethral tape
2. BOral duloxetine
3. CSupervised pelvic floor training
4. DOral oxybutynin
Answer and explanation in LearnFree account
Question 24 · Medium
Since menarche two years ago, a schoolgirl has had periods lasting 9-10 days with clots, changing pads every hour; she bled for a day after a tooth extraction and her mother has frequent nosebleeds. Hb is 8.6 g/dL, platelets 2.8 lakh/mm3, PT normal and aPTT slightly prolonged. Under PALM-COEIN, her bleeding is best coded as:
1. AAUB-N
2. BAUB-C
3. CAUB-E
4. DAUB-O
Answer and explanation in LearnFree account
Question 25 · Medium
Something comes down per vaginum when she stands, says a nulliparous woman of 24 who married a year ago. There is second-degree uterine descent without cervical elongation or cystocele, and she wants children. Pelvic floor exercises have not helped. Which operation is most suitable?
1. ALe Fort colpocleisis
2. BVaginal hysterectomy with pelvic floor repair
3. CFothergill (Manchester) repair
4. DUterus-preserving sling (sacrohysteropexy)
Answer and explanation in LearnFree account

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Gynaecological classifications, urogynaecology and surgery

On hysteroscopy, a fibroid hangs on a narrow stalk and lies wholly within the uterine cavity. What is its FIGO leiomyoma type?

Six hours after a vaginal delivery under epidural analgesia, a primipara has not passed urine. The uterus is pushed up to the right and a tender suprapubic swelling is felt. What is the next step?

When POP-Q is recorded in a woman who has had a total hysterectomy, which measurement is left out?

LEEP cone specimen from a nulligravida shows squamous carcinoma with stromal invasion of 2 mm, no lymphovascular space invasion and clear margins of 4 mm. She wants children. What is the appropriate management?

Thoracocentesis of a right pleural effusion in a woman with bilateral ovarian masses and an omental cake shows malignant cells. CT shows no liver or splenic parenchymal metastases. What is the FIGO 2014 stage?

Urgency and urge leakage several times a day trouble a retired headmistress of 76 who has mild Alzheimer disease and takes donepezil. Six weeks of bladder training has helped only partly. Urine culture is sterile, post-void residual is 40 mL and BP is 132/80 mmHg. Which drug is the best choice?

Continuous leakage of urine began on day 8 after vaginal hysterectomy in a woman at a CHC. Cystoscopy shows a 3 mm fistula in the bladder base above the trigone, with healthy surrounding tissue. What is the most appropriate initial management?

Wide local excision is planned for a 1.5 cm squamous carcinoma on the right labium majus of a woman of 68. Biopsy shows stromal invasion of 0.8 mm. What should be done about the groin nodes?

Filling cystometry: at 150 mL there are phasic rises in detrusor pressure of 25 cm H2O with urgency and leakage, abdominal pressure does not change, and there is no leakage on coughing. What is the urodynamic diagnosis?

Colour Doppler shows a tangle of high-velocity, low-resistance vessels in the myometrium of a woman with sudden heavy bleeding 6 weeks after a suction evacuation; serum beta-hCG is negative. Which category fits, and what is the preferred treatment?

About PALM-COEIN: 1. PALM causes are structural and can be confirmed by imaging or histology. 2. Atypical endometrial hyperplasia is coded AUB-M. 3. Bleeding caused by a copper IUD is coded AUB-E. 4. One patient may have more than one category coded at the same time. Which statements are correct?

While opening the vesicouterine fold during a difficult abdominal hysterectomy after two caesareans, the surgeon sees a 2 cm tear in the bladder dome; the ureteric orifices are well away from it. What is the correct management?

POP-Q record: Aa +2, Ba +2, C -6, D -8, Ap -2, Bp -2; gh 4 cm, pb 3 cm, tvl 9 cm. What is the stage, and which compartment is mainly involved?

Three months after insertion of a levonorgestrel intrauterine system for contraception, a nurse has light, irregular spotting most weeks. Ultrasound shows the device in place and no structural lesion. In PALM-COEIN, this bleeding is:

During abdominal hysterectomy, the ureter is most often injured where it:

Leakage of urine on coughing and sneezing troubles a mother of three; her bladder diary shows no urgency and urine culture is sterile. What is the first-line treatment?

Something comes down per vaginum when she stands, says a nulliparous woman of 24 who married a year ago. There is second-degree uterine descent without cervical elongation or cystocele, and she wants children. Pelvic floor exercises have not helped. Which operation is most suitable?