Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1091: What is the most common cause of acute salpingitis?

A. N. gonorrhoeae
B. Chlamydia trachomatis (Correct Answer)
C. Mycoplasma
D. Staphylococcus

Explanation: ***Chlamydia trachomatis*** - **_Chlamydia trachomatis_** is the most common bacterial cause of **sexually transmitted infections (STIs)** globally and a leading cause of **pelvic inflammatory disease (PID)**, which includes salpingitis. - Its infections are often **asymptomatic**, leading to delayed diagnosis and treatment, increasing the risk of upper genital tract involvement and complications like **infertility** and **ectopic pregnancies**. *N. gonorrhoeae* - **_Neisseria gonorrhoeae_** is another common cause of salpingitis, often presenting with **more acute and severe symptoms** compared to chlamydial infections. - While significant, studies consistently show a **higher prevalence of _Chlamydia_** in confirmed cases of salpingitis/PID. *Mycoplasma* - **_Mycoplasma genitalium_** and **_Ureaplasma urealyticum_** are increasingly recognized as causes of PID and salpingitis. - However, their overall contribution to acute salpingitis is **less frequent** than that of _Chlamydia trachomatis_ and _N. gonorrhoeae_. *Staphylococcus* - **_Staphylococcus_ species** are typically associated with skin and soft tissue infections or bacterial vaginosis, but are **uncommon causes of acute salpingitis**. - While they can be found in the genital tract, they are **not primary pathogens** for acute inflammation of the fallopian tubes.

Question 1092: What is the primary mechanism proposed by Sampson's theory for the development of endometriosis?

A. Celomic metaplasia
B. Hematogenous spread
C. Lymphatic spread
D. Retrograde menstruation (Correct Answer)

Explanation: ***Retrograde menstruation*** - **Sampson's theory** is primarily based on the concept of **retrograde menstruation**, where endometrial cells shed during menstruation flow backward through the fallopian tubes into the peritoneal cavity. - These retrogradely shed endometrial cells then implant and grow outside the uterus, leading to the development of **endometriotic lesions**. *Celomic metaplasia* - This theory, proposed by **Meyer**, suggests that peritoneal cells, which originate from the **celomic epithelium**, can undergo metaplastic transformation into endometrial-like tissue. - This mechanism is often considered for endometriosis in unusual sites but is not the primary mechanism of Sampson's theory. *Hematogenous spread* - This theory involves the dissemination of endometrial cells through the **bloodstream** to distant sites, such as the lungs or brain. - While it can explain rare cases of **extrapelvic endometriosis**, it is not the main mechanism proposed by Sampson for typical pelvic endometriosis. *Lymphatic spread* - This theory postulates that endometrial cells can migrate via the **lymphatic system** to other locations, potentially explaining the presence of endometriosis in lymph nodes. - Similar to hematogenous spread, it accounts for less common presentations and is not Sampson's primary proposed mechanism.

Question 1093: What is the most common cause for hysterectomy?

A. Fibroids (Correct Answer)
B. Uterine prolapse
C. Endometrial cancer
D. Chronic pelvic inflammatory disease

Explanation: ***Fibroids (Correct Answer)*** - **Uterine fibroids (leiomyomas)** are the **most common indication for hysterectomy**, accounting for approximately 30-40% of all hysterectomies performed. - They are benign smooth muscle tumors of the uterus with very high prevalence (affecting up to 70-80% of women by age 50). - **Symptomatic fibroids** causing heavy menstrual bleeding (menorrhagia), bulk symptoms (pressure, urinary frequency), pain, or reproductive issues often require hysterectomy when conservative management (medical therapy, UAE, myomectomy) fails or is not suitable. - The high prevalence combined with potential for significant symptoms makes fibroids the leading cause globally. *Uterine prolapse (Incorrect)* - While **uterine prolapse** can necessitate hysterectomy, it is considerably less common than fibroids as the primary indication. - Many cases are managed with pessaries, pelvic floor exercises, or reconstructive surgery (sacrocolpopexy). - Hysterectomy (vaginal hysterectomy) is reserved for severe symptomatic cases or when conservative measures fail. *Endometrial cancer (Incorrect)* - **Endometrial cancer** is an important indication for hysterectomy with bilateral salpingo-oophorectomy as part of surgical staging. - However, its **incidence is much lower** compared to the prevalence of symptomatic fibroids. - While nearly all endometrial cancer cases require hysterectomy, the absolute number is far less than fibroid-related hysterectomies. *Chronic pelvic inflammatory disease (Incorrect)* - **Chronic PID** can lead to hysterectomy in cases of severe, intractable pain, tubo-ovarian abscess, or extensive adnexal damage unresponsive to medical therapy. - However, it is a **considerably less common** indication in modern practice due to improved antibiotic therapy and earlier intervention. - Most PID cases are managed medically; hysterectomy is reserved for rare complicated cases.

Question 1094: Which condition is characterized by a 'pearl necklace' appearance on ultrasound?

A. PCOS (Correct Answer)
B. Ectopic pregnancy
C. Pelvic Inflammatory Disease (PID)
D. Endometriosis

Explanation: ***PCOS (Polycystic Ovary Syndrome)*** - The "pearl necklace" appearance on ultrasound refers to multiple **small follicles (cysts)** arranged peripherally in the ovary, a classic finding in **PCOS**. - These peripheral cysts are typically **2-9 mm in diameter** and are often associated with other hormonal imbalances. *Ectopic pregnancy* - An ectopic pregnancy is characterized by a fertilized egg implanting outside the uterus, most commonly in the **fallopian tube**. - Ultrasound findings usually include an **adnexal mass** or a gestational sac outside the uterus, rather than diffusely cystic ovaries. *Pelvic Inflammatory Disease (PID)* - PID is an infection of the female reproductive organs, often leading to **inflammation** and **abscess formation** in the fallopian tubes and ovaries. - Ultrasound may show dilated, fluid-filled fallopian tubes (hydrosalpinx) or tubo-ovarian abscesses, not a "pearl necklace" appearance. *Endometriosis* - Endometriosis involves the growth of **endometrial tissue outside the uterus**, causing pain and potentially forming cysts called **endometriomas** (chocolate cysts). - Ultrasound typically reveals these endometriomas, which are single or multiple cysts with characteristic internal echoes, but not the diffuse pattern seen in PCOS.

Question 1095: Which of the following is NOT part of the classic triad of symptoms associated with endometriosis?

A. Infertility
B. Cyclical hematuria (Correct Answer)
C. Dysmenorrhea
D. Dyspareunia

Explanation: ***Cyclical hematuria*** - While endometriosis can cause hematuria if it affects the bladder, it is **not part of the classic triad** of endometriosis symptoms. - Cyclical hematuria represents bladder involvement, which is an extra-pelvic manifestation occurring in only 1-2% of cases. - The classic triad focuses on symptoms directly related to the presence of endometrial tissue in the **pelvic cavity**: dysmenorrhea, dyspareunia, and either dyschezia or infertility (depending on classification). *Infertility* - **Infertility** is a very common consequence in women with endometriosis and is considered part of the classic triad in many classifications. - The condition can distort pelvic anatomy, cause adhesions, interfere with ovulation, and impair fertilization or implantation. - Up to 30-50% of women with endometriosis experience some degree of infertility, making it a cardinal feature. *Dysmenorrhea* - **Dysmenorrhea**, or painful menstruation, is a hallmark symptom and core component of the classic triad. - The pain is typically **severe, progressive, and secondary** in nature, worsening over time. - It arises from the inflammatory reaction and cyclic bleeding of ectopic endometrial tissue during menstruation. *Dyspareunia* - **Dyspareunia**, or painful sexual intercourse (particularly deep dyspareunia), is another essential component of the classic triad. - This pain is typically due to endometriotic lesions on the posterior cul-de-sac, uterosacral ligaments, or rectovaginal septum. - The pain is aggravated by deep penetration and pelvic pressure during intercourse.

Question 1096: Which of the following best describes endometriosis?

A. Endometrial tissue found within the myometrium.
B. Endometrial-like tissue located outside the uterus. (Correct Answer)
C. Myometrial tissue found within the endometrium.
D. A rare type of endometrial cancer.

Explanation: ***Endometrial-like tissue located outside the uterus.*** - Endometriosis is defined by the presence of **endometrial-like tissue** (glands and stroma) outside the uterine cavity. - This ectopic tissue responds to **hormonal fluctuations** of the menstrual cycle, leading to bleeding, inflammation, and pain. *Endometrial tissue found within the myometrium.* - This condition describes **adenomyosis**, where endometrial glands and stroma are invaginated into the **myometrium** (uterine muscle wall). - While also causing pain and heavy bleeding, it is distinct from endometriosis where the tissue is located *outside* the uterus. *Myometrial tissue found within the endometrium.* - Myometrial tissue is normally the muscle layer of the uterus; finding it within the endometrium (the inner lining) is not a described medical condition. - This statement generally signifies a **misunderstanding of uterine anatomy** and common pathologies. *A rare type of endometrial cancer.* - Endometriosis is a **benign condition**, although rarely it can undergo malignant transformation into **endometrioid adenocarcinoma** or clear cell carcinoma. - It is not itself a type of cancer, but rather an inflammatory and proliferative disease.

Question 1097: Most common ovarian cyst to undergo torsion?

A. Dysgerminoma
B. Ovarian fibroma
C. Brenner's tumor
D. Benign cystic teratoma (Correct Answer)

Explanation: ***Benign cystic teratoma*** - These cysts are the **most common ovarian tumors** and have a higher likelihood of undergoing torsion due to their typical size and irregular shape, making them prone to twisting on their pedicle. - Their often **heterogeneous consistency** (containing various tissues like fat, hair, and bone) can also contribute to uneven weight distribution, increasing the risk of torsion. *Dysgerminoma* - While it is a germ cell tumor, **dysgerminomas are malignant** and generally less likely to undergo torsion than benign cystic teratomas. - They tend to grow rapidly and are often solid, reducing the chance of twisting compared to more mobile, pediculated cysts. *Ovarian fibroma* - **Ovarian fibromas are solid, benign tumors** that are typically less mobile due to their density and attachment, making torsion less common. - While they can be associated with Meigs syndrome, their risk of torsion is lower than that of cystic lesions. *Brenner's tumor* - **Brenner's tumors are uncommon, solid epithelial tumors** of the ovary and are rarely associated with ovarian torsion. - Their solid nature and typically small to moderate size make them less prone to twisting on their vascular pedicle.

Question 1098: What does LEEP stand for in the management of cervical lesions?

A. Loop electrosurgical excision procedure (Correct Answer)
B. Loop electromagnetic excision procedure
C. Loop electrodiagnostic excision procedure
D. Loop electrochemical excision procedure

Explanation: ***Loop electrosurgical excision procedure*** - **LEEP** is an acronym for **loop electrosurgical excision procedure**, a common method used to remove abnormal cells from the cervix - This procedure plays a crucial role in treating **high-grade cervical dysplasia** (CIN 2-3) and early-stage cervical cancer - It is both **diagnostic** (provides tissue for histopathology) and **therapeutic** (removes abnormal tissue) - The procedure uses a thin wire loop heated by electrical current to excise abnormal cervical tissue *Loop electromagnetic excision procedure* - Incorrect terminology; the "E" in **LEEP** stands for **electrosurgical**, not electromagnetic - Electromagnetic procedures are not standard for cervical lesion management *Loop electrodiagnostic excision procedure* - Incorrect terminology; while LEEP does provide diagnostic tissue, the "E" stands for **electrosurgical**, which describes the cutting technique - The term "electrodiagnostic" is not used in this context *Loop electrochemical excision procedure* - Incorrect terminology; the procedure uses **electrical current** for cutting and coagulation, not electrochemical reactions - The "E" in LEEP specifically refers to **electrosurgical** technique

Question 1099: Most common malignant ovarian tumor is?

A. Malignant teratoma
B. Sarcoma
C. Mucinous cystadenocarcinoma
D. Serous cystadenocarcinoma (Correct Answer)

Explanation: ***Serous cystadenocarcinoma*** - This is the **most common type of malignant ovarian tumor**, accounting for approximately 40-50% of all ovarian cancers. - It is typically characterized by **cystic and solid components** and is often bilateral. *Mucinous cystadenocarcinoma* - This is the **second most common type** of epithelial ovarian cancer, less frequent than serous types. - Mucinous tumors are often **larger** and more commonly unilateral than serous tumors. *Malignant teratoma* - This is a rare type of ovarian germ cell tumor, which is distinct from the more common epithelial ovarian cancers. - Malignant teratomas include immature teratomas and are far less common than epithelial tumors like serous cystadenocarcinomas. *Sarcoma* - **Ovarian sarcomas** are exceedingly rare primary ovarian malignancies, forming a very small percentage of all ovarian cancers. - Most ovarian malignancies originate from the **surface epithelium** of the ovary, not stromal tissue.

Question 1100: What is the most common type of fibroid?

A. Intramural (Correct Answer)
B. Subserosal
C. Cervical
D. Submucosal

Explanation: ***Intramural*** - **Intramural fibroids** are located within the **uterine wall muscle (myometrium)** and are the most prevalent type. - Their presence often leads to **enlargement of the uterus** and can cause symptoms like **heavy menstrual bleeding** and **pelvic pressure**. *Subserosal* - **Subserosal fibroids** grow on the **outer surface of the uterus** and may project outwards. - While common, they are found **less frequently** than intramural fibroids and often cause **pressure symptoms** more than bleeding issues. *Cervical* - **Cervical fibroids** are located in the **cervix**, the lower part of the uterus, and are relatively rare. - They can cause symptoms such as **dyspareunia**, **urinary obstruction**, or **bleeding** due to their position. *Submucosal* - **Submucosal fibroids** are located just beneath the **endometrial lining** of the uterus, protruding into the uterine cavity. - Although they are the **least common type**, they are associated with the **most severe symptoms**, including heavy and prolonged menstrual bleeding and infertility.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

Practice Questions

Pelvic Inflammatory Disease

Practice Questions

Vulvovaginitis

Practice Questions

Pelvic Organ Prolapse

Practice Questions

Vulvar Disorders

Practice Questions

Benign Breast Diseases

Practice Questions

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