Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1101: What is the condition characterized by the ingrowth of both glandular and stromal components of the endometrium into the myometrium?

A. Courvelaire uterus
B. Placenta accreta
C. Uterine fibroid
D. Adenomyosis (Correct Answer)

Explanation: ***Adenomyosis*** - **Adenomyosis** is defined by the presence of **endometrial glands and stroma within the myometrium**. - This ectopic tissue causes the uterus to become enlarged and boggy, often leading to **dysmenorrhea** and **menorrhagia**. *Courvelaire uterus* - **Couvelaire uterus** is a condition where there is **hemorrhage into the myometrium** as a result of **placental abruption**. - It is an acute obstetric complication, not a chronic ingrowth of endometrial tissue. *Placenta accreta* - **Placenta accreta** involves abnormal adherence of the **placenta to the myometrium**, with villi invading the uterine wall. - While it involves invasion into the myometrium, it is specific to the placenta and occurs during pregnancy, not involving endometrial glands and stroma themselves. *Uterine fibroid* - A **uterine fibroid** (leiomyoma) is a **benign tumor of smooth muscle** within the myometrium. - It is composed primarily of muscle and fibrous connective tissue, not endometrial glandular tissue.

Question 1102: What is the most common site of sarcoma botryoides?

A. It presents with blood stained watery vaginal discharge
B. It can be treated with VAC regime
C. Also called embryonal rhabdomyosarcoma
D. Vagina (Correct Answer)

Explanation: ***Vagina*** - Sarcoma botryoides is a specific variant of **embryonal rhabdomyosarcoma** that characteristically arises from the **vagina**, specifically the anterior vaginal wall, in young girls (typically under 8 years). - Its presentation as a **grape-like polypoid mass** protruding from the vagina is a classic clinical finding. - This is the **most common site** for sarcoma botryoides, making it the correct answer. *Also called embryonal rhabdomyosarcoma* - While sarcoma botryoides is a **subtype of embryonal rhabdomyosarcoma**, this statement describes the classification, not the anatomical site. - Embryonal rhabdomyosarcoma can occur in various locations (head/neck, genitourinary tract, extremities), but sarcoma botryoides specifically refers to the variant with **mucosal origin**, most commonly in the vagina. *It presents with blood stained watery vaginal discharge* - This is a **clinical presentation/symptom**, not an anatomical site. - Blood-stained discharge occurs due to **ulceration** and **tumor necrosis** of the vaginal mass, and is indeed a common presenting feature. *It can be treated with VAC regime* - The **VAC (Vincristine, Actinomycin D, Cyclophosphamide)** regimen is the standard chemotherapy protocol for rhabdomyosarcoma, including sarcoma botryoides. - This statement describes the **treatment modality**, not the most common site of origin.

Question 1103: What is used to aid identification of areas of dysplasia in colposcopy?

A. 3 - 5% acetic acid (Correct Answer)
B. Acetocarmine red
C. 1 % formic acid
D. 1 % alcohol

Explanation: ***3 - 5% acetic acid*** - **Acetic acid** dehydrates cells and causes nuclear proteins and keratins to coagulate, making areas with high nuclear-to-cytoplasmic ratio (like dysplastic cells) appear **acetowhite**. - This transient **acetowhite change** helps colposcopists identify dysplastic lesions that are not visible to the naked eye. *Acetocarmine red* - This is a stain used in **cytogenetics** for staining chromosomes, not for colposcopic identification of dysplasia. - It highlights nuclear material and is not applied topically during a colposcopic examination to reveal acetowhite changes. *1 % formic acid* - **Formic acid** is a strong organic acid used in various industrial applications and as a decalcifying agent in histology. - It is not used as a diagnostic agent in colposcopy to identify dysplastic areas. *1 % alcohol* - **Alcohol** is an antiseptic and dehydrating agent, but it does not selectively identify dysplastic cells through an acetowhite change like acetic acid. - It is not routinely used in colposcopy for the purpose of highlighting abnormal epithelial areas.

Question 1104: In cases of genital tuberculosis, which condition is most commonly associated with tubal adhesions, fibrosis, and hydrosalpinx formation?

A. Tuberculosis of the fallopian tube (Correct Answer)
B. Tuberculosis of the endometrium
C. Tuberculosis of the ovary
D. Tuberculosis of the cervix

Explanation: ***Tuberculosis of the fallopian tube*** - **Tubal tuberculosis** is the **most common site** of genital tuberculosis (90-95% of cases), directly affecting the fallopian tubes - Leads to severe inflammatory responses causing **adhesions**, **fibrosis**, and ultimately **hydrosalpinx formation** - This is a **significant cause of infertility** due to tubal obstruction and distortion - Classic presentation includes bilateral involvement with **beaded appearance** of tubes *Tuberculosis of the endometrium* - While **endometrial tuberculosis** is the second most common site (50-80% of cases), it's less directly associated with the specific tubal pathologies like **hydrosalpinx** - Endometrial involvement primarily leads to **menstrual irregularities**, **thin endometrium**, and **implantation failure**, rather than the structural distortion of the fallopian tubes - Often occurs secondary to tubal infection *Tuberculosis of the ovary* - **Ovarian tuberculosis** is less common (10-30% of cases) and typically presents as **tuberculous oophoritis** or ovarian mass - Does not directly cause the characteristic **hydrosalpinx** and extensive **tubal adhesions** seen with fallopian tube infection - Usually occurs in association with tubal disease *Tuberculosis of the cervix* - **Cervical tuberculosis** is rare (1-5% of cases) and presents as hypertrophic or ulcerative lesions - Does not cause **tubal adhesions**, **fibrosis**, or **hydrosalpinx formation** - Clinically may mimic cervical carcinoma

Question 1105: Meigs syndrome is associated with which tumor ?

A. Fibroma (Correct Answer)
B. Cystadenoma
C. Dysgerminoma
D. Teratoma

Explanation: ***Fibroma*** - **Meigs syndrome** is defined by the classic triad of a **benign ovarian fibroma** (or fibroma-like tumor such as thecoma), **ascites**, and **pleural effusion**. - The effusions **resolve completely after tumor removal**, which is a key diagnostic feature. - While other ovarian tumors can cause ascites and pleural effusion, the specific combination with a **fibroma** is characteristic of true Meigs syndrome. *Cystadenoma* - **Cystadenomas** (serous or mucinous) are common benign ovarian tumors that are typically cystic. - They can cause ascites and pleural effusion, a condition termed **"pseudo-Meigs syndrome"**, but they lack the fibrous solid component central to the definition of true Meigs syndrome. - The distinction is important for classification purposes, though clinical management may be similar. *Dysgerminoma* - A **dysgerminoma** is a malignant germ cell tumor of the ovary, most common in young women. - While it can cause ascites as a feature of malignancy or peritoneal spread, it is not a benign tumor and is therefore not associated with Meigs syndrome. - Malignant tumors causing effusions do not fit the criteria for Meigs syndrome. *Teratoma* - **Teratomas** are germ cell tumors that can be benign (mature cystic teratoma or dermoid cyst) or malignant (immature teratoma). - Though they can rarely cause ascites and pleural effusion (pseudo-Meigs syndrome), especially if complicated by rupture, torsion, or malignant transformation, they are not fibromas and thus do not fit the criteria for true Meigs syndrome. - The most common complication of dermoid cysts is torsion, not Meigs syndrome.

Question 1106: What type of tubal damage is associated with Pelvic Inflammatory Disease (PID) caused by Neisseria gonorrhoeae?

A. Peritubal
B. Endotubal (Correct Answer)
C. Extratubal
D. Juxtatubal

Explanation: ***Endotubal*** - *Neisseria gonorrhoeae* infection in **Pelvic Inflammatory Disease (PID)** primarily affects the **mucosa lining the fallopian tubes**, causing inflammation and damage from within. - This **endotubal inflammation** can lead to scarring, adhesion formation, and destruction of the ciliary epithelium, impairing tubal function. *Peritubal* - **Peritubal damage** refers to inflammation and adhesions on the **exterior surface of the fallopian tubes**, often involving surrounding structures. - While PID can eventually cause peritubal adhesions, the **primary and initial site of damage** from *N. gonorrhoeae* is endotubal. *Extratubal* - **Extratubal** damage implies pathology located **completely outside** the fallopian tube itself, such as in the ovaries or peritoneum. - Although PID is a broad infection of the upper genital tract, the **direct damage** to the tube from *N. gonorrhoeae* starts inside the lumen. *Juxtatubal* - **Juxtatubal** refers to damage located **adjacent to** or in close proximity to the fallopian tube, but not necessarily within it or on its surface. - This term is less specific regarding the primary site of infection and damage caused by *N. gonorrhoeae* in the fallopian tubes.

Question 1107: Cryptomenorrhoea is a feature of?

A. Gonadal agenesis
B. Empty sella syndrome
C. Turner syndrome
D. Vaginal atresia (Correct Answer)

Explanation: ***Vaginal atresia*** - **Cryptomenorrhoea** is defined as menstruation occurring but not flowing out of the body due to an **obstruction in the outflow tract**. - **Vaginal atresia** or an **imperforate hymen** creates such an obstruction, leading to the accumulation of menstrual blood in the vagina (**hematocolpos**) and/or uterus (**hematometra**). *Empty sella syndrome* - This condition involves a flattened or shrunken **pituitary gland** and is typically associated with hormonal deficiencies, not an anatomical obstruction of menstrual flow. - It can cause menstrual irregularities or **amenorrhea** due to hypopituitarism, but not cryptomenorrhoea where menstruation forms but cannot exit. *Gonadal agenesis* - **Gonadal agenesis** means the complete absence of gonads, leading to a lack of estrogen production and consequently, a lack of pubertal development and menstruation. - This would result in **primary amenorrhoea** (no menstruation at all), not cryptomenorrhoea, as no menstrual cycle is established. *Turner syndrome* - **Turner syndrome** (45, XO) is characterized by **gonadal dysgenesis** (streak gonads), leading to undeveloped ovaries. - This results in a lack of estrogen and progesterone, preventing the initiation of menstruation and causing **primary amenorrhoea**, not cryptomenorrhoea.

Question 1108: What is the most common germ cell tumor of the ovary?

A. Dysgerminoma
B. Serous cystadenoma
C. Yolk sac tumor
D. Mature cystic teratoma (Correct Answer)

Explanation: ***Mature cystic teratoma*** - **Mature cystic teratomas**, also known as **dermoid cysts**, are the most common type of **ovarian germ cell tumor**, accounting for approximately 10-20% of all ovarian neoplasms. - They are typically benign and characterized by the presence of **tissue from all three germ layers** (ectoderm, mesoderm, endoderm), often including hair, teeth, bone, and sebaceous material. *Dysgerminoma* - **Dysgerminomas** are the most common **malignant** germ cell tumor of the ovary, but overall less common than mature cystic teratomas. - They are analogous to **seminomas** in males and are often associated with high levels of **lactate dehydrogenase (LDH)**. *Serous cystadenoma* - **Serous cystadenomas** are the most common type of **epithelial ovarian tumor**, not germ cell tumors, and are typically benign. - They originate from the surface epithelium of the ovary and are filled with clear, watery fluid. *Yolk sac tumor* - **Yolk sac tumors** (endodermal sinus tumors) are rare, highly malignant germ cell tumors of the ovary. - They are characterized by elevated levels of **alpha-fetoprotein (AFP)** and the presence of **Schiller-Duval bodies**.

Question 1109: What is the next step in investigating a 45 year old female with post coital bleeding and abnormal appearing cervix on speculum examination?

A. Dilatation and curettage
B. Conisation
C. Colposcopy (Correct Answer)
D. Hysteroscopy

Explanation: ***Colposcopy*** - Colposcopy is the appropriate next step to **directly visualize the cervical abnormality under magnification** and identify suspicious areas for targeted biopsy. - This allows for precise, **colposcopy-guided biopsies** of abnormal areas, which is crucial for **histopathological diagnosis** of potential cervical pathology including dysplasia or cancer. - It provides better visualization of the transformation zone and helps determine the extent of any lesion. *Dilatation and curettage* - This procedure involves scraping the uterine lining and is primarily used for diagnosing conditions affecting the **endometrium**, not cervical abnormalities. - It would not provide visualization or targeted biopsy of a cervical lesion. *Conisation* - Conisation is both a diagnostic and therapeutic procedure to remove a cone-shaped piece of cervical tissue. - It is typically performed **after** colposcopy and biopsy have confirmed significant dysplasia or cancer, not as the initial investigative step. - Performing conisation without prior colposcopic assessment risks inadequate margins or unnecessary tissue removal. *Hysteroscopy* - Hysteroscopy is a procedure to visualize the **inside of the uterine cavity** and is used to investigate intrauterine conditions like polyps, fibroids, or endometrial abnormalities. - It does not provide visualization of the cervix and would not help investigate cervical pathology causing post-coital bleeding.

Question 1110: What is the first-line investigation of choice for diagnosis of PID?

A. Colposcopy
B. Hysteroscopy
C. Laparoscopy
D. Ultrasonography (Correct Answer)

Explanation: ***Ultrasonography*** - **Transvaginal ultrasonography (TVUS)** is the **first-line imaging investigation of choice** for diagnosing PID because it is **non-invasive**, readily available, cost-effective, and can visualize important diagnostic features such as adnexal masses, hydrosalpinx, free fluid, or tubo-ovarian abscesses. - While laparoscopy offers direct visualization, TVUS provides valuable diagnostic information with less risk and discomfort, making it the preferred initial investigation that guides further management. *Laparoscopy* - **Laparoscopy** is considered the **gold standard** for definitive diagnosis of PID as it allows direct visualization of the pelvic organs and can confirm inflammation, adhesions, or abscesses. - However, it is an **invasive surgical procedure** with associated risks and is therefore reserved for cases where the diagnosis is uncertain, when conservative management fails, or when complications are suspected. - It is not the first-line investigation due to its invasiveness and the need for anesthesia. *Colposcopy* - **Colposcopy** is a procedure used to **examine the cervix and vagina** with magnification; it is primarily used for screening and diagnosis of **cervical abnormalities** or cervical intraepithelial neoplasia. - It does not visualize the internal pelvic organs (uterus, fallopian tubes, ovaries) and therefore has no role in the diagnosis of PID. *Hysteroscopy* - **Hysteroscopy** involves inserting a scope into the **uterine cavity to visualize the endometrium** and inspect for intrauterine pathology such as polyps, fibroids, or adhesions. - While it can diagnose some uterine conditions, it does not allow for visualization of the fallopian tubes or adnexa, making it unsuitable for diagnosing PID which primarily affects these extrauterine structures.

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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