Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1151: What is the first-line treatment for simple hyperplasia of the endometrium?

A. Endometrial ablation (surgical procedure)
B. Estrogen therapy (e.g., Estradiol)
C. Total abdominal hysterectomy (surgical removal of the uterus)
D. Progestin therapy (e.g., Medroxyprogesterone acetate) (Correct Answer)

Explanation: ***Progestin therapy (e.g., Medroxyprogesterone acetate)*** - **Progestin therapy** is the first-line treatment for simple endometrial hyperplasia because it counteracts the unopposed estrogen effect causing the hyperplasia. - **Progestins** lead to endometrial atrophy and shedding, helping to reverse the hyperplastic changes and prevent progression to cancer. *Estrogen therapy (e.g., Estradiol)* - **Estrogen therapy** without concomitant progestins would exacerbate endometrial hyperplasia by further stimulating endometrial growth. - This treatment is contraindicated in cases of endometrial hyperplasia unless carefully balanced with progestins. *Endometrial ablation (surgical procedure)* - **Endometrial ablation** is a destructive procedure to remove the endometrial lining and is typically considered for persistent abnormal uterine bleeding, not as a primary treatment for simple hyperplasia. - It is often reserved for patients who have completed childbearing and fail medical management. *Total abdominal hysterectomy (surgical removal of the uterus)* - A **total abdominal hysterectomy** is an invasive surgical procedure that is generally reserved for complex or atypical endometrial hyperplasia, or hyperplasia that is recurrent and unresponsive to medical management. - It is not the first-line treatment for simple hyperplasia, especially in patients who may desire future fertility or wish to avoid major surgery.

Question 1152: A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?

A. Chlamydia trachomatis
B. Candida albicans
C. Gardnerella vaginalis
D. Trichomonas vaginalis (Correct Answer)

Explanation: ***Trichomonas vaginalis*** - **Trichomoniasis** commonly presents with **intense vulvovaginal pruritus**, a **frothy, greenish-yellow discharge**, and sometimes a **strawberry cervix**. - It is a **sexually transmitted infection (STI)** caused by a flagellated protozoan. *Candida vaginitis* - Typically causes severe **pruritus**, **dysuria**, and a **thick, white, curd-like discharge**, often without the watery characteristic. - Known as a **yeast infection**, it is caused by an overgrowth of *Candida* species. *Gardnerella vaginalis* - Associated with **bacterial vaginosis**, which presents with a **thin, grayish-white discharge** and a **fishy odor**, especially after intercourse, but usually less intense pruritus. - It's characterized by an imbalance of vaginal flora rather than being a true STI in the same sense as trichomoniasis. *Chlamydia trachomatis* - Often causes **asymptomatic infections** or symptoms such as **mucopurulent discharge**, **dysuria**, or **post-coital bleeding**, but usually **not intense pruritus** or watery discharge. - It is a **bacterial STI** known for causing cervicitis and pelvic inflammatory disease.

Question 1153: What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?

A. Candida
B. Bacterial vaginosis
C. Chlamydia trachomatis
D. Trichomonas vaginalis (Correct Answer)

Explanation: ***Trichomonas vaginalis (Correct)*** - The characteristic presentation of **yellow-green, frothy, watery vaginal discharge** with associated **pruritus** is highly suggestive of **trichomoniasis**. - Other clinical findings may include **dyspareunia**, **dysuria**, and a **"strawberry cervix"** on speculum examination. - Trichomoniasis is a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. *Candida (Incorrect)* - **Candidiasis** (yeast infection) typically presents with **thick, white, cottage cheese-like discharge** and severe pruritus, often described as a burning sensation. - The discharge is usually not watery or yellow-green, and the characteristic fishy odor is absent. - pH is typically normal (<4.5), unlike trichomoniasis where pH is elevated (>4.5). *Bacterial vaginosis (Incorrect)* - **Bacterial vaginosis** is characterized by a **thin, gray-white discharge** with a **fishy odor**, especially after intercourse or with alkalinization. - The discharge is not typically yellow-green or frothy. - Pruritus may be present but is usually less prominent than with candidiasis or trichomoniasis. *Chlamydia trachomatis (Incorrect)* - **Chlamydia** infection is often **asymptomatic** in women (up to 70% of cases), but when symptoms occur, they may include **mucopurulent cervical discharge**, intermenstrial bleeding, or lower abdominal pain. - It does not typically cause the **profuse, frothy, yellow-green discharge** with significant pruritus described in this clinical presentation. - Chlamydia primarily causes cervicitis rather than vaginitis.

Question 1154: What is a cochleate uterus?

A. Large uterus
B. Acute anteflexion (Correct Answer)
C. Acute retroflexion
D. Large cervix

Explanation: ***Acute anteflexion*** - A **cochleate uterus** describes a uterus with an **acute anteflexion**, meaning it is sharply bent forward at the junction of the cervix and the body of the uterus. - This anatomical variation can sometimes be associated with **dysmenorrhea** or difficulty with **intrauterine device (IUD) insertion**. *Large uterus* - A large uterus, also known as **uteromegaly**, is a general descriptive term for an enlarged uterus, which can be due to various causes such as **fibroids** or **adenomyosis**, and is not specific to an acute anteflexion. - It does not directly describe the acute angulation that defines a cochleate uterus. *Acute retroflexion* - **Acute retroflexion** refers to a uterus that is sharply bent backward at the level of the cervix. - This is the opposite of **anteflexion**, which describes a forward bend, and therefore is not a cochleate uterus. *Large cervix* - A **large cervix** describes an enlarged uterine cervix, which is the lower, narrow part of the uterus. - This typically relates to conditions like **cervical hypertrophy** or **nabothian cysts** and is distinct from the overall angulation of the uterine body in relation to the cervix.

Question 1155: Which of the following statements about Asherman's syndrome is true?

A. May be secondary to TB
B. Progesterone challenge test is positive
C. Characterized by intrauterine adhesions (Correct Answer)
D. Not associated with menstrual irregularities

Explanation: ***Characterized by intrauterine adhesions*** - **Asherman's syndrome** is fundamentally defined by the presence of **intrauterine adhesions** or scarring of the uterine cavity. - These adhesions develop following trauma to the basal layer of the endometrium, often from gynecological procedures like **dilation and curettage (D&C)**. - This is the **pathognomonic feature** that defines the syndrome. *Progesterone challenge test is positive* - The **progesterone challenge test** assesses the presence of an intact endometrium and adequate estrogen priming. - In Asherman's syndrome, due to the scarred endometrium, the response to progesterone is typically **absent or minimal**, leading to a **negative** result. - A negative progesterone challenge test indicates outflow obstruction or endometrial non-responsiveness. *May be secondary to TB* - While **genital tuberculosis** can cause intrauterine adhesions and is a recognized etiology, it represents a **small minority** of cases. - The primary etiology of Asherman's syndrome is usually **iatrogenic**, following uterine instrumentation such as D&C, particularly post-partum or post-abortion. - TB-related adhesions may have additional features like caseating granulomas. *Not associated with menstrual irregularities* - This is **false** - Asherman's syndrome is classically associated with **menstrual irregularities**. - Common presentations include **hypomenorrhea** (scanty periods), **amenorrhea** (absent periods), or oligomenorrhea. - These menstrual changes result from the reduced functional endometrium available for cyclical shedding due to intrauterine adhesions.

Question 1156: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

A. Increase incidence of ectopic pregnancy
B. Involvement of endosalpinx
C. Most common is ascending infection (Correct Answer)
D. Mostly secondary

Explanation: ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Question 1157: What is the treatment of choice for Bartholin's cyst?

A. Excision
B. Antibiotic therapy
C. Marsupialization (Correct Answer)
D. Cyst drainage

Explanation: ***Marsupialization*** - This procedure involves incising the cyst, draining its contents, and then everting and suturing the edges of the cyst wall to the surrounding skin, creating a permanent-draining pouch. - **Marsupialization** is the treatment of choice because it prevents recurrence by allowing continuous drainage of mucus, unlike simple incision and drainage. *Excision* - Complete surgical excision of the Bartholin's gland or cyst is a more invasive procedure and is typically reserved for cases of **recurrent cysts** after marsupialization or suspected malignancy. - It carries a higher risk of bleeding and infection compared to marsupialization, and can lead to **vaginal dryness** due to loss of glandular secretions. *Antibiotic therapy* - Antibiotics are primarily used if the Bartholin's gland becomes **infected**, leading to an **abscess**, or if there is surrounding cellulitis. - They do not address the underlying blockage of the duct and will not resolve a Bartholin's cyst, which is a collection of mucus due to duct obstruction. *Cyst drainage* - Simple incision and drainage (I&D) provides temporary relief by emptying the cyst contents but has a **high recurrence rate** because the duct often re-occludes. - While it may be used as an initial temporizing measure, it is not the definitive treatment for preventing future episodes of Bartholin's cysts.

Question 1158: Vaginal pH before puberty is?

A. Approximately 6
B. Approximately 4.5
C. Approximately 5
D. Neutral (around 7) (Correct Answer)

Explanation: ***Neutral (around 7)*** - Before puberty, the vagina lacks the influence of **estrogen**, which is essential for the colonization of **Lactobacillus** bacteria. - Without Lactobacillus, there is no significant production of lactic acid, resulting in a **neutral pH** environment. *Approximately 6* - A pH of approximately 6 is still slightly acidic but less so than a mature vagina. - This value is not typical for the prepubertal stage, which generally represents an environment without significant acidic production. *Approximately 4.5* - A pH of approximately 4.5 is characteristic of a **healthy, estrogenized adult vagina** where **Lactobacillus** bacteria produce lactic acid. - This acidic environment is crucial for protecting against pathogenic infections and is not found in prepubertal individuals. *Approximately 5* - A pH of approximately 5 is acidic, though less so than the optimal adult vaginal pH. - This value indicates some lactic acid production, which is minimal or absent before the onset of puberty.

Question 1159: What is the definitive management for adenomyosis?

A. Endometrial ablation.
B. Hysterectomy (surgical removal of the uterus). (Correct Answer)
C. Hormonal therapy (e.g., Danazol) for temporary symptom relief.
D. Hormonal therapy (e.g., GnRH analogue) for temporary symptom relief.

Explanation: ***Hysterectomy (surgical removal of the uterus)*** - This is considered the **definitive management** for adenomyosis because it completely removes the uterine tissue where the ectopic endometrial glands are found. - Hysterectomy effectively eliminates the source of symptoms such as **heavy menstrual bleeding** and **pelvic pain** by removing the uterus entirely. *Endometrial ablation* - Endometrial ablation involves destroying the **lining of the uterus** and is primarily used for heavy menstrual bleeding. - It is **ineffective for adenomyosis** since the endometrial tissue is embedded deep within the myometrium and is not fully reached by ablation. *Hormonal therapy (e.g., Danazol) for temporary symptom relief* - **Danazol** (an androgen derivative) can suppress ovarian function and reduce symptoms of adenomyosis by shrinking endometrial tissue. - However, its effects are **temporary**, and symptoms typically return upon cessation of treatment, making it not a definitive solution. *Hormonal therapy (e.g., GNRH analogue) for temporary symptom relief* - **GnRH analogues** induce a temporary menopausal state, which can significantly reduce symptoms by inhibiting estrogen production, leading to atrophy of the adenomyotic tissue. - This treatment is also **temporary**, and symptoms often recur once the medication is stopped; it's often used as a bridge to surgery or for women nearing menopause.

Question 1160: Gold standard technique for diagnosis of endometriosis?

A. Ca 125 level
B. Ultrasound
C. MRI
D. Laparoscopy (Correct Answer)

Explanation: ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.

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

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