Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1171: Most common site for endometriosis in the urinary system is

A. Kidney
B. Ureter - lower segment
C. Bladder (Correct Answer)
D. Ureter - upper segment

Explanation: ***Bladder*** - The **bladder** is the most common site for **urinary tract endometriosis**, accounting for approximately 80% of all cases. - This is often due to its anatomical proximity to the uterus and broad ligaments, allowing for easier implantation of **ectopic endometrial tissue**. *Kidney* - **Kidney involvement** in endometriosis is extremely rare and typically occurs only in severe, widespread cases. - It is not considered a common site for endometrial implants in the urinary system. *Ureter - lower segment* - While the **ureter** can be affected by endometriosis, particularly the lower segment, it is less common than bladder involvement. - Ureteral obstruction due to endometriosis can lead to **hydronephrosis**. *Ureter - upper segment* - Endometriosis of the **upper ureter** is very uncommon, with the disease more frequently found in the distal (lower) segments if the ureter is affected at all. - The close anatomical relationship between the **pelvic organs** makes lower urinary tract involvement more likely.

Question 1172: What is the characteristic discharge associated with Trichomonas vaginalis?

A. Greenish discharge (Correct Answer)
B. White curdy discharge
C. Blood-stained discharge
D. Milky discharge

Explanation: ***Greenish discharge*** - A characteristic presentation of **Trichomonas vaginalis** infection is a **frothy, foul-smelling, greenish-yellow vaginal discharge**. - This discharge is often accompanied by **pruritus**, **dyspareunia**, and **vulvovaginal irritation**. *White curdy discharge* - This type of discharge, often described as "cottage cheese-like," is typically associated with **vulvovaginal candidiasis** (yeast infection). - It is usually **odorless** but causes significant itching and burning. *Blood-stained discharge* - While various gynecological conditions can cause **blood-stained discharge**, it is not a primary or characteristic symptom of **Trichomonas vaginalis** infection. - Causes can range from **cervical polyps** or **STIs** like **gonorrhea** and **chlamydia** to more serious conditions like **cervical cancer**. *Milky discharge* - A **milky or homogeneous discharge** can be associated with **bacterial vaginosis** which often has a **fishy odor**. - It differs from the frothy, green discharge seen in trichomoniasis.

Question 1173: The treatment of choice for a 25-year-old patient who presents with vaginal discharge and examination reveals the presence of Chlamydial infection is:

A. Azithromycin with contact tracing (Correct Answer)
B. Doxycycline with Metronidazole
C. Fluconazole with Doxycycline
D. Metronidazole alone

Explanation: ***Azithromycin with contact tracing*** - **Azithromycin** is a recommended first-line treatment for uncomplicated **Chlamydia trachomatis** infections due to its single-dose regimen which improves adherence. - **Contact tracing** is crucial to prevent re-infection and further spread of the infection within the community by identifying and treating sexual partners. *Doxycycline with Metronidazole* - **Doxycycline** is an alternative effective treatment for chlamydia, typically given as a 7-day course, but it is not the single-dose option often preferred. - **Metronidazole** is an antibiotic primarily used to treat bacterial vaginosis and trichomoniasis, not chlamydial infection. *Fluconazole with Doxycycline* - **Fluconazole** is an antifungal medication used for yeast infections and is not effective against bacterial chlamydial infections. - While **doxycycline** is effective for chlamydia, its combination with an antifungal when only chlamydia is identified is inappropriate. *Metronidazole alone* - **Metronidazole** is effective against anaerobic bacteria and parasites like those causing trichomoniasis or bacterial vaginosis, but it has no activity against **Chlamydia trachomatis**. - Using metronidazole alone for chlamydial infection would be an ineffective treatment, leading to persistent infection and potential complications.

Question 1174: All are true regarding adenomyosis except:

A. Enlarged uterus that rarely exceeds 12 weeks.
B. Ectopic rests of endometrium located deep within the myometrium.
C. Glands found within myometrium originate from stratum functionalis. (Correct Answer)
D. Spongy surface trabeculated with focal areas of hemorrhage.

Explanation: ***Glands found within myometrium originate from stratum functionalis*** - The ectopic endometrial glands and stroma found in adenomyosis originate from the **stratum basalis** (basal layer) of the endometrium, not the stratum functionalis. - The stratum functionalis is the layer that sheds during menstruation, whereas the stratum basalis is responsible for regenerating the functionalis layer. *Enlarged uterus that rarely exceeds 12 weeks* - This statement is largely true for adenomyosis, as the uterus typically becomes **globularly enlarged** but usually does not reach the size of a 12-week pregnancy. - Significant uterine enlargement that exceeds this limit might suggest other pathologies like **fibroids**. *Ectopic rests of endometrium located deep within the myometrium* - This is the **defining characteristic** of adenomyosis, where endometrial tissue (glands and stroma) is found abnormally within the muscular wall of the uterus. - These ectopic endometrial implants cause the surrounding myometrial cells to undergo **hyperplasia and hypertrophy**. *Spongy surface trabeculated with focal areas of hemorrhage* - The cut surface of an adenomyotic uterus often appears **trabeculated or spongy** due to the hypertrophy of the myometrium surrounding the endometrial islands. - **Focal areas of hemorrhage** (small blood clots) may be seen where ectopic endometrial tissue has bled into the myometrium, especially during menstruation.

Question 1175: Which one of the following is NOT a characteristic feature of bacterial vaginosis?

A. Vaginal pH >4.5
B. Fishy odour
C. Presence of clue cells
D. Thick white discharge (Correct Answer)

Explanation: ***Thick white discharge*** - Bacterial vaginosis is characterized by a **thin, grayish-white, homogeneous discharge**, not a thick white one. - A thick, white, "cottage cheese-like" discharge is more typical of **vulvovaginal candidiasis (yeast infection)**. *Presence of clue cells* - **Clue cells** are epithelial cells covered with bacteria, which are a hallmark microscopic finding in bacterial vaginosis. - Their presence is a key diagnostic criterion (Amsel criteria) for the condition. *Vaginal pH >4.5* - Bacterial vaginosis is associated with an **elevated vaginal pH, typically greater than 4.5**, due to the shift in vaginal flora. - This alkaline pH is a critical diagnostic indicator. *Fishy odour* - A **distinctive fishy odor**, particularly after intercourse or douching, is a classic symptom of bacterial vaginosis. - This odor is due to the production of **volatile amines** by anaerobic bacteria.

Question 1176: Which of the following is not used to shrink fibroids?

A. Estrogen (Correct Answer)
B. Danazol
C. Mifepristone
D. GnRH analogue

Explanation: ***Estrogen*** - **Estrogen** promotes the growth of **fibroids**, which are estrogen-sensitive tumors, rather than shrinking them. - Using estrogen would likely worsen fibroid symptoms and increase their size. *Danazol* - Danazol is an androgenic steroid that creates a **hypoestrogenic environment**, leading to fibroid regression. - It works by suppressing gonadotropin secretion, thereby inhibiting ovarian estrogen production. *Mifepristone* - Mifepristone is an **anti-progesterone** agent, which can reduce fibroid size by inhibiting the effects of progesterone, a hormone that also promotes fibroid growth. - It also has anti-estrogenic effects that contribute to fibroid shrinkage. *GnRH analogue* - **GnRH analogues** induce a **pseudo-menopausal state** by downregulating GnRH receptors in the pituitary, which significantly reduces estrogen production. - This hypoestrogenic state effectively shrinks fibroids, though their size often returns after treatment cessation.

Question 1177: What is the most common cause of pyometra?

A. Carcinoma vagina
B. Uterine myoma
C. Carcinoma endometrium
D. Carcinoma cervix (Correct Answer)

Explanation: ***Carcinoma cervix*** - **Cervical cancer** often obstructs the cervical os, trapping pus and debris within the uterine cavity, leading to pyometra. - The resulting **obstruction** prevents drainage of infected material from the uterus, creating a favorable environment for infection. *Carcinoma endometrium* - While endometrial cancer can cause uterine bleeding or discharge, it less frequently causes **cervical obstruction** severe enough to lead to pyometra. - The nature of endometrial cancer often involves diffuse growth rather than a focal occlusive lesion at the cervical canal. *Carcinoma vagina* - Vaginal carcinoma is less likely to directly obstruct the **cervical canal** or compromise uterine drainage. - Its progression typically impacts the vagina locally and does not primarily cause accumulation of pus within the uterus. *Uterine myoma* - **Uterine fibroids (myomas)** are benign tumors that can cause abnormal bleeding or pressure symptoms. - They rarely cause complete **cervical obstruction** leading to pyometra unless they are very large pedunculated fibroids prolapsing into the cervix.

Question 1178: What is the most common Müllerian anomaly?

A. Unicornuate uterus
B. Bicornuate uterus
C. Septate uterus (Correct Answer)
D. Müllerian agenesis (RMKH)

Explanation: ***Correct - Septate uterus*** - A **septate uterus** is the most common Müllerian anomaly, resulting from the incomplete reabsorption of the uterine septum after the fusion of the paramesonephric ducts. - It is associated with the highest rates of **recurrent pregnancy loss** among all Müllerian anomalies due to poor blood supply in the septum. *Incorrect - Unicornuate uterus* - This anomaly involves the **partial or complete aplasia of one Müllerian duct**, resulting in a uterus that is half the normal size with only one fallopian tube. - While it can lead to **infertility** and **ectopic pregnancies**, it is less common than a septate uterus. *Incorrect - Bicornuate uterus* - A **bicornuate uterus** occurs due to incomplete fusion of the two paramesonephric ducts, leading to a heart-shaped uterus with two horns. - Pregnancy outcomes can be complicated by **preterm labor** or **malpresentation**, but it is not the most prevalent type. *Incorrect - Müllerian agenesis (RMKH)* - **Müllerian agenesis**, or Mayer-Rokitansky-Küster-Hauser syndrome, is characterized by the **absence or underdevelopment of the uterus and vagina**. - This is a rare condition that typically presents with **primary amenorrhea** but a normal karyotype and functioning ovaries.

Question 1179: Surgery is not indicated in which of the following conditions associated with genital TB?

A. Pyosalpinx
B. Persistence of symptoms despite medical management
C. Pyometra (uterine infection)
D. Bowel adhesions due to genital TB (Correct Answer)

Explanation: ***Bowel adhesions due to genital TB*** - **Bowel adhesions** from genital TB typically resolve with **anti-tuberculosis therapy** alone, as the inflammatory process subsides with medical treatment. - Surgical intervention can actually **worsen adhesion formation** and is only indicated for complications like **complete bowel obstruction**. *Pyosalpinx* - **Pyosalpinx** involves pus-filled fallopian tubes that require **surgical drainage** or **salpingectomy** to prevent rupture and sepsis. - Medical therapy alone cannot adequately drain the **purulent collection**, making surgery essential for complete resolution. *Persistence of symptoms despite medical management* - **Refractory symptoms** after adequate **anti-TB therapy** indicate need for surgical removal of **fibrotic** or **calcified tissue** that cannot respond to medications. - Surgery helps eliminate **persistent infection foci** and restore normal anatomy when medical treatment fails. *Pyometra (uterine infection)* - **Pyometra** requires immediate **surgical drainage** through **dilatation and curettage** or **hysterectomy** to prevent life-threatening sepsis. - The **purulent uterine contents** cannot be adequately cleared by antibiotics alone, necessitating mechanical evacuation.

Question 1180: Fibromyoma is seen in which age group?

A. Reproductive (Correct Answer)
B. Early adolescence
C. Prepubertal
D. Late postmenopausal

Explanation: ***Reproductive*** - **Fibroids** (leiomyomas) are **estrogen-dependent tumors** and thus most commonly develop during a woman's reproductive years. - Their growth is stimulated by the high levels of **estrogen** and **progesterone** present during this period. *Early adolescence* - Fibroids are rare in **early adolescence** as estrogen levels are typically not yet high enough to promote their development and growth. - The uterus is still maturing during this stage, and hormonal peaks that drive fibroid growth are less common. *Late postmenopausal* - After menopause, **estrogen levels decline significantly**, which usually causes existing fibroids to shrink. - New fibroids rarely develop in the **late postmenopausal** period due to the low hormonal environment. *Prepubeal* - This period is characterized by very **low estrogen levels**, making the development of fibroids extremely rare. - The uterus is immature, and there is no hormonal stimulus for fibroid formation.

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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