Gynecological Disorders Practice Questions

Q: A young sexually active female patient presented to the outpatient department with complaints of lower abdominal pain, fever, vomiting, and foul-smelling vaginal discharge. On examination, the body temperature is 103 degrees Fahrenheit, pulse rate is 109 per minute and there is abdominal tenderness. Cervical motion tenderness is present on examination. What is the most likely diagnosis?

Pelvic inflammatory disease. ***Pelvic inflammatory disease*** - The presentation —lower abdominal pain, high **fever**, **foul-smelling vaginal discharge**, and severe **cervical motion tenderness (CMT)** in a sexually active woman —is the classic clinical triad for **acute Pelvic Inflammatory Disease (PID)**. - CMT, often called the **"Chandelier sign"**, is highly characteristic of PID, indicating inflammation of the fallopian tubes and surrounding structures (*salpingitis*). *Endometriosis* - This condition is characterized by chronic, cyclical pelvic pain, **dysmenorrhea**, and **dyspareunia**, and generally lacks acute signs of infection like high fever and leukorrhea. - It results from the presence of **endometrial tissue** outside the uterus and does not cause purulent vaginal discharge or acute CMT characteristic of infectious PID. *Adenomyosis* - Typically presents with **menorrhagia** (heavy bleeding) and worsening **dysmenorrhea** in older, often multiparous women, without acute febrile illness or infectious discharge. - It involves the invasion of **endometrial tissue** into the myometrium (uterine muscle wall), leading to a diffusely enlarged, globular uterus. *Appendicitis* - While it causes acute lower abdominal pain, fever, and vomiting, **appendicitis** typically presents with pain localized to the **right lower quadrant (RLQ)** and lacks the prominent **vaginal discharge** and specific **cervical motion tenderness** seen in PID. - The primary pathology involves inflammation of the appendix, not the female genital tract, thus the absence of associated **foul-smelling vaginal discharge**.

Q: Which of the following procedures is done with the instrument shown below? ![img-39.jpeg](img-39.jpeg)

Endometrial sampling. ***Endometrial sampling*** - The instrument shown is a **Sims uterine curette**, which is specifically designed with a fenestrated (windowed) tip to scrape and collect tissue from the uterine lining. - This procedure, also known as an **endometrial biopsy**, is performed to obtain a sample of the **endometrium** for histological examination, often to investigate abnormal uterine bleeding or infertility. - When asked about the **primary procedure** performed with this instrument, endometrial sampling is the most direct and specific answer. *Dilatation and curettage* - While a curette **is used** in a D&C, the question asks about the procedure done with **this specific instrument**. - D&C is a **two-step procedure**: cervical **dilatation** (using dilators) followed by **curettage** (using the curette). - The complete D&C procedure involves **multiple instruments**, whereas the curette shown specifically performs the endometrial sampling/curettage component. - Therefore, "endometrial sampling" more precisely describes what **this instrument alone** accomplishes. *Hysterosalpingography* - This is a radiological imaging procedure used to evaluate the uterus and fallopian tubes, not a tissue sampling method. - It involves injecting a contrast medium through the cervix using a **cannula**, followed by X-ray imaging. - A curette is not used in this procedure. *Cervical sampling* - This procedure, commonly for a **Pap smear**, uses instruments like an **Ayre's spatula** or a **cytobrush** to collect cells from the cervix. - A uterine curette is designed to reach the endometrium inside the uterus and is not used for sampling the cervix.

Q: Which of the following procedures is done with the instrument shown below?

Dilatation and curettage. ***Dilatation and curettage*** - The instrument shown is a **uterine curette** (specifically, a Sims uterine curette), which is the primary instrument used in D&C procedures. - D&C involves two steps: **dilatation** of the cervix using dilators (e.g., Hegar dilators) followed by **curettage** of the endometrial cavity using a curette. - This is a classic operative gynecological procedure used for diagnostic purposes (to obtain endometrial tissue) or therapeutic purposes (to evacuate uterine contents). - When asked about the procedure done with a uterine curette, the specific procedural name is **D&C**, not just endometrial sampling. *Endometrial sampling* - While D&C does sample the endometrium, the term "endometrial sampling" in modern practice typically refers to **office-based procedures** using simpler instruments. - Examples include **Pipelle catheter**, endometrial biopsy cannula, or Vabra aspirator, which are thin suction devices that do not require cervical dilatation. - These are outpatient procedures, whereas D&C with a curette is typically performed in an operating room under anesthesia. - The question asks about the specific procedure associated with the instrument (curette), which is D&C. *Hysterosalpingography* - This is a radiological procedure that involves injecting contrast dye into the uterus and fallopian tubes to assess their patency and shape. - It is performed using a **cannula** (like a Leech-Wilkinson cannula) or a balloon catheter to introduce the dye, not a curette. *Cervical sampling* - This procedure, such as a Pap smear, is performed to collect cells from the surface of the cervix (ectocervix and endocervical canal). - Instruments like an **Ayre's spatula** and a **cytobrush** are used for cervical sampling, not a uterine curette which is designed to bypass the cervix and reach the endometrial cavity.

Q: A woman presents with complaints of greenish-frothy vaginal discharge for 1 month. On examination, vulvovaginal erythema is noticed. On saline microscopy, motile organisms are seen. What is the most likely diagnosis?

Trichomoniasis. ***Trichomoniasis***- The classic triad for this parasitic infection caused by **Trichomonas vaginalis** includes vulvovaginal erythema, dyspareunia, and a characteristic **greenish-frothy discharge**.- The diagnosis is confirmed by visualizing the **motile, flagellated protozoa** on saline wet mount microscopy, which directly matches the findings in the clinical presentation.*Bacterial vaginosis*- This condition, usually due to an overgrowth of **Gardnerella vaginalis**, typically presents with a thin, **gray discharge** and a strong **fishy odor**.- Saline microscopy characteristically reveals **clue cells** (vaginal epithelial cells covered in bacteria), not motile parasitic organisms.*Chlamydial cervicitis*- Infections with **Chlamydia trachomatis** primarily cause **cervicitis**, which is often asymptomatic or results in **mucopurulent discharge** from the cervix.- The diagnosis is typically made using highly sensitive **nucleic acid amplification tests (NAATs)**, and motile organisms are not seen on microscopy.*Candidiasis*- Vaginal candidiasis (yeast infection) typically causes intense pruritus (itching) and a **thick, white, cottage-cheese-like discharge**.- Microscopy shows **pseudohyphae** and **budding yeasts**, which are non-motile fungal elements, differentiating it from the motile organisms of Trichomoniasis.

Q: A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?

Adenomyosis. ***Adenomyosis*** - This diagnosis is strongly suggested by the triad of **chronic lower abdominal pain**, severe **dysmenorrhea**, and an associated **diffusely enlarged uterus** (globular). - MRI typically shows ill-defined thickening of the **junctional zone** (>12 mm) and scattered high-signal intensity foci within the myometrium, representing ectopic endometrial tissue. *Uterine fibroid* - While fibroids cause chronic pain and heavy menstrual bleeding (**menorrhagia**), they less commonly cause severe, primary **dysmenorrhea** compared to adenomyosis. - On imaging, fibroids are typically **well-circumscribed** solid masses with sharply defined borders, unlike the diffuse enlargement of adenomyosis. *Endometriosis* - Endometriosis causes **chronic pelvic pain** and dysmenorrhea, but the symptoms are due to implants outside the uterus (e.g., ovaries, peritoneum). - Imaging (MRI) would primarily show features like **endometriomas** (chocolate cysts) or deep infiltrating nodules, rather than the diffuse myometrial involvement seen here. *Endometrial carcinoma* - The principal symptom of endometrial carcinoma in pre-menopausal women is typically **abnormal uterine bleeding** (menorrhagia or metrorrhagia), not primarily chronic pelvic pain and dysmenorrhea. - MRI would show hallmark features like **focal endometrial thickening** and invasion, which are generally distinct from the diffuse process of adenomyosis.

Q: Identify the instrument shown below:

Colposcope. ***Colposcope*** - The image clearly displays a **colposcope**, identified by its distinctive features such as the mounted microscope head, adjustable arm, and stand. - A colposcope is used for magnified visual inspection of the **cervix**, vagina, and vulva, primarily for detecting abnormal cells. *Babcock forceps* - **Babcock forceps** are grasping and holding instruments with fenestrated, triangular jaws and a blunt, rounded tip, used for holding delicate tissue without crushing it. - They are commonly used in abdominal surgeries for holding tubes (e.g., fallopian tube, ureter) or bowel. *Mosquito forceps* - **Mosquito forceps** are small, delicate hemostatic clamps with fine, serrated jaws, designed to grasp and occlude small blood vessels. - They are significantly smaller and have a different appearance compared to the large, mounted device shown. *Kocher forceps* - **Kocher forceps** are traumatic grasping forceps characterized by sharp teeth at the tip of their jaws, making them suitable for holding tough tissue or in situations where tissue crushing is not a concern. - This instrument is designed for clamping and has a completely different structure and function than the device depicted.

Q: Identify the instrument shown below:

Uterine sound. ***Uterine sound*** - This instrument, characterized by a **long, slender shaft** with a blunt, slightly curved or knobbed tip and a handle, is consistent with a uterine sound. - It is used in gynecology to **measure the depth and direction of the uterine cavity**. *Jardine decapitation hook* - A Jardine decapitation hook is a specific obstetrical instrument used for **fetal decapitation** in cases of obstructed labor with a dead fetus, and it has a distinct sharp, curved hook for this purpose. - Its appearance is very different from the smooth, blunt-tipped instrument shown. *Myoma screw* - A myoma screw is used in gynecological surgery for **grasping and extracting uterine fibroids** (myomas) from the uterus. - It typically has a **threaded, corkscrew-like tip** designed to penetrate and hold fibrous tissue, which is not visible here. *Vulsellum* - A vulsellum is a type of **forceps with sharp, hooked tips** used to grasp and hold tissues, particularly the cervix, during gynecological procedures. - The pictured instrument is a long, thin rod with a blunt end, not a grasping instrument with sharp hooks.

Q: Identify the instrument shown below:

Tenaculum. ***Tenaculum*** - The instrument shown has sharp, pointed tips designed for securely grasping and holding tissue, which is characteristic of a **tenaculum**. - **Tenaculum** is commonly used in gynecology to hold the cervix during procedures like IUD insertion, cervical biopsies, or hysteroscopy. - It typically has **single or double sharp hooks/teeth** on each jaw that penetrate the tissue for a secure grip. *Vulsellum* - A **vulsellum (volsellum)** is very similar to a tenaculum and the terms are often used interchangeably in clinical practice. - Classically, a vulsellum has **multiple small teeth** on each jaw rather than single hooks, providing a broader grip. - Both instruments serve the same function of grasping the cervix, but the specific tooth configuration may differ. *Cervical biopsy forceps* - **Cervical biopsy forceps** (such as Tischler or Eppendorf forceps) are used to excise small pieces of tissue for diagnostic purposes. - They have **cup-shaped jaws with sharp cutting edges**, not pointed grasping tips. - Designed for cutting and removing tissue specimens, not for holding structures. *EB curette* - An **EB curette** (Endometrial Biopsy curette or Pipelle) is a thin, flexible instrument with a small opening at its tip. - Used for **sampling the uterine lining** by scraping or aspiration. - The pictured instrument is rigid with grasping tips, not designed for scraping tissue from an internal cavity.

Q: Identify the instrument shown below:

Flushing curette. ***Flushing curette*** - This instrument is characterized by its **long shaft** and **fenestrated, looped tip**, often used for flushing and gentle tissue removal from the uterus. - The design allows for both **scraping** and **irrigating or aspirating** simultaneously, making it suitable for removing retained products of conception or uterine polyps while minimizing trauma. *Uterine curette* - A standard uterine curette typically has a **solid spoon-shaped or loop-shaped tip** that is sharp or blunt, designed solely for scraping the uterine lining. - It lacks the **perforations or channels** for fluid flushing or aspiration seen in the flushing curette. *Ovum forceps* - Ovum forceps are grasping instruments with **fenestrated jaws**, designed to remove **retained products of conception** or gestational tissue from the uterus. - They are used for **grasping and extracting** tissue, not for scraping or flushing. *Uterine tenaculum* - A uterine tenaculum has **sharp, pointed hooks** at its tip, designed to grasp and stabilize the cervix during gynecological procedures. - Its primary function is to **immobilize the cervix**, not to scrape, flush, or remove uterine contents.

Question 1

A young sexually active female patient presented to the outpatient department with complaints of lower abdominal pain, fever, vomiting, and foul-smelling vaginal discharge. On examination, the body temperature is 103 degrees Fahrenheit, pulse rate is 109 per minute and there is abdominal tenderness. Cervical motion tenderness is present on examination. What is the most likely diagnosis?

Accepted Answer

Pelvic inflammatory disease

Answer

Adenomyosis

Answer

Endometriosis

Answer

Appendicitis

Question 2

Which of the following procedures is done with the instrument shown below? ![img-39.jpeg](img-39.jpeg)

Accepted Answer

Endometrial sampling

Answer

Cervical sampling

Answer

Hysterosalpingography

Answer

Dilatation and curettage

Question 3

Which of the following procedures is done with the instrument shown below?

Accepted Answer

Dilatation and curettage

Answer

Endometrial sampling

Answer

Cervical sampling

Answer

Hysterosalpingography

Question 4

A woman presents with complaints of greenish-frothy vaginal discharge for 1 month. On examination, vulvovaginal erythema is noticed. On saline microscopy, motile organisms are seen. What is the most likely diagnosis?

Accepted Answer

Trichomoniasis

Answer

Chlamydial cervicitis

Answer

Candidiasis

Answer

Bacterial vaginosis

Question 5

A 26-year-old woman presents with amenorrhea for 8 weeks, lower abdominal pain, and vaginal spotting. Beta-hCG is 3,500 mIU/mL. Transvaginal ultrasound shows an empty uterus with a 3 cm adnexal mass and moderate free fluid in the pouch of Douglas. Vital signs are stable. What is the most appropriate management?

Accepted Answer

Diagnostic laparoscopy

Answer

Expectant management with serial beta-hCG monitoring

Answer

Methotrexate therapy

Answer

Immediate laparotomy

Question 6

A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?

Accepted Answer

Adenomyosis

Answer

Endometrial carcinoma

Answer

Endometriosis

Answer

Uterine fibroid

Question 7

Identify the instrument shown below:

Accepted Answer

Colposcope

Answer

Babcock forceps

Answer

Mosquito forceps

Answer

Kocher forceps

Question 8

Identify the instrument shown below:

Accepted Answer

Uterine sound

Answer

Jardine decapitation hook

Answer

Myoma screw

Answer

Vulsellum

Question 9

Identify the instrument shown below:

Accepted Answer

Tenaculum

Answer

Cervical biopsy forceps

Answer

Vulsellum

Answer

EB curette

Question 10

Identify the instrument shown below:

Accepted Answer

Flushing curette

Answer

Uterine curette

Answer

Ovum forceps

Answer

Uterine tenaculum

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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