Gynecological Disorders Practice Questions

Q: What is incorrect about this instrument?

Used for Copper T removal. ***Used for Copper T removal*** - While a speculum is often used to *visualize* the cervix for **Copper T (IUD) removal**, the removal itself is performed using specific **forceps** or a **hook** to grasp the IUD strings. - This instrument, a speculum, primarily serves to **open the vaginal canal** and provide visibility, not to directly remove an IUD. *Self-retaining speculum* - The image clearly shows a **screw mechanism** at the handle which allows the blades to be fixed in an open position without manual holding. - This feature makes it a **self-retaining instrument**, providing hands-free operation once inserted and opened. *Excellent visualization of vagina* - This **bivalved speculum**, when properly inserted and opened, effectively separates the anterior and posterior vaginal walls. - This action allows for **broad and clear visualization** of the vaginal vault and cervix. *Bivalved speculum* - The instrument consists of **two blades (valves)**, one anterior and one posterior, which are articulated and operated by a handle. - This design is characteristic of a **bivalved speculum**, designed to open the vaginal canal.

Q: Which of the following is incorrect about the instrument shown below? (Recent Neet Pattern 2016-17)

Contraindicated in postpartum state. ***Contraindicated in postpartum state*** - The instrument shown is a **uterine sound**, used to measure the **depth of the uterine cavity**. It is **not contraindicated in the postpartum state**; in fact, it can be used cautiously to check for retained products of conception or assess the uterine cavity, keeping in mind the uterus is softer and more prone to perforation. - This statement is **INCORRECT**, making it the right answer to this question. *Used to determine uterine size* - A **uterine sound** is primarily used to measure the **length of the uterine cavity from the external os to the fundus**, which helps determine uterine size. - This measurement is crucial for procedures like **IUD insertion**, endometrial biopsy, and hysteroscopy. - This is a **CORRECT** statement about the uterine sound. *Passed till it meets resistance at the fundus* - The uterine sound is passed through the **cervical canal** until it gently touches the **fundus** (top) of the uterus. - The measurement is read from the marking on the instrument corresponding to the external cervical os, typically ranging from **6-8 cm** in normal uteri. - This is a **CORRECT** statement about the technique. *Malleable sound* - The image depicts a **uterine sound**, which is typically made of **malleable metal** (usually stainless steel). - Its malleability allows it to be bent or shaped to match the **curvature of the uterus** (anteversion/retroversion), reducing the risk of perforation and facilitating accurate measurement. - This is a **CORRECT** statement about the instrument.

Q: What is the instrument shown below used for?

Dilating the ostium uteri. ***Dilating the ostium uteri*** - The image depicts a set of **Hegar dilators**, which are instruments used to **dilate the cervical os (ostium uteri)**. - They come in graduated sizes and are inserted sequentially to gradually widen the cervical canal for procedures like D&C, IUD insertion, or hysteroscopy. *Dilate urethral strictures* - While dilators are used for urethral strictures, the instruments shown are specifically designed with a curvature and length optimized for the **cervical canal**, not the male or female urethra. - **Urethral stricture dilators** generally have a different shape, often longer and straighter or with a specific angle for the male urethra. *Measure uterus size in pregnancy* - Measuring uterus size in pregnancy is typically done by **fundal height measurement** with a tape measure or **ultrasound**, not with these solid dilators. - Hegar dilators are for dilating, not measuring length or size of the uterus during pregnancy. *Measure thickness of uterine wall* - The thickness of the uterine wall is measured using **imaging techniques** like **ultrasound** or MRI. - These dilators are solid instruments designed for mechanical dilation and cannot measure tissue thickness.

Q: The following hysteroscopy view shows presence of: (Recent Neet Pattern 2016-17)

Septate uterus. ***Septate uterus*** - The image clearly shows a **distinct septum** dividing the **uterine cavity** into two hemicavities, a characteristic feature of a septate uterus. - This anatomical anomaly is a common cause of **recurrent pregnancy loss** and can be resected hysteroscopically. *Normal uterine cavity* - A normal uterine cavity would appear as a **single, smooth, triangular space** without any dividing structures. - The presence of a **central wall** clearly indicates an abnormality, ruling out a normal cavity. *Asherman syndrome* - Asherman syndrome is characterized by the presence of **intrauterine adhesions** or **synechiae**, which are fibrous bands often appearing as thin, web-like structures or dense scar tissue. - While adhesions can divide the cavity, they typically appear as **irregular, often avascular, fibrous strands** rather than a well-formed, fleshy septum as seen here. *Uterine perforation* - Uterine perforation would typically present as a **hole or tear in the uterine wall**, which might lead to visualization of extrauterine structures or free fluid in the peritoneal cavity. - The image shows an **internal anatomical division** of the uterus, not a breach of its outer wall.

Q: A 23-year-old woman presents to your clinic with complaints of vulvar pain. The patient's history is significant for a new sexual partner and a recent history of flu-like symptoms and vaginal burning. On physical examination, extremely painful shallow ulcers with red borders are appreciated on the vulva, vagina, and perineal region. Which of the following is the most appropriate course of treatment for this patient?

Acyclovir. ***Acyclovir*** - The patient's symptoms, including **vulvar pain**, **flu-like symptoms**, **vaginal burning**, and **extremely painful shallow ulcers with red borders** are highly suggestive of a **primary herpes simplex virus (HSV) infection**. - **Acyclovir**, a guanosine analog, is an antiviral medication that specifically inhibits viral DNA synthesis and is the treatment of choice for HSV infections. *Penicillin* - **Penicillin** is an antibiotic primarily used to treat bacterial infections, particularly those caused by gram-positive bacteria like *Streptococcus* and *Staphylococcus*, and certain sexually transmitted infections such as **syphilis**. - The clinical presentation with **vesicular/ulcerative lesions** and **flu-like prodrome** is not consistent with bacterial infections responsive to penicillin. *Azithromycin* - **Azithromycin** is a macrolide antibiotic commonly used to treat bacterial infections such as **chlamydia**, **gonorrhea**, and certain respiratory tract infections. - The described lesions and systemic symptoms do not fit the typical presentation of bacterial sexually transmitted infections treated with azithromycin. *Doxycycline* - **Doxycycline** is a tetracycline antibiotic effective against a broad range of bacterial infections, including **chlamydia**, **lyme disease**, and **rickettsial infections**. - It is not indicated for **viral infections** like HSV, which is characterized by painful vesicular or ulcerative lesions.

Q: Name the condition shown in the image.

Gartner cyst. ***Gartner cyst*** - The image shows a cystic lesion located on the **lateral wall of the vagina**, consistent with the typical presentation of a Gartner cyst. - Gartner cysts are remnants of the **mesonephric (Wolffian) duct** found along the anterolateral vaginal wall. *Bartholin cyst* - A Bartholin cyst would be located in the **posterior-inferior portion of the labia majora**, near the vaginal introitus, as it arises from the obstruction of the Bartholin gland duct. - The image depicts a lesion higher up on the lateral vaginal wall, not in the typical Bartholin gland location. *Nabothian cyst* - Nabothian cysts are **mucus-filled cysts on the surface of the cervix**, which would not be visible on an external or low vaginal examination as shown. - They result from blocked cervical glands and are typically small and asymptomatic. *Chocolate cyst* - A chocolate cyst is an **endometrioma**, a type of ovarian cyst filled with old, dark blood, resembling melted chocolate. - These are intra-abdominal or pelvic masses and are not externally visible vaginal lesions.

Q: HSG image given below shows:

Asherman syndrome. ***Asherman syndrome*** - The HSG image shows multiple **filling defects** and an **irregular, partially obliterated endometrial cavity**, which are characteristic findings of Asherman syndrome. - This condition is caused by **intrauterine adhesions** (synechiae) resulting from trauma to the endometrial lining, typically due to procedures like D&C. *Endometrial polyp* - An endometrial polyp would typically appear as a **single, well-defined filling defect** within the endometrial cavity. - The image demonstrates **multiple, irregular adhesions** rather than a solitary, smooth-bordered mass. *Genital TB* - Genital tuberculosis can cause a variety of HSG findings, including **calcifications**, **beading of the fallopian tubes**, and a **"T-shaped" or constricted endometrial cavity**. - While it can cause intrauterine adhesions, the image's appearance of widespread, irregular filling defects with partial obliteration is more classic for Asherman syndrome, specifically if there is no other evidence of TB. *Subserosal fibroids* - Subserosal fibroids are located on the **outer surface of the uterus** and typically do not distort the endometrial cavity or appear as filling defects within it on an HSG. - On HSG, they may cause **extrinsic compression** or displacement of the uterus but would not appear as intraluminal filling defects or adhesions.

Q: Identify the STD. (Recent Neet Pattern 2016-17)

Chlamydia. ***Chlamydia*** - The image exhibits **cervicitis** with a visible **purulent exudate** and **cervical edema**, which is highly characteristic of **Chlamydia trachomatis** infection. - Given that Chlamydia is often **asymptomatic** or presents with non-specific symptoms, direct visualization of such changes on the cervix is a key diagnostic indicator in symptomatic cases. *Gonorrhea* - While gonorrhea can also cause cervicitis with purulent discharge, the specific appearance in the image with more pronounced **edema** and somewhat **friable cervix** is more classically associated with Chlamydia in many clinical presentations. - Differentiation often requires **laboratory testing** (e.g., NAAT) as visual signs can overlap, but the depicted features lean more towards Chlamydia. *Syphilis* - Syphilis is typically characterized by **chancres** (painless ulcers) in its primary stage, or rashes and condylomata lata in secondary syphilis, none of which are seen in this image. - The image shows inflammation and discharge, not ulcerative lesions. *Chancroid* - Chancroid is characterized by **painful genital ulcers** with a characteristic soft base and often associated with **buboes** (swollen lymph nodes). - The findings in the image—cervical inflammation and discharge—do not align with the typical presentation of chancroid.

Q: What is shown below in the image of a PID patient?

Fitz-Hugh-Curtis syndrome. ***Fitz-Hugh-Curtis syndrome*** - The image displays **violin string adhesions** between the liver capsule and the parietal peritoneum, which are characteristic of Fitz-Hugh-Curtis syndrome. - This condition is a perihepatitis, often associated with **pelvic inflammatory disease (PID)**, caused by bacterial infection spreading from the pelvic organs to the liver capsule. *Asherman syndrome* - This condition involves the formation of **intrauterine adhesions** causing partial or complete obliteration of the uterine cavity. - Asherman syndrome typically results from trauma to the endometrial lining, such as from dilation and curettage, and is characterized by menstrual abnormalities and infertility, not perihepatic adhesions. *Rokitansky syndrome* - Also known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, this is a congenital disorder characterized by **agenesis of the uterus and vagina**. - It involves developmental abnormalities of the female reproductive tract and does not present with intra-abdominal adhesions. *Keratoderma blennorrhagicum* - This is a mucocutaneous manifestation of **reactive arthritis**, characterized by **hyperkeratotic skin lesions** on the palms and soles. - It is a dermatological condition and does not involve intra-abdominal adhesions or directly relate to PID in the manner of Fitz-Hugh-Curtis syndrome.

Question 1

What is incorrect about this instrument?

Accepted Answer

Used for Copper T removal

Answer

Self-retaining speculum

Answer

Excellent visualization of vagina

Answer

Bivalved speculum

Question 2

Which of the following is incorrect about the instrument shown below? (Recent Neet Pattern 2016-17)

Accepted Answer

Contraindicated in postpartum state

Answer

Used to determine uterine size

Answer

Passed till it meets resistance at the fundus

Answer

Malleable sound

Question 3

What is the instrument shown below used for?

Accepted Answer

Dilating the ostium uteri

Answer

Dilate urethral strictures

Answer

Measure uterus size in pregnancy

Answer

Measure thickness of uterine wall

Question 4

The following hysteroscopy view shows presence of: (Recent Neet Pattern 2016-17)

Accepted Answer

Septate uterus

Answer

Normal uterine cavity

Answer

Asherman syndrome

Answer

Uterine perforation

Question 5

All the following statements regarding the picture are true except: (Recent Neet Pattern 2016-17)

Accepted Answer

Develops due to failure of development of both the Müllerian ducts

Answer

Metroplasty is performed

Answer

Cornual pregnancy is an associated condition

Answer

Can present as recurrent abortions

Question 6

A 23-year-old woman presents to your clinic with complaints of vulvar pain. The patient's history is significant for a new sexual partner and a recent history of flu-like symptoms and vaginal burning. On physical examination, extremely painful shallow ulcers with red borders are appreciated on the vulva, vagina, and perineal region. Which of the following is the most appropriate course of treatment for this patient?

Accepted Answer

Acyclovir

Answer

Penicillin

Answer

Azithromycin

Answer

Doxycycline

Question 7

Name the condition shown in the image.

Accepted Answer

Gartner cyst

Answer

Bartholin cyst

Answer

Nabothian cyst

Answer

Chocolate cyst

Question 8

HSG image given below shows:

Accepted Answer

Asherman syndrome

Answer

Endometrial polyp

Answer

Genital TB

Answer

Subserosal fibroids

Question 9

Identify the STD. (Recent Neet Pattern 2016-17)

Accepted Answer

Chlamydia

Answer

Gonorrhea

Answer

Syphilis

Answer

Chancroid

Question 10

What is shown below in the image of a PID patient?

Accepted Answer

Fitz-Hugh-Curtis syndrome

Answer

Asherman syndrome

Answer

Rokitansky syndrome

Answer

Keratoderma blennorrhagicum

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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