Gynecological Disorders Practice Questions

Q: A 28 -year-old female patient presented with lower abdominal pain along with dysmenorrhea. The following finding was seen on laparoscopic examination. What is the likely diagnosis?

Pelvic Endometriosis. ***Pelvic Endometriosis*** - The laparoscopic image shows classic findings of **endometriosis**, including **dark, hemorrhagic lesions** (powder-burn or gunshot lesions), adhesions, and potentially **endometriomas** (chocolate cysts) on the ovaries. - The patient's symptoms of **lower abdominal pain** and **dysmenorrhea** are highly characteristic of endometriosis, which involves the presence of endometrial-like tissue outside the uterus. - **Laparoscopy** is the gold standard for diagnosing endometriosis, revealing typical hemorrhagic implants and scarring. *Pelvic Inflammatory Disease* - PID typically presents with **acute pelvic pain**, **fever**, **purulent vaginal discharge**, and **cervical motion tenderness**. - Laparoscopic findings would show **hyperemia**, **purulent exudate**, and **tubo-ovarian abscesses**, not the dark hemorrhagic lesions seen here. - The chronic nature of dysmenorrhea and absence of infectious features make PID unlikely. *Ovarian Dermoid Cyst* - Dermoid cysts are **benign mature cystic teratomas** that appear as smooth, round cystic masses on laparoscopy. - They typically do not cause significant dysmenorrhea unless complicated by torsion or rupture. - The hemorrhagic implants and adhesions seen in the image are not consistent with dermoid cysts. *Adenomyosis* - Adenomyosis involves endometrial tissue within the **myometrium** (uterine muscle wall), causing an **enlarged, boggy uterus**. - Diagnosis is typically made by **ultrasound** or **MRI** showing thickened myometrium with heterogeneous echogenicity. - **Laparoscopy** would not reveal the characteristic dark hemorrhagic lesions seen in endometriosis, as adenomyosis is an intrauterine condition.

Q: A 21-year-old girl is having vaginal discharge one week after unprotected sexual intercourse. The smear of vaginal discharge is shown below. All are diagnostic criteria for the condition shown except:

Vaginal pH 4.5**, not less than 4.5. This elevated pH is due to the reduction of normal lactobacilli, which produce lactic acid. - Healthy vaginal pH is typically between 3.8 and 4.5; a pH less than 4.5 would suggest a normal vaginal flora or potentially Candida infection, not BV. *Positive whiff test* - A **positive whiff test**, characterized by a **fishy odor** when 10% potassium hydroxide (KOH) is added to a vaginal discharge sample, is a diagnostic criterion for bacterial vaginosis. - This odor results from the release of volatile amines produced by anaerobic bacteria overgrowing in the vagina. *Clue cells = 20% of cells* - The presence of **clue cells**, which are vaginal epithelial cells covered with bacteria, constitutes a key diagnostic criterion for bacterial vaginosis, especially when they represent **20% or more of the epithelial cells** on a wet mount. - The image provided clearly depicts epithelial cells encrusted with coccobacillary bacteria, characteristic of clue cells. *Presence of more Gardnerella with few lactobacillus* - Bacterial vaginosis is caused by an **overgrowth of anaerobic bacteria**, primarily *Gardnerella vaginalis*, and a **reduction in the protective lactobacilli** that normally dominate the vaginal flora. - This imbalance in the vaginal microbiome is central to the pathophysiology of BV and is a diagnostic feature.

Q: Which of the following is used in the gynecological procedure being performed in the image?

Acetic acid. ***Acetic acid*** - **Acetic acid** (typically 3-5%) is routinely applied to the cervix during **colposcopy** to highlight abnormal areas. - It causes areas of **dysplasia or cancer** to dehydrate and appear as opaque **acetowhite lesions**, making them visible under magnification. *Formic acid* - **Formic acid** is not typically used in colposcopy or similar gynecological procedures for diagnostic purposes. - It is more commonly found in nature (e.g., ant venom) and has industrial applications. *Trichloroacetic acid* - **Trichloroacetic acid (TCA)** is a corrosive agent used for the treatment of **warts** (including genital warts) and as a chemical peel. - While it can be used in gynecology, its primary role is therapeutic destruction of tissue, not diagnostic visualization during colposcopy. *Picric acid* - **Picric acid** is a highly explosive compound and is generally not used in clinical gynecological procedures. - It has historical uses as a dye and antiseptic, but its toxicity and explosive nature make it unsuitable for modern medical diagnostics or treatment.

Q: The procedure being performed is called:

Culdocentesis. **Culdocentesis** - The image depicts a needle being inserted into the **posterior cul-de-sac** (pouch of Douglas) through the posterior vaginal fornix to aspirate fluid, which is the definition of **culdocentesis**. - This procedure is commonly used to detect the presence of **blood** or **pus** in the peritoneal cavity, particularly in cases of suspected ectopic pregnancy or pelvic infection. *Cervicopexy* - **Cervicopexy** is a surgical procedure to fix the cervix in a higher position, typically to prevent or treat uterine prolapse. - It involves suspending the cervix and does not involve fluid aspiration through the vaginal wall. *Cervical cytology* - **Cervical cytology**, also known as a Pap smear, involves collecting cells from the surface of the cervix to screen for **precancerous** or **cancerous changes**. - This procedure uses a brush or spatula to collect cells, not a needle for fluid aspiration from the cul-de-sac. *Colposuspension* - **Colposuspension** is a surgical procedure to treat **stress urinary incontinence** by lifting and supporting the bladder neck and urethra. - This procedure involves a surgical approach through the abdomen, not a transvaginal needle aspiration from the posterior cul-de-sac.

Q: The image shows: (Recent Neet Pattern 2016-17)

Uterine sound. ***Uterine sound*** - The image displays a **uterine sound**, characterized by its long, thin, malleable shaft with a curved or angled tip, and a flat handle with measurement markings. - Its primary function is to **measure the depth of the uterine cavity** and assess its position and patency before procedures like IUD insertion or D&C. *Endometrial curette* - An endometrial curette is typically **spoon-shaped or loop-shaped** at the tip with sharpened edges for scraping endometrial tissue. - It is used for **biopsy or removal of uterine lining**, which is distinct from the sounding function of the pictured instrument. *Rocket endocervical brush* - An endocervical brush is designed with **fine bristles** to collect cells from the endocervix for cytology, such as a Pap smear. - Its appearance is vastly different from the metallic, rigid instrument shown, which is used for **measurement and exploration**. *Endometrial sampler* - An endometrial sampler, like a Pipelle, usually consists of a **flexible plastic tube** with a piston or plunger mechanism to create suction for tissue collection. - While used in the uterus, its design and mechanism are different from the depicted **metallic uterine sound**.

Q: The image shows: (Recent Neet Pattern 2016-17)

Uterine sound. ***Uterine sound*** - This instrument is a **uterine sound**, used to measure the **depth of the uterine cavity** before procedures like IUD insertion or D&C. - It is characterized by its long, thin, malleable shaft with markings and usually a handle or ring at one end. *Endometrial curette* - An endometrial curette is typically a **spoon-shaped instrument** used for scraping the uterine lining to obtain tissue samples. - It does not have the uniform, slender, and marked appearance of the instrument shown. *Rocket endocervical brush* - An endocervical brush is designed to collect **cervical cells** and consists of bristles at the tip, which is not depicted here. - This instrument is too rigid and lacks the brush-like tip for cell collection. *Endometrial sampler* - An endometrial sampler, like a Pipelle, is a thin, flexible device with a plunger used to **aspirate endometrial tissue**. - While used for obtaining uterine samples, its structure, particularly the presence of a plunger and suction mechanism, differs from the simple measuring device shown.

Q: A patient presents with the following clinical finding on pelvic examination. What is the most likely diagnosis?

Gartner cyst. ***Gartner cyst*** - The image shows a fluid-filled lesion in the **anterolateral vaginal wall**, consistent with a Gartner's cyst, which is a remnant of the **Wolffian duct**. - This cyst is typically located along the course of the Gartner's duct and can be palpated or visualized during pelvic examination. *Rectocele* - A rectocele involves the **posterior vaginal wall bulging into the vaginal lumen** due to rectovaginal fascia weakness, where the rectum protrudes. - The image clearly depicts an anterior vaginal wall lesion, not a posterior one. *Nabothian cyst* - **Nabothian cysts** are retention cysts located on the **cervix**, resulting from blocked cervical glands. - The lesion in the image is located in the vagina, not on the cervix. *Submucous fibroids* - **Submucous fibroids** are **uterine leiomyomas** that protrude into the endometrial cavity, originating from the myometrium. - The image shows a vaginal lesion, not a uterine pathology.

Q: What is the best treatment for the condition shown below?

Hysteroscopic adhesiolysis. ***Hysteroscopic adhesiolysis*** - The image shows an **intrauterine synechia**, also known as an **Asherman syndrome** or uterine adhesion, which manifests as fibrous bands within the uterine cavity (indicated by the arrow). - **Hysteroscopic adhesiolysis** is the gold standard for treating intrauterine adhesions, involving the surgical removal of these adhesions under direct visualization to restore the uterine cavity's normal anatomy. *OCP* - **Oral contraceptive pills (OCPs)** are primarily used for contraception, managing menstrual irregularities, or hormonal therapy. - They do not address or resolve **intrauterine adhesions** causing conditions like Asherman syndrome. *Transvaginal hysterectomy* - A **transvaginal hysterectomy** involves the surgical removal of the entire uterus, which is an aggressive and irreversible procedure. - This is not an appropriate treatment for intrauterine adhesions, especially in patients who may desire future fertility. *Intrauterine hyaluronidase injection* - While hyaluronidase is an enzyme that breaks down hyaluronic acid and has been explored in various applications, its efficacy as a primary treatment for established **intrauterine adhesions** is not well-supported in clinical practice. - The **mechanical removal** of fibrous adhesions is typically required.

Q: Transvaginal saline infusion sonographic evaluation shows:

Asherman's syndrome. ***Asherman's syndrome*** - The image shows **intracavitary adhesions** within the endometrial cavity, characterized by bridging bands or strands of tissue with an irregular endometrial surface, as indicated by the arrow. - These findings on **saline infusion sonography (SIS)** are highly suggestive of **Asherman's syndrome**, which involves the formation of intrauterine adhesions. *Submucous leiomyoma* - Submucous leiomyomas (submucosal fibroids) are fibroids that project into the endometrial cavity and typically appear as **well-defined, hypoechoic masses** that distort the cavity. - The image does not show a distinct mass but rather **irregular strands** and a distorted cavity indicative of adhesions, not a fibroid. *Cervical stenosis* - Cervical stenosis involves an **abnormal narrowing of the cervical canal**, which would be seen as an obstruction to fluid flow into the uterine cavity during SIS. - While the image shows fluid within the uterine cavity, the primary pathology is within the cavity itself, not merely an obstruction at the cervix. *PCOD* - **Polycystic ovary syndrome (PCOS)** is primarily an ovarian disorder characterized by **multiple small follicles** (cysts) in the ovaries and hormonal imbalances. - PCOS is not a condition diagnosed by evaluating the endometrial cavity for adhesions using saline infusion sonography.

Q: Which one of the following is implicated in the etiology of these adhesions around the liver?

Chlamydial infection. ***Chlamydial infection*** - The image shows **Fitz-Hugh-Curtis syndrome**, characterized by **violin-string adhesions** visible between the liver capsule and the parietal peritoneum. - This condition is a perihepatitis that occurs as a complication of **pelvic inflammatory disease (PID)**, most commonly caused by **Chlamydia trachomatis** or Neisseria gonorrhoeae. *Perforation of dermoid cyst* - A perforated dermoid cyst (mature cystic teratoma) typically causes a **chemical peritonitis** due to the leakage of sebaceous material, hair, and other contents. - While it can lead to adhesions, these are usually diffuse and not specifically the **violin-string type perihepatic adhesions** characteristic of Fitz-Hugh-Curtis syndrome. *Pseudomyxoma peritonei* - Pseudomyxoma peritonei is characterized by the accumulation of **gelatinous ascites** and mucin-producing tumor cells in the peritoneal cavity, often originating from a ruptured appendiceal mucinous neoplasm. - It results in widespread mucinous deposits and adhesions, which are distinct from the fibrous, violin-string adhesions around the liver seen in the image. *Liver metastases in ovarian cancer* - Liver metastases from ovarian cancer would appear as **nodular lesions within the liver parenchyma** or on its surface, not as fibrous adhesions between the liver and abdominal wall. - While ovarian cancer can cause ascites and peritoneal carcinomatosis, the presentation of **perihepatic adhesions** in the image is not typical for direct metastatic spread to the liver surface in this manner.

Question 1

A 28 -year-old female patient presented with lower abdominal pain along with dysmenorrhea. The following finding was seen on laparoscopic examination. What is the likely diagnosis?

Accepted Answer

Pelvic Endometriosis

Answer

Pelvic Inflammatory Disease

Answer

Ovarian Dermoid Cyst

Answer

Adenomyosis

Question 2

A 21-year-old girl is having vaginal discharge one week after unprotected sexual intercourse. The smear of vaginal discharge is shown below. All are diagnostic criteria for the condition shown except:

Accepted Answer

Vaginal pH < 4.5

Answer

Positive whiff test

Answer

Presence of more Gardnerella with few lactobacillus

Answer

Clue cells = 20% of cells

Question 3

Which of the following is used in the gynecological procedure being performed in the image?

Accepted Answer

Acetic acid

Answer

Formic acid

Answer

Trichloroacetic acid

Answer

Picric acid

Question 4

The procedure being performed is called:

Accepted Answer

Culdocentesis

Answer

Cervicopexy

Answer

Cervical cytology

Answer

Colposuspension

Question 5

The image shows: (Recent Neet Pattern 2016-17)

Accepted Answer

Uterine sound

Answer

Endometrial curette

Answer

Rocket endocervical brush

Answer

Endometrial sampler

Question 6

The image shows: (Recent Neet Pattern 2016-17)

Accepted Answer

Uterine sound

Answer

Endometrial curette

Answer

Rocket endocervical brush

Answer

Endometrial sampler

Question 7

A patient presents with the following clinical finding on pelvic examination. What is the most likely diagnosis?

Accepted Answer

Gartner cyst

Answer

Rectocele

Answer

Nabothian cyst

Answer

Submucous fibroids

Question 8

What is the best treatment for the condition shown below?

Accepted Answer

Hysteroscopic adhesiolysis

Answer

OCP

Answer

Transvaginal hysterectomy

Answer

Intrauterine hyaluronidase injection

Question 9

Transvaginal saline infusion sonographic evaluation shows:

Accepted Answer

Asherman's syndrome

Answer

Submucous leiomyoma

Answer

Cervical stenosis

Answer

PCOD

Question 10

Which one of the following is implicated in the etiology of these adhesions around the liver?

Accepted Answer

Chlamydial infection

Answer

Perforion of dermoid cyst

Answer

Pseudomyxoma peritonei

Answer

Liver metastases in ovarian cancer

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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