Gynecological Disorders Practice Questions

Q: Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease? 1. Coexisting pregnancy 2. Mild fever and pain responding well to antibiotics 3. Suspected tubo-ovarian abscess 4. Coexistent HIV infection Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Coexisting pregnancy** is a critical indication for hospitalization in PID due to the increased risk of adverse pregnancy outcomes, including **septic abortion**, preterm birth, and disseminated infection. - **Suspected tubo-ovarian abscess (TOA)** requires inpatient management because it can lead to **sepsis**, rupture, and peritonitis, necessitating aggressive intravenous antibiotics and potentially surgical intervention. - **Coexistent HIV infection** is an important hospitalization criterion as immunocompromised patients may experience more severe PID, atypical presentations, and a higher risk of systemic complications or treatment failure. *1, 2 and 4* - This option incorrectly includes "Mild fever and pain responding well to antibiotics," which signifies a less severe course typically managed **outpatient**. - The other conditions (pregnancy, HIV) are valid reasons for hospitalization, but the presence of mild, responsive symptoms argues against inpatient care. *1, 2 and 3* - This option also incorrectly includes "Mild fever and pain responding well to antibiotics," which would typically allow for **outpatient management**. - While pregnancy and suspected TOA are strong indications for hospitalization, mild symptoms that resolve quickly with antibiotics do not warrant inpatient admission. *2, 3 and 4* - This option mistakenly includes "Mild fever and pain responding well to antibiotics," which is a criterion for **outpatient management**, not hospitalization. - It excludes "Coexisting pregnancy," which is a significant reason for inpatient care due to potential maternal and fetal risks.

Q: Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Hysteroscopy and laparoscopy. ***Hysteroscopy and laparoscopy*** - **Hysteroscopy** allows visualization of the uterine cavity, revealing two distinct hemi-cavities separated by a septum or deep indentation. - **Laparoscopy** provides external visualization of the uterus, confirming the presence of two separate uterine horns and distinguishing a bicornuate uterus from a septate uterus by identifying the deep indentation on the fundus and the angle between the horns greater than 75 degrees. *Hysteroscopy* - While hysteroscopy can visualize the **internal uterine cavity** and may suggest dual cavities, it alone cannot definitively distinguish between a deeply septate uterus and a bicornuate uterus. - It does not offer a view of the **external uterine contour**, which is crucial for diagnosis. *Hysterectomy* - A hysterectomy is the **surgical removal of the uterus**, which is a definitive treatment but not a diagnostic procedure for uterine anomalies. - This procedure would only reveal the uterine anatomy after its removal, which is not the purpose of a **confirmatory diagnostic evaluation**. *Dilatation and curettage* - This procedure involves **dilating the cervix** and **scraping the lining of the uterus**, primarily used for diagnostic sampling or therapeutic abortion. - It does not provide any information about the **uterine morphology** or congenital anomalies like a bicornuate uterus.

Q: Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?

Pelvic endometriosis. ***Pelvic endometriosis*** - Pelvic endometriosis causes **dense adhesions, anatomical distortion, and obliteration of normal tissue planes**, making surgical dissection technically challenging during hysterectomy. - The **fibrotic adhesions** bind pelvic organs together, obscure surgical landmarks, and increase the risk of inadvertent injury to the uterus, bladder, ureters, and bowel. - Studies show that **endometriosis is a significant risk factor** for intraoperative complications, including uterine perforation and vascular injury. - The **distorted pelvic anatomy** requires careful dissection and may necessitate modifications in surgical technique. *Hydrosalpinx* - Hydrosalpinx is a **fluid-filled, dilated fallopian tube** resulting from distal tubal obstruction, typically from prior pelvic inflammatory disease. - While it may be encountered during hysterectomy, it does **not distort the uterine anatomy or create adhesions** that would increase the risk of uterine injury. - Hydrosalpinx is generally easily separated from surrounding structures. *Ovarian teratoma* - Ovarian teratoma (dermoid cyst) is a **benign germ cell tumor of the ovary** containing mature tissues from all three germ layers. - It is typically **well-encapsulated and does not cause significant pelvic adhesions** unless there has been rupture or torsion. - It does not increase the risk of uterine injury during hysterectomy. *Adenomyosis* - Adenomyosis is **endometrial tissue within the myometrium**, causing an enlarged, boggy, tender uterus. - While adenomyosis is often an **indication for hysterectomy**, it is an intrinsic uterine condition that does **not cause pelvic adhesions or anatomical distortion**. - The uterus may be more vascular and bulky, but this does not specifically increase the risk of uterine injury during standard hysterectomy technique.

Q: Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Septate uterus. ***Septate uterus*** - **Metroplasty**, specifically **hysteroscopic metroplasty**, is the primary surgical treatment for a septate uterus to remove the fibrous or muscular septum dividing the uterine cavity. - This procedure aims to improve reproductive outcomes by restoring normal uterine anatomy and reducing the risk of miscarriage or preterm birth. *Arcuate uterus* - An **arcuate uterus** is a mild indentation of the uterine fundus, considered a normal variant or a minor anomaly, and does not typically require metroplasty or surgical correction. - It is usually **asymptomatic** and not associated with increased risks of adverse pregnancy outcomes. *Uterus didelphys* - **Uterus didelphys** is characterized by two completely separate uteri, cervices, and often two vaginas, due to complete non-fusion of the paramesonephric ducts. - Surgical intervention like metroplasty is generally **not indicated** as it would involve fusing two distinct uteri, which is not feasible or beneficial. *Imperforate hymen* - An **imperforate hymen** is a congenital anomaly where the hymen completely obstructs the vaginal opening. - The surgical procedure for an imperforate hymen is a simple **hymenotomy** or hymenectomy to create an opening, not a metroplasty, as it involves the hymen and not the uterus itself.

Q: A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Bacterial vaginosis. ***Bacterial vaginosis*** - The classic presentation includes **grayish-white vaginal discharge** with a **fishy odor**, especially after intercourse, and **absence of itching**. - This clinical picture aligns perfectly with **Amsel's criteria** for bacterial vaginosis, which include vaginal pH >4.5, clue cells on microscopy, and a positive whiff test. *Trichomoniasis* - Characteristically presents with a **frothy, greenish-yellow discharge** and often causes **vulvovaginal itching and irritation**, which are not reported here. - While it can cause a foamy discharge and sometimes a foul odor, the specific symptom profile given is less typical for trichomoniasis. *Urinary tract infection* - Primarily involves symptoms such as **dysuria (painful urination)**, frequent urination, and urgency, rather than vaginal discharge. - A UTI does not typically present with a "fishy-smelling grayish-white discharge" as its primary symptom. *Candidiasis* - Typically presents with a **thick, white, "cottage cheese-like" discharge** and is almost always associated with significant **vulvovaginal itching and burning**. - The absence of itching and the description of a grayish, fishy-smelling discharge make candidiasis highly unlikely.

Q: The common manifestations of genital tuberculosis include the following except

Foul-smelling vaginal discharge. ***Foul-smelling vaginal discharge*** - While infections can cause vaginal discharge, a **foul-smelling discharge** is typically associated with bacterial vaginosis or trichomoniasis, not primarily with genital tuberculosis due to its granulomatous nature. - Genital tuberculosis often presents with **non-specific symptoms** or no symptoms at all, rather than purulent or foul-smelling discharge. *Pelvic pain* - **Chronic pelvic pain** is a very common symptom of genital tuberculosis, often due to inflammation and involvement of pelvic organs. - The pain can be constant or intermittent and may be difficult to localize. *Amenorrhoea* - **Amenorrhea**, particularly secondary amenorrhoea, can occur due to endometrial damage or destruction caused by the tuberculous infection. - This can lead to **intrauterine adhesions (Asherman's syndrome)** or functional impairment of the endometrium, hindering menstruation. *Infertility* - **Infertility** is one of the most frequent and significant manifestations of genital tuberculosis, especially in women. - It often results from **tubal occlusion** or distortion, endometrial damage, or ovarian dysfunction caused by the disease, leading to an inability to conceive or carry a pregnancy to term.

Q: A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Candidiasis. ***Candidiasis*** - The symptoms of **itching**, **redness**, **swelling** of the vulva, and **white flakes** (often described as "cottage cheese-like") around the introitus are highly characteristic of vulvovaginal **candidiasis (yeast infection)**. - This condition is common, especially in parous women, and is caused by an overgrowth of *Candida* species. *Trichomoniasis* - Typically presents with a **foamy, greenish-yellow discharge**, a **foul odor**, and often **punctate hemorrhages** on the cervix (strawberry cervix). - While it can cause itching and irritation, the presence of **white flakes** is not a characteristic feature. *Gonorrhoea* - Often **asymptomatic** in women or presents with **purulent vaginal discharge**, **dysuria**, and **pelvic pain**. - It does not typically cause **white flakes** around the introitus and the discharge is usually not itchy initially. *Pyogenic vulvovaginitis* - This is a general term for bacterial vulvovaginitis that would present with signs of **bacterial infection**, such as a **malodorous discharge** and significant inflammation. - While it can cause redness and swelling, the description of **white flakes** is not specific to pyogenic infections and points more towards a fungal etiology.

Q: The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is

Retroverted uterus. ***Retroverted uterus*** - A **retroverted uterus** means the cervix is directed forward and the uterine body tilts backward, which aligns with the description. - The ability to easily **antepose** (bring forward) the uterus indicates it's a mobile, normal variant rather than a fixed pathological condition. *Posterior wall tumour of the uterus* - A tumor would typically present as a **fixed, hard mass** and would likely make anteposing the uterus difficult or impossible. - It would also likely cause **symptoms** such as abnormal bleeding or pain, which are not mentioned. *An ovarian cyst in the pouch of Douglas* - An ovarian cyst in the pouch of Douglas would be palpable as a **separate adnexal mass** and would not inherently cause the uterine body to be *retroverted*. - While it could displace the uterus, the primary description is of the uterine position itself, not an external mass causing displacement. *Pelvic endometriosis* - Endometriosis commonly causes a **fixed retroverted uterus** due to adhesions, making it difficult or impossible to antepose. - It would also typically be associated with **dyspareunia**, dysmenorrhea, and other pain symptoms, none of which are noted.

Q: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Trichomoniasis. ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.

Question 1

Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease?

1. Coexisting pregnancy
2. Mild fever and pain responding well to antibiotics
3. Suspected tubo-ovarian abscess
4. Coexistent HIV infection

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 2

Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Accepted Answer

Hysteroscopy and laparoscopy

Answer

Hysteroscopy

Answer

Hysterectomy

Answer

Dilatation and curettage

Question 3

Which of the following is a common pathology that increases the risk of uterine injury during abdominal hysterectomy?

Accepted Answer

Pelvic endometriosis

Answer

Hydrosalpinx

Answer

Ovarian teratoma

Answer

Adenomyosis

Question 4

Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Accepted Answer

Septate uterus

Answer

Arcuate uterus

Answer

Uterus didelphys

Answer

Imperforate hymen

Question 5

A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Accepted Answer

Bacterial vaginosis

Answer

Trichomoniasis

Answer

Urinary tract infection

Answer

Candidiasis

Question 6

The common manifestations of genital tuberculosis include the following except

Accepted Answer

Foul-smelling vaginal discharge

Answer

Pelvic pain

Answer

Amenorrhoea

Answer

Infertility

Question 7

A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Accepted Answer

Candidiasis

Answer

Trichomoniasis

Answer

Gonorrhoea

Answer

Pyogenic vulvovaginitis

Question 8

Which of the following is not an outcome of gonococcal salpingitis ?

Accepted Answer

Ovarian cyst

Answer

Hydrosalpinx

Answer

Multiple tubal blocks

Answer

Salpingitis isthmica nodosa

Question 9

The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is

Accepted Answer

Retroverted uterus

Answer

Posterior wall tumour of the uterus

Answer

An ovarian cyst in the pouch of Douglas

Answer

Pelvic endometriosis

Question 10

A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Accepted Answer

Trichomoniasis

Answer

Chlamydia infection

Answer

Gonococcal vaginitis

Answer

Candidiasis

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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