Gynecological Disorders Practice Questions

Q: The diagnostic criteria for bacterial vaginosis include the following except

Vaginal pH 4.5**, due to the decrease in lactic acid-producing bacteria. *Presence of clue cells* - **Clue cells** are a hallmark of bacterial vaginosis, characterized by vaginal epithelial cells studded with bacteria, obscuring their borders. - Their presence is one of the **Amsel criteria** for diagnosing bacterial vaginosis. *Positive whiff test* - A **positive whiff test** involves adding a drop of 10% potassium hydroxide (KOH) to vaginal discharge, producing a strong, fishy odor. - This odor is due to the release of **amines** produced by anaerobic bacteria, and it is a key diagnostic criterion for bacterial vaginosis. *Homogenous vaginal discharge* - The discharge in bacterial vaginosis is typically described as **thin, milky white, or grayish, and homogenous**. - This characteristic appearance is one of the **Amsel criteria** and helps distinguish it from other forms of vaginitis.

Q: The ideal distension medium for operative hysteroscopy using electro-cautery is

1.5% glycine. ***1.5% glycine*** - **1.5% glycine** is an **electrically non-conductive hypotonic fluid**, making it the **ideal distension medium** for operative hysteroscopy using **monopolar electro-cautery**. - It allows safe transmission of electrical current without dispersion, enabling effective tissue cutting and coagulation. - Provides excellent visualization during operative procedures and can clear blood and debris effectively. - **Risk consideration**: Prolonged procedures with excessive absorption can lead to **hyponatremia, hypo-osmolality syndrome, and glycine toxicity** (causing visual disturbances and encephalopathy), requiring careful fluid balance monitoring. *CO₂* - **CO₂** is used exclusively for **diagnostic hysteroscopy**, not operative procedures. - While it is non-conductive, it provides **poor visibility when bleeding occurs** as it cannot clear blood or debris. - **Contraindicated in operative hysteroscopy** due to high risk of **gas embolism** when vessels are opened during surgery. - Rapid absorption can occur through opened blood vessels, making it unsafe for electrosurgical procedures. *5% dextrose saline* - **Dextrose saline** solutions are **electrically conductive** due to the saline component, causing current dispersion during monopolar electro-cautery. - Would lead to **non-target tissue damage** and ineffective surgical effect. - Also carries risk of **fluid overload and electrolyte disturbances** with excessive absorption. *N-saline* - **Normal saline** is an **electrically conductive** solution and is **contraindicated for monopolar electro-cautery** as it disperses electrical current. - It is the **preferred medium for bipolar electro-cautery** where the electrical circuit is contained between the two poles of the instrument. - Safe, isotonic, and no risk of hyponatremia, but cannot be used with monopolar systems.

Q: Which of the following is/are the risk factors for acute pelvic inflammatory disease in women? 1. Intercourse during menstruation 2. Multiple sex partners Select the correct answer using the code given below:

Both 1 and 2. **Both 1 and 2** - **Intercourse during menstruation** increases the risk for acute PID, as the cervical mucus plug, which normally protects against ascending infection, is absent during menses. - **Multiple sex partners** significantly raises the risk of exposure to sexually transmitted infections (STIs), which are the primary cause of PID. *2 only* - While **multiple sex partners** is a major risk factor, denying intercourse during menstruation as a risk factor is incorrect. - The physiological changes during menstruation facilitate the ascent of bacteria, making coitus during this period a risk. *Neither 1 nor 2* - Both statements describe established risk factors for PID. - This option is incorrect because both **intercourse during menstruation** and **multiple sex partners** contribute to increased risk. *1 only* - While **intercourse during menstruation** is a risk factor, it is incorrect to exclude **multiple sex partners** as a significant risk factor for PID. - Having multiple partners dramatically increases the likelihood of acquiring **STIs**, the main cause of PID.

Q: Fitz‐Hugh‐Curtis syndrome involving perihepatitis is present in the following:

Gonorrhoea. **Gonorrhoea** - **Fitz-Hugh-Curtis syndrome** is a complication of **pelvic inflammatory disease (PID)**, which is predominantly caused by sexually transmitted infections like *Neisseria gonorrhoeae* and *Chlamydia trachomatis*. - Perihepatitis, or inflammation of the liver capsule, occurs when bacteria from the pelvic infection spread to the liver surface. *Syphilis* - **Syphilis** primarily presents with chancres, rashes, and neurological or cardiovascular complications in later stages. - It does not typically cause **perihepatitis** as a direct complication of the infection itself. *Tuberculosis* - **Tuberculosis** is caused by *Mycobacterium tuberculosis* and usually affects the lungs, but can spread to other organs. - While it can cause peritonitis, it is not associated with **perihepatitis** in the context of **Fitz-Hugh-Curtis syndrome**. *Moniliasis* - **Moniliasis** (candidiasis) is a fungal infection caused by *Candida* species. - It is commonly associated with vaginal yeast infections or thrush but does not cause **Fitz-Hugh-Curtis syndrome** or perihepatitis.

Q: A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?

Conservative with follow up ultrasound. ***Conservative with follow up ultrasound*** - A 5cm **unilocular, echo-free ovarian cyst** in a 17-year-old with a normal **CA-125** (8 U/mL is well within the normal range, typically <35 U/mL) is highly suggestive of a **benign functional cyst**. - Expectant management with **serial ultrasound follow-up** is the most appropriate initial approach, as these cysts often resolve spontaneously. *Laparoscopy for cyst removal* - This is an **invasive procedure** that is not indicated for a likely benign, asymptomatic ovarian cyst, especially given the young age of the patient. - Surgical intervention would only be considered if the cyst persists, grows significantly, causes symptoms, or shows suspicious features on imaging. *Laparotomy for cyst removal* - **Laparotomy** is an even more invasive surgical approach than laparoscopy, involving a larger incision, and is reserved for cases where malignancy is strongly suspected or for very large, complex cysts that cannot be removed laparoscopically. - Given the benign characteristics of the cyst, this approach is unwarranted. *Medical treatment* - There is **no specific medical treatment** (e.g., medication) that effectively resolves functional ovarian cysts. - While hormonal contraceptives can sometimes suppress the formation of new functional cysts, they do not typically treat an existing one of this nature.

Q: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Gonorrhoea. ***Gonorrhoea*** - This presentation, including **yellow/green vaginal discharge**, a **Bartholin cyst**, and **proctitis**, is highly suggestive of **gonorrhoea**. - *Neisseria gonorrhoeae* can cause inflammation in these specific areas and is a known cause of **infertility** due to pelvic inflammatory disease. *Trichomoniasis* - Characterized by a **frothy, foul-smelling, yellow-green discharge** and often involves **cervical petechiae** (strawberry cervix). - While it causes vaginal discharge, **Bartholin cysts** and **proctitis** are not typical features. *Syphilis* - The primary stage presents as a **painless chancre**, secondary syphilis involves a **rash** and **lymphadenopathy**, and tertiary syphilis has severe organ involvement. - It does not typically present with the specific combination of **Bartholin cyst**, vaginal discharge, and **proctitis**. *Candidiasis* - Causes a **thick, white, "cottage cheese-like" discharge** associated with significant **pruritus** and **vaginal irritation**. - It does not typically lead to **Bartholin cysts** or **proctitis**.

Q: A 44 year old woman presents with polymenorrhoea for one year. Clinical examination reveals bulky uterus with no other abnormality. D & C report is simple hyperplasia. What is the treatment of choice?

Progestogen therapy. ***Progestogen therapy*** - **Simple hyperplasia** is a benign condition of the endometrium and typically responds well to progestogen therapy, which helps to **antagonize estrogen's proliferative effects** on the endometrium. - This treatment helps to induce secretory changes and shedding of the hyperplastic tissue, effectively managing the associated **polymenorrhoea**. *GnRH analogues* - While GnRH analogues can induce a **hypoestrogenic state**, they are generally reserved for more severe forms of endometrial hyperplasia (e.g., atypical hyperplasia) or conditions like **endometriosis** and **fibroids** that do not respond to progestogens. - Their significant side effects, resembling menopause, make them less suitable as an initial choice for simple hyperplasia. *Combined oral pills* - Combined oral contraceptive pills primarily work by **suppressing ovulation** and thinning the endometrial lining, which can help with heavy bleeding but are not the primary treatment for established endometrial hyperplasia. - While they contain progestins, the progestin dose and regimen in combined oral pills are typically not sufficient or specifically tailored to reverse significant endometrial hyperplasia. *Total hysterectomy with bilateral salpingo-oophorectomy* - This is a **surgical intervention** and is an overly aggressive treatment for simple endometrial hyperplasia, which carries a very low risk of progression to cancer. - It would be considered only for persistent atypical hyperplasia, cancer, or if a woman has completed childbearing and has other compelling reasons for surgery.

Q: The most accurate method to diagnose adenomyosis is:

MRI. ***Correct Option: MRI*** - **Magnetic Resonance Imaging (MRI)** offers superior soft tissue contrast, allowing for detailed visualization of the **junctional zone** and myometrial architecture, which is crucial for diagnosing adenomyosis. - It can accurately identify characteristic features such as **thickening of the junctional zone** (>12 mm), altered signal intensity, and the presence of **stromal and glandular ectopic endometrial tissue** within the myometrium. - MRI is the **most accurate non-invasive imaging modality** for adenomyosis with sensitivity of 70-90% and specificity of 65-91%. *Incorrect Option: Transvaginal sonography* - While TVS is often the **first-line imaging modality** due to its accessibility and lower cost, its diagnostic accuracy for adenomyosis is **operator-dependent** and generally lower than MRI. - It can suggest adenomyosis through findings like **globular uterus**, **myometrial cysts**, and heterogeneous myometrial echotexture, but these are **less specific** than MRI findings. *Incorrect Option: Hysterosalpingography* - **Hysterosalpingography (HSG)** is primarily used to evaluate **fallopian tube patency** and uterine cavity morphology, typically in the context of infertility. - It is **not designed to visualize the myometrium** or diagnose adenomyosis, as it assesses the uterine lumen rather than the myometrial invasion characteristic of adenomyosis. *Incorrect Option: PET-CT* - **Positron Emission Tomography-Computed Tomography (PET-CT)** is mainly used in **oncology** for cancer staging, detection of recurrence, and metastasis assessment due to its ability to detect metabolic activity. - It has **no role** in the diagnosis of adenomyosis, a benign gynecological condition characterized by endometrial tissue within the myometrium.

Q: A 30 year old multiparous woman comes with an ultrasound report of fibroid uterus measuring 3 x 3 cm. Her only complaint is mild pain during menstruation. The best management in this would be:

Reassurance. ***Reassurance*** - Given the small size of the fibroid (3x3 cm) and the patient's only complaint being **mild menstrual pain**, which can often be managed symptomatically, **reassurance** is the most appropriate initial step. - Many small fibroids are **asymptomatic** or cause minimal symptoms and do not require aggressive intervention, especially if the patient is not seeking to conceive immediately. *Myomectomy* - Myomectomy is a surgical procedure to remove fibroids, usually considered for **symptomatic fibroids**, particularly those causing significant pain, heavy bleeding, or impacting fertility. - It involves surgical risks and potential complications, which are **unjustified** for a small, minimally symptomatic fibroid. *GnRH analogues* - **GnRH analogues** temporarily reduce fibroid size by inducing a **hypoestrogenic state**, which can alleviate symptoms like heavy bleeding and pain. - However, their effects are temporary, and fibroids typically **regrow after cessation** of treatment, and they are usually reserved for larger, symptomatic fibroids or as a preoperative measure. *Hysterectomy* - Hysterectomy is the surgical removal of the uterus, a definitive treatment for fibroids, but it is an **irreversible procedure** that ends fertility. - It is typically reserved for women with **large, highly symptomatic fibroids** who have completed childbearing or for whom other treatments have failed, which is not the case here.

Question 1

The diagnostic criteria for bacterial vaginosis include the following except

Accepted Answer

Vaginal pH < 4.5

Answer

Presence of clue cells

Answer

Positive whiff test

Answer

Homogenous vaginal discharge

Question 2

The ideal distension medium for operative hysteroscopy using electro-cautery is

Accepted Answer

1.5% glycine

Answer

5% dextrose saline

Answer

N-saline

Answer

CO₂

Question 3

Which of the following is/are the risk factors for acute pelvic inflammatory disease in women?

1. Intercourse during menstruation
2. Multiple sex partners

Select the correct answer using the code given below:

Accepted Answer

Both 1 and 2

Answer

2 only

Answer

Neither 1 nor 2

Answer

1 only

Question 4

Fitz‐Hugh‐Curtis syndrome involving perihepatitis is present in the following:

Accepted Answer

Gonorrhoea

Answer

Syphilis

Answer

Tuberculosis

Answer

Moniliasis

Question 5

A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?

Accepted Answer

Conservative with follow up ultrasound

Answer

Laparoscopy for cyst removal

Answer

Laparotomy for cyst removal

Answer

Medical treatment

Question 6

A 50 year old P4L4 has a simple left ovarian cyst of 10cm. Ca 125 is 30u/ml. Treatment of choice would be:

Accepted Answer

Laparoscopic bilateral oophorectomy (BSO)

Answer

Medical management with oral contraceptives

Answer

Laparoscopic cystectomy

Answer

TAH + BSO (Total abdominal hysterectomy + Bilateral salpingo-oophorectomy)

Question 7

An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Accepted Answer

Gonorrhoea

Answer

Trichomoniasis

Answer

Syphilis

Answer

Candidiasis

Question 8

A 44 year old woman presents with polymenorrhoea for one year. Clinical examination reveals bulky uterus with no other abnormality. D & C report is simple hyperplasia. What is the treatment of choice?

Accepted Answer

Progestogen therapy

Answer

GnRH analogues

Answer

Combined oral pills

Answer

Total hysterectomy with bilateral salpingo-oophorectomy

Question 9

The most accurate method to diagnose adenomyosis is:

Accepted Answer

MRI

Answer

Transvaginal sonography

Answer

Hysterosalpingography

Answer

PET-CT

Question 10

A 30 year old multiparous woman comes with an ultrasound report of fibroid uterus measuring 3 x 3 cm. Her only complaint is mild pain during menstruation. The best management in this would be:

Accepted Answer

Reassurance

Answer

Myomectomy

Answer

GnRH analogues

Answer

Hysterectomy

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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