Gynecological Disorders Practice Questions

Q: A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Adenomyosis. ***Adenomyosis*** - **Adenomyosis** is characterized by the presence of **endometrial glands and stroma within the myometrium**, leading to a diffusely enlarged uterus and often presenting with **severe dysmenorrhoea** and **dyspareunia**. - A **uniformly enlarged, tender uterus** (described as 8 weeks size) in a patient with these symptoms is highly suggestive of adenomyosis, as the ectopic endometrial tissue causes pain and uterine enlargement. *Fibroid uterus* - **Fibroids (leiomyomas)** typically cause an **irregularly enlarged uterus** and can lead to heavy menstrual bleeding (menorrhagia) and pelvic pressure, but severe dyspareunia is less common. - While fibroids can cause an enlarged uterus and dysmenorrhoea, the **uniform enlargement** and prominent **tenderness of the posterior fornix** (suggesting broad involvement) are more aligned with adenomyosis. *Endometrial carcinoma* - **Endometrial carcinoma** typically presents with **postmenopausal bleeding** or abnormal uterine bleeding, often in older women, and usually does not cause a uniformly enlarged and tender uterus. - While it can cause pelvic pain, the specific presentation of **severe dysmenorrhoea and dyspareunia** with a diffusely enlarged and tender uterus is not characteristic of endometrial cancer. *Dysfunctional uterine bleeding* - **Dysfunctional uterine bleeding (DUB)** refers to abnormal bleeding that is not due to structural or systemic causes, often associated with **anovulation** and hormonal imbalances, primarily characterized by irregular or heavy periods. - DUB usually does not cause a **uniformly enlarged or tender uterus** and is less directly associated with the severe dysmenorrhoea and dyspareunia seen in this case.

Q: For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Tranexamic acid. ***Tranexamic acid*** - **Tranexamic acid** is an antifibrinolytic agent used to reduce **heavy menstrual bleeding** by inhibiting plasminogen activation. - In a woman with a **normal menstrual cycle** who has undergone surgery for a chocolate cyst, heavy bleeding is not an issue, so tranexamic acid would be **unnecessary** and not indicated for endometriosis management. *Oral progestogens* - **Oral progestogens** are commonly prescribed for endometriosis to **suppress ovarian activity** and induce decidualization and atrophy of endometrial implants. - They help manage symptoms like **pain** and prevent recurrence of chocolate cysts by creating a **progestin-dominant environment**. *Injection leuprolide* - **Leuprolide** is a **GnRH agonist** that creates a **hypoestrogenic state** by downregulating pituitary GnRH receptors, thereby suppressing ovarian hormone production. - This effectively reduces the growth of **endometrial implants** and manages endometriosis symptoms, often used post-operatively to prevent recurrence. *Tablet dienogest* - **Dienogest** is a **fourth-generation progestin** specifically approved for the treatment of endometriosis. - It works by suppressing ovarian estrogen production and inhibiting the growth of **endometrial lesions**, making it a suitable long-term post-operative therapy.

Q: A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Monilial vaginitis. ***Monilial vaginitis*** - The classic presentation of **curdy white discharge** and **pruritus vulvae** is highly suggestive of vulvovaginal candidiasis (**monilial vaginitis**), often exacerbated by **oral contraceptive pill** use. - OCPs can alter vaginal flora and increase glycogen content, promoting the growth of *Candida* species. *Atrophic vaginitis* - This condition is caused by **estrogen deficiency**, typically seen in **postmenopausal women**, and is unlikely in a woman using oral contraceptive pills. - Symptoms include **vaginal dryness**, irritation, and dyspareunia, usually without a thick, curdy discharge. *Gardnerella vaginalis* - *Gardnerella vaginalis* causes **bacterial vaginosis**, characterized by a **thin, gray, malodorous ("fishy") discharge**, not a curdy white one. - There is typically no significant vulval pruritus with *Gardnerella* infection. *Trichomonal vaginitis* - **Trichomoniasis** presents with a **frothy, greenish-yellow discharge** and often a **"strawberry cervix"** on examination, which is distinct from the described curdy white discharge. - It is a sexually transmitted infection, and while pruritus can occur, the discharge characteristics are different.

Q: Which of the following conditions is best treated by a posterior colpotomy?

Pelvic abscess. ***Pelvic abscess*** - A **posterior colpotomy** allows for direct access and drainage of a pelvic abscess located in the **cul-de-sac** (pouch of Douglas). - This minimally invasive surgical approach provides effective relief for loculated pelvic infections. - **Most definitive indication** for posterior colpotomy as it allows complete drainage of purulent material. *Pyosalpinx* - Refers to a pus-filled fallopian tube, which is typically located **laterally to the uterus** and not easily accessible via a posterior colpotomy. - Drainage of a pyosalpinx usually requires a **laparoscopic or open abdominal approach**. *Pyometra* - Characterized by **pus accumulation within the uterine cavity**, which is drained via the cervix, not the posterior vaginal fornix. - **Cervical dilation** and drainage are the primary treatment, not colpotomy. *Pelvic haematocele* - Involves a collection of **blood in the pelvic cavity**, often within the cul-de-sac. - While technically accessible via colpotomy, **pelvic haematoceles are usually managed conservatively** or require laparoscopy to identify and control the bleeding source. - Colpotomy drainage alone is insufficient as it doesn't address the underlying cause of bleeding.

Q: Which of the following is not a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome?

Cardiac anomalies. ***Cardiac anomalies*** - While other systemic abnormalities can be associated with MRKH syndrome, **cardiac anomalies** are generally not considered a characteristic feature. - MRKH syndrome primarily affects the **Müllerian ducts** and is often linked to renal and skeletal issues due to common developmental origins. *Skeletal abnormalities* - **Skeletal abnormalities**, particularly of the **vertebral column** (e.g., scoliosis, fused vertebrae), are commonly associated with MRKH syndrome. - This association is thought to arise from defects in the paraxial mesoderm during embryonic development, which affects both skeletal and Müllerian structures. *Renal abnormalities* - Around 30-50% of individuals with MRKH syndrome also have **renal anomalies**, such as **unilateral renal agenesis**, horseshoe kidney, or renal ectopia. - These abnormalities are due to the close developmental proximity and shared mesodermal origin of the Müllerian ducts and the **urogenital system**. *Mullerian duct aplasia* - **Müllerian duct aplasia** is the **defining characteristic** of MRKH syndrome, leading to the absence or hypoplasia of the uterus and upper vagina. - Individuals typically present with **primary amenorrhea** despite having normal secondary sexual characteristics and functioning ovaries.

Q: A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?

Leiomyoma. ***Leiomyoma*** - A **leiomyoma**, or **fibroid**, is a common benign smooth muscle tumor of the uterus, often presenting as **menorrhagia** and a **pelvic mass**. - The mass being **firm, 16-18 weeks size**, and **moving with the cervix** is classic for a uterine fibroid, differentiating it from an adnexal or fixed uterine mass. *Adenomyosis* - Characterized by endometrial tissue within the myometrium, leading to a **globular, tender uterus**, often associated with **dysmenorrhea** and **menorrhagia**. - While it causes menorrhagia, the uterus is typically **tender** and **boggy**, not a firm, discrete mass freely mobile with the cervix. *Ovarian tumour* - An **ovarian tumor** would typically present as an **adnexal mass**, often separate from the uterus and not moving with the cervix. - While an ovarian tumor can cause a pelvic mass, it is less likely to be directly associated with the described menorrhagia or involve the cervix's movement. *Endometrial carcinoma* - Primarily causes **abnormal uterine bleeding**, especially in **postmenopausal women**, but usually does not present as a large, firm, mobile mass detectable on abdominal palpation. - While it can cause menorrhagia, a firm, discrete uterine mass that moves with the cervix is not a typical presentation of **endometrial carcinoma**.

Q: A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?

Bartholin's abscess. ***Bartholin's abscess*** - The presentation of a **unilateral, tender swelling** in the **posterior half of the labium majus (not minus)**, with overlying **red and edematous skin**, is highly characteristic of a **Bartholin's abscess**. - This occurs when the **Bartholin's gland duct** becomes obstructed and infected, leading to pus accumulation and inflammation. *Trichomoniasis* - This is a **sexually transmitted infection** that causes **vaginitis**, characterized by a **frothy, foul-smelling discharge**, itching, and dysuria. - It does not present as a **localized, tender swelling** in the labia. *Utero vaginal prolapse* - This condition involves the **descent of the uterus and/or vagina** from their normal position, often causing a **feeling of pressure or a bulge** in the vagina. - It does not manifest as an acute, **unilateral, tender inflammatory swelling** of the labia. *Inversion of uterus* - **Uterine inversion** is a rare and life-threatening obstetric emergency, typically occurring **postpartum**, where the uterus turns inside out. - Its symptoms include **severe pain, hemorrhage, and shock**, and it is not related to a localized labial swelling.

Q: Consider the following statements regarding Uterine Leiomyoma: 1. Prevalence is highest between 35 and 45 years 2. More common in nulliparous women 3. Display reversible shrinkage after treatment with GnRH 4. Requires to be treated only if symptomatic Which of the statements given above are correct?

1, 2, 3 and 4. ***1, 2, 3 and 4*** - **Statement 1 is correct**: The prevalence of uterine leiomyomas is highest between **35 and 45 years of age**, as these are estrogen-dependent tumors that grow during reproductive years and peak in the 4th-5th decades. - **Statement 2 is correct**: Leiomyomas are **more common in nulliparous women**. Nulliparity is a well-established risk factor for fibroids. Each full-term pregnancy is associated with a reduced risk of developing fibroids, likely due to hormonal changes and uterine remodeling during pregnancy. - **Statement 3 is correct**: GnRH agonists cause **reversible shrinkage** of leiomyomas (typically 30-60% volume reduction). The term "reversible" accurately describes that fibroids regrow after treatment cessation. This makes GnRH agonists useful for preoperative shrinkage or temporary symptom relief, but not a permanent solution. - **Statement 4 is correct**: Leiomyomas **require treatment only if symptomatic**. Asymptomatic fibroids are managed with observation. Treatment is indicated for symptoms like menorrhagia, pelvic pain, pressure symptoms, or reproductive issues. *1 and 4 only* - Incorrect because statements 2 and 3 are also correct. *2 and 3 only* - Incorrect because statements 1 and 4 are also correct. *1, 2 and 3 only* - Incorrect because statement 4 is also correct.

Q: Which one of the following statements regarding Bartholin's glands is NOT true?

Gonococci is the most common cause of Bartholin's abscess. ***Gonococci is the most common causing Bartholin's abscess*** - This statement is **incorrect** because while *Neisseria gonorrhoeae* can cause Bartholin's abscess, polymicrobial infections involving **Escherichia coli (E. coli)** are far more common. - **Anaerobic bacteria** and other enteric organisms frequently contribute to Bartholin's gland infections and abscess formation. *Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions* - This is a **true** statement, accurately describing the typical anatomical location where the ducts of the Bartholin's glands open onto the vulva. - This specific position makes the ducts vulnerable to **obstruction and infection**. *The duct is lined by columnar epithelium* - This is a **true** statement, as the ducts of the Bartholin's glands are indeed lined by **columnar epithelium**, which transitions to squamous epithelium as it approaches the vestibular opening. - This type of lining is characteristic of glands that secrete mucus. *They are situated in superficial perineal pouch* - This is a **true** statement, as the Bartholin's glands are located within the **superficial perineal pouch** (or superficial perineal space), posterior to the vestibular bulbs. - Their presence in this space is clinically relevant for understanding their anatomy and pathology.

Q: A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

1 and 2 only. ***1 and 2 only*** - The presentation of **painful, unilateral vulvar swelling for 3 days** is highly suggestive of a **Bartholin's abscess**, making statement 1 correct. - **Marsupialization** is a valid surgical management option for Bartholin's abscess. While **incision and drainage with Word catheter placement** is preferred for acute cases, marsupialization can be performed and is especially indicated for recurrent cases. Statement 2 is considered true as marsupialization is an accepted treatment modality. - **Statement 3 is false**: Gonococcus is NOT the most common organism. **Polymicrobial infections** (E. coli, Staphylococcus, Streptococcus, anaerobes) are most common in current practice. Gonococcus accounts for <10% of cases. *3 only* - This option is incorrect because statement 3 alone is false (Gonococcus is not the most common organism), while statements 1 and 2 are true. - Selecting only statement 3 contradicts the clinical presentation and current microbiology data. *1, 2 and 3* - This option is incorrect because **statement 3 is false**. Gonococcus is no longer the most common pathogenic organism causing Bartholin's abscesses. - **Polymicrobial infections** predominate in modern practice, making this combination incorrect. *1 and 3 only* - This option is incorrect because it excludes statement 2 (marsupialization is a valid management option) while including statement 3 (which is false regarding Gonococcus being the most common organism). - This combination is medically inaccurate on both counts.

Question 1

A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Accepted Answer

Adenomyosis

Answer

Fibroid uterus

Answer

Endometrial carcinoma

Answer

Dysfunctional uterine bleeding

Question 2

For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Accepted Answer

Tranexamic acid

Answer

Oral progestogens

Answer

Injection leuprolide

Answer

Tablet dienogest

Question 3

A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Accepted Answer

Monilial vaginitis

Answer

Atrophic vaginitis

Answer

Gardnerella vaginalis

Answer

Trichomonal vaginitis

Question 4

Which of the following conditions is best treated by a posterior colpotomy?

Accepted Answer

Pelvic abscess

Answer

Pyosalpinx

Answer

Pyometra

Answer

Pelvic haematocele

Question 5

Which of the following is not a characteristic of Mayer-Rokitansky-Küster-Hauser syndrome?

Accepted Answer

Cardiac anomalies

Answer

Skeletal abnormalities

Answer

Renal abnormalities

Answer

Mullerian duct aplasia

Question 6

A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?

Accepted Answer

Leiomyoma

Answer

Adenomyosis

Answer

Ovarian tumour

Answer

Endometrial carcinoma

Question 7

A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?

Accepted Answer

Bartholin's abscess

Answer

Trichomoniasis

Answer

Utero vaginal prolapse

Answer

Inversion of uterus

Question 8

Consider the following statements regarding Uterine Leiomyoma:

1. Prevalence is highest between 35 and 45 years
2. More common in nulliparous women
3. Display reversible shrinkage after treatment with GnRH
4. Requires to be treated only if symptomatic
Which of the statements given above are correct?

Accepted Answer

1, 2, 3 and 4

Answer

2 and 3 only

Answer

1 and 4 only

Answer

1, 2 and 3 only

Question 9

Which one of the following statements regarding Bartholin's glands is NOT true?

Accepted Answer

Gonococci is the most common cause of Bartholin's abscess

Answer

The duct is lined by columnar epithelium

Answer

Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions

Answer

They are situated in superficial perineal pouch

Question 10

A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case?

1. Bartholin's abscess may be the likely diagnosis
2. It is to be managed by marsupialisation
3. Gonococcus is the most common pathogenic organism

Select the correct answer using the code given below:

Accepted Answer

1 and 2 only

Answer

3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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