Gynecological Disorders Practice Questions

Q: Monilial vaginitis is commonly associated with all EXCEPT:

Treatment of malaria with chloroquine. ***Treatment of malaria with chloroquine*** - **Chloroquine** is an antimalarial drug and has no direct known association with an increased risk of **monilial vaginitis (candidiasis)**. - Unlike antibiotics, corticosteroids, or immunosuppressants, chloroquine does not significantly alter the vaginal flora or immune response in a way that predisposes to Candida overgrowth. *Prolonged antibiotic therapy* - **Antibiotics** can disrupt the normal vaginal flora by killing off beneficial bacteria (like *Lactobacillus*), leading to an overgrowth of **Candida albicans**. - This altered microbial balance is a common cause of **vulvovaginal candidiasis (VVC)**. *Pregnancy* - Hormonal changes during **pregnancy**, particularly elevated estrogen levels, can increase **glycogen deposition** in vaginal epithelial cells. - This provides a rich food source for **Candida**, making pregnant women more susceptible to **monilial vaginitis**. *Diabetes Mellitus* - **Poorly controlled diabetes mellitus** leads to hyperglycemia, which can result in **elevated glucose levels** in vaginal secretions. - This increased glucose serves as a nutrient for **Candida albicans**, fostering its growth and making diabetic women more prone to recurrent **vaginal yeast infections**.

Q: Which of the following are characteristics of Trichomonas vaginitis? 1. Presence of greenish frothy discharge 2. Vaginal pH > 4.5 3. Presence of clue cells in microscopic examination 4. Strawberry spots on the vaginal mucosa Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - **Trichomonas vaginalis** infection classically presents with a **greenish, frothy, malodorous vaginal discharge**, and the vaginal pH is typically **elevated (>4.5)** due to the pathogen's metabolic activity. - The presence of **strawberry spots (colpitis macularis)** on the vaginal and cervical mucosa is a hallmark sign, resulting from punctate hemorrhages. *1, 3 and 4* - This option correctly includes **greenish frothy discharge** and **strawberry spots**, which are characteristic of *Trichomonas vaginitis*. - However, the inclusion of "presence of **clue cells**" is incorrect as clue cells are pathognomonic for **bacterial vaginosis**, not *Trichomonas*. *2, 3 and 4* - This option correctly identifies **vaginal pH > 4.5** and **strawberry spots** as features of *Trichomonas vaginitis*. - The presence of **clue cells** is a misattribution to *Trichomonas* infection; instead, clue cells are defining features of **bacterial vaginosis**. *1, 2 and 3* - While **greenish frothy discharge** and **vaginal pH > 4.5** are indeed characteristic of *Trichomonas vaginitis*, the presence of **clue cells** is a diagnostic criterion for **bacterial vaginosis**. - **Strawberry spots** are a distinct feature of *Trichomonas* that is missing from this selection.

Q: During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

During division and ligation of the round ligaments. ***During division and ligation of the round ligaments*** - The round ligaments are located **far from the ureters**, passing through the **inguinal canal** anteriorly. - They are **anterior and lateral** to the broad ligament and do not cross the ureteral path. - **Ureteral injury is highly unlikely** during their division and ligation, making this the correct answer to the EXCEPT question. *During division and ligation of mackenrodt's and uterosacral ligaments* - The **ureter passes about 1-2 cm lateral to the cervix** at the level of the internal os, in close proximity to the **cardinal (Mackenrodt's) and uterosacral ligaments**. - These ligaments provide significant support to the uterus and are one of the **most common sites of ureteral injury** during hysterectomy. - The ureter is particularly vulnerable during clamping and ligating these structures. *At the vaginal angles while incising the vagina to remove the cervix with the uterus* - The **ureters are at the level of the vaginal fornices** as they course toward the bladder base. - This is a well-recognized **high-risk area** for ureteral injury during vaginal cuff clamping and incision. - The ureter can be inadvertently caught in the clamps applied to control bleeding from the vaginal angles. *During division and ligation of infundibulopelvic ligaments* - The **infundibulopelvic ligament** (IP ligament or suspensory ligament of the ovary) contains the **ovarian vessels**. - The ureter runs along the **pelvic sidewall immediately medial and posterior** to the IP ligament. - This is another **high-risk area** for ureteral injury, especially if the ligament is not elevated adequately away from the pelvic sidewall during clamping.

Q: Which one of the following is a protective factor for endometrial hyperplasia?

Multiparity. ***Multiparity*** - **Multiparity** is a protective factor against endometrial hyperplasia due to **periods of anovulation and progesterone dominance** during pregnancy. - Each pregnancy provides prolonged exposure to high levels of **progesterone**, which counteracts unopposed estrogenic effects on the endometrium and prevents hyperplasia. - Multiple pregnancies reduce the total number of **ovulatory cycles** in a woman's lifetime, thereby decreasing cumulative exposure to unopposed estrogen. *Tamoxifen therapy* - **Tamoxifen**, while an anti-estrogen in breast tissue, acts as a **partial estrogen agonist** on the endometrium, increasing the risk of endometrial hyperplasia and cancer. - It can lead to changes in the endometrial lining, including **polyps** and hyperplasia, due to its estrogenic effects in the uterus. *Diabetes* - **Diabetes**, particularly type 2, is a risk factor for endometrial hyperplasia and cancer, not a protective factor. - It is associated with **increased insulin levels** and insulin-like growth factors, which can promote endometrial cell proliferation. *Delayed menopause* - **Delayed menopause** means a longer lifetime exposure to estrogen during the reproductive years. - Prolonged exposure to **unopposed estrogen** is a significant risk factor for endometrial hyperplasia, as it promotes endometrial proliferation.

Q: Which of the following statements about bacterial vaginosis is TRUE?

It results from displacement of lactobacilli by anaerobes. ***It results from displacement of lactobacilli by anaerobes*** - **Bacterial vaginosis (BV)** is characterized by an imbalance in the vaginal microbiota, where the protective **Lactobacillus** species are significantly reduced or replaced. - This reduction allows for the overgrowth of **anaerobic bacteria** like *Gardnerella vaginalis* and *Mycoplasma hominis*, leading to the typical symptoms. *Sexual partners should routinely receive treatment* - **BV** is not considered a sexually transmitted infection, and routine treatment of **male sexual partners** has not been shown to prevent recurrence in women. - Treatment is generally focused on the affected individual to restore the vaginal flora. *It is characterized by a decrease in vaginal pH* - **Bacterial vaginosis** is characterized by an **increase in vaginal pH** (typically >4.5), which is a key diagnostic criterion. - The normal acidic vaginal environment, maintained by lactobacilli, is disrupted, allowing for the proliferation of anaerobic bacteria. *It is commonly associated with vaginal candidiasis* - **Bacterial vaginosis** and **vaginal candidiasis** are two distinct conditions with different etiologies and clinical presentations. - While both can cause vaginal symptoms, they are not commonly associated in a direct causative way; rather, they are independent conditions.

Q: A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?

Reinfection from untreated partner. ***Reinfection from untreated partner*** - **Trichomoniasis** is a sexually transmitted infection, and treatment of only one partner often leads to **reinfection** from the untreated partner. - The recurrence of symptoms within a short period (2 months) after successful treatment strongly suggests exposure to the pathogen again. *Concurrent bacterial vaginosis* - While **bacterial vaginosis** can cause discharge, it is a different infection, and its presence does not explain the recurrence of **trichomonads** found on the wet mount. - Co-occurrence is possible, but it doesn't account for the re-emergence of the *Trichomonas* organism. *Metronidazole resistance* - **Metronidazole resistance** in *Trichomonas vaginalis* is rare, especially after an initial successful treatment with a single dose. - Resistance is usually suspected if symptoms persist *despite* adequate treatment, rather than recurring after a period of being symptom-free. *Inadequate initial therapy* - A single-dose regimen of **metronidazole** is typically an effective and standard treatment for trichomoniasis. - If the initial treatment was truly inadequate, symptoms would likely have persisted or returned much sooner, rather than appearing 2 months later.

Q: A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?

Weekly fluconazole 150mg for 6 months. ***Weekly fluconazole 150mg for 6 months*** - The patient's history of **recurrent episodes** of vulvovaginal candidiasis, coupled with the presence of **budding yeast and pseudohyphae**, indicates a need for **prophylactic treatment**. - **Weekly fluconazole** for an extended period (e.g., 6 months) is the recommended regimen for **recurrent vulvovaginal candidiasis**, aiming to suppress future outbreaks. *Fluconazole 150mg orally as single dose* - A **single dose of fluconazole** is typically effective for **uncomplicated, sporadic vulvovaginal candidiasis**. - It is insufficient to prevent recurrence in a patient with a history of **recurrent candidiasis**. *Topical clotrimazole for 7 days* - **Topical antifungals** like clotrimazole are effective for **acute episodes of candidiasis**, particularly when symptoms are mild or localized. - Similar to a single oral dose, a 7-day course of topical treatment is generally not adequate for **preventing recurrence** in chronic cases. *Metronidazole 500mg orally twice daily for 7 days* - **Metronidazole** is an antibiotic used to treat **bacterial vaginosis** and **trichomoniasis**, which are caused by bacteria and parasites, respectively. - It has **no antifungal activity** and would be ineffective against vulvovaginal candidiasis.

Q: Which of the following is NOT a complication of untreated trichomoniasis?

Ectopic pregnancy. ***Ectopic pregnancy*** - While other **sexually transmitted infections (STIs)** like chlamydia and gonorrhea are significant risk factors for **ectopic pregnancy** due to fallopian tube damage, trichomoniasis is not directly associated with it. - The inflammatory response from *Trichomonas vaginalis* primarily affects the **lower genital tract** (vagina, cervix, urethra) and does not typically lead to the kind of **tubal scarring** associated with ectopic gestations. - Unlike ascending infections that cause PID, trichomoniasis remains localized to lower genital structures. *Infertility in women* - Untreated trichomoniasis can lead to **chronic cervicitis** and **endometritis**, which may contribute to female infertility. - The persistent inflammation can affect the **cervical mucus quality** and create a hostile environment for sperm. - Studies have demonstrated associations between *Trichomonas vaginalis* infection and reduced fertility rates. *Preterm delivery* - Studies have linked untreated *Trichomonas vaginalis* infection during pregnancy to an increased risk of **preterm birth** and **low birth weight**. - The inflammation caused by the parasite can contribute to **premature rupture of membranes (PROM)** and uterine contractions. - Maternal trichomoniasis is considered a modifiable risk factor for adverse pregnancy outcomes. *Increased susceptibility to HIV infection* - Trichomoniasis causes **genital inflammation** and microscopic lesions, which can disrupt the natural protective barriers of the genital tract. - These disruptions make individuals more vulnerable to acquiring **HIV infection** if exposed, as the virus can more easily enter the bloodstream through damaged tissues. - Co-infection with trichomoniasis increases HIV viral shedding, further facilitating transmission.

Q: What is the most common clinical manifestation of Trichomonas vaginalis infection in women?

Frothy, yellow-green vaginal discharge. ***Frothy, yellow-green vaginal discharge*** - **Frothy, yellow-green vaginal discharge** is the most characteristic and common symptomatic manifestation of *Trichomonas vaginalis* infection, occurring in 50-70% of symptomatic cases. - This discharge results from inflammation and gas production by the motile trophozoites, and is often accompanied by a **foul, fishy odor**. - The frothy nature and yellow-green color make this discharge highly distinctive for trichomoniasis. *Dysuria* - **Dysuria** (painful urination) can occur with *Trichomonas vaginalis* infection but is less specific and less common than the characteristic discharge. - Dysuria is usually secondary to vulvar inflammation and urethral involvement rather than a primary manifestation. - This symptom can be present in various urinary tract infections and other sexually transmitted infections. *Strawberry cervix* - **Strawberry cervix** (colpitis macularis) refers to punctate hemorrhages on the cervix, creating a strawberry-like appearance. - While this is a specific sign of trichomoniasis, it is only visible in approximately 2-5% of cases and requires colposcopic examination. - This makes it much less common than the characteristic vaginal discharge as a clinical manifestation. *Vulvar burning and itching* - **Vulvar burning and itching** are common symptoms in trichomoniasis due to local inflammation. - However, these symptoms are also prevalent in other vaginal infections such as candidiasis and bacterial vaginosis, making them less specific. - The frothy, yellow-green discharge remains more distinctive and frequently reported as the primary manifestation of symptomatic trichomoniasis.

Question 1

Monilial vaginitis is commonly associated with all EXCEPT:

Accepted Answer

Treatment of malaria with chloroquine

Answer

Prolonged antibiotic therapy

Answer

Pregnancy

Answer

Diabetes Mellitus

Question 2

Which of the following are characteristics of Trichomonas vaginitis?

1. Presence of greenish frothy discharge
2. Vaginal pH > 4.5
3. Presence of clue cells in microscopic examination
4. Strawberry spots on the vaginal mucosa

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Question 3

During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

Accepted Answer

During division and ligation of the round ligaments

Answer

During division and ligation of infundibulopelvic ligaments

Answer

During division and ligation of mackenrodt's and uterosacral ligaments

Answer

At the vaginal angles while incising the vagina to remove the cervix with the uterus

Question 4

Which one of the following is a protective factor for endometrial hyperplasia?

Accepted Answer

Multiparity

Answer

Tamoxifen therapy

Answer

Diabetes

Answer

Delayed menopause

Question 5

Which of the following statements about bacterial vaginosis is TRUE?

Accepted Answer

It results from displacement of lactobacilli by anaerobes

Answer

Sexual partners should routinely receive treatment

Answer

It is characterized by a decrease in vaginal pH

Answer

It is commonly associated with vaginal candidiasis

Question 6

A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?

Accepted Answer

Reinfection from untreated partner

Answer

Concurrent bacterial vaginosis

Answer

Metronidazole resistance

Answer

Inadequate initial therapy

Question 7

A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?

Accepted Answer

Weekly fluconazole 150mg for 6 months

Answer

Fluconazole 150mg orally as single dose

Answer

Topical clotrimazole for 7 days

Answer

Metronidazole 500mg orally twice daily for 7 days

Question 8

Which of the following is NOT a complication of untreated trichomoniasis?

Accepted Answer

Ectopic pregnancy

Answer

Infertility in women

Answer

Preterm delivery

Answer

Increased susceptibility to HIV infection

Question 9

What is the most common clinical manifestation of Trichomonas vaginalis infection in women?

Accepted Answer

Frothy, yellow-green vaginal discharge

Answer

Dysuria

Answer

Strawberry cervix

Answer

Vulvar burning and itching

Question 10

A 25-year-old woman with recurrent urinary tract infections presents with dyspareunia, post-coital bleeding, and mucopurulent cervical discharge. Nucleic acid amplification test for C. trachomatis and N. gonorrhoeae is negative. Microscopy shows increased polymorphonuclear leukocytes from endocervical sample. What is the most likely diagnosis and appropriate management?

Accepted Answer

Mycoplasma genitalium cervicitis - Doxycycline followed by Moxifloxacin therapy

Answer

Bacterial vaginosis - Clindamycin therapy

Answer

Cervical ectopy - Cryotherapy

Answer

Trichomoniasis - Metronidazole therapy

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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