Gynecological Disorders Practice Questions

Q: A woman presents with painless ulcers on the vulva, she gives a history of having multiple sexual partners and has had a stillbirth at 28 weeks in the past. What is the next best step of investigation?

VDRL. ***VDRL*** - The presentation of **painless vulvar ulcers**, a history of **multiple sexual partners**, and a past **stillbirth at 28 weeks** are highly suggestive of **syphilis**. - A **VDRL (Venereal Disease Research Laboratory) test** is a non-treponemal serologic test used for screening and monitoring the treatment of syphilis. *PCR* - While **PCR** can be used to detect the genetic material of *Treponema pallidum*, it is not the primary diagnostic test for syphilis, especially given the classic clinical picture. - It is more commonly used for detecting other sexually transmitted infections (STIs) or for specific situations where direct detection of the organism from a lesion is preferred. *Vaginal swab and culture* - A **vaginal swab and culture** would be appropriate for diagnosing bacterial vaginosis, candidiasis, or certain bacterial STIs, but it is not suitable for diagnosing syphilis. - Syphilis is caused by a spirochete (*Treponema pallidum*) that cannot be cultured on standard media. *NAT* - **Nucleic Acid Amplification Tests (NATs)** are a broad category of tests that include PCR. - Like PCR, while potentially applicable for *Treponema pallidum* detection, they are not the standard or first-line diagnostic investigation for syphilis given the strong clinical indicators.

Q: Identify the instrument given below.

Cusco's speculum. ***Cusco's speculum*** - This is a **bivalved, self-retaining speculum** with two articulated blades that open and close using a **thumbscrew/locking mechanism** at the handle. - Commonly used for **per speculum examination** to visualize the **cervix and vaginal walls** during gynecological procedures. *Sims' speculum* - A **single-bladed (univalve) speculum** that requires an **assistant to hold** during examination, unlike the self-retaining instrument shown. - Used to retract the **posterior vaginal wall** but lacks the dual-blade design visible in the image. *Graves' speculum* - Similar bivalved design to Cusco's but features **longer and wider blades** for better visualization in larger patients. - More commonly used in the **United States**, with a bulkier appearance than the instrument pictured. *Auvard's speculum* - A **weighted, self-retaining single-blade speculum** used as a **posterior vaginal retractor**. - Completely different design from the bivalved instrument shown, with only **one blade** and no locking mechanism.

Q: A female patient having frothy vaginal discharge was found to have a strawberry cervix. Which of the following is the drug of choice?

Metronidazole. ***Correct Option: Metronidazole*** - The combination of **frothy vaginal discharge** and a **strawberry cervix** (colpitis macularis) is highly indicative of **trichomoniasis**, caused by *Trichomonas vaginalis*. - **Metronidazole** is the drug of choice for treating trichomoniasis, effectively eradicating the protozoan parasite. - Alternative: **Tinidazole** is also highly effective for trichomoniasis treatment. *Incorrect Option: Cefixime* - **Cefixime** is a third-generation cephalosporin antibiotic primarily used to treat bacterial infections, particularly **gonorrhea** (*Neisseria gonorrhoeae*). - It is not effective against parasitic infections like **trichomoniasis**. *Incorrect Option: Tetracycline* - **Tetracycline** is a broad-spectrum antibiotic commonly used for bacterial infections like **chlamydia** and certain atypical organisms. - It is not indicated for the treatment of **trichomoniasis**, which requires antiprotozoal therapy. *Incorrect Option: Fluconazole* - **Fluconazole** is an antifungal medication specifically used to treat **yeast infections** (vulvovaginal candidiasis caused by *Candida* species). - It has no activity against the protozoan parasite *Trichomonas vaginalis*.

Q: Which of the following symptoms are seen in endometriosis? 1. Infertility 2. Dysmenorrhea 3. Vaginal discharge 4. Vaginal bleeding

1,2. ***Correct: 1,2 (Infertility and Dysmenorrhea)*** - **Infertility** is present in 30-50% of women with endometriosis, making it one of the most common presentations. Caused by inflammation, adhesions, altered pelvic anatomy, and inflammatory mediators that impair reproductive function. - **Dysmenorrhea (painful menstruation)** is the hallmark symptom of endometriosis. The pain is typically severe, progressive, and occurs due to cyclic bleeding from ectopic endometrial tissue, causing inflammation and irritation of surrounding structures. - These are the two most characteristic and consistent symptoms of endometriosis. *Incorrect: 2,3* - While dysmenorrhea is correct, **vaginal discharge is NOT a characteristic symptom of endometriosis**. Vaginal discharge is typically associated with infections (vaginitis, cervicitis) or other gynecological conditions, not endometriosis. *Incorrect: 1,2,4* - While infertility and dysmenorrhea are correct, including "vaginal bleeding" makes this option less accurate. Although some women with endometriosis may experience menorrhagia or irregular bleeding (particularly with adenomyosis or ovarian endometriomas), **abnormal vaginal bleeding is not a primary or pathognomonic symptom** of endometriosis. *Incorrect: 3,4* - **Vaginal discharge** is not associated with endometriosis. - **Vaginal bleeding** as a standalone symptom is not a primary feature of endometriosis, though menstrual abnormalities can occasionally occur. **Note:** Other classic symptoms of endometriosis include dyspareunia (painful intercourse), dyschezia (painful defecation), and chronic pelvic pain.

Q: A 24-year-old woman presents with abnormal vaginal discharge. Wet mount shows motile trichomonads. Her male partner is asymptomatic. Which of the following is the most appropriate management for her partner?

Treat regardless of symptoms. ***Treat regardless of symptoms*** - **Trichomoniasis** is a sexually transmitted infection, and partners of infected individuals should be treated even if they are asymptomatic to prevent **reinfection** and further transmission. - **Male partners** often carry the infection asymptomatically, acting as a reservoir for transmission. *No treatment unless symptoms develop* - This approach would lead to **persistent infection** in the male partner and an increased risk of **reinfection** for the female patient. - Asymptomatic carriers can still transmit the infection, undermining the treatment of the symptomatic partner. *Test before treating* - While testing is possible, current guidelines recommend **presumptive treatment** for male partners of women diagnosed with trichomoniasis to ensure effective eradication and prevent recurrence. - The **sensitivity** of diagnostic tests for trichomoniasis in men can be lower than in women, potentially leading to false negatives. *Monitor without intervention* - Monitoring without intervention is inadequate as it allows the male partner to remain an **infectious source** and risks **recurrent infection** for the female patient. - The goal is to break the chain of transmission and fully cure both partners.

Q: Which of the following is NOT a criterion in Amsel's criteria for diagnosing bacterial vaginosis?

Positive culture for G. vaginalis. ***Positive culture for G. vaginalis*** - A positive culture for **Gardnerella vaginalis** is not part of Amsel's criteria, as this bacterium is also found in the normal vaginal flora of many healthy women. - The diagnosis of bacterial vaginosis (BV) relies on clinical and microscopic findings, not on bacterial culture. *Presence of clue cells* - **Clue cells** (vaginal epithelial cells covered with bacteria, obscuring the cell borders) are a key diagnostic criterion in Amsel's, indicating the presence of abundant bacteria. - Their presence under microscopy is a strong indicator of bacterial overgrowth. *Vaginal pH > 4.5* - An elevated **vaginal pH above 4.5** is a crucial criterion, reflecting the shift from a healthy acidic environment to a more alkaline one in BV. - This change in pH is due to the reduction of lactobacilli and overgrowth of anaerobic bacteria. *Positive whiff test* - A **positive whiff test**, characterized by a fishy odor after adding potassium hydroxide (KOH) to vaginal secretions, is a diagnostic criterion. - This odor is caused by the production of volatile amines by anaerobic bacteria.

Q: A 25-year-old woman presents with thin, gray-white vaginal discharge and mild itching. Microscopy shows clue cells and pH is 5.5. What is the most appropriate treatment?

Metronidazole 500mg BD for 7 days. ***Metronidazole 500mg BD for 7 days*** - The patient's symptoms (thin, gray-white discharge, mild itching), microscopic findings (**clue cells**), and **vaginal pH of 5.5** are classic for **bacterial vaginosis (BV)**. - **Oral metronidazole 500mg twice daily for 7 days** is a highly effective and commonly recommended first-line treatment for BV, targeting anaerobic bacteria responsible for the condition. *Metronidazole gel 0.75% for 5 days* - Metronidazole gel is an alternative treatment for BV, but it is typically prescribed for **5 days**, not 7 days, and is a **vaginal application**, not oral. - While effective, oral metronidazole is often preferred for more severe or recurrent cases, or if patient preference dictates. *Fluconazole 150mg single dose* - **Fluconazole** is an **antifungal medication** used to treat **vulvovaginal candidiasis (yeast infection)**, which typically presents with thick, white, "cottage cheese-like" discharge and severe itching, and is not associated with clue cells. - The presented symptoms and findings are inconsistent with a yeast infection. *Clindamycin cream 2% for 7 days* - **Clindamycin cream** is another effective topical treatment for **bacterial vaginosis**; however, it is typically applied **intravaginally** for 7 days. - While clindamycin is an appropriate antibiotic for BV, oral metronidazole is often favored for its systemic effect and patient convenience in many cases.

Q: A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-

Candida vaginitis. ***Candida vaginitis*** - **Candida vaginitis** is characterized by a **curdy white vaginal discharge**, often described as cottage cheese-like. - This condition is caused by an overgrowth of *Candida* species, typically *Candida albicans*, and is associated with **vaginal itching, burning**, and **dyspareunia**. *Trichomoniasis* - **Trichomoniasis** typically presents with a **frothy, greenish-yellow discharge** and a **foul odor**. - It often causes **severe itching, redness, and irritation**, which differ from the curdy discharge described. *Gonococcal vulvovaginitis* - **Gonococcal vulvovaginitis** in women can cause a **purulent or mucopurulent discharge**, often yellowish. - While it can lead to vaginal irritation, a **curdy white discharge** is not its classic presentation. *Chlamydia trachomatis* - **Chlamydia trachomatis** often causes an **asymptomatic infection**; when symptoms occur, they may include a **mucopurulent discharge**. - A **curdy white discharge** is not a typical symptom of *Chlamydia* infection.

Q: Amsel's criteria are used for?

Bacterial vaginosis. ***Bacterial vaginosis*** - **Amsel's criteria** are a set of four clinical signs used to diagnose **bacterial vaginosis**, a common vaginal infection. - At least three of the four criteria must be present for a positive diagnosis: **thin, white, homogeneous discharge**, **clue cells** on microscopy, vaginal pH >4.5, and a **fishy odor** before or after adding 10% KOH (whiff test). *Candidiasis* - Diagnosed based on clinical symptoms such as **pruritus** and thick, white, **"cottage cheese-like" discharge**, along with identification of yeast (hyphae/pseudohyphae) on microscopy. - **Amsel's criteria** are not used for its diagnosis. *Trichomoniasis* - Typically diagnosed by microscopic observation of **motile trichomonads** in a wet mount, or by nucleic acid amplification tests (NAATs). - It presents with a **foamy, yellow-green discharge** and sometimes a **"strawberry cervix"**, none of which are part of Amsel's criteria. *Chlamydia infection* - Primarily diagnosed using **nucleic acid amplification tests (NAATs)** from urine or swab samples. - It is often **asymptomatic** or presents with non-specific symptoms like discharge or dysuria, and **Amsel's criteria** are not applicable.

Q: Late rupture of tubal pregnancy is seen in?

Interstitial. ***Interstitial*** - The interstitial portion of the fallopian tube is the segment that passes through the **myometrium** of the uterus. This muscular wall provides greater distensibility and support, allowing the pregnancy to grow for a longer period before rupture. - Rupture in the interstitial part typically occurs later (around **8-12 weeks**) and is often more catastrophic due to its proximity to the **uterine blood vessels**, leading to severe hemorrhage. *Fimbriae* - Pregnancies rarely implant in the fimbriae, and if they do, they are more likely to undergo **tubal abortion** rather than rupture. - The fimbriae are finger-like projections at the end of the fallopian tube which is why they cannot hold pregnancy for a longer duration. *Ampulla* - The ampulla is the **widest part** of the fallopian tube and is the most common site of ectopic pregnancy (about 70%). - Rupture in the ampulla typically occurs earlier, around **6-8 weeks**, as its wall is thinner and less distensible compared to the interstitial segment. *Isthmus* - The isthmus is a **narrower, more muscular** segment of the fallopian tube. - Pregnancy in the isthmus tends to rupture early (around **4-6 weeks**) because the lumen is very narrow and the wall is rigid, accommodating very little expansion.

Question 1

A woman presents with painless ulcers on the vulva, she gives a history of having multiple sexual partners and has had a stillbirth at 28 weeks in the past. What is the next best step of investigation?

Accepted Answer

VDRL

Answer

PCR

Answer

Vaginal swab and culture

Answer

NAT

Question 2

Identify the instrument given below.

Accepted Answer

Cusco's speculum

Answer

Sims' speculum

Answer

Graves' speculum

Answer

Auvard's speculum

Question 3

A female patient having frothy vaginal discharge was found to have a strawberry cervix. Which of the following is the drug of choice?

Accepted Answer

Metronidazole

Answer

Cefixime

Answer

Tetracycline

Answer

Fluconazole

Question 4

Which of the following symptoms are seen in endometriosis?

1. Infertility
2. Dysmenorrhea
3. Vaginal discharge
4. Vaginal bleeding

Accepted Answer

1,2

Answer

2,3

Answer

1,2,4

Answer

3,4

Question 5

A 24-year-old woman presents with abnormal vaginal discharge. Wet mount shows motile trichomonads. Her male partner is asymptomatic. Which of the following is the most appropriate management for her partner?

Accepted Answer

Treat regardless of symptoms

Answer

No treatment unless symptoms develop

Answer

Test before treating

Answer

Monitor without intervention

Question 6

Which of the following is NOT a criterion in Amsel's criteria for diagnosing bacterial vaginosis?

Accepted Answer

Positive culture for G. vaginalis

Answer

Presence of clue cells

Answer

Vaginal pH > 4.5

Answer

Positive whiff test

Question 7

A 25-year-old woman presents with thin, gray-white vaginal discharge and mild itching. Microscopy shows clue cells and pH is 5.5. What is the most appropriate treatment?

Accepted Answer

Metronidazole 500mg BD for 7 days

Answer

Metronidazole gel 0.75% for 5 days

Answer

Fluconazole 150mg single dose

Answer

Clindamycin cream 2% for 7 days

Question 8

A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-

Accepted Answer

Candida vaginitis

Answer

Trichomoniasis

Answer

Gonococcal vulvovaginitis

Answer

Chlamydia trachomatis

Question 9

Amsel's criteria are used for?

Accepted Answer

Bacterial vaginosis

Answer

Candidiasis

Answer

Trichomoniasis

Answer

Chlamydia infection

Question 10

Late rupture of tubal pregnancy is seen in?

Accepted Answer

Interstitial

Answer

Fimbriae

Answer

Ampulla

Answer

Isthmus

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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