Gynecological Disorders Practice Questions

Q: True about endometriosis:

Presence of endometrium at ectopic locations. ***Presence of endometrium at ectopic locations*** - **Endometriosis** is defined as the presence of endometrial glands and stroma outside of the uterine cavity. - These ectopic endometrial implants respond to hormonal changes, leading to cyclical pain and inflammation. *Presence of endometrial gland in deep myometrium* - This describes **adenomyosis**, a condition where endometrial tissue invades the muscular wall of the uterus (myometrium). - While both can cause pelvic pain, endometriosis specifically refers to endometrial tissue *outside* the uterus. *Treated preferably with hysterectomy* - Hysterectomy is a definitive treatment option, especially for severe cases or when fertility is not desired, but it is not the *preferred* initial treatment for all patients. - Initial management often includes **pain relievers**, **hormonal therapy**, or **laparoscopic excision** of endometriotic implants. *Seen in multiparous women* - Endometriosis is more commonly diagnosed in **nulliparous (never given birth)** or women who delay childbearing. - While it can occur in multiparous women, it is not a characteristic association.

Q: Most common organism causing the pelvic inflammatory disease?

Chlamydia. ***Chlamydia*** - **Chlamydia trachomatis** is the most common bacterial cause of **pelvic inflammatory disease (PID)**, often leading to subtle or asymptomatic infections [1]. - Untreated chlamydial infections can ascend from the lower genital tract, causing inflammation and scarring in the fallopian tubes and other pelvic organs [1]. *Gardnerella Vaginalis* - **Gardnerella vaginalis** is primarily associated with **bacterial vaginosis (BV)**, a common cause of vaginal discharge. - While BV can sometimes predispose to PID, *Gardnerella* itself is not considered a primary causative agent of ascending PID. *Bacteroides* - **Bacteroides species** are anaerobic bacteria that are part of the normal vaginal flora and can be found in some cases of PID, particularly in **tubo-ovarian abscesses** [1]. - However, they are typically considered secondary invaders or coinfecting organisms rather than the initial causative agent of PID. *Neisseria gonorrhoeae* - **Neisseria gonorrhoeae** is a common and significant cause of **pelvic inflammatory disease (PID)**, historically being the most recognized pathogen [1]. - While still prevalent and capable of causing severe PID, **Chlamydia trachomatis** has surpassed it in overall incidence as the leading cause of PID [1].

Q: Most common uterine tumor is:-

Leiomyoma. ***Leiomyoma*** - **Leiomyomas**, also known as **fibroids**, are the most **common benign tumors of the uterus**. - They are composed of **smooth muscle cells** and can vary in size and location within the uterus. *Adenomyoma* - An **adenomyoma** is a benign uterine tumor characterized by the presence of **endometrial glands and stroma** within the myometrium. - While it is a uterine tumor, it is significantly **less common** than leiomyomas. *Endometrial cancer* - **Endometrial cancer** is a **malignant tumor** arising from the endometrium and is the most common gynecologic malignancy. - However, malignant tumors are generally **less common** than benign tumors like leiomyomas. *Leiomyosarcoma* - **Leiomyosarcoma** is a **rare and aggressive malignant tumor** of the smooth muscle tissue of the uterus. - It accounts for a very small percentage of uterine masses and is much less common than benign leiomyomas.

Q: A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Endometriosis. ***Endometriosis*** - The classic triad of symptoms in this 29-year-old female—**dysmenorrhea**, **dyspareunia**, and **infertility**—is highly suggestive of endometriosis. - **Ectopic endometrial tissue** can cause chronic abdominal pain, menorrhagia, and inflammation, contributing to infertility. *Adenomyosis* - This condition involves the presence of **endometrial tissue within the myometrium**, leading to a thickened uterine wall. - While it can cause dysmenorrhea and menorrhagia, **infertility** is not its primary presentation, and it is less commonly associated with severe dyspareunia compared to endometriosis. *Cervicitis* - **Inflammation of the cervix** typically presents with vaginal discharge, post-coital bleeding, or pelvic pain. - It is not a common cause of primary infertility, severe dysmenorrhea, or dyspareunia as described. *Myomas* - Uterine **fibroids (leiomyomas)** are benign tumors that can cause heavy menstrual bleeding (menorrhagia), pelvic pressure, and sometimes infertility. - However, they are less commonly associated with the triad of severe dysmenorrhea and dyspareunia as prominently as seen in endometriosis.

Q: Most common ovarian tumor in young lady is ?

Mature cystic teratoma (dermoid cyst). ***Mature cystic teratoma (dermoid cyst)*** - **Mature cystic teratoma** is the **most common ovarian tumor in young women and adolescents**, accounting for 10-25% of all ovarian tumors. - These benign tumors are derived from **germ cells** and contain differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm), such as hair, teeth, skin, and sebaceous material. - They occur most frequently in women of **reproductive age** (20-40 years) and are usually **asymptomatic** unless complicated by torsion or rupture. *Dysgerminoma* - **Dysgerminoma** is the most common **malignant** germ cell tumor of the ovary, but represents only 1-2% of all ovarian malignancies. - It occurs predominantly in young women and adolescents and is highly sensitive to **radiation and chemotherapy** with excellent prognosis. - The question asks for "most common ovarian tumor" (not specifically malignant), making this incorrect. *Ovarian Serous Cystadenocarcinoma* - **Serous cystadenocarcinomas** are the most common type of epithelial ovarian cancer, but they typically occur in **older, postmenopausal women** (mean age 60-65 years). - They are characterized by **serous fluid-filled cysts** and are often bilateral. *Ovarian Mucinous Cystadenocarcinoma* - **Mucinous cystadenocarcinomas** are also epithelial ovarian cancers, less common than serous types, and generally affect **older women**. - These tumors are characterized by large, often **multiloculated cysts** filled with mucinous material.

Q: Laparoscopy is the diagnostic procedure of choice for:

Endometriosis. ***Endometriosis*** - Laparoscopy allows for direct visualization of **endometrial implants** outside the uterus, which is crucial for diagnosis and staging. - It also allows for **biopsy confirmation** and potential treatment (excision or ablation) of endometriotic lesions during the same procedure. *Ca rectum* - The primary diagnostic procedure for **rectal cancer** is usually **colonoscopy** with biopsy. - **Laparoscopy** may be used for staging **rectal cancer** but it is not the initial diagnostic procedure of choice. *Ca cervix* - The primary diagnostic procedure for **cervical cancer** is a **colposcopy** with directed biopsy of suspicious lesions. - **Laparoscopy** is not typically used for the initial diagnosis of **cervical cancer** but may be used for staging in advanced cases. *Ca uterus* - The primary diagnostic procedure for **uterine cancer** (endometrial cancer) is an **endometrial biopsy** or **dilation and curettage (D&C)**. - **Laparoscopy** may be used for surgical staging of **uterine cancer** but is not the initial diagnostic procedure.

Q: Violin string adhesion is seen in ?

Fitz-Hugh-Curtis syndrome. ***Fitz-Hugh-Curtis syndrome*** - **Fitz-Hugh-Curtis syndrome** is a perihepatitis characterized by inflammation of the liver capsule and adjacent peritoneal surfaces. - The classic "violin string" adhesions are **fibrinous adhesions** that form between the liver capsule and the anterior abdominal wall or diaphragm. *Ruptured ectopic pregnancy* - A ruptured ectopic pregnancy typically presents with acute abdominal pain and **hypovolemic shock** due to hemoperitoneum. - While it can cause pelvic adhesions, "violin string" adhesions are not a characteristic finding; the primary concern is **intra-abdominal hemorrhage**. *Endometriosis* - **Endometriosis** involves the presence of endometrial-like tissue outside the uterus, causing pain, inflammation, and adhesions, especially in the pelvis. - While it does lead to adhesions, these are usually **dense and diffuse pelvic adhesions**, not the specific "violin string" pattern associated with the liver capsule. *PCOS* - **Polycystic ovary syndrome (PCOS)** is an endocrine disorder characterized by hormonal imbalances, anovulation, and polycystic ovaries. - It primarily affects **ovarian function** and metabolism and does not directly cause adhesions in the abdominal cavity.

Q: Whiff test is useful in the diagnosis of:

Bacterial vaginosis. ***Bacterial vaginosis*** - The **whiff test** is positive in bacterial vaginosis due to the presence of **amines**, which are volatile metabolic products produced by anaerobic bacteria. - A positive test produces a **fishy odor** when a drop of 10% potassium hydroxide (KOH) is added to a sample of vaginal discharge. *Candida* - **Candida infections** (vulvovaginal candidiasis) typically present with a thick, white, **cottage cheese-like discharge** and intense itching, without a characteristic odor on whiff test. - The whiff test is generally **negative** in Candida infections, as amines are not produced. *Trichomonas* - **Trichomonas vaginalis infection** can sometimes produce a frothy, green-yellow discharge with a foul odor, but the whiff test, while occasionally positive, is **not as specific or consistently strong** as in bacterial vaginosis. - Diagnosis is more reliably made by observing motile **trichomonads** on a wet mount. *PID* - **Pelvic Inflammatory Disease (PID)** is an infection of the upper female reproductive organs and is a clinical diagnosis based on symptoms like **lower abdominal pain**, cervical motion tenderness, and adnexal tenderness. - The **whiff test is not used** in the diagnosis of PID, as it is a test for specific vaginal infections rather than upper genital tract infections.

Q: MC site of injury to the ureter during a hysterectomy is:

Site of crossing by the uterine artery. ***Site of crossing by the uterine artery*** - This is the most common site of ureteral injury during a hysterectomy because the **ureter** and the **uterine artery** cross paths in close proximity. The ureter passes *under* the uterine artery, making it vulnerable to **ligation or transection** during clamping or cutting of the artery. - The phrase "water under the bridge" is a common mnemonic used to remember this relationship, where **water (ureter)** passes under the **bridge (uterine artery)**. *In the ovarian fossa* - While the ureter is in proximity to the ovarian vessels, injury in the ovarian fossa is more common during procedures like **oophorectomy** or **pelvic lymph node dissection**, not typically hysterectomy. - The ureter can be injured here if it's mistaken for a blood vessel during **ligament ligation** or when securing the ovarian pedicle. *At the pelvic brim* - Injury at the pelvic brim is less common during a hysterectomy, though it can occur during procedures that involve **dissection of the great vessels** or extensive pelvic lymphadenectomy. - At this point, the ureter crosses the **iliac vessels**, which might be relevant in procedures like radical hysterectomy with lymph node dissection, but not a standard total hysterectomy. *As it enters the bladder* - Although the terminal portion of the ureter is close to the bladder, injury at its entry point into the bladder during a hysterectomy is not the most common site. - This area is more often at risk during procedures involving the **bladder itself**, such as cystectomy or extensive dissection of the bladder base for endometriosis.

Question 1

True about endometriosis:

Accepted Answer

Presence of endometrium at ectopic locations

Answer

Presence of endometrial gland in deep myometrium

Answer

Treated preferably with hysterectomy

Answer

Seen in multiparous women

Question 2

Most common organism causing the pelvic inflammatory disease?

Accepted Answer

Chlamydia

Answer

Gardnerella Vaginalis

Answer

Bacteroides

Answer

Neisseria gonorrhoeae

Question 3

Most common uterine tumor is:-

Accepted Answer

Leiomyoma

Answer

Adenomyoma

Answer

Endometrial cancer

Answer

Leiomyosarcoma

Question 4

A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Cervicitis

Answer

Myomas

Question 5

A 67-year-old female with hypertension and diabetes presents with heavy vaginal bleeding. What is the next step in management?

Accepted Answer

Endometrial biopsy

Answer

Pelvic ultrasound

Answer

Detailed history and physical examination

Answer

Complete blood count and coagulation studies

Question 6

Most common ovarian tumor in young lady is ?

Accepted Answer

Mature cystic teratoma (dermoid cyst)

Answer

Ovarian Serous Cystadenocarcinoma

Answer

Ovarian Mucinous Cystadenocarcinoma

Answer

Dysgerminoma

Question 7

Laparoscopy is the diagnostic procedure of choice for:

Accepted Answer

Endometriosis

Answer

Ca rectum

Answer

Ca cervix

Answer

Ca uterus

Question 8

Violin string adhesion is seen in ?

Accepted Answer

Fitz-Hugh-Curtis syndrome

Answer

Ruptured ectopic pregnancy

Answer

Endometriosis

Answer

PCOS

Question 9

Whiff test is useful in the diagnosis of:

Accepted Answer

Bacterial vaginosis

Answer

Candida

Answer

Trichomonas

Answer

PID

Question 10

MC site of injury to the ureter during a hysterectomy is:

Accepted Answer

Site of crossing by the uterine artery

Answer

In the ovarian fossa

Answer

At the pelvic brim

Answer

As it enters the bladder

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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