Gynecological Disorders Practice Questions

Q: A 27-year-old woman with regular menstrual cycles presents with acute pelvic pain. An ultrasound reveals a ruptured ovarian cyst. What is the initial management?

Observation and analgesia. ***Observation and analgesia*** - For a symptomatic but hemodynamically stable patient with a **ruptured ovarian cyst**, **conservative management** with pain control is usually appropriate. - Most ruptured ovarian cysts, especially **functional cysts**, resolve spontaneously without surgical intervention. *Immediate surgery* - **Surgical intervention** is typically reserved for patients with signs of **hemodynamic instability** (e.g., significant hemorrhage), suspicion of malignancy, or persistent and severe pain refractory to conservative measures. - The patient's presentation of acute pelvic pain without further information on instability suggests conservative management is the initial approach. *Hormonal therapy* - **Hormonal therapy** (e.g., oral contraceptives) might be used to prevent recurrence of ovarian cysts, but it is not the initial treatment for an **acutely ruptured cyst**. - It does not address the immediate pain or the consequences of a rupture. *Antibiotics* - **Antibiotics** are indicated for **infection**, such as in cases of a **tubo-ovarian abscess** or pelvic inflammatory disease. - There is no mention of fever, elevated white blood cell count, or other signs of infection in this patient's presentation.

Q: A 45-year-old woman with chronic pelvic pain, dyspareunia, and irregular cycles presents with uterosacral ligament nodularity. MRI reveals pelvic lesions. What is the diagnosis?

Endometriosis. ***Endometriosis*** - The classic triad of symptoms, **chronic pelvic pain**, **dyspareunia**, and **irregular cycles**, combined with **uterosacral ligament nodularity** on examination, is highly suggestive of endometriosis. - **Pelvic lesions** seen on MRI further support the diagnosis, as endometriosis involves ectopic endometrial tissue implants. *Chronic PID* - While chronic pelvic pain can be a symptom, **Pelvic Inflammatory Disease (PID)** is typically associated with a history of sexually transmitted infections and includes symptoms like **fever** and **vaginal discharge**, which are not mentioned here. - PID does not typically cause **uterosacral ligament nodularity** or specific MRI lesions consistent with ectopic endometrial tissue. *Interstitial cystitis* - This condition primarily causes **bladder pain** and **urinary urgency/frequency**, often exacerbated by bladder filling and relieved by urination. - It does not involve **uterosacral ligament nodularity** or **irregular cycles**, as the primary pathology is in the bladder wall. *Uterine fibroids* - **Uterine fibroids (leiomyomas)** are benign growths in the muscular wall of the uterus, commonly causing **heavy menstrual bleeding**, **pelvic pressure/fullness**, and sometimes pain. - They do not typically present with **dyspareunia** as a primary symptom or **uterosacral ligament nodularity**, and their MRI appearance is distinct from endometriosis.

Q: A 25-year-old woman with pelvic pain and a history of STIs presents with cervical motion tenderness. What is the best initial treatment?

Oral antibiotics. ***Oral antibiotics*** * Given the presentation of **pelvic pain**, a history of **STIs**, and **cervical motion tenderness**, **pelvic inflammatory disease (PID)** is highly likely. * Initial management for uncomplicated PID is typically with a course of **oral antibiotics** to cover common causative organisms like *Chlamydia trachomatis* and *Neisseria gonorrhoeae*. *Surgical drainage* * **Surgical drainage** is indicated for complications of PID, such as a **tubo-ovarian abscess** (TOA) that has failed antibiotic therapy or is ruptured. * There is no mention of a TOA or other surgical indications in the initial presentation. *Observation* * **Observation** is inappropriate given the strong clinical suspicion of PID, which requires prompt treatment to prevent long-term complications such as **infertility, ectopic pregnancy**, and **chronic pelvic pain**. * Delaying treatment can lead to worsening infection and more severe outcomes. *IV antibiotics* * **Intravenous antibiotics** are reserved for more severe cases of PID, such as those with **high fever, systemic toxicity, tubo-ovarian abscess**, or inability to tolerate oral medications. * While an important treatment modality, it is not the best *initial* approach for an otherwise stable patient.

Q: A 25-year-old woman presents with itching and white vaginal discharge. Microscopy reveals budding yeast cells. What is the most likely diagnosis?

Candidiasis. ***Candidiasis*** - The presence of **budding yeast cells on microscopy** is pathognomonic for vulvovaginal candidiasis, most commonly caused by *Candida albicans*. - Clinical features of **itching** and **white, thick, curd-like discharge** are classic findings. - This is one of the most common causes of vaginitis in reproductive-age women. *Bacterial vaginosis* - Presents with **thin, gray discharge** with a characteristic **fishy odor**, especially after intercourse. - Microscopy reveals **clue cells** (vaginal epithelial cells covered with bacteria), not budding yeast. - pH typically >4.5 and positive whiff test. *Trichomoniasis* - Caused by *Trichomonas vaginalis*, a flagellated protozoan. - Presents with **frothy, yellow-green discharge**, vulvovaginal irritation, and **strawberry cervix** (punctate hemorrhages). - Microscopy shows **motile trichomonads**, not budding yeast cells. *Gonorrhea* - Caused by *Neisseria gonorrhoeae*. - Often **asymptomatic** in women; when symptomatic, presents with **mucopurulent cervical discharge**, dysuria, or pelvic pain. - Diagnosed by identifying **Gram-negative intracellular diplococci** on Gram stain or through nucleic acid amplification testing (NAAT), not yeast cells.

Q: During a routine examination, a gynecologist discovers a cystic mass in the ovary of a 30-year-old woman. What is the most common type of benign ovarian cyst?

Follicular cyst. ***Follicular cyst*** - **Follicular cysts** are the most common type of **benign functional ovarian cyst**, resulting from the non-rupture or inadequate absorption of a mature follicle. - They are typically asymptomatic, resolve spontaneously, and are common in women of reproductive age. *Dermoid cyst* - **Dermoid cysts**, also known as mature cystic teratomas, contain various tissues such as hair, teeth, or bone, originating from pluripotent germ cells. - While common, they are not as frequent as follicular cysts and arise from a different embryological origin. *Cystadenoma* - **Cystadenomas** are benign epithelial tumors of the ovary, often categorized as serous or mucinous based on their fluid content. - They are less common than functional cysts and represent a true neoplastic growth, differing from the physiological origin of follicular cysts. *Corpus luteum cyst* - A **corpus luteum cyst** forms when the corpus luteum, which develops after ovulation, fails to regress and instead fills with fluid or blood. - Although common, they are less frequent than follicular cysts and occur specifically after ovulation, while follicular cysts precede it.

Q: A 22-year-old woman presents with menorrhagia and a pelvic mass. An ultrasound reveals a well-circumscribed, homogeneous mass within the uterine wall. What is the most likely diagnosis?

Leiomyoma. ***Leiomyoma*** - **Leiomyomas** (fibroids) are common benign uterine tumors that typically present as **well-circumscribed, homogeneous masses within the uterine wall**, often causing **menorrhagia** and a palpable **pelvic mass**. - The patient's age (22) is consistent, as fibroids are more common in women of reproductive age. *Adenomyosis* - **Adenomyosis** involves endometrial tissue growing into the **myometrium**, typically causing a diffusely enlarged, globular uterus, rather than a discrete mass. - While it can cause **menorrhagia** and pelvic pain, the ultrasound finding of a **well-circumscribed mass** points away from adenomyosis. *Endometrial carcinoma* - **Endometrial carcinoma** is more common in **postmenopausal women** and presents with abnormal uterine bleeding, but it is typically associated with an **irregular endometrial stripe** or mass, not a well-circumscribed intramural mass. - Ultrasound findings are usually of **endometrial thickening** or an endometrial mass. *Ovarian cyst* - An **ovarian cyst** is located in the **ovary**, not within the uterine wall, and would typically present as an adnexal mass. - While some ovarian cysts can cause pelvic pain or mass sensation, they would not be described as a mass *within the uterine wall*.

Q: A 29-year-old woman presents with dyspareunia and nodularity in the posterior fornix. What is the most likely diagnosis?

Endometriosis. ***Endometriosis*** - **Dyspareunia** (painful intercourse) and **nodularity in the posterior fornix** are classic signs of endometriosis, especially when endometrial tissue implants on the uterosacral ligaments or rectovaginal septum. - The presence of **ectopic endometrial tissue** can cause chronic pelvic pain, dysmenorrhea, and painful defecation, in addition to dyspareunia. *Adenomyosis* - Characterized by the presence of **endometrial tissue within the myometrium** (muscular wall of the uterus), leading to a bulky, tender uterus. - While it can cause dysmenorrhea and menorrhagia, **dyspareunia and posterior fornix nodularity are not typical presentations**; these findings are more specific to peritoneal implants of endometriosis. *Pelvic inflammatory disease* - PID is an infection of the upper female reproductive tract, often causing **pelvic pain, fever, vaginal discharge**, and sometimes cervical motion tenderness. - It does not typically present with **nodularity in the posterior fornix**, which suggests solid tissue involvement rather than infection. *Ovarian cyst* - Ovarian cysts are fluid-filled sacs on the ovary, which can cause **pelvic pain or pressure**, especially if large or ruptured. - They do not typically cause **nodularity in the posterior fornix** and dyspareunia specifically related to this finding.

Q: A 38-year-old female with a history of multiple sexual partners presents with lower abdominal pain, fever, and purulent cervical discharge. Despite initial treatment for pelvic inflammatory disease, her symptoms persist. What is the most appropriate next step?

Pelvic ultrasound. ***Pelvic ultrasound*** - A persistent **lower abdominal pain**, **fever**, and **purulent cervical discharge** despite initial treatment for PID suggests a possible **pelvic abscess** or **tubo-ovarian abscess (TOA)**. - A pelvic ultrasound is the most appropriate initial imaging study to **visualize pelvic structures** and identify abscess formation, which would necessitate a change in management. *Laparoscopy* - Laparoscopy is an **invasive surgical procedure** that is not typically the first step when a patient fails initial medical management for PID, especially without prior imaging. - It would be considered if imaging confirms an abscess or if the diagnosis remains uncertain and conservative measures have failed. *Repeat antibiotics* - While adjusting antibiotic regimens may be necessary, simply repeating antibiotics **without further investigation** into the persistent symptoms may delay the diagnosis and treatment of a possible pelvic abscess. - It is crucial to determine if there's a **collection of pus** that requires drainage. *Endometrial biopsy* - An endometrial biopsy is primarily used to investigate abnormal uterine bleeding, infertility, or suspected endometrial pathology (e.g., endometrial cancer or hyperplasia). - It would not be the initial step for persistent symptoms of pelvic inflammatory disease, nor would it help to diagnose a pelvic abscess.

Q: A 32-year-old woman presents with menorrhagia and dysmenorrhea. An ultrasound reveals adenomyosis. What is the best initial treatment option for this condition?

NSAIDs. **NSAIDs** - **Nonsteroidal anti-inflammatory drugs (NSAIDs)** are often the first-line treatment for pain and heavy bleeding associated with adenomyosis, as they help reduce prostaglandin production and uterine contractions. - They are a conservative, **symptomatic treatment** suitable for women who desire future fertility or milder symptoms. *Hysterectomy* - **Hysterectomy** is a definitive cure for adenomyosis but is typically reserved for women with severe symptoms who have completed childbearing or when other treatments have failed, as it is a major surgical procedure. - It permanently removes the uterus, thus eliminating all symptoms, but it's not the **initial, least invasive** option. *Endometrial ablation* - **Endometrial ablation** involves destroying the uterine lining and is effective for heavy menstrual bleeding, but it does not treat the deep myometrial invasion characteristic of adenomyosis and may provide only temporary relief for pain in such cases. - It is generally less effective for adenomyosis compared to its efficacy in treating typical dysfunctional uterine bleeding because the **adenomyotic tissue** is often located deep within the myometrium, beyond the reach of standard ablation techniques. *Gonadotropin-releasing hormone agonists* - **Gonadotropin-releasing hormone (GnRH) agonists** induce a temporary, reversible menopause-like state by suppressing ovarian hormone production, which can reduce symptoms of adenomyosis. - However, they are typically used for **short-term treatment** due to potential side effects like bone loss and menopausal symptoms, and are often considered after NSAIDs or as a bridge to surgery, not as the primary initial treatment.

Q: A 30-year-old woman presents with severe menorrhagia and is found to have a 5 cm submucosal fibroid. What is the most appropriate treatment?

Myomectomy. ***Myomectomy*** - **Myomectomy** is the most appropriate treatment as it removes the fibroid while preserving the uterus, which is crucial for a 30-year-old woman who may desire future fertility. - This procedure directly addresses the cause of the **menorrhagia** by removing the submucosal fibroid. *Hysterectomy* - **Hysterectomy** involves the removal of the uterus and is a definitive cure for fibroids, but it is not appropriate for a 30-year-old woman who may wish to preserve her fertility. - It is a more invasive procedure with a longer recovery time and is typically reserved for women who have completed childbearing or have more extensive uterine pathology. *Endometrial ablation* - **Endometrial ablation** destroys the uterine lining to reduce bleeding, but it is less effective for large or submucosal fibroids. - While it can reduce menorrhagia, it does not remove the fibroid itself and is generally unsuitable for women who desire future pregnancies. *Uterine artery embolization* - **Uterine artery embolization (UAE)** blocks blood supply to the fibroid, causing it to shrink, but its long-term effects on fertility are still under investigation. - UAE may be considered, but **myomectomy** is often preferred for a 5 cm submucosal fibroid in a woman desiring fertility due to more predictable outcomes and less concern about future pregnancy complications.

Question 1

A 27-year-old woman with regular menstrual cycles presents with acute pelvic pain. An ultrasound reveals a ruptured ovarian cyst. What is the initial management?

Accepted Answer

Observation and analgesia

Answer

Immediate surgery

Answer

Hormonal therapy

Answer

Antibiotics

Question 2

A 45-year-old woman with chronic pelvic pain, dyspareunia, and irregular cycles presents with uterosacral ligament nodularity. MRI reveals pelvic lesions. What is the diagnosis?

Accepted Answer

Endometriosis

Answer

Chronic PID

Answer

Interstitial cystitis

Answer

Uterine fibroids

Question 3

A 25-year-old woman with pelvic pain and a history of STIs presents with cervical motion tenderness. What is the best initial treatment?

Accepted Answer

Oral antibiotics

Answer

Surgical drainage

Answer

Observation

Answer

IV antibiotics

Question 4

A 25-year-old woman presents with itching and white vaginal discharge. Microscopy reveals budding yeast cells. What is the most likely diagnosis?

Accepted Answer

Candidiasis

Answer

Bacterial vaginosis

Answer

Trichomoniasis

Answer

Gonorrhea

Question 5

During a routine examination, a gynecologist discovers a cystic mass in the ovary of a 30-year-old woman. What is the most common type of benign ovarian cyst?

Accepted Answer

Follicular cyst

Answer

Dermoid cyst

Answer

Cystadenoma

Answer

Corpus luteum cyst

Question 6

A 22-year-old woman presents with menorrhagia and a pelvic mass. An ultrasound reveals a well-circumscribed, homogeneous mass within the uterine wall. What is the most likely diagnosis?

Accepted Answer

Leiomyoma

Answer

Adenomyosis

Answer

Endometrial carcinoma

Answer

Ovarian cyst

Question 7

A 29-year-old woman presents with dyspareunia and nodularity in the posterior fornix. What is the most likely diagnosis?

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Pelvic inflammatory disease

Answer

Ovarian cyst

Question 8

A 38-year-old female with a history of multiple sexual partners presents with lower abdominal pain, fever, and purulent cervical discharge. Despite initial treatment for pelvic inflammatory disease, her symptoms persist. What is the most appropriate next step?

Accepted Answer

Pelvic ultrasound

Answer

Repeat antibiotics

Answer

Endometrial biopsy

Answer

Laparoscopy

Question 9

A 32-year-old woman presents with menorrhagia and dysmenorrhea. An ultrasound reveals adenomyosis. What is the best initial treatment option for this condition?

Accepted Answer

NSAIDs

Answer

Hysterectomy

Answer

Endometrial ablation

Answer

Gonadotropin-releasing hormone agonists

Question 10

A 30-year-old woman presents with severe menorrhagia and is found to have a 5 cm submucosal fibroid. What is the most appropriate treatment?

Accepted Answer

Myomectomy

Answer

Hysterectomy

Answer

Endometrial ablation

Answer

Uterine artery embolization

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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