Gynecological Disorders Practice Questions

Q: 60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Endometrial polyp. ***Endometrial polyp*** - The ultrasound image shows a well-defined, **echogenic focal lesion within the endometrial cavity**, which is characteristic of an endometrial polyp. - In a 60-year-old female with intermittent bleeding, a polyp is a common cause of **postmenopausal bleeding** and is often identified as an intracavitary mass on ultrasound. - Endometrial polyps appear as **focal, hyperechoic or isoechoic masses** with a smooth contour projecting into the endometrial cavity. *Ca endometrium* - **Endometrial carcinoma** typically appears as diffuse endometrial thickening (>4-5 mm in postmenopausal women), irregular endometrial-myometrial interface, or heterogeneous endometrial echoes, often with evidence of myometrial invasion. - While bleeding is a cardinal symptom of endometrial carcinoma, the distinct **focal, well-circumscribed nature** of the lesion on ultrasound is less typical for carcinoma, which tends to be more diffuse and irregular. *Submucosal fibroid* - A **submucosal fibroid** (leiomyoma) is a benign smooth muscle tumor originating from the myometrium that protrudes into the endometrial cavity. - While it can appear as an intracavitary mass and cause abnormal bleeding, fibroids often have a more **heterogeneous or hypoechoic appearance** with posterior acoustic shadowing, compared to the isoechoic to hyperechoic appearance of a polyp. - The feeding vessel sign (blood flow at the base) is more characteristic of polyps than fibroids. *Endometrial hyperplasia* - **Endometrial hyperplasia** presents as **diffuse, uniform endometrial thickening** rather than a focal intracavitary mass. - It typically shows homogeneous increased echogenicity of the entire endometrium without a discrete, well-defined lesion as seen with a polyp. - While it can cause postmenopausal bleeding, the focal nature of the lesion in this case makes hyperplasia less likely.

Q: Based on the provided image of a uterine anomaly, what is the most likely diagnosis?

Unicornuate Uterus. ***Unicornuate Uterus*** - A unicornuate uterus is characterized by the development of **only one functional Mullerian duct**, resulting in a uterus with a single horn and usually a single fallopian tube. The provided image shows a uterus that is distinctly single-horned and banana-shaped, fitting this description. - This anomaly can be associated with the presence of a **rudimentary horn** (with or without an endometrial cavity) on the contralateral side, which is often shown as a small, non-functional structure in imaging. *Uterus didelphys* - Uterus didelphys involves the **complete non-fusion of both Mullerian ducts**, leading to two separate uteri, two cervices, and often two vaginas. The image does not show two distinct uterine bodies. - Each uterus in uterus didelphys would have its own fallopian tube and be fully developed, unlike the single-horn structure seen in the image. *Bicornuate Uterus* - A bicornuate uterus results from **partial fusion of the Mullerian ducts**, leading to a heart-shaped uterus with two horns but a single cervix and vagina. The image clearly depicts a single, elongated horn, not two distinct horns within an overall heart shape. - While it has two horns, the degree of separation can vary, but it would still present as a symmetrical structure with two uterine bodies, unlike the unilateral development shown. *Septate uterus* - A septate uterus occurs due to **incomplete resorption of the uterine septum** after Mullerian duct fusion, presenting as a single uterus with an internal wall (septum) dividing the cavity. The image does not show a septum inside a single, normally shaped outer uterus. - The external contour of a septate uterus is typically normal or nearly normal, unlike the distinctly asymmetric, banana-shaped appearance in the image.

Q: Dilatation & curettage (D&C) is contraindicated in-

Pelvic inflammatory disease (PID). ***Pelvic inflammatory disease (PID)*** - D&C is **contraindicated** in PID due to the high risk of **spreading pre-existing infection** from the cervix or vagina into the sterile uterine cavity and beyond. - This procedure can worsen the infection, potentially leading to **sepsis**, **tubo-ovarian abscesses**, or chronic pain. *Endometriosis* - D&C is not typically contraindicated in **endometriosis**, as it is sometimes used diagnostically to rule out other causes of abnormal uterine bleeding, though it isn't a treatment for endometriosis itself. - Endometriosis involves the presence of **endometrial tissue outside the uterus**, and a D&C performed on the uterus does not directly exacerbate this condition. *Ectopic pregnancy* - D&C is not contraindicated in **ectopic pregnancy**; however, it is not the primary treatment. - A D&C may be performed if the diagnosis of ectopic pregnancy is uncertain and to rule out an **intrauterine pregnancy** or retained products of conception. *Abnormal uterine bleeding* - D&C is frequently indicated and can be both **diagnostic and therapeutic** for abnormal uterine bleeding, especially to investigate causes like polyps, fibroids, or endometrial hyperplasia. - It helps in obtaining tissue for **histopathological examination** to guide further management.

Q: What type of uterine anomaly is shown in this X-ray HSG image?

Unicornuate uterus. ***Unicornuate uterus*** - The image shows a single, elongated uterine horn with a single fallopian tube arising from it, consistent with a **unicornuate uterus**. - This congenital anomaly results from the **failure of one Müllerian duct to develop**, leading to an abnormally shaped uterus. *Septate uterus* - A **septate uterus** would show a normal uterine fundus with an internal septum dividing the uterine cavity. - This image clearly depicts only **one rudimentary horn** and no visible septum. *Uterus didelphys* - **Uterus didelphys** involves two completely separate uteri, each with its own cervix and vagina. - The image does not show evidence of a **second, separate uterine structure**. *Bicornuate uterus* - A **bicornuate uterus** is characterized by two distinct uterine horns, which fuse at the cervix or lower uterine segment, creating a heart-shaped appearance of the fundus. - The image shows a **single, long horn** rather than two distinct horns.

Q: In a woman complaining of AUB following image was seen in endoscopic examination of uterus. What will be the diagnosis?

Leiomyoma. ***Leiomyoma*** - The image shows **well-circumscribed, smooth, rounded masses protruding into the uterine cavity**, which are characteristic of **submucous (intracavitary) leiomyomas (fibroids)** seen on hysteroscopy. - Submucous leiomyomas are benign smooth muscle tumors that project into the endometrial cavity and commonly cause **abnormal uterine bleeding (AUB)** due to increased endometrial surface area, distortion of the endometrial cavity, ulceration of overlying endometrium, and interference with normal uterine contractility. - On **hysteroscopic examination**, they appear as firm, pale, smooth-surfaced masses with overlying endometrium. *Adenomyosis* - Adenomyosis involves the presence of **endometrial tissue within the myometrium**, leading to diffuse uterine enlargement. - On hysteroscopy, it may show a **globally irregular endometrial surface** with small endometrial openings or cystic spaces, but not the discrete, well-circumscribed protruding masses seen in the image. - While it can cause AUB and dysmenorrhea, the appearance is distinctly different from submucous leiomyomas. *Ovarian neoplasm* - Ovarian neoplasms originate in the **ovaries**, which are separate from the uterus. - **Hysteroscopic examination** visualizes only the **endometrial cavity** and cannot directly visualize ovarian pathology. - Ovarian masses do not protrude into the uterine cavity. *Carcinoma of uterus* - Endometrial carcinoma typically presents on hysteroscopy as **irregular, friable, ulcerative, or fungating lesions** with abnormal vascularity and易出血 (easy bleeding). - The **smooth, well-defined, and rounded appearance** with intact overlying mucosa in the image is characteristic of benign leiomyomas, not malignant growths. - Uterine sarcomas are rare and would show more irregular, infiltrative features rather than well-circumscribed masses.

Q: Long-standing pelvic inflammatory disease (PID) may lead to which of the following complications?

Hydrosalpinx. ***Hydrosalpinx*** - **Hydrosalpinx** is a condition where the fallopian tube is blocked and filled with serous fluid, representing the **end-stage of chronic pelvic inflammatory disease (PID)**. - Chronic inflammation from **repeated or inadequately treated PID** causes damage to the tubal epithelium, loss of fimbrial function, and **adhesions that seal the distal end of the tube**. - This leads to accumulation of sterile transudate within the obstructed tube, creating a **fluid-filled, dilated fallopian tube**. - It is a major cause of **tubal factor infertility** and increased risk of **ectopic pregnancy**. - Classic imaging finding: **sausage-shaped cystic structure** on ultrasound. *Uterine polyposis* - **Endometrial polyps** are benign growths arising from the endometrium, typically associated with **unopposed estrogen stimulation** or hormonal imbalances. - They are **not a complication of chronic PID** but rather a proliferative endometrial disorder. - Common causes include obesity, tamoxifen use, and perimenopause. *Asherman syndrome* - **Asherman syndrome** involves **intrauterine adhesions** (synechiae) causing partial or complete obliteration of the uterine cavity. - It typically results from **endometrial trauma** following procedures like **D&C (dilatation and curettage)**, particularly post-abortion or postpartum curettage. - While PID can cause adhesions, Asherman syndrome specifically refers to **intrauterine** adhesions, not a typical sequela of chronic PID, which primarily affects the **tubes and ovaries**. *Endometriosis* - **Endometriosis** is the presence of **endometrial tissue outside the uterine cavity**, most commonly on ovaries, pelvic peritoneum, and uterosacral ligaments. - It is thought to result from **retrograde menstruation** (Sampson's theory) and genetic/immune factors. - It is **not caused by PID** but is a distinct pathological entity with different etiology and pathophysiology.

Q: Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Bacterial vaginosis. ***Bacterial vaginosis*** - This condition is characterized by a "fishy" or **malodorous vaginal discharge**, particularly noticeable after intercourse due to the release of amines. - It results from an imbalance in the vaginal flora, with an overgrowth of anaerobic bacteria and a decrease in protective lactobacilli. *Chlamydia trachomatis* - Often presents with **asymptomatic cervicitis** or mild watery discharge; **malodorous discharge** is not a common or prominent symptom. - While it can cause pelvic pain or dysuria, it's not typically associated with the characteristic smell of bacterial vaginosis. *Trichomonas vaginalis* - Can cause a **frothy, yellow-green discharge** that may be malodorous, but the "fishy" odor is more classically associated with bacterial vaginosis. - Other common symptoms include intense itching, burning, and dyspareunia. *Neisseria gonorrhoeae* - Causes cervicitis, which can lead to a **purulent or mucopurulent vaginal discharge**, but it does not typically produce the distinctive malodor seen in bacterial vaginosis. - Infection can also manifest as dysuria, pelvic pain, or be asymptomatic.

Q: In MRKH syndrome, which of the following structures is typically absent?

Uterus. ***Uterus*** - **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome** is characterized by congenital aplasia of the **uterus** and upper two-thirds of the vagina. - This is due to abnormal development of the **Müllerian ducts**, which are embryonic structures that form the uterus, fallopian tubes, cervix, and upper vagina. *Breast development* - **Breast development** is typically normal in MRKH syndrome as it is influenced by ovarian hormones, and the **ovaries are usually functional** in these individuals. - Normal breast development indicates that the **estrogen production** from the ovaries is intact. *Pubic hair development* - **Pubic hair development** is also normal in MRKH syndrome, as it is a secondary sexual characteristic driven by **adrenal androgens** and ovarian hormones, which are generally not affected. - The presence of pubic hair indicates **normal adrenal and ovarian androgen production**. *Testes* - **Testes** are male gonads and are therefore not present in individuals with MRKH syndrome, as these patients are **genetically female (46,XX karyotype)**. - The absence of testes is a normal finding in females, and thus not a characteristic feature or absence due to MRKH syndrome itself.

Q: Most common complication of dermoid cyst is -

Torsion. ***Torsion*** - Ovarian dermoid cysts (mature cystic teratomas) are prone to **torsion** due to their common unilateral, round, and easily mobile nature. - Torsion results from the **twisting of the ovarian pedicle**, which can lead to exquisite pain and potential **ischemic necrosis** of the ovary. - **Most common complication** occurring in **15-20% of dermoid cysts**. *Cyst Rupture* - While rupture can occur, it is a **less common complication** than torsion, occurring in **1-4% of cases**. - Rupture can release sebaceous material and hair into the peritoneal cavity, leading to **chemical peritonitis**. *Malignant degeneration* - **Malignant transformation** within a dermoid cyst is rare, occurring in **less than 1-2% of cases**, making it much less common than torsion. - The most common type of malignancy arising from a dermoid cyst is **squamous cell carcinoma**. *Infection* - **Secondary infection** of dermoid cysts is a rare complication. - Much less common than torsion, and typically presents with fever, pain, and signs of inflammation.

Question 1

60-year-old female with a history of intermittent bleeding. What is the diagnosis based on the ultrasound image?

Accepted Answer

Endometrial polyp

Answer

Ca endometrium

Answer

Submucosal fibroid

Answer

Endometrial hyperplasia

Question 2

Based on the provided image of a uterine anomaly, what is the most likely diagnosis?

Accepted Answer

Unicornuate Uterus

Answer

Uterus didelphys

Answer

Bicornuate Uterus

Answer

Septate uterus

Question 3

Dilatation & curettage (D&C) is contraindicated in-

Accepted Answer

Pelvic inflammatory disease (PID)

Answer

Endometriosis

Answer

Ectopic pregnancy

Answer

Abnormal uterine bleeding

Question 4

What type of uterine anomaly is shown in this X-ray HSG image?

Accepted Answer

Unicornuate uterus

Answer

Septate uterus

Answer

Uterus didelphys

Answer

Bicornuate uterus

Question 5

In a woman complaining of AUB following image was seen in endoscopic examination of uterus. What will be the diagnosis?

Accepted Answer

Leiomyoma

Answer

Adenomyosis

Answer

Ovarian neoplasm

Answer

Carcinoma of uterus

Question 6

Long-standing pelvic inflammatory disease (PID) may lead to which of the following complications?

Accepted Answer

Hydrosalpinx

Answer

Uterine polyposis

Answer

Endometriosis

Answer

Asherman syndrome

Question 7

Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Accepted Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis

Answer

Trichomonas vaginalis

Answer

Neisseria gonorrhoeae

Question 8

Which of the following statements about nabothian cysts is true?

Accepted Answer

Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands.

Answer

It is a premalignant condition that requires excision.

Answer

It is a malignant condition.

Answer

It may be associated with chronic irritation and inflammation but is not defined by it.

Question 9

In MRKH syndrome, which of the following structures is typically absent?

Accepted Answer

Uterus

Answer

Testes

Answer

Breast development

Answer

Pubic hair development

Question 10

Most common complication of dermoid cyst is -

Accepted Answer

Torsion

Answer

Cyst Rupture

Answer

Malignant degeneration

Answer

Infection

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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