Gynecological Disorders Practice Questions

Q: Intrauterine adhesions best seen by?

Hysteroscopy. ***Hysteroscopy*** - **Hysteroscopy** provides direct visualization of the uterine cavity, allowing for precise identification and characterization of **intrauterine adhesions (IUA)** or **Asherman's syndrome**. - It not only diagnoses IUAs but also allows for simultaneous treatment through **adhesiolysis**, making it the gold standard for both diagnosis and management. *Ultrasound* - While ultrasound can sometimes suggest the presence of adhesions through abnormal endometrial appearances or fluid collections, it is generally **not definitive** for diagnosing IUAs. - Its sensitivity is limited, especially for subtle or fine adhesions, and it often requires confirmation by other methods. *Computed Tomography* - **Computed Tomography (CT)** scans are generally **not used** for the diagnosis of intrauterine adhesions. - CT provides limited soft tissue contrast in the endometrial cavity and exposes the patient to **ionizing radiation**, without offering a clear advantage over other imaging modalities. *Magnetic Resonance Imaging* - **Magnetic Resonance Imaging (MRI)** can provide good soft tissue detail and may visualize severe adhesions, but it is **not as sensitive or specific** as hysteroscopy for detecting all types of IUAs. - MRI is more expensive and less accessible than hysteroscopy, and it does not allow for immediate therapeutic intervention.

Q: Most common congenital uterine anomaly is?

Septate uterus. ***Septate uterus*** - A septate uterus is the most common congenital uterine anomaly, characterized by a **fibrous or muscular septum** dividing the uterine cavity. - This anomaly results from incomplete resorption of the **müllerian ducts** during development. *Bicornuate uterus* - A bicornuate uterus involves **two uterine horns** that are partially or completely separate, leading to a heart-shaped uterus. - While relatively common, it is **less prevalent** than the septate uterus. *Unicornuate uterus* - A unicornuate uterus is an anomaly where only **one side of the müllerian duct develops**, resulting in a uterus with only one horn and one fallopian tube. - This is a **rare anomaly** compared to septate and bicornuate uteri. *Arcuate uterus* - An arcuate uterus is considered a **mild variant of a normal uterus**, with a slight indentation in the fundus. - It often has **no clinical significance** and is less severe than other anomalies.

Q: What is the first-line treatment for simple hyperplasia of the endometrium?

Progestin therapy (e.g., Medroxyprogesterone acetate). ***Progestin therapy (e.g., Medroxyprogesterone acetate)*** - **Progestin therapy** is the first-line treatment for simple endometrial hyperplasia because it counteracts the unopposed estrogen effect causing the hyperplasia. - **Progestins** lead to endometrial atrophy and shedding, helping to reverse the hyperplastic changes and prevent progression to cancer. *Estrogen therapy (e.g., Estradiol)* - **Estrogen therapy** without concomitant progestins would exacerbate endometrial hyperplasia by further stimulating endometrial growth. - This treatment is contraindicated in cases of endometrial hyperplasia unless carefully balanced with progestins. *Endometrial ablation (surgical procedure)* - **Endometrial ablation** is a destructive procedure to remove the endometrial lining and is typically considered for persistent abnormal uterine bleeding, not as a primary treatment for simple hyperplasia. - It is often reserved for patients who have completed childbearing and fail medical management. *Total abdominal hysterectomy (surgical removal of the uterus)* - A **total abdominal hysterectomy** is an invasive surgical procedure that is generally reserved for complex or atypical endometrial hyperplasia, or hyperplasia that is recurrent and unresponsive to medical management. - It is not the first-line treatment for simple hyperplasia, especially in patients who may desire future fertility or wish to avoid major surgery.

Q: What is a cochleate uterus?

Acute anteflexion. ***Acute anteflexion*** - A **cochleate uterus** describes a uterus with an **acute anteflexion**, meaning it is sharply bent forward at the junction of the cervix and the body of the uterus. - This anatomical variation can sometimes be associated with **dysmenorrhea** or difficulty with **intrauterine device (IUD) insertion**. *Large uterus* - A large uterus, also known as **uteromegaly**, is a general descriptive term for an enlarged uterus, which can be due to various causes such as **fibroids** or **adenomyosis**, and is not specific to an acute anteflexion. - It does not directly describe the acute angulation that defines a cochleate uterus. *Acute retroflexion* - **Acute retroflexion** refers to a uterus that is sharply bent backward at the level of the cervix. - This is the opposite of **anteflexion**, which describes a forward bend, and therefore is not a cochleate uterus. *Large cervix* - A **large cervix** describes an enlarged uterine cervix, which is the lower, narrow part of the uterus. - This typically relates to conditions like **cervical hypertrophy** or **nabothian cysts** and is distinct from the overall angulation of the uterine body in relation to the cervix.

Q: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Most common is ascending infection. ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Q: What is the definitive management for adenomyosis?

Hysterectomy (surgical removal of the uterus).. ***Hysterectomy (surgical removal of the uterus)*** - This is considered the **definitive management** for adenomyosis because it completely removes the uterine tissue where the ectopic endometrial glands are found. - Hysterectomy effectively eliminates the source of symptoms such as **heavy menstrual bleeding** and **pelvic pain** by removing the uterus entirely. *Endometrial ablation* - Endometrial ablation involves destroying the **lining of the uterus** and is primarily used for heavy menstrual bleeding. - It is **ineffective for adenomyosis** since the endometrial tissue is embedded deep within the myometrium and is not fully reached by ablation. *Hormonal therapy (e.g., Danazol) for temporary symptom relief* - **Danazol** (an androgen derivative) can suppress ovarian function and reduce symptoms of adenomyosis by shrinking endometrial tissue. - However, its effects are **temporary**, and symptoms typically return upon cessation of treatment, making it not a definitive solution. *Hormonal therapy (e.g., GNRH analogue) for temporary symptom relief* - **GnRH analogues** induce a temporary menopausal state, which can significantly reduce symptoms by inhibiting estrogen production, leading to atrophy of the adenomyotic tissue. - This treatment is also **temporary**, and symptoms often recur once the medication is stopped; it's often used as a bridge to surgery or for women nearing menopause.

Q: What is the treatment of choice for Bartholin's cyst?

Marsupialization. ***Marsupialization*** - This procedure involves incising the cyst, draining its contents, and then everting and suturing the edges of the cyst wall to the surrounding skin, creating a permanent-draining pouch. - **Marsupialization** is the treatment of choice because it prevents recurrence by allowing continuous drainage of mucus, unlike simple incision and drainage. *Excision* - Complete surgical excision of the Bartholin's gland or cyst is a more invasive procedure and is typically reserved for cases of **recurrent cysts** after marsupialization or suspected malignancy. - It carries a higher risk of bleeding and infection compared to marsupialization, and can lead to **vaginal dryness** due to loss of glandular secretions. *Antibiotic therapy* - Antibiotics are primarily used if the Bartholin's gland becomes **infected**, leading to an **abscess**, or if there is surrounding cellulitis. - They do not address the underlying blockage of the duct and will not resolve a Bartholin's cyst, which is a collection of mucus due to duct obstruction. *Cyst drainage* - Simple incision and drainage (I&D) provides temporary relief by emptying the cyst contents but has a **high recurrence rate** because the duct often re-occludes. - While it may be used as an initial temporizing measure, it is not the definitive treatment for preventing future episodes of Bartholin's cysts.

Q: Which of the following statements about Asherman's syndrome is true?

Characterized by intrauterine adhesions. ***Characterized by intrauterine adhesions*** - **Asherman's syndrome** is fundamentally defined by the presence of **intrauterine adhesions** or scarring of the uterine cavity. - These adhesions develop following trauma to the basal layer of the endometrium, often from gynecological procedures like **dilation and curettage (D&C)**. - This is the **pathognomonic feature** that defines the syndrome. *Progesterone challenge test is positive* - The **progesterone challenge test** assesses the presence of an intact endometrium and adequate estrogen priming. - In Asherman's syndrome, due to the scarred endometrium, the response to progesterone is typically **absent or minimal**, leading to a **negative** result. - A negative progesterone challenge test indicates outflow obstruction or endometrial non-responsiveness. *May be secondary to TB* - While **genital tuberculosis** can cause intrauterine adhesions and is a recognized etiology, it represents a **small minority** of cases. - The primary etiology of Asherman's syndrome is usually **iatrogenic**, following uterine instrumentation such as D&C, particularly post-partum or post-abortion. - TB-related adhesions may have additional features like caseating granulomas. *Not associated with menstrual irregularities* - This is **false** - Asherman's syndrome is classically associated with **menstrual irregularities**. - Common presentations include **hypomenorrhea** (scanty periods), **amenorrhea** (absent periods), or oligomenorrhea. - These menstrual changes result from the reduced functional endometrium available for cyclical shedding due to intrauterine adhesions.

Q: Which of the following conditions is not typically treated by laparoscopy?

Genital prolapse. ***Genital prolapse*** - **Genital prolapse** (including uterine, vaginal vault, and pelvic organ prolapse) is traditionally managed via **vaginal approaches** due to direct access to the pelvic floor muscles and ligaments required for anatomical restoration. - While **laparoscopic sacrocolpopexy** can be used for certain types of apical prolapse, the majority of prolapse cases, especially symptomatic uterine prolapse, are still primarily repaired through **vaginal hysterectomy with pelvic floor repair** or transvaginal mesh procedures. - The vaginal approach remains the **gold standard** for most prolapse repairs due to superior outcomes and direct access to support structures. *Ectopic pregnancy* - **Laparoscopy** is the **gold standard** for the surgical management of **ectopic pregnancy**, allowing for minimally invasive removal of the pregnancy. - It enables visualization and treatment of the affected fallopian tube via **salpingostomy** (tube-preserving) or **salpingectomy** (tube removal). *Sterilization* - **Laparoscopic tubal ligation** is a common and highly effective method for female sterilization, involving occlusion or excision of portions of the **fallopian tubes**. - Its minimally invasive nature offers significant advantages including smaller incisions, reduced postoperative pain, and quicker recovery. *Ovarian cyst* - **Laparoscopy** is the preferred surgical approach for most **ovarian cysts** requiring intervention, particularly for benign-appearing cysts. - **Laparoscopic cystectomy** or **oophorectomy** offers excellent visualization, reduced morbidity, and faster recovery compared to laparotomy.

Q: Gold standard technique for diagnosis of endometriosis?

Laparoscopy. ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.

Question 1

Intrauterine adhesions best seen by?

Accepted Answer

Hysteroscopy

Answer

Ultrasound

Answer

Computed Tomography

Answer

Magnetic Resonance Imaging

Question 2

Most common congenital uterine anomaly is?

Accepted Answer

Septate uterus

Answer

Bicornuate uterus

Answer

Unicornuate uterus

Answer

Arcuate uterus

Question 3

What is the first-line treatment for simple hyperplasia of the endometrium?

Accepted Answer

Progestin therapy (e.g., Medroxyprogesterone acetate)

Answer

Endometrial ablation (surgical procedure)

Answer

Estrogen therapy (e.g., Estradiol)

Answer

Total abdominal hysterectomy (surgical removal of the uterus)

Question 4

What is a cochleate uterus?

Accepted Answer

Acute anteflexion

Answer

Large uterus

Answer

Acute retroflexion

Answer

Large cervix

Question 5

Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Accepted Answer

Most common is ascending infection

Answer

Increase incidence of ectopic pregnancy

Answer

Involvement of endosalpinx

Answer

Mostly secondary

Question 6

What is the definitive management for adenomyosis?

Accepted Answer

Hysterectomy (surgical removal of the uterus).

Answer

Endometrial ablation.

Answer

Hormonal therapy (e.g., Danazol) for temporary symptom relief.

Answer

Hormonal therapy (e.g., GnRH analogue) for temporary symptom relief.

Question 7

What is the treatment of choice for Bartholin's cyst?

Accepted Answer

Marsupialization

Answer

Excision

Answer

Antibiotic therapy

Answer

Cyst drainage

Question 8

Which of the following statements about Asherman's syndrome is true?

Accepted Answer

Characterized by intrauterine adhesions

Answer

May be secondary to TB

Answer

Progesterone challenge test is positive

Answer

Not associated with menstrual irregularities

Question 9

Which of the following conditions is not typically treated by laparoscopy?

Accepted Answer

Genital prolapse

Answer

Ovarian cyst

Answer

Ectopic pregnancy

Answer

Sterilization

Question 10

Gold standard technique for diagnosis of endometriosis?

Accepted Answer

Laparoscopy

Answer

Ca 125 level

Answer

Ultrasound

Answer

MRI

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?