Gestational Trophoblastic Disease Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Gestational Trophoblastic Disease. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Gestational Trophoblastic Disease Indian Medical PG Question 1: Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:
- A. More Theca lutein cysts
- B. Sub urethral nodule (Correct Answer)
- C. Increase uterus size
- D. Rising hCG
Gestational Trophoblastic Disease Explanation: ***Sub urethral nodule***
- A **suburethral nodule** is a sign of **metastatic choriocarcinoma**, indicating the disease has already converted and spread.
- The question asks for signs indicating a *possible conversion* to choriocarcinoma, not an established metastatic disease.
*More Theca lutein cysts*
- **Theca lutein cysts** result from overstimulation of the ovaries by high levels of **hCG**, which is elevated in both hydatidiform mole and choriocarcinoma.
- An increase in these cysts suggests persistent trophoblastic activity, raising suspicion for transition to choriocarcinoma.
*Increase uterus size*
- An **enlarging uterus** post-evacuation of a hydatidiform mole can indicate persistent trophoblastic tissue or the development of choriocarcinoma.
- This suggests continued growth and abnormal proliferation of trophoblastic cells.
*Rising hCG*
- **Persistently rising or plateauing hCG levels** after evacuation of a hydatidiform mole are the most critical indicator of persistent gestational trophoblastic disease (GTD), including potential conversion to choriocarcinoma.
- Serial hCG monitoring is essential for surveillance following a molar pregnancy to detect malignant transformation.
Gestational Trophoblastic Disease Indian Medical PG Question 2: Snow storm appearance on an ultrasound is seen in:
- A. Vesicular mole (Correct Answer)
- B. Chronic ectopic pregnancy
- C. Hydatid cyst
- D. Dermoid cyst
Gestational Trophoblastic Disease Explanation: ***Vesicular mole***
- The classic ultrasound finding in a **complete hydatidiform mole** is a **"snowstorm" appearance**, characterized by a uterine cavity filled with echogenic, vesicular tissue and no fetal parts.
- This appearance is due to the **swollen chorionic villi** and **trophoblastic proliferation**.
*Chronic ectopic pregnancy*
- While an ectopic pregnancy involves an implantation outside the uterus, it typically presents with an **adnexal mass**, sometimes with a **"ring of fire" sign** on Doppler, but not a snowstorm pattern within the uterine cavity.
- Chronic ectopic pregnancies may show a more complex adnexal mass with varying echogenicity due to hemorrhage and organization, but this is distinct from the diffuse uterine changes in a hydatidiform mole.
*Hydatid cyst*
- A **hydatid cyst**, caused by *Echinococcus granulosus*, is typically found in the liver or lungs and appears as a **well-defined, anechoic lesion** with possible internal septations or daughter cysts (often called a "water lily" sign if ruptured) but not a diffuse snowstorm pattern within the uterus.
- This condition is a parasitic infection, entirely unrelated to pregnancy.
*Dermoid cyst*
- A **dermoid cyst** (mature cystic teratoma) is an ovarian tumor that typically appears as a **complex adnexal mass** with characteristic features like a **"Rokitansky nodule"**, fat-fluid levels, and highly echogenic components (e.g., hair, teeth).
- Its appearance is localized to the ovary and does not mimic the widespread uterine findings of a vesicular mole.
Gestational Trophoblastic Disease Indian Medical PG Question 3: Which of the following statements is true regarding placental site trophoblastic disease?
- A. Has a highly malignant potential
- B. It secretes human placental lactogen (Correct Answer)
- C. Mainly contains syncytiotrophoblasts
- D. The treatment of choice is hysterectomy followed by chemotherapy
Gestational Trophoblastic Disease Explanation: ***It secretes human placental lactogen***
- Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**.
- Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**.
*Has a highly malignant potential*
- PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%.
- It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases.
*Mainly contains syncytiotrophoblasts*
- PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts.
- The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site.
*The treatment of choice is hysterectomy followed by chemotherapy*
- **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease.
- **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.
Gestational Trophoblastic Disease Indian Medical PG Question 4: Chromosome number of partial hydatidiform mole is-
- A. 46 XX
- B. 45 XO
- C. 69 chromosomes (Correct Answer)
- D. 47 chromosomes (XXY)
Gestational Trophoblastic Disease Explanation: ***69 chromosomes***
- A **partial hydatidiform mole** typically results from **dispermy** (fertilization of one ovum by two sperm), leading to a **triploid karyotype** (69 chromosomes).
- This triploidy usually consists of **69, XXY** or **69, XXX**, with the paternal contribution being twice the maternal.
*46 XX*
- This is a normal diploid female karyotype and is the typical chromosome number for a **complete hydatidiform mole** if the maternal chromosomes are lost and the paternal chromosomes duplicate.
- In a complete mole, there is **no fetal tissue**, unlike in a partial mole.
*45 XO*
- This karyotype, known as **Turner syndrome**, is characterized by the absence of one sex chromosome.
- It does not represent a hydatidiform mole but is a chromosomal abnormality associated with developmental disorders.
*47 chromosomes (XXY)*
- This karyotype is characteristic of **Klinefelter syndrome**, a sex chromosome aneuploidy in males (47,XXY).
- While it involves an extra sex chromosome, it is not associated with partial hydatidiform moles, which are triploid with 69 chromosomes.
Gestational Trophoblastic Disease Indian Medical PG Question 5: Tumor marker of epithelial ovarian carcinoma is:
- A. Alpha feto protein
- B. CA-125 (Correct Answer)
- C. Beta HCG
- D. LDH
Gestational Trophoblastic Disease Explanation: ***CA-125***
- **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**.
- Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence.
*Alpha feto protein*
- **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma.
- Its presence usually indicates a different histological subtype of ovarian malignancy.
*Beta HCG*
- **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy.
- It is not typically elevated in epithelial ovarian carcinoma.
*LDH*
- **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma.
- Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.
Gestational Trophoblastic Disease Indian Medical PG Question 6: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
- A. Chlamydia infection
- B. Gonococcal vaginitis
- C. Candidiasis
- D. Trichomoniasis (Correct Answer)
Gestational Trophoblastic Disease Explanation: ***Trichomoniasis***
- The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*.
- This infection often causes **vaginal itching, irritation**, and dyspareunia.
*Chlamydia infection*
- Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix.
- It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic.
*Gonococcal vaginitis*
- Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy.
- It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding.
*Candidiasis*
- Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like.
- It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.
Gestational Trophoblastic Disease Indian Medical PG Question 7: Surgical staging is done for all the genital malignancies EXCEPT:
- A. Gestational trophoblastic neoplasia (Correct Answer)
- B. Fallopian tube malignancy
- C. Endometrial carcinoma
- D. Ovarian malignancy
Gestational Trophoblastic Disease Explanation: ***Gestational trophoblastic neoplasia***
- Gestational trophoblastic neoplasia (GTN) is primarily staged **clinically** and **biochemically** using beta-human chorionic gonadotropin (β-hCG) levels.
- **Surgical staging is not typically performed** for GTN due to its high sensitivity to chemotherapy and its hematogenous spread pattern.
*Fallopian tube malignancy*
- **Surgical staging is essential** for fallopian tube malignancy to determine disease extent and guide treatment.
- Staging often involves **laparotomy**, histological examination, and evaluation of surrounding tissues.
*Endometrial carcinoma*
- **Surgical staging is the cornerstone of management** for endometrial carcinoma, as it provides crucial prognostic information.
- This typically includes **hysterectomy**, bilateral salpingo-oophorectomy, and lymph node dissection.
*Ovarian malignancy*
- **Comprehensive surgical staging** is standard for ovarian malignancy to assess the spread of the disease within the peritoneal cavity.
- This involves **laparotomy**, biopsies, and often extensive debulking procedures.
Gestational Trophoblastic Disease Indian Medical PG Question 8: A 32-year-old woman with a history of molar pregnancy presents with heavy vaginal bleeding. Which of the following is a serious malignant complication of molar pregnancy?
- A. Choriocarcinoma (Correct Answer)
- B. Endometrial carcinoma
- C. Cervical cancer
- D. Benign ovarian cysts
Gestational Trophoblastic Disease Explanation: **Choriocarcinoma**
- **Choriocarcinoma** is a highly malignant form of trophoblastic neoplasia that can arise after a **molar pregnancy**, especially a complete hydatidiform mole.
- The persistent elevation of **human chorionic gonadotropin (hCG)** following a molar pregnancy is a key indicator for the development of choriocarcinoma.
*Endometrial carcinoma*
- **Endometrial carcinoma** is a cancer of the lining of the uterus and is typically associated with hormonal imbalances or genetic predispositions, not directly with molar pregnancy.
- While both affect the uterus, they originate from different cell types: molar pregnancy complications arise from **trophoblasts**, whereas endometrial cancer arises from **endometrial glandular cells**.
*Benign ovarian cysts*
- **Benign ovarian cysts**, particularly **theca-lutein cysts**, can be associated with molar pregnancies due to excessive hCG stimulation of the ovaries.
- However, these cysts are typically **benign** and resolve spontaneously after the molar pregnancy is treated, and are not a malignant complication like choriocarcinoma.
*Cervical cancer*
- **Cervical cancer** is caused primarily by persistent infection with **human papillomavirus (HPV)** and is not a direct complication of molar pregnancy.
- The pathology and risk factors for **cervical cancer** are distinct from those associated with gestational trophoblastic disease.
Gestational Trophoblastic Disease Indian Medical PG Question 9: What are the potential complications in subsequent pregnancies for a woman with a history of gestational trophoblastic disease?
- A. Neural tube defects
- B. Skeletal defects
- C. Cardiac defects
- D. Increased risk of recurrent GTD and pregnancy complications (Correct Answer)
Gestational Trophoblastic Disease Explanation: ***Increased risk of recurrent GTD and pregnancy complications***
- A history of **gestational trophoblastic disease (GTD)** significantly increases the risk of recurrence in subsequent pregnancies, emphasizing the need for close monitoring.
- There is also an elevated risk of other **adverse pregnancy outcomes**, including **preterm birth** and **preeclampsia**, following a GTD history.
*Neural tube defects*
- **Neural tube defects** are congenital anomalies primarily associated with **folate deficiency** and genetic factors, not a prior history of GTD.
- They involve incomplete closure of the neural tube during embryonic development, unrelated to trophoblastic tissue.
*Cardiac defects*
- **Congenital cardiac defects** are multifactorial, linked to genetic predisposition, maternal conditions like **diabetes**, and certain exposures, but not a history of GTD.
- They result from abnormal heart development in the early stages of pregnancy.
*Skeletal defects*
- **Skeletal defects** can be hereditary or related to maternal infections (e.g., rubella), drug exposure (e.g., thalidomide), or specific genetic syndromes, not GTD.
- These malformations occur during fetal bone and limb development.
Gestational Trophoblastic Disease Indian Medical PG Question 10: Which is the most common complication of molar pregnancy?
- A. Placenta previa
- B. Ovarian torsion
- C. Choriocarcinoma
- D. Invasive mole (Correct Answer)
Gestational Trophoblastic Disease Explanation: **Invasive mole**
- An **invasive mole** is the most common complication of molar pregnancy, occurring in about 10-15% of complete hydatidiform moles and 1-5% of partial moles.
- It involves the trophoblastic tissue invading the myometrium, which can lead to continued **human chorionic gonadotropin (hCG) elevation** and persistent vaginal bleeding.
*Placenta previa*
- **Placenta previa** is a condition where the placenta partially or totally covers the cervix, which is unrelated to the abnormal trophoblastic proliferation seen in molar pregnancies.
- Its primary risk factors differ from those for molar pregnancy complications and include prior C-sections or uterine surgery.
*Ovarian torsion*
- **Ovarian torsion** is the twisting of the ovary and/or fallopian tube, cutting off blood supply, and although it can occur in pregnancy, it is not a direct complication of molar pregnancy.
- It is often associated with ovarian cysts or masses, and while **theca lutein cysts** can be seen with molar pregnancy, torsion of these cysts is less common than invasive mole.
*Choriocarcinoma*
- While a serious neoplastic complication of molar pregnancy, **choriocarcinoma** is much rarer than an invasive mole, occurring in only 2-3% of complete hydatidiform moles.
- It represents a **malignant transformation** of trophoblastic tissue with metastatic potential, distinguishing it from the localized invasion of an invasive mole.
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