INI-CET 2023 — Obstetrics and Gynecology

12 Questions — Page 2 of 2

All Subjects Anatomy (9)Anesthesiology (2)Biochemistry (9)Community Medicine (4)Dermatology (7)ENT (1)Forensic Medicine (3)Internal Medicine (18)Microbiology (7)Obstetrics and Gynecology (12)Ophthalmology (4)Pathology (14)Pediatrics (7)Pharmacology (17)Physiology (11)Psychiatry (3)Radiology (3)Surgery (11)

Q11

What are clue cells?

Q12

The patient presented with a retroverted uterus, dysmenorrhea, and dyspareunia. What is the next step of the investigation?

INI-CET 2023 - Obstetrics and Gynecology INI-CET Practice Questions and MCQs

Question 11: What are clue cells?

A. Uterine epithelial cells lined by bacteria
B. Cervical epithelial cells lined by bacteria
C. Abdominal cells lined by bacteria
D. Vaginal epithelial cells lined by bacteria (Correct Answer)

Explanation: ***Vaginal epithelial cells lined by bacteria*** - **Clue cells** are definitive diagnostic features of **bacterial vaginosis**, identified on microscopy. - They are specifically **vaginal epithelial cells** that appear "cluey" or stippled due to their surface being obscured by numerous adherent bacteria, primarily *Gardnerella vaginalis*. *Uterine endothelial cells lined by bacteria* - The **endometrium** (uterine lining) is composed of epithelial cells, not typically referred to as endothelial cells in this context, and is not where clue cells are found. - Presence of bacteria adherent to uterine cells would suggest an **endometritis** or other uterine infection, not bacterial vaginosis. *Cervical epithelial cells lined by bacteria* - While bacteria can adhere to **cervical epithelial cells**, especially in the presence of infection, these are not typically called **clue cells**. - **Clue cells** are characteristic of the vaginal environment and are specifically associated with bacterial vaginosis. *Abdominal cells lined by bacteria* - **Abdominal cells** are not relevant to the definition of clue cells, which are found in the vaginal canal. - The presence of bacteria on abdominal cells would indicate a completely different pathology, such as a **peritoneal infection**.

Question 12: The patient presented with a retroverted uterus, dysmenorrhea, and dyspareunia. What is the next step of the investigation?

A. HSG
B. USG (Correct Answer)
C. Laparotomy
D. Diagnostic Laparoscopy

Explanation: ***USG*** - **Transvaginal ultrasound (TVS)** is the initial imaging modality of choice for evaluating uterine position, assessing for causes of dysmenorrhea and dyspareunia (e.g., **endometriosis**, adenomyosis, fibroids), and can visualize the retroverted uterus. - It is **non-invasive**, readily available, and provides good resolution of pelvic organs, making it suitable for first-line investigation. *HSG* - **Hysterosalpingography (HSG)** is primarily used to assess **fallopian tube patency** in cases of infertility. - It will **not provide detailed information** about the uterine position or other pelvic pathologies contributing to pain. *Laparotomy* - **Laparotomy** is a major surgical procedure involving a large abdominal incision, typically reserved for **definitive diagnosis and treatment** of significant pelvic pathology when less invasive methods are insufficient. - It is **not an initial investigatory step** for symptoms like dysmenorrhea and dyspareunia. *Diagnostic Laparoscopy* - **Diagnostic laparoscopy** is a minimally invasive surgical procedure that allows direct visualization of pelvic organs, often used to **confirm endometriosis** or other pathologies. - While it offers definitive diagnosis, it is an **invasive procedure** and usually performed **after initial non-invasive imaging** (like USG) has been completed.