Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1011: Bacterial vaginosis is caused by all except

A. Coccobacillus
B. Mobiluncus
C. Proteus (Correct Answer)
D. Gardnerella

Explanation: ***Proteus*** - **Proteus** species are commonly associated with **urinary tract infections (UTIs)** and wound infections, not typically with bacterial vaginosis. - The presence of **Proteus** in vaginal flora is generally considered an opportunistic infection rather than a causative agent of BV. *Coccobacillus* - **Coccobacillary bacteria**, such as **Gardnerella vaginalis**, are primary organisms contributing to the polymicrobial shift that defines bacterial vaginosis. - The disruption of normal lactobacilli dominance allows for the overgrowth of these specific anaerobic and facultative organisms. *Mobiluncus* - **Mobiluncus species** are curved, rod-shaped anaerobic bacteria frequently found in high numbers in women with bacterial vaginosis. - They are considered key anaerobic bacteria involved in the microbial imbalance characteristic of BV. *Gardnerella* - **Gardnerella vaginalis** is the most commonly isolated bacterium in bacterial vaginosis and is considered the primary initiating organism. - While BV is polymicrobial, **Gardnerella's** overgrowth is central to the diagnostic criteria and pathogenesis.

Question 1012: Late rupture of tubal pregnancy is seen in?

A. Fimbriae
B. Ampulla
C. Isthmus
D. Interstitial (Correct Answer)

Explanation: ***Interstitial*** - The interstitial portion of the fallopian tube is the segment that passes through the **myometrium** of the uterus. This muscular wall provides greater distensibility and support, allowing the pregnancy to grow for a longer period before rupture. - Rupture in the interstitial part typically occurs later (around **8-12 weeks**) and is often more catastrophic due to its proximity to the **uterine blood vessels**, leading to severe hemorrhage. *Fimbriae* - Pregnancies rarely implant in the fimbriae, and if they do, they are more likely to undergo **tubal abortion** rather than rupture. - The fimbriae are finger-like projections at the end of the fallopian tube which is why they cannot hold pregnancy for a longer duration. *Ampulla* - The ampulla is the **widest part** of the fallopian tube and is the most common site of ectopic pregnancy (about 70%). - Rupture in the ampulla typically occurs earlier, around **6-8 weeks**, as its wall is thinner and less distensible compared to the interstitial segment. *Isthmus* - The isthmus is a **narrower, more muscular** segment of the fallopian tube. - Pregnancy in the isthmus tends to rupture early (around **4-6 weeks**) because the lumen is very narrow and the wall is rigid, accommodating very little expansion.

Question 1013: True about endometriosis:

A. Presence of endometrial gland in deep myometrium
B. Presence of endometrium at ectopic locations (Correct Answer)
C. Treated preferably with hysterectomy
D. Seen in multiparous women

Explanation: ***Presence of endometrium at ectopic locations*** - **Endometriosis** is defined as the presence of endometrial glands and stroma outside of the uterine cavity. - These ectopic endometrial implants respond to hormonal changes, leading to cyclical pain and inflammation. *Presence of endometrial gland in deep myometrium* - This describes **adenomyosis**, a condition where endometrial tissue invades the muscular wall of the uterus (myometrium). - While both can cause pelvic pain, endometriosis specifically refers to endometrial tissue *outside* the uterus. *Treated preferably with hysterectomy* - Hysterectomy is a definitive treatment option, especially for severe cases or when fertility is not desired, but it is not the *preferred* initial treatment for all patients. - Initial management often includes **pain relievers**, **hormonal therapy**, or **laparoscopic excision** of endometriotic implants. *Seen in multiparous women* - Endometriosis is more commonly diagnosed in **nulliparous (never given birth)** or women who delay childbearing. - While it can occur in multiparous women, it is not a characteristic association.

Question 1014: Most common organism causing the pelvic inflammatory disease?

A. Gardnerella Vaginalis
B. Bacteroides
C. Neisseria gonorrhoeae
D. Chlamydia (Correct Answer)

Explanation: ***Chlamydia*** - **Chlamydia trachomatis** is the most common bacterial cause of **pelvic inflammatory disease (PID)**, often leading to subtle or asymptomatic infections [1]. - Untreated chlamydial infections can ascend from the lower genital tract, causing inflammation and scarring in the fallopian tubes and other pelvic organs [1]. *Gardnerella Vaginalis* - **Gardnerella vaginalis** is primarily associated with **bacterial vaginosis (BV)**, a common cause of vaginal discharge. - While BV can sometimes predispose to PID, *Gardnerella* itself is not considered a primary causative agent of ascending PID. *Bacteroides* - **Bacteroides species** are anaerobic bacteria that are part of the normal vaginal flora and can be found in some cases of PID, particularly in **tubo-ovarian abscesses** [1]. - However, they are typically considered secondary invaders or coinfecting organisms rather than the initial causative agent of PID. *Neisseria gonorrhoeae* - **Neisseria gonorrhoeae** is a common and significant cause of **pelvic inflammatory disease (PID)**, historically being the most recognized pathogen [1]. - While still prevalent and capable of causing severe PID, **Chlamydia trachomatis** has surpassed it in overall incidence as the leading cause of PID [1].

Question 1015: Most common uterine tumor is:-

A. Adenomyoma
B. Endometrial cancer
C. Leiomyosarcoma
D. Leiomyoma (Correct Answer)

Explanation: ***Leiomyoma*** - **Leiomyomas**, also known as **fibroids**, are the most **common benign tumors of the uterus**. - They are composed of **smooth muscle cells** and can vary in size and location within the uterus. *Adenomyoma* - An **adenomyoma** is a benign uterine tumor characterized by the presence of **endometrial glands and stroma** within the myometrium. - While it is a uterine tumor, it is significantly **less common** than leiomyomas. *Endometrial cancer* - **Endometrial cancer** is a **malignant tumor** arising from the endometrium and is the most common gynecologic malignancy. - However, malignant tumors are generally **less common** than benign tumors like leiomyomas. *Leiomyosarcoma* - **Leiomyosarcoma** is a **rare and aggressive malignant tumor** of the smooth muscle tissue of the uterus. - It accounts for a very small percentage of uterine masses and is much less common than benign leiomyomas.

Question 1016: A 16-year-old girl with acute vaginal bleeding presents to the clinic. What is the immediate management?

A. Administer high-dose estrogen
B. Perform dilation and curettage
C. Start tranexamic acid
D. Stabilize the patient and investigate the cause of bleeding (Correct Answer)

Explanation: ***Stabilize the patient and investigate the cause of bleeding*** - In a patient with acute bleeding, the **immediate priority** is to stabilize their hemodynamic status, which may involve intravenous fluids or blood transfusion, followed by a thorough investigation to identify the underlying cause of bleeding. - A 16-year-old presenting with acute vaginal bleeding requires a **comprehensive medical evaluation** to rule out trauma, pregnancy-related complications, coagulation disorders, or structural abnormalities before specific treatments are initiated. *Administer high-dose estrogen* - High-dose estrogen can be used to **acutely stop uterine bleeding** by promoting rapid endometrial proliferation, but it is not the *immediate* management without patient stabilization and identifying the cause, especially in an acute setting. - While effective for some types of dysfunctional uterine bleeding, it is a **therapeutic intervention**, not the primary step for initial stabilization or diagnosis. *Perform dilation and curettage* - Dilation and curettage (D&C) is a **surgical procedure** used to remove tissue from the uterus and is typically performed for diagnostic or therapeutic reasons after initial assessment and stabilization, or if medical management fails. - It carries risks and is not the first-line immediate management for acute vaginal bleeding in an adolescent without a clear indication, such as severe, uncontrolled bleeding resistant to medical therapy or suspected retained products of conception. *Start tranexamic acid* - Tranexamic acid is an **antifibrinolytic** that helps reduce bleeding by inhibiting fibrinolysis, making it useful for managing menstrual bleeding or other bleeding disorders. - While it can be part of medical management once the patient is stabilized, it is not the *immediate* initial step before hemodynamic stabilization or diagnostic workup to determine the cause of bleeding.

Question 1017: A 67-year-old female with hypertension and diabetes presents with heavy vaginal bleeding. What is the next step in management?

A. Endometrial biopsy (Correct Answer)
B. Pelvic ultrasound
C. Detailed history and physical examination
D. Complete blood count and coagulation studies

Explanation: ***Endometrial biopsy*** - **Postmenopausal bleeding is endometrial cancer until proven otherwise** - this is a fundamental principle in gynecology requiring immediate tissue diagnosis. - **Endometrial biopsy is the first-line investigation** for any postmenopausal woman presenting with vaginal bleeding, as per **ACOG, RCOG, and WHO guidelines**. - An office endometrial biopsy (using **Pipelle sampler**) can be performed quickly and has **90-97% sensitivity** for detecting endometrial cancer and hyperplasia. - In this 67-year-old patient with risk factors (hypertension, diabetes), direct tissue sampling is mandatory to rule out **endometrial carcinoma**, which is the most concerning etiology. - If office biopsy is inadequate or negative but bleeding persists, proceed to **hysteroscopy with directed biopsy** or **dilatation and curettage (D&C)**. *Pelvic ultrasound* - While transvaginal ultrasound can assess **endometrial thickness** (cancer unlikely if <4-5mm in postmenopausal women), it **cannot replace histological diagnosis**. - Ultrasound may be used as an **adjunct** or for **triage in resource-limited settings**, but in established postmenopausal bleeding, **tissue diagnosis takes priority**. - Some protocols use ultrasound first, but the definitive diagnostic step remains biopsy, and many guidelines recommend proceeding directly to biopsy in postmenopausal bleeding. *Detailed history and physical examination* - History and examination are **always performed initially** when a patient presents, but the question asks for the "next step in management" after the presentation is established. - These would have already been completed to confirm postmenopausal status, exclude obvious causes (trauma, atrophic vaginitis), and assess hemodynamic stability. - The "next step" implies the specific diagnostic or therapeutic intervention to identify the cause. *Complete blood count and coagulation studies* - **CBC** helps assess the degree of anemia from blood loss and guides need for transfusion. - **Coagulation studies** may identify bleeding disorders but are not routinely indicated unless clinical suspicion exists. - These investigations are **supportive** but do not identify the **anatomical source** or **histological cause** of bleeding, which is essential for management of postmenopausal bleeding.

Question 1018: Most common ovarian tumor in young lady is ?

A. Mature cystic teratoma (dermoid cyst) (Correct Answer)
B. Ovarian Serous Cystadenocarcinoma
C. Ovarian Mucinous Cystadenocarcinoma
D. Dysgerminoma

Explanation: ***Mature cystic teratoma (dermoid cyst)*** - **Mature cystic teratoma** is the **most common ovarian tumor in young women and adolescents**, accounting for 10-25% of all ovarian tumors. - These benign tumors are derived from **germ cells** and contain differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm), such as hair, teeth, skin, and sebaceous material. - They occur most frequently in women of **reproductive age** (20-40 years) and are usually **asymptomatic** unless complicated by torsion or rupture. *Dysgerminoma* - **Dysgerminoma** is the most common **malignant** germ cell tumor of the ovary, but represents only 1-2% of all ovarian malignancies. - It occurs predominantly in young women and adolescents and is highly sensitive to **radiation and chemotherapy** with excellent prognosis. - The question asks for "most common ovarian tumor" (not specifically malignant), making this incorrect. *Ovarian Serous Cystadenocarcinoma* - **Serous cystadenocarcinomas** are the most common type of epithelial ovarian cancer, but they typically occur in **older, postmenopausal women** (mean age 60-65 years). - They are characterized by **serous fluid-filled cysts** and are often bilateral. *Ovarian Mucinous Cystadenocarcinoma* - **Mucinous cystadenocarcinomas** are also epithelial ovarian cancers, less common than serous types, and generally affect **older women**. - These tumors are characterized by large, often **multiloculated cysts** filled with mucinous material.

Question 1019: Laparoscopy is the diagnostic procedure of choice for:

A. Ca rectum
B. Endometriosis (Correct Answer)
C. Ca cervix
D. Ca uterus

Explanation: ***Endometriosis*** - Laparoscopy allows for direct visualization of **endometrial implants** outside the uterus, which is crucial for diagnosis and staging. - It also allows for **biopsy confirmation** and potential treatment (excision or ablation) of endometriotic lesions during the same procedure. *Ca rectum* - The primary diagnostic procedure for **rectal cancer** is usually **colonoscopy** with biopsy. - **Laparoscopy** may be used for staging **rectal cancer** but it is not the initial diagnostic procedure of choice. *Ca cervix* - The primary diagnostic procedure for **cervical cancer** is a **colposcopy** with directed biopsy of suspicious lesions. - **Laparoscopy** is not typically used for the initial diagnosis of **cervical cancer** but may be used for staging in advanced cases. *Ca uterus* - The primary diagnostic procedure for **uterine cancer** (endometrial cancer) is an **endometrial biopsy** or **dilation and curettage (D&C)**. - **Laparoscopy** may be used for surgical staging of **uterine cancer** but is not the initial diagnostic procedure.

Question 1020: Whiff test is useful in the diagnosis of:

A. Candida
B. Trichomonas
C. PID
D. Bacterial vaginosis (Correct Answer)

Explanation: ***Bacterial vaginosis*** - The **whiff test** is positive in bacterial vaginosis due to the presence of **amines**, which are volatile metabolic products produced by anaerobic bacteria. - A positive test produces a **fishy odor** when a drop of 10% potassium hydroxide (KOH) is added to a sample of vaginal discharge. *Candida* - **Candida infections** (vulvovaginal candidiasis) typically present with a thick, white, **cottage cheese-like discharge** and intense itching, without a characteristic odor on whiff test. - The whiff test is generally **negative** in Candida infections, as amines are not produced. *Trichomonas* - **Trichomonas vaginalis infection** can sometimes produce a frothy, green-yellow discharge with a foul odor, but the whiff test, while occasionally positive, is **not as specific or consistently strong** as in bacterial vaginosis. - Diagnosis is more reliably made by observing motile **trichomonads** on a wet mount. *PID* - **Pelvic Inflammatory Disease (PID)** is an infection of the upper female reproductive organs and is a clinical diagnosis based on symptoms like **lower abdominal pain**, cervical motion tenderness, and adnexal tenderness. - The **whiff test is not used** in the diagnosis of PID, as it is a test for specific vaginal infections rather than upper genital tract infections.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

Practice Questions

Pelvic Inflammatory Disease

Practice Questions

Vulvovaginitis

Practice Questions

Pelvic Organ Prolapse

Practice Questions

Vulvar Disorders

Practice Questions

Benign Breast Diseases

Practice Questions

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