Gynecological Disorders Practice Questions

Q: A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?

She is at risk of endometrial cancer. ***She is at risk of endometrial cancer*** - The combination of **obesity**, **hirsutism**, and **high testosterone** in a 35-year-old female is highly suggestive of **Polycystic Ovary Syndrome (PCOS)**. - PCOS is associated with **anovulation**, leading to unopposed estrogen exposure which increases the risk of **endometrial hyperplasia** and **cancer**. *She is at risk of cervical cancer* - **Cervical cancer** is primarily caused by persistent infection with **high-risk human papillomavirus (HPV)**. - The patient's presentation of hirsutism and high testosterone does not directly indicate an increased risk of cervical cancer. *She is at risk of ovarian cancer* - While PCOS is a risk factor for some types of cancer, it is not consistently linked to an increased risk of common **epithelial ovarian cancers**. - There is a debated, but not strongly established, link between PCOS and certain **sex cord stromal tumors** of the ovary, but not the more common forms of ovarian cancer. *None of the above* - This option is incorrect because the clinical picture strongly points to a condition (PCOS) that significantly increases the risk for endometrial cancer.

Q: Cribriform hymen is also known as:

Sieve hymen. ***Sieve hymen*** - A **cribriform hymen** is characterized by multiple tiny perforations, resembling a sieve or colander. - The term "cribriform" comes from the Latin word *cribrum*, meaning sieve. - While it usually allows for menstrual flow, it can sometimes cause minor obstruction or discomfort. *Microperforate hymen* - A **microperforate hymen** has a very small opening, which may allow for menstrual flow but can cause difficulty with tampon insertion. - This differs from cribriform hymen, which has multiple small perforations rather than one tiny opening. *Imperforate hymen* - An **imperforate hymen** completely covers the vaginal opening with no perforations, blocking menstrual flow and potentially leading to hematocolpos. - This is a more severe condition than a cribriform hymen, which has multiple perforations allowing some drainage. *Septate hymen* - A **septate hymen** has a band of tissue running through the hymen, creating two separate openings. - This differs from a cribriform hymen, which has multiple small holes distributed across the membrane.

Q: Vaginal adenosis is evident in women who had exposure to which of the following in utero?

DES. ***DES*** - **Vaginal adenosis** is a histological finding where glandular epithelial tissue is present in the vagina. It is a well-established consequence of **in utero exposure to diethylstilbestrol (DES)**. - This exposure can also increase the risk of developing **clear cell adenocarcinoma of the vagina or cervix** later in life. *Nickel* - **Nickel** is a common allergen known to cause **contact dermatitis** and, less commonly, respiratory issues. - There is **no established link** between in utero exposure to nickel and the development of vaginal adenosis. *Asbestos* - **Asbestos** exposure is primarily associated with respiratory diseases such as **asbestosis, mesothelioma**, and lung cancer. - It is **not known** to cause reproductive tract abnormalities like vaginal adenosis from in utero exposure. *Cadmium* - **Cadmium** is a heavy metal toxicant associated with kidney damage, bone demineralization, and certain cancers. - While it can be a developmental toxicant, there is **no evidence** linking in utero cadmium exposure to vaginal adenosis.

Q: A case of obstructed labor which was delivered by cesarean section complains of cyclical passage of menstrual blood in urine. Which is the most likely site of fistula?

Vesicouterine. ***Vesicouterine*** - **Vesicouterine fistula** is the most likely diagnosis, as menstrual blood collects in the uterus and then passes into the bladder and out with urine (**menouria**). - This type of fistula is a known complication of **cesarean section**, especially after difficult or repeated procedures, due to the close proximity of the bladder and uterus. *Urethrovaginal* - A **urethrovaginal fistula** involves a communication between the urethra and the vagina, leading to urine leakage into the vagina, not menstrual blood in urine. - While it can cause urinary symptoms, it would not explain the cyclical passage of menstrual blood in the urine. *Ureterouterine* - A **ureterouterine fistula** involves a connection between the ureter and the uterus, causing urine to leak into the uterus. - This typically leads to **hydronephrosis** or **pyelonephritis** due to urine reflux, and would not present as menstrual blood in urine. *Vesicovaginal* - A **vesicovaginal fistula** is a communication between the bladder and the vagina, resulting in continuous urinary leakage into the vagina. - This condition causes **stress incontinence** and not the cyclical passage of menstrual blood in urine.

Q: Causes of retention of urine in reproductive age group: a) Cervical fibroid b) Retroverted gravid uterus c) Unilateral hydronephrosis d) Severe UTI e) Posterior urethral valve

ABD. ***Correct: ABD*** - **Cervical fibroid** and **retroverted gravid uterus** can cause extrinsic compression of the urethra or bladder neck, leading to **urinary retention** in women of reproductive age. - **Severe UTI** can cause bladder inflammation and dysfunction, manifesting as acute urinary retention. *Incorrect: ACD* - This option incorrectly includes **unilateral hydronephrosis** as a direct cause of urinary retention. - Unilateral hydronephrosis is typically due to an obstruction higher up in one ureter and does not directly obstruct bladder emptying, though bilateral hydronephrosis *could* occur with lower urinary tract obstruction. *Incorrect: BCD* - This option correctly identifies **retroverted gravid uterus** and **severe UTI** as causes but incorrectly includes **unilateral hydronephrosis**. - It also omits **cervical fibroid**, which is a significant cause of retention in this demographic. *Incorrect: ABC* - This option incorrectly includes **unilateral hydronephrosis**. - Unilateral hydronephrosis affects the upper urinary tract (kidney/ureter) and does not cause bladder outlet obstruction or urinary retention. **Key Points:** - **Cervical fibroid**: Causes mechanical urethral/bladder neck compression - **Retroverted gravid uterus**: Classic cause in 2nd trimester (12-16 weeks) when incarcerated uterus compresses urethra - **Severe UTI**: Causes retention via bladder inflammation, edema, and detrusor dysfunction - **Unilateral hydronephrosis**: Upper urinary tract issue, NOT a cause of urinary retention - **Posterior urethral valve**: Congenital male condition, irrelevant to reproductive age women

Q: Most common complication of vaginoplasty is

Restenosis. ***Restenosis (Correct Answer)*** - **Restenosis** (narrowing or closure of the vaginal canal) is the **most common complication** of vaginoplasty, occurring in 10-15% of cases - Particularly prominent in **neovaginal construction** procedures - Results from **fibrosis and scar tissue formation** during healing - Requires **regular dilation** or further surgical intervention to maintain patency - Prevention involves strict adherence to post-operative dilation protocols *Vaginal bleeding* - Minor post-operative bleeding is expected and manageable with conservative measures - Severe or prolonged hemorrhage is uncommon and not the most frequent complication - Less persistent than restenosis, which requires ongoing management *Dysmenorrhea* - Refers to painful menstruation, not directly related to vaginoplasty - Vaginoplasty primarily involves vaginal reconstruction and does not affect the uterus or menstrual cycle - Not a recognized complication of the procedure *Ectopic pregnancy* - Not possible after vaginoplasty alone, as the procedure involves vaginal construction/reconstruction only - Does not establish functional fallopian tubes or affect reproductive tract anatomy relevant to conception - Unrelated to the scope of vaginoplasty complications

Q: All of the following are true about the isthmus EXCEPT:

Measures 20 mm in length. ***Measures 20 mm in length*** - The uterine **isthmus** is a narrow region connecting the **corpus** to the **cervix**, and its length is not typically 20 mm. - While it lengthens during pregnancy to form part of the **lower uterine segment**, a standard, non-pregnant measurement of 20 mm is incorrect. *Forms lower uterine segment* - During **pregnancy**, the isthmus undergoes significant stretching and thinning to form the **lower uterine segment**, facilitating childbirth. - This anatomical change is crucial for the passage of the fetus and is distinct from its non-pregnant state. *Present between cervical mucosa and endometrial mucosa* - The **isthmus** is located anatomically between the main body of the uterus (containing **endometrial mucosa**) and the cervix (containing **cervical mucosa**). - It marks a transition zone in the uterine lining, reflecting its intermediate position. *Mucosa similar to endometrium* - The mucosal lining of the **isthmus** is often described as resembling the **endometrial mucosa** due to its responsiveness to hormonal changes. - However, it has specific characteristics that distinguish it from both the fundal endometrium and the cervical lining, making it a unique transitional area.

Q: Cause of decubitus ulcer in uterine prolapse is :

Friction. ***Friction*** - In uterine prolapse, the **cervix and vaginal walls protrude outside the introitus** and become exposed to the external environment. - The prolapsed tissue undergoes **constant friction against clothing, undergarments, and opposing skin surfaces** during walking, sitting, and daily activities. - This continuous mechanical trauma leads to **mucosal abrasion, drying, keratinization, and eventually ulceration** (decubitus ulcer). - Decubitus ulcers in prolapse are primarily **traumatic/mechanical** in nature, caused by prolonged pressure and friction on the exposed tissue. *Trauma* - While trauma contributes to ulcer formation, it is more accurately described as part of the **friction and pressure mechanism** rather than a separate cause. - Friction is the more specific and primary mechanism, whereas trauma is a broader term that encompasses the injury. *Intercourse* - Sexual intercourse is generally **not implicated** as a cause of decubitus ulcers in uterine prolapse. - It might cause superficial irritation but is not the primary pathophysiological mechanism for ulcer formation. *Venous congestion* - While **venous congestion can occur** in prolapsed tissue, it is **not the primary cause** of decubitus ulcers. - The ulcers are predominantly caused by **mechanical factors** (friction and pressure) rather than vascular compromise. - Venous congestion may contribute to tissue edema but does not explain the characteristic ulceration pattern seen in prolapse.

Q: Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids is:

TAH. ***TAH*** - A **Total Abdominal Hysterectomy (TAH)** is the treatment of choice for a perimenopausal woman with significant **bleeding due to multiple fibroids**. At this stage, fertility preservation is generally not a primary concern, and removing the uterus permanently resolves the fibroid-related symptoms. - This approach effectively eliminates the source of bleeding and recurrence of fibroids, providing a definitive solution to her problem. *Vaginal hysterectomy* - **Vaginal hysterectomy** is generally preferred for cases of **uterine prolapse** or smaller uteri, and it may be challenging for **multiple, large fibroids** and a uterus that is significantly enlarged. - The approach is limited for extensive fibroids and may not be feasible if the uterus is too bulky or fixed. *Enucleation of fibroids* - **Myomectomy (enucleation of fibroids)** is primarily performed in women who desire to **preserve fertility** or the uterus. In a perimenopausal woman with severe bleeding, a definitive procedure is often preferred. - While it removes the fibroids, it carries a risk of **fibroid recurrence** and may not fully address the symptoms as effectively as a hysterectomy in this age group. *TAH with BSO* - **TAH with Bilateral Salpingo-Oophorectomy (BSO)** involves removal of the ovaries, which would induce **surgical menopause**. While it can be considered, it is not the initial treatment of choice unless there are coexisting **ovarian pathologies** or a strong family history of ovarian cancer. - Removing healthy ovaries in a perimenopausal woman could exacerbate menopausal symptoms by rapidly lowering hormone levels, which might be avoided if not strictly indicated.

Question 1

A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?

Accepted Answer

She is at risk of endometrial cancer

Answer

She is at risk of cervical cancer

Answer

She is at risk of ovarian cancer

Answer

None of the above

Question 2

Compared with other mullerian duct defects, a transverse vaginal septum is associated with lower rate of

Accepted Answer

Renal anomalies

Answer

Ectopic pregnancy

Answer

Retrograde menstruation

Answer

Endometriosis

Question 3

Cribriform hymen is also known as:

Accepted Answer

Sieve hymen

Answer

Microperforate hymen

Answer

Imperforate hymen

Answer

Septate hymen

Question 4

Vaginal adenosis is evident in women who had exposure to which of the following in utero?

Accepted Answer

DES

Answer

Nickel

Answer

Asbestos

Answer

Cadmium

Question 5

A case of obstructed labor which was delivered by cesarean section complains of cyclical passage of menstrual blood in urine. Which is the most likely site of fistula?

Accepted Answer

Vesicouterine

Answer

Urethrovaginal

Answer

Ureterouterine

Answer

Vesicovaginal

Question 6

Causes of retention of urine in reproductive age group:
a) Cervical fibroid
b) Retroverted gravid uterus
c) Unilateral hydronephrosis
d) Severe UTI
e) Posterior urethral valve

Accepted Answer

ABD

Answer

ACD

Answer

BCD

Answer

ABC

Question 7

Most common complication of vaginoplasty is

Accepted Answer

Restenosis

Answer

Vaginal bleeding

Answer

Dysmenorrhea

Answer

Ectopic pregnancy

Question 8

All of the following are true about the isthmus EXCEPT:

Accepted Answer

Measures 20 mm in length

Answer

Forms lower uterine segment

Answer

Present between cervical mucosa and endometrial mucosa

Answer

Mucosa similar to endometrium

Question 9

Cause of decubitus ulcer in uterine prolapse is :

Accepted Answer

Friction

Answer

Trauma

Answer

Intercourse

Answer

Venous congestion

Question 10

Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids is:

Accepted Answer

TAH

Answer

Vaginal hysterectomy

Answer

Enucleation of fibroids

Answer

TAH with BSO

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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