Gynecological Disorders — MCQs
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Fourteen weeks pregnancy with third degree prolapse. Best management will be:
In which condition is a rubber-ring pessary an appropriate management for a woman who is having uterovaginal prolapse?
A multiparous woman with a history of LSCS presents with cyclical hematuria and normal menstruation. The most likely diagnosis is:
Which of the following is the LEAST likely cause of tuberculosis of the fallopian tube?
A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following?
A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?
Which among the following is not a premalignant lesion of vulva?
A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?
In young women suffering from 2nd & 3rd degree uterovaginal prolapse, the choice of operation is:
Which of the following is the most common cause of perforation of uterus in non-pregnant state?
Gynecological Disorders Indian Medical PG Practice Questions and MCQs
Question 1031: Fourteen weeks pregnancy with third degree prolapse. Best management will be:
- A. No treatment
- B. Foot end elevation
- C. Ring pessary (Correct Answer)
- D. Sling surgery
Explanation: ***Ring pessary*** - A **ring pessary** is the most appropriate management for a **third-degree uterine prolapse** during pregnancy, especially in the second trimester (14 weeks). - It provides **mechanical support** to the uterus, relieving symptoms and potentially allowing the pregnancy to progress without surgical intervention. *No treatment* - Leaving a **third-degree prolapse untreated** during pregnancy can lead to complications such as cervical erosion, infection, miscarriage, or preterm labor, making it an unsuitable option. - The patient would experience significant discomfort and potential obstruction, which needs active management. *Foot end elevation* - While **foot end elevation** can temporarily relieve some pelvic pressure, it is not an effective or sufficient treatment for a **third-degree uterine prolapse**, which requires direct mechanical support. - It does not address the underlying anatomical displacement and would not sustainedly reduce the prolapse. *Sling surgery* - **Sling surgery** is a surgical procedure typically indicated for severe, symptomatic uterine prolapse in non-pregnant individuals or after childbirth, not during pregnancy. - Performing surgery during the **second trimester** carries significant risks to both the mother and the fetus, including potential for miscarriage or preterm labor.
Question 1032: In which condition is a rubber-ring pessary an appropriate management for a woman who is having uterovaginal prolapse?
- A. Early pregnancy
- B. Prolapse associated with carcinoma of cervix
- C. Old age (Correct Answer)
- D. Active reproductive age
Explanation: ***Old age*** - A rubber-ring pessary is an appropriate management option for uterovaginal prolapse in older women, especially those who are **not candidates for surgery** due to comorbidities or personal preference. - The goal is to **alleviate symptoms** and improve quality of life without invasive interventions. *Early pregnancy* - Uterovaginal prolapse can occur in early pregnancy, but a rubber-ring pessary is generally **not the primary treatment** as the condition often improves spontaneously with uterine growth at around 12-14 weeks. - Additionally, pessaries can increase the risk of **vaginal infections and discomfort** during pregnancy. *Prolapse associated with carcinoma of cervix* - If uterovaginal prolapse is associated with carcinoma of the cervix, the **carcinoma needs to be addressed first**, typically through oncological treatment. - A pessary would **mask symptoms** and is not an appropriate treatment for underlying malignancy. *Active reproductive age* - For women in their active reproductive age, especially those desiring future pregnancies, **surgical correction** is often preferred for uterovaginal prolapse. - While pessaries can provide temporary relief, they might not be suitable for long-term management or for women with a **desire for definitive repair**.
Question 1033: A multiparous woman with a history of LSCS presents with cyclical hematuria and normal menstruation. The most likely diagnosis is:
- A. Bladder endometriosis (Correct Answer)
- B. Vesicouterine fistula
- C. Urinary tract infection
- D. Both bladder endometriosis and vesicouterine fistula
Explanation: ***Bladder endometriosis*** - This is the **correct diagnosis** given the presentation of **cyclical hematuria with normal menstruation**. - **Bladder endometriosis** involves endometrial tissue growing in the bladder wall, which responds to hormonal changes during the menstrual cycle. - It leads to **cyclical hematuria concurrent with menstruation**, while the patient continues to have normal vaginal menstrual bleeding. - **Risk factors** include previous pelvic surgery such as LSCS, which can lead to endometrial tissue implantation. *Vesicouterine fistula* - A **vesicouterine fistula** (Youssef syndrome) is an abnormal communication between the bladder and uterus, often a complication of uterine surgery like LSCS. - It presents with **menouria** - cyclical hematuria with **amenorrhea** (absence of vaginal menstruation), as menstrual blood drains directly into the bladder. - This patient has **normal menstruation**, which rules out vesicouterine fistula. *Both bladder endometriosis and vesicouterine fistula* - While both can occur after LSCS, they are **distinguished by the presence or absence of menstruation**. - The presence of **normal menstruation** in this case points specifically to bladder endometriosis, not both conditions. *Urinary tract infection* - While UTIs can cause hematuria, it is typically **non-cyclical** and often accompanied by symptoms like dysuria, frequency, and urgency. - The key differentiating factor here is the **cyclical nature** of the hematuria synchronized with the menstrual cycle, which is not characteristic of UTI.
Question 1034: Which of the following is the LEAST likely cause of tuberculosis of the fallopian tube?
- A. Hematogenous spread
- B. Lymphatic spread
- C. Ascending infection
- D. Direct spread from adjacent organs
- E. Primary infection (Correct Answer)
Explanation: ***Primary infection*** - **Tuberculosis of the fallopian tube** is almost always a **secondary infection**, meaning it results from the spread of a primary tuberculous focus elsewhere in the body, typically the lungs. - **Primary infection** originating directly within the fallopian tube itself is exceedingly rare and virtually nonexistent in clinical practice. - This makes it the **LEAST likely cause** among all routes of infection. *Hematogenous spread* - This is the **most common route** for tuberculosis to reach the fallopian tubes, occurring in the majority of cases. - **Mycobacterium tuberculosis** travels through the bloodstream from a primary focus (usually lungs) to seed the reproductive organs, particularly the highly vascular fallopian tubes. - This is the **classic pathway** described in genital tuberculosis. *Lymphatic spread* - **Lymphatic dissemination** is a recognized route, though less common than hematogenous spread. - Can occur from retroperitoneal or mesenteric lymph nodes infected with tuberculosis. - Leads to involvement of pelvic organs including the fallopian tubes. *Direct spread from adjacent organs* - **Tuberculosis can spread directly** from adjacent infected organs, such as the peritoneum, bowel, or urinary tract, to the fallopian tubes. - More common when there is extensive tuberculous peritonitis or pelvic tuberculosis. *Ascending infection* - While ascending infections are common for bacterial STIs, **tuberculosis rarely ascends** from the lower genital tract (cervix, vagina) to the fallopian tubes. - The typical route for genital tuberculosis in women is hematogenous rather than ascending from external genitalia.
Question 1035: A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following?
- A. Chlamydia (Correct Answer)
- B. Herpes
- C. Bacterial vaginosis
- D. Syphilis
Explanation: **Chlamydia** - Due to the high rate of **co-infection** between *Neisseria gonorrhoeae* and *Chlamydia trachomatis*, it is standard practice to empirically treat for chlamydia when gonorrhea is diagnosed. - The patient's symptoms (vaginal discharge, dysuria, cervical erythema) are consistent with both infections, and co-treatment ensures all likely pathogens are addressed. *Herpes* - Genital herpes typically presents with **painful vesicular or ulcerative lesions**, which are not described in this patient. - While sexually transmitted, there is no high co-infection rate with gonorrhea that mandates empirical treatment. *Bacterial vaginosis* - This is an imbalance of vaginal flora, often characterized by a **fishy odor** and a thin, gray discharge, which are not mentioned here. - It is not routinely co-treated with gonorrhea unless specifically diagnosed, and its symptoms do not mimic gonorrhea as closely as chlamydia. *Syphilis* - Syphilis presents with distinct stages, such as a **painless chancre** in primary syphilis or a rash in secondary syphilis, none of which are described. - While also sexually transmitted, there is no automatic co-treatment recommendation for syphilis with gonorrhea due to a low rate of co-infection and different testing/treatment protocols.
Question 1036: A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?
- A. Molluscum
- B. Condyloma acuminata (Correct Answer)
- C. Herpes genitalis
- D. Chancroid
Explanation: ***Condyloma acuminata*** - **Condyloma acuminata**, also known as genital warts, are typically **sessile or pedunculated lesions** with a verrucous (cauliflower-like) appearance, commonly found on the vulva. - These lesions are caused by the **human papillomavirus (HPV)** and generally do not bleed on touch unless traumatized. *Molluscum* - **Molluscum contagiosum** presents as **dome-shaped, pearly papules** with a central umbilication, not sessile lesions. - The lesions are typically smaller and have a characteristic central dimple. *Herpes genitalis* - **Herpes genitalis** presents as painful **vesicles or ulcers** that often rupture and form crusts, not sessile lesions. - These lesions are typically accompanied by pain and itching. *Chancroid* - **Chancroid** is characterized by one or more **painful, soft chancres** with irregular, undermined borders and a grayish base that often bleeds easily. - Ulcers are the hallmark of chancroid, not sessile growths.
Question 1037: Which among the following is not a premalignant lesion of vulva?
- A. Paget's disease
- B. Bacterial Vaginosis (Correct Answer)
- C. Bowen's disease
- D. Lichen Sclerosus
Explanation: ***Bacterial Vaginosis*** - This is a common **vaginal infection** caused by an imbalance of normal vaginal bacteria, characterized by specific symptoms like increased discharge and odor. - Bacterial vaginosis is not considered a premalignant lesion and does not increase the risk of developing vulvar cancer. *Paget's disease* - This is a rare form of intraepithelial adenocarcinoma that can occur on the vulva, presenting as a red, itchy, scaly rash. - While it is a **carcinoma in situ**, it has the potential to become invasive, thus considered a premalignant or pre-invasive condition. *Bowen's disease* - This is a form of **squamous cell carcinoma in situ (SCCIS)**, typically appearing as a slow-growing, red, scaly patch on the skin. - It is considered a premalignant lesion because it can progress to invasive squamous cell carcinoma if left untreated. *Lichen Sclerosus* - This is a chronic inflammatory skin condition primarily affecting the anogenital region, leading to thinning, whitening, and scarring of the skin. - Although it is a benign condition, individuals with vulvar lichen sclerosus have an increased risk (3-5%) of developing **vulvar squamous cell carcinoma**, making it a premalignant condition.
Question 1038: A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?
- A. Endometrial Polyp (Correct Answer)
- B. Submucous Fibroid
- C. Adenomyosis
- D. Endometrial Cancer
Explanation: ***Endometrial Polyp*** - Intermittent bleeding and an **endometrial collection** with **thickening** are classic signs of an endometrial polyp. - The **anterior bulging of the fundal area** on ultrasound is characteristic of a **localized, sessile polyp** protruding into the endometrial cavity. - Polyps are benign overgrowths of endometrial tissue that commonly present with postmenopausal bleeding. *Submucous Fibroid* - While submucous fibroids can cause intermittent bleeding and fundal bulging, they typically appear as a distinct **hypoechoic mass arising from the myometrium** with a whorled pattern. - Fibroids are solid lesions, whereas the description of "endometrial collection" suggests a more cystic or polypoid nature. *Adenomyosis* - Adenomyosis involves **endometrial tissue within the myometrium**, typically causing diffuse uterine enlargement with a heterogeneous myometrial echotexture. - It usually presents with **dysmenorrhea and menorrhagia** rather than intermittent bleeding with focal fundal bulging. - The ultrasound findings described are more consistent with an **intracavitary lesion** rather than myometrial pathology. *Endometrial Cancer* - Endometrial cancer is an important consideration in postmenopausal bleeding with endometrial thickening. - However, malignancy typically presents with a **heterogeneous, irregular endometrial pattern** with increased vascularity on Doppler. - The description of a **discrete collection with focal bulging** points more toward a **benign, localized lesion** like a polyp rather than diffuse malignancy.
Question 1039: In young women suffering from 2nd & 3rd degree uterovaginal prolapse, the choice of operation is:
- A. Vaginal hysterectomy with vault suspension
- B. Uterosacral ligament suspension
- C. Manchester repair (Correct Answer)
- D. Laparoscopic sacrohysteropexy
Explanation: ***Manchester repair*** - For **young women** with 2nd and 3rd degree uterovaginal prolapse, **Manchester repair** (Fothergill's operation) is the traditional procedure of choice as it **preserves fertility** while effectively treating the prolapse. - The procedure involves **amputation of the elongated cervix** and **plication of the cardinal ligaments** anteriorly, providing excellent support while maintaining the uterus for future childbearing. - This is particularly suitable for young women who have not completed their family, addressing both the anatomical defect and fertility preservation. *Vaginal hysterectomy with vault suspension* - This is an effective and definitive treatment for uterovaginal prolapse but involves **removal of the uterus**, making it unsuitable as the first choice for young women who may desire future fertility. - This procedure is more appropriate for women who have completed their family or in whom uterine preservation is not a priority. *Laparoscopic sacrohysteropexy* - While this modern procedure preserves the uterus and fertility, it is a **more complex and expensive** minimally invasive approach that may not be widely available in all centers. - Though increasingly used, it is not traditionally considered the standard first-line procedure in examination contexts, where Manchester repair remains the classical fertility-preserving option for young women. *Uterosacral ligament suspension* - This procedure is primarily used for **vaginal vault prolapse** after hysterectomy or as a component of prolapse repair, not as a standalone treatment for uterovaginal prolapse with the uterus in situ. - It does not address the cervical elongation and uterine descent that typically accompany 2nd and 3rd degree uterovaginal prolapse in young women.
Question 1040: Which of the following is the most common cause of perforation of uterus in non-pregnant state?
- A. Dilatation and curettage (Correct Answer)
- B. Laparoscopy
- C. IUCD
- D. Carcinoma Endometrium
Explanation: ***Dilatation and curettage*** - **Dilatation and curettage (D&C)** is the most frequent iatrogenic cause of uterine perforation in the non-pregnant state due to the blind nature of the procedure, especially in cases of uterine anatomical variations or reduced uterine wall integrity. - The risk of perforation is higher in postmenopausal women due to **atrophic, thinned uterine walls**, and in procedures performed for conditions like endometrial hyperplasia or polyps. *Laparoscopy* - While laparoscopic procedures involve inserting instruments into the abdomen, **uterine perforation during laparoscopy itself is rare**, as it usually involves instrumentation *outside* the uterus unless direct uterine manipulation or hysteroscopy is part of the procedure. - Laparoscopy more commonly results in complications like bowel or vascular injury due to trocar insertion, rather than uterine perforation. *IUCD* - **Intrauterine contraceptive device (IUCD)** insertion can cause uterine perforation, but it is less common than with D&C, with an estimated incidence of 1-2 per 1000 insertions. - Perforation during IUCD insertion is typically an immediate event, whereas D&C-related perforations can occur at any stage of the curettage. *Carcinoma Endometrium* - **Endometrial carcinoma** does not typically cause spontaneous uterine perforation, though it can weaken the uterine wall, making it more susceptible to perforation during diagnostic or therapeutic procedures like D&C. - Perforation directly attributable to the carcinoma itself without instrumental intervention is exceedingly rare.
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
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