Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1061: A 29-year-old woman with a history of fibroids presents with menorrhagia. Which medication is most appropriate for managing her symptoms?

A. Oral contraceptive pills
B. NSAIDs
C. GnRH agonists
D. Progesterone IUD (Correct Answer)

Explanation: ***Progesterone IUD*** - A **progesterone IUD (e.g., Mirena)** is highly effective for managing menorrhagia associated with fibroids by causing **endometrial atrophy** and reduced blood loss. - It provides **localized hormone delivery**, minimizing systemic side effects, and is a long-acting reversible contraceptive. *Oral contraceptive pills* - While OCPs can reduce menstrual bleeding, their effectiveness in managing significant menorrhagia due to **fibroids** may be limited compared to other options. - They also carry risks like **thromboembolism**, which might be a consideration for some patients. *GnRH agonists* - **GnRH agonists (e.g., leuprolide)** induce a **hypoestrogenic state**, which can shrink fibroids and reduce bleeding, but their use is typically short-term due to side effects like hot flashes and bone loss. - They are often used as a pre-operative measure rather than a long-term solution for symptomatic management. *NSAIDs* - **NSAIDs (e.g., ibuprofen, naproxen)** primarily work by reducing **prostaglandin production**, which can decrease menstrual blood flow and pain. - However, they are generally less effective for **heavy bleeding** associated with significant fibroids compared to hormonal treatments.

Question 1062: Which of the following sexually transmitted infections is known to cause a "strawberry cervix"?

A. Chlamydia
B. Gonorrhea
C. Trichomoniasis (Correct Answer)
D. Syphilis

Explanation: ***Trichomoniasis*** - The classic "strawberry cervix" (colpitis macularis) is characterized by **punctate hemorrhages** and **cervical erythema**, which are pathognomonic for *Trichomonas vaginalis* infection. - This appearance results from capillary dilation and tiny hemorrhages caused by the inflammatory response to the parasite. *Chlamydia* - Chlamydia infection of the cervix often presents as **mucopurulent cervicitis**, with a friable cervix and purulent discharge. - It typically does not cause the characteristic punctate lesions seen in a "strawberry cervix." *Gonorrhea* - Gonorrhea can cause **cervicitis**, presenting with purulent vaginal discharge, dysuria, and intermenstrual bleeding. - Similar to chlamydia, it does not lead to the specific "strawberry cervix" appearance. *Syphilis* - Syphilis primarily manifests with a **painless chancre** in its primary stage, usually on the cervix or vulva. - It does not cause a "strawberry cervix"; cervical involvement is typically ulceration rather than punctate lesions.

Question 1063: A 45-year-old woman presents with a fishy-smelling vaginal discharge, and the whiff test is positive. What is the most likely diagnosis?

A. Candidiasis
B. Bacterial vaginosis (Correct Answer)
C. Trichomoniasis
D. Gonorrhea

Explanation: ***Bacterial vaginosis*** - A **fishy-smelling vaginal discharge** that becomes stronger after intercourse or washing, and a **positive whiff test** (amine odor with KOH), are classic signs of bacterial vaginosis. - This condition is caused by an **overgrowth of anaerobic bacteria** and a decrease in protective lactobacilli in the vagina. *Trichomoniasis* - While it can cause a malodorous discharge, it is often described as **frothy, yellow-green**, and is associated with **strawberry cervix** on examination, which are not mentioned here. - The whiff test is **less commonly positive** with trichomoniasis compared to bacterial vaginosis. *Candidiasis* - Typically presents with a **thick, white, 'cottage cheese-like' discharge** and intense **vaginal itching and irritation**, not a fishy odor. - The whiff test would be **negative**, as there is no amine production. *Gonorrhea* - This sexually transmitted infection often causes a **purulent, sometimes odorless, discharge**, or can be asymptomatic, particularly in women. - It does not typically produce a **fishy smell** or a positive whiff test.

Question 1064: A 25-year-old woman presents with intermenstrual bleeding and a negative pregnancy test. What is the most appropriate next step in her management?

A. Pelvic ultrasound (Correct Answer)
B. Pap smear
C. Hormonal therapy
D. Endometrial biopsy

Explanation: ***Pelvic ultrasound*** - A **pelvic ultrasound** is the most appropriate initial diagnostic step to evaluate the uterus and adnexa specifically for structural causes of **intermenstrual bleeding**, such as **fibroids**, **polyps**, or **cysts**. - It provides valuable information on uterine and ovarian anatomy and pathology, which can guide further management. *Pap smear* - A **Pap smear** screens for **cervical dysplasia** and **cervical cancer**, which can cause abnormal bleeding but is not the primary diagnostic tool for intermenstrual bleeding. - While an important part of routine women's health, its role here would be secondary to ruling out structural causes of the current symptom. *Hormonal therapy* - **Hormonal therapy** is a treatment option for dysfunctional uterine bleeding, but it should generally be initiated **after a definitive diagnosis** is made to rule out serious underlying conditions. - Starting empirical hormonal therapy without investigating the cause risks masking a significant pathology. *Endometrial biopsy* - An **endometrial biopsy** is typically indicated for patients at risk of **endometrial hyperplasia** or **endometrial cancer**, such as those with **postmenopausal bleeding** or persistent abnormal bleeding after initial workup, or women over 45 with abnormal bleeding. - For a 25-year-old with intermenstrual bleeding and a negative pregnancy test, it is usually not the first-line diagnostic step unless other investigations are inconclusive or specific risk factors are present.

Question 1065: What is the most effective method for diagnosing endometrial cancer in a postmenopausal woman with abnormal uterine bleeding?

A. Transvaginal ultrasound
B. Endometrial biopsy (Correct Answer)
C. Hysteroscopy
D. CA-125 blood test

Explanation: ***Endometrial biopsy*** - An **endometrial biopsy** is the most definitive method for diagnosing endometrial cancer as it allows for direct histological examination of endometrial tissue. - It is crucial for confirming the presence of malignancy and determining the specific type and grade of cancer. *Transvaginal ultrasound* - While useful for measuring **endometrial thickness** and identifying abnormalities, it cannot definitively diagnose cancer. - Thickened endometrium on ultrasound in a postmenopausal woman with bleeding warrants further investigation, typically with a biopsy. *Hysteroscopy* - **Hysteroscopy** allows for direct visualization of the uterine cavity and directed biopsies of suspicious areas. - While valuable, it is often performed in conjunction with or after an initial endometrial biopsy, or when biopsy results are inconclusive, rather than as a primary diagnostic tool. *CA-125 blood test* - **CA-125** is a tumor marker primarily used for monitoring ovarian cancer treatment response and recurrence, not for initial diagnosis of endometrial cancer. - Its levels can be elevated in various benign conditions and other cancers, making it non-specific for endometrial cancer diagnosis.

Question 1066: What is the most common complication of untreated gonorrhea in women?

A. Ectopic pregnancy
B. Infertility
C. Pelvic inflammatory disease (Correct Answer)
D. Fitz-Hugh-Curtis syndrome

Explanation: ***Pelvic inflammatory disease*** - **Untreated gonorrhea** in women often ascends from the lower genital tract, causing inflammation and infection of the **uterus, fallopian tubes, and ovaries**. - **PID** is the direct result of this ascending infection, leading to chronic pelvic pain, scarring, and subsequent reproductive complications. *Infertility* - While **infertility** is a significant long-term consequence of untreated gonorrhea, it is typically *caused* by the damage resulting from **pelvic inflammatory disease (PID)**, making PID the more immediate and common complication. - **Tubal scarring** from PID is a major cause of infertility, as it obstructs the passage of eggs. *Ectopic pregnancy* - **Ectopic pregnancy** is also a serious sequela of untreated gonorrhea, but it arises from the **tubal damage and scarring caused by PID**, which impedes the normal transport of a fertilized egg to the uterus. - This complication is a *result* of PID, rather than PID itself. *Fitz-Hugh-Curtis syndrome* - **Fitz-Hugh-Curtis syndrome** is a localized complication characterized by **perihepatitis (inflammation of the liver capsule)**, often associated with gonococcal or chlamydial PID. - While it is a specific manifestation of PID, it is not the most common overall complication of ascending gonococcal infection in women.

Question 1067: A 27-year-old woman with regular menstrual cycles presents with acute pelvic pain. An ultrasound reveals a ruptured ovarian cyst. What is the initial management?

A. Immediate surgery
B. Observation and analgesia (Correct Answer)
C. Hormonal therapy
D. Antibiotics

Explanation: ***Observation and analgesia*** - For a symptomatic but hemodynamically stable patient with a **ruptured ovarian cyst**, **conservative management** with pain control is usually appropriate. - Most ruptured ovarian cysts, especially **functional cysts**, resolve spontaneously without surgical intervention. *Immediate surgery* - **Surgical intervention** is typically reserved for patients with signs of **hemodynamic instability** (e.g., significant hemorrhage), suspicion of malignancy, or persistent and severe pain refractory to conservative measures. - The patient's presentation of acute pelvic pain without further information on instability suggests conservative management is the initial approach. *Hormonal therapy* - **Hormonal therapy** (e.g., oral contraceptives) might be used to prevent recurrence of ovarian cysts, but it is not the initial treatment for an **acutely ruptured cyst**. - It does not address the immediate pain or the consequences of a rupture. *Antibiotics* - **Antibiotics** are indicated for **infection**, such as in cases of a **tubo-ovarian abscess** or pelvic inflammatory disease. - There is no mention of fever, elevated white blood cell count, or other signs of infection in this patient's presentation.

Question 1068: A 45-year-old woman with chronic pelvic pain, dyspareunia, and irregular cycles presents with uterosacral ligament nodularity. MRI reveals pelvic lesions. What is the diagnosis?

A. Chronic PID
B. Endometriosis (Correct Answer)
C. Interstitial cystitis
D. Uterine fibroids

Explanation: ***Endometriosis*** - The classic triad of symptoms, **chronic pelvic pain**, **dyspareunia**, and **irregular cycles**, combined with **uterosacral ligament nodularity** on examination, is highly suggestive of endometriosis. - **Pelvic lesions** seen on MRI further support the diagnosis, as endometriosis involves ectopic endometrial tissue implants. *Chronic PID* - While chronic pelvic pain can be a symptom, **Pelvic Inflammatory Disease (PID)** is typically associated with a history of sexually transmitted infections and includes symptoms like **fever** and **vaginal discharge**, which are not mentioned here. - PID does not typically cause **uterosacral ligament nodularity** or specific MRI lesions consistent with ectopic endometrial tissue. *Interstitial cystitis* - This condition primarily causes **bladder pain** and **urinary urgency/frequency**, often exacerbated by bladder filling and relieved by urination. - It does not involve **uterosacral ligament nodularity** or **irregular cycles**, as the primary pathology is in the bladder wall. *Uterine fibroids* - **Uterine fibroids (leiomyomas)** are benign growths in the muscular wall of the uterus, commonly causing **heavy menstrual bleeding**, **pelvic pressure/fullness**, and sometimes pain. - They do not typically present with **dyspareunia** as a primary symptom or **uterosacral ligament nodularity**, and their MRI appearance is distinct from endometriosis.

Question 1069: A 25-year-old woman with pelvic pain and a history of STIs presents with cervical motion tenderness. What is the best initial treatment?

A. Surgical drainage
B. Observation
C. Oral antibiotics (Correct Answer)
D. IV antibiotics

Explanation: ***Oral antibiotics*** * Given the presentation of **pelvic pain**, a history of **STIs**, and **cervical motion tenderness**, **pelvic inflammatory disease (PID)** is highly likely. * Initial management for uncomplicated PID is typically with a course of **oral antibiotics** to cover common causative organisms like *Chlamydia trachomatis* and *Neisseria gonorrhoeae*. *Surgical drainage* * **Surgical drainage** is indicated for complications of PID, such as a **tubo-ovarian abscess** (TOA) that has failed antibiotic therapy or is ruptured. * There is no mention of a TOA or other surgical indications in the initial presentation. *Observation* * **Observation** is inappropriate given the strong clinical suspicion of PID, which requires prompt treatment to prevent long-term complications such as **infertility, ectopic pregnancy**, and **chronic pelvic pain**. * Delaying treatment can lead to worsening infection and more severe outcomes. *IV antibiotics* * **Intravenous antibiotics** are reserved for more severe cases of PID, such as those with **high fever, systemic toxicity, tubo-ovarian abscess**, or inability to tolerate oral medications. * While an important treatment modality, it is not the best *initial* approach for an otherwise stable patient.

Question 1070: What screening test is recommended for cervical cancer prevention in women aged 21 to 29 years?

A. HPV vaccination
B. HPV testing
C. Pap smear (Correct Answer)
D. Visual inspection with acetic acid

Explanation: ***Pap smear*** - For women aged 21 to 29 years, **cytology (Pap smear)** alone is the recommended primary screening method for cervical cancer. - This screening is typically performed every **three years** in this age group, provided previous results are normal. *HPV vaccination* - **HPV vaccination** is a primary prevention method that protects against HPV infection, but it is not a screening test for cervical cancer. - It is recommended for adolescents and young adults but does not replace the need for regular cervical cancer screening. *HPV testing* - **HPV testing** is not typically recommended as the primary screening method for women under 30 due to the high prevalence of transient HPV infections that often clear spontaneously. - For women aged 30-65, **co-testing (Pap smear and HPV test)** or primary HPV testing is generally recommended. *Visual inspection with acetic acid* - **Visual inspection with acetic acid (VIA)** is a low-cost screening method primarily used in resource-limited settings where Pap smears or HPV testing may not be readily available. - It is not the standard of care for routine cervical cancer screening in countries with advanced healthcare systems.

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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