Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1091: What is the primary mechanism proposed by Sampson's theory for the development of endometriosis?

A. Celomic metaplasia
B. Hematogenous spread
C. Lymphatic spread
D. Retrograde menstruation (Correct Answer)

Explanation: ***Retrograde menstruation*** - **Sampson's theory** is primarily based on the concept of **retrograde menstruation**, where endometrial cells shed during menstruation flow backward through the fallopian tubes into the peritoneal cavity. - These retrogradely shed endometrial cells then implant and grow outside the uterus, leading to the development of **endometriotic lesions**. *Celomic metaplasia* - This theory, proposed by **Meyer**, suggests that peritoneal cells, which originate from the **celomic epithelium**, can undergo metaplastic transformation into endometrial-like tissue. - This mechanism is often considered for endometriosis in unusual sites but is not the primary mechanism of Sampson's theory. *Hematogenous spread* - This theory involves the dissemination of endometrial cells through the **bloodstream** to distant sites, such as the lungs or brain. - While it can explain rare cases of **extrapelvic endometriosis**, it is not the main mechanism proposed by Sampson for typical pelvic endometriosis. *Lymphatic spread* - This theory postulates that endometrial cells can migrate via the **lymphatic system** to other locations, potentially explaining the presence of endometriosis in lymph nodes. - Similar to hematogenous spread, it accounts for less common presentations and is not Sampson's primary proposed mechanism.

Question 1092: Which of the following is NOT part of the classic triad of symptoms associated with endometriosis?

A. Infertility
B. Cyclical hematuria (Correct Answer)
C. Dysmenorrhea
D. Dyspareunia

Explanation: ***Cyclical hematuria*** - While endometriosis can cause hematuria if it affects the bladder, it is **not part of the classic triad** of endometriosis symptoms. - Cyclical hematuria represents bladder involvement, which is an extra-pelvic manifestation occurring in only 1-2% of cases. - The classic triad focuses on symptoms directly related to the presence of endometrial tissue in the **pelvic cavity**: dysmenorrhea, dyspareunia, and either dyschezia or infertility (depending on classification). *Infertility* - **Infertility** is a very common consequence in women with endometriosis and is considered part of the classic triad in many classifications. - The condition can distort pelvic anatomy, cause adhesions, interfere with ovulation, and impair fertilization or implantation. - Up to 30-50% of women with endometriosis experience some degree of infertility, making it a cardinal feature. *Dysmenorrhea* - **Dysmenorrhea**, or painful menstruation, is a hallmark symptom and core component of the classic triad. - The pain is typically **severe, progressive, and secondary** in nature, worsening over time. - It arises from the inflammatory reaction and cyclic bleeding of ectopic endometrial tissue during menstruation. *Dyspareunia* - **Dyspareunia**, or painful sexual intercourse (particularly deep dyspareunia), is another essential component of the classic triad. - This pain is typically due to endometriotic lesions on the posterior cul-de-sac, uterosacral ligaments, or rectovaginal septum. - The pain is aggravated by deep penetration and pelvic pressure during intercourse.

Question 1093: What is the most common cause of acute salpingitis?

A. N. gonorrhoeae
B. Chlamydia trachomatis (Correct Answer)
C. Mycoplasma
D. Staphylococcus

Explanation: ***Chlamydia trachomatis*** - **_Chlamydia trachomatis_** is the most common bacterial cause of **sexually transmitted infections (STIs)** globally and a leading cause of **pelvic inflammatory disease (PID)**, which includes salpingitis. - Its infections are often **asymptomatic**, leading to delayed diagnosis and treatment, increasing the risk of upper genital tract involvement and complications like **infertility** and **ectopic pregnancies**. *N. gonorrhoeae* - **_Neisseria gonorrhoeae_** is another common cause of salpingitis, often presenting with **more acute and severe symptoms** compared to chlamydial infections. - While significant, studies consistently show a **higher prevalence of _Chlamydia_** in confirmed cases of salpingitis/PID. *Mycoplasma* - **_Mycoplasma genitalium_** and **_Ureaplasma urealyticum_** are increasingly recognized as causes of PID and salpingitis. - However, their overall contribution to acute salpingitis is **less frequent** than that of _Chlamydia trachomatis_ and _N. gonorrhoeae_. *Staphylococcus* - **_Staphylococcus_ species** are typically associated with skin and soft tissue infections or bacterial vaginosis, but are **uncommon causes of acute salpingitis**. - While they can be found in the genital tract, they are **not primary pathogens** for acute inflammation of the fallopian tubes.

Question 1094: Kamla, a 30-year-old woman, P2L2 with a 3.2 x 4.1 cm fibroid uterus, presents with menorrhagia and has been on symptomatic treatment for the past 6 months. She refuses surgery. What is the next line of management?

A. Danazol for symptomatic relief of menorrhagia.
B. Myomectomy for fibroid removal (surgical option).
C. Uterine artery embolization (UAE) to shrink fibroids and control symptoms.
D. GnRH analogs to temporarily reduce fibroid size and control symptoms. (Correct Answer)

Explanation: ***GnRH analogs to temporarily reduce fibroid size and control symptoms.*** - GnRH analogs induce a **hypoestrogenic state**, leading to a significant (up to 50%) reduction in fibroid size and resolution of menorrhagia. - This is a suitable non-surgical option for patients who decline surgery and have failed symptomatic treatment, offering temporary relief and potentially improving their anemia before other definitive treatments. *Danazol for symptomatic relief of menorrhagia.* - Danazol is an **androgen derivative** that can reduce menorrhagia, but it has significant **androgenic side effects** (e.g., hirsutism, acne, weight gain) that make it less desirable for long-term use. - It does not directly shrink fibroids effectively and is generally reserved for patients who cannot tolerate other hormonal therapies. *Myomectomy for fibroid removal (surgical option).* - Myomectomy is a surgical procedure to remove fibroids while preserving the uterus, but the patient explicitly **refuses surgery**, making this an inappropriate immediate next step. - While it is a definitive treatment for fibroids causing menorrhagia, patient preference must be respected. *Uterine artery embolization (UAE) to shrink fibroids and control symptoms.* - UAE is an effective **minimally invasive procedure** to shrink fibroids by blocking their blood supply, but it is considered an interventional radiological procedure. - Although less invasive than myomectomy, it still involves an invasive procedure and the question implies exploring non-surgical *medical* management first, given the refusal of surgery.

Question 1095: What is the definitive treatment for adenomyosis?

A. OC pills
B. NSAIDS
C. Endometrial ablation
D. Hysterectomy (Correct Answer)

Explanation: ***Hysterectomy*** - **Hysterectomy** (surgical removal of the uterus) is the only definitive treatment for adenomyosis as it removes the ectopic endometrial tissue embedded within the myometrium. - This procedure alleviates symptoms such as **heavy menstrual bleeding (menorrhagia)** and **severe pelvic pain** by eliminating the source of the problem. *OC pills* - **Oral contraceptive pills** can help manage the symptoms of adenomyosis, such as heavy bleeding and pain, by suppressing endometrial growth. - However, they do not remove the **ectopic endometrial tissue** and therefore are not a definitive cure for the condition. *NSAIDS* - **NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)** are used for symptomatic relief of pain associated with adenomyosis, particularly dysmenorrhea. - They reduce **prostaglandin production** and inflammation, but they do not address the underlying pathology or provide a definitive cure. *Endometrial ablation* - **Endometrial ablation** destroys the uterine lining and is primarily used for abnormal uterine bleeding. - It is generally *not effective* for adenomyosis because the ectopic endometrial tissue is deep within the **myometrium**, beyond the reach of ablation.

Question 1096: Which condition is characterized by a 'pearl necklace' appearance on ultrasound?

A. PCOS (Correct Answer)
B. Ectopic pregnancy
C. Pelvic Inflammatory Disease (PID)
D. Endometriosis

Explanation: ***PCOS (Polycystic Ovary Syndrome)*** - The "pearl necklace" appearance on ultrasound refers to multiple **small follicles (cysts)** arranged peripherally in the ovary, a classic finding in **PCOS**. - These peripheral cysts are typically **2-9 mm in diameter** and are often associated with other hormonal imbalances. *Ectopic pregnancy* - An ectopic pregnancy is characterized by a fertilized egg implanting outside the uterus, most commonly in the **fallopian tube**. - Ultrasound findings usually include an **adnexal mass** or a gestational sac outside the uterus, rather than diffusely cystic ovaries. *Pelvic Inflammatory Disease (PID)* - PID is an infection of the female reproductive organs, often leading to **inflammation** and **abscess formation** in the fallopian tubes and ovaries. - Ultrasound may show dilated, fluid-filled fallopian tubes (hydrosalpinx) or tubo-ovarian abscesses, not a "pearl necklace" appearance. *Endometriosis* - Endometriosis involves the growth of **endometrial tissue outside the uterus**, causing pain and potentially forming cysts called **endometriomas** (chocolate cysts). - Ultrasound typically reveals these endometriomas, which are single or multiple cysts with characteristic internal echoes, but not the diffuse pattern seen in PCOS.

Question 1097: Most common ovarian cyst to undergo torsion?

A. Dysgerminoma
B. Ovarian fibroma
C. Brenner's tumor
D. Benign cystic teratoma (Correct Answer)

Explanation: ***Benign cystic teratoma*** - These cysts are the **most common ovarian tumors** and have a higher likelihood of undergoing torsion due to their typical size and irregular shape, making them prone to twisting on their pedicle. - Their often **heterogeneous consistency** (containing various tissues like fat, hair, and bone) can also contribute to uneven weight distribution, increasing the risk of torsion. *Dysgerminoma* - While it is a germ cell tumor, **dysgerminomas are malignant** and generally less likely to undergo torsion than benign cystic teratomas. - They tend to grow rapidly and are often solid, reducing the chance of twisting compared to more mobile, pediculated cysts. *Ovarian fibroma* - **Ovarian fibromas are solid, benign tumors** that are typically less mobile due to their density and attachment, making torsion less common. - While they can be associated with Meigs syndrome, their risk of torsion is lower than that of cystic lesions. *Brenner's tumor* - **Brenner's tumors are uncommon, solid epithelial tumors** of the ovary and are rarely associated with ovarian torsion. - Their solid nature and typically small to moderate size make them less prone to twisting on their vascular pedicle.

Question 1098: What type of tubal damage is associated with Pelvic Inflammatory Disease (PID) caused by Neisseria gonorrhoeae?

A. Peritubal
B. Endotubal (Correct Answer)
C. Extratubal
D. Juxtatubal

Explanation: ***Endotubal*** - *Neisseria gonorrhoeae* infection in **Pelvic Inflammatory Disease (PID)** primarily affects the **mucosa lining the fallopian tubes**, causing inflammation and damage from within. - This **endotubal inflammation** can lead to scarring, adhesion formation, and destruction of the ciliary epithelium, impairing tubal function. *Peritubal* - **Peritubal damage** refers to inflammation and adhesions on the **exterior surface of the fallopian tubes**, often involving surrounding structures. - While PID can eventually cause peritubal adhesions, the **primary and initial site of damage** from *N. gonorrhoeae* is endotubal. *Extratubal* - **Extratubal** damage implies pathology located **completely outside** the fallopian tube itself, such as in the ovaries or peritoneum. - Although PID is a broad infection of the upper genital tract, the **direct damage** to the tube from *N. gonorrhoeae* starts inside the lumen. *Juxtatubal* - **Juxtatubal** refers to damage located **adjacent to** or in close proximity to the fallopian tube, but not necessarily within it or on its surface. - This term is less specific regarding the primary site of infection and damage caused by *N. gonorrhoeae* in the fallopian tubes.

Question 1099: What is used to aid identification of areas of dysplasia in colposcopy?

A. 3 - 5% acetic acid (Correct Answer)
B. Acetocarmine red
C. 1 % formic acid
D. 1 % alcohol

Explanation: ***3 - 5% acetic acid*** - **Acetic acid** dehydrates cells and causes nuclear proteins and keratins to coagulate, making areas with high nuclear-to-cytoplasmic ratio (like dysplastic cells) appear **acetowhite**. - This transient **acetowhite change** helps colposcopists identify dysplastic lesions that are not visible to the naked eye. *Acetocarmine red* - This is a stain used in **cytogenetics** for staining chromosomes, not for colposcopic identification of dysplasia. - It highlights nuclear material and is not applied topically during a colposcopic examination to reveal acetowhite changes. *1 % formic acid* - **Formic acid** is a strong organic acid used in various industrial applications and as a decalcifying agent in histology. - It is not used as a diagnostic agent in colposcopy to identify dysplastic areas. *1 % alcohol* - **Alcohol** is an antiseptic and dehydrating agent, but it does not selectively identify dysplastic cells through an acetowhite change like acetic acid. - It is not routinely used in colposcopy for the purpose of highlighting abnormal epithelial areas.

Question 1100: In cases of genital tuberculosis, which condition is most commonly associated with tubal adhesions, fibrosis, and hydrosalpinx formation?

A. Tuberculosis of the fallopian tube (Correct Answer)
B. Tuberculosis of the endometrium
C. Tuberculosis of the ovary
D. Tuberculosis of the cervix

Explanation: ***Tuberculosis of the fallopian tube*** - **Tubal tuberculosis** is the **most common site** of genital tuberculosis (90-95% of cases), directly affecting the fallopian tubes - Leads to severe inflammatory responses causing **adhesions**, **fibrosis**, and ultimately **hydrosalpinx formation** - This is a **significant cause of infertility** due to tubal obstruction and distortion - Classic presentation includes bilateral involvement with **beaded appearance** of tubes *Tuberculosis of the endometrium* - While **endometrial tuberculosis** is the second most common site (50-80% of cases), it's less directly associated with the specific tubal pathologies like **hydrosalpinx** - Endometrial involvement primarily leads to **menstrual irregularities**, **thin endometrium**, and **implantation failure**, rather than the structural distortion of the fallopian tubes - Often occurs secondary to tubal infection *Tuberculosis of the ovary* - **Ovarian tuberculosis** is less common (10-30% of cases) and typically presents as **tuberculous oophoritis** or ovarian mass - Does not directly cause the characteristic **hydrosalpinx** and extensive **tubal adhesions** seen with fallopian tube infection - Usually occurs in association with tubal disease *Tuberculosis of the cervix* - **Cervical tuberculosis** is rare (1-5% of cases) and presents as hypertrophic or ulcerative lesions - Does not cause **tubal adhesions**, **fibrosis**, or **hydrosalpinx formation** - Clinically may mimic cervical carcinoma

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free