Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1091: 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 1092: What is the most common presenting symptom of fibroids?

A. Menorrhagia (Correct Answer)
B. Infertility
C. Lump
D. Compression

Explanation: ***Menorrhagia*** - **Heavy and prolonged menstrual bleeding** is the most frequent symptom associated with uterine fibroids due to their effect on the uterine lining and vascularity. - Fibroids can increase the **surface area of the endometrium** and interfere with uterine contractility, leading to increased menstrual blood loss. *Infertility* - While fibroids can contribute to **infertility**, particularly if they distort the uterine cavity or block fallopian tubes, it is a less common presenting symptom compared to menorrhagia. - Many women with fibroids do not experience infertility, and its presence depends on the **size and location** of the fibroids. *Lump* - A palpable **abdominal mass or lump** can occur with large fibroids, but it is not typically the *most common* initial symptom. - Many fibroids are small and may not be noticed externally, or their presence might be overshadowed by bleeding symptoms. *Compression* - **Compression symptoms** such as urinary frequency or pelvic pressure can occur when fibroids grow large and press on adjacent organs like the bladder or rectum. - However, these symptoms are generally less common as an initial presentation compared to menstrual abnormalities.

Question 1093: 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 1094: What is the most common cause for hysterectomy?

A. Fibroids (Correct Answer)
B. Uterine prolapse
C. Endometrial cancer
D. Chronic pelvic inflammatory disease

Explanation: ***Fibroids (Correct Answer)*** - **Uterine fibroids (leiomyomas)** are the **most common indication for hysterectomy**, accounting for approximately 30-40% of all hysterectomies performed. - They are benign smooth muscle tumors of the uterus with very high prevalence (affecting up to 70-80% of women by age 50). - **Symptomatic fibroids** causing heavy menstrual bleeding (menorrhagia), bulk symptoms (pressure, urinary frequency), pain, or reproductive issues often require hysterectomy when conservative management (medical therapy, UAE, myomectomy) fails or is not suitable. - The high prevalence combined with potential for significant symptoms makes fibroids the leading cause globally. *Uterine prolapse (Incorrect)* - While **uterine prolapse** can necessitate hysterectomy, it is considerably less common than fibroids as the primary indication. - Many cases are managed with pessaries, pelvic floor exercises, or reconstructive surgery (sacrocolpopexy). - Hysterectomy (vaginal hysterectomy) is reserved for severe symptomatic cases or when conservative measures fail. *Endometrial cancer (Incorrect)* - **Endometrial cancer** is an important indication for hysterectomy with bilateral salpingo-oophorectomy as part of surgical staging. - However, its **incidence is much lower** compared to the prevalence of symptomatic fibroids. - While nearly all endometrial cancer cases require hysterectomy, the absolute number is far less than fibroid-related hysterectomies. *Chronic pelvic inflammatory disease (Incorrect)* - **Chronic PID** can lead to hysterectomy in cases of severe, intractable pain, tubo-ovarian abscess, or extensive adnexal damage unresponsive to medical therapy. - However, it is a **considerably less common** indication in modern practice due to improved antibiotic therapy and earlier intervention. - Most PID cases are managed medically; hysterectomy is reserved for rare complicated cases.

Question 1095: 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 1096: 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 1097: What is the next step in investigating a 45 year old female with post coital bleeding and abnormal appearing cervix on speculum examination?

A. Dilatation and curettage
B. Conisation
C. Colposcopy (Correct Answer)
D. Hysteroscopy

Explanation: ***Colposcopy*** - Colposcopy is the appropriate next step to **directly visualize the cervical abnormality under magnification** and identify suspicious areas for targeted biopsy. - This allows for precise, **colposcopy-guided biopsies** of abnormal areas, which is crucial for **histopathological diagnosis** of potential cervical pathology including dysplasia or cancer. - It provides better visualization of the transformation zone and helps determine the extent of any lesion. *Dilatation and curettage* - This procedure involves scraping the uterine lining and is primarily used for diagnosing conditions affecting the **endometrium**, not cervical abnormalities. - It would not provide visualization or targeted biopsy of a cervical lesion. *Conisation* - Conisation is both a diagnostic and therapeutic procedure to remove a cone-shaped piece of cervical tissue. - It is typically performed **after** colposcopy and biopsy have confirmed significant dysplasia or cancer, not as the initial investigative step. - Performing conisation without prior colposcopic assessment risks inadequate margins or unnecessary tissue removal. *Hysteroscopy* - Hysteroscopy is a procedure to visualize the **inside of the uterine cavity** and is used to investigate intrauterine conditions like polyps, fibroids, or endometrial abnormalities. - It does not provide visualization of the cervix and would not help investigate cervical pathology causing post-coital bleeding.

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 the most common site of sarcoma botryoides?

A. It presents with blood stained watery vaginal discharge
B. It can be treated with VAC regime
C. Also called embryonal rhabdomyosarcoma
D. Vagina (Correct Answer)

Explanation: ***Vagina*** - Sarcoma botryoides is a specific variant of **embryonal rhabdomyosarcoma** that characteristically arises from the **vagina**, specifically the anterior vaginal wall, in young girls (typically under 8 years). - Its presentation as a **grape-like polypoid mass** protruding from the vagina is a classic clinical finding. - This is the **most common site** for sarcoma botryoides, making it the correct answer. *Also called embryonal rhabdomyosarcoma* - While sarcoma botryoides is a **subtype of embryonal rhabdomyosarcoma**, this statement describes the classification, not the anatomical site. - Embryonal rhabdomyosarcoma can occur in various locations (head/neck, genitourinary tract, extremities), but sarcoma botryoides specifically refers to the variant with **mucosal origin**, most commonly in the vagina. *It presents with blood stained watery vaginal discharge* - This is a **clinical presentation/symptom**, not an anatomical site. - Blood-stained discharge occurs due to **ulceration** and **tumor necrosis** of the vaginal mass, and is indeed a common presenting feature. *It can be treated with VAC regime* - The **VAC (Vincristine, Actinomycin D, Cyclophosphamide)** regimen is the standard chemotherapy protocol for rhabdomyosarcoma, including sarcoma botryoides. - This statement describes the **treatment modality**, not the most common site of origin.

Question 1100: Cryptomenorrhoea is a feature of?

A. Gonadal agenesis
B. Empty sella syndrome
C. Turner syndrome
D. Vaginal atresia (Correct Answer)

Explanation: ***Vaginal atresia*** - **Cryptomenorrhoea** is defined as menstruation occurring but not flowing out of the body due to an **obstruction in the outflow tract**. - **Vaginal atresia** or an **imperforate hymen** creates such an obstruction, leading to the accumulation of menstrual blood in the vagina (**hematocolpos**) and/or uterus (**hematometra**). *Empty sella syndrome* - This condition involves a flattened or shrunken **pituitary gland** and is typically associated with hormonal deficiencies, not an anatomical obstruction of menstrual flow. - It can cause menstrual irregularities or **amenorrhea** due to hypopituitarism, but not cryptomenorrhoea where menstruation forms but cannot exit. *Gonadal agenesis* - **Gonadal agenesis** means the complete absence of gonads, leading to a lack of estrogen production and consequently, a lack of pubertal development and menstruation. - This would result in **primary amenorrhoea** (no menstruation at all), not cryptomenorrhoea, as no menstrual cycle is established. *Turner syndrome* - **Turner syndrome** (45, XO) is characterized by **gonadal dysgenesis** (streak gonads), leading to undeveloped ovaries. - This results in a lack of estrogen and progesterone, preventing the initiation of menstruation and causing **primary amenorrhoea**, not cryptomenorrhoea.

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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