Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1101: 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 1102: What does LEEP stand for in the management of cervical lesions?

A. Loop electrosurgical excision procedure (Correct Answer)
B. Loop electromagnetic excision procedure
C. Loop electrodiagnostic excision procedure
D. Loop electrochemical excision procedure

Explanation: ***Loop electrosurgical excision procedure*** - **LEEP** is an acronym for **loop electrosurgical excision procedure**, a common method used to remove abnormal cells from the cervix - This procedure plays a crucial role in treating **high-grade cervical dysplasia** (CIN 2-3) and early-stage cervical cancer - It is both **diagnostic** (provides tissue for histopathology) and **therapeutic** (removes abnormal tissue) - The procedure uses a thin wire loop heated by electrical current to excise abnormal cervical tissue *Loop electromagnetic excision procedure* - Incorrect terminology; the "E" in **LEEP** stands for **electrosurgical**, not electromagnetic - Electromagnetic procedures are not standard for cervical lesion management *Loop electrodiagnostic excision procedure* - Incorrect terminology; while LEEP does provide diagnostic tissue, the "E" stands for **electrosurgical**, which describes the cutting technique - The term "electrodiagnostic" is not used in this context *Loop electrochemical excision procedure* - Incorrect terminology; the procedure uses **electrical current** for cutting and coagulation, not electrochemical reactions - The "E" in LEEP specifically refers to **electrosurgical** technique

Question 1103: 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 1104: What is the most common germ cell tumor of the ovary?

A. Dysgerminoma
B. Serous cystadenoma
C. Yolk sac tumor
D. Mature cystic teratoma (Correct Answer)

Explanation: ***Mature cystic teratoma*** - **Mature cystic teratomas**, also known as **dermoid cysts**, are the most common type of **ovarian germ cell tumor**, accounting for approximately 10-20% of all ovarian neoplasms. - They are typically benign and characterized by the presence of **tissue from all three germ layers** (ectoderm, mesoderm, endoderm), often including hair, teeth, bone, and sebaceous material. *Dysgerminoma* - **Dysgerminomas** are the most common **malignant** germ cell tumor of the ovary, but overall less common than mature cystic teratomas. - They are analogous to **seminomas** in males and are often associated with high levels of **lactate dehydrogenase (LDH)**. *Serous cystadenoma* - **Serous cystadenomas** are the most common type of **epithelial ovarian tumor**, not germ cell tumors, and are typically benign. - They originate from the surface epithelium of the ovary and are filled with clear, watery fluid. *Yolk sac tumor* - **Yolk sac tumors** (endodermal sinus tumors) are rare, highly malignant germ cell tumors of the ovary. - They are characterized by elevated levels of **alpha-fetoprotein (AFP)** and the presence of **Schiller-Duval bodies**.

Question 1105: What is the most common type of fibroid?

A. Intramural (Correct Answer)
B. Subserosal
C. Cervical
D. Submucosal

Explanation: ***Intramural*** - **Intramural fibroids** are located within the **uterine wall muscle (myometrium)** and are the most prevalent type. - Their presence often leads to **enlargement of the uterus** and can cause symptoms like **heavy menstrual bleeding** and **pelvic pressure**. *Subserosal* - **Subserosal fibroids** grow on the **outer surface of the uterus** and may project outwards. - While common, they are found **less frequently** than intramural fibroids and often cause **pressure symptoms** more than bleeding issues. *Cervical* - **Cervical fibroids** are located in the **cervix**, the lower part of the uterus, and are relatively rare. - They can cause symptoms such as **dyspareunia**, **urinary obstruction**, or **bleeding** due to their position. *Submucosal* - **Submucosal fibroids** are located just beneath the **endometrial lining** of the uterus, protruding into the uterine cavity. - Although they are the **least common type**, they are associated with the **most severe symptoms**, including heavy and prolonged menstrual bleeding and infertility.

Question 1106: 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.

Question 1107: Meigs syndrome is associated with which tumor ?

A. Fibroma (Correct Answer)
B. Cystadenoma
C. Dysgerminoma
D. Teratoma

Explanation: ***Fibroma*** - **Meigs syndrome** is defined by the classic triad of a **benign ovarian fibroma** (or fibroma-like tumor such as thecoma), **ascites**, and **pleural effusion**. - The effusions **resolve completely after tumor removal**, which is a key diagnostic feature. - While other ovarian tumors can cause ascites and pleural effusion, the specific combination with a **fibroma** is characteristic of true Meigs syndrome. *Cystadenoma* - **Cystadenomas** (serous or mucinous) are common benign ovarian tumors that are typically cystic. - They can cause ascites and pleural effusion, a condition termed **"pseudo-Meigs syndrome"**, but they lack the fibrous solid component central to the definition of true Meigs syndrome. - The distinction is important for classification purposes, though clinical management may be similar. *Dysgerminoma* - A **dysgerminoma** is a malignant germ cell tumor of the ovary, most common in young women. - While it can cause ascites as a feature of malignancy or peritoneal spread, it is not a benign tumor and is therefore not associated with Meigs syndrome. - Malignant tumors causing effusions do not fit the criteria for Meigs syndrome. *Teratoma* - **Teratomas** are germ cell tumors that can be benign (mature cystic teratoma or dermoid cyst) or malignant (immature teratoma). - Though they can rarely cause ascites and pleural effusion (pseudo-Meigs syndrome), especially if complicated by rupture, torsion, or malignant transformation, they are not fibromas and thus do not fit the criteria for true Meigs syndrome. - The most common complication of dermoid cysts is torsion, not Meigs syndrome.

Question 1108: What is the condition characterized by the ingrowth of both glandular and stromal components of the endometrium into the myometrium?

A. Courvelaire uterus
B. Placenta accreta
C. Uterine fibroid
D. Adenomyosis (Correct Answer)

Explanation: ***Adenomyosis*** - **Adenomyosis** is defined by the presence of **endometrial glands and stroma within the myometrium**. - This ectopic tissue causes the uterus to become enlarged and boggy, often leading to **dysmenorrhea** and **menorrhagia**. *Courvelaire uterus* - **Couvelaire uterus** is a condition where there is **hemorrhage into the myometrium** as a result of **placental abruption**. - It is an acute obstetric complication, not a chronic ingrowth of endometrial tissue. *Placenta accreta* - **Placenta accreta** involves abnormal adherence of the **placenta to the myometrium**, with villi invading the uterine wall. - While it involves invasion into the myometrium, it is specific to the placenta and occurs during pregnancy, not involving endometrial glands and stroma themselves. *Uterine fibroid* - A **uterine fibroid** (leiomyoma) is a **benign tumor of smooth muscle** within the myometrium. - It is composed primarily of muscle and fibrous connective tissue, not endometrial glandular tissue.

Question 1109: Most common malignant ovarian tumor is?

A. Malignant teratoma
B. Sarcoma
C. Mucinous cystadenocarcinoma
D. Serous cystadenocarcinoma (Correct Answer)

Explanation: ***Serous cystadenocarcinoma*** - This is the **most common type of malignant ovarian tumor**, accounting for approximately 40-50% of all ovarian cancers. - It is typically characterized by **cystic and solid components** and is often bilateral. *Mucinous cystadenocarcinoma* - This is the **second most common type** of epithelial ovarian cancer, less frequent than serous types. - Mucinous tumors are often **larger** and more commonly unilateral than serous tumors. *Malignant teratoma* - This is a rare type of ovarian germ cell tumor, which is distinct from the more common epithelial ovarian cancers. - Malignant teratomas include immature teratomas and are far less common than epithelial tumors like serous cystadenocarcinomas. *Sarcoma* - **Ovarian sarcomas** are exceedingly rare primary ovarian malignancies, forming a very small percentage of all ovarian cancers. - Most ovarian malignancies originate from the **surface epithelium** of the ovary, not stromal tissue.

Question 1110: What is the treatment of choice for a Bartholin cyst?

A. Aspiration
B. Observe
C. Curettage and closure
D. Marsupialization (Correct Answer)

Explanation: ***Marsupialization*** - **Marsupialization** is the gold standard for Bartholin cysts because it creates a permanent opening for drainage, preventing recurrence. - This procedure involves incising the cyst, draining its contents, and then suturing the cyst walls to the surrounding skin, forming a **self-draining pouch**. *Aspiration* - **Aspiration** is generally not recommended as a primary treatment because it offers only temporary relief and has a high rate of recurrence. - The cyst will likely refill without a permanent drainage pathway, making it an ineffective long-term solution. *Observe* - **Observation** is only appropriate for very small, asymptomatic cysts that do not cause any discomfort or pain. - For symptomatic cysts, intervention is necessary to alleviate symptoms and prevent complications like infection. *Curettage and closure* - **Curettage and closure** is not a standard treatment for Bartholin cysts and would likely lead to immediate recurrence. - Simply excising the cyst without creating a new drainage duct for the Bartholin gland would result in the gland's continued blockage and cyst formation.

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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