Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1101: 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

Question 1102: 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 1103: 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 1104: 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 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: 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 1107: 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 1108: 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 1109: 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 1110: What is the first-line investigation of choice for diagnosis of PID?

A. Colposcopy
B. Hysteroscopy
C. Laparoscopy
D. Ultrasonography (Correct Answer)

Explanation: ***Ultrasonography*** - **Transvaginal ultrasonography (TVUS)** is the **first-line imaging investigation of choice** for diagnosing PID because it is **non-invasive**, readily available, cost-effective, and can visualize important diagnostic features such as adnexal masses, hydrosalpinx, free fluid, or tubo-ovarian abscesses. - While laparoscopy offers direct visualization, TVUS provides valuable diagnostic information with less risk and discomfort, making it the preferred initial investigation that guides further management. *Laparoscopy* - **Laparoscopy** is considered the **gold standard** for definitive diagnosis of PID as it allows direct visualization of the pelvic organs and can confirm inflammation, adhesions, or abscesses. - However, it is an **invasive surgical procedure** with associated risks and is therefore reserved for cases where the diagnosis is uncertain, when conservative management fails, or when complications are suspected. - It is not the first-line investigation due to its invasiveness and the need for anesthesia. *Colposcopy* - **Colposcopy** is a procedure used to **examine the cervix and vagina** with magnification; it is primarily used for screening and diagnosis of **cervical abnormalities** or cervical intraepithelial neoplasia. - It does not visualize the internal pelvic organs (uterus, fallopian tubes, ovaries) and therefore has no role in the diagnosis of PID. *Hysteroscopy* - **Hysteroscopy** involves inserting a scope into the **uterine cavity to visualize the endometrium** and inspect for intrauterine pathology such as polyps, fibroids, or adhesions. - While it can diagnose some uterine conditions, it does not allow for visualization of the fallopian tubes or adnexa, making it unsuitable for diagnosing PID which primarily affects these extrauterine structures.

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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