Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1141: Which of the following drugs is commonly used in the treatment of endometriosis?

A. None of the above
B. Letrozole
C. Mifepristone
D. Combined oral contraceptives (Correct Answer)

Explanation: ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** are the **most commonly used first-line medical treatment** for endometriosis, as they suppress ovulation and reduce estrogen production, thereby reducing endometrial lesion growth. - They help manage **endometriosis-associated pain** by decreasing menstrual flow and uterine contractions. - COCs are widely prescribed due to their efficacy, safety profile, and additional contraceptive benefits. *Letrozole* - **Letrozole** is an aromatase inhibitor that reduces local estrogen production and has shown efficacy in treating endometriosis, particularly in refractory cases. - However, it is **not commonly used as first-line therapy** due to potential side effects (bone density concerns, teratogenicity) and is typically reserved for cases resistant to conventional hormonal therapy. - It may be used in combination with progestins for better outcomes. *Mifepristone* - **Mifepristone** is an antiprogestin primarily used for medical abortion or in the treatment of Cushing's syndrome. - It works by blocking **progesterone receptors** and is not a standard treatment for endometriosis. *None of the above* - This option is incorrect because **combined oral contraceptives** are the most widely accepted and commonly used treatment for endometriosis.

Question 1142: Which of the following symptoms is least commonly associated with endometriosis?

A. Vaginal discharge (Correct Answer)
B. Infertility
C. Chronic pelvic pain
D. Dyspareunia

Explanation: ***Vaginal discharge*** - **Vaginal discharge** is a symptom more commonly associated with **infections or cervical issues**, rather than endometriosis. - While women with endometriosis may experience occasional discharge, it is **not a primary or characteristic symptom** of the condition itself. *Infertility* - **Infertility** is a very common issue for women with endometriosis, affecting their ability to conceive due to **inflammation, scarring, and anatomical distortion** of reproductive organs. - Endometrial implants can **disrupt ovarian function**, block fallopian tubes, and create a hostile uterine environment. *Chronic pelvic pain* - **Chronic pelvic pain** is the hallmark symptom of endometriosis, often severe and debilitating. - It results from the **inflammation, adhesions, and nerve sensitization** caused by ectopic endometrial tissue growing outside the uterus. *Dyspareunia* - **Dyspareunia**, or **painful intercourse**, is frequently experienced by women with endometriosis. - This symptom typically occurs when endometrial implants are located on the **uterosacral ligaments, posterior cul-de-sac, or rectovaginal septum**, leading to irritation during deep penetration.

Question 1143: What percentage of ectopic pregnancies occur in the fallopian tube?

A. 90% (Correct Answer)
B. 75%
C. 80%
D. 67%

Explanation: ***90%*** - Approximately **90-95%** of all ectopic pregnancies occur within the fallopian tube, making it the most common site. - The **ampulla** is the most frequent tubal site, accounting for about 80% of tubal ectopics, followed by the isthmus and fimbrial end. *75%* - While a significant percentage, **75%** falls short of the actual prevalence of tubal ectopic pregnancies. - This percentage does not accurately reflect the high frequency of implantation within the fallopian tube. *80%* - **80%** is a common statistic for ectopic pregnancies occurring in the **ampulla** specifically, which is a segment of the fallopian tube. - However, the overall percentage for all fallopian tube locations is higher than 80%. *67%* - **67%** is too low and does not represent the vast majority of ectopic pregnancies that are found within the fallopian tube. - Such a low percentage would imply a higher incidence of ectopic pregnancies in other locations (e.g., ovary, cervix, abdomen), which is not the case.

Question 1144: Intrauterine adhesions best seen by?

A. Hysteroscopy (Correct Answer)
B. Ultrasound
C. Computed Tomography
D. Magnetic Resonance Imaging

Explanation: ***Hysteroscopy*** - **Hysteroscopy** provides direct visualization of the uterine cavity, allowing for precise identification and characterization of **intrauterine adhesions (IUA)** or **Asherman's syndrome**. - It not only diagnoses IUAs but also allows for simultaneous treatment through **adhesiolysis**, making it the gold standard for both diagnosis and management. *Ultrasound* - While ultrasound can sometimes suggest the presence of adhesions through abnormal endometrial appearances or fluid collections, it is generally **not definitive** for diagnosing IUAs. - Its sensitivity is limited, especially for subtle or fine adhesions, and it often requires confirmation by other methods. *Computed Tomography* - **Computed Tomography (CT)** scans are generally **not used** for the diagnosis of intrauterine adhesions. - CT provides limited soft tissue contrast in the endometrial cavity and exposes the patient to **ionizing radiation**, without offering a clear advantage over other imaging modalities. *Magnetic Resonance Imaging* - **Magnetic Resonance Imaging (MRI)** can provide good soft tissue detail and may visualize severe adhesions, but it is **not as sensitive or specific** as hysteroscopy for detecting all types of IUAs. - MRI is more expensive and less accessible than hysteroscopy, and it does not allow for immediate therapeutic intervention.

Question 1145: For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?

A. Just before menstruation (Correct Answer)
B. 10-12 days after menstruation
C. Just after menstruation
D. At the time of ovulation

Explanation: ***Just before menstruation*** - An endometrial biopsy is typically performed in the **late secretory phase (just before menstruation)**. This timing is crucial for evaluating the endometrial response to progesterone and for detecting abnormalities that may be evident during this phase. - This timing allows for the assessment of the **full development of the secretory glands** and stroma, which can reveal issues like **inadequate luteal phase** or **endometrial hyperplasia** more clearly. *10-12 days after menstruation* - This time point corresponds to the mid-proliferative phase, where the endometrium is still growing under **estrogen influence**. - While suitable for evaluating proliferative changes, it might **miss subtle secretory phase abnormalities** or early signs of hyperplasia that are more evident later. *Just after menstruation* - This period is the early proliferative phase, where the endometrium is **thin and regenerating**. - Biopsying at this time might yield insufficient tissue for comprehensive evaluation and would be too early to assess **hormonal responses** that occur later in the cycle. *At the time of ovulation* - Ovulation marks the transition from the proliferative to the secretory phase, influenced by a surge in **luteinizing hormone (LH)**. - An endometrial biopsy at this phase would primarily show a proliferative endometrium and would not provide adequate information about the **key features of the secretory phase**, which are important for diagnostic purposes related to fertility or abnormal bleeding.

Question 1146: What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?

A. Cyclical OC pill
B. Continuous OC pill (Correct Answer)
C. Progesterone only pill
D. Danazole

Explanation: ***Continuous OC pill*** - For **mild endometriosis** in a young woman, **continuous oral contraceptive pills (OCP)** are the **first-line medical treatment** according to current evidence-based guidelines (ACOG, ESHRE). - Continuous OCP use provides better suppression of endometriosis by creating a **stable hormonal environment** that prevents cyclic menstrual bleeding and retrograde menstruation, which can worsen endometriosis. - This approach effectively manages symptoms like **dysmenorrhea** and **pelvic pain** while preserving future fertility, and is well-tolerated in young women with the added benefit of menstrual suppression. *Cyclical OC pill* - While cyclical OCPs can help manage endometriosis symptoms, they are **less effective** than continuous OCPs because they allow withdrawal bleeding, which may perpetuate retrograde menstruation and endometrial implant stimulation. - Cyclical OCPs may still provide symptom relief but are considered a **second-line option** when continuous use is not acceptable to the patient. *Progesterone only pill* - **Progesterone-only pills (POP)** can suppress endometriosis by inducing amenorrhea and decidualization of endometrial implants, but they may cause **irregular bleeding patterns**, especially in the first few months. - While effective, they are generally considered when combined OCPs are contraindicated (e.g., migraine with aura, thrombotic risk) rather than as first-line for uncomplicated mild endometriosis. *Danazole* - **Danazol** is an androgenic agent that creates a hypoestrogenic environment, leading to atrophy of endometrial tissue, but it is **rarely used today** due to significant androgenic side effects. - Common side effects include **acne**, **hirsutism**, **weight gain**, and **voice deepening**, which are often unacceptable for a 21-year-old woman, making it an obsolete option for first-line management of mild endometriosis.

Question 1147: What is the first-line treatment for simple hyperplasia of the endometrium?

A. Endometrial ablation (surgical procedure)
B. Estrogen therapy (e.g., Estradiol)
C. Total abdominal hysterectomy (surgical removal of the uterus)
D. Progestin therapy (e.g., Medroxyprogesterone acetate) (Correct Answer)

Explanation: ***Progestin therapy (e.g., Medroxyprogesterone acetate)*** - **Progestin therapy** is the first-line treatment for simple endometrial hyperplasia because it counteracts the unopposed estrogen effect causing the hyperplasia. - **Progestins** lead to endometrial atrophy and shedding, helping to reverse the hyperplastic changes and prevent progression to cancer. *Estrogen therapy (e.g., Estradiol)* - **Estrogen therapy** without concomitant progestins would exacerbate endometrial hyperplasia by further stimulating endometrial growth. - This treatment is contraindicated in cases of endometrial hyperplasia unless carefully balanced with progestins. *Endometrial ablation (surgical procedure)* - **Endometrial ablation** is a destructive procedure to remove the endometrial lining and is typically considered for persistent abnormal uterine bleeding, not as a primary treatment for simple hyperplasia. - It is often reserved for patients who have completed childbearing and fail medical management. *Total abdominal hysterectomy (surgical removal of the uterus)* - A **total abdominal hysterectomy** is an invasive surgical procedure that is generally reserved for complex or atypical endometrial hyperplasia, or hyperplasia that is recurrent and unresponsive to medical management. - It is not the first-line treatment for simple hyperplasia, especially in patients who may desire future fertility or wish to avoid major surgery.

Question 1148: Acute PID, the most common route of spread?

A. Descending
B. Ascending infection (Correct Answer)
C. Lymphatics
D. Hematogenous

Explanation: ***Ascending infection*** - **Pelvic Inflammatory Disease (PID)** most commonly occurs when microorganisms from the **lower genital tract (vagina, cervix)** ascend into the upper genital tract (uterus, fallopian tubes, ovaries). - This upward spread leads to infection and inflammation of the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis). *Descending* - A descending route of infection implies spread from an organ superior to the pelvis, which is not the typical mechanism for acute PID. - While infections can sometimes spread from adjacent structures, direct downward spread from non-genital organs is rare for primary PID. *Lymphatics* - While lymphatic spread can occur in some infections, it is not the primary or most common route for the initial onset of acute PID. - Lymphatic spread is more commonly associated with chronic or severe infections, or specific types of pelvic infections like tuberculosis. *Hematogenous* - Hematogenous spread involves pathogens traveling through the bloodstream to reach the pelvic organs. - This route is less common for typical acute PID but can be seen in cases of systemic infections or specific sexually transmitted infections like tuberculosis.

Question 1149: A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?

A. Chlamydia trachomatis
B. Candida albicans
C. Gardnerella vaginalis
D. Trichomonas vaginalis (Correct Answer)

Explanation: ***Trichomonas vaginalis*** - **Trichomoniasis** commonly presents with **intense vulvovaginal pruritus**, a **frothy, greenish-yellow discharge**, and sometimes a **strawberry cervix**. - It is a **sexually transmitted infection (STI)** caused by a flagellated protozoan. *Candida vaginitis* - Typically causes severe **pruritus**, **dysuria**, and a **thick, white, curd-like discharge**, often without the watery characteristic. - Known as a **yeast infection**, it is caused by an overgrowth of *Candida* species. *Gardnerella vaginalis* - Associated with **bacterial vaginosis**, which presents with a **thin, grayish-white discharge** and a **fishy odor**, especially after intercourse, but usually less intense pruritus. - It's characterized by an imbalance of vaginal flora rather than being a true STI in the same sense as trichomoniasis. *Chlamydia trachomatis* - Often causes **asymptomatic infections** or symptoms such as **mucopurulent discharge**, **dysuria**, or **post-coital bleeding**, but usually **not intense pruritus** or watery discharge. - It is a **bacterial STI** known for causing cervicitis and pelvic inflammatory disease.

Question 1150: Most common congenital uterine anomaly is?

A. Bicornuate uterus
B. Unicornuate uterus
C. Arcuate uterus
D. Septate uterus (Correct Answer)

Explanation: ***Septate uterus*** - A septate uterus is the most common congenital uterine anomaly, characterized by a **fibrous or muscular septum** dividing the uterine cavity. - This anomaly results from incomplete resorption of the **müllerian ducts** during development. *Bicornuate uterus* - A bicornuate uterus involves **two uterine horns** that are partially or completely separate, leading to a heart-shaped uterus. - While relatively common, it is **less prevalent** than the septate uterus. *Unicornuate uterus* - A unicornuate uterus is an anomaly where only **one side of the müllerian duct develops**, resulting in a uterus with only one horn and one fallopian tube. - This is a **rare anomaly** compared to septate and bicornuate uteri. *Arcuate uterus* - An arcuate uterus is considered a **mild variant of a normal uterus**, with a slight indentation in the fundus. - It often has **no clinical significance** and is less severe than other anomalies.

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