Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1161: Gold standard technique for diagnosis of endometriosis?

A. Ca 125 level
B. Ultrasound
C. MRI
D. Laparoscopy (Correct Answer)

Explanation: ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.

Question 1162: Which of the following is a criterion used in the classification of endometriosis according to the ASRM classification?

A. Severity of lesions
B. Size of lesions (Correct Answer)
C. Number of lesions
D. Anatomical location of lesions

Explanation: ***Size of lesions*** - The **ASRM (American Society for Reproductive Medicine) classification** system for endometriosis primarily relies on the **size of peritoneal implants**, ovarian endometriomas, and the extent of adhesions. - This criterion is crucial for assigning a **score** that contributes to determining the stage of endometriosis (minimal, mild, moderate, or severe). *Number of lesions* - While the number of lesions is observed during surgical evaluation, it is **not a primary independent criterion** used to assign a specific score in the ASRM classification. - The scoring focuses more on the **size and depth** of individual lesions rather than a simple count. *Severity of lesions* - The term "severity of lesions" is **too broad** to be a distinct criterion in the ASRM classification. - The classification assesses specific characteristics like **size and depth of implants** to collectively determine the overall severity (stage) of endometriosis, rather than using severity itself as a measurable criterion. *Anatomical location of lesions* - The ASRM classification **does consider anatomical location** (e.g., peritoneum, ovaries, deep infiltrative sites) but not as a stand-alone, independent criterion for scoring in the same way as implant size. - While essential for charting and acknowledging the presence of lesions, the **scoring mechanism** directly assigns points based on features like **size and depth** at these locations, not just the location itself.

Question 1163: Which of the following is NOT a risk factor for malignant transformation of an endometrial polyp?

A. Abnormal uterine bleeding
B. Use of tamoxifen
C. Use of oral contraceptives (Correct Answer)
D. Large polyp > 1.5 cm size

Explanation: ***Use of oral contraceptives*** - **Oral contraceptives** are not considered a risk factor for malignant transformation of endometrial polyps; in fact, they may be protective against endometrial hyperplasia and cancer. - Their progestin component induces endometrial atrophy, counteracting potential proliferative effects. *Large polyp > 1.5 cm size* - **Larger polyp size**, typically defined as >1.5 cm, is associated with a higher likelihood of malignant transformation. - Larger polyps have a greater chance of containing atypical histology or cancerous foci. *Abnormal uterine bleeding* - **Abnormal uterine bleeding (AUB)**, especially postmenopausal bleeding, is a common symptom of endometrial polyps and also a significant risk factor for malignancy within a polyp. - AUB warrants investigation to rule out endometrial carcinoma, which can arise within a polyp. *Use of tamoxifen* - **Tamoxifen**, a selective estrogen receptor modulator used in breast cancer treatment, has estrogenic effects on the endometrium, increasing the risk of endometrial polyps, hyperplasia, and cancer. - The use of tamoxifen is a well-established risk factor for both the development of polyps and their malignant transformation.

Question 1164: In a patient presenting with glistening spots found in the tubal serosa during a pelvic examination, which of the following conditions is most likely responsible?

A. Metastases from ovary
B. Tubal fibrosis
C. Paraovarian cysts
D. Walthard cell nests (Correct Answer)

Explanation: ***Walthard cell nests*** - **Walthard cell nests** are benign inclusions of transitional epithelium, often found on the **tubal serosa**. - They appear as **glistening, pearly white to yellow spots** due to their squamous metaplasia and mucinous content. *Metastases from ovary* - Ovarian metastases would typically present as **irregular, solid, or cystic lesions** that are unlikely to be described as glistening spots. - They are usually associated with a primary ovarian tumor and may involve significant architectural distortion of the fallopian tube. *Paraovarian cysts* - **Paraovarian cysts** are typically fluid-filled, thin-walled structures adjacent to the ovary and fallopian tube. - They are generally larger and more translucent than "glistening spots" and do not represent epithelial inclusions on the tubal surface itself. *Tubal fibrosis* - **Tubal fibrosis** refers to the thickening and scarring of the fallopian tube, often leading to infertility. - It would appear as a **dense, non-glistening thickening** of the tubal wall or serosa, not as discrete surface spots.

Question 1165: What is the best method to assess endometrial activity?

A. Endometrial biopsy (Correct Answer)
B. HSG
C. USG
D. Colposcopy

Explanation: ***Biopsy*** - **Endometrial biopsy** provides direct tissue samples, allowing for histological examination of the endometrial glands and stroma to assess their phase (proliferative, secretory) and underlying pathology. - This method is considered the **gold standard** for accurately determining endometrial activity and diagnosing conditions like hyperplasia or carcinoma. *HSG* - **Hysterosalpingography (HSG)** is primarily used to evaluate the patency of the fallopian tubes and the shape of the uterine cavity, not the functional activity of the endometrium itself. - It involves injecting contrast dye and taking X-rays, which helps identify structural abnormalities but does not provide microscopic details of endometrial tissue. *USG* - **Transvaginal ultrasonography (USG)** measures endometrial thickness and identifies gross structural abnormalities like polyps or fibroids. - While it can suggest the endometrial phase based on thickness, it does not offer the definitive cellular-level detail of endometrial activity that a biopsy provides. *Colposcopy* - **Colposcopy** is a procedure used to visualize the cervix and vagina with a magnified view, primarily for detecting and evaluating abnormal cells that may lead to cervical cancer. - It is **not used** for assessing the endometrial lining or its physiological activity.

Question 1166: Endosalpingitis is best diagnosed by?

A. laparoscopy (Correct Answer)
B. X-Ray abdomen
C. Hysterosalpingography
D. Hystero-laparoscopy

Explanation: ***Laparoscopy*** - **Laparoscopy** is the **gold standard** for diagnosing endosalpingitis as it allows direct visualization of the fallopian tubes, pelvic organs, and peritoneal cavity. - It enables identification of **inflammation, adhesions, tubal edema, and purulent exudate** characteristic of endosalpingitis. - It also permits **tissue sampling** for histopathological confirmation and culture of infectious agents. - Laparoscopy has high sensitivity and specificity for diagnosing pelvic inflammatory disease (PID) and its complications. *X-Ray abdomen* - An **X-ray abdomen** provides limited information regarding soft tissue structures like the fallopian tubes. - It is primarily used for visualizing bones or detecting gross abnormalities like bowel obstruction or free air. - It **cannot directly diagnose endosalpingitis** or provide detailed images of adnexal structures. *Hysterosalpingography* - **Hysterosalpingography (HSG)** is an imaging technique used to assess the patency and contour of the fallopian tubes and uterine cavity by injecting contrast dye. - While it can detect **tubal occlusion or hydrosalpinx**, it cannot visualize external tubal inflammation, adhesions, or the peritoneal surface. - HSG is more useful for evaluating **tubal patency in infertility workup** rather than diagnosing acute inflammation. *Hystero-laparoscopy* - This term refers to **combined hysteroscopy and laparoscopy** performed together. - While the laparoscopic component can diagnose endosalpingitis, **hysteroscopy** (visualization of the uterine cavity) adds no additional value for diagnosing tubal inflammation. - For endosalpingitis specifically, **laparoscopy alone** is sufficient and is the most direct diagnostic approach.

Question 1167: Which of the following is not a complication of pelvic inflammatory disease?

A. Ectopic
B. Pyometra (Correct Answer)
C. Endometritis
D. Infertility

Explanation: ***Pyometra*** - **Pyometra** is a collection of pus in the uterine cavity, typically caused by cervical stenosis (from surgery, radiation, or postmenopausal atrophy) or cervical malignancy, and is **not a recognized complication of Pelvic Inflammatory Disease (PID)**. - While PID involves ascending infection causing **endometritis** (inflammation of the endometrial lining), it does not typically lead to pyometra, which requires obstruction at the cervical level. - Pyometra is not listed among standard PID complications in major obstetrics and gynecology textbooks. *Ectopic pregnancy* - **Ectopic pregnancy** is a well-recognized complication of PID due to damage and scarring of the **fallopian tubes**, which impairs the normal transit of a fertilized egg to the uterus. - The inflammation and adhesions caused by PID create an environment that can trap the embryo outside the uterus, most commonly in the fallopian tube. - Risk of ectopic pregnancy increases 6-10 fold after PID. *Infertility* - **Infertility** is a common long-term consequence of PID, resulting from scarring and damage to the fallopian tubes, ovaries, and surrounding structures. - Tubal factor infertility occurs in approximately 10-20% of women after one episode of PID, with the risk increasing with recurrent infections. - This damage can obstruct the passage of eggs and sperm, or impair tubal function necessary for conception. *Endometritis* - **Endometritis** is an inflammation of the lining of the uterus and is a **direct component** of PID, not just a complication. - PID involves the ascension of infection from the cervix through the endometrium to the fallopian tubes and potentially to the ovaries and peritoneum. - Endometritis represents the uterine involvement in the spectrum of upper genital tract infection that defines PID.

Question 1168: Most common site for endometriosis in the urinary system is

A. Kidney
B. Ureter - lower segment
C. Bladder (Correct Answer)
D. Ureter - upper segment

Explanation: ***Bladder*** - The **bladder** is the most common site for **urinary tract endometriosis**, accounting for approximately 80% of all cases. - This is often due to its anatomical proximity to the uterus and broad ligaments, allowing for easier implantation of **ectopic endometrial tissue**. *Kidney* - **Kidney involvement** in endometriosis is extremely rare and typically occurs only in severe, widespread cases. - It is not considered a common site for endometrial implants in the urinary system. *Ureter - lower segment* - While the **ureter** can be affected by endometriosis, particularly the lower segment, it is less common than bladder involvement. - Ureteral obstruction due to endometriosis can lead to **hydronephrosis**. *Ureter - upper segment* - Endometriosis of the **upper ureter** is very uncommon, with the disease more frequently found in the distal (lower) segments if the ureter is affected at all. - The close anatomical relationship between the **pelvic organs** makes lower urinary tract involvement more likely.

Question 1169: Ulceration of the vulva is commonly seen in all except:

A. Chancroid
B. Behcet's disease
C. Syphilis
D. Bacterial vaginosis (Correct Answer)

Explanation: ***Bacterial vaginosis*** - This condition is characterized by an imbalance of vaginal flora, leading to a thin, *fishy-smelling discharge* and *vulvar irritation*, but *not ulceration*. - It does *not typically cause vulvar lesions* or ulcers, which are more common in sexually transmitted infections (STIs) or inflammatory conditions. *Syphilis* - **Primary syphilis** classically presents with a *painless chancre*, which is a firm, indurated ulcer, commonly found on the vulva. - The ulcer is highly infectious and is a hallmark of the early stage of the disease. *Chancroid* - Caused by *Haemophilus ducreyi*, chancroid is characterized by *painful, ragged-edged ulcers* on the vulva. - These *ulcers* are often accompanied by *tender inguinal lymphadenopathy* that can progress to *buboes*. *Behcet's disease* - This is a chronic inflammatory disorder that causes recurrent *oral and genital ulcers*, including on the vulva. - The *genital ulcers* are often *painful* and can be *scarring*, resembling those seen in *herpes simplex virus* infections.

Question 1170: Examination of a 26-year-old obese infertile female reveals a fixed retroverted uterus and nodularity of the uterosacral ligaments. The most likely diagnosis is?

A. Pelvic Inflammatory Disease (PID)
B. Endometriosis (Correct Answer)
C. Tuberculosis (TB)
D. Polycystic Ovary Syndrome (PCOS)

Explanation: ***Endometriosis*** - **Fixed retroverted uterus** and **nodularity of the uterosacral ligaments** are classic findings suggestive of endometriosis, caused by endometrial tissue outside the uterus. - This condition is a common cause of **infertility** and often presents with pelvic pain, which can be exacerbated by the deep infiltrative lesions seen on the ligaments. *Pelvic Inflammatory Disease (PID)* - PID typically presents with acute pelvic pain, fever, and cervical motion tenderness, and can lead to a **fixed uterus** due to adhesions, but **nodularity of the uterosacral ligaments** is not a hallmark. - While PID can cause infertility due to tubal damage, the specific physical exam findings described are less characteristic of PID than endometriosis. *Tuberculosis (TB)* - Genital TB is rare in developed countries but can cause infertility and chronic pelvic pain. However, it usually presents with more generalized symptoms like fever, weight loss and often affects the fallopian tubes, leading to a "beading" appearance. - While TB can cause adhesions, it does not typically manifest with the specific **nodularity of the uterosacral ligaments** that strongly points to endometriosis. *Polycystic Ovary Syndrome (PCOS)* - PCOS is a common cause of infertility, characterized by **anovulation**, hyperandrogenism (e.g., hirsutism, acne), and polycystic ovaries on ultrasound. - It does not cause a **fixed retroverted uterus** or **nodularity of the uterosacral ligaments**, which are structural changes.

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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