Gynecological Disorders Practice Questions

Q: Which of the following statements about Asherman's syndrome is true?

Characterized by intrauterine adhesions. ***Characterized by intrauterine adhesions*** - **Asherman's syndrome** is fundamentally defined by the presence of **intrauterine adhesions** or scarring of the uterine cavity. - These adhesions develop following trauma to the basal layer of the endometrium, often from gynecological procedures like **dilation and curettage (D&C)**. - This is the **pathognomonic feature** that defines the syndrome. *Progesterone challenge test is positive* - The **progesterone challenge test** assesses the presence of an intact endometrium and adequate estrogen priming. - In Asherman's syndrome, due to the scarred endometrium, the response to progesterone is typically **absent or minimal**, leading to a **negative** result. - A negative progesterone challenge test indicates outflow obstruction or endometrial non-responsiveness. *May be secondary to TB* - While **genital tuberculosis** can cause intrauterine adhesions and is a recognized etiology, it represents a **small minority** of cases. - The primary etiology of Asherman's syndrome is usually **iatrogenic**, following uterine instrumentation such as D&C, particularly post-partum or post-abortion. - TB-related adhesions may have additional features like caseating granulomas. *Not associated with menstrual irregularities* - This is **false** - Asherman's syndrome is classically associated with **menstrual irregularities**. - Common presentations include **hypomenorrhea** (scanty periods), **amenorrhea** (absent periods), or oligomenorrhea. - These menstrual changes result from the reduced functional endometrium available for cyclical shedding due to intrauterine adhesions.

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

Size of lesions. ***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.

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

Use of oral contraceptives. ***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.

Q: Endosalpingitis is best diagnosed by?

laparoscopy. ***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.

Q: What is the best method to assess endometrial activity?

Endometrial biopsy. ***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.

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

Pyometra. ***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.

Q: 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?

Walthard cell nests. ***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.

Q: Most common site for endometriosis in the urinary system is

Bladder. ***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.

Q: Which of the following statements is true regarding bacterial vaginosis?

All of these. ***All of these*** - **Bacterial vaginosis (BV)** is characterized by a **fishy odor discharge**, a **grayish vaginal discharge**, and the presence of **clue cells** on microscopy, making all the other statements true features of the condition. - The combination of these findings is diagnostic of BV, often confirmed using the **Amsel criteria** which include these features. *It is characterized by fishy odour discharge* - A characteristic symptom of **bacterial vaginosis** is a **fishy odor**, especially after intercourse, due to the production of amines by anaerobic bacteria. - While a prominent feature, it is not the sole diagnostic criterion for BV. *It is characterized by grey discharge* - Women with **bacterial vaginosis** often present with a **thin, whitish-gray, homogenous vaginal discharge**. - This discharge is typically adherent to the vaginal walls and may not cause significant irritation. *Clue cells are found on microscopy* - **Clue cells** are **vaginal epithelial cells** covered in bacteria, observable on microscopy, and are considered the **hallmark diagnostic feature of bacterial vaginosis**. - Their presence on a wet mount is a key indicator of the altered vaginal flora.

Q: Ulceration of the vulva is commonly seen in all except:

Bacterial vaginosis. ***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 1

Which of the following statements about Asherman's syndrome is true?

Accepted Answer

Characterized by intrauterine adhesions

Answer

May be secondary to TB

Answer

Progesterone challenge test is positive

Answer

Not associated with menstrual irregularities

Question 2

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

Accepted Answer

Size of lesions

Answer

Severity of lesions

Answer

Number of lesions

Answer

Anatomical location of lesions

Question 3

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

Accepted Answer

Use of oral contraceptives

Answer

Abnormal uterine bleeding

Answer

Use of tamoxifen

Answer

Large polyp > 1.5 cm size

Question 4

Endosalpingitis is best diagnosed by?

Accepted Answer

laparoscopy

Answer

X-Ray abdomen

Answer

Hysterosalpingography

Answer

Hystero-laparoscopy

Question 5

What is the best method to assess endometrial activity?

Accepted Answer

Endometrial biopsy

Answer

HSG

Answer

USG

Answer

Colposcopy

Question 6

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

Accepted Answer

Pyometra

Answer

Ectopic

Answer

Endometritis

Answer

Infertility

Question 7

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?

Accepted Answer

Walthard cell nests

Answer

Metastases from ovary

Answer

Tubal fibrosis

Answer

Paraovarian cysts

Question 8

Most common site for endometriosis in the urinary system is

Accepted Answer

Bladder

Answer

Kidney

Answer

Ureter - lower segment

Answer

Ureter - upper segment

Question 9

Which of the following statements is true regarding bacterial vaginosis?

Accepted Answer

All of these

Answer

It is characterized by fishy odour discharge

Answer

It is characterized by grey discharge

Answer

Clue cells are found on microscopy

Question 10

Ulceration of the vulva is commonly seen in all except:

Accepted Answer

Bacterial vaginosis

Answer

Chancroid

Answer

Behcet's disease

Answer

Syphilis

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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