Gynecological Disorders Practice Questions

Q: 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?

Endometriosis. ***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.

Q: What is the characteristic discharge associated with Trichomonas vaginalis?

Greenish discharge. ***Greenish discharge*** - A characteristic presentation of **Trichomonas vaginalis** infection is a **frothy, foul-smelling, greenish-yellow vaginal discharge**. - This discharge is often accompanied by **pruritus**, **dyspareunia**, and **vulvovaginal irritation**. *White curdy discharge* - This type of discharge, often described as "cottage cheese-like," is typically associated with **vulvovaginal candidiasis** (yeast infection). - It is usually **odorless** but causes significant itching and burning. *Blood-stained discharge* - While various gynecological conditions can cause **blood-stained discharge**, it is not a primary or characteristic symptom of **Trichomonas vaginalis** infection. - Causes can range from **cervical polyps** or **STIs** like **gonorrhea** and **chlamydia** to more serious conditions like **cervical cancer**. *Milky discharge* - A **milky or homogeneous discharge** can be associated with **bacterial vaginosis** which often has a **fishy odor**. - It differs from the frothy, green discharge seen in trichomoniasis.

Q: The treatment of choice for a 25-year-old patient who presents with vaginal discharge and examination reveals the presence of Chlamydial infection is:

Azithromycin with contact tracing. ***Azithromycin with contact tracing*** - **Azithromycin** is a recommended first-line treatment for uncomplicated **Chlamydia trachomatis** infections due to its single-dose regimen which improves adherence. - **Contact tracing** is crucial to prevent re-infection and further spread of the infection within the community by identifying and treating sexual partners. *Doxycycline with Metronidazole* - **Doxycycline** is an alternative effective treatment for chlamydia, typically given as a 7-day course, but it is not the single-dose option often preferred. - **Metronidazole** is an antibiotic primarily used to treat bacterial vaginosis and trichomoniasis, not chlamydial infection. *Fluconazole with Doxycycline* - **Fluconazole** is an antifungal medication used for yeast infections and is not effective against bacterial chlamydial infections. - While **doxycycline** is effective for chlamydia, its combination with an antifungal when only chlamydia is identified is inappropriate. *Metronidazole alone* - **Metronidazole** is effective against anaerobic bacteria and parasites like those causing trichomoniasis or bacterial vaginosis, but it has no activity against **Chlamydia trachomatis**. - Using metronidazole alone for chlamydial infection would be an ineffective treatment, leading to persistent infection and potential complications.

Q: Which one of the following is NOT a characteristic feature of bacterial vaginosis?

Thick white discharge. ***Thick white discharge*** - Bacterial vaginosis is characterized by a **thin, grayish-white, homogeneous discharge**, not a thick white one. - A thick, white, "cottage cheese-like" discharge is more typical of **vulvovaginal candidiasis (yeast infection)**. *Presence of clue cells* - **Clue cells** are epithelial cells covered with bacteria, which are a hallmark microscopic finding in bacterial vaginosis. - Their presence is a key diagnostic criterion (Amsel criteria) for the condition. *Vaginal pH >4.5* - Bacterial vaginosis is associated with an **elevated vaginal pH, typically greater than 4.5**, due to the shift in vaginal flora. - This alkaline pH is a critical diagnostic indicator. *Fishy odour* - A **distinctive fishy odor**, particularly after intercourse or douching, is a classic symptom of bacterial vaginosis. - This odor is due to the production of **volatile amines** by anaerobic bacteria.

Q: Which of the following is not used to shrink fibroids?

Estrogen. ***Estrogen*** - **Estrogen** promotes the growth of **fibroids**, which are estrogen-sensitive tumors, rather than shrinking them. - Using estrogen would likely worsen fibroid symptoms and increase their size. *Danazol* - Danazol is an androgenic steroid that creates a **hypoestrogenic environment**, leading to fibroid regression. - It works by suppressing gonadotropin secretion, thereby inhibiting ovarian estrogen production. *Mifepristone* - Mifepristone is an **anti-progesterone** agent, which can reduce fibroid size by inhibiting the effects of progesterone, a hormone that also promotes fibroid growth. - It also has anti-estrogenic effects that contribute to fibroid shrinkage. *GnRH analogue* - **GnRH analogues** induce a **pseudo-menopausal state** by downregulating GnRH receptors in the pituitary, which significantly reduces estrogen production. - This hypoestrogenic state effectively shrinks fibroids, though their size often returns after treatment cessation.

Q: What is the most common cause of pyometra?

Carcinoma cervix. ***Carcinoma cervix*** - **Cervical cancer** often obstructs the cervical os, trapping pus and debris within the uterine cavity, leading to pyometra. - The resulting **obstruction** prevents drainage of infected material from the uterus, creating a favorable environment for infection. *Carcinoma endometrium* - While endometrial cancer can cause uterine bleeding or discharge, it less frequently causes **cervical obstruction** severe enough to lead to pyometra. - The nature of endometrial cancer often involves diffuse growth rather than a focal occlusive lesion at the cervical canal. *Carcinoma vagina* - Vaginal carcinoma is less likely to directly obstruct the **cervical canal** or compromise uterine drainage. - Its progression typically impacts the vagina locally and does not primarily cause accumulation of pus within the uterus. *Uterine myoma* - **Uterine fibroids (myomas)** are benign tumors that can cause abnormal bleeding or pressure symptoms. - They rarely cause complete **cervical obstruction** leading to pyometra unless they are very large pedunculated fibroids prolapsing into the cervix.

Q: What is the most common Müllerian anomaly?

Septate uterus. ***Correct - Septate uterus*** - A **septate uterus** is the most common Müllerian anomaly, resulting from the incomplete reabsorption of the uterine septum after the fusion of the paramesonephric ducts. - It is associated with the highest rates of **recurrent pregnancy loss** among all Müllerian anomalies due to poor blood supply in the septum. *Incorrect - Unicornuate uterus* - This anomaly involves the **partial or complete aplasia of one Müllerian duct**, resulting in a uterus that is half the normal size with only one fallopian tube. - While it can lead to **infertility** and **ectopic pregnancies**, it is less common than a septate uterus. *Incorrect - Bicornuate uterus* - A **bicornuate uterus** occurs due to incomplete fusion of the two paramesonephric ducts, leading to a heart-shaped uterus with two horns. - Pregnancy outcomes can be complicated by **preterm labor** or **malpresentation**, but it is not the most prevalent type. *Incorrect - Müllerian agenesis (RMKH)* - **Müllerian agenesis**, or Mayer-Rokitansky-Küster-Hauser syndrome, is characterized by the **absence or underdevelopment of the uterus and vagina**. - This is a rare condition that typically presents with **primary amenorrhea** but a normal karyotype and functioning ovaries.

Q: Surgery is not indicated in which of the following conditions associated with genital TB?

Bowel adhesions due to genital TB. ***Bowel adhesions due to genital TB*** - **Bowel adhesions** from genital TB typically resolve with **anti-tuberculosis therapy** alone, as the inflammatory process subsides with medical treatment. - Surgical intervention can actually **worsen adhesion formation** and is only indicated for complications like **complete bowel obstruction**. *Pyosalpinx* - **Pyosalpinx** involves pus-filled fallopian tubes that require **surgical drainage** or **salpingectomy** to prevent rupture and sepsis. - Medical therapy alone cannot adequately drain the **purulent collection**, making surgery essential for complete resolution. *Persistence of symptoms despite medical management* - **Refractory symptoms** after adequate **anti-TB therapy** indicate need for surgical removal of **fibrotic** or **calcified tissue** that cannot respond to medications. - Surgery helps eliminate **persistent infection foci** and restore normal anatomy when medical treatment fails. *Pyometra (uterine infection)* - **Pyometra** requires immediate **surgical drainage** through **dilatation and curettage** or **hysterectomy** to prevent life-threatening sepsis. - The **purulent uterine contents** cannot be adequately cleared by antibiotics alone, necessitating mechanical evacuation.

Q: Fibromyoma is seen in which age group?

Reproductive. ***Reproductive*** - **Fibroids** (leiomyomas) are **estrogen-dependent tumors** and thus most commonly develop during a woman's reproductive years. - Their growth is stimulated by the high levels of **estrogen** and **progesterone** present during this period. *Early adolescence* - Fibroids are rare in **early adolescence** as estrogen levels are typically not yet high enough to promote their development and growth. - The uterus is still maturing during this stage, and hormonal peaks that drive fibroid growth are less common. *Late postmenopausal* - After menopause, **estrogen levels decline significantly**, which usually causes existing fibroids to shrink. - New fibroids rarely develop in the **late postmenopausal** period due to the low hormonal environment. *Prepubeal* - This period is characterized by very **low estrogen levels**, making the development of fibroids extremely rare. - The uterus is immature, and there is no hormonal stimulus for fibroid formation.

Question 1

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?

Accepted Answer

Endometriosis

Answer

Pelvic Inflammatory Disease (PID)

Answer

Tuberculosis (TB)

Answer

Polycystic Ovary Syndrome (PCOS)

Question 2

What is the characteristic discharge associated with Trichomonas vaginalis?

Accepted Answer

Greenish discharge

Answer

White curdy discharge

Answer

Blood-stained discharge

Answer

Milky discharge

Question 3

All are true regarding adenomyosis except:

Accepted Answer

Glands found within myometrium originate from stratum functionalis.

Answer

Enlarged uterus that rarely exceeds 12 weeks.

Answer

Ectopic rests of endometrium located deep within the myometrium.

Answer

Spongy surface trabeculated with focal areas of hemorrhage.

Question 4

The treatment of choice for a 25-year-old patient who presents with vaginal discharge and examination reveals the presence of Chlamydial infection is:

Accepted Answer

Azithromycin with contact tracing

Answer

Doxycycline with Metronidazole

Answer

Fluconazole with Doxycycline

Answer

Metronidazole alone

Question 5

Which one of the following is NOT a characteristic feature of bacterial vaginosis?

Accepted Answer

Thick white discharge

Answer

Vaginal pH >4.5

Answer

Fishy odour

Answer

Presence of clue cells

Question 6

Which of the following is not used to shrink fibroids?

Accepted Answer

Estrogen

Answer

Danazol

Answer

Mifepristone

Answer

GnRH analogue

Question 7

What is the most common cause of pyometra?

Accepted Answer

Carcinoma cervix

Answer

Carcinoma vagina

Answer

Uterine myoma

Answer

Carcinoma endometrium

Question 8

What is the most common Müllerian anomaly?

Accepted Answer

Septate uterus

Answer

Unicornuate uterus

Answer

Bicornuate uterus

Answer

Müllerian agenesis (RMKH)

Question 9

Surgery is not indicated in which of the following conditions associated with genital TB?

Accepted Answer

Bowel adhesions due to genital TB

Answer

Pyosalpinx

Answer

Persistence of symptoms despite medical management

Answer

Pyometra (uterine infection)

Question 10

Fibromyoma is seen in which age group?

Accepted Answer

Reproductive

Answer

Early adolescence

Answer

Prepubertal

Answer

Late postmenopausal

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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