Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 1181: Hysteroscopy is indicated in all of the following except:

A. Asherman syndrome
B. Infertility
C. Misplaced intrauterine devices
D. Active pelvic infection (Correct Answer)

Explanation: ***Active pelvic infection*** - An **active pelvic infection** is a **contraindication** to hysteroscopy due to the risk of exacerbating the infection and spreading it systemically. - Performing hysteroscopy in the presence of infection can lead to **sepsis** or worsening of pelvic inflammatory disease. *Asherman syndrome* - **Asherman syndrome**, characterized by **intrauterine adhesions**, is a common indication for hysteroscopy to diagnose and surgically resect the adhesions. - Hysteroscopy allows for direct visualization and **lysis of adhesions** to restore uterine cavity integrity. *Infertility* - **Infertility** is a frequent indication for hysteroscopy to evaluate the uterine cavity for **structural abnormalities** such as polyps, fibroids, or septa that might impede conception or implantation. - It helps in identifying and often correcting intrauterine pathologies that contribute to a woman's inability to conceive. *Misplaced intrauterine devices* - Hysteroscopy is indicated for the retrieval of **misplaced or embedded intrauterine devices (IUDs)**, especially if they cannot be removed by simpler methods. - It provides direct visualization of the uterine cavity to help locate and safely extract the IUD, preventing further complications.

Question 1182: Which of the following statements about outpatient hysteroscopy is false?

A. Normal saline as distension medium can be used
B. It is not reliable to exclude endometrial carcinoma
C. Abnormal uterine bleeding is an indication
D. Hysteroscopy is less accurate than saline infusion sonography (SIS) for uterine cavity assessment (Correct Answer)

Explanation: ***Hysteroscopy is less accurate than saline infusion sonography (SIS) for uterine cavity assessment*** - This statement is **FALSE** and is the correct answer - **Hysteroscopy** is the **gold standard** for directly visualizing the uterine cavity and identifying endometrial pathology - While **saline infusion sonography (SIS)** is excellent for screening, hysteroscopy offers **direct visual confirmation** and the ability to perform biopsies or interventions - Hysteroscopy provides superior diagnostic accuracy compared to SIS *Abnormal uterine bleeding is an indication* - This statement is **TRUE** (incorrect option) - **Abnormal uterine bleeding (AUB)** is a primary indication for outpatient hysteroscopy - Allows direct visualization of the endometrial cavity to identify causes such as polyps, fibroids, or hyperplasia - Helps differentiate between various causes of AUB and guides management *Normal saline as distension medium can be used* - This statement is **TRUE** (incorrect option) - **Normal saline** is a commonly used and safe distension medium for outpatient hysteroscopy - It is an **isotonic solution** that allows clear visualization with smaller diagnostic hysteroscopes - Well-tolerated by patients in outpatient settings *It is not reliable to exclude endometrial carcinoma* - This statement is **TRUE** (incorrect option) - While hysteroscopy with **targeted biopsies** is valuable for identifying suspicious lesions, it cannot definitively exclude microscopic carcinoma without histological confirmation - Normal hysteroscopy improves reliability of endometrial assessment through direct visualization and guided sampling compared to blind biopsies - Histopathological examination remains essential for definitive diagnosis

Question 1183: In which of the following scenarios is per rectal examination of the uterus most appropriate?

A. Placenta previa (abnormal placental position)
B. Virgins (Correct Answer)
C. Primigravida (first-time pregnant women)
D. Grand multiparas (women who have had many pregnancies)

Explanation: ***Virgins*** - **Per rectal examination** has been traditionally taught as an option for assessing the uterus in **unmarried women or virgins** when concerns about hymenal integrity exist. - However, **modern medical practice** recognizes that: - The hymen is **not a reliable indicator of virginity** and "virginity testing" is considered **unethical** by WHO and medical organizations - If clinically necessary, a **per vaginal examination** with appropriate consent and a narrow speculum is the **preferred and more informative method** - PR examination is **less accurate** for uterine assessment compared to PV examination - PR examination may be considered when **PV examination is not feasible** due to anatomical abnormalities, severe vaginismus, or in **prepubertal girls** when pelvic pathology is suspected - In the context of **traditional medical teaching and examinations**, this remains a recognized indication, though clinical practice is evolving *Placenta previa (abnormal placental position)* - A **per vaginal examination** is strictly **contraindicated** in cases of suspected or confirmed **placenta previa** due to the high risk of severe hemorrhage - **Ultrasound** is the diagnostic modality of choice - PR examination offers **no benefit** and is not appropriate for placenta previa *Primigravida (first-time pregnant women)* - A **per vaginal examination** is the **standard and most appropriate method** for assessing the uterus and cervical changes in a **primigravida** during pregnancy and labor - PR examination is generally not performed unless a vaginal examination is impossible *Grand multiparas (women who have had many pregnancies)* - Similar to primigravida, a **per vaginal examination** is the **typical and appropriate method** for assessing uterine size, position, and cervical dilation - There is **no specific indication** for a per rectal examination in this group

Question 1184: A 45-year-old woman with a diagnosis of atypical endometrial hyperplasia should be treated by:

A. Hysterectomy (Correct Answer)
B. Progesterone
C. Hysteroscopic resection
D. Danazol

Explanation: ***Hysterectomy*** - **Atypical endometrial hyperplasia (AEH)**, also known as **endometrial intraepithelial neoplasia (EIN)**, carries a significant risk of progression to **endometrial cancer** (up to 25-40% when left untreated), making definitive surgical management with **hysterectomy** the most appropriate treatment, especially in women who have completed childbearing. - For a 45-year-old woman, **total hysterectomy** (often with bilateral salpingo-oophorectomy) ensures complete removal of the diseased endometrium and eliminates the risk of future **malignancy**. *Progesterone* - **Progestin therapy** (high-dose progestogens) might be considered for atypical endometrial hyperplasia in women who desire to preserve their fertility, as it can induce regression of hyperplasia. - However, it requires **close follow-up** with endometrial biopsies every 3-6 months to monitor for treatment success and rule out progression to cancer. - This is generally reserved for younger women with strong fertility desires, not the standard treatment for a 45-year-old. *Hysteroscopic resection* - While hysteroscopic resection can remove localized polyps or areas of hyperplasia, it is generally **not sufficient** for atypical endometrial hyperplasia due to the diffuse nature of the condition and the high risk of occult or future malignancy. - This method carries a risk of incomplete removal and may miss areas of undiagnosed **carcinoma**. *Danazol* - **Danazol** is a synthetic androgen used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its anti-estrogenic and immunosuppressive properties. - It does **not have a primary role** in the treatment of atypical endometrial hyperplasia, which specifically requires management targeting estrogen-driven proliferation with either surgery or progestin therapy.

Question 1185: Greenish vaginal discharge with severe itching is suggestive of:

A. Candidiasis
B. Senile vaginitis
C. Trichomoniasis (Correct Answer)
D. Pyogenic vaginitis

Explanation: ***Trichomoniasis*** - **Trichomoniasis** is characterized by a **greenish-yellow, frothy vaginal discharge** and severe **vaginal itching**, often accompanied by discomfort during urination and intercourse. - The causative agent is *Trichomonas vaginalis*, a **flagellated protozoan**, which can lead to inflammation and irritation of the vaginal mucosa. *Candidiasis* - **Candidiasis** (yeast infection) typically presents with a **thick, white, cottage cheese-like discharge** and intense itching, but the discharge is rarely greenish. - The primary cause is an overgrowth of *Candida albicans*, and the classic appearance of the discharge is distinct from the greenish discharge mentioned. *Senile vaginitis* - **Senile vaginitis**, also known as **atrophic vaginitis**, is caused by **estrogen deficiency** after menopause, leading to thinning and inflammation of the vaginal walls. - Symptoms include vaginal dryness, itching, and dyspareunia, but the discharge is usually minimal, watery, or blood-tinged, not greenish. *Pyogenic vaginitis* - **Pyogenic vaginitis** is a general term for bacterial infections causing inflammation of the vagina, which can produce various types of discharge. - While it can cause itching and discharge, it is less specific for a greenish discharge than trichomoniasis, and other symptoms like foul odor or pain might be more prominent depending on the specific bacteria involved.

Question 1186: Which of the following statements accurately describes adenomyosis?

A. More common in parous women
B. More common in middle-aged women
C. Presents with menorrhagia, dysmenorrhea, and an enlarged uterus (Correct Answer)
D. Typically resolves after menopause without treatment

Explanation: ***Presents with menorrhagia, dysmenorrhea, and an enlarged uterus*** - **Adenomyosis** is defined by the presence of **endometrial tissue within the myometrium**, leading to symptoms like **heavy menstrual bleeding (menorrhagia)** and **painful menstruation (dysmenorrhea)**. - The infiltration of endometrial glands and stroma into the uterine muscle causes the uterus to become **enlarged** and often **globular** or boggy on examination. *More common in parous women* - While adenomyosis is more common in women who have had children, this statement alone does not fully encompass the characteristic presentation of the condition. - The exact link between parity and adenomyosis is not completely understood, but it is often attributed to uterine trauma during childbirth allowing endometrial tissue to invade the myometrium. *More common in middle-aged women* - Adenomyosis is indeed more prevalent in **women aged 35 to 50**, but this statement only describes its epidemiology, not its clinical manifestation. - Hormonal fluctuations and prolonged estrogen exposure are thought to contribute to its development in this age group. *Typically resolves after menopause without treatment* - This statement is accurate regarding its resolution, but does not describe adenomyosis itself; rather, it describes its natural progression. - Since adenomyosis is **estrogen-dependent**, its symptoms usually regress or disappear after menopause due to the decline in estrogen levels.

Question 1187: Most common site for extra-mammary Paget's disease is:

A. Uterus
B. Vulva (Correct Answer)
C. Vagina
D. Ovary

Explanation: ***Vulva*** - **Extramammary Paget's disease** most commonly occurs in the **vulvar region**, presenting as a red, eczematous lesion [1]. - It is often associated with underlying **adenocarcinoma** or other malignancies in the genital area [2]. *Ovary* - Paget's disease is **rarely** found in the ovary, which is primarily associated with **gonadal** tumors. - Symptoms and lesions are not typically localized to the **ovarian** area. *Vagina* - Extramammary Paget's disease does not commonly present in the vagina and is **not a typical site** for the lesions. - Vaginal cancers are usually **squamous cell carcinomas**, which differ from Paget's disease pathology. *Uterus* - The uterus is not a common site for **extramammary Paget's disease**, which primarily affects the external genitalia. - Uterine disorders more typically include **leiomyomas** or **endometrial carcinomas**, differing significantly from Paget's features. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1004. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 465-466.

Question 1188: Investigation of choice in postcoital bleeding in a 60-year-old woman is:

A. Pap smear
B. Colposcopy and biopsy (Correct Answer)
C. Pelvic ultrasound
D. Cone excision of cervix

Explanation: ***Colposcopy and biopsy*** - **Postcoital bleeding** in a 60-year-old postmenopausal woman requires investigation for **cervical pathology** (cancer, polyps, or atrophic changes). - **Colposcopy** allows direct visualization of the cervix with magnification, identifying suspicious areas for targeted **biopsy**, which provides definitive histological diagnosis. - While this age group also requires **endometrial evaluation** (transvaginal ultrasound), the question specifically asks for investigation of **postcoital bleeding**, which typically originates from the **cervix or vagina**. - Colposcopy with biopsy is the most appropriate initial investigation when cervical pathology is the suspected source. *Pap smear* - A **Pap smear** is a **screening tool** for cervical cancer in asymptomatic women, not a diagnostic test for symptomatic bleeding. - It has lower sensitivity for detecting invasive cancer compared to direct visualization and biopsy. - In the presence of **postcoital bleeding** (a red flag symptom), tissue diagnosis via biopsy is required rather than cytology alone. *Pelvic ultrasound* - **Pelvic/transvaginal ultrasound** is essential for evaluating **endometrial thickness** in postmenopausal women and assessing uterine and ovarian pathology. - However, it does not provide direct visualization of **cervical lesions** or tissue diagnosis. - While important in comprehensive evaluation of postmenopausal bleeding, it is not the primary investigation for **postcoital bleeding** specifically, which more commonly indicates cervical pathology. - Ultrasound would be complementary to rule out endometrial causes. *Cone excision of cervix* - **Cone biopsy (conization)** is both a diagnostic and therapeutic procedure for **high-grade cervical dysplasia (CIN 2/3)** or **microinvasive cervical cancer**. - It is performed **after** colposcopy and biopsy confirm significant cervical pathology, not as the initial investigation. - This is an invasive surgical procedure requiring anesthesia and carries risks of bleeding, infection, and cervical stenosis.

Question 1189: What type of ovarian neoplasm is most likely to occur in a 14-year-old girl?

A. Germ cell tumour (Correct Answer)
B. Epithelial tumour
C. Granulosa cell tumour
D. Sertoli-Leydig cell tumour

Explanation: ***Germ cell tumour*** - **Germ cell tumors** are the **most common type of ovarian neoplasm** in females under the age of 20, including adolescent girls [1]. - These tumors arise from the primordial germ cells of the ovary and include types such as **dysgerminoma**, **teratoma**, and **yolk sac tumor** [2], [3]. *Epithelial tumour* - **Epithelial ovarian tumors** are far more common in **older women**, typically those over 40 years of age. - They are rare in adolescents and young women. *Sertoli-Leydig cell tumour* - **Sertoli-Leydig cell tumors** are a type of **sex cord-stromal tumor** that can occur at any age but are relatively rare overall. - While they can affect young women, they are not the most common type of ovarian neoplasm in a 14-year-old. *Granulosa cell tumour* - **Granulosa cell tumors** are another type of **sex cord-stromal tumor** and are the most common malignant sex cord-stromal tumor. - They tend to occur predominantly in **adult women**, with a mean age of presentation around 50-55 years, making them less likely in an adolescent.

Question 1190: What is the recommended duration for GnRH agonist therapy for leiomyoma?

A. 3 to 6 months (Correct Answer)
B. 4 to 8 months
C. 5 to 10 months
D. 2 to 4 months

Explanation: ***3 to 6 months*** - **GnRH agonists** are typically used for a short duration, usually **3 to 6 months**, to shrink **leiomyomas** and reduce bleeding. - Prolonged use is generally avoided due to the risk of **bone mineral density loss** and other hypoestrogenic side effects. *4 to 8 months* - While falling within a similar range, **8 months** is often considered at the longer end of the recommended duration due to potential side effects. - Most patients achieve maximal benefit within the 3-6 month window, making longer durations less common. *5 to 10 months* - This duration is generally considered **too long** for routine GnRH agonist therapy for leiomyomas. - Risks of **osteoporosis** and other menopausal symptoms significantly increase with therapy extending beyond 6 months. *2 to 4 months* - While some benefit may be seen within **2 months**, the full therapeutic effect of maximal shrinkage and symptom improvement often requires a slightly longer duration. - **4 months** falls within the acceptable range, but 3 to 6 months is more commonly cited for optimal outcomes.

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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