Gynecological Disorders Practice Questions

Q: Which one of the following is implicated in the etiology of these adhesions around the liver?

Chlamydial infection. ***Chlamydial infection*** - The image shows **Fitz-Hugh-Curtis syndrome**, characterized by **violin-string adhesions** visible between the liver capsule and the parietal peritoneum. - This condition is a perihepatitis that occurs as a complication of **pelvic inflammatory disease (PID)**, most commonly caused by **Chlamydia trachomatis** or Neisseria gonorrhoeae. *Perforation of dermoid cyst* - A perforated dermoid cyst (mature cystic teratoma) typically causes a **chemical peritonitis** due to the leakage of sebaceous material, hair, and other contents. - While it can lead to adhesions, these are usually diffuse and not specifically the **violin-string type perihepatic adhesions** characteristic of Fitz-Hugh-Curtis syndrome. *Pseudomyxoma peritonei* - Pseudomyxoma peritonei is characterized by the accumulation of **gelatinous ascites** and mucin-producing tumor cells in the peritoneal cavity, often originating from a ruptured appendiceal mucinous neoplasm. - It results in widespread mucinous deposits and adhesions, which are distinct from the fibrous, violin-string adhesions around the liver seen in the image. *Liver metastases in ovarian cancer* - Liver metastases from ovarian cancer would appear as **nodular lesions within the liver parenchyma** or on its surface, not as fibrous adhesions between the liver and abdominal wall. - While ovarian cancer can cause ascites and peritoneal carcinomatosis, the presentation of **perihepatic adhesions** in the image is not typical for direct metastatic spread to the liver surface in this manner.

Q: Comment on the Pap smear taken in a 31-year-old woman with normal menses taken in pre-ovulatory stage. She complains of occasional postcoital bleeding.

Koilocyte. ***Koilocyte*** - The image shows cells with **perinuclear halos (koilocytic atypia)**, which are **pathognomonic cytopathic effects of human papillomavirus (HPV) infection**. - Koilocytes are the **characteristic cells** identified in this Pap smear, representing the specific cytomorphological finding. - These cells are the hallmark feature seen in **low-grade squamous intraepithelial lesions (LSIL)** and explain the patient's postcoital bleeding. - When asked to "comment on" cytology with an image showing specific cellular changes, identifying the **characteristic cell type** (koilocyte) is the most direct and specific answer. *Squamous intraepithelial lesion* - While this is the **clinical diagnosis/Bethesda classification** that would be reported when koilocytes are found, this option is less specific than identifying the actual cellular finding. - In clinical practice, the presence of koilocytes leads to a diagnosis of LSIL (a type of squamous intraepithelial lesion). - However, "Squamous intraepithelial lesion" is a broader category that could include findings beyond just koilocytic changes. - The question specifically asks to "comment on" the Pap smear image, making identification of the **specific cytological feature** (koilocyte) more appropriate than the diagnostic category. *Normal study* - A normal Pap smear would show **mature squamous cells without atypia**, with no perinuclear halos or other abnormal cellular changes. - The presence of koilocytes with their characteristic perinuclear halos indicates **pathology**, not a normal study. *Candida infection* - **Candida infection** presents with **budding yeast cells and pseudohyphae** on Pap smear, which are distinctly different from koilocytic changes. - While Candida can cause vaginal discharge, the cytomorphology shown (perinuclear halos in squamous cells) is characteristic of **HPV infection**, not fungal infection.

Q: A 28 -year-old P_2 ~L_2 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?

Positive 10% potassium hydroxide test. ***Positive 10% potassium hydroxide test*** - A **positive whiff test** (amine test) with 10% KOH, producing a **fishy odor**, is a characteristic bedside diagnostic criterion for **bacterial vaginosis**. - This test detects the presence of **amines** produced by anaerobic bacteria in the vaginal discharge. *Presence of RBCs in vaginal smear* - The presence of **red blood cells (RBCs)** in a vaginal smear is not a specific diagnostic criterion for bacterial vaginosis. - RBCs may indicate **inflammation**, trauma, or other infections, but not specifically bacterial overgrowth. *Vaginal pH 4.5)** due to the reduction of **lactobacilli** and overgrowth of anaerobic bacteria. - A pH less than 4.5 would suggest a normal vaginal flora or possibly a fungal infection, not bacterial vaginosis. *Positive NAAT test* - **Nucleic acid amplification tests (NAATs)** are used to detect specific pathogens like **Chlamydia** or **Gonorrhea**, not typically bacterial vaginosis. - While NAATs are highly sensitive and specific, they are not a **bedside diagnostic criterion** for bacterial vaginosis.

Q: Which one of the following is not a differential diagnosis of chronic inversion of uterus?

Gartner's cyst. ***Gartner's cyst*** - A **Gartner's cyst** is a benign vaginal cyst resulting from remnants of the **Wolffian duct**. - It is typically a **small, asymptomatic lesion** along the lateral vaginal wall and would not be mistaken for a uterine inversion, which involves the uterus turning inside out. - This is **not a differential diagnosis** of chronic uterine inversion. *Fungating cervical malignancy* - An **exophytic (fungating) cervical malignancy** can present as a mass protruding through the cervix. - On examination, it can be confused with an inverted uterus, as both can present with **vaginal bleeding** and a **fleshy mass** visible at or beyond the cervix. - This is a **recognized differential diagnosis** of chronic uterine inversion. *Fibroid polyp* - A **pedunculated submucous fibroid** (fibroid polyp) that prolapses through the cervix is a **classic differential diagnosis** of chronic uterine inversion. - Its appearance as a firm, smooth, fleshy mass protruding through the cervix can closely mimic an inverted uterine fundus. - Differentiation requires careful examination - the attachment site and presence of a pedicle help identify a fibroid polyp. *Cervical prolapse* - **Cervical prolapse** (procidentia) involves the descent of the entire uterus with the cervix leading. - While both conditions involve protrusion beyond the vaginal opening, they are **clinically distinct** - in prolapse, the cervix is visible with its external os, and the uterus remains anatomically normal (not inverted). - However, in exam contexts, **cervical prolapse is sometimes listed as a differential** as both present with a mass at the introitus, though experienced clinicians can readily distinguish them on examination.

Q: What are the characteristics of dermoid cyst? I. Germ cell ovarian tumour II. Bilateral in 15-20 % cases III. Torsion is common IV. Rupture is common Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - **Dermoid cysts (mature cystic teratomas) are germ cell ovarian tumors** arising from totipotent germ cells, containing mature tissues from all three germ layers (ectoderm, mesoderm, endoderm) - They are **bilateral in 15-20% of cases**, which is a significant percentage for benign ovarian masses - **Torsion is the most common complication** (10-15% of cases) due to their buoyancy, irregular shape, and mobility - **Rupture is relatively uncommon** (spontaneous rupture in only 1-4% of cases), making statement IV incorrect *II and IV only* - While bilaterality (15-20%) is correct, rupture is NOT a common characteristic - This option incorrectly includes statement IV (rupture common) and misses the fundamental classification as a germ cell tumor *I and III only* - Correctly identifies germ cell origin and torsion risk - However, this excludes the significant bilaterality rate (15-20%), which is an important clinical characteristic - Incomplete answer *II, III and IV* - Correctly identifies bilaterality and torsion - Incorrectly states rupture is common (actually occurs in only 1-4% of cases) - Critically fails to mention the germ cell tumor classification, which is fundamental to understanding dermoid cysts

Q: Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - Amsel's criteria are used for diagnosing **bacterial vaginosis** and include a vaginal pH >4.5, a positive **Whiff test** (amine odor with KOH), and the presence of **clue cells** (>20%) on microscopy. - The presence of at least three out of these four criteria is generally considered diagnostic for bacterial vaginosis. *I, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Bacterial vaginal culture is generally not part of Amsel's criteria for diagnosing bacterial vaginosis, as it is often difficult to interpret due to the polymicrobial nature of the condition and doesn't differentiate between normal flora and pathogenic overgrowth. *I, II and IV* - This option also incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Amsel's criteria rely on direct, rapid clinical assessment rather than labor-intensive culture methods for diagnosis of bacterial vaginosis. *II, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** and omits **vaginal pH >4.5**, which is a key component of Amsel's criteria. - The elevated vaginal pH is crucial as it indicates a shift from the normal acidic vaginal environment, making it a critical diagnostic marker.

Q: Which of the following are indications of endometrial sampling? I. Routine screening in asymptomatic premenopausal women II. Endometrial polyp III. Postmenopausal bleeding IV. Abnormal uterine bleeding Select the correct answer using the code given below :

II, III and IV. ***II, III and IV*** - **Endometrial polyps** require sampling for histopathological diagnosis and to assess for malignancy, especially when symptomatic or found in postmenopausal women. - **Postmenopausal bleeding** is a red-flag symptom that mandates endometrial sampling to rule out **endometrial hyperplasia** or **endometrial carcinoma**, as 5-10% of cases are associated with malignancy. - **Abnormal uterine bleeding** in premenopausal or perimenopausal women often requires endometrial sampling to investigate underlying causes such as **endometrial hyperplasia**, **polyps**, **endometritis**, or **malignancy**. *I, II and IV* - This option incorrectly includes **routine screening in asymptomatic premenopausal women (I)**, which is NOT an indication for endometrial sampling. - Endometrial sampling is not recommended for routine screening in asymptomatic women without risk factors or concerning symptoms. *I, III and IV* - This option also incorrectly includes **routine screening (I)** as an indication. - Additionally, it excludes **endometrial polyps (II)**, which are a definite indication for endometrial sampling when detected. *I, II and III* - This option incorrectly includes **routine screening (I)** while excluding **abnormal uterine bleeding (IV)**. - **Abnormal uterine bleeding** is one of the most common and important indications for endometrial evaluation across all age groups.

Q: Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Gartner's cyst is not reducible. ***Gartner's cyst is not reducible*** * **Gartner's cysts** are typically **fixed structures** within the vagina, representing remnants of the Wolffian duct, and therefore cannot be reduced or pushed back into place. * The **immobility** and non-reducibility of the cyst is a key characteristic that helps differentiate it from conditions like cystocele. * A **cystocele** is a prolapse of the bladder into the vagina, which is **reducible** (can be pushed back) and typically shows an impulse on coughing due to increased intra-abdominal pressure. *There is no impulse on coughing in cystocele* * This statement is **incorrect** as a **cystocele** typically **does show a cough impulse** due to increased intra-abdominal pressure transmitted through the prolapsed bladder. * The presence of a cough impulse is a characteristic feature of cystocele, not its absence. *Marked cough impulse in Gartner's cyst* * **Gartner's cysts** are fluid-filled sacs and do not transmit increased intra-abdominal pressure from coughing, therefore they typically **do not have a cough impulse**. * A marked cough impulse is more characteristic of a prolapsed organ, like a cystocele or rectocele, not a fixed cystic structure. *Margins are ill-defined in Gartner's cyst* * **Gartner's cysts** usually have **well-defined margins** as they are encapsulated structures. * Ill-defined margins might suggest an infiltrative process or inflammation, which is not characteristic of a simple Gartner's cyst.

Q: Which of the following are symptoms of genital tuberculosis? 1. Postmenopausal bleeding 2. Infertility 3. Chronic pelvic pain 4. Oligomenorrhoea Select the correct answer using the code given below.

2, 3 and 4. ***2, 3 and 4*** * **Genital tuberculosis** (GTB) predominantly affects women of reproductive age (20-40 years) and classically presents with the triad of **infertility, menstrual irregularities, and pelvic pain**. * **Infertility** is the most common presentation (70-80% of cases), primarily due to **tubal damage and scarring** affecting the fallopian tubes, which are involved in 90-100% of GTB cases. * **Chronic pelvic pain** occurs in 20-30% of cases due to pelvic adhesions, inflammation, and peritoneal involvement. * **Oligomenorrhoea** and other menstrual abnormalities (including amenorrhoea) are common (25-50% of cases) due to **endometrial involvement** causing destruction of the endometrium and affecting normal cyclical changes. *1, 2 and 4* * This option incorrectly includes **postmenopausal bleeding**, which is NOT a typical or well-established symptom of genital tuberculosis. * GTB primarily affects women during their reproductive years, not postmenopausal women. The disease presentation is centered around reproductive dysfunction in younger women. * This option also excludes **chronic pelvic pain**, which is a recognized symptom in the clinical presentation of GTB. *1, 2 and 3* * This option incorrectly includes **postmenopausal bleeding**, which is not a characteristic symptom of genital tuberculosis. * While infertility and chronic pelvic pain are valid symptoms, **oligomenorrhoea** and other menstrual irregularities are more commonly reported than postmenopausal bleeding in the clinical presentation of GTB. *1, 3 and 4* * This option incorrectly includes **postmenopausal bleeding** while excluding infertility. * **Infertility** is the single most common presenting feature of female genital tuberculosis and should not be excluded from any correct answer about typical GTB symptoms.

Question 1

Which one of the following is implicated in the etiology of these adhesions around the liver?

Accepted Answer

Chlamydial infection

Answer

Perforion of dermoid cyst

Answer

Pseudomyxoma peritonei

Answer

Liver metastases in ovarian cancer

Question 2

Comment on the Pap smear taken in a 31-year-old woman with normal menses taken in pre-ovulatory stage. She complains of occasional postcoital bleeding.

Accepted Answer

Koilocyte

Answer

Normal study

Answer

Squamous intraepithelial lesion

Answer

Candida infection

Question 3

A 28 -year-old P_2 ~L_2 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?

Accepted Answer

Positive 10% potassium hydroxide test

Answer

Presence of RBCs in vaginal smear

Answer

Vaginal pH < 4.5

Answer

Positive NAAT test

Question 4

Which one of the following is not a differential diagnosis of chronic inversion of uterus?

Accepted Answer

Gartner's cyst

Answer

Fungating cervical malignancy

Answer

Fibroid polyp

Answer

Cervical prolapse

Question 5

What are the characteristics of dermoid cyst?
I. Germ cell ovarian tumour
II. Bilateral in 15-20 % cases
III. Torsion is common
IV. Rupture is common

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

II and IV only

Answer

I and III only

Answer

II, III and IV

Question 6

Which of the following are Amsel's diagnostic criteria?
I. Vaginal pH>4.5
II. Positive Whiff test
III. Presence of clue cells >20 %
IV. Positive bacterial vaginal culture

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I, III and IV

Answer

I, II and IV

Answer

II, III and IV

Question 7

For which of the following conditions, surgery is indicated in a case of Fibroid Uterus ?
I. Symptomatic and failed medical management
II. Size >12 weeks
III. Pedunculated fibroid

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I and II only

Answer

I and III only

Answer

II and III only

Question 8

Which of the following are indications of endometrial sampling?
I. Routine screening in asymptomatic premenopausal women
II. Endometrial polyp
III. Postmenopausal bleeding
IV. Abnormal uterine bleeding

Select the correct answer using the code given below :

Accepted Answer

II, III and IV

Answer

I, II and IV

Answer

I, III and IV

Answer

I, II and III

Question 9

Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele ?

Accepted Answer

Gartner's cyst is not reducible

Answer

There is no impulse on coughing in cystocele

Answer

Marked cough impulse in Gartner's cyst

Answer

Margins are ill-defined in Gartner's cyst

Question 10

Which of the following are symptoms of genital tuberculosis?

1. Postmenopausal bleeding
2. Infertility
3. Chronic pelvic pain
4. Oligomenorrhoea

Select the correct answer using the code given below.

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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