Gynecological Disorders Practice Questions

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.

Q: Hysteroscopy is indicated in all of the following except:

Active pelvic infection. ***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.

Q: What is the percentage of myomas undergoing malignant transformation?

0.50%. ***0.50%*** - The risk of **leiomyosarcoma** arising from a pre-existing uterine fibroid (myoma) is generally considered to be very low, approximately **0.1% to 0.5%**. - This low percentage highlights that most uterine fibroids are **benign** and do not undergo malignant transformation. *5%* - This percentage is considerably **higher** than the actual reported rates for malignant transformation. - A 5% risk would imply a much greater clinical concern for malignancy in patients with fibroids than is currently recognized. *10%* - This percentage is significantly **too high** for the malignant transformation of uterine myomas. - While fibroids are common, the development of leiomyosarcoma is a **rare event**. *1%* - While closer than 5% or 10%, 1% is still generally considered to be an overestimate of the malignant transformation rate of myomas. - Most reputable sources cite a risk of **less than 1%**, often in the range of 0.1% to 0.5%.

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

Virgins. ***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

Q: Greenish vaginal discharge with severe itching is suggestive of:

Trichomoniasis. ***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.

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

3 to 6 months. ***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.

Q: What does a positive whiff test indicate?

Bacterial vaginosis. ***Bacterial vaginosis*** - A **positive whiff test** (amine odor upon adding potassium hydroxide to vaginal discharge) is a hallmark clinical characteristic of **bacterial vaginosis**. - This **fishy odor** is produced by amines generated by anaerobic bacteria overgrowing in the vagina. *Candidiasis* - **Candidiasis**, or yeast infection, typically presents with a **thick, white, 'cottage cheese-like' discharge** and intense itching, without a characteristic foul odor. - A whiff test is generally **negative** in cases of Candida infection. *Chlamydial infection* - **Chlamydia** often causes cervicitis or urethritis, and can be **asymptomatic** or present with mild discharge, pelvic pain, or dysuria. - It is a bacterial infection but does **not produce the characteristic amines** responsible for a positive whiff test. *HSV infection* - **Herpes Simplex Virus (HSV) infection** causes painful genital lesions, ulcers, and blisters. - While there may be associated discharge, it is typically **seropurulent** and **does not produce a fishy odor** or a positive whiff test.

Question 1

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 2

Fibromyoma is seen in which age group?

Accepted Answer

Reproductive

Answer

Early adolescence

Answer

Prepubertal

Answer

Late postmenopausal

Question 3

Hysteroscopy is indicated in all of the following except:

Accepted Answer

Active pelvic infection

Answer

Asherman syndrome

Answer

Infertility

Answer

Misplaced intrauterine devices

Question 4

What is the percentage of myomas undergoing malignant transformation?

Accepted Answer

0.50%

Answer

5%

Answer

10%

Answer

1%

Question 5

Which of the following statements about outpatient hysteroscopy is false?

Accepted Answer

Hysteroscopy is less accurate than saline infusion sonography (SIS) for uterine cavity assessment

Answer

Normal saline as distension medium can be used

Answer

It is not reliable to exclude endometrial carcinoma

Answer

Abnormal uterine bleeding is an indication

Question 6

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

Accepted Answer

Virgins

Answer

Placenta previa (abnormal placental position)

Answer

Primigravida (first-time pregnant women)

Answer

Grand multiparas (women who have had many pregnancies)

Question 7

Which of the following statements accurately describes adenomyosis?

Accepted Answer

Presents with menorrhagia, dysmenorrhea, and an enlarged uterus

Answer

More common in parous women

Answer

More common in middle-aged women

Answer

Typically resolves after menopause without treatment

Question 8

Greenish vaginal discharge with severe itching is suggestive of:

Accepted Answer

Trichomoniasis

Answer

Candidiasis

Answer

Senile vaginitis

Answer

Pyogenic vaginitis

Question 9

What is the recommended duration for GnRH agonist therapy for leiomyoma?

Accepted Answer

3 to 6 months

Answer

4 to 8 months

Answer

5 to 10 months

Answer

2 to 4 months

Question 10

What does a positive whiff test indicate?

Accepted Answer

Bacterial vaginosis

Answer

Chlamydial infection

Answer

HSV infection

Answer

Candidiasis

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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