Gynecological Disorders Practice Questions

Q: The procedure being performed is called:

Culdocentesis. **Culdocentesis** - The image depicts a needle being inserted into the **posterior cul-de-sac** (pouch of Douglas) through the posterior vaginal fornix to aspirate fluid, which is the definition of **culdocentesis**. - This procedure is commonly used to detect the presence of **blood** or **pus** in the peritoneal cavity, particularly in cases of suspected ectopic pregnancy or pelvic infection. *Cervicopexy* - **Cervicopexy** is a surgical procedure to fix the cervix in a higher position, typically to prevent or treat uterine prolapse. - It involves suspending the cervix and does not involve fluid aspiration through the vaginal wall. *Cervical cytology* - **Cervical cytology**, also known as a Pap smear, involves collecting cells from the surface of the cervix to screen for **precancerous** or **cancerous changes**. - This procedure uses a brush or spatula to collect cells, not a needle for fluid aspiration from the cul-de-sac. *Colposuspension* - **Colposuspension** is a surgical procedure to treat **stress urinary incontinence** by lifting and supporting the bladder neck and urethra. - This procedure involves a surgical approach through the abdomen, not a transvaginal needle aspiration from the posterior cul-de-sac.

Q: The image shows: (Recent Neet Pattern 2016-17)

Uterine sound. ***Uterine sound*** - This instrument is a **uterine sound**, used to measure the **depth of the uterine cavity** before procedures like IUD insertion or D&C. - It is characterized by its long, thin, malleable shaft with markings and usually a handle or ring at one end. *Endometrial curette* - An endometrial curette is typically a **spoon-shaped instrument** used for scraping the uterine lining to obtain tissue samples. - It does not have the uniform, slender, and marked appearance of the instrument shown. *Rocket endocervical brush* - An endocervical brush is designed to collect **cervical cells** and consists of bristles at the tip, which is not depicted here. - This instrument is too rigid and lacks the brush-like tip for cell collection. *Endometrial sampler* - An endometrial sampler, like a Pipelle, is a thin, flexible device with a plunger used to **aspirate endometrial tissue**. - While used for obtaining uterine samples, its structure, particularly the presence of a plunger and suction mechanism, differs from the simple measuring device shown.

Q: Identify the gynecological instrument shown below. (Recent Neet Pattern 2016-17)

Rocket endocervical brush. **Rocket endocervical brush** - The image distinctly shows a **rocket-shaped head** with multiple lamellae, which is characteristic of the Rocket endocervical brush. - This instrument is designed for **simultaneous collection of both ectocervical and endocervical cells** for Pap testing. *Ayre spatula* - An Ayre spatula is typically made of **wood or plastic**, has a flat, broad blade with a notch at one end. - Its design is primarily for **ectocervical scraping**, not the extensive endocervical sampling offered by the pictured brush. *Cervical brush* - While this is a type of cervical brush, the term "cervical brush" is a **general category**. The specific design depicted (rocket-shaped) points to a more precise identification. - A standard cervical brush often has a **single set of bristles** arranged circularly, unlike the multi-lamellar, winged design shown. *Wooden spatula* - A wooden spatula, like the Ayre spatula, is primarily used for **ectocervical cell collection** and has a flat, paddle-like structure. - It lacks the **bristled or lamellar design** that characterizes the instrument shown for simultaneous comprehensive sampling.

Q: The procedure shown below is called:

Cone biopsy. ***Cone biopsy*** - The image clearly depicts a **cone-shaped section** being removed from the **cervix**, which is characteristic of a cone biopsy (also known as conization). - This procedure is performed to diagnose or treat abnormal cervical cells, typically identified during a Pap test. *Colpocleisis* - This procedure involves **surgically closing the vaginal canal**, often performed for severe pelvic organ prolapse in women who no longer desire vaginal intercourse. - The image shows a cervical excision, not a closure of the vagina. *Cervicopexy* - **Cervicopexy** is a surgical procedure to lift and suspend the cervix, typically to correct **pelvic organ prolapse**. - The illustration shows a fragment of the cervix being removed, not repositioned or suspended. *Colposuspension* - **Colposuspension** is a surgical procedure to support the **bladder neck** and **urethra** to treat **stress urinary incontinence**. - This involves attaching the vaginal wall near the urethra to ligaments in the pelvis, which is different from the cervical tissue removal shown.

Q: A patient is having following clinical presentation. What is the most likely diagnosis of this condition? (Recent Neet Pattern 2016-17)

Gartner cyst. ***Gartner cyst*** - The image shows a fluid-filled lesion in the **anterolateral vaginal wall**, consistent with a Gartner's cyst, which is a remnant of the **Wolffian duct**. - This cyst is typically located along the course of the Gartner's duct and can be palpated or visualized during pelvic examination. *Rectocele* - A rectocele involves the **posterior vaginal wall bulging into the vaginal lumen** due to rectovaginal fascia weakness, where the rectum protrudes. - The image clearly depicts an anterior vaginal wall lesion, not a posterior one. *Nabothian cyst* - **Nabothian cysts** are retention cysts located on the **cervix**, resulting from blocked cervical glands. - The lesion in the image is located in the vagina, not on the cervix. *Submucous fibroids* - **Submucous fibroids** are **uterine leiomyomas** that protrude into the endometrial cavity, originating from the myometrium. - The image shows a vaginal lesion, not a uterine pathology.

Q: A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Partial mole. ***Partial mole*** - The ultrasound image shows a **thickened placenta** with **multiple cystic spaces** (vesicles), often described as a "grape-like cluster" or "Swiss cheese" appearance, which is characteristic of a partial hydatidiform mole. - In a partial mole, there is often **fetal tissue present**, which may be seen as a small, abnormal fetus or amniotic sac, although sometimes it can be difficult to identify in early stages or if very rudimentary. *Complete mole* - A **complete mole** would typically show a **uterus filled with hydropic villi** and no evidence of fetal parts or an amniotic sac. - The "snowstorm" appearance due to diffuse hydropic villi is more characteristic of a complete mole, and while there are vesicles here, the presence of what appears to be some organized placental tissue with vesicles within it is more typical of a partial mole. *PCOS* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **multiple small follicles (cysts)** arranged peripherally in the ovaries, and it would not present with this kind of uterine contents, which is clearly a product of conception. - PCOS is a hormonal disorder leading to chronic anovulation and hyperandrogenism, and its ultrasound findings are distinct from placental abnormalities. *Endometrioma* - An **endometrioma** is a type of **ovarian cyst** filled with old blood, presenting as a **homogenous, hypoechoic mass** with internal echoes, often described as a "ground glass" appearance. - This image clearly depicts contents within the uterine cavity related to a pregnancy, not an ovarian cyst.

Q: What is the best treatment for the condition shown below?

Hysteroscopic adhesiolysis. ***Hysteroscopic adhesiolysis*** - The image shows an **intrauterine synechia**, also known as an **Asherman syndrome** or uterine adhesion, which manifests as fibrous bands within the uterine cavity (indicated by the arrow). - **Hysteroscopic adhesiolysis** is the gold standard for treating intrauterine adhesions, involving the surgical removal of these adhesions under direct visualization to restore the uterine cavity's normal anatomy. *OCP* - **Oral contraceptive pills (OCPs)** are primarily used for contraception, managing menstrual irregularities, or hormonal therapy. - They do not address or resolve **intrauterine adhesions** causing conditions like Asherman syndrome. *Transvaginal hysterectomy* - A **transvaginal hysterectomy** involves the surgical removal of the entire uterus, which is an aggressive and irreversible procedure. - This is not an appropriate treatment for intrauterine adhesions, especially in patients who may desire future fertility. *Intrauterine hyaluronidase injection* - While hyaluronidase is an enzyme that breaks down hyaluronic acid and has been explored in various applications, its efficacy as a primary treatment for established **intrauterine adhesions** is not well-supported in clinical practice. - The **mechanical removal** of fibrous adhesions is typically required.

Q: Identify the type of sonography shown:

Saline infusion sonography. ***Saline infusion sonography*** - The image shows a **fluid-filled uterine cavity** (hypoechoic space) with a visible **echogenic endometrial lining**, which is characteristic of saline infusion sonography. - This technique involves injecting saline into the uterus to distend the cavity, allowing for better visualization of **endometrial abnormalities** like polyps or fibroids. *Doppler sonography* - **Doppler sonography** is used to assess **blood flow** and would show color overlays or spectral patterns indicating flow direction and velocity, which are absent here. - It's often used to evaluate **vascularity of masses** or blood flow in vessels, not to outline the uterine cavity with fluid. *3D sonography* - **3D sonography** generates **multiplanar views** and volumetric images, creating a three-dimensional reconstruction, which is not depicted in this single 2D image. - While it can be used to evaluate uterine anomalies, this particular image does not show the typical output of a 3D reconstruction. *Hysterosalpingography* - **Hysterosalpingography (HSG)** involves injecting **radiopaque contrast** into the uterus and fallopian tubes, followed by X-ray imaging. - It would appear as a series of X-ray images, with contrast visible in the tubes and spilling into the peritoneum, not an ultrasound image of the uterine cavity.

Q: Transvaginal saline infusion sonographic evaluation shows:

Asherman's syndrome. ***Asherman's syndrome*** - The image shows **intracavitary adhesions** within the endometrial cavity, characterized by bridging bands or strands of tissue with an irregular endometrial surface, as indicated by the arrow. - These findings on **saline infusion sonography (SIS)** are highly suggestive of **Asherman's syndrome**, which involves the formation of intrauterine adhesions. *Submucous leiomyoma* - Submucous leiomyomas (submucosal fibroids) are fibroids that project into the endometrial cavity and typically appear as **well-defined, hypoechoic masses** that distort the cavity. - The image does not show a distinct mass but rather **irregular strands** and a distorted cavity indicative of adhesions, not a fibroid. *Cervical stenosis* - Cervical stenosis involves an **abnormal narrowing of the cervical canal**, which would be seen as an obstruction to fluid flow into the uterine cavity during SIS. - While the image shows fluid within the uterine cavity, the primary pathology is within the cavity itself, not merely an obstruction at the cervix. *PCOD* - **Polycystic ovary syndrome (PCOS)** is primarily an ovarian disorder characterized by **multiple small follicles** (cysts) in the ovaries and hormonal imbalances. - PCOS is not a condition diagnosed by evaluating the endometrial cavity for adhesions using saline infusion sonography.

Question 1

The procedure being performed is called:

Accepted Answer

Culdocentesis

Answer

Cervicopexy

Answer

Cervical cytology

Answer

Colposuspension

Question 2

The image shows: (Recent Neet Pattern 2016-17)

Accepted Answer

Uterine sound

Answer

Endometrial curette

Answer

Rocket endocervical brush

Answer

Endometrial sampler

Question 3

Identify the gynecological instrument shown below. (Recent Neet Pattern 2016-17)

Accepted Answer

Rocket endocervical brush

Answer

Ayre spatula

Answer

Cervical brush

Answer

Wooden spatula

Question 4

The procedure shown below is called:

Accepted Answer

Cone biopsy

Answer

Colpocleisis

Answer

Cervicopexy

Answer

Colposuspension

Question 5

A patient is having following clinical presentation. What is the most likely diagnosis of this condition? (Recent Neet Pattern 2016-17)

Accepted Answer

Gartner cyst

Answer

Rectocele

Answer

Nabothian cyst

Answer

Submucous fibroids

Question 6

All are true about the procedure being performed except: (Recent Neet Pattern 2016-17)

Accepted Answer

Procedure to be done after bimanual examination

Answer

Cusco speculum introduced without lubrication

Answer

Ayre spatula

Answer

Scraping material fixed over slide using 95% ether and alcohol

Question 7

A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

Accepted Answer

Partial mole

Answer

Complete mole

Answer

Endometrioma

Answer

PCOS

Question 8

What is the best treatment for the condition shown below?

Accepted Answer

Hysteroscopic adhesiolysis

Answer

OCP

Answer

Transvaginal hysterectomy

Answer

Intrauterine hyaluronidase injection

Question 9

Identify the type of sonography shown:

Accepted Answer

Saline infusion sonography

Answer

Doppler sonography

Answer

3D sonography

Answer

Hysterosalpingography

Question 10

Transvaginal saline infusion sonographic evaluation shows:

Accepted Answer

Asherman's syndrome

Answer

Submucous leiomyoma

Answer

Cervical stenosis

Answer

PCOD

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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