Gynecological Disorders — MCQs

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 911: The procedure being performed is called:

A. Cervicopexy
B. Cervical cytology
C. Colposuspension
D. Culdocentesis (Correct Answer)

Explanation: **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.

Question 912: The image shows: (Recent Neet Pattern 2016-17)

A. Uterine sound (Correct Answer)
B. Endometrial curette
C. Rocket endocervical brush
D. Endometrial sampler

Explanation: ***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.

Question 913: Identify the gynecological instrument shown below. (Recent Neet Pattern 2016-17)

A. Rocket endocervical brush (Correct Answer)
B. Ayre spatula
C. Cervical brush
D. Wooden spatula

Explanation: **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.

Question 914: The procedure shown below is called:

A. Cone biopsy (Correct Answer)
B. Colpocleisis
C. Cervicopexy
D. Colposuspension

Explanation: ***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.

Question 915: A patient is having following clinical presentation. What is the most likely diagnosis of this condition? (Recent Neet Pattern 2016-17)

A. Gartner cyst (Correct Answer)
B. Rectocele
C. Nabothian cyst
D. Submucous fibroids

Explanation: ***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.

Question 916: All are true about the procedure being performed except: (Recent Neet Pattern 2016-17)

A. Cusco speculum introduced without lubrication
B. Procedure to be done after bimanual examination (Correct Answer)
C. Ayre spatula
D. Scraping material fixed over slide using 95% ether and alcohol

Explanation: ***Procedure to be done after bimanual examination*** - This statement is **FALSE** and is the correct answer to this "except" question - The standard sequence for pelvic examination is: **speculum exam → Pap smear collection → bimanual examination** - The Pap smear must be performed **BEFORE** the bimanual examination because the lubricant used during bimanual examination would contaminate the cervical sample and interfere with cytological interpretation - Performing the procedure after bimanual examination would compromise the quality of the cervical cell collection *Cusco speculum introduced without lubrication* - This statement is **TRUE** in the context of Pap smear collection - When performing a Pap test, the Cusco (Cusco's) speculum should be introduced using **warm water only** as a lubricant, avoiding gel-based or petroleum-based lubricants - Commercial lubricating gels can interfere with the cytological examination and obscure cellular details - While technically using "warm water," this is standard practice for Pap smear procedures *Ayre spatula* - This statement is **TRUE** - The Ayre spatula is the classic wooden spatula designed specifically for collecting ectocervical cells during Pap smear procedures - The spatula has a curved end that fits the contour of the cervix, with the longer projection inserted into the external os - Modern variations include combination devices like cytobrush for endocervical sampling or broom-like devices for liquid-based cytology *Scraping material fixed over slide using 95% ether and alcohol* - This statement is **TRUE** for conventional Pap smear technique, though somewhat outdated - Immediate fixation is crucial to prevent air-drying artifacts - **95% ethyl alcohol** is the standard fixative for conventional Pap smears - While ether-alcohol mixtures were historically used, modern practice typically uses 95% ethanol alone or commercial cytology fixative sprays - Many laboratories now use liquid-based cytology (LBC) where cells are rinsed into a preservative solution, eliminating immediate slide fixation

Question 917: A 25-year-old presents with amenorrhea of 8 weeks. What does the USG show?

A. Partial mole (Correct Answer)
B. Complete mole
C. Endometrioma
D. PCOS

Explanation: ***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.

Question 918: What is the best treatment for the condition shown below?

A. Hysteroscopic adhesiolysis (Correct Answer)
B. OCP
C. Transvaginal hysterectomy
D. Intrauterine hyaluronidase injection

Explanation: ***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.

Question 919: Identify the type of sonography shown:

A. Doppler sonography
B. Saline infusion sonography (Correct Answer)
C. 3D sonography
D. Hysterosalpingography

Explanation: ***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.

Question 920: Transvaginal saline infusion sonographic evaluation shows:

A. Submucous leiomyoma
B. Cervical stenosis
C. PCOD
D. Asherman's syndrome (Correct Answer)

Explanation: ***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.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

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Ovarian Cysts

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Pelvic Inflammatory Disease

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Vulvovaginitis

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Pelvic Organ Prolapse

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Vulvar Disorders

Practice Questions

Benign Breast Diseases

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