Gynecological Disorders Practice Questions

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.

Q: Which of the following are risk factors for Pelvic Inflammatory Disease (PID)? 1. Multiple sexual partners 2. IUD use 3. Genetic predisposition 4. Sexually active teenagers Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Multiple sexual partners** is a well-established risk factor for PID as it increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **IUD use** increases the risk of PID, particularly during the first 3 weeks after insertion when the insertion procedure can introduce vaginal flora into the upper genital tract. The risk returns to baseline after this initial period. - **Sexually active teenagers** are at higher risk due to biological factors (cervical ectopy with larger area of columnar epithelium susceptible to infection) and behavioral factors (multiple partners, inconsistent condom use, higher rates of STIs). *1, 2 and 3* - This option incorrectly includes **genetic predisposition** as a primary risk factor for PID. - PID is predominantly an **infectious disease** caused by ascending infection from the lower genital tract, not directly linked to genetic predisposition. *1, 3 and 4* - This option incorrectly includes **genetic predisposition** while correctly identifying multiple sexual partners and sexually active teenagers. - Genetic factors are not established risk factors for PID compared to behavioral and infectious causes. *2, 3 and 4* - This option incorrectly includes **genetic predisposition** and omits multiple sexual partners, which is one of the most important behavioral risk factors for PID. - The primary risk factors are related to sexual behavior and STI exposure, not genetics.

Q: Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease? 1. Coexisting pregnancy 2. Mild fever and pain responding well to antibiotics 3. Suspected tubo-ovarian abscess 4. Coexistent HIV infection Select the correct answer using the code given below.

1, 3 and 4. ***1, 3 and 4*** - **Coexisting pregnancy** is a critical indication for hospitalization in PID due to the increased risk of adverse pregnancy outcomes, including **septic abortion**, preterm birth, and disseminated infection. - **Suspected tubo-ovarian abscess (TOA)** requires inpatient management because it can lead to **sepsis**, rupture, and peritonitis, necessitating aggressive intravenous antibiotics and potentially surgical intervention. - **Coexistent HIV infection** is an important hospitalization criterion as immunocompromised patients may experience more severe PID, atypical presentations, and a higher risk of systemic complications or treatment failure. *1, 2 and 4* - This option incorrectly includes "Mild fever and pain responding well to antibiotics," which signifies a less severe course typically managed **outpatient**. - The other conditions (pregnancy, HIV) are valid reasons for hospitalization, but the presence of mild, responsive symptoms argues against inpatient care. *1, 2 and 3* - This option also incorrectly includes "Mild fever and pain responding well to antibiotics," which would typically allow for **outpatient management**. - While pregnancy and suspected TOA are strong indications for hospitalization, mild symptoms that resolve quickly with antibiotics do not warrant inpatient admission. *2, 3 and 4* - This option mistakenly includes "Mild fever and pain responding well to antibiotics," which is a criterion for **outpatient management**, not hospitalization. - It excludes "Coexisting pregnancy," which is a significant reason for inpatient care due to potential maternal and fetal risks.

Q: Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Hysteroscopy and laparoscopy. ***Hysteroscopy and laparoscopy*** - **Hysteroscopy** allows visualization of the uterine cavity, revealing two distinct hemi-cavities separated by a septum or deep indentation. - **Laparoscopy** provides external visualization of the uterus, confirming the presence of two separate uterine horns and distinguishing a bicornuate uterus from a septate uterus by identifying the deep indentation on the fundus and the angle between the horns greater than 75 degrees. *Hysteroscopy* - While hysteroscopy can visualize the **internal uterine cavity** and may suggest dual cavities, it alone cannot definitively distinguish between a deeply septate uterus and a bicornuate uterus. - It does not offer a view of the **external uterine contour**, which is crucial for diagnosis. *Hysterectomy* - A hysterectomy is the **surgical removal of the uterus**, which is a definitive treatment but not a diagnostic procedure for uterine anomalies. - This procedure would only reveal the uterine anatomy after its removal, which is not the purpose of a **confirmatory diagnostic evaluation**. *Dilatation and curettage* - This procedure involves **dilating the cervix** and **scraping the lining of the uterus**, primarily used for diagnostic sampling or therapeutic abortion. - It does not provide any information about the **uterine morphology** or congenital anomalies like a bicornuate uterus.

Q: Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Septate uterus. ***Septate uterus*** - **Metroplasty**, specifically **hysteroscopic metroplasty**, is the primary surgical treatment for a septate uterus to remove the fibrous or muscular septum dividing the uterine cavity. - This procedure aims to improve reproductive outcomes by restoring normal uterine anatomy and reducing the risk of miscarriage or preterm birth. *Arcuate uterus* - An **arcuate uterus** is a mild indentation of the uterine fundus, considered a normal variant or a minor anomaly, and does not typically require metroplasty or surgical correction. - It is usually **asymptomatic** and not associated with increased risks of adverse pregnancy outcomes. *Uterus didelphys* - **Uterus didelphys** is characterized by two completely separate uteri, cervices, and often two vaginas, due to complete non-fusion of the paramesonephric ducts. - Surgical intervention like metroplasty is generally **not indicated** as it would involve fusing two distinct uteri, which is not feasible or beneficial. *Imperforate hymen* - An **imperforate hymen** is a congenital anomaly where the hymen completely obstructs the vaginal opening. - The surgical procedure for an imperforate hymen is a simple **hymenotomy** or hymenectomy to create an opening, not a metroplasty, as it involves the hymen and not the uterus itself.

Q: A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Bacterial vaginosis. ***Bacterial vaginosis*** - The classic presentation includes **grayish-white vaginal discharge** with a **fishy odor**, especially after intercourse, and **absence of itching**. - This clinical picture aligns perfectly with **Amsel's criteria** for bacterial vaginosis, which include vaginal pH >4.5, clue cells on microscopy, and a positive whiff test. *Trichomoniasis* - Characteristically presents with a **frothy, greenish-yellow discharge** and often causes **vulvovaginal itching and irritation**, which are not reported here. - While it can cause a foamy discharge and sometimes a foul odor, the specific symptom profile given is less typical for trichomoniasis. *Urinary tract infection* - Primarily involves symptoms such as **dysuria (painful urination)**, frequent urination, and urgency, rather than vaginal discharge. - A UTI does not typically present with a "fishy-smelling grayish-white discharge" as its primary symptom. *Candidiasis* - Typically presents with a **thick, white, "cottage cheese-like" discharge** and is almost always associated with significant **vulvovaginal itching and burning**. - The absence of itching and the description of a grayish, fishy-smelling discharge make candidiasis highly unlikely.

Q: Pelvic abscess can present with all symptoms except:

bleeding rectum. ***bleeding rectum*** - A **bleeding rectum** is not a typical presentation of a pelvic abscess. It might suggest other conditions like hemorrhoids, colorectal cancer, or inflammatory bowel disease. - Pelvic abscesses are collections of pus in the pelvic cavity, and while they can cause various gastrointestinal symptoms due to local inflammation and pressure, direct rectal bleeding is generally not among them. *pain abdomen* - **Abdominal pain** is a very common symptom of a pelvic abscess, often localized to the lower abdomen. - This pain is caused by inflammation, pressure, and irritation of surrounding organs and tissues. *diarrhea with mucus discharge* - A pelvic abscess can cause irritation to the adjacent **bowel segments**, leading to changes in bowel habits such as diarrhea. - The presence of **mucus discharge** can also be a sign of bowel irritation or inflammation, which can occur secondary to a nearby abscess. *fever* - **Fever** is a classic systemic sign of infection and inflammation, and thus is almost always present in patients with an abscess, including a pelvic abscess. - The body's inflammatory response to the infection typically elevates body temperature.

Q: The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are

Firm, shotty, painless nodes that do not suppurate. **Firm, shotty, painless nodes that do not suppurate** - Lymphadenopathy in **primary syphilis** typically presents as **firm, bilateral, painless**, and non-suppurative lymph nodes, often described as "shotty." - These nodes are usually discrete and do not tend to mat together or form abscesses, reflecting the inflammatory response to **_Treponema pallidum_**. *Painful, tender nodes which become matted together to form an abscess* - **Painful, matted, and suppurative** lymph nodes are more characteristic of other infections, such as those caused by bacterial pathogens like **_Staphylococcus aureus_** or **_Streptococcus pyogenes_**, or conditions like **lymphogranuloma venereum**. - These features are generally not associated with the indolent inflammatory response seen in primary syphilis. *Non-suppurative tender enlarged nodes* - While the nodes in primary syphilis are **non-suppurative and enlarged**, they are typically **painless**, not tender. - **Tenderness** can suggest a more acute or active inflammatory process, and the absence of pain is a key distinguishing feature of syphilitic lymphadenopathy. *Painful inflamed nodes which undergo necrosis and develop a chronic sinus* - **Necrotic lymph nodes** with **chronic sinus formation** are indicative of severe and chronic infections such as **tuberculosis (scrofula)** or deep fungal infections, or conditions like **cat-scratch disease** in some cases. - These aggressive features are not consistent with the typical presentation of primary syphilis.

Q: A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Candidiasis. ***Candidiasis*** - The symptoms of **itching**, **redness**, **swelling** of the vulva, and **white flakes** (often described as "cottage cheese-like") around the introitus are highly characteristic of vulvovaginal **candidiasis (yeast infection)**. - This condition is common, especially in parous women, and is caused by an overgrowth of *Candida* species. *Trichomoniasis* - Typically presents with a **foamy, greenish-yellow discharge**, a **foul odor**, and often **punctate hemorrhages** on the cervix (strawberry cervix). - While it can cause itching and irritation, the presence of **white flakes** is not a characteristic feature. *Gonorrhoea* - Often **asymptomatic** in women or presents with **purulent vaginal discharge**, **dysuria**, and **pelvic pain**. - It does not typically cause **white flakes** around the introitus and the discharge is usually not itchy initially. *Pyogenic vulvovaginitis* - This is a general term for bacterial vulvovaginitis that would present with signs of **bacterial infection**, such as a **malodorous discharge** and significant inflammation. - While it can cause redness and swelling, the description of **white flakes** is not specific to pyogenic infections and points more towards a fungal etiology.

Question 1

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 2

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

Question 3

Which of the following are risk factors for Pelvic Inflammatory Disease (PID)?

1. Multiple sexual partners
2. IUD use
3. Genetic predisposition
4. Sexually active teenagers

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Question 4

Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease?

1. Coexisting pregnancy
2. Mild fever and pain responding well to antibiotics
3. Suspected tubo-ovarian abscess
4. Coexistent HIV infection

Select the correct answer using the code given below.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 5

Which of the following is confirmatory for the diagnosis of bicornuate uterus?

Accepted Answer

Hysteroscopy and laparoscopy

Answer

Hysteroscopy

Answer

Hysterectomy

Answer

Dilatation and curettage

Question 6

Metroplasty is the surgical procedure done for which one of the following uterine anomalies?

Accepted Answer

Septate uterus

Answer

Arcuate uterus

Answer

Uterus didelphys

Answer

Imperforate hymen

Question 7

A 27-year-old female is complaining of grayish white discharge with fishy odour. There is no history of itching associated with discharge. Which one of the following is the most likely diagnosis?

Accepted Answer

Bacterial vaginosis

Answer

Trichomoniasis

Answer

Urinary tract infection

Answer

Candidiasis

Question 8

Pelvic abscess can present with all symptoms except:

Accepted Answer

bleeding rectum

Answer

pain abdomen

Answer

diarrhea with mucus discharge

Answer

fever

Question 9

The characteristic features of inguinal lymph nodes associated with a primary syphilitic lesion of the vulva are

Accepted Answer

Firm, shotty, painless nodes that do not suppurate

Answer

Painful, tender nodes which become matted together to form an abscess

Answer

Non-suppurative tender enlarged nodes

Answer

Painful inflamed nodes which undergo necrosis and develop a chronic sinus

Question 10

A parous woman complains of itching in the vulva. On examination, there is local redness and swelling and white flakes around the introitus. The most probable diagnosis is

Accepted Answer

Candidiasis

Answer

Trichomoniasis

Answer

Gonorrhoea

Answer

Pyogenic vulvovaginitis

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?