Gynecological Disorders Practice Questions

Q: A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be

Ring pessary. ***Ring pessary*** - A ring pessary can provide **symptomatic relief** for uterine prolapse while allowing the woman to continue trying to conceive and carry a pregnancy. - It is a **non-surgical** and reversible option, making it suitable for women who desire future fertility. *Cervical amputation* - This procedure, such as a **Manchester Fothergill operation**, involves amputation of the cervix and can compromise future fertility and cervical competence during pregnancy. - It is a **definitive surgical treatment** usually reserved for women who have completed childbearing. *Sling operation* - Sling operations, such as sacral colpopexy, involve suspending the uterus or vaginal vault. These are generally performed for **pelvic organ prolapse** in women who are not planning future pregnancies or for more severe prolapse. - These procedures can **interfere with future fertility** and the natural physiological changes during pregnancy and labor. *Fothergill repair* - The Fothergill repair (or Manchester operation) involves **cervical amputation**, anterior colporrhaphy, and posterior colpoperineorrhaphy. It is a surgical procedure aimed at correcting uterine prolapse. - While effective for prolapse, it is **not suitable for women desiring future fertility** due to the cervical amputation and potential impact on pregnancy.

Q: The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is

Retroverted uterus. ***Retroverted uterus*** - A **retroverted uterus** means the cervix is directed forward and the uterine body tilts backward, which aligns with the description. - The ability to easily **antepose** (bring forward) the uterus indicates it's a mobile, normal variant rather than a fixed pathological condition. *Posterior wall tumour of the uterus* - A tumor would typically present as a **fixed, hard mass** and would likely make anteposing the uterus difficult or impossible. - It would also likely cause **symptoms** such as abnormal bleeding or pain, which are not mentioned. *An ovarian cyst in the pouch of Douglas* - An ovarian cyst in the pouch of Douglas would be palpable as a **separate adnexal mass** and would not inherently cause the uterine body to be *retroverted*. - While it could displace the uterus, the primary description is of the uterine position itself, not an external mass causing displacement. *Pelvic endometriosis* - Endometriosis commonly causes a **fixed retroverted uterus** due to adhesions, making it difficult or impossible to antepose. - It would also typically be associated with **dyspareunia**, dysmenorrhea, and other pain symptoms, none of which are noted.

Q: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Trichomoniasis. ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.

Q: The diagnostic criteria for bacterial vaginosis include the following except

Vaginal pH 4.5**, due to the decrease in lactic acid-producing bacteria. *Presence of clue cells* - **Clue cells** are a hallmark of bacterial vaginosis, characterized by vaginal epithelial cells studded with bacteria, obscuring their borders. - Their presence is one of the **Amsel criteria** for diagnosing bacterial vaginosis. *Positive whiff test* - A **positive whiff test** involves adding a drop of 10% potassium hydroxide (KOH) to vaginal discharge, producing a strong, fishy odor. - This odor is due to the release of **amines** produced by anaerobic bacteria, and it is a key diagnostic criterion for bacterial vaginosis. *Homogenous vaginal discharge* - The discharge in bacterial vaginosis is typically described as **thin, milky white, or grayish, and homogenous**. - This characteristic appearance is one of the **Amsel criteria** and helps distinguish it from other forms of vaginitis.

Q: Which of the following is/are the risk factors for acute pelvic inflammatory disease in women? 1. Intercourse during menstruation 2. Multiple sex partners Select the correct answer using the code given below:

Both 1 and 2. **Both 1 and 2** - **Intercourse during menstruation** increases the risk for acute PID, as the cervical mucus plug, which normally protects against ascending infection, is absent during menses. - **Multiple sex partners** significantly raises the risk of exposure to sexually transmitted infections (STIs), which are the primary cause of PID. *2 only* - While **multiple sex partners** is a major risk factor, denying intercourse during menstruation as a risk factor is incorrect. - The physiological changes during menstruation facilitate the ascent of bacteria, making coitus during this period a risk. *Neither 1 nor 2* - Both statements describe established risk factors for PID. - This option is incorrect because both **intercourse during menstruation** and **multiple sex partners** contribute to increased risk. *1 only* - While **intercourse during menstruation** is a risk factor, it is incorrect to exclude **multiple sex partners** as a significant risk factor for PID. - Having multiple partners dramatically increases the likelihood of acquiring **STIs**, the main cause of PID.

Q: A woman presents with heavy foul smelling discharge with sharply demarcated ulcers without induration on the perineum and the labia majora. Inguinal lymphadenopathy is also present. What is the most probable diagnosis?

Chancroid. ***Chancroid*** - The presence of **heavy, foul-smelling discharge** with **sharply demarcated, painful ulcers** that are **not indurated** on the perineum and labia majora, along with **inguinal lymphadenopathy**, is highly characteristic of chancroid, caused by *Haemophilus ducreyi*. - The **lack of induration** and the **painful nature** of the ulcers are key differentiating features from syphilis (painless chancre with induration). - The **tender inguinal lymphadenopathy** can progress to form suppurative buboes, which is pathognomonic for chancroid. *Tuberculosis* - While tuberculosis can cause genital ulcers, they are typically **chronic, painless**, and often associated with systemic symptoms like weight loss and night sweats, which are not described here. - Genital tuberculosis is less likely to present with acute, foul-smelling discharge and sharply demarcated, non-indurated ulcers with prominent lymphadenopathy in this manner. *Trichomoniasis* - Trichomoniasis causes a **frothy, yellowish-green, foul-smelling vaginal discharge** and can lead to **vaginal irritation** and sometimes "strawberry cervix," but it **does not cause discrete ulcers** on the perineum or labia majora. - This is primarily a vaginitis caused by *Trichomonas vaginalis*, not an ulcerative condition. - Inguinal lymphadenopathy is not a feature of trichomoniasis. *Gonorrhoea* - Gonorrhoea usually presents with a **purulent vaginal or cervical discharge**, dysuria, and pelvic pain in women, but it **does not typically cause ulcers** on the perineum or labia. - This is a mucosal infection affecting the endocervix primarily, not causing ulcerative lesions. - While disseminated gonococcal infection can occur, the predominant presenting feature of ulcers points away from gonorrhoea.

Q: A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?

Conservative with follow up ultrasound. ***Conservative with follow up ultrasound*** - A 5cm **unilocular, echo-free ovarian cyst** in a 17-year-old with a normal **CA-125** (8 U/mL is well within the normal range, typically <35 U/mL) is highly suggestive of a **benign functional cyst**. - Expectant management with **serial ultrasound follow-up** is the most appropriate initial approach, as these cysts often resolve spontaneously. *Laparoscopy for cyst removal* - This is an **invasive procedure** that is not indicated for a likely benign, asymptomatic ovarian cyst, especially given the young age of the patient. - Surgical intervention would only be considered if the cyst persists, grows significantly, causes symptoms, or shows suspicious features on imaging. *Laparotomy for cyst removal* - **Laparotomy** is an even more invasive surgical approach than laparoscopy, involving a larger incision, and is reserved for cases where malignancy is strongly suspected or for very large, complex cysts that cannot be removed laparoscopically. - Given the benign characteristics of the cyst, this approach is unwarranted. *Medical treatment* - There is **no specific medical treatment** (e.g., medication) that effectively resolves functional ovarian cysts. - While hormonal contraceptives can sometimes suppress the formation of new functional cysts, they do not typically treat an existing one of this nature.

Q: In a 40 year old woman, pap smear shows atypical glandular cells. The next step of management should be:

Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy. ***Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy*** - Atypical glandular cells (AGC) on a Pap smear require comprehensive evaluation of both the **cervix** and the **endometrium** due to the potential for underlying **adenocarcinoma** or its precursors. - This thorough workup includes visually inspecting the cervix (**colposcopy**), sampling any abnormal cervical areas (**cervical biopsy**), assessing the endocervical canal (**endocervical curettage**), and evaluating the uterine lining (**endometrial biopsy**). *Hysteroscopy and directed endometrial biopsy* - While an **endometrial biopsy** is crucial for evaluating glandular abnormalities, particularly in a woman over 35, it alone is insufficient. - This option **neglects the cervical component**, which is also a common site for glandular abnormalities detected by AGC. *Colposcopic directed cervical biopsy* - This approach focuses solely on the **cervix** and would miss potential pathology within the **endometrium**, which is a significant concern with AGC. - In a 40-year-old woman, the risk of **endometrial adenocarcinoma** is substantial enough to warrant endometrial sampling. *Repeat pap smear after three months* - Repeating a Pap smear is **inappropriate for AGC**, as these findings carry a high risk of underlying significant pathology (up to 20-60% for high-grade lesions or cancer). - Delaying definitive evaluation could lead to the **progression of undetected cancer**.

Q: A 28 year old P1L1 presents with severe pain in her abdomen and is taken for laparotomy. On opening the abdomen pseudomyxoma peritonei is present. What should be the probable reason?

Mucinous cystadenoma of ovary. ***Mucinous cystadenoma of ovary*** - **Pseudomyxoma peritonei** is most frequently caused by the rupture of a low-grade mucinous tumor, often originating from the **appendix** or, less commonly, the **ovary**. - A **mucinous cystadenoma of the ovary**, upon rupture, can release mucinous material into the peritoneal cavity, leading to the characteristic "jelly belly" appearance. *Rupture of dermoid tumor* - Rupture of a **dermoid tumor** (mature cystic teratoma) can cause **chemical peritonitis** due to the release of sebaceous material and hair, but it does not typically lead to pseudomyxoma peritonei. - The contents of a dermoid tumor are usually **fatty** or **keratinous**, not mucinous. *Endometriosis* - **Endometriosis** involves endometrial-like tissue growing outside the uterus, causing pelvic pain and adhesions. - It does not involve the production of a large volume of mucinous material and is therefore not a cause of pseudomyxoma peritonei. *Serous cystadenoma of ovary* - A ruptured **serous cystadenoma** would release serous (watery) fluid, not mucinous material. - While it can cause ascites, it does not produce the characteristic thick, gelatinous material seen in pseudomyxoma peritonei.

Question 1

Which of the following is not an outcome of gonococcal salpingitis ?

Accepted Answer

Ovarian cyst

Answer

Hydrosalpinx

Answer

Multiple tubal blocks

Answer

Salpingitis isthmica nodosa

Question 2

A woman who is being investigated for infertility is diagnosed to have a nulliparous prolapse of the uterus. The most appropriate management will be

Accepted Answer

Ring pessary

Answer

Cervical amputation

Answer

Sling operation

Answer

Fothergill repair

Question 3

The pelvic examination of a woman reveals that the cervix is directed forwards, the body is backward, but it can be anteposed easily. The examination does not demonstrate any other abnormality. The most probable diagnosis is

Accepted Answer

Retroverted uterus

Answer

Posterior wall tumour of the uterus

Answer

An ovarian cyst in the pouch of Douglas

Answer

Pelvic endometriosis

Question 4

A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?

Accepted Answer

Trichomoniasis

Answer

Chlamydia infection

Answer

Gonococcal vaginitis

Answer

Candidiasis

Question 5

The diagnostic criteria for bacterial vaginosis include the following except

Accepted Answer

Vaginal pH < 4.5

Answer

Presence of clue cells

Answer

Positive whiff test

Answer

Homogenous vaginal discharge

Question 6

Which of the following is/are the risk factors for acute pelvic inflammatory disease in women?

1. Intercourse during menstruation
2. Multiple sex partners

Select the correct answer using the code given below:

Accepted Answer

Both 1 and 2

Answer

2 only

Answer

Neither 1 nor 2

Answer

1 only

Question 7

A woman presents with heavy foul smelling discharge with sharply demarcated ulcers without induration on the perineum and the labia majora. Inguinal lymphadenopathy is also present. What is the most probable diagnosis?

Accepted Answer

Chancroid

Answer

Tuberculosis

Answer

Trichomoniasis

Answer

Gonorrhoea

Question 8

A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free, unilocular and CA 125 of 8U/ml. What is most appropriate management?

Accepted Answer

Conservative with follow up ultrasound

Answer

Laparoscopy for cyst removal

Answer

Laparotomy for cyst removal

Answer

Medical treatment

Question 9

In a 40 year old woman, pap smear shows atypical glandular cells. The next step of management should be:

Accepted Answer

Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy

Answer

Hysteroscopy and directed endometrial biopsy

Answer

Colposcopic directed cervical biopsy

Answer

Repeat pap smear after three months

Question 10

A 28 year old P1L1 presents with severe pain in her abdomen and is taken for laparotomy. On opening the abdomen pseudomyxoma peritonei is present. What should be the probable reason?

Accepted Answer

Mucinous cystadenoma of ovary

Answer

Rupture of dermoid tumor

Answer

Endometriosis

Answer

Serous cystadenoma of ovary

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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