Gynecological Disorders Practice Questions

Q: An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Gonorrhoea. ***Gonorrhoea*** - This presentation, including **yellow/green vaginal discharge**, a **Bartholin cyst**, and **proctitis**, is highly suggestive of **gonorrhoea**. - *Neisseria gonorrhoeae* can cause inflammation in these specific areas and is a known cause of **infertility** due to pelvic inflammatory disease. *Trichomoniasis* - Characterized by a **frothy, foul-smelling, yellow-green discharge** and often involves **cervical petechiae** (strawberry cervix). - While it causes vaginal discharge, **Bartholin cysts** and **proctitis** are not typical features. *Syphilis* - The primary stage presents as a **painless chancre**, secondary syphilis involves a **rash** and **lymphadenopathy**, and tertiary syphilis has severe organ involvement. - It does not typically present with the specific combination of **Bartholin cyst**, vaginal discharge, and **proctitis**. *Candidiasis* - Causes a **thick, white, "cottage cheese-like" discharge** associated with significant **pruritus** and **vaginal irritation**. - It does not typically lead to **Bartholin cysts** or **proctitis**.

Q: The most accurate method to diagnose adenomyosis is:

MRI. ***Correct Option: MRI*** - **Magnetic Resonance Imaging (MRI)** offers superior soft tissue contrast, allowing for detailed visualization of the **junctional zone** and myometrial architecture, which is crucial for diagnosing adenomyosis. - It can accurately identify characteristic features such as **thickening of the junctional zone** (>12 mm), altered signal intensity, and the presence of **stromal and glandular ectopic endometrial tissue** within the myometrium. - MRI is the **most accurate non-invasive imaging modality** for adenomyosis with sensitivity of 70-90% and specificity of 65-91%. *Incorrect Option: Transvaginal sonography* - While TVS is often the **first-line imaging modality** due to its accessibility and lower cost, its diagnostic accuracy for adenomyosis is **operator-dependent** and generally lower than MRI. - It can suggest adenomyosis through findings like **globular uterus**, **myometrial cysts**, and heterogeneous myometrial echotexture, but these are **less specific** than MRI findings. *Incorrect Option: Hysterosalpingography* - **Hysterosalpingography (HSG)** is primarily used to evaluate **fallopian tube patency** and uterine cavity morphology, typically in the context of infertility. - It is **not designed to visualize the myometrium** or diagnose adenomyosis, as it assesses the uterine lumen rather than the myometrial invasion characteristic of adenomyosis. *Incorrect Option: PET-CT* - **Positron Emission Tomography-Computed Tomography (PET-CT)** is mainly used in **oncology** for cancer staging, detection of recurrence, and metastasis assessment due to its ability to detect metabolic activity. - It has **no role** in the diagnosis of adenomyosis, a benign gynecological condition characterized by endometrial tissue within the myometrium.

Q: A 30 year old multiparous woman comes with an ultrasound report of fibroid uterus measuring 3 x 3 cm. Her only complaint is mild pain during menstruation. The best management in this would be:

Reassurance. ***Reassurance*** - Given the small size of the fibroid (3x3 cm) and the patient's only complaint being **mild menstrual pain**, which can often be managed symptomatically, **reassurance** is the most appropriate initial step. - Many small fibroids are **asymptomatic** or cause minimal symptoms and do not require aggressive intervention, especially if the patient is not seeking to conceive immediately. *Myomectomy* - Myomectomy is a surgical procedure to remove fibroids, usually considered for **symptomatic fibroids**, particularly those causing significant pain, heavy bleeding, or impacting fertility. - It involves surgical risks and potential complications, which are **unjustified** for a small, minimally symptomatic fibroid. *GnRH analogues* - **GnRH analogues** temporarily reduce fibroid size by inducing a **hypoestrogenic state**, which can alleviate symptoms like heavy bleeding and pain. - However, their effects are temporary, and fibroids typically **regrow after cessation** of treatment, and they are usually reserved for larger, symptomatic fibroids or as a preoperative measure. *Hysterectomy* - Hysterectomy is the surgical removal of the uterus, a definitive treatment for fibroids, but it is an **irreversible procedure** that ends fertility. - It is typically reserved for women with **large, highly symptomatic fibroids** who have completed childbearing or for whom other treatments have failed, which is not the case here.

Q: For the treatment of a woman with frothy vaginal discharge with fishy smell the following are essential except:

Washing of private parts with antiseptics /disinfectants. ***Washing of private parts with antiseptics/disinfectants*** - This is **NOT recommended** and can actually be harmful for managing vaginal discharge - Antiseptics or disinfectants can **disrupt the normal vaginal flora**, potentially worsening the condition or leading to other infections - Such practices can cause irritation, further alter vaginal pH, and interfere with natural protective mechanisms - Vaginal hygiene should involve gentle external cleaning with plain water only *Metronidazole* (Essential for treatment) - **Metronidazole** is the drug of choice for treating **trichomoniasis** (which causes frothy discharge) and **bacterial vaginosis** (which causes fishy smell) - It is effective against anaerobic bacteria and Trichomonas vaginalis parasite - Typically given as 2g single dose or 400-500mg twice daily for 5-7 days - This is the **cornerstone of treatment** and absolutely essential *Partner treatment* (Essential for treatment) - For vaginitis caused by **Trichomonas vaginalis**, treating **sexual partner(s)** simultaneously is crucial to prevent re-infection - Untreated partners act as a reservoir for infection, leading to a **ping-pong effect** and cycle of re-infection - Both partners should complete treatment and abstain from intercourse until cure is achieved - Essential for eradicating infection from the sexual network *Use of condom by partner* (Essential for treatment) - While primarily a **preventive measure**, condom use during and after treatment helps prevent re-infection - Reduces exposure to external flora that might disrupt vaginal environment - However, **abstinence during active treatment** is actually preferred over condom use - Among the essential measures listed, this is the least critical for immediate treatment, though still important for comprehensive management

Q: Serum CA-125 levels can be raised in all the following except:

Mature cystic teratoma of ovary. ***Mature cystic teratoma of ovary*** - **Mature cystic teratomas** (dermoid cysts) are **germ cell tumors** of the ovary and typically produce tumor markers like **alpha-fetoprotein (AFP)** or **beta-hCG**, but not CA-125. - While they can be large, their cellular origin does not involve the epithelial cells that express CA-125. *Epithelial ovarian cancer* - **Epithelial ovarian cancer** is the most common cause of significantly elevated **CA-125**, as CA-125 is a cell surface glycoprotein produced by coelomic epithelium. - It is used in monitoring treatment response and recurrence in ovarian cancer patients. *Endometriosis* - **Endometriosis** involves the presence of endometrial-like tissue outside the uterus, which can cause local inflammation and irritation, leading to elevated **CA-125** levels. - The degree of CA-125 elevation often correlates with the extent and severity of the disease in some patients. *Tubercular ascites* - **Tubercular ascites** causes inflammation of the peritoneum, which can stimulate mesothelial cells (derived from coelomic epithelium) to produce **CA-125**. - In cases of peritoneal inflammation, such as with tuberculosis, CA-125 levels can be significantly elevated, mimicking ovarian cancer.

Q: Therapeutic options for a 30 year old woman suffering from severe pain due to endometriosis are the following except:

Sildenafil. ***Sildenafil*** - **Sildenafil** is a **vasodilator** primarily used for **erectile dysfunction** and **pulmonary hypertension**. - It has no established role in the **endocrine** or **anti-inflammatory** management required for endometriosis pain. *Mirena* - **Mirena** (levonorgestrel-releasing intrauterine system) is an effective treatment for endometriosis pain because it releases **progestin**, which **suppresses endometrial growth** and inflammation. - It helps reduce both **dysmenorrhea** and **chronic pelvic pain** associated with endometriosis. *Letrozole* - **Letrozole** is an **aromatase inhibitor** that reduces **estrogen synthesis**, which is crucial because endometriosis is an **estrogen-dependent** condition. - By lowering estrogen levels, it can significantly **reduce pain** and the progression of endometrial implants. *Oral contraceptives* - **Combined oral contraceptives (COCs)** are a common and effective first-line treatment for endometriosis pain, as they create a **pseudo-pregnancy state** and **suppress ovulation**. - This suppression leads to a reduction in **estrogen-driven endometrial growth** and subsequent pain.

Q: All of the following are the features of functional ovarian cyst EXCEPT:

Usually symptomatic. ***Correct Answer: Usually symptomatic*** - Functional ovarian cysts are typically **asymptomatic** and discovered incidentally during pelvic examination or imaging studies. - Most patients have no symptoms; when symptoms occur, they are usually mild (pelvic pressure, dull ache). - Being "usually symptomatic" is **NOT a feature** of functional cysts, making this the correct answer to this EXCEPT question. *Incorrect: Usually < 7 cm in diameter* - Most functional ovarian cysts (follicular cysts, corpus luteum cysts) are relatively small, typically measuring **less than 5-7 cm** in diameter. - Cysts larger than 7 cm may warrant further evaluation to rule out neoplastic etiology. - This **IS a feature** of functional cysts. *Incorrect: Unilocular* - Functional cysts are characteristically **simple in structure**: unilocular (single-chambered), thin-walled, containing clear anechoic fluid. - Complex features (septations, solid components, thick walls) suggest neoplastic or other pathologic cysts. - This **IS a feature** of functional cysts. *Incorrect: Spontaneous regression occurs* - Functional ovarian cysts are by definition **transient** and typically resolve spontaneously within **1-3 menstrual cycles** without intervention. - This self-limiting nature is a key characteristic distinguishing them from persistent or neoplastic cysts. - This **IS a feature** of functional cysts.

Q: Which one of the following is NOT a feature of Candida Vaginitis?

Metronidazole is the treatment of choice. ***Metronidazole is the treatment of choice*** - **Metronidazole** is the drug of choice for **bacterial vaginosis** and **trichomoniasis**, not candidal vaginitis. - The primary treatment for **Candida vaginitis** involves **azole antifungal agents** (e.g., fluconazole, miconazole, clotrimazole). *Yeast-buds and pseudohyphae forms can be seen under the microscope* - Microscopic examination of vaginal discharge revealing **yeast buds** and **pseudohyphae** is a classic diagnostic finding for **Candida vaginitis**. - This observation directly confirms the presence of **Candida** organisms. *Pruritus is out of proportion to discharge* - In **Candida vaginitis**, **intense pruritus** (itching) is a hallmark symptom, often severe and disproportionate to the amount of vaginal discharge. - This characteristic itching is due to the inflammatory response triggered by the Candida infection. *Discharge is thick and curdy* - The typical vaginal discharge associated with **Candida vaginitis** is often described as **thick, white, and "cottage cheese-like"** or curdy. - This distinct appearance is a key clinical indicator of a yeast infection.

Q: A 39 year old nulliparous female has presented to Gynaecology OPD with complaint of post-coital bleeding for past six months. The first investigation to be offered to this female will be

Pap smear. ***Pap smear*** - **Post-coital bleeding** is a classic symptom of **cervical pathology**, including **cervical cancer**, which a Pap smear is designed to detect. - As a **screening tool**, a Pap smear is the appropriate initial investigation to broadly assess for abnormal cervical cells. *Hysteroscopy* - Hysteroscopy is an invasive procedure primarily used to visualize the **uterine cavity** and would be considered if concerns about intrauterine pathology arise after initial screening. - It's not the first-line investigation for post-coital bleeding, which typically points to a **cervical or vaginal source**. *Ultrasound* - **Pelvic ultrasound** is useful for evaluating uterine, ovarian, and adnexal pathologies but is less effective for directly visualizing the **cervical surface** where post-coital bleeding often originates. - It would be considered if there are other symptoms suggesting uterine or ovarian issues that aren't typically associated with post-coital bleeding alone. *Endometrial biopsy* - An **endometrial biopsy** is indicated for investigating **abnormal uterine bleeding** originating from the endometrium, such as in cases of suspected **endometrial hyperplasia** or cancer. - Post-coital bleeding is generally not an indication for an initial endometrial biopsy unless other findings suggest an endometrial origin.

Q: A 25-year-old woman presents to the Gynaecology OPD with complaints of abdominal pain and heavy menstrual bleeding. On examination, there is a mass arising from the hypogastrium corresponding to 16 weeks gravid uterus. Her urine pregnancy test is negative. The most likely diagnosis is

Uterine fibroid. ***Uterine fibroid*** - The combination of **heavy menstrual bleeding (menorrhagia)**, **abdominal pain**, and a **palpable mass in the hypogastrium** corresponding to a 16-week gravid uterus in a young woman with a **negative pregnancy test** is classic for uterine fibroid. - Fibroids (leiomyomas) are **benign smooth muscle tumors** of the uterus that can grow to significant size, causing **bulk-related symptoms** and **abnormal uterine bleeding**. - This represents a **large symptomatic fibroid** with the classic triad: menorrhagia, pelvic mass, and pelvic pressure/pain. *Endometriosis* - While endometriosis can cause **cyclical pelvic pain** and **dysmenorrhea**, it typically does not present as a large, palpable mass mimicking a 16-week gravid uterus. - Endometriomas (chocolate cysts) can form masses but are usually **adnexal** rather than central, and menorrhagia is not the primary symptom. *Ovarian tumour* - An ovarian tumor could present with an **abdominal mass** and **pain**, but heavy menstrual bleeding is not a typical feature unless it's a **hormonally active tumor** (rare). - The description of the mass specifically corresponding to a "**gravid uterus**" suggests a **uterine origin** rather than an adnexal mass. - Ovarian masses are typically felt **laterally** or can be more mobile. *Pelvic inflammatory disease* - PID commonly causes **acute pelvic pain**, **fever**, **vaginal discharge**, and **cervical motion tenderness**, but does not typically manifest as a large, smooth, palpable mass arising from the hypogastrium. - Tubo-ovarian abscesses can form masses but are usually **tender**, **irregular**, and associated with **systemic signs of infection**.

Question 1

An infertile woman presents with yellow or green vaginal discharge, a Bartholin cyst and proctitis. What is the most probable diagnosis?

Accepted Answer

Gonorrhoea

Answer

Trichomoniasis

Answer

Syphilis

Answer

Candidiasis

Question 2

The most accurate method to diagnose adenomyosis is:

Accepted Answer

MRI

Answer

Transvaginal sonography

Answer

Hysterosalpingography

Answer

PET-CT

Question 3

A 30 year old multiparous woman comes with an ultrasound report of fibroid uterus measuring 3 x 3 cm. Her only complaint is mild pain during menstruation. The best management in this would be:

Accepted Answer

Reassurance

Answer

Myomectomy

Answer

GnRH analogues

Answer

Hysterectomy

Question 4

For the treatment of a woman with frothy vaginal discharge with fishy smell the following are essential except:

Accepted Answer

Washing of private parts with antiseptics /disinfectants

Answer

Use of condom by partner

Answer

Metronidazole

Answer

Partner treatment

Question 5

Serum CA-125 levels can be raised in all the following except:

Accepted Answer

Mature cystic teratoma of ovary

Answer

Epithelial ovarian cancer

Answer

Endometriosis

Answer

Tubercular ascites

Question 6

Therapeutic options for a 30 year old woman suffering from severe pain due to endometriosis are the following except:

Accepted Answer

Sildenafil

Answer

Mirena

Answer

Letrozole

Answer

Oral contraceptives

Question 7

All of the following are the features of functional ovarian cyst EXCEPT:

Accepted Answer

Usually symptomatic

Answer

Usually < 7 cm in diameter

Answer

Unilocular

Answer

Spontaneous regression occurs

Question 8

Which one of the following is NOT a feature of Candida Vaginitis?

Accepted Answer

Metronidazole is the treatment of choice

Answer

Yeast-buds and pseudohyphae forms can be seen under the microscope

Answer

Pruritus is out of proportion to discharge

Answer

Discharge is thick and curdy

Question 9

A 39 year old nulliparous female has presented to Gynaecology OPD with complaint of post-coital bleeding for past six months. The first investigation to be offered to this female will be

Accepted Answer

Pap smear

Answer

Hysteroscopy

Answer

Ultrasound

Answer

Endometrial biopsy

Question 10

A 25-year-old woman presents to the Gynaecology OPD with complaints of abdominal pain and heavy menstrual bleeding. On examination, there is a mass arising from the hypogastrium corresponding to 16 weeks gravid uterus. Her urine pregnancy test is negative. The most likely diagnosis is

Accepted Answer

Uterine fibroid

Answer

Endometriosis

Answer

Ovarian tumour

Answer

Pelvic inflammatory disease

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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