Gynecological Disorders Practice Questions

Q: Which of the following are the characteristic features of Meigs' syndrome in a female? 1. Right sided hydrothorax 2. Ascites 3. Genital warts 4. Ovarian fibroma

1, 2 and 4. **1, 2 and 4** - **Meigs' syndrome** is defined by the triad of an **ovarian fibroma** (or other benign ovarian tumor), **ascites**, and **right-sided hydrothorax**. - All three components must be present for a clinical diagnosis of Meigs' syndrome. *1, 3 and 4* - While **right-sided hydrothorax** and an **ovarian fibroma** are components of Meigs' syndrome, **genital warts** are not. - **Genital warts** are caused by Human Papillomavirus (HPV) and are not associated with this syndrome. *2, 3 and 4* - **Ascites** and an **ovarian fibroma** are correctly identified as features, but **genital warts** are not part of Meigs' syndrome. - The syndrome specifically requires the presence of a **pleural effusion (hydrothorax)**, typically on the right side. *1, 2, 3 and 4* - This option mistakenly includes **genital warts**, which are not a feature of Meigs' syndrome. - The core diagnostic criteria are limited to the ovarian tumor, ascites, and hydrothorax.

Q: Which of the following are risk factors for developing pelvic inflammatory disease in females? 1. Use of oral contraception pills 2. Multiple sexual partners 3. Lower socioeconomic status 4. Genetic predisposition

1, 2 and 3. ***1, 2 and 3*** - **Multiple sexual partners** is a well-established major risk factor for PID as it significantly increases exposure to sexually transmitted infections (STIs), particularly *Chlamydia trachomatis* and *Neisseria gonorrhoeae*, which are the primary causative organisms of PID. - **Lower socioeconomic status** is associated with increased PID risk due to reduced access to healthcare services, delayed diagnosis and treatment of STIs, and barriers to preventive care. - **Use of oral contraception pills** has a controversial relationship with PID. While OCPs do not prevent STIs and may be associated with behavioral factors (reduced condom use), the direct relationship remains debated. Some evidence suggests OCPs may actually provide modest protection against ascending infection by thickening cervical mucus. However, this option represents the best available answer among the choices given. *1, 2 and 4* - This incorrectly includes **genetic predisposition**, which is not an established risk factor for PID. PID is primarily an infectious disease driven by behavioral and socioeconomic factors, not genetic susceptibility. *2, 3 and 4* - This incorrectly includes **genetic predisposition** as a risk factor for PID, which lacks evidence-based support. - It also excludes oral contraception pills, making this option incomplete even considering the controversial role of OCPs. *1, 3 and 4* - This incorrectly includes **genetic predisposition** and critically excludes **multiple sexual partners**, which is the most significant and well-established behavioral risk factor for PID. - Missing this key risk factor makes this option clearly incorrect.

Q: The vaginal pH in childbearing age normally ranges between

4 - 5.5. ***4 - 5.5*** - A vaginal pH within the range of **4.0 to 5.5** is considered normal for women of childbearing age, indicating a healthy acidic environment. - This acidic pH is maintained primarily by **Lactobacillus species** bacteria, which produce lactic acid, protecting against pathogenic bacteria. *1 - 2* - A pH range of 1-2 is **extremely acidic** and would be highly corrosive, far outside the physiological range for the vagina. - This level of acidity is typically found in the **stomach**, not the vagina. *7 - 8* - A pH range of 7-8 is considered **alkaline** and suggests an imbalance in the vaginal flora, potentially leading to infections such as **bacterial vaginosis**. - A neutral to alkaline pH is harmful to the normal vaginal microbiota and can promote the growth of opportunistic pathogens. *2.5 - 3.5* - While acidic, a pH of 2.5-3.5 is generally **too low** for a healthy vagina in most women of childbearing age, as the normal range typically starts closer to 4.0. - Although the vagina is acidic, this range is at the **extreme lower end** and might indicate an altered microenvironment.

Q: A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from

Fibrocystic disease. ***Fibrocystic disease*** - **Fibrocystic changes** usually present with **lumpy breasts**, pain, and sometimes **multiple** duct nipple discharge, which can be clear or milky. - A **single duct serous discharge** is not a typical presentation, making it less likely given the details. *Intraductal Papilloma* - **Intraductal papilloma** is the **most common cause** of **serous or bloody nipple discharge** from a **single duct**. - This benign tumor grows within the milk ducts and is a frequent finding with the described symptoms. *Carcinoma* - **Ductal carcinoma in situ (DCIS)** or **invasive ductal carcinoma** can present with **unilateral, bloody or serous nipple discharge** from a **single duct**. - The type of discharge and its unilateral, single-duct nature are concerning features that warrant malignancy exclusion. *Duct Ectasia* - **Duct ectasia** can cause nipple discharge which is often **thick, sticky, and multicolored** (green, black, or brown), and may be associated with **nipple inversion**. - While it can be from a single duct, the discharge is typically **not serous** and is more characteristic of a **dilated or inflamed duct**.

Q: The second most common site for endometriosis after the ovary is:

Peritoneum of the pouch of Douglas. ***Peritoneum of the pouch of Douglas*** - The **pouch of Douglas** (rectouterine pouch) is the most common site for endometriosis after the ovaries, where endometrial tissue deposits frequently occur. - Due to its dependent position in the pelvis, **shed endometrial cells** from retrograde menstruation are thought to accumulate here. *Round ligaments* - While endometriosis can occur in the round ligaments, it is far **less common** than in the cul-de-sac or on the ovaries. - Endometriotic lesions in this location might mimic other conditions, making diagnosis challenging. *Fallopian tubes* - Endometriosis can affect the fallopian tubes, leading to conditions like **hydrosalpinx** or adhesion formation, but it is not the second most common site. - The tubes are more frequently involved by **pelvic inflammatory disease** or ectopic pregnancy. *Outer surface of uterus* - Endometriosis on the outer surface of the uterus (serosa) is possible, but **less common** than in the ovaries or the pouch of Douglas. - Lesions here can contribute to **adhesions** between the uterus and adjacent structures.

Q: A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Adenomyosis. ***Adenomyosis*** - **Adenomyosis** is characterized by the presence of **endometrial glands and stroma within the myometrium**, leading to a diffusely enlarged uterus and often presenting with **severe dysmenorrhoea** and **dyspareunia**. - A **uniformly enlarged, tender uterus** (described as 8 weeks size) in a patient with these symptoms is highly suggestive of adenomyosis, as the ectopic endometrial tissue causes pain and uterine enlargement. *Fibroid uterus* - **Fibroids (leiomyomas)** typically cause an **irregularly enlarged uterus** and can lead to heavy menstrual bleeding (menorrhagia) and pelvic pressure, but severe dyspareunia is less common. - While fibroids can cause an enlarged uterus and dysmenorrhoea, the **uniform enlargement** and prominent **tenderness of the posterior fornix** (suggesting broad involvement) are more aligned with adenomyosis. *Endometrial carcinoma* - **Endometrial carcinoma** typically presents with **postmenopausal bleeding** or abnormal uterine bleeding, often in older women, and usually does not cause a uniformly enlarged and tender uterus. - While it can cause pelvic pain, the specific presentation of **severe dysmenorrhoea and dyspareunia** with a diffusely enlarged and tender uterus is not characteristic of endometrial cancer. *Dysfunctional uterine bleeding* - **Dysfunctional uterine bleeding (DUB)** refers to abnormal bleeding that is not due to structural or systemic causes, often associated with **anovulation** and hormonal imbalances, primarily characterized by irregular or heavy periods. - DUB usually does not cause a **uniformly enlarged or tender uterus** and is less directly associated with the severe dysmenorrhoea and dyspareunia seen in this case.

Q: For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Tranexamic acid. ***Tranexamic acid*** - **Tranexamic acid** is an antifibrinolytic agent used to reduce **heavy menstrual bleeding** by inhibiting plasminogen activation. - In a woman with a **normal menstrual cycle** who has undergone surgery for a chocolate cyst, heavy bleeding is not an issue, so tranexamic acid would be **unnecessary** and not indicated for endometriosis management. *Oral progestogens* - **Oral progestogens** are commonly prescribed for endometriosis to **suppress ovarian activity** and induce decidualization and atrophy of endometrial implants. - They help manage symptoms like **pain** and prevent recurrence of chocolate cysts by creating a **progestin-dominant environment**. *Injection leuprolide* - **Leuprolide** is a **GnRH agonist** that creates a **hypoestrogenic state** by downregulating pituitary GnRH receptors, thereby suppressing ovarian hormone production. - This effectively reduces the growth of **endometrial implants** and manages endometriosis symptoms, often used post-operatively to prevent recurrence. *Tablet dienogest* - **Dienogest** is a **fourth-generation progestin** specifically approved for the treatment of endometriosis. - It works by suppressing ovarian estrogen production and inhibiting the growth of **endometrial lesions**, making it a suitable long-term post-operative therapy.

Q: A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Monilial vaginitis. ***Monilial vaginitis*** - The classic presentation of **curdy white discharge** and **pruritus vulvae** is highly suggestive of vulvovaginal candidiasis (**monilial vaginitis**), often exacerbated by **oral contraceptive pill** use. - OCPs can alter vaginal flora and increase glycogen content, promoting the growth of *Candida* species. *Atrophic vaginitis* - This condition is caused by **estrogen deficiency**, typically seen in **postmenopausal women**, and is unlikely in a woman using oral contraceptive pills. - Symptoms include **vaginal dryness**, irritation, and dyspareunia, usually without a thick, curdy discharge. *Gardnerella vaginalis* - *Gardnerella vaginalis* causes **bacterial vaginosis**, characterized by a **thin, gray, malodorous ("fishy") discharge**, not a curdy white one. - There is typically no significant vulval pruritus with *Gardnerella* infection. *Trichomonal vaginitis* - **Trichomoniasis** presents with a **frothy, greenish-yellow discharge** and often a **"strawberry cervix"** on examination, which is distinct from the described curdy white discharge. - It is a sexually transmitted infection, and while pruritus can occur, the discharge characteristics are different.

Q: A 35 year old married woman with no risk factors for cervical cancer is having Pap smear showing 'atypical squamous cells of undetermined significance (ASCUS)' for the first time. What is the further step in the management?

To follow up with Pap test at 6 months. ***To follow up with Pap test at 6 months*** - For **ASCUS** (atypical squamous cells of undetermined significance) in women with **no risk factors** and a first-time finding, **repeat Pap testing** in 6-12 months is the recommended initial follow-up strategy. - This approach allows for the possibility of **spontaneous regression** of minor cellular changes, avoiding unnecessary immediate interventions. *Cryotherapy* - **Cryotherapy** is a treatment for **cervical intraepithelial neoplasia (CIN)**, a more severe finding than ASCUS. - It would be **premature and excessive** for an initial finding of ASCUS, which may resolve on its own. *Large loop excision of the transformation zone* - **LLETZ** is a procedure used to **remove abnormal cervical cells**, typically for **high-grade CIN** or persistent CIN, not for ASCUS. - Performing LLETZ for ASCUS would be an **overtreatment** and carries procedural risks without clear benefit. *Repeat Pap immediately* - Repeating the Pap smear **immediately** after an ASCUS finding is generally **not recommended** as it is unlikely to provide new diagnostic information due to the rapid cellular turnover. - A 6-month interval allows for potential cellular changes to become more definitive, whether for improvement or progression.

Q: Defective fusion of the Mullerian ducts may give rise to which of the following?

Uterus bicornis unicollis. ***Uterus bicornis unicollis*** - This condition results from the **incomplete fusion** of the two Müllerian ducts, leading to a uterus with a **septum** or two distinct uterine cavities but a single cervix and vagina. - The Müllerian ducts are embryological structures that develop into the **female reproductive tract**, including the uterus, fallopian tubes, cervix, and upper two-thirds of the vagina. *Imperforate anus* - This congenital condition is due to the **failure of the anal membrane to rupture** during development, not related to Müllerian duct fusion. - It affects the **gastrointestinal tract** and is not derived from Müllerian structures. *Absence of the ovaries* - The **ovaries** develop from the **gonadal ridges** and are distinct from the Müllerian ducts; therefore, their absence is not due to defective Müllerian fusion. - Conditions like **gonadal dysgenesis** can lead to absent or streak ovaries. *Imperforate hymen* - An imperforate hymen results from the failure of the **hymen to canalize** during fetal development, leading to an obstruction of the vaginal introitus. - The hymen is formed from the **urogenital sinus**, which is embryologically distinct from the Müllerian ducts.

Question 1

Which of the following are the characteristic features of Meigs' syndrome in a female?

1. Right sided hydrothorax
2. Ascites
3. Genital warts
4. Ovarian fibroma

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2, 3 and 4

Question 2

Which of the following are risk factors for developing pelvic inflammatory disease in females?

1. Use of oral contraception pills
2. Multiple sexual partners
3. Lower socioeconomic status
4. Genetic predisposition

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 3

The vaginal pH in childbearing age normally ranges between

Accepted Answer

4 - 5.5

Answer

1 - 2

Answer

7 - 8

Answer

2.5 - 3.5

Question 4

A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from

Accepted Answer

Fibrocystic disease

Answer

Intraductal Papilloma

Answer

Carcinoma

Answer

Duct Ectasia

Question 5

The second most common site for endometriosis after the ovary is:

Accepted Answer

Peritoneum of the pouch of Douglas

Answer

Round ligaments

Answer

Fallopian tubes

Answer

Outer surface of uterus

Question 6

A 30-year-old female has severe dysmenorrhoea and dyspareunia. On examination, uterus is 8-week size, uniformly enlarged and there is tenderness in posterior fornix. What is the most probable diagnosis?

Accepted Answer

Adenomyosis

Answer

Fibroid uterus

Answer

Endometrial carcinoma

Answer

Dysfunctional uterine bleeding

Question 7

For a woman who has been operated for chocolate cyst with normal menstrual cycle, any of the following may be prescribed except:

Accepted Answer

Tranexamic acid

Answer

Oral progestogens

Answer

Injection leuprolide

Answer

Tablet dienogest

Question 8

A lady who is using oral contraceptive pills comes with a complaint of vaginal discharge and pruritus vulvae. On local examination, there is curdy white discharge from the vagina. What is the most likely clinical diagnosis?

Accepted Answer

Monilial vaginitis

Answer

Atrophic vaginitis

Answer

Gardnerella vaginalis

Answer

Trichomonal vaginitis

Question 9

A 35 year old married woman with no risk factors for cervical cancer is having Pap smear showing 'atypical squamous cells of undetermined significance (ASCUS)' for the first time. What is the further step in the management?

Accepted Answer

To follow up with Pap test at 6 months

Answer

Cryotherapy

Answer

Large loop excision of the transformation zone

Answer

Repeat Pap immediately

Question 10

Defective fusion of the Mullerian ducts may give rise to which of the following?

Accepted Answer

Uterus bicornis unicollis

Answer

Imperforate anus

Answer

Absence of the ovaries

Answer

Imperforate hymen

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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