Gynecological Disorders — MCQs

Consider the following statements regarding Uterine Leiomyoma: 1. Prevalence is highest between 35 and 45 years 2. More common in nulliparous women 3. Display reversible shrinkage after treatment with GnRH 4. Requires to be treated only if symptomatic Which of the statements given above are correct?

Q975

Which one of the following statements regarding Bartholin's glands is NOT true?

Q976

A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

Q977

Monilial vaginitis is commonly associated with all EXCEPT:

Q978

Which of the following are characteristics of Trichomonas vaginitis? 1. Presence of greenish frothy discharge 2. Vaginal pH > 4.5 3. Presence of clue cells in microscopic examination 4. Strawberry spots on the vaginal mucosa Select the correct answer using the code given below:

Q979

Which one of the following is a protective factor for endometrial hyperplasia?

Q980

A female presents with dysuria and vaginal discharge. Wet mount examination shows pear-shaped organisms. What is the most likely diagnosis?

Gynecological Disorders Indian Medical PG Practice Questions and MCQs

Question 971: A 35 year old nulliparous woman complains of menorrhagia and mass per abdomen. On examination, the positive findings are: she is anaemic, has a pelvic mass of 16-18 weeks size, firm in consistency which moves with the movement of cervix. What is the most likely clinical diagnosis?

A. Leiomyoma (Correct Answer)
B. Adenomyosis
C. Ovarian tumour
D. Endometrial carcinoma

Explanation: ***Leiomyoma*** - A **leiomyoma**, or **fibroid**, is a common benign smooth muscle tumor of the uterus, often presenting as **menorrhagia** and a **pelvic mass**. - The mass being **firm, 16-18 weeks size**, and **moving with the cervix** is classic for a uterine fibroid, differentiating it from an adnexal or fixed uterine mass. *Adenomyosis* - Characterized by endometrial tissue within the myometrium, leading to a **globular, tender uterus**, often associated with **dysmenorrhea** and **menorrhagia**. - While it causes menorrhagia, the uterus is typically **tender** and **boggy**, not a firm, discrete mass freely mobile with the cervix. *Ovarian tumour* - An **ovarian tumor** would typically present as an **adnexal mass**, often separate from the uterus and not moving with the cervix. - While an ovarian tumor can cause a pelvic mass, it is less likely to be directly associated with the described menorrhagia or involve the cervix's movement. *Endometrial carcinoma* - Primarily causes **abnormal uterine bleeding**, especially in **postmenopausal women**, but usually does not present as a large, firm, mobile mass detectable on abdominal palpation. - While it can cause menorrhagia, a firm, discrete uterine mass that moves with the cervix is not a typical presentation of **endometrial carcinoma**.

Question 972: A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium majus, overlying skin is red and edematous. What is the most probable diagnosis?

A. Bartholin's abscess (Correct Answer)
B. Trichomoniasis
C. Utero vaginal prolapse
D. Inversion of uterus

Explanation: ***Bartholin's abscess*** - The presentation of a **unilateral, tender swelling** in the **posterior half of the labium majus (not minus)**, with overlying **red and edematous skin**, is highly characteristic of a **Bartholin's abscess**. - This occurs when the **Bartholin's gland duct** becomes obstructed and infected, leading to pus accumulation and inflammation. *Trichomoniasis* - This is a **sexually transmitted infection** that causes **vaginitis**, characterized by a **frothy, foul-smelling discharge**, itching, and dysuria. - It does not present as a **localized, tender swelling** in the labia. *Utero vaginal prolapse* - This condition involves the **descent of the uterus and/or vagina** from their normal position, often causing a **feeling of pressure or a bulge** in the vagina. - It does not manifest as an acute, **unilateral, tender inflammatory swelling** of the labia. *Inversion of uterus* - **Uterine inversion** is a rare and life-threatening obstetric emergency, typically occurring **postpartum**, where the uterus turns inside out. - Its symptoms include **severe pain, hemorrhage, and shock**, and it is not related to a localized labial swelling.

Question 973: Which of the following is NOT an ideally suited condition for use of ring pessary in case of uterine prolapse?

A. Puerperium
B. Patient's unwillingness for surgery
C. Patient unfit for surgery
D. Late pregnancy (Correct Answer)

Explanation: ***Late pregnancy*** - A ring pessary is generally **contraindicated** in late pregnancy due to the risk of inducing uterine contractions, premature rupture of membranes, or infection, and it is not an appropriate long-term solution for prolapse during this period. - The gravid uterus itself acts as a natural support for prolapsed organs, making a pessary less necessary and potentially harmful. *Puerperium* - The **puerperium** can be an ideal time for pessary use, especially if prolapse is noted shortly after delivery. - Tissues are still lax and remodeling, and a pessary can help support the uterus and vagina during this healing phase, potentially preventing more severe prolapse later on. *Patient's unwillingness for surgery* - For patients who **decline surgical intervention**, a ring pessary offers a non-surgical management option for uterine prolapse, providing relief from symptoms. - It allows patients to manage their condition conservatively and is a practical choice given their personal preference. *Patient unfit for surgery* - In cases where a patient has significant comorbidities that make them **unsuitable for surgery** (e.g., severe cardiac disease, advanced age), a ring pessary is a safe and effective alternative. - It provides symptomatic relief without the risks associated with general anesthesia and surgical recovery.

Question 974: Consider the following statements regarding Uterine Leiomyoma: 1. Prevalence is highest between 35 and 45 years 2. More common in nulliparous women 3. Display reversible shrinkage after treatment with GnRH 4. Requires to be treated only if symptomatic Which of the statements given above are correct?

A. 2 and 3 only
B. 1 and 4 only
C. 1, 2 and 3 only
D. 1, 2, 3 and 4 (Correct Answer)

Explanation: ***1, 2, 3 and 4*** - **Statement 1 is correct**: The prevalence of uterine leiomyomas is highest between **35 and 45 years of age**, as these are estrogen-dependent tumors that grow during reproductive years and peak in the 4th-5th decades. - **Statement 2 is correct**: Leiomyomas are **more common in nulliparous women**. Nulliparity is a well-established risk factor for fibroids. Each full-term pregnancy is associated with a reduced risk of developing fibroids, likely due to hormonal changes and uterine remodeling during pregnancy. - **Statement 3 is correct**: GnRH agonists cause **reversible shrinkage** of leiomyomas (typically 30-60% volume reduction). The term "reversible" accurately describes that fibroids regrow after treatment cessation. This makes GnRH agonists useful for preoperative shrinkage or temporary symptom relief, but not a permanent solution. - **Statement 4 is correct**: Leiomyomas **require treatment only if symptomatic**. Asymptomatic fibroids are managed with observation. Treatment is indicated for symptoms like menorrhagia, pelvic pain, pressure symptoms, or reproductive issues. *1 and 4 only* - Incorrect because statements 2 and 3 are also correct. *2 and 3 only* - Incorrect because statements 1 and 4 are also correct. *1, 2 and 3 only* - Incorrect because statement 4 is also correct.

Question 975: Which one of the following statements regarding Bartholin's glands is NOT true?

A. The duct is lined by columnar epithelium
B. Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions
C. Gonococci is the most common cause of Bartholin's abscess (Correct Answer)
D. They are situated in superficial perineal pouch

Explanation: ***Gonococci is the most common causing Bartholin's abscess*** - This statement is **incorrect** because while *Neisseria gonorrhoeae* can cause Bartholin's abscess, polymicrobial infections involving **Escherichia coli (E. coli)** are far more common. - **Anaerobic bacteria** and other enteric organisms frequently contribute to Bartholin's gland infections and abscess formation. *Duct opens in the groove between hymen and labia minora at 4 and 8 o'clock positions* - This is a **true** statement, accurately describing the typical anatomical location where the ducts of the Bartholin's glands open onto the vulva. - This specific position makes the ducts vulnerable to **obstruction and infection**. *The duct is lined by columnar epithelium* - This is a **true** statement, as the ducts of the Bartholin's glands are indeed lined by **columnar epithelium**, which transitions to squamous epithelium as it approaches the vestibular opening. - This type of lining is characteristic of glands that secrete mucus. *They are situated in superficial perineal pouch* - This is a **true** statement, as the Bartholin's glands are located within the **superficial perineal pouch** (or superficial perineal space), posterior to the vestibular bulbs. - Their presence in this space is clinically relevant for understanding their anatomy and pathology.

Question 976: A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true regarding the above case? 1. Bartholin's abscess may be the likely diagnosis 2. It is to be managed by marsupialisation 3. Gonococcus is the most common pathogenic organism Select the correct answer using the code given below:

A. 3 only
B. 1, 2 and 3
C. 1 and 2 only (Correct Answer)
D. 1 and 3 only

Explanation: ***1 and 2 only*** - The presentation of **painful, unilateral vulvar swelling for 3 days** is highly suggestive of a **Bartholin's abscess**, making statement 1 correct. - **Marsupialization** is a valid surgical management option for Bartholin's abscess. While **incision and drainage with Word catheter placement** is preferred for acute cases, marsupialization can be performed and is especially indicated for recurrent cases. Statement 2 is considered true as marsupialization is an accepted treatment modality. - **Statement 3 is false**: Gonococcus is NOT the most common organism. **Polymicrobial infections** (E. coli, Staphylococcus, Streptococcus, anaerobes) are most common in current practice. Gonococcus accounts for <10% of cases. *3 only* - This option is incorrect because statement 3 alone is false (Gonococcus is not the most common organism), while statements 1 and 2 are true. - Selecting only statement 3 contradicts the clinical presentation and current microbiology data. *1, 2 and 3* - This option is incorrect because **statement 3 is false**. Gonococcus is no longer the most common pathogenic organism causing Bartholin's abscesses. - **Polymicrobial infections** predominate in modern practice, making this combination incorrect. *1 and 3 only* - This option is incorrect because it excludes statement 2 (marsupialization is a valid management option) while including statement 3 (which is false regarding Gonococcus being the most common organism). - This combination is medically inaccurate on both counts.

Question 977: Monilial vaginitis is commonly associated with all EXCEPT:

A. Prolonged antibiotic therapy
B. Treatment of malaria with chloroquine (Correct Answer)
C. Pregnancy
D. Diabetes Mellitus

Explanation: ***Treatment of malaria with chloroquine*** - **Chloroquine** is an antimalarial drug and has no direct known association with an increased risk of **monilial vaginitis (candidiasis)**. - Unlike antibiotics, corticosteroids, or immunosuppressants, chloroquine does not significantly alter the vaginal flora or immune response in a way that predisposes to Candida overgrowth. *Prolonged antibiotic therapy* - **Antibiotics** can disrupt the normal vaginal flora by killing off beneficial bacteria (like *Lactobacillus*), leading to an overgrowth of **Candida albicans**. - This altered microbial balance is a common cause of **vulvovaginal candidiasis (VVC)**. *Pregnancy* - Hormonal changes during **pregnancy**, particularly elevated estrogen levels, can increase **glycogen deposition** in vaginal epithelial cells. - This provides a rich food source for **Candida**, making pregnant women more susceptible to **monilial vaginitis**. *Diabetes Mellitus* - **Poorly controlled diabetes mellitus** leads to hyperglycemia, which can result in **elevated glucose levels** in vaginal secretions. - This increased glucose serves as a nutrient for **Candida albicans**, fostering its growth and making diabetic women more prone to recurrent **vaginal yeast infections**.

Question 978: Which of the following are characteristics of Trichomonas vaginitis? 1. Presence of greenish frothy discharge 2. Vaginal pH > 4.5 3. Presence of clue cells in microscopic examination 4. Strawberry spots on the vaginal mucosa Select the correct answer using the code given below:

A. 1, 3 and 4
B. 2, 3 and 4
C. 1, 2 and 3
D. 1, 2 and 4 (Correct Answer)

Explanation: ***1, 2 and 4*** - **Trichomonas vaginalis** infection classically presents with a **greenish, frothy, malodorous vaginal discharge**, and the vaginal pH is typically **elevated (>4.5)** due to the pathogen's metabolic activity. - The presence of **strawberry spots (colpitis macularis)** on the vaginal and cervical mucosa is a hallmark sign, resulting from punctate hemorrhages. *1, 3 and 4* - This option correctly includes **greenish frothy discharge** and **strawberry spots**, which are characteristic of *Trichomonas vaginitis*. - However, the inclusion of "presence of **clue cells**" is incorrect as clue cells are pathognomonic for **bacterial vaginosis**, not *Trichomonas*. *2, 3 and 4* - This option correctly identifies **vaginal pH > 4.5** and **strawberry spots** as features of *Trichomonas vaginitis*. - The presence of **clue cells** is a misattribution to *Trichomonas* infection; instead, clue cells are defining features of **bacterial vaginosis**. *1, 2 and 3* - While **greenish frothy discharge** and **vaginal pH > 4.5** are indeed characteristic of *Trichomonas vaginitis*, the presence of **clue cells** is a diagnostic criterion for **bacterial vaginosis**. - **Strawberry spots** are a distinct feature of *Trichomonas* that is missing from this selection.

Question 979: Which one of the following is a protective factor for endometrial hyperplasia?

A. Tamoxifen therapy
B. Multiparity (Correct Answer)
C. Diabetes
D. Delayed menopause

Explanation: ***Multiparity*** - **Multiparity** is a protective factor against endometrial hyperplasia due to **periods of anovulation and progesterone dominance** during pregnancy. - Each pregnancy provides prolonged exposure to high levels of **progesterone**, which counteracts unopposed estrogenic effects on the endometrium and prevents hyperplasia. - Multiple pregnancies reduce the total number of **ovulatory cycles** in a woman's lifetime, thereby decreasing cumulative exposure to unopposed estrogen. *Tamoxifen therapy* - **Tamoxifen**, while an anti-estrogen in breast tissue, acts as a **partial estrogen agonist** on the endometrium, increasing the risk of endometrial hyperplasia and cancer. - It can lead to changes in the endometrial lining, including **polyps** and hyperplasia, due to its estrogenic effects in the uterus. *Diabetes* - **Diabetes**, particularly type 2, is a risk factor for endometrial hyperplasia and cancer, not a protective factor. - It is associated with **increased insulin levels** and insulin-like growth factors, which can promote endometrial cell proliferation. *Delayed menopause* - **Delayed menopause** means a longer lifetime exposure to estrogen during the reproductive years. - Prolonged exposure to **unopposed estrogen** is a significant risk factor for endometrial hyperplasia, as it promotes endometrial proliferation.

Question 980: A female presents with dysuria and vaginal discharge. Wet mount examination shows pear-shaped organisms. What is the most likely diagnosis?

A. Candida
B. Chlamydia
C. Trichomonas (Correct Answer)
D. Bacterial vaginosis

Explanation: ***Trichomonas*** - The presence of **dysuria**, **vaginal discharge**, and **pear-shaped organisms** on wet mount examination is classic for **Trichomonas vaginalis** infection. - **Microscopic identification of motile trichomonads** confirms the diagnosis. *Candida* - **Candida** infections typically present with **thick, white, curd-like vaginal discharge**, and a wet mount would show **yeast buds or pseudohyphae**, not pear-shaped organisms. - While it can cause dysuria, the discharge characteristics and microscopy findings differentiate it. *Chlamydia* - **Chlamydia trachomatis** causes **mucopurulent cervicitis** with dysuria and vaginal discharge, but requires **specific diagnostic tests** such as **NAAT (nucleic acid amplification test)** or cell culture for diagnosis. - Wet mount examination would **not show pear-shaped organisms**; instead, it may show increased white blood cells but no specific pathogen visualization. *Bacterial vaginosis* - **Bacterial vaginosis** is characterized by a **thin, gray discharge** and a **"fishy" odor**, which is especially noticeable after intercourse. - Wet mount shows **clue cells** (vaginal epithelial cells studded with bacteria), not pear-shaped organisms, and **absent or few white blood cells**.

Practice by Chapter

Abnormal Uterine Bleeding

Practice Questions

Endometriosis

Practice Questions

Adenomyosis

Practice Questions

Uterine Fibroids

Practice Questions

Ovarian Cysts

Practice Questions

Pelvic Inflammatory Disease

Practice Questions

Vulvovaginitis

Practice Questions

Pelvic Organ Prolapse

Practice Questions

Vulvar Disorders

Practice Questions

Benign Breast Diseases

Practice Questions

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