Diseases of Female Genital Tract — MCQs
A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?
Most common uterine tumor is:-
Which of the following is a tumor marker associated with ovarian solid-cystic masses?
Vaginal pH before puberty is?
Which HPV oncoprotein initiates cervical carcinogenesis primarily by inactivating the p53 tumor suppressor?
A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
The mucosal lining of the vagina is composed of cells:
In a woman complaining of AUB following image was seen in endoscopic examination of uterus. What will be the diagnosis?
Which of the following structures has the function of capacitation?
What visual disturbance is caused by an optic tract lesion?
Diseases of Female Genital Tract Indian Medical PG Practice Questions and MCQs
Question 1: A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?
- A. She is at risk of cervical cancer
- B. She is at risk of endometrial cancer (Correct Answer)
- C. She is at risk of ovarian cancer
- D. None of the above
Explanation: ***She is at risk of endometrial cancer*** - The combination of **obesity**, **hirsutism**, and **high testosterone** in a 35-year-old female is highly suggestive of **Polycystic Ovary Syndrome (PCOS)**. - PCOS is associated with **anovulation**, leading to unopposed estrogen exposure which increases the risk of **endometrial hyperplasia** and **cancer**. *She is at risk of cervical cancer* - **Cervical cancer** is primarily caused by persistent infection with **high-risk human papillomavirus (HPV)**. - The patient's presentation of hirsutism and high testosterone does not directly indicate an increased risk of cervical cancer. *She is at risk of ovarian cancer* - While PCOS is a risk factor for some types of cancer, it is not consistently linked to an increased risk of common **epithelial ovarian cancers**. - There is a debated, but not strongly established, link between PCOS and certain **sex cord stromal tumors** of the ovary, but not the more common forms of ovarian cancer. *None of the above* - This option is incorrect because the clinical picture strongly points to a condition (PCOS) that significantly increases the risk for endometrial cancer.
Question 2: Most common uterine tumor is:-
- A. Adenomyoma
- B. Endometrial cancer
- C. Leiomyosarcoma
- D. Leiomyoma (Correct Answer)
Explanation: ***Leiomyoma*** - **Leiomyomas**, also known as **fibroids**, are the most **common benign tumors of the uterus**. - They are composed of **smooth muscle cells** and can vary in size and location within the uterus. *Adenomyoma* - An **adenomyoma** is a benign uterine tumor characterized by the presence of **endometrial glands and stroma** within the myometrium. - While it is a uterine tumor, it is significantly **less common** than leiomyomas. *Endometrial cancer* - **Endometrial cancer** is a **malignant tumor** arising from the endometrium and is the most common gynecologic malignancy. - However, malignant tumors are generally **less common** than benign tumors like leiomyomas. *Leiomyosarcoma* - **Leiomyosarcoma** is a **rare and aggressive malignant tumor** of the smooth muscle tissue of the uterus. - It accounts for a very small percentage of uterine masses and is much less common than benign leiomyomas.
Question 3: Which of the following is a tumor marker associated with ovarian solid-cystic masses?
- A. CEA
- B. HCG
- C. HER2/neu
- D. AFP (Correct Answer)
Explanation: ***AFP (Alpha-fetoprotein)*** - **AFP** is a reliable tumor marker for differentiating **germ cell tumors**, especially **yolk sac tumors**, which often present as an ovarian solid-cystic mass. - Elevated **AFP** levels help in diagnosis, monitoring treatment response, and detecting recurrence of these specific ovarian malignancies. *CEA (Carcinoembryonic antigen)* - **CEA** is primarily associated with **gastrointestinal cancers**, such as colorectal cancer, and is less specific for ovarian masses. - While it can be elevated in some mucinous ovarian carcinomas, it's not the most specific marker for a general solid-cystic ovarian mass. *HCG (Human chorionic gonadotropin)* - **HCG** is a key marker for **gestational trophoblastic disease** and some **germ cell tumors**, such as choriocarcinoma. - It is not typically elevated in most common solid-cystic ovarian masses, especially those of epithelial origin. *HER2/neu (Human Epidermal growth factor Receptor 2)* - **HER2/neu** is primarily associated with **breast cancer** and some gastric cancers, playing a role in targeted therapy. - It is not a standard tumor marker for the general evaluation or diagnosis of ovarian solid-cystic masses.
Question 4: Vaginal pH before puberty is?
- A. Approximately 6
- B. Approximately 4.5
- C. Approximately 5
- D. Neutral (around 7) (Correct Answer)
Explanation: ***Neutral (around 7)*** - Before puberty, the vagina lacks the influence of **estrogen**, which is essential for the colonization of **Lactobacillus** bacteria. - Without Lactobacillus, there is no significant production of lactic acid, resulting in a **neutral pH** environment. *Approximately 6* - A pH of approximately 6 is still slightly acidic but less so than a mature vagina. - This value is not typical for the prepubertal stage, which generally represents an environment without significant acidic production. *Approximately 4.5* - A pH of approximately 4.5 is characteristic of a **healthy, estrogenized adult vagina** where **Lactobacillus** bacteria produce lactic acid. - This acidic environment is crucial for protecting against pathogenic infections and is not found in prepubertal individuals. *Approximately 5* - A pH of approximately 5 is acidic, though less so than the optimal adult vaginal pH. - This value indicates some lactic acid production, which is minimal or absent before the onset of puberty.
Question 5: Which HPV oncoprotein initiates cervical carcinogenesis primarily by inactivating the p53 tumor suppressor?
- A. E3
- B. E5
- C. E6 (Correct Answer)
- D. E7
Explanation: ***E6*** - **E6 oncoprotein is the HPV protein that specifically targets and degrades p53** through ubiquitin-mediated proteolysis [2]. - **p53 degradation** prevents apoptosis and allows cells with damaged DNA to survive and proliferate, a critical early step in malignant transformation [3]. - E6 works synergistically with E7 in cervical carcinogenesis, but **E6 is uniquely responsible for p53 inactivation** [1]. *E3* - HPV does not have a clinically significant E3 oncoprotein in the context of cervical cancer pathogenesis. - This is not a major viral oncoprotein involved in malignant transformation. *E5* - **E5 oncoprotein** plays a minor role in early infection by enhancing growth factor receptor signaling. - It does **not target p53** and is often lost during viral integration, making it less critical for malignant progression. *E7* - **E7 oncoprotein targets the retinoblastoma protein (Rb)**, not p53 [1]. - Rb inactivation releases E2F transcription factors, driving cell cycle progression [1]. - E7 and E6 work together, but **E7's specific target is Rb, not p53** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 334-335. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1006-1007. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 303-304.
Question 6: A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
- A. Malignancy of the vulva
- B. Malignancy of the cervix
- C. Malignancy of the endometrium (Correct Answer)
- D. Malignancy of the ovary
Explanation: ***Malignancy of the endometrium*** - **Postmenopausal bleeding** is the classic presenting symptom of **endometrial cancer**, which must be ruled out in all such cases. - **Diabetes** is a known risk factor for endometrial cancer, along with obesity, hypertension, and unopposed estrogen exposure. *Malignancy of the vulva* - Vulvar cancer typically presents with a **pruritic lesion**, lump, or ulcer on the vulva, rather than solely with vaginal bleeding. - While bleeding can occur from an advanced vulvar lesion, it is not the primary or most common presentation for new onset postmenopausal bleeding. *Malignancy of the cervix* - Cervical cancer often presents with **postcoital bleeding** or irregular vaginal bleeding in premenopausal women, or less commonly, postmenopausal bleeding. - Screening with **Pap smears** typically detects precancerous changes or early cervical cancer, making it less likely to be the first presentation with postmenopausal bleeding in a well-screened population. *Malignancy of the ovary* - Ovarian cancer is often asymptomatic in its early stages and presents with non-specific symptoms like **abdominal distension**, bloating, or pelvic pain. - **Vaginal bleeding** is not a typical symptom of ovarian cancer, unless the tumor is very large, involves adjacent structures, or is a hormone-producing tumor.
Question 7: The mucosal lining of the vagina is composed of cells:
- A. Stratified squamous non-keratinized (Correct Answer)
- B. Ciliated columnar epithelium
- C. Pseudostratified columnar epithelium
- D. Transitional epithelium
Explanation: ***Stratified squamous non-keratinized*** - The **vaginal epithelium** is composed of several layers of flattened, nucleated cells that provide **protection against friction** and resist pathogen entry during intercourse and childbirth [1]. - The **non-keratinized nature** ensures the mucosa remains moist and flexible, essential for its function. *Ciliated columnar epithelium* - This type of epithelium is found in locations like the **fallopian tubes** and parts of the **respiratory tract**, where cilia help in moving fluids or particles. - It does not provide the robust protective barrier required for the vagina. *Pseudostratified columnar epithelium* - This epithelium, characterized by nuclei at different levels giving a "pseudostratified" appearance, is typically found in the **trachea** and **bronchi**. In the uterus, however, the endometrial glands are lined by regular, tall, pseudostratified columnar cells during the proliferative phase [2]. - Its primary function is secretion and absorption, not the physical protection needed in the vagina. *Transitional epithelium* - Also known as **urothelium**, this type is specialized to accommodate stretching and is found in the **urinary bladder** and ureters. - It is not suited for the constant friction and protective role of the vaginal lining.
Question 8: In a woman complaining of AUB following image was seen in endoscopic examination of uterus. What will be the diagnosis?
- A. Leiomyoma (Correct Answer)
- B. Adenomyosis
- C. Ovarian neoplasm
- D. Carcinoma of uterus
Explanation: ***Leiomyoma*** - The image shows **well-circumscribed, smooth, rounded masses protruding into the uterine cavity**, which are characteristic of **submucous (intracavitary) leiomyomas (fibroids)** seen on hysteroscopy. - Submucous leiomyomas are benign smooth muscle tumors that project into the endometrial cavity and commonly cause **abnormal uterine bleeding (AUB)** due to increased endometrial surface area, distortion of the endometrial cavity, ulceration of overlying endometrium, and interference with normal uterine contractility. - On **hysteroscopic examination**, they appear as firm, pale, smooth-surfaced masses with overlying endometrium. *Adenomyosis* - Adenomyosis involves the presence of **endometrial tissue within the myometrium**, leading to diffuse uterine enlargement. - On hysteroscopy, it may show a **globally irregular endometrial surface** with small endometrial openings or cystic spaces, but not the discrete, well-circumscribed protruding masses seen in the image. - While it can cause AUB and dysmenorrhea, the appearance is distinctly different from submucous leiomyomas. *Ovarian neoplasm* - Ovarian neoplasms originate in the **ovaries**, which are separate from the uterus. - **Hysteroscopic examination** visualizes only the **endometrial cavity** and cannot directly visualize ovarian pathology. - Ovarian masses do not protrude into the uterine cavity. *Carcinoma of uterus* - Endometrial carcinoma typically presents on hysteroscopy as **irregular, friable, ulcerative, or fungating lesions** with abnormal vascularity and易出血 (easy bleeding). - The **smooth, well-defined, and rounded appearance** with intact overlying mucosa in the image is characteristic of benign leiomyomas, not malignant growths. - Uterine sarcomas are rare and would show more irregular, infiltrative features rather than well-circumscribed masses.
Question 9: Which of the following structures has the function of capacitation?
- A. Male reproductive tract
- B. Vas deferens
- C. Female reproductive tract (Correct Answer)
- D. Capillary
Explanation: ***Female reproductive tract*** - **Capacitation** is a biochemical process that occurs in the **female reproductive tract** (primarily the fallopian tubes and uterus), enabling sperm to gain the ability to fertilize an egg. - This process involves the removal of **cholesterol and glycoproteins** from the sperm head membrane, which modifies its motility and prepares it for the **acrosome reaction**. - Capacitation typically takes **5-6 hours** and is essential for successful fertilization. *Male reproductive tract* - The male reproductive tract produces and stores sperm, but it is **not the site where capacitation occurs**. - Sperm are immature and unable to fertilize an egg when they leave the male reproductive tract. - Sperm only gain fertilizing capacity after exposure to the female reproductive tract environment. *Vas deferens* - The vas deferens is a tube that transports sperm from the epididymis to the ejaculatory duct. - It is a part of the male reproductive tract and does **not contribute to capacitation**. *Capillary* - Capillaries are tiny blood vessels involved in nutrient and waste exchange, entirely unrelated to sperm function or capacitation. - This option is biologically implausible in the context of reproduction.
Question 10: What visual disturbance is caused by an optic tract lesion?
- A. Marcus Gunn pupil
- B. Bilateral blindness
- C. Contralateral homonymous hemianopsia (Correct Answer)
- D. Ipsilateral homonymous hemianopsia
Explanation: ***Contralateral homonymous hemianopsia*** - An **optic tract lesion** interrupts the nerve fibers originating from the contralateral nasal retina and the ipsilateral temporal retina, leading to **vision loss in the contralateral visual field** of both eyes. - This results in a defect where the patient cannot see objects on the **opposite side** of the body from the lesion. *Marcus Gunn pupil* - A **Marcus Gunn pupil**, also known as an **afferent pupillary defect**, indicates asymmetric disease of the **retina** or **optic nerve**, not specifically the optic tract. - It is characterized by paradoxical dilation of the affected pupil when light is swung from the unaffected to the affected eye. *Bilateral blindness* - **Bilateral blindness** typically results from severe damage to both **optic nerves**, the **optic chiasm**, or extensive bilateral lesions in the visual cortex. - An optic tract lesion affects only one side of the visual pathway posterior to the chiasm, thus not causing complete bilateral vision loss. *Ipsilateral homonymous hemianopsia* - **Ipsilateral homonymous hemianopsia** is not a standard neurological visual field defect. Visual field defects are usually described relative to the lesion side as contralateral or ipsilateral based on the specific anatomical location. - An optic tract lesion always produces a **contralateral homonymous hemianopsia** because optic tract fibers cross at the optic chiasm.
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