23 - AIIMS november 2008 gynaecology mcqs

163.IN Mc ROBERTS MANOEUVRE HIP IS FLEXED AGAINST MOTHERS ABDOMEN.THIS LEADS TO INJURY OF WHICH NERVE?
A. LUMBOSACRAL TRUNK
B. OBTURATOR N
C. FEMORAL N.
D. LATERAL CUTANEOUS N OF THIGH

164. ALL ARE DONE IN MANAGEMENT OF SHOULDER DYSTOCIA EXCEPT?
A. FUNDAL PRESSURE
B. Mc ROBERTS MANOEUVRE
C. SUPRAPUBIC PRESSURE
D. WOOD S MANOEUVRE

165.A 25 YEAR OLD MARRIED NULLIPARA UNDERGOES LAPROSCOPIC CYSTECTOMY FOR OVARIAN CYST WHICH ON HISTOPATH REVEALS SEROUS OVARIAN ADENOCARCINOMA.WHAT SHOULD BE THE NEXT MANAGEMENT?
A. SERIAL CA-125 AND FOLLOW UP
B. HYSTERECTOMY AND SALPINGOOOPHORECTOMY
C. HYSTERECTOMY + RADIOTHERAPY
D. RADIOTHERAPY



166. SAFEST VASOPRESSOR IN PREGNANCY IS?
A. EPHEDRINE
B. PHENYLEPHRINE
C. METHOXAMINE
D. MEPHENTINE

167.FALLOPIAN TUBE DYSMOTILITY IS SEEN IN?
A. NOONAN SYN
B. TURNER SYN
C. KARTAGENER SYN
D. MARFAN SYN

168.ALL OF THE FOLLOWING INVESTIGATIONS ARE USED IN FIGO STAGING OF CARCINOMA CERVIX EXCEPT?
A. CECT
B. IVP
C. CYSTOSCOPY
C. PROCTOSIGMOIDOSCOPY

169.CLUE CELLS ARE FOUND IN?
A. CANDIDIAL VAGINOSIS
B. BACTERIAL VAGINOSIS
C. TRICHOMONIASIS
D.

170. BEST INDICATOR OF OVARIAN RESERVE IS?
A. FSH
B. ESTRADIOL
C. LH
D. FSH/ LH RATIO

171. A PREGNANT LADY ACQUIRES CHICKEN POX 3 DAYS PRIOR TO DELIVERY.SHE DELIVERS BY NORMAL VAGINAL ROUTE.WHICH OF THE FOLLOWING STATEMENTS IS TRUE?
A. BOTH MOTHER AND BABY ARE SAFE
B. GIVE ANTIVIRAL TT TO MOTHER BEFORE DELIVERY
C. GIVE ANTIVIRAL TT TO BABY
D. BABY WILL DEVELOP CONGENITAL VARICELLA SYNDROME

172. EARLIEST DETECTABLE CONGENITAL MALFORMATION BY USG IS?
A. ANENCEPHALY
B. SPINA BIFIDA
C. MENINGOCOELE
D. CYSTIC HYGROMA

173.ALL OF THE FOLLOWING SHOULD BE DONE TO PREVENT THE TRANSMISSION OF HIV FROM MOTHER TO BABY EXCEPT?
A. VIT A SUPPLEMENTATION TO MOTHER
B. NO BREAST FEEDING
C. VAGINAL DELIVERY
D. ZIDOVUDINE TO MOTHER




174.A 45YR OLD LADY WITH DUB HAS 8mm THICKNESS OF ENDOMETRIUM.NEXT STEP IN MANAGEMENT?
A. HISTOPATHOLOGY’
B. HYSTERECTOMY
C. PROGESTERONE
D.OCP

175. ALL ARE TRUE ABOUT PCOD EXCEPT?
A. PERSISTENTLY ELEVATED LH
B. INCREASED LH/FSH RATIO
C. INCREASED DHEAS
D. INCREASED PROLACTIN

176.A FEMALE AT 37 WKS OF GESTATION HAS MILD LABOUR PAIN FOR 10 HOURS AND CERVIX IS PERSISTENTLY 1cm DIALATED NON EFFECED.WHAT WILL BE NEXT APPROPRIATE MANAGEMENT?
A. SEDATION AND WAIT
B. AUGMENTATION WITH SYNTOCINON
C. CESAREAN SECTION
D. AMNIOTOMY

177.A WOMAN COMES WITH OBSTRUCTED LABOUR AND GROSSY DEHYDRATED INVESTIGATIONS REVEAL FETAL DEMISE.WHAT WILL BE THE MANAGEMENT?
A. CRANIOTOMY
B. DECAPITATION
C. CESAREAN SECTION
D. FORCEPS EXTRACTION

178.INVESTIGATION OF CHOICE IN CHOLESTASIS OF PREGNANCY?
A. BILIRUBIN
B. BILE ACIDS
C. ALK PHOSPHATASE
D. ALT&AST

179.A FEMALE HAS HISTORY OF 6 WEEKS AMENORRHOEA,USG SHOWS EMPTY SAC,SERUM BETA HCG -1000IU.WHAT WOULD BE NEXT MANAGEMENT?
A. MEDICAL MANAGEMENT
B. REPEAT HCG AFTER 48 HOURS
C. REPEAT HCG AFTER 1 WEEK

to view all the 200 mcqs of AIIMS november 2008 click here

22 - carcinoma cervix staging

STAGE I : carcinoma strictly confined to the cervix

STAGE II : cancer spread beyond the cervix , but not to pelvic wall or lower third

Of vagina .

STAGE III : tumor extends to the lateral pelvic wall , involves the lower third of

Vagina and/or causes hydronephrosis or non functioning kidney .

STAGE IV : tumor extends beyond true pelvis .

STAGE I has IA and IB . IA has IA 1 and IA2 , IB has IB 1 and IB 2 .

STAGE II has IIA and IIB

STAGE III has IIIA and IIIB

STAGE IV has IVA and IVB .

STAGE IA – microinvasive carcinoma , stromal invasion not exceeding 5.0 mm

From the base . lateral spread not exceeding 7.0 mm . vascular or

Lymphatic involvement does not alter classification .

Stage IA 1 – measured stromal invasion of less than 3.0 mm in depth and less than

7.0 mm in horizontal spread .

Stage IA 2 – measured stromal invasion between 3-5 mm in depth and not exceeding

7.0 mm in horizontal spread

STAGE IB - clinically visible lesion confined to the cervix or microscopic lesion

Greater than stage IA 2 .

Stage IB 1 – clinically visible lesion 4.0 cm or less in size

Stage IB 2 – clinically visible lesion more than 4.0 cms in dimension

STAGE IIA – tumor without parametrial invasion (vagina lower third not involved)

STAGE IIB – tumor with parametrial invasion (vagina lower third not involved)

STAGE IIIA – tumor involves lower third of the vagina , no extension to the lateral

Pelvic wall

STAGE IIIB – tumor extends to pelvic wall and / or involves kidney .

STAGE IVA – tumor involves bladder / rectum or spreads beyond the pelvis

STAGE IV B – widespread tumor with distant metastases

21 - endometriosis

Endometriosis introduction :

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.
Endometriosis lesions can be found anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, and on the pelvic sidewall. Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum.
In addition, it can be found in caecarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum.
In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain.
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.
Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis."
It is estimated that 30-40% of women with endometriosis are infertile.
If you or someone you care about has endometriosis, it is important to research the disease as much as possible. Many myths and misconceptions about endometriosis still persist, even in medical literature. For many women, management of this disease may be a long-term process. Therefore, it is important to educate yourself, take the time to find a good doctor, and consider joining a local support group.

Symptoms of endometriosis :
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, however a woman with endometriosis may also experience pain at other times during her monthly cycle.
For many women, but not everyone, the pain of endometriosis can unfortunately be so severe and debilitating that it impacts on her life significant ways.
Pain may be felt:
before/during/after menstruation
during ovulation
in the bowel during menstruation
when passing urine
during or after sexual intercourse
in the lower back region
Other symptoms may include:
diarrhoea or constipation (in particular in connection with menstruation)
abdominal bloating (again, in connection with menstruation)
heavy or irregular bleeding
fatigue
The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis are subfertile.
When a woman or a girl has decided that she wishes to discuss her symptoms with a physician, she may benefit from preparing for this consultation by using the aid, your first consultation, which highlights the questions a doctor may ask her. By assessing the responses, it will help her physician to evaluate her symptoms, and together they can decide the right treatment plan for her.


What causes endometriosis?
Several different hypotheses have been put forward as to what causes endometriosis. Unfortunately, none of these theories have ever been entirely proven, nor do they fully explain all the mechanisms associated with the development of the disease. Thus, the cause of endometriosis remains unknown.
Most researchers, however, agree that endometriosis is exacerbated by oestrogen. Subsequently, most of the current treatments for endometriosis attempt to temper oestrogen production in a woman's body in order to relieve her of symptoms. At the moment there are no treatments, which fully cure endometriosis.
Several theories have become more accepted, and reality is that it may be a combination of factors, which make some women develop endometriosis.
Metaplasia

Metaplasia means to change from one normal type of tissue to another normal type of tissue. It has been proposed by some that endometrial tissue has the ability in some cases to replace other types of tissues outside the uterus.
Some researchers believe this happens in the embryo, when the uterus is first forming. Others believe that some adult cells retain the ability they had in the embryonic stage to transform into reproductive tissue.
Retrograde menstruation


This theory was promoted by Dr. John Sampson in the 1920s. He surmised that menstrual tissue flows backwards through the fallopian tubes (called “retrograde flow”) and deposits on the pelvic organs where it seeds and grows. However, there is little evidence that endometrial cells can actually attach to women’s pelvic organs and grow. Years later, researchers found that 90% of women have retrograde flow. But since most women don’t develop endometriosis, some doctors have concluded that something else (perhaps an immune system problem or hormonal dysfunction) may be the trigger for endometriosis. The Retrograde Menstruation Theory also doesn’t explain how endometriosis develops in women who’ve had a hysterectomy or a tubal ligation nor why, in rare cases, men have developed endometriosis when they’ve been treated with oestrogen after prostate surgery.

Genetic predisposition

Studies have shown that first-degree relatives of women with this disease are more likely to develop endometriosis. And when there is a hereditary link, the disease tends to be worse in the next generation.
An ongoing worldwide study called the International Endogene study is conducting research based on the blood samples from sisters with endometriosis in hopes of isolating an endometriosis gene.
DEC 2006Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15
OCT 2005Researchers identify one gene's critical role in the human embryo implantation process
AUG 2005First report of linkage to a major locus for endometriosis

Lymphatic or vascular distribution

Endometrial fragments may travel through blood vessels or the lymphatic system to other parts of the body. This may explain how endometriosis ends up in distant sites, such as the lung, brain, skin, or eye.
Immune system dysfunctions

Some women with endometriosis appear to display certain immunologic defects or dysfunctions. Whether this is a cause or effect of the disease remains unknown.
Environmental influences

Some studies have pointed to environmental factors as contributors to the development of endometriosis, specifically related to the way toxins in the environment have an effect on the reproductive hormones and immune system response, though this theory has not been proven and remains controversial.

Diagnosing endometriosis
There is no simple test that can be used to diagnose endometriosis. In fact, the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue. This is what is known as "the golden standard".
However, this is an expensive, invasive proceduce. Furthermore, if the surgeon is not a specialist in endometriosis s/he may not recognise the disease, which can result in a "negative" diagnosis.
In addition, the woman/girl may not want to have surgery.
This makes diagnosis a challenge, and therefore an experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis through talking with the woman/girl and obtain a history of her symptoms. For this to be effective, it is important that the woman/girl is honest with her physician about all of her symptoms and the pattern of these.
To aid her in preparation for this consultation she can consult the questionnaire, your first consultation, which will help her in preparing for the questions her doctor may ask her - and, in turn, help him/her in determining whether her symptoms may be due to endometriosis (not all pelvic pain, nor fertility issues, are caused by endometriosis).
There are other tests, which the gynaecologist may perform. These include ultrasound, MRI scans, and gynaecological examinations. None of these can definitively confirm endometriosis (though they can be suggestive of the disease), nor can they definitively dismiss the presence of endometriotic lesions/cysts.
The fact that there is no non-invasive, definitive diagnostic method for endometriosis is as frustrating for clinicians as it is for women with the disease.

Treatments for endometriosis
Since the cause of endometriosis remains unknown, a treatment which fully cures endometriosis has yet to be developed, and there is no overwhelming medical evidence to support one specific type of endometriosis treatment over another.
Chosing a treatment therefore comes down to the individual woman's needs, depending on her symptoms, her age, and her fertility wishes. She should discuss these with her physician so that they, together, can determine, which long term, holistic, treatment plan is best for her individual needs. For many women, this can be a combination of more than one treatment over longer periods of time.
Pain killers
Pain is the most common symptom for many women with endometriosis.
Pain killers vary from simple analgesics (such as aspirin and paracetamol), through compound analgesics (which are a combination of either aspirin or paracetamol and a mild narcotic such as codeine) and narcotic analgesics (similar to morphine), through to non-steroidal anti-inflammatory drugs (such as nurofen, ponstan, voltaren, etc).
More about painkillers

Hormonal treatments
Most researchers agree that endometriosis is exacerbated by oestrogen. Subsequently, hormonal treatments for endometriosis attempt to temper oestrogen production in a woman's body and thereby relieve her of symptoms.
Hormonal therapy may include birth control pills, progestins, a class of drugs known as GnRH-agonists, and danazol (though this is seldom used any more).
The combined oral contraceptive pill
Progestins
Mirena
GnRH-agonists
Danazol
Aromatase inhibitors [still somewhat experimental]
Hormonal therapies have varying degrees of side effects, and unfortunately, whatever pain relief that is achieved tends to be only temporary for many girls and women.
TIPS for dealing with side effects associated with drug treatments


Surgery
Most doctors agree that laparoscopic surgery is the only definitive way to diagnose endometriosis. In many cases, the disease can be diagnosed and treated in the same procedure.
The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions.
Today, most endometriosis surgery is being done through the laparoscope, although a full abdominal incision called a laparotomy may still be required in rare cases for extensive disease or bowel resections.
More about laparoscopic surgery
Although women with endometriosis are often told that hysterectomy is the “definitive” solution for endometriosis, the disease can recur even after a hysterectomy.
More about hysterectomy


Nutritional therapy
The correct balance of daily nutrients are essential for all of us. Proper nutrition helps improve our general health.
For a woman with endometriosis it may also increase her ability to tolerate medical treatments, increase her ability to deal with potential side effects of treatment, increase her energy, and enhance her ability to think clearly. Nutritionists can work with women and girls with endometriosis to put together an appropriate dietary plan.
More about dietary modification to alleviate endometriosis symptoms



Complementary therapies
Given the chronic and stubborn nature of endometriosis, there may be times when it is beneficial to explore therapies beyond the medical mainstream. Whilst there is no clinical evidence as to the effectiveness of these therapies, many women with endometriosis have had good symptom relief by using homeopathy, osteopathy, herbs, and Traditional Chinese Medicine.
Physiotherapists (physical therapists) can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.

A multi-disciplinary approach
To provide holistic treatment to women and girls with endometriosis, a team of medical professionals may be involved in providing care, including: - general practitioners- gynaecologists- surgeons (from a number of disciplines)- reproductive endocrinologists- immunologists- nutritionists/dieticians- nurses- psychologists- counsellors- pain specialists- physiotherapists
All of these disciplines can play an important role in providing an individualised treatment plan for a woman or girl with endometriosis.
Finally, please remember that endometriosis affects more than just the physical body. It often affects women and girls in profound emotional ways as well. Psychologists and counsellors can play an important role by helping women and girls cope with the feelings of confusion, disbelief, chronic pain, infertility, and frustration that often accompany this disease.
Support groups also play a vital role in learning to cope with endometriosis and may be able to provide information about national or regional centres, who specialise in the treatment of endometriosis.

20 - endometriosis mcqs - part 1

1Q- a 36 yr old woman completed her treatment for endometriosis 6 months back .during t/t suffered from bouts of depression,weight gain, menorrahagia ,she now complains of amenorrhea.what is the management?

a- danazol
b- estrogen
c- expectant management
d- progesterone
e- Gnrh anologues

the ans given is progestrone,could any one tell why? read the theory part of endometriosis before u answer ..... click here

19 - endometrial carcinoma - FIGO staging

The International Federation of Gynecology and Obstetrics (FIGO) staging system for carcinoma of corpus uteri is as follows:

• Stage IA - Tumor limited to endometrium
• Stage IB - Invasion to less than one half the myometrium
• Stage IC - Invasion to more than one half the myometrium
• Stage IIA - Endocervical glandular involvement only
• Stage IIB - Cervical stromal invasion
• Stage IIIA - Tumor invades serosa and/or adnexa and/or positive peritoneal cytology.
• Stage IIIB - Vaginal metastasis
• Stage IIIC - Metastases to pelvic and/or para-aortic lymph nodes
• Stage IVA - Tumor invasion of bladder and/or bowel mucosa
• Stage IVB - Distant metastases including intra-abdominal and/or inguinal lymph nodes.

18 - gynaecology mcqs - 121 to 130

Question 121 :
Intrauterine pregnancy rate after linear salpingostomy is approximately
a) 35%
b) 45%
c) 60% * * Right
d) 75%
e) 90%

Question 122 :
All of the following are necessary for the treatment of ectopic pregnancy with MTX EXCEPT
a) Unruptured
b) No pain * * Right
c) Hemodynamically stable
d) Normal blood count & liver enzymes

Question 123 :
Which of the following side effects is least common with cisplatin
a) Thrombocytopenia
b) Hypomagnesimia
c) Cardiac toxicity * * Right
d) Neuropathy
e) High frequency hearing loss

Question 124 :
Perforation tends to occur earliest when an ectopic pregnancy is located in which portion of fallopian tube ?
a) Isthmic * * Right
b) Interstitial
c) Ampullary
d) Infundibular
e) No difference

Question 125 :
The rate of disappearance of hCG is most rapid in which condition
a) Induced abortion
b) Spontaneous abortion c) Complete removal of ectopic pregnancy by resection d) Complete removal of ectopic pregnancy by linear salpingostomy
e) No difference * * Right

Question 126 :
Which is the least frequent site of an ectopic pregnancy
a) Fallopian tube
b) Cervix
c) Ovary
d) Abdominal cavity
e) Between the leaves of broad ligament * * Right

Question 127 :
What treatment is recommended for a complete tubal abortion when the fallopian tube appears undamaged, there is no further bleeding, and product of gestation have been expelled
a) Non operative treatment
b) Evacuation of production of gestation and blood clots from pouch of Douglas and peritoneal cavity * * Right
c) Removal of the abortion and clots and incision in tube for exploration
d) Removal of abortion and clots and salpingectomy
e) Removal of abortion and clots and salpingo oophorectomy

Question 128 :
Which is not an indication for chemotherapeutic treatment of postmolar trophoblastic disease
a) Abnormal hCG regression curve
b) Presence of metastasis
c) Uterine infection * * Right
d) Uterine haemorrhage
e) Tissue diagnosis of choriocarcinoma

Question 129 :
Incidence of all of the following conditions are increased in tamoxifen users EXCEPT
a) Cervial dysplasia * * Right
b) Endometrial polyps
c) Endometrial hyperplasia
d) Uterine fibroids
e) Endometrial adenocarcinoma

Question 130 :
Women with postmenopausal bleeding need endometrial sampling if endometrial on gynae USG is thicker than
a) 1mm
b) 2mm
c) 5mm * * Right
d) 8mm
e) 10mm

17 - gynaecology mcqs - 111 to 120

Question 111 :
GnRH agonists successfully reduce fibroid & total uterine size in what percentage of patients
a) 30%
b) 50%
c) 60%
d) 70%
e) 95% * * Right

Question 112 :
Menstrual regulation can be performed upto
a) 6 wks * * Right
b) 12 wks
c) 18 wk
d) 20 wks

Question 113 :
Straussman operation consists of
a) Unification of seperate uterus * * Right
b) Sling operation for prolapse
c) Tightening of cervical os
d) None of the above

Question 114 : Perforation of the uterus while doing endometrial biopsy in non pregnant uterus, needs
a) Laparoscopy
b) Observation * * Right
c) Immediate laparotomy
d) Hysterectomy

Question 115 :
After fertilization, ova is embedded in the endometrium on which day ?
a) 2nd day
b) 4th day
c) 6th day * * Right
d) 10th day

Question 116 :
Time taken by the spermatatozoa to reach ampulla of the fallopian tube after ejaculation is
a) 20 mins
b) 30 mins
c) 60 mins * * Right
d) 2 hrs

Question 117 :
Least common type of ut anomaly in patients with RPL
a) Unicornuate * * Right
b) Arcuate
c) Septate
d) Bicornuate
e) Didelphys

Question 118 :
The first trimester spontaneous abortion rate is highest for patients with which type of ut anomalya) Unicornuate
b) Arcuate
c) Septate * * Right
d) Bicornuate
e) Didelphys

Question 119 :
The gold standard in diagnosing ectopic pregnancy
a) Laparoscopy * * Right
b) Culdocentesis
c) Beta HCG
d) USG
e) Progesterone

Question 120 :
What is the most common side effect with MTX therapy for ectopic pregnancy
a) Transient pelvic pain 3 - 7 days after starting treatment * * Right
b) Stomatitis
c) Bone marrow suppression
d) Gastritis

16 - gynaecology mcqs - 101 to 110

Question 101 :
Radiotherapy is indicated in Endometrial Ca in following situation EXCEPT
a) Preop radiotherapy followed by TAH + BSO
b) Postop adjuvant radiotherapy after TAH + BSO
c) Primary treatment for medically inoperable
d) To specifically treat pelvic side wall involvement * * Right
e) Vaginal recurrence after hysterectomy

Question 102 :
Invasive molar tissue is most commonly found in
a) Myometrium * * Right
b) Vaginal wall
c) Ovary
d) Liver
e) Lungs

Question 103 :
Which method of terminating a molar gestation is never indicated
a) Suction curettage
b) Prostaglandic
c) Hypertonicsaline * * Right
d) Hysterotomy
e) Hyterectomy

Question 104 : The following are the risk factors for H mole EXCEPT
a) Maternal age > 40 yrs
b) Prior h/o H mole
c) Prior h/o term pregnancy * * Right
d) Prior h/o spontaneous abortion

Question 105 :
Treatment of choice for 30 years old para 1 with stress incontinence is
a) Pelvic floor exercise * * Right
b) Bladder training
c) Mechanical incontinence device
d) Kelly's repair
e) Sling operation

Question 106 :
Treatment of choice for a 55 yrs old multipara with 3rd degree prolapse uterus with cystocele with rectocele with stress incontinence
a) Vaginal hysterectomy with pelvic floor repair
b) Kelly's repair
c) a) + b) * * Right
d) a) + colposuspension

Question 107 :
Best treatment for severe stress incontinence without prolapse is
a) Pelvic floor exercise
b) Kelly's repair
c) Burch colposuspension * * Right
d) MMK operation
e) Urethral collagen implant

Question 108 :
Diagnosis of genuine stress incontinence is made by which of the following before taking the patient for surgery
a) History
b) Subjective demonstration of stress incontinence
c) Objective demonstration of stress incontinence
d) Urodynamic studies * * Right

Question 109 :
The commonest cause of stress incontinence is
a) Constipation
b) Raised intra abdominal pressure
c) Congenital weakness of sphincter
d) Childbirth trauma * * Right
e) Estrogen deficiency

Question 110 :
The amount of progesterone released per day by the progesterone releasing IUCD ( Progestarest ) is
a) 60 mugm
b) 65 mugm * * Right
c) 70 mugm
d) 75 mugm

15 - gynaecology mcqs - 91 to 100

Question 91 :
The standard Cu 250 IUCD is appropriate for a uterus having uterocervical length of
a) 5 - 8 cm
b) 6 - 9 cm * * Right
c) 7 - 10 cm
d) 8 - 11 cm

Question 92 :
An ideal candidate for the use of IUCD as a contraceptive method should have all of the following EXCEPT
a) Nulliparous * * Right
b) One child
c) Normal menstrual cycle
d) Monogamous relationship

Question 93 :
The commonest complication of laparoscopic ring tubal ligation is
a) Failure of sterilization
b) Menstrual abnormality
c) Mesosalpingeal bleeding * * Right
d) Bowel injury
e) Wound infection

Question 94 :
Which of the following cancidates will be immediately eligible for sterilization
a) Women having uncontrolled diabetes
b) Women having Hb less than 6
c) Past h/o treated pulmonary koch's * * Right
d) Febrile patient

Question 95 :
After vasectomy , a backup contraceptive method is required for how many weeks
a) 8 wks
b) 10 wks
c) 12 wks * * Right
d) 14 wks

Question 96 :
AFP is most often useful for monitoring the response to treatment of which germ cell tumor
a) Dysgerminima
b) Immature teratoma
c) Endodermal sinus tumor * * Right
d) Choriocarcinoma

Question 97 :
Granulosa cell tumor are associated with all EXCEPT
a) Isosexual precoerty
b) Endometrial hyperplasia & adenocarcinoma
c) Present most commonly before the age of 5 * * Right
d) Vaginal bleeding

Question 98 :
Combination chemotherapy regimen in Ca ovary
a) Is the treatment of choice for most patients with residual disease following surgery * * Right
b) Less toxic than single agent therapy
c) Less expensive than single agent therapy
d) Produces better results if it is a combination containing cyclophosphamide
e) None of the above

Question 99 :
The following are the pathological features of an ovary , EXCEPT
a) Round shape with irregular internal or external outline
b) Thick septae of > 5mm
c) Size more than 10 cm
d) Volume 5 to 15 ml - right

Question 100 : The following are the factors associated with CIN EXCEPT
a) Onset of coitus at early stage
b) Multiple sexual partners
c) Lower socioeconomic status
d) Nulliparity * * Right
e) H/o veneral disease

14 - gynaecology mcqs - 81 to 90

Question 81 :
Endometrial Carcinoma with vaginal metastasis is staged as
a) II b
b) III a
c) III b----------------------------------------------
d) III c
e) IV a

Question 82 :
Stress urinary incontenence is characterised by involuntary loss of urine with all of the following EXCEPT
a) Coughing
b) Exercising
c) Laughing
d) Sleeping---------------------------------------- *
e) Sneezing

Question 83 :
The following are associated with increased incidence of recurrent pregnancy loss EXCEPT
a) Presence of thyroid antibodies----------------------------------- *
b) Polycystic ovarian disease
c) Overt diabetes mellitus
d) Partial HLA homozygosity
e) Balanced translocation in either patient

Question 84 :
Management of proximal tubal occlusion is all EXCEPT
a) Transcervical canulation---------------------------------- *
b) Intramural isthmic anastomosis
c) Uterotubal implantation
d) Isthmic - Isthmic anastomosis

Question 85 :
Which of the following is most reliable in diagnosing ovarian malignancy ?
a) Medical history
b) Plain Xray
c) Physical examination
d)USG-----------------------------------
e) Cytology from ovarian cyst fluid

Question 86 :
Which of the following is not associated with an increased risk for ovarian carcinoma ?
a) Radiation exposure-------------------------------------- *
b) Nulliparity
c) A diet low in fibre and Vit A.
d) Familial tendency
e) Peutz - Jeghers Syndrome

Question 87 :
Approximately 75 - 80% of ovarian tumors originate from
a) Epithelium----------------------------- *
b) Stroma
c) Germ cells
d) Mesoderm
e) Unclassified tissue

Question 88 : Side effects of Gn RH agonists includes all of the following EXCEPT
a) Hot flashes
b) Vaginal dryness
c) Bone resorption & osteoporosis
d) Headache
e) Decreased high density lipoproteins--------------------------------------------

Question 89 :
The least common side effect caused by GnRH agonists
a) Decreased libido---------------------------------- *
b) Vasomotor symptoms
c) Headache
d) Vaginal dryness
e) Mood changes

Question 90 : Least expensive hormonal regimen for treatment of pelvic pain caused by endometriosis
a) Danazol
b) Medroxy progesterone----------------------------
c) Nafarclin
d) Buscrelin
e) Leuprolide

13 - gynaecology mcqs - 76 to 80

Question 76

A 28-year-old woman develops the sudden onset of severe lower abdominal pain. On physical examination there is tenderness to palpation of the right lower quadrant. Laboratory studies show her serum pregnancy test is positive. An ultrasound scan does not reveal a gestational sac in the uterus, but there is a right adnexal mass. The development of these findings is most closely related to past infection with which of the following organisms?

A Treponema pallidum
B Human papillomavirus
C Neisseria gonorrheae
D Candida albicans
E Group B Streptococcus
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(C) CORRECT. Many cases of pelvic inflammatory disease (PID) are due to gonorrhea. The tubal scarring from the inflammation leads to an increased risk for ectopic pregnancy(A) Incorrect. Syphilis can produce a chancre of the external genitalia or cervix.(B) Incorrect. HPV is associated with increased risk for squamous epithelial dysplasias.(D) Incorrect. Candida is the cause for vaginitis.(E) Incorrect. This organism presents the greatest risk as an intrauterine infection resulting in stillbirth in the third trimester.

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Question 77

A 45-year-old woman has had irregular menstrual periods for the past 9 months. On physical examination she has an enlarged uterus. An ultrasound scan shows a 9 cm solitary, solid mass in the uterus. A total abdominal hysterectomy is performed. Gross examination of the irregular reddish-tan mass located in the myometrium shows bundles of smooth muscle cells along with heterogenous elements of pleomorphic cartilaginous cells. There are also areas with poorly differentiated gland formation. Mitotic figures are frequent. Which of the following neoplasms is she most likely to have?

A Leiomyosarcoma
B Sarcoma botryoides
C Malignant mixed mullerian tumor
D Endolymphatic stromal myosis
E Leiomyoma
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(C) CORRECT. The malignant mixed mullerian tumor typically has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues.(A) Incorrect. The leiomyosarcoma is distinguished from a leiomyoma by the cellularity and the mitotic rate, but it is composed only of cells resembling smooth muscle.(B) Incorrect. Sarcoma botryoides is a rare neoplasm most likely to occur in the vagina of a child. It is composed of primitive cells most resembling an embryonal rhabdomyosarcoma.(D) Incorrect. This rare condition consists of endometrial stromal cells extending into the body of uterus and beyond.(E) Incorrect. A leiomyoma should not have a significant mitotic rate.

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Question 78

A 72-year-old woman has been feeling tired for the past year. She has had episodes of vaginal bleeding during this time. On physical examination there are no abnormal findings. Laboratory studies show Hgb 9.1 g/dL, Hct 26.5%, MCV 72 fL, platelet count 158,000/microliter, and WBC count 7150/microliter. An endometrial biopsy is performed and on microscopic examination shows atypical adenomatous hyperplasia. Which of the following is the most likely risk factor for development of her disease?

A Human papillomavirus infection
B Long term use of an intrauterine contraceptive device
C Chronic endometritis
D Pelvic inflammatory disease
E Unopposed estrogenic stimulation

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(E) CORRECT. The unopposed estrogen drives the hyperplasia, which if atypical carries an increased risk for development of an endometrial adenocarcinoma.(A) Incorrect. HPV infection mainly produces lesions of squamous epithelium of external genitalia and cervix, such as dysplasias and carcinoma.(B) Incorrect. An IUD can cause endometritis, but not a preneoplastic lesion.(C) Incorrect. Chronic endometritis is not generally known as an antecedent to preneoplastic or neoplastic conditions.(D) Incorrect. PID can produce inflammation with scarring, mainly of tubes and ovaries.
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Question 79

A 56-year-old G0 P0 woman reports vaginal bleeding in the past 2 months. Her last menstrual period was 6 years ago. On physical examination there are no abnormal findings. Which of the following procedures is most appropriate to perform on this woman?

A Endometrial biopsy
B Pap smear
C Vaginal culture
D Colposcopy
E CT scan

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(A) CORRECT. This history points to a possible endometrial carcinoma, and nulliparity increases the risk.(B) Incorrect. CIN is less likely than an endometrial lesion in this setting.(C) Incorrect. An infection would be unlikely to cause bleeding.(D) Incorrect. This will show cervical lesions, not endometrial.(E) Incorrect. The possible causes of uterine bleeding cannot be distinguished by CT (or MRI) scan.

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Question 80

A 50-year-old woman has experienced mild pelvic discomfort for 3 months. On physical examination there are bilateral adnexal masses. A pelvic CT scan reveals irregular unilocular cystic, bilateral mass lesions in the region of the ovaries. One is 10 cm and the other is 8 cm in size. Which of the following types of neoplasm is most likely to be present in this woman?

A Mature cystic teratoma
B Serous cystadenocarcinoma
C Endometrioid carcinoma
D Fibrothecoma
E Mucinous cystadenoma

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(B) CORRECT. Ovarian serous tumors are bilateral more often than other ovarian tumors. Serous cystadenocarcinomas are bilateral in about 2/3 of cases.(A) Incorrect. Teratomas of the ovary are bilateral in about 10 to 15% of cases.(C) Incorrect. These are bilateral in about 40% of cases; however, they tend to be solid masses.(D) Incorrect. These are unlikely to be bilateral; they are solid masses(E) Incorrect. Benign mucinous ovarian tumors are bilateral in about 5% of cases. Malignant mucinous ovarian tumors are bilateral about 20% of the time. They tend to be multilocular.

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12 - gynaecology mcqs - 71 to 75

Question 71

25-year-old woman is G2 P1. Her first pregnancy resulted in a normal term birth. Now at 15 weeks gestation, a prenatal checkup reveals that she has a blood pressure of 140/90 mm Hg. An ultrasound is performed that reveals no fetal cardiac motion. Misoprostol induction is performed for termination of the pregnancy. Examination of the malformed stillborn fetus reveals that it is small for gestational age and has 3,4 syndactyly bilaterally, an indented nasal bridge, and a two vessel cord. The placenta is small for gestation and has scattered 0.5 cm grape-like villi. A chromosome analysis performed on the placental tissue will most likely demonstrate which of the following karyotypes?

A 46, XX
B 69, XXY
C 45, X
D 47, XX, +18
E 23, X
F 47, XYY
G 47, XXX
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(B) CORRECT. In a partial mole, a fetus is present but malformed and small for gestational age. Only occasional villi, or none at all, may be grape-like, but there is trophoblastic proliferation typical of molar pregnancy.(A) Incorrect. The 46, XX karyotype would be appropriate for a normal female fetus. It could also be seen with a complete mole in which no fetus would be present.(C) Incorrect. The 45, X karyotype is seen with Turner syndrome, one of the more common chromosomal abnormalities seen with fetal losses. It is not accompanied by placental changes of molar pregnancy.(D) Incorrect. Trisomy 18 leads to an abnormal appearing fetus with clenched hands (not syndactyly), and the placenta may be small, but does not show changes of molar pregnancy.(E) Incorrect. The 23, X karyotype is that of an unfertilized ovum or a sperm.(F) Incorrect. This karyotype is indicative of Klinfelter syndrome, seen in nearly normal appearing males with oligospermia.(G) Incorrect. This is the 'superfemale' karyotype with only mild mental retardation.
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Question 72

A 16-year-old girl has not begun menstruation. Physical examination reveals that she has breast development, but a short vagina and no palpable uterus or adnexa, only bilateral inguinal masses. She appears otherwise normally developed. Which of the following laboratory tests would be most appropriate to order on this girl?

A Chromosome analysis
B Serum estrogen
C Assay for luteinizing hormone
D Serum cortisol
E Serum testosterone
F Magnetic resonance imaging of brain
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(A) CORRECT. The findings point to testicular feminization (androgen insensitivity syndrome), with a karyotype of 46, XY. The inguinal masses are the testes.(B) Incorrect. This would be more useful for workup of secondary amenorrhea.(C) Incorrect. This would be more useful for workup of secondary amenorrhea.(D) Incorrect. A serum cortisol would be useful for workup of congenital adrenal hyperplasia.(E) Incorrect. This is more useful for workup of male infertility or developmental problems.(F) Incorrect. It is unlikely that her problems can be explained by a neoplasm of the brain, including the pituitary.
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Question 73

A 38-year-old healthy woman has had a white, curd-like vaginal discharge for the past week. There is no bleeding. A Pap smear demonstrates normal appearing squamous epithelial cells along with scattered neutrophils and budding cells with pseudohyphae. Which of the following infectious agents is most likely to be present in this woman?

A Treponema pallidum
B Neisseria gonorrhea
C Chlamydia trachomatis
D Herpes simplex virus
E Escherichia coli
F Gardnerella vaginalis
G Trichomonas vaginalis
H Candida albicans
I Human papillomavirus

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(H) CORRECT. Vaginal yeast infections are quite common. Fungal vulvovaginitis is the second most common cause of vaginal infections in the U.S. (Bacterial vaginosis is the most frequent cause).(A) Incorrect. This is the causative agent for syphilis, which as a primary lesion causes a hard chancre.(B) Incorrect. Gonorrhea is more of a cause for vaginitis in children.(C) Incorrect. Chlamydia trachomatis is a sexually transmitted disease that is unlikely to produce a marked vaginal exudate.(D) Incorrect. HSV infection leads to the recurrent appearance of crops of painful vesicles, typically on the external genitalia.(E) Incorrect. Gram negative enteric bacterial infections are not common at this site.(F) Bacterial vaginosis is caused by overgrowth of a variety of bacteria (Gardnerella vaginalis, Prevotella, Mobiluncus, Peptostreptococcus, Mycoplasma hominis, etc.) in the vagina. It differs from fungal vulvovaginitis in that (1) there is usually a rather unpleasant and quite noticeable 'fishy' odor; (2) the vaginal discharge is homogenous, lower in viscosity, and uniformly coats the vaginal walls; and (3) the vaginal pH is usually >4.5.(G) Incorrect. Trichomonas vulvovaginitis is caused by the protozoan Trhicomonas vaginalis. It differs from fungal vulvovaginitis in that there is a profuse, homogenous vaginal discharge that usually has a yellow or greenish-yellow color. Vaginal pH is usually > 5.0, and the 'fishy' odor may or may not be present. Trichomonas vulvovaginitis is diagnosed by observation of motile trichomonads and large numbers of PMNs in a vaginal smear.(I) Incorrect. HPV is a cause for condyloma and for squamous dysplasias and carcinomas, not vaginosis.
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Question 74

A 35-year-old woman has had dull pelvic pain for 4 months. A pelvic examination reveals a normal appearing cervix, a normal sized uterus, and a large tender right adnexal mass. Ultrasound reveals an 8 cm cystic, fluid-filled mass involving the right adnexal region. At laparotomy, there are many filmy fibrous adhesions in the pelvis. The mass is excised and on gross examination is found to have a thin wall and is filled with purulent exudate. Microscopically, there are thin remnants of fallopian tube and ovary comprising the wall of the mass, with numerous neutrophils filling the lumen. Which of the following infectious agents is most likely to have produced these findings?

A Human papillomavirus
B Mycobacterium tuberculosis
C Trichomonas vaginalis
D Candida albicans
E Neisseria gonorrheae

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(E) CORRECT. She has findings of pelvic inflammatory disease complicated by a tubo-ovarian abscess. These are potential complications of sexually transmitted diseases caused by gonorrhea or chlamydia most often.(A) Incorrect. HPV is a sexually transmitted disease that affects the external genitalia and cervix.(B) Incorrect. Tuberculosis is a rare infection of the female genital tract that can produce a chronic endometritis or a chronic salpingitis.(C) Incorrect. Trichomonal infections are not very severe. They typically involve the vagina.(D) Incorrect. Yeast infections are a nuisance, but not severe, and involve the vagina.
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Question 75

Abnormal uterine bleeding for the past 5 months prompts a 62-year-old woman to see her physician. She has never been pregnant and went through menopause 10 years previously. On physical examination her BMI is 33. There are no abnormal findings on physical examination. An endometrial biopsy is performed and on microscopic examination shows a well-differentiated endometrial adenocarcinoma. Which of the following ovarian neoplasms is she most likely to have?

A Papillary serous cystadenocarcinoma
B Krukenberg tumor
C Mucinous cystadenoma
D Granulosa cell tumor
E Immature teratoma

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(D) CORRECT. She could have an ovarian tumor producing estrogen, and the granulosa cell tumor is most likely to do that, of the ones listed.(A) Incorrect. Cystadenocarcinomas are epithelial tumors unlikely to secrete estrogen.(B) Incorrect. A Krukenberg tumor represents metastatic disease of the ovary, most often from a gastrointestinal malignancy (such as primary gastric adenocarcinoma).(C) Incorrect. Cystadenomas, which are of epithelial origin, are not likely to secrete estrogen.(E) Incorrect. Immature teratomas contain primitive elements with neural differentiation and are unlikely to secrete estrogens.
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11 - gynaecology mcqs - 66 to 70

Question 66
Two weeks after delivery of a term infant boy following an uncomplicated pregnancy, a 25-year-old woman still has a vaginal discharge consisting of dark brown, foul-smelling material. Her temperature is 37.4 C. On pelvic examination, the uterus is slightly enlarged and she has pelvic tenderness. Laboratory studies show her serum beta-HCG is negative. Which of the following conditions is she most likely to have?

A Invasive mole
B Degenerating leiomyoma
C Sheehan syndrome
D Endometriosis
E Retained products of conception
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(E) CORRECT. The retained placental fragements are a source for infection producing an acute endometritis. A D&C must be done to remove the fragments. At the time of delivery, the placenta should be checked for completeness; a missing cotyledon suggests incomplete placental delivery.(A) Incorrect. Her beta-HCG is negative, so molar pregnancy is ruled out.(B) Incorrect. A leiomyoma may degenerate and abort following delivery, but this is a rare event.(C) Incorrect. Anterior pituitary necrosis leads to lack of lactation and other evidence for hypopituitarism which are signs of Sheehan's syndrome.(D) Incorrect. Endometriosis is the presence of endometrial glands and stroma outside the endometrium, producing pain but no discharge.----------------------------------------------------------------
Question 67
A 39-year-old woman has had dysmenorrhea for 7 months. On pelvic examination, there are no adnexal masses, and the cervix appears normal, but the uterus is three times normal size. The uterus appears to be symmetrically enlarged on abdominal ultrasound, with no masses present and an endometrial cavity that is nearly normal in size. A Pap smear is normal. Her serum pregnancy test is negative. A total abdominal hysterectomy is performed. Which of the following microscopic findings is most likely to be present in her uterus?
A Atypical glands invading through the uterine wall
B Large avascular villi with trophoblastic proliferation
C Hyperchromatic and pleomorphic smooth muscle cells
D Extensive acute inflammation
E Endometrial glands and stroma in the myometrium
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(E) CORRECT. Adenomyosis can produce diffuse uterine enlargement.(A) Incorrect. An endometrial adenocarcinoma is most likely to occur at a postmenopausal age, and it is not likely to greatly enlarge the uterus.(B) Incorrect. The avascular villi with trophoblastic proliferation are features of a molar pregnancy.(C) Incorrect. A leiomyosarcoma is usually a large, solitary mass.(D) Incorrect. Endometritis does not typically enlarge the uterus.
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Question 68
A 15-year-old girl has had irregular menstrual cycles for 5 months. She had menarche at age 13. There are no abnormal physical examination findings. An endometrial biopsy is taken on post-ovulatory day 9 and shows proliferative phase endometrium. Which of the following is the most likely diagnosis?

A Adenomyosis
B Anovulatory cycles
C Endometrial adenocarcinoma
D Leiomyomata
E Oral contraceptive use
F Ovarian thecoma
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(B) CORRECT. Anovulatory cycles occur most often at the time of menarche, menopause, or with ovarian dysfunction such as in polycystic ovarian disease.(A) Incorrect. Adenomyosis is uncommon at this age. It could produce irregular bleeding. The uterus is usually enlarged.(C) Incorrect. Endometrial adenocarcinoma is rare at this age.(D) Incorrect. Leiomyomas may produce irregular bleeding. It would be rare to have leiomyomas of sufficient size to produce problems at her age.(E) Incorrect. Oral contraceptive use produces regular menstrual cycles.(F) Incorrect. Ovarian thecomas could produce estrogens and cause endometrial hyperplasia and bleeding. An ovarian tumor is rare at her age, and it would produce a mass lesion.
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Question 69
A 29-year-old woman has had dyspareunia for the past 2 months. She has had only one sexual partner--her husband. She is G2 P2. On physical examination there are no abnormal findings except for a small but slightly tender 1.5 cm mass located in the right lateral wall of her vagina. The lesion is excised. On gross examination this mass is cystic and fluid filled. On microscopic examination the cyst is lined by a cuboidal epithelium. Which of the following is the most likely etiology for this lesion?
A Diethylstilbestrol exposure
B Embryologic remnant
C Gonoccocal infection
D Metastatic adenocarcinoma
E Oral contraceptive use
F Foreign body
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(B) CORRECT. This is a Gartner duct cyst, which is a remnant of the mesonephric duct in the lateral vaginal wall. They can be multiple. There is no risk for malignancy.(A) Incorrect. DES exposure leads to vaginal adenosis and to clear cell carcinomas.(C) Incorrect. Gonorrhea is more likely to produce a urethritis, cervicitis, or pelvic inflammatory disease. It is unlikely to produce a mass lesion of the vagina.(D) Incorrect. Carcinomas are uncommon at her age. The vagina is an uncommon site for metastases.(E) Incorrect. Oral contraceptive use does not lead to vaginal mass lesions.(F) Incorrect. Objects inserted are likely to be large and smooth-surfaced, though local trauma with abrasion or contusion is possible.
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Question 70
A 55-year-old woman has had lower abdominal pain for the past 6 months. She had a simple hysterectomy performed 25 years before. On pelvic examination, she has a vagina that ends in a blind pouch, and a large non-tender left adnexal mass is palpable. At laparotomy, there is a 9 cm mass involving the left ovary. Microscopic examination reveals malignant glands resembling endometrial glands. What pathologic abnormality was her hysterectomy specimen most likely to have shown?

A Endometriosis
B Adenomyosis
C Malignant mixed mullerian tumor
D Chronic endometritis
E Endometrial hyperplasia
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(A) CORRECT. An endometrioid carcinoma can develop in the setting of endometriosis. These processes can occur decades apart.(B) Incorrect. Adenomyosis does not carry a risk for development of any epithelial or stromal neoplasm.(C) Incorrect. A 3M tumor may have an epithelial component, but it is not related to ovarian endometroid carcinoma.(D) Incorrect. Chronic endometritis is not associated with malignancies, but the uterine bleeding that could occur must be distinguished from that caused by a carcinoma.(E) Incorrect. Atypical endometrial hyperplasia is a precursor to endometrial carcinoma.

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10 - gynaecology mcqs - 61 to 65

Question 61
A 39-year-old woman had noted intermenstrual spotting of blood for the past 3 months. On pelvic examination, she is found to have a nodular 2 x 3 cm mass in the upper vagina. Biopsy of the mass is performed and on microscopic examination shows a clear cell carcinoma. Which of the following risk factors probably preceded development of this carcinoma?

A Human papilloma virus infection
B Previous endometriosis
C Irregular menstrual cycles
D Exposure to diethylstilbestrol in utero
E Precocious pseudopuberty
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(D) CORRECT. Although DES has not been used for decades, the women who were exposed to it are past their 40's and developing adenosis and clear cell carcinoma.(A) Incorrect. HPV infections are associated with increased risk for cervical neoplasia.(B) Incorrect. Endometriosis is a risk for endometrioid carcinoma decades later.(C) Incorrect. Such irregular cycles are a risk for development of endometrial carcinoma.(E) Incorrect. This occurs with an ovarian neoplasm, such as a granulosa-theca cell tumor, that secretes estrogen.------------------------------------------------------------------

Question 62
A 19-year-old woman has noted the increasing size and number of warty lesions on her external genitalia for the past 5 years. On physical examination she has several pink-tan rounded 1 to 2 cm slightly raised lesions on the perineum and vulva. Biopsy of one of the lesions is performed and on microscopic examination demonstrates acanthosis of the squamous epithelium along with koilocytosis. Which of the following is the most appropriate interpretation of these findings?A The lesions are usually cystic.
B Most often they occur in the endometrium.
C There is an association with Candida infection.
D She may develop a squamous cell carcinoma.
E This condition is commonly seen in prepubertal males.
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(D) CORRECT. Condyloma is one of the manifestations of human papillomavirus infection. Some subtypes of HPV, such as 16, increase the risk for squamous dysplasias and carcinomas of the cervix.(A) Incorrect. Condylomas are usually raised white wart-like lesions.(B) Incorrect. Most occur on the external genitalia and perineum, and some on the cervix.(C) Incorrect. There is an association with human papillomavirus (HPV) infection.(E) Incorrect. They are most common in sexually promiscuous persons (or persons whose sexual partners are promiscuous).
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Question 63
A 40-year-old woman has experienced pelvic discomfort for over a month, along with a 4 kg weight loss, nervousness, and diaphoresis. A pelvic examination reveals a large left adnexal mass that, on transvaginal ultrasound, appears as a discrete 10 cm cystic mass. The uterus appears normal in size. A Pap smear is normal. The mass is removed and on gross pathologic examination is filled with hair and sebum, along with solid tan areas next to the smooth-surfaced outer wall. Which of the following laboratory test findings is most likely to have been present just prior to her surgery?
A Thyroxine of 11.3 microgm/dL
B HCG of 45,000 IU/L
C Potassium of 2.9 mmol/L
D Estradiol of 1700 pg/mL
E Cancer antigen 125 of 540 U/mL
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(A) CORRECT. The abundant hair is typical for an ectodermal component of a mature cystic teratoma, but mesodermal and endodermal components will also be present. This one probably has thyroid tissue, also called struma ovarii when the majority of the teratoma is composed of thyroid tissue. It is a rare cause for hyperthyroidism.(B) Incorrect. An elevated HCG could indicate an intrauterine pregnancy or a choriocarcinoma.(C) Incorrect. Hypokalemia is seen with aldosteronomas of the adrenal gland.(D) Incorrect. Elevated estrogen levels are seen with pregnancy, but high levels such as this are rarely present, even with neoplasms such as thecomas.(E) Incorrect. The CA-125 is a marker for ovarian malignancies.
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Question 64
A 32-year-old G3 P2 pregnant woman goes for a routine prenatal check at 12 weeks. On physical examination she is found to be large for dates, and no fetal heart tones are audible. An ultrasound is performed and revealed that no fetus was present, only many echogenic cystic areas within the uterus. Which of the following is the most likely diagnosis?
A Invasive mole
B Partial hydatidiform mole
C Placental site trophoblastic tumor
D Choriocarcinoma
E Complete hydatidiform mole
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(E) CORRECT. No fetus is present, only grape-like chorionic villi. Complete mole is the most common form of gestational trophoblastic disease.(A) Incorrect. An invasive mole is less common than a complete mole.(B) Incorrect. A fetus is usually present with a partial mole.(C) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited to the pregnanc.(D) Incorrect. Choriocarcinomas are solid, but hemorrhagic lesions that invade the myometrial wall, though the uterus can be enlarged. They can follow a hydatidiform mole.
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Question 65
A 38-year-old woman goes to her physician for a routine checkup. On physical examination there are no abnormal findings. A Pap smear is taken and cytologically there are dysplastic cells present. A cervical biopsy is performed. Microscopic examination shows dysplasia involving the full thickness of the cervical epithelium. Which of the following is the most likely diagnosis?

A Cervical intraepithelial neoplasia III
B Severe chronic cervicitis with Herpes simplex virus
C Previous diethylstilbestrol (DES) exposure
D Endocervical adenocarcinoma
E Extramammary Paget disease

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(A) CORRECT. With proper therapy, the lesion will be removed and not given a chance to progress to invasive carcinoma.(B) Incorrect. Inflammation will produce some inflammatory atypia, but not dysplasia.(C) Incorrect. DES exposure in utero predisposes women to vaginal clear cell carcinoma and to adenosis.(D) Incorrect. DES exposure can lead to microglandular hyperplasia and to vaginal clear cell carcinomas.(E) Incorrect. This is seen on the vulva and consists of malignant cells in the epithelium that are mucin positive, indicating adenocarcinoma.

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9 - gynaecology mcqs - 56 to 60

Question 56

A 14-year-old girl has had pelvic pain for the past 3 months. She refuses physical examination. She has not had any sexual activity. She has not had a menstrual period. Which of the following is the most likely diagnosis?

A Cervical condyloma
B Endometriosis
C Cervical gonorrhea
D Imperforate hymen
E Ruptured Bartholin's cyst

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(D) CORRECT. Following the onset of menarche, the blockage to menstrual flow leads to an accumulation of blood in the vagina, called hematocolpos.(A) Incorrect. Condylomas consist of thickened epithelium that does not bleed.(B) Incorrect. Endometriotic lesions are usually located on serosal surfaces in the pelvis and abdomen. There is minimal hemorrhage just at the site of the lesion itself. The onset of pelvic pain is typically at a later age than that of this patient.(C) Incorrect. Gonorrhea can produce inflammation, but not hemorrhage. Gonorrhea is a sexually transmitted disease.(E) Incorrect. A Bartholin's cyst will contain clear fluid, and when inflamed may contain purulent material.
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Question 57.

A 64-year-old woman has had itching with irritation of the vulvar region, along with vaginal dryness, for the past 8 months. On physical examination there are pale grey patches from 1 to 2 cm in size on the vulva. Biopsy of one lesion is performed and on microscopic examination shows epithelial thinning, dermal fibrosis, and perivascular chronic inflammation. Which of the following is the most likely diagnosis?

A Squamous cell carcinoma
B Lichen sclerosus
C Condyloma acuminatum
D Adenosis
E Extramammary Paget disease
F Dermatophyte infection
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(B) CORRECT. Lichen sclerosus et atrophicus is typically seen after menopause and is slowly progressive. It may predispose to infection, but is not premalignant.(A) Incorrect. This is a neoplasm that would lead to a mass with malignant squamous epithelial cells.(C) Incorrect. This is a 'venereal wart' from human papillomavirus infection, leading to verrucous white plaques that histologically have epithelial hyperplasia.(D) Incorrect. Vaginal adenosis may occur in women with exposure to diethylstilbestrol in utero.(E) Incorrect. This is a red, crusted area that has clusters of malignant epithelial cells within the epidermis and its appendages.(F) Incorrect. This would be an uncommon location for such an infection. There would likely be hyperkeratosis and minimal inflammation.
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Question 58

For the past year, a 50-year-old woman has noted that her menstrual periods have been exceptionally heavy, lasting 7 to 9 days. She has noted occasional minor intermenstrual bleeding. For the past 3 months, she has been taking supplemental dietary iron for iron deficiency anemia. On pelvic examination, the uterine cervix appears normal, but the uterus is enlarged to twice normal size. Transvaginal ultrasound reveals the presence of a 9 cm solid mass in the uterus. A hysterectomy is performed, and on gross inspection with sectioning the uterus a reddish-tan mass is found with a fleshy cut surface. Microscopically the mass is highly cellular, with spindle cells having hyperchromatic nuclei and 10 to 20 mitoses per high power field. Which of the following is the most likely diagnosis?
A Endometrial polyp
B Adenomyosis
C Leiomyoma
D Ectopic pregnancy
E Leiomyosarcoma
F Malignant mixed mullerian tumor
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(E) CORRECT. Leiomyosarcomas of the uterus are uncommon malignant neoplasms. They do not arise from leiomyomas. They are larger and more cellular than benign leiomyomas, and have mitotic figures.(A) Incorrect. The endometrial polyp is composed of both glands and stroma.(B) Incorrect. Adenomyosis, which is the presence of endometrial glands in the uterine myometrium, results in diffuse uterine enlargement, and is not very common.(C) Incorrect. At least 20% of women have at least one leiomyoma, but leiomyosarcomas are rare. However, a large cellular mass with mitoses is less likely to be a leiomyoma. Postmenopausally, most leiomyomas stop growing or even regress.(D) Incorrect. An ectopic is a more acute process, when rupture occurs, though the course may be weeks. An ectopic is located outside the uterus, typically in a fallopian tube.(F) Incorrect. A malignant mixed mullerian tumor has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues; these heterologous elements can resemble malignant cartilage or bone. The 3MT also tends to be a large, bulky mass.
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Question 59

A 31-year-old G3 P2 woman is at 14 weeks gestation, but has noted a small amount of vaginal bleeding for the past 2 weeks. Laboratory studies show an HCG level of 650,000 U/L. An ultrasound shows a "snowstorm" for intrauterine contents but no identifiable fetus. A D&C is performed with evacuation of 500 mL of grape-like vesicles. A month later her vaginal bleeding persists and her serum beta-HCG is 35,000 U/L. Which of the following pathologic abnormalities is most likely to be present in this woman?

A Pulmonary metastases
B Tubal ectopic pregnancy
C Endometritis
D Placental site trophoblastic tumor
E Invasive mole

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(E) CORRECT. Invasive moles constitute about 10% of molar pregnancies. The failure of the HCG to diminish to near negative following the D&C suggests residual gestational trophoblastic disease.(A) Incorrect. Such masses would be typical for metastatic choriocarcinoma, but choriocarcinoma complicates only about 2 to 3 % of molar pregnancies.(B) Incorrect. If the pregnancy were tubal, it would not typically last more than a month before rupture of the tube occurred.(C) Incorrect. An endometritis would not account for a continued high HCG level.(D) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited to the pregnancy.-------------------------------------------------

Question 60

A 33-year-old woman and her husband have wanted a child, but she has been unable to conceive for the past 10 years. She has mild pelvic pain. She has regular menstrual cycles. On physical examination the cervix and vagina appear normal. The uterus and adnexal regions are normal on palpation. A pelvic ultrasound shows no lesions. A Pap smear is normal. Her husband's sperm count is normal. Which of the following is most likely to be the cause for her infertility?

A Adenomyosis
B Prolactinoma
C Pelvic inflammatory disease
D Teratoma
E Chronic cervicitis----------------------------------------------------

(C) CORRECT. PID leads to scarring that interferes with movement of the ovum released from the ovary down the fallopian tube.(A) Incorrect. Adenomyosis can produce irregular cycles and irregular vaginal bleeding. The uterus is typically enlarged.(B) Incorrect. Amenorrhea and dysmenorrhea are the classic findings from the secretion of prolactin by a pituitary adenoma. There is often galactorrhea as well.(D) Incorrect. A teratoma is most often unilateral, though occasionally bilateral. It produces a mass lesion that can often be felt, and it should be found with ultrasound.(E) Incorrect. Many women have some degree of chronic cervicitis.

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8 - gynaecology mcqs - 51 to 55

Question 51
A 28-year-old woman goes to her physician for a routine examination. She is sexually active. Pelvic examination reveals no abnormalities. A Pap smear is obtained. The cytopathology report indicates the presence of severely dysplastic cells. A biopsy of the cervix is performed, and on microscopic examination shows cervical intraepithelial neoplasia III (CIN III). Infection with which of the following organisms is most likely to cause her disease?
A Herpes simplex virus infection
B Epstein-Barr virus
C Candida albicans
D Human papillomavirus
E Trichomonas vaginalis
F Gardnerella vaginalis
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(D) CORRECT. HPV infections can lead to squamous epithelial dysplasia and carcinoma.
(A) Incorrect. HSV produces an infection with recurrent crops of painful vesicles, but these lesions are no pre-neoplastic.
(B) Incorrect. EBV infection is not characteristic for the genital tract.
(C) Incorrect. Candidal infections can produce vaginitis, but are not premalignant.
(E) Incorrect. Trichomonal infections are typically mild and do not presage CIN.
(F) Incorrect. G. vaginalis is a cause for bacterial vaginosis, not dysplasia.
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Question 52
A 23-year-old woman is admitted to the hospital with a one day history of increasing obtundation. On physical examination her temperature is 37.3 C, pulse 85/minute, respirations 16/minute, and blood pressure 90/45 mm Hg. A culdocentesis yields no blood. Laboratory studies show a positive pregnancy test. Her CBC shows a WBC count of 11,400/microliter, Hgb 10.6 g/dL, Hct 31.1%, MCV 95 fL, and platelet count 26,400/microliter. Schistocytes are noted on the peripheral blood smear. Her protime is 44 sec, partial thromboplastin time 61 sec, and D-Dimer 16 microgm/mL. A urinalysis dipstick examination shows no blood, protein, or glucose. Which of the following problems is most likely to explain her condition?
A Placental infarction
B Eclampsia
C Amniotic fluid embolus
D Retained dead fetus
E Ruptured tubal ectopic
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(D) CORRECT. This complication results in release of thromboplastin into the circulation, promoting disseminated intravascular coagulation (DIC) ith consumption of clotting factors and thrombocytopenia.
(A) Incorrect. Most placental infarcts are small and insignificant and do not lead to disseminated intravascular coagulation (DIC).
(B) Incorrect. Eclampsia can uteroplacental insufficiency with ischemia, leading to endothelial injury that promotes disseminated intravascular coagulation (DIC). However, there should be hypertension, proteinuria, and seizures.
(C) Incorrect. This is a rare complication of late third trimester pregnancy with a high mortality rate. Thromboplastins released into the circulation promotes disseminated intravascular coagulation (DIC). However, patients typically present with dypsnea.
(E) Incorrect. The shock resulting from the rupture leads to hypoxia and endothelial damage with resultant disseminated intravascular coagulation (DIC). However, in this case the culdocentesis was negative.
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Question 53
A 22-year-old woman passed grape-like masses of tissue per vagina in the 16th week of her first pregnancy. She had not felt any fetal movement at any time. On physical examination she measured 18 weeks in size. A D&C is then performed, yielding about 1000 cc of 0.5 to 1.5 cm fluid-filled vesicles. Microscopic examination of this tissue shows large avascular villi along with trophoblastic proliferation. Which of the following is the best method to employ for her follow-up?
A Chest radiograph
B Serum beta-HCG
C Endometrial biopsy
D Pelvic ultrasound
E Pap smear
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(B) CORRECT. She has a hydatidiform mole. Persistence or an increase in the HCG level should suggest that trophoblastic disease is still present, such as invasive mole or choriocarcinoma.
(A) Incorrect. The appearance of lung metastases from a choriocarcinoma arising in this hydatidiform mole would be a late finding.
(C) Incorrect. The biopsy might not pick up invasive mole or metastatic choriocarcinoma.
(D) Incorrect. The ultrasound could demonstrate mass lesions, but these would not be early findings.
(E) Incorrect. A Pap smear is relatively insensitive for endometrial lesions, and it certainly would not indicate invasive mole or metastasis of a choriocarcinoma.
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Question 54
A 23-year-old woman goes to the emergency room because of the sudden onset of lower abdominal pain. Pelvic examination reveals a normal sized uterus and normal appearing cervix and vagina. However, there is marked tenderness upon palpation of the left adnexal region. A transvaginal ultrasound demonstrates no intrauterine gestational sac, but there is a 2 cm left adnexal mass. Culdoscocentesis yields bloody fluid. Which of the following is most useful procedure to perform at this point for the patient?
A Serum complement determination
B Urinalysis with microscopic examination
C Pap smear
D Serum beta-HCG
E Endometrial biopsy
F WBC count
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(D) CORRECT. You should strongly suspect an ectopic pregnancy in this setting.
(A) Incorrect. Complement levels are used to solve complex problems with autoimmune diseases, which are chronic in nature.
(B) Incorrect. A routine urinalysis does not include a pregnancy test or a determination of HCG level.
(C) Incorrect. Besides, this is not a 'STAT' test. The Pap smear is useful for screening for dysplasia or carcinoma and for some infections.
(E) Incorrect. The endometrial biopsy might be a next step with a positive HCG to help determine if the pregnancy is ectopic.
(F) Incorrect. She does not have a reported fever. Although an inflammatory process is possible, there is a diagnosis higher on the list here.
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Question 55
A 20-year-old woman has had irregular menstrual bleeding for the past 6 months. On physical examination there are no abnormal findings. Laboratory studies show a negative pregnancy test. A D&C is performed and microscopic examination shows dyssynchronous endometrial glands and stroma of anovulatory cycles. Following the procedure she ceases to have menstrual bleeding. Which of the following is the most likely diagnosis?
A Endometriosis
B Asherman syndrome
C Prolactinoma
D Ovarian failure
E Oral contraceptive use
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(B) CORRECT. This is a very rare complication of a D&C procedure in which endometrium, including the stratum basalis, is removed.
(A) Incorrect. Endometriosis is best known as a cause for pelvic pain, though it may cause irregular menstrual cycles. It is unlikely to cause amenorrhea.
(C) Incorrect. Elevated prolactin levels can produce amenorrhea along with galactorrhea. The onset is not related to a D&C procedure.
(D) Incorrect. Ovarian failure is unlikely to have a relationship to a D&C.
(E) Incorrect. Oral contraceptives produce more regular cycles.

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7 - gynaecology mcqs - 46 to 50

Question 46
A representative of the law firm of Flotsam, Flotsam & Jetsam enters your office one day and serves you with a subpoena. The subpoena requires you to appear in regard to litigation by one of your former patients, a 31-year-old woman who is claiming that your malpractice led to medical expenses, pain, and suffering because she developed invasive cervical carcinoma. She was last seen in your office 10 years ago. She had been your patient for 5 years, receiving Pap smears in 4 of those 5 years. Your records indicate that she had no abnormal Pap smears. After discussion with your malpractice carrier's attorney, which of the following conclusions is most appropriate?
A The patient should have continued to return for yearly Pap smears
B You are at fault in this case and should avoid a trial
C The laboratory to which the Pap smears were sent is at fault for missing abnormal cells
D Nothing anyone could have done would have prevented this carcinoma
E The patient's health insurer is at fault for not covering the full cost of Pap smear testing
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(A) CORRECT. It is unlikely that a signficicant lesion will be missed in four Pap smears, which is the reason for annual Pap smears. The natural history of the progression from dysplasia to invasive carcinoma is a decade or more, so there is plenty of time to make a diagnosis and treat conservatively. Cervical carcinoma is a preventable condition.
(B) Incorrect. You have not seen the patient for 10 years, during which time a lesion had plenty of time to develop.
(C) Incorrect. It is highly unlikely that abnormal cells would be missed in four Pap smears.
(D) Incorrect. Invasive cervical carcinomas are potentially preventable through Pap smear screening and simple observation on pelvic examination.
(E) Incorrect. Policies vary markedly, but this is an inexpensive test worth getting regardless of the coverage.
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Question 47
A quality assurance (QA) project is done by a group of physicians staffing an outpatient clinic to study rates of false negative Pap smears. The QA project reveals that one physician has accounted for half of all the false negative Pap smears collected by the group over the prior year, when compared to follow-up testing. The physician's collection techniques are analyzed. Of the following procedures practiced, which is the only one that is appropriate?
A Wrote the patient's name on the slides
B Air-dried the slides prior to shipping
C Used lubricant on the speculum during collection
D Scheduled the patient visit during the menstrual phase of her cycle
E Advised the patient to douche the day prior to the appointment
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(A) CORRECT. The Pap smear is a very useful test if performed properly. Patient identification is key to any laboratory testing procedure.
(B) Incorrect. Once the cells are smeared on the slide, it must be fixed quickly to avoid air-drying artefact, which interferes with interpretation.
(C) Incorrect. Any lubricant will interfere with collection and interpretation of the specimen.
(D) Incorrect. Patients should be instructed to schedule an appointment to collect a Pap smear when they are not in the menstrual phase of the cycle.
(E) Incorrect. Patients should be advised not to douche, as this interferes with the Pap test.
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Question 48
A 30-year-old infertile woman has had episodic lower abdominal and pelvic pain for 2 years. A physical examination, including pelvic exam, reveals no abnormalities. A Pap smear shows only a few trichomonads and no dysplastic cells. A laparoscopy is performed, and the gynecologist notes the presence of several blue to red 0.2 to 0.4 cm slighted raised lesions scattered on the pelvic peritoneum in the cul-de-sac and broad ligaments. Which of the following is the most likely diagnosis?
A Metastatic adenocarcinoma
B Neisseria gonorrheae infection
C Endometriosis
D Candidiasis
E Leiomyomata
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(C) CORRECT. These 'powder burns' are typical for the small hemorrhagic foci of endometriosis on pelvic peritoneum that can produce so much discomfort for their size.
(A) Incorrect. Metastases should produce mass lesions, and she would become severly debilitated after several years with an extensive carcinoma.
(B) Incorrect. Gonorrheal infections can produce salpingitis that can be severe, but it usually resolves in several weeks, though pelvic inflammatory disease can continue to produce pain. There is scarring, but no focal red or blue lesions.
(D) Incorrect. Yeast infections involve the vagina, producing discharge and local irritation.
(E) Incorrect. Leiomyomata can be large enough to cause pelvic discomfort, but they are firm masses.
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Question 49
A 43-year-old woman has noted menstrual periods that have been exceptionally heavy, lasting 6 to 8 days, for 4 months. She has also noted minor intermenstrual bleeding. On physical examination her uterine cervix appears normal, and a Pap smear shows no abnormal cells. Pelvic examination reveals that the uterus is enlarged to twice normal size and is nodular. There are no adnexal masses. Which of the following is the most likely diagnosis?
A Endometrial carcinoma
B Leiomyomata
C Ectopic pregnancy
D Endometriosis
E Secondary syphilis
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(B) CORRECT. The most common tumor of the uterus is a leiomyoma. They can be multiple and can lead to abnormal bleeding.
(A) Incorrect. An endometrial carcinoma does not greatly enlarge the uterus. They are most common in postmenopausal women.
(C) Incorrect. An ectopic pregnancy is most likely to occur in the fallopian tube, leading to a small mass that ruptures and bleeds, producing a medical emergency.
(D) Incorrect. Endometriosis consists of small foci no more than a few millimeters in size.
(E) Incorrect. Syphilis can produce a chancre on external genitalia or cervix, but no masses.
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Question 50
A 50-year-old woman has noted increasing abdominal enlargement for the past year. On physical examination, there is a fluid wave, but no tenderness. Bowel sounds are present. She has no vaginal bleeding. An abdominal ultrasound reveals bilateral 10 and 7 cm adnexal masses. At surgery there are bilateral mass lesions of the ovaries. A total abdominal hysterectomy is performed. Pathologic examination of the ovarian masses reveals that they are unilocular, filled with watery fluid, and covered with papillary excrescences on all surfaces. Which of the following neoplasms is this woman most likely to have?
A Granulosa-theca cell tumors
B Mature cystic teratomas
C Fibrosarcoma with metastases
D Serous cystadenocarcinomas
E Clear cell carcinomas
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(D) CORRECT. This is a classic appearance. However, a borderline serous tumor must be distinguished microscopically.
(A) Incorrect. Granulosa-theca cell tumors or fibrothecomas are solid tumors.
(B) Incorrect. Such 'dermoid cysts' are often filled with sebaceous material and lots of hair.
(C) Incorrect. This is rare. Sarcomas are typically large, solid masses.
(E) Incorrect. Clear cell carcinomas of the ovary are usually solid tumors.

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