BENIGN GYNECOLOGIC LESIONS 1.2 (TB)

Question 1

Which part of the vagina is in close relationship with the urogenital and pelvic diaphragms?

Answer 1

The lower third of the vagina.

Question 2

What supports the middle third of the vagina?

Answer 2

The levator ani muscles and the lower portion of the cardinal ligaments.

Question 3

What structures support the upper third of the vagina?

Answer 3

The upper portions of the cardinal ligaments and the parametria.

Question 4

What is a Gartner’s duct cyst?

Answer 4

A cystic dilation of the embryonic mesonephros, usually present on the lateral wall of the vagina.

Question 5

Where are Gartner’s duct cysts typically located?

Answer 5

In the lower third of the vagina, present anteriorly.

Question 6

How can you differentiate a large urethral diverticulum from a Gartner’s duct cyst?

Answer 6

A urethral diverticulum will shrink when the urethra is milked and urine comes out, whereas a Gartner duct cyst does not.

Question 7

What is the most common periurethral mass in women?

Answer 7

Urethral diverticulum, representing approximately 84% of periurethral masses.

Question 8

What is a key clinical test for urethral diverticulum?

Answer 8

Insert two fingers and compress towards you; if urine leaks out, it indicates a urethral diverticulum.

Question 9

What are the common symptoms of a urethral diverticulum?

Answer 9

Urinary urgency, frequency, dysuria (90%), hematuria (15%).

Question 10

Which imaging modalities can diagnose a urethral diverticulum?

Answer 10

Voiding cystourethrography, cystourethroscopy, MRI, and ultrasonography.

Question 11

What is the definitive treatment for a urethral diverticulum?

Answer 11

Excisional surgery when the diverticulum is not infected.

Question 12

What is the recurrence rate of urethral diverticulum after surgery?

Answer 12

10-20% due to incomplete resection.

Question 13

What are potential complications of urethral diverticulum repair?

Answer 13

Urinary incontinence and urethrovaginal fistula.

Question 14

What is an inclusion cyst?

Answer 14

A cyst that forms from vaginal epithelium buried beneath the surface following a gynecologic or obstetric procedure.

Question 15

Where are inclusion cysts commonly found?

Answer 15

In the posterior and lateral walls of the lower third of the vagina.

Question 16

What is the management of an inclusion cyst with dyspareunia or pain?

Answer 16

Excisional biopsy.

Question 17

What is a dysontogenic cyst?

Answer 17

A thin-walled, soft cyst of embryonic origin, usually 1-5 cm in diameter, found in the upper half of the vagina.

Question 18

What are the three types of dysontogenic cysts and their origins?

Answer 18

Gartner duct cyst (mesonephros), Müllerian cyst (paramesonephricum), Vestibular cyst (urogenital sinus).

Question 19

What is the most common vaginal foreign body?

Answer 19

A forgotten tampon.

Question 20

What are the symptoms of a forgotten tampon?

Answer 20

Foul-smelling vaginal discharge or spotting.

Question 21

What serious condition can a forgotten tampon cause?

Answer 21

Toxic shock syndrome due to Staphylococcus aureus.

Question 22

How do you treat a retained tampon?

Answer 22

Remove the tampon, wash with normal saline and betadine, and prescribe Clindamycin or Metronidazole.

Question 23

What is the most frequent cause of vaginal trauma in adult females?

Answer 23

Coitus (sexual intercourse, 80%).

Question 24

What are common causes of vaginal trauma?

Answer 24

Straddle injuries, penetration by foreign materials, sexual assault, vaginismus, and waterskiing accidents.

Question 25

What is a common predisposing factor for vaginal trauma?

Answer 25

Virginity, postpartum or postmenopausal vaginal epithelium, pregnancy, and prolonged abstinence.

Question 26

What is the most common type of coital laceration?

Answer 26

Transverse tear of the posterior fornix.

Question 27

What are the clinical manifestations of post-coital laceration?

Answer 27

Profuse vaginal bleeding, sharp pain during intercourse, and persistent abdominal pain (25%).

Question 28

What is the most serious complication of vaginal trauma?

Answer 28

Vaginal evisceration, where intestines protrude through a large vaginal tear.

Question 29

What is the source of vaginal lubrication during intercourse?

Answer 29

A transudate produced by engorgement of the vascular plexuses encircling the vagina.

Question 30

What is the difference between vaginal and cervical secretions during coitus?

Answer 30

Vaginal secretions are transudates, while cervical secretions are thick and copious.

Question 31

What is the lower, narrow portion of the uterus called?

Answer 31

Cervix

Question 32

What is the Latin origin of the word 'cervix'?

Answer 32

Neck

Question 33

What is the Greek word for cervix?

Answer 33

Trachelos

Question 34

What does 'trachelorrhaphy' mean?

Answer 34

Repair of the cervix

Question 35

What is the Greek word for vagina?

Answer 35

Kolpos

Question 36

What is the shape of the cervix?

Answer 36

Cylindrical to conical

Question 37

What type of tissue predominantly makes up the cervix?

Answer 37

Fibrous tissue

Question 38

What are other names for Nabothian cysts?

Answer 38

Mucinous retention cysts, epithelial inclusion cysts

Question 39

What causes a Nabothian cyst to form?

Answer 39

A cleft of columnar epithelium becomes covered with squamous cells, trapping secretions.

Question 40

What is the appearance of a Nabothian cyst?

Answer 40

Translucent or opaque whitish or yellow, 2-10 mm or 1 cm

Question 41

What is the common cause of trauma to the cervix that leads to Nabothian cyst formation?

Answer 41

Minor trauma or childbirth

Question 42

Are Nabothian cysts considered normal?

Answer 42

Yes, they are a normal feature of the adult cervix.

Question 43

How are Nabothian cysts diagnosed?

Answer 43

Clinical exam and speculum examination.

Question 44

What is the management for asymptomatic Nabothian cysts?

Answer 44

No treatment necessary.

Question 45

What is the treatment for painful Nabothian cysts?

Answer 45

Cryosurgery or ablation using electrosurgery.

Question 46

What is the most common benign neoplastic growth of the cervix?

Answer 46

Cervical polyp

Question 47

In which group are endocervical polyps most common?

Answer 47

Multiparous women in their 40s and 50s.

Question 48

What are the two main types of cervical polyps?

Answer 48

Endocervical (narrow, long pedicle & cherry red) and ectocervical (short, broad base & grayish white).

Question 49

What is a common symptom of cervical polyps?

Answer 49

Postcoital bleeding or intermenstrual bleeding.

Question 50

How are cervical polyps diagnosed?

Answer 50

Speculum examination and biopsy.

Question 51

What is the management of cervical polyps?

Answer 51

Polypectomy, cauterization if needed, or surgical procedures like hysteroscopic polypectomy.

Question 52

What is the usual number of cervical myomas present?

Answer 52

Usually solitary.

Question 53

What are symptoms of cervical myoma?

Answer 53

Vaginal bleeding, dysuria, urgency, obstruction, dyspareunia.

Question 54

How is cervical myoma diagnosed?

Answer 54

Speculum, pelvic examination, biopsy.

Question 55

What is the management of cervical myoma in reproductive age?

Answer 55

GnRH agonists, excision.

Question 56

What is the management of cervical myoma in patients with completed family size?

Answer 56

Hysterectomy.

Question 57

What is the immediate management of acute cervical laceration?

Answer 57

Suturing.

Question 58

What can happen if a cervical laceration is not repaired?

Answer 58

May lead to cervical incompetence in future pregnancies.

Question 59

Where is the major arterial supply to the cervix located?

Answer 59

Lateral cervical walls at 3 and 9 o’clock positions.

Question 60

What type of suture is used to reduce blood loss during cervical procedures?

Answer 60

Deep figure-of-eight suture through vaginal mucosa and cervical stroma at 3 and 9 o’clock.

Question 61

What is cervical ectropion?

Answer 61

Eversion of the endocervix, exposing columnar epithelium to the vaginal environment.

Question 62

What is the appearance of cervical ectropion?

Answer 62

Reddish, similar to granulation tissue, may be covered by yellow turbid discharge.

Question 63

Who commonly has cervical ectropion?

Answer 63

Adolescents, pregnant women, and those taking estrogen-progestin contraceptives.

Question 64

What is the management of asymptomatic cervical ectropion?

Answer 64

No treatment needed.

Question 65

What is the first step before treating cervical ectropion?

Answer 65

Rule out malignancy.

Question 66

What are treatment options for symptomatic cervical ectropion?

Answer 66

Acidifying agent trial or invasive procedures like cryosurgery/electrosurgery.

Question 67

What is cervical stenosis?

Answer 67

Narrowing or obstruction of the cervix.

Question 68

What are causes of acquired cervical stenosis?

Answer 68

LEEP, cervical cautery, radiation, infection, neoplasia, atrophic changes.

Question 69

What are symptoms of cervical stenosis in premenopausal women?

Answer 69

Dysmenorrhea, pelvic pain, amenorrhea, infertility.

Question 70

What are possible complications of cervical stenosis in postmenopausal women?

Answer 70

Hematometra, hydrometra, pyometra.

Question 71

How is cervical stenosis diagnosed?

Answer 71

Inability to introduce a 1-2 mm dilator into the uterine cavity.

Question 72

What is the management of cervical stenosis?

Answer 72

Dilation under ultrasound guidance, stenting to maintain patency.