1). A 57 year old woman presents with post menopausal bleeding. Pelvic examination is normal.

On
Physical examination her Blood pressure 120/70 mmHg, pulse rate 75/min, temperature 37.8 C.On CT
pelvis she found tohave the following findings in the image shown below.

https://images.radiopaedia.org/images/1719508/eddaa1716c028c9c15aa37932f8fac_g
allery.jpg

A. Cystadenocarcinoma
B. Mesonephroid tumors
C. Endometrioid tumour
D. Brenner tumour

Correct answer : C. Endometrioid tumour

The image shows a Solid tumour with cystic areas in between

Endometrioid tumours account for about 20% of all ovarian cancers. They are mostly malignant.They are
lined by glandular epithelium. They are moderate sized solid tumours with cystic areas in between filled
with haemorrhagic fluid. Ovarian endometriosis coexist in 15% of cases.

2). A 65 year old woman complain of a vaginal bulge and heavy straining during defeacation. She
underwent a diagnostic test and had the following findings shown in the image below.

http://ars.els-cdn.com/content/image/1-s2.0-S1878788616301655-gr1.jpg

What is the diagnosis and the operative procedure done for the above condition?
A. Vault prolapsed & Vault repair
B. Enterocoele & Moschcowitz repair
C. Chronic inversion of uterus & vaginal pessary
D. Adenomyosis & Myomectomy

Correct answer : B. Enterocoele & Moschcowitz repair

MRI defecogram: sagittal slice during straining. A. The arrow indicates moderate grade internal prolapse,
descending onto but not into the rectocele. B. The double arrow indicates high-grade internal prolapse. The
lower pole descends into the rectocele.

The above patient is found to have enterocele

In Moschcowitz repair, several purse string sutures starting from below are used to obliterate the cul-de-sac of
the pouch of Douglas. Care should be taken not to include the ureter in the stitch.

3). A Lady with infertility found to have the following findings on diagnostic hysteroscopy. The most
likely condition that leads to the problem shown in the image below?

https://i.ytimg.com/vi/5KTnus9nWR4/maxresdefault.jpg
A. Pelvic inflammatory disease
B. Endometriosis
C. Hydrosalphynx
D. Hemosalphynx

Answer : A; Pelvic inflammatory disease leads to the bilateral tubal block due to the ascending infection

4). Infection of which gland will cause the condition shown in the figure below:

https://obgynkey.com/wp-content/uploads/2017/04/A307466_1_En_11_Fig3_HTML.jpg

A. Bartholins gland
B. Skenes gland
C. Clitoral gland
D. Vulvovaginal gland

Answer : B ; Periurethral glands (Skene's glands) are tubuloalveolar structures along thedorsolateral
aspect that drain into the distal two thirds of the urethra. Repeated infectionand obstruction of these
glands lead to formation of suburethral cysts or abscesses thatcan rupture into the urethral lumen

5). The vaginal condition in the figure below

https://mediklik.com/new_assets/diseaseimages/809.jpg

A. Candidiasis
B. Trichomoniasis
C. Bacterial vaginosis
D. None of the above

Answer: A;vaginal candidiasis is presented with curdy white discharge and itching

6). A 30 year old female presented with infertility and underwent hysteroscopy and figure below shows?

http://www.ultrasoundcare.com.au/images/EndoUVPouchEmCri.jpg

A. Endometriosis
B. Fibroid uterus
C. Endometrial cancer
D. None of the above

Answer: A; Endometriosis visualized as burnt powder appearance in laparoscopy

7). A 13-year old girl came to the casualty with acute lower abdominal pain. She had cyclical pain for
the last 6 months. She has not yet attained her menarche. On examination, the following finding shown
in the image below and her vitals: Blood pressure 110/70 mmHg, Pulse rate 72/min, respiratory rate
18/min.

https://ars.els-cdn.com/content/image/1-s2.0-S1110570415000028-gr3.jpg

The most probable diagnosis is?

A. Mayer-Rokitansky-Kster-Hauser syndrome
B. Imperforate hymen
C. Ashermans syndrome
D. Congenital adrenal hyperplasia

Correct answer : B. Imperforate hymen

The above image shows a bulge at vagina and hematocolpos

Imperforate hymen prevents the drainage of menstrual blood.

This results in the accumulation of blood in the vagina leading to hematocolpos.
This is visualised as the tense bulge.
In long standing cases it can even lead to hematometra.

8). A primigravida in the first trimester of pregnancy and underwent sputum examination which shows
the following findings shown in the image below. There is no prior history of tuberculosis. What is the
treatment of choice for this patient?

http://microbeonline.com/wp-content/uploads/2013/12/Acid-fast-bacillus.png

A. Category I DOTS
B. Category II DOTS
C. Category III DOTS
D. Start ATT after delivery

Correct answer : A. Category I DOTS

Newly smear positive cases of Tuberculosis are treated with Category I DOTS (Directly Observed
Treatment Short course) in India. The drugs given in category I DOTS Isoniazid, Rifampicin, Ethambutol
and Pyrazinamide are not contraindicated in pregnancy. But if the disease is not treated properly, it is
harmful for the foetus. Streptomycin is not given in pregnant patients as it is teratogenic

9). A 25 year pregnant woman underwent an antenatal scan and found to have the following
condition shown in the image below.

https://images.radiopaedia.org/images/4200112/a7e225cb22e70ef2d49105da67e558_big_gallery.jpg

What is the Virus responsible for the above condition?

A. Cytomegalovirus

B. Herpes simplex virus

C. Hepatitis B virus

D. Parvovirus

Correct answer : D. Parvovirus

The antenatal scan showed subcutaneous oedema including scalp oedema, fetal ascites and
placentomegaly suggesting a diagnosis of hydrops fetalis.

Parvovirus is the commonest infectious etiology for hydrops foetalis. The other viruses
implicated include Cytomegalovirus, Hepatitis B virus, Herpes simplex virus, Rubella
virus and Adenovirus.

10). A 35 year old primigravida underwent an obstretic scan and found to have the following
finding shown in the image below.

https://i.ytimg.com/vi/9c2LimtE2UY/hqdefault.jpg

The above finding is characteristic of ?

A. Turner syndrome

B. Downs syndrome

C. Hydrocephalus

D. Klinefelter syndrome

Correct answer : B. Downs syndrome

The above image shows nuchal trabnslucency which is suggestive of downs syndrome.

Downs syndrome is the most common cause of increased nuchal translucency in fetal ultrasound. The other
causes are Trisomy 13, Trisomy 18, Klinefelter syndrome & Turners syndrome.

11). A 27 year sexulally active woman who presents with non cyclical bleeding underwent
colposcopy examination and had the following findings shown in the image below.

http://www.womenhpv.com/wp-
content/uploads/2016/03/Colposcopy_colpoview_cervix.gif
Which among the following is most commonly associated with the above condition?

A. HPV 35

B. HPV 33

C. HPV 18

D. HPV 16

Correct answer : D. HPV 16

HPV 16 is most commonly associated with carcinoma cervix. It is responsible for 40-
70% of all invasive squamous cell cervical cancers.

12).A 25 year old primigravida is in the labour. During 2nd stage of labor she had the following
problem which is shown in the image below.

https://www.levylaw.com/images/stories/shoulder-dystocia.jpg

Which of the following maneuvers is not used for the management of the above problem?

A. McRoberts maneuver

B. Suprapubic pressure

C. Woods corkscrew maneuver

D. Mauriceau Smellie Veit maneuver

Correct answer : D. Mauriceau Smellie Veit maneuver

The above patient had shoulder dystocia. It is a type of obstructed labour in which the anterior shoulder of the
fetus fails to deliver after the emergence of the head.

Mauriceau Smellie Veit maneuver is used in the management of after coming head in case of breech delivery
but not used for shoulder dystocia

13). A 36 year old woman presents with passing feculent material per vaginum. On
examination her vitals: : Blood pressure 110/70 mmHg, Pulse rate 72/min, respiratory rate 18/min. She
underwent sagittal CT abdomen and pelvis and found to have the following problem which is shown in the
image below.

https://images.radiopaedia.org/images/6870609/f49083e91ae400c6e2313408191149_big_gallery.jpg
Which of the following is the initial step in the management of the above condition?

A. Colostomy
B. Primary repair
C. Colporrhaphy
D. Anterior resection

Correct answer : A. Colostomy

The definitive treatment is surgery. But to increase the success rate of surgery,
colostomy can be done initially. This decreases inflammation.

14). A 40 year female complains of long history of vulval itching and soreness.. She denies any history of
genital infections. On examination of vulva the following findings are noted which are shown in the
figure below.

What can be the diagnosis?

A. Candidiasis
B. Lichen planus
C. Lichen simplex
D. Condylomata acuminate

Correct answer: C. Lichen simplex

The image shows inflamed and thickened labia majora and soreness of vulva which is suggestive of
lichen simplex

15).A 50 year old African lady presents to the clinic with difficulty passing urine and got emptied by
catheter. She had multiple history of urine emptying situations. The image shown below indicates which
grade of prolapse?
http://www.annalsafrmed.org/articles/2007/6/4/images/AnnAfrMed_2007_6_4_194_55697_f1.jpg

A. 1st degree
B. 2nd degree
C. 3rd degree
D. 4th degree

Correct Answer: 4th degree

In 4th degree uterine prolapsed, both uterus and cervix are outside the vaginal introitus.

16). A lady presented to clinic with difficulty in urination, hesitancy and incontinence. She underwent an
upright MRI and found to have the following condition responsible for her symptoms.

Which of the following is the diagnosis?

A. Rectocele
B. Cystocele
C. Uterine prolapsed
D. None of the above

Correct answer: B. Cystocele

Cystocele causes the above mentioned symptoms.

cystocele occurs when the supportive tissue between the bladder and vaginal wall weakens and
stretches, allowing the bladder to bulge into the vagina.

17). A 20 year sexually active woman complain of vaginal discharge , vulval pruritus and superficial
dyspareunia. On microscopic examination of vaginal swab it showed the findings in the image below.

https://lng2dthf2c-flywheel.netdna-ssl.com/wp-content/uploads/2015/12/Trichomoniasis.jpg
 A. Treponema pallidum
B. Neisseria gonorrhoea
C. Human Papilloma Virus
D. Trichomonas vaginalis

Correct answer: D. Trichomonas vaginalis

Trichomonas vaginalis is a flagellate which shows a tuft of flagella on one side on microscopic
examination.

18). A 25 year old woman complain of Painless bumps on her genital area, pruritus, and discharge. On
examination of vulva, the following condition is noted which is shown in the image.

http://bestcureforgenitalwarts.com/wp-content/uploads/2015/08/genital-warts-labia-296x300.png

which of the following can be the cause?

A. Chlamydia
B. Syphilis
C. Gonorrhoea
D. Human pailloma virus

Correct answer: D. Human pailloma virus

19). A 30 year old woman presents to the clinic with complaints of vaginal discharge. On examination
the vaginal PH is 5 and microscopic examination shows the following findings in the image below.

http://www.mtnstopshiv.org/lab/wetmount_training/slide5_0.jpg

Which of the following is the diagnosis?

A. Candidiasis
B. Bacterial vaginosis
C. Lichen sclerosus
D. Lichen vaginosis

Correct answer: B. Bacterial vaginosis

The above image shows the wet mount of vaginal discharge which contains clue cells.

20). A pregnant woman with 30 weeks of gestation presents to the emergency department with
bleeding per vaginum. On examination the fetal heart rate is 142/min, uterus is relaxed and internal os
is closed. On ultrasound the following findings are noted. She perceives the fetal movements.

http://rocketparents.com/uploads/blog/pregnancy-week-30-6.jpg
which of the following is the condition?

A. Incomplete miscarriage
B. Threatened miscarriage
C. Missed miscarriage
D. Septic miscarriage

Correct answer: B. Threatened miscarriage

The above finding reveals threatened miscarriage in which the fetus is still alive with normal heart rate
and the internal os is closed.

21). A pregnant woman with G3P1L1 came to the antenatal clinic with history of 2 spontaneous 2nd
trimester miscarriages. She underwent the following g procedure shown below in the image.

https://media.licdn.com/mpr/mpr/AAEAAQAAAAAAAAdSAAAAJDM3MGJlN2JjLWMxOGUtNGVhYi04Yjk4
LWZlNDc3ZjE0NDJlZQ.jpg

A. Cervical cerclage
B. Cervical circling
C. Cervical softening
D. Cervical rub

Correct answer: A. Cervical cerclage

Cervical cerclage is done for the cervical incompetence which causes recurrent miscarriages.

22). A 25 year old pregnant woman with 32 weeks gestation came to the antenatal visit and complain of
the following condition shown below in the image. Her blood pressure is 110/70 mmHg, pulse rate is
79/min, respiratory rate 20/min. her blood pressures are maintained within normal limits when the
nurse check her BP.

http://www.indusladies.com/wp/wp-content/uploads/2014/03/edema.jpg

The treatment for the above condition?

A. Hydrochlorthiazide
B. Metolazone
C. Furosemide
D. No treatment

Correct answer: D. No treatment

The generalized ankle edema without any changes in blood pressure does not require any treatment
and the patient can be reassured for her condition.
23). A 30 year P2L2 female complain of bleeding per vaginum in between the menstrual cycles. She
found to have the following condition in the image shown below.

The appropriate treatment for the above condition?

A. Myomectomy
B. Hormone manipulation
C. Hysterectomy
D. Uterine artery embolization

Correct answer: A. Myomectomy

The above shown image reveals submucosal fibroid and the treatment of choice is myomectomy which
is minimal invasive and provides relief from menorrhagia.

24). A 17 year old female presents to the clinic with short stature, no menarche, broad shield chest but
with normal development of pubic hair. The following investigation done which is shown in the image
below to diagnose her condition.

http://www.doctortipster.com/wp-content/uploads/2011/07/turner-syndrome.jpg

Which of the following can be the diagnosis?

A. Klinefelter syndrome
B. Turner syndrome
C. Downs syndrome
D. Mittelshmerz syndrome

Correct answer: B. Turner syndrome

In turner syndrome there will be short stature, webbed neck, broad shield chest, failure to get
menarche, normal development of pubic hair, hypoplastic nails, multiple nevi, high arched palate,
coarctation of aorta, cutic laxa. The image shown above shows the karyotype of the patient with
chromosome number 44X
25). A 27 year pregnant women with 28 weeks of gestation came for the antenatal visit. She underwent
obstretic scan and found to have the following condition shown in the image below.

Which of the following indicates the above condition?

A. Oligohydramnios
B. Hydrops fetalis
C. Polyhydramnios
D. Polyamnionitis

Correct answer: C. Polyhydramnios

26). A 24 year primigravida with 8 weeks of geststion presents with tertiary fever, vomiting, headache,
body aches and general weakness. The below image shows the causative agent of the above symptoms.

http://amjmed.org/wp-content/uploads/2016/02/gr12.jpg

What can be the appropriate management?

A. Chloroquine
B. Sulfadoxine-pyrimethamine
C. Mefloquine
D. Lumefantrene

Correct answer: A. Chloroquine

A peripheral blood smear obtained from the patient on admission demonstrated approximately 50%
parasitemia. Note the early ring-form trophozoites (arrows), mature trophozoites (triangles), and
developing schizont (circle).

Chloroquine can be used in the 1st trimester of pregnancy.

27). A 25 year old woman needs contraception for 3 years but she dont want to take the OCPs. The
gynaecologist advised a method of contraception shown below in the image.

http://www.greenstar.org.pk/assets/images/products/iucd-proc.jpg

What can be the most common complication of the above type of contraception?
A. Bleeding
B. Pain
C. Pelvic infection
D. Ectopic pregnancy

Correct answer:A.Bleeding

Bleeding is the most common complication of IUCD (Intrauterine contraceptive device)

28). A 35 year old woman presents with primary infertility and mass per abdomen. CA
125 level is 90U/ml. she underwent MRI pelvis and found to have the following
condition shown in the image.

http://eu-csite-storage-prod.s3.amazonaws.com/www-eurorad-
org/mediafiles/0000008359/000009_text.jpg

Most probable diagnosis is?

A. Ovarian cancer
B. Borderline ovarian tumor
C. Tuberculosis
D. Endometrioma

Best answer : D. Endometrioma

axial T1-weighted image revealing the high signal of a 5 cm endometrioma, on left side
of the cul-de-sac (open arrow) and apparent mural nodules (solid arrow) in the right
ovarian cyst with 10x8 cm and intermediate signal intensity.

CA 125 can be raised in all of the conditions mentioned above. But it is not of much
significance in case of tuberculosis. Mass per abdomen can be seen in all of the above.
Infertility is a feature of both endometriosis and tuberculosis. Infertility is also a risk
factor for ovarian cancer. Based on the age of the patient, endometrioma is the most
probably diagnosis among the options given. Ovarian cancer is seen in elderly age
group (56-60 years). Borderline tumours are seen at an average age of 46 years.
Tuberculosis is seen in patients in 20-30 years of age.

29). The pseudomyxoma peritonei occurs as a complication of the following ovarian

tumor:

http://learningradiology.com/images/guimages/jelly%20bellyx2ann.jpg

a) Serous cystadenoma
b) Mucinous cystadenoma
c) Dysgerminoma
d) Gonadoblastoma

Correct answer : b) Mucinous cystadenoma

Axial contrast-enhanced CT images of the abdomen and pelvis

demonstrate lobulated, low-attenuation soft tissue masses scalloping the borders of the
liver, spleen and along mesentery due to mucin producing tumor.

Causes of pseudomyxoma peritonei Mucinous cystadenoma of ovary, mucocele of

appendix, carcinoma of large intestine in men

30). A 30 year old woman with history of dilatation and curettage for her condition presents with
amenorrhea. She underwent diagnostic hysteroscopy and had the following findings shown in the
image below.

The risk of getting the above shown condition is the highest if Dilatation and Curettage
(D & C) is done for the following condition:
a) Medical termination of pregancy
b) Missed abortion
c) Dysfunctional uterine bleeding
d) Post partum haemorrhage

Correct answer : d) Post partum haemorrhage

31). A 35 year old woman (P2L2) presents to the clinic with amenorrhea from 8 months. She also
complain of occasional headache on and off. Her blood pressure is 130/70 mmHg, pulse rate is 75/min,
respiratory rate 18/min. she underwent MRI head and it revealed the following diagnosis shown in the
image below.
https://medicalimages.files.wordpress.com/2011/10/pituitary-adenoma-micro-if-less-than-1cm-
bitemporal-hemianopiaioc-mri-ttt-cortisone-dopamine-agonist-sertonin-antagonist-somatostatin-
analogue2.jpg

which of the following is the treatment of the above condition?

A. Transsphenoidal resection
B. Craniotomy
C. Hormonal manipulation
D. None of the above

Correct answer: A. Transsphenoidal resection

Transsphenoidal microscopic surgery is the most frequent surgical approach for the resection of
pituitary tumors.

32). A 30 year old woman with history of the condition shown below in the image
undergoing caesarian section.

http://c.ymcdn.com/sites/scmr.org/resource/resmgr/cow_images/2016/Lili_2016/Figur
e_2._Chest_X-ray_Annota.jpg

Which type of anaesthesia technique is chosen?

A. Spinal anaethesia

B. Epidural anaesthesia

C. General anaesthesia

D. Local anaesthesia with nerve blocks

Correct answer: C. General anaesthesia

The above image shows rib notchin and 3 sign

General anaesthesia is preferred because of more rapid induction, less hypotension and
better airway & ventilation.

33). A 35 year old primigravida complain of passing grape like vesicles along with the
bleeding per vaginum. On examination her abdomen is according to the gestational
period but on ultrasound she found to have the following condition.

https://images.radiopaedia.org/images/2038753/94b406549d5a3d552add7600487830.
jpg
Which of the following is the treatment for the condition shown above?

A. Myomectomy
B. Suction & evacuation
C. Hysterectomy
D. Diagnostic hysteroscopy

Correct answer: B. Suction & evacuation

Molar Evacuation Suction curettage is the preferred method of evacuation of the uterine
cavity using suction, as it gives the lowest incidence of sequelae like uterine
perforation.

34). A 27 year old lady and her partner are seen in gynaecology OPD with primary infertility. They
stopped using condoms 2 years ago and had regular intercourse since then. The partner has no previous
history of note. He drinks 8 units of alcohol per week. The woman also has no previous history but her
periods occur every 31 to 46 days with heavy bleeding but no pain. There is no intermenstrual or post
coital bleeding. No history of sexually transmitted infections. She underwent transvaginal ultrasonogram
and found to have the following finding shown in the image below.

Her lab findings are as follows

Day 3 LH 6.2 IU/L

Day 3 FSH 3.1 IU/L

Day 21 progesterone 15 nmol/L

What is the diagnosis?

A. PCOS
B. Prolactinoma
C. Fibroid uterus
D. Ashermans syndrome

Correct answer: PCOS

The problem is anovulatory infertility due to PCOS. Anovulation is shown by progesterone level < 30
nmol/L

35). A 77 year old lady is admitted with shortness of breathe. She says that she was unwell for 8 weeks.
She has decreased appetite and nausea when she eats. She has generalized abdominal pain and
constipation which is unusual for her. No urinary symptoms. She is a widow and did not have children.
She was healthy and no previous hospital admissions. She got her menopause at 52 years age. On
examination she had a left iliac fossa mass of 10 cm. she underwent CT abdomen and chest X ray and
the findings are shown in the image below.

https://images.radiopaedia.org/images/4776608/ca8d9c7359b3700b0b63df0dc63b3b_jumbo.JPEG

http://www.auntminnie.com/user/images/content_images/nws_rad/2006_08_22_15_30_29_706.jpg

Her CA 125 is 118ku/L

What is the diagnosis?

A. Endometrial carcinoma
B. Ovarian cancer
C. Liver failure
D. Uterine leiomyosarcoma

Correct answer: B. Ovarian cancer

History and examination reveals right pleural effusion and ascites due to the mass. The ultimate
management is to do a laparotomy and send the specimen for HPE.

36). A 48 year old woman complain of intermenstrual bleeding for 2 months. Episodes of bleeding can
occur any time in the cycle. This is usually fresh red blood and much lighter than a normal period. It can
last for 1 6 days. There is no pain and hot flushes. She is sexually active and not noticed any vaginal
dryness. She had 3 children and used progesterone only pill for 5 years. Her last smear test was 2 years
ago and all smears have been normal. She takes no medication and no other relevant history. She
underwent ultrasound and found to have the following condition shown in the image below.

http://www.ultrasoundcare.com.au/images/Pelvic%20Ultrasound%20img1.jpg

What is the diagnosis?

 A. Endometrial polyp
B. Cancer cervix
C. Endometrial carcinoma
D. Fibroid uterus.

Correct answer: A. Endometrial polyp

Endometrial polyps are more common in older women and can be asymptomatic or cause
intermenstrual bleeding. However the specimen should be sent to HPE to rule out endometrial
carcinoma.

37). A 36 year old Aafrican-carribean woman presents with abdominal swelling 10 months. She has to
wear large clothes and people have asked her that if she is pregnant, which she finds distressing. She has
no abdominal pain, no dysuria, normal bowel movements but she had urinary frequency. Her periods
are regular but she passes heavy clots but never received any treatment for this. She has been with her
partner from 7 years and not used any contraception. After some work up she underwent MRI abdomen
and pelvis and had the following finding which is shown in the below image.

http://www.fibroids.co.uk/images/scan1.jpg

what is the diagnosis?

A. Endometrial carcinoma
B. Ovarian cyst
C. Uterine leiomyoma
D. Molar pregnancy

Correct answer: C. Uterine leiomyoma

The MRI image shows 12cm large uterine fibroid

The woman has large uterine fibroid which is causing menorrhagia and infertility. Typical presentation of
fibroid includes, menorrhagia, pressure on bladder or bowel, abdominal mass, infertility. African-
carribean women tends to develop fibroids

38). A 28 year old wwoman attends clinic after an abnormal smear test and underwent colposcopy and
found to have following condition shown in the images below. The smear is reported as severe
dyskaryosis. She has not had any postcoital bleeding or intermenstrual bleeding. She is in sexual
relationship from the age of 14. Had multiple sexual partners. She smokes 15 to 20 cigarettes per day.

http://www.aafp.org/afp/2006/0101/afp20060101p105-f7.jpg

which of the following is the appropriate procedure?

A. Cervical conization
 B. Large loop excision of the transformation zone
C. Cervical cryotherapy
D. Colpectomy

Correct answer: B. Large loop excision of the transformation zone

39). A 59 year old woman woke with blood on her night dress, which was bright red but not heavy.
There were no clots or pain abdomen. The bleeding recurred twice. Her last period was at 49 years of
age. She is sexually active but noticed vaginal dryness recently. She underwent transvaginal
ultrasonography and had the following findings (endometrial thickness 3mm) shown in the image below.
She takes Atenolol for hypertension and omeprazole for epigastric pain. On examination there were no
palpable adnexal masses. An outpatient endometrial biopsy done which shows no evidence of
inflammation, malignancy or hyperplasia.

http://www.cwsabq.com/wp/wp-content/uploads/2013/05/Trilaminar-Endometrium.jpg

What can be the diagnosis?

A. Endometrial cancer
B. Cancer cervix
C. Atrophic vaginitis
D. Endometrial polyp.

Correct answer: C. Atrophic vaginitis

The diagnosis of atrophic vaginitis can be made by exclusion of serious causes based on the biopsy and
ultrasound reports. Treatment can be topical estrogen daily for 3 weeks and then twice weekly for
maintenance for 2 to 3 months. Latter an alternative solution is to give combined systemic HRT to
protect endometrium.

40). A 43 year old woman referred by her GP with painful periods. She says that her periods were quite
painful and heavy from last 3 years. She bleeds for every 24 days and lasts for 7 9 days. The pain is
constant, severe, dull and she will take Paracetamol and mefenamic acid at the edge, but not relieved
of pain completely. She had 4 children and her husband was vasectomised. Her smear is normal which
was done 18 months ago. On transvaginal ultrasound, she found to have multiple ill-defined cystic
spaces and an indistinct endometrial border in the image shown below.

https://www.researchgate.net/profile/Nick_Raine-
Fenning/publication/223486193/figure/fig1/AS:305305796792320@1449801982859/Figure-2-
Adenomyosis-There-is-enlargement-of-the-posterior-myometrium-but-no-definable.png

What is the likely diagnosis?

A. Pre-menstrual syndrome
 B. Pelvic inflammatory disease
C. Adenomyosis
D. Endometriosis

Correct answer: C. Adenomyosis

The symptoms of menorrhagia and dysmenorrhea with the findings of ultrasound report suggests a
diagnosis of adenomyosis