Hysteroscopy

Hysteroscopy

Q. 1

Hysteroscopy can diagnose all, except :

 A

Asherman’s syndrome

 B

Septate uterus

 C

Adenomyosis

 D

TB endometritis

Q. 1

Hysteroscopy can diagnose all, except :

 A

Asherman’s syndrome

 B

Septate uterus

 C

Adenomyosis

 D

TB endometritis

Ans. C

Explanation:

Adenomyosis


Q. 2

Hysteroscopy means visualization of :

 A

Genital tract

 B

Fallopian tube

 C

Uterine cavity

 D

Cervix

Q. 2

Hysteroscopy means visualization of :

 A

Genital tract

 B

Fallopian tube

 C

Uterine cavity

 D

Cervix

Ans. C

Explanation:

Uterine cavity


Q. 3

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Q. 3

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Ans. D

Explanation:

None


Q. 4

Fallopian tube patency is checked by

 A

Hysterosalpingography

 B

Laparoscopy

 C

Hysteroscopy

 D

All of the above

Q. 4

Fallopian tube patency is checked by

 A

Hysterosalpingography

 B

Laparoscopy

 C

Hysteroscopy

 D

All of the above

Ans. D

Explanation:

All of the above

Tests Performed for Tubal patency are : 1. CO, insufflation test/ Rubins test (out dated)°

  1. Hysterosalpingography (HSG)°: Screening test.
  2. Laparoscopic chromotubation°: Best test
  3. Sonosalpingography (Sion Test)°
  4. Hysteroscopy°
  5. Transcervical Falloscopy°
  6. Ampullary and Fimbrial Salpingoscopy.°

Extra Edge : Time of performing Tubal Patency test 61‘ – 111h day of cycle (-= 10′h day).

Result :

  • If tubes are patent, the medium will be seen to spill out of the abdominal ostia on to the adjacent viscera.°
  • If either of the tubes is blocked – site will be shown.°
  • A hydrosalpinx will show as a large confined mass of dye without peritoneal spill.°
 
  • Bilateral cornual block with extravasation of the dye is suggestive of tubercular salpingitis.° • Laparoscopic chromotubation -Once HSG shows blocked tubes, it can be confirmed by laparoscopic visualization of the pelvis, fallopian tubes and ovary and injection of methylene blue through the cervix to visualize free spill or absence of spill.

In addition to tuba! patency it can diagnose any peritubal adhesions or endometriosis.

Sonosalpingography -(SION TEST) : In this test, 200 ml of physiological saline is slowly injected into the uterine cavity with the help of foleys catheter (its inflated bulb lies at the level of internal os) and flow of the saline along the tube is then visualized by USG.


Q. 5

Diagnosis of septate uterus done by :

 A

USG

 B

Uterine sound and Hysterosalpingography both

 C

Hysteroscopy and Laparoscopy both

 D

All are correct

Q. 5

Diagnosis of septate uterus done by :

 A

USG

 B

Uterine sound and Hysterosalpingography both

 C

Hysteroscopy and Laparoscopy both

 D

All are correct

Ans. D

Explanation:

All are correct

USG; Uterine sound; Hysteroscopy; Hysterosalpingography, and Laproscopy

Friends here it is first important to understand that septate uterus is confused with bicornuate uterus.

In septate uterus after lateral fusion of mullerian ducts their is failure of their medial segments to regress which creates a permanent septum within the uteruine cavity. The septum passes down from the uterine fundus. The fundus is normal in appearance.

In Bicornuate uterus the two halves of mullerian duct do not fuse and there is defect in fusion of fundus as well.

So, both these conditions are different.

Septate uterus can be distinguished :Clinically by : PN examination – Septate vagina and 2 cervix may be feltI I.By passing a sound.

Investigations :

1. HSG : HSG is the initial step in evaluation of a septate uterus but it cannot distinguish between a septate and Bicornuate uterus. This is be cause in order to distinguish between the two, uterine fundus should be visible

2.   Trans vaginal USG : It is the best method to distinguish between a septate and bicornuate uterus. As it reveals the shape of the fundal contour. The septate uterus presents a single unified fundus that is after broader than normal while bicornuate uterus has two entirely separate fundi divided by a distinct midline cleft of varying depth. The diagnostic accuracy of sonography may be improved when coupled with HSG.

3.   Hysteroscopy : It is both diagnostic and curative.

4.   MR1 : Expensive technique but provides the most accurate diagnosis.

5.     Sonohysterography (involves transvaginal ultrasound during or after introduction of sterile saline). It can also distinguish between a septate and bicornuate uterus by revealing both the double uterine cavity and the shape of fundal contour.

Laparoscopy and Laparotomy (per se) may fail to reveal septate uterus.

This is quite obvious as outward appearance of a septate uterus is normal but ‑

“When presumptive diagnosis is a septate uterus, laparoscopy is indicated for a definitive diagnosis and before hysteroscopic resection of the septum is initiated.”

It is done to confirm that septate uterus is actually a septate and not a bicornuate uterus.

So, reading the text from Williams Gynae. – I am including laparoscopy also in the correct options.


Q. 6

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Q. 6

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Ans. A

Explanation:

Hysteroscopy + Laparoscopy


Q. 7

Submucosal fibroid is detected by :

 A

Hysteroscopy

 B

Hysterosalpingography

 C

USG (Transabdominal)

 D

All

Q. 7

Submucosal fibroid is detected by :

 A

Hysteroscopy

 B

Hysterosalpingography

 C

USG (Transabdominal)

 D

All

Ans. D

Explanation:

Ans. is a, b and c i.e. Hysteroscopy; Hysterosalpingography; and USG (Transabdominal)  

USG • Ultrasound is the main diagnostic tool in case of fibroid.° It checks the number°, location° and size° of fibroids and helps to reduce overlooking small fibroids during surgery (which might lead to persistence or recurrence of symptoms).

USG findings in case of Fibroid

  • Enlarged and distorted uterine contour
  • Depending on connective tissue amount — fibroid may have varying echogenecity (hypoechoic or hyperechoic.
  • Vascularisation is seen at periphery.

Hysteroscopy or hysterosalpingography : These methods are useful to detect submucous fibroid in unexplained infertility and repeated pregnancy wastage. The presence and site of submucous fibroid can be diagnosed by direct visualization during hysteroscopy or indirectly as a filling defect on HSG. Hysteroscopy also allows its excision under direct vision.

Uterine Curettage : It can also help in diagnosis of submucous fibroid by feeling of a bump during curettage.° Laparoscopy : is helpful if uterine size is less than 12 weeks, for detection of a subserous fibroid. It can also differentiate a pedunculated fibroid from an ovarian tumour not revealed by clinical examination and ultrasound. Investigation which can be done is MRI.°

Role of Doppler in diagnosis of Fibroid :

Leiomyomas have characteristic vascular patterns which can be identified by color flow doppler. A peripheral rim of vascularity from which a few vessels arise and penetrate into the centre is seen. Doppler imaging can be used to differentiate an extrauterine leiomyoma from other pelvic masses or a submucous leiomyoma from an endometrial polyp or adenomyosis.

Also know :

  • Best investigation for submucous fibroid – Hysteroscopy°
  • Best investigation to detect fibroid (in general)°

—       USG (Pt choicer

—       MRI (2fd choicer


Q. 8

Which is not a test for ovulation?

 A Fern test
 B

Basal body temperature

 C Hysteroscopy
 D

LH surge

Q. 8

Which is not a test for ovulation?

 A Fern test
 B

Basal body temperature

 C Hysteroscopy
 D

LH surge

Ans. C

Explanation:

Hysteroscopy REF: 12th edition of Novak’s Gynecology p. 408

METHODS TO DOCUMENT OVULATION:

  • Luteinizing Hormone Monitoring Documentation of the LH surge represents a remarkably reproducible method of predicting ovulation. Ovulation occurs 34 to 36 hours after the onset of the LH surge and about 10 to 12 hours after the LH peak
  • Basal Body Temperature The least expensive method of confirming ovulation is for the
    patient to record her temperature each morning on a basal body temperature (BBT) chart.
  • Midluteal Serum Progesterone
  • Ultrasound Monitoring Ovulation can also be documented by monitoring the development of a dominant follicle by ultrasound until ovulation takes place
  • A ferning pattern is seen when periovulatory cervical mucus is spread and dried on a microscope slide.

Q. 9

Which is NOT a documentation test for ovulation in women of reproductive age?

 A

Fern test

 B

Basal body temperature

 C

Hysteroscopy

 D

LH surge

Q. 9

Which is NOT a documentation test for ovulation in women of reproductive age?

 A

Fern test

 B

Basal body temperature

 C

Hysteroscopy

 D

LH surge

Ans. C

Explanation:

Methods to document ovulation:

  • Luteinizing Hormone Monitoring Documentation of the LH surge represents a remarkable reproducible method of predicting ovulation. Ovulation occurs 34 to 36 hours after the onsof the LH surge and about 10 to 12 hours after the LH peak.
  • Basal Body Temperature
  • Midluteal Serum Progesterone
  • Ultrasound Monitoring Ovulation
  • A ferning pattern is seen when periovulatory cervical mucus is spread and dried on a microscope slide.

Q. 10

Salpingitis /Endosalpingitis is best confirmed by:

 A

Marsupialisation Hysteroscopy + Laparascopy

 B

X-ray

 C

Hysterosalpingography

 D

Sonosalpingography

Q. 10

Salpingitis /Endosalpingitis is best confirmed by:

 A

Marsupialisation Hysteroscopy + Laparascopy

 B

X-ray

 C

Hysterosalpingography

 D

Sonosalpingography

Ans. A

Explanation:

Both Hysteroscopy and laparoscopy cab give a confirmed diagnosis of salpingitis and endosalpingitis.

Features of salpingitis such as pus extruding from the fimbrial end and adhesions can be visualized under direct laparoscopy.

Although both the procedures cannot be used as a routine investigation, they are sure to confirm the diagnosis.

Ref: Blaustein’s Pathology of the Female Genital Tract By Ancel Blaustein, Robert J. Kurman; 5th edition, Pages 622-25; Shaw’s Textbook of Gynaecology; 13th edition, Pages 417-28; Family Practice Guidelines By Jill C. Cash, Cheryl A. Glass; 347 -48

Q. 11

The method to diagnosis misplaced intra uterine device is

 A

Ultrasound

 B

X-Ray abdomen (Erect view)

 C

Uterine sound & Hysteroscopy

 D

All of the above

Q. 11

The method to diagnosis misplaced intra uterine device is

 A

Ultrasound

 B

X-Ray abdomen (Erect view)

 C

Uterine sound & Hysteroscopy

 D

All of the above

Ans. D

Explanation:

D i.e. All of above

Investigation of choice in displaced IUD is Ultrasound, but we can also diagnose this by X-Ray abdomen (metal in IUD produces radioopaque shadow) & Hysteroscopy (Endoscopic visualization of uterus).


Q. 12

Hysteroscopy is indicated in all of the following except:         

March 2011

 A

Asherman syndrome

 B

Infertility

 C

Misplaced intrauterine devices

 D

Active pelvic infection

Q. 12

Hysteroscopy is indicated in all of the following except:         

March 2011

 A

Asherman syndrome

 B

Infertility

 C

Misplaced intrauterine devices

 D

Active pelvic infection

Ans. D

Explanation:

Ans. D: Active pelvic infection

Genital tract infection is a contraindication to hysteroscopic therapeutic procedures


Q. 13

Gold standard IOC for female infertility is:

September 2011

 A

Laparoscopy

 B

Transvaginal USG

 C

Hysteroscopy

 D

Laparoscopy and hysteroscopy

Q. 13

Gold standard IOC for female infertility is:

September 2011

 A

Laparoscopy

 B

Transvaginal USG

 C

Hysteroscopy

 D

Laparoscopy and hysteroscopy

Ans. D

Explanation:

Ans. D: Laparoscopy and hysteroscopy

Laparoscopy is combined with hysteroscopy as a comprehensive one-stop infertility work-up, to detect cause of infertility and treat the cause in one go


Q. 14

Treatment of choice for Asherman’s syndrome:

September 2011

 A

Hormones

 B

Hysteroscopy and adhesiolysis

 C

IUCD

 D

All of the above

Q. 14

Treatment of choice for Asherman’s syndrome:

September 2011

 A

Hormones

 B

Hysteroscopy and adhesiolysis

 C

IUCD

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Laparoscopic adhesionolysis is followed by insertion of IUCD (for 3 months) and estrogen therapy, which prevents re-adhesions and helps to build up the endometrium


Q. 15

Media commonly used for distension in hysteroscopy is:       

September 2011

 A

Oxygen

 B

Carbon dioxide

 C

Nitrous oxide

 D

Hydrogen

Q. 15

Media commonly used for distension in hysteroscopy is:       

September 2011

 A

Oxygen

 B

Carbon dioxide

 C

Nitrous oxide

 D

Hydrogen

Ans. B

Explanation:

Ans. B: Carbon dioxide

The media in common usage for hysteroscopy include carbon dioxide gas delivered through the hysteroflator at a maximum rate of 70 ml/ min and pressure less than 100 mm Hg


Q. 16

The method to diagnose displaced intrauterine device is:

 A

Ultrasound

 B

X-ray abdomen (erect view)

 C

Uterine sound and hysteroscopy

 D

All of the above

Q. 16

The method to diagnose displaced intrauterine device is:

 A

Ultrasound

 B

X-ray abdomen (erect view)

 C

Uterine sound and hysteroscopy

 D

All of the above

Ans. D

Explanation:

Ans. All of the above


Q. 17

Diagnosis of  congenital uterine anomaly, as shown in the picture below is done by ? 

 A

USG.

 B

Uterine sound and Hysterosalpingography both.

 C

Hysteroscopy and Laparoscopy both.

 D

All are correct.

Q. 17

Diagnosis of  congenital uterine anomaly, as shown in the picture below is done by ? 

 A

USG.

 B

Uterine sound and Hysterosalpingography both.

 C

Hysteroscopy and Laparoscopy both.

 D

All are correct.

Ans. D

Explanation:

septate uterus is a common type of congenital uterine anomaly, and it may lead to an increased rate of pregnancy loss. 

In septate uterus after lateral fusion of mullerian ducts their is failure of their medial segments to regress which creates a permanent septum within the uteruine cavity. The septum passes down from the uterine fundus. The fundus is normal in appearance.

In Bicornuate uterus the two halves of mullerian duct do not fuse and there is defect in fusion of fundus as well.

So, both these conditions are different.

Septate uterus can be distinguished :Clinically by : PN examination – Septate vagina and 2 cervix may be feltI I.By passing a sound.

Investigations :

1. HSG : HSG is the initial step in evaluation of a septate uterus but it cannot distinguish between a septate and Bicornuate uterus. This is be cause in order to distinguish between the two, uterine fundus should be visible

2.   Trans vaginal USG : It is the best method to distinguish between a septate and bicornuate uterus. As it reveals the shape of the fundal contour. The septate uterus presents a single unified fundus that is after broader than normal while bicornuate uterus has two entirely separate fundi divided by a distinct midline cleft of varying depth. The diagnostic accuracy of sonography may be improved when coupled with HSG.

3.   Hysteroscopy : It is both diagnostic and curative.

4.   MR1 : Expensive technique but provides the most accurate diagnosis.

5.     Sonohysterography (involves transvaginal ultrasound during or after introduction of sterile saline). It can also distinguish between a septate and bicornuate uterus by revealing both the double uterine cavity and the shape of fundal contour.



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