Pelvic Inflammatory Disease and Genital Tuberculosis MCQs

Obstetrics & Gynaecology · 81 free questions with answers & explanations.

  1. A 24-year-old sexually active woman presents with bilateral lower abdominal pain, cervical motion tenderness, and mucopurulent cervical discharge. Temperature is 38.2°C. What is the MINIMUM diagnostic criterion for diagnosing pelvic inflammatory disease (PID) according to CDC guidelines?
  2. A 26-year-old woman with primary infertility undergoes hysterosalpingography (HSG) which shows a 'tobacco-pouch' deformity of the fallopian tubes with bilateral hydrosalpinx and calcified lymph nodes. Mantoux test is strongly positive. Which investigation provides the MOST definitive diagnosis of genital tuberculosis?
  3. A 22-year-old woman with PID develops a 5 cm tubo-ovarian abscess confirmed on ultrasound. She is admitted and started on IV cefoxitin and doxycycline. After 72 hours of antibiotics, she remains febrile with increasing pelvic pain. The NEXT management step is:
  4. In genital tuberculosis, the organ MOST commonly involved and the characteristic pattern seen on hysterosalpingography is:
  5. A 24-year-old woman presents with lower abdominal pain, fever, and purulent cervical discharge. On examination, she has cervical motion tenderness and adnexal tenderness bilaterally. Pregnancy test is negative. Her WBC count is 14,000/µL. She is hemodynamically stable. Which of the following is the MOST appropriate outpatient antibiotic regimen according to CDC 2021 guidelines?
  6. A 28-year-old woman presents with infertility of 3 years. Hysterosalpingogram shows bilateral tubal block with calcifications. Endometrial biopsy shows granulomas with Langerhans giant cells and caseation. PCR for Mycobacterium tuberculosis is positive. What is the MOST likely prognosis regarding fertility after anti-tubercular therapy (ATT)?
  7. A 26-year-old woman undergoes laparoscopy for pelvic pain and bilateral adnexal tenderness. The finding of violin-string adhesions between the liver capsule and anterior abdominal wall is noted along with bilateral tubal inflammation. This specific finding is called the Fitz-Hugh-Curtis syndrome. The pathogen most commonly responsible in the current era is:
  8. In genital tuberculosis, the characteristic finding on hysterosalpingography (HSG) that is virtually pathognomonic of tuberculous salpingitis is:
  9. A 25-year-old presents with 5 days of lower abdominal pain, cervical motion tenderness, and mucopurulent cervical discharge. Temperature 38.2°C, WBC 14,000/µL. Transvaginal ultrasound shows bilateral adnexal thickening but no abscess. Per CDC 2021 guidelines, which outpatient treatment regimen is appropriate for PID?
  10. A 30-year-old woman with primary infertility for 4 years has a hysterosalpingogram showing a 'pipe-stem' appearance of the tubes, bilateral tubal blockage at the cornua, and calcified lymph nodes on X-ray. Menstrual cycles are regular. Which investigation will provide the highest sensitivity for confirming genital tuberculosis as the underlying aetiology?
  11. A woman with PID requires admission. According to CDC 2021 PID treatment guidelines, which combination is recommended as the PREFERRED parenteral regimen?
  12. In female genital tuberculosis (FGTB), which structure is MOST commonly affected, and what is the most reliable diagnostic test?
  13. The CDC 2021 STI Treatment Guidelines recommend outpatient oral treatment for mild-to-moderate PID. Which antibiotic combination is currently recommended for outpatient oral treatment of PID, including coverage for Neisseria gonorrhoeae and Chlamydia trachomatis?
  14. Genital tuberculosis (GTB) typically affects the fallopian tubes first. Which histological finding on endometrial biopsy is pathognomonic of endometrial tuberculosis?
  15. Genital tuberculosis as a cause of infertility involves endometrial TB in what proportion of cases, and which diagnostic test has the highest sensitivity for endometrial TB?
  16. The Fitz-Hugh-Curtis syndrome (perihepatitis) as a complication of PID is caused by which pathogen most commonly, and what is its characteristic finding on laparoscopy?
  17. In the Fitz-Hugh-Curtis syndrome (perihepatitis associated with PID), the characteristic finding that clinches the diagnosis is:
  18. In genital tuberculosis, the most reliable diagnostic test combining PCR, culture, and histology is the GeneXpert MTB/RIF (Xpert). The characteristic histological finding in fallopian tube tuberculosis that is nearly pathognomonic is:
  19. A laparoscopy performed for suspected PID in a sexually active 25-year-old reveals violin-string adhesions between the liver capsule and anterior abdominal wall. This finding is:
  20. A 28-year-old woman with genital tuberculosis is being treated with anti-TB therapy for 9 months and is found to be infertile. Hysteroscopy reveals intrauterine synechiae. The expected fertility outcome after hysteroscopic adhesiolysis is:
  21. A 25-year-old woman presents with lower abdominal pain, mucopurulent cervical discharge, and bilateral adnexal tenderness. Nucleic acid amplification test (NAAT) is positive for Neisseria gonorrhoeae. According to 2021 CDC guidelines, the preferred OUTPATIENT treatment regimen is:
  22. A 28-year-old nulliparous woman with infertility undergoes laparoscopy. Findings include bilateral hydrosalpinges, peritubal adhesions, and granulomatous deposits on peritoneum. Biopsy confirms genital tuberculosis. She is started on RNTCP Category I ATT. After completing 6 months of ATT with culture negativity, she requests reproductive outcome counseling. The MOST accurate statement regarding her fertility prognosis is:
  23. A 22-year-old sexually active woman presents with pelvic pain, cervical motion tenderness, and mucopurulent cervical discharge. The Fitz-Hugh-Curtis syndrome (perihepatitis) is noted on ultrasound (perihepatic adhesions). She is treated for PID. Which organism is most commonly associated with Fitz-Hugh-Curtis syndrome complicating PID?
  24. A 28-year-old woman with primary infertility and amenorrhoea undergoes hysteroscopy which shows a hypoplastic uterine cavity with pale adhesions and absent endometrium. Endometrial biopsy shows epithelioid granulomas with Langhans giant cells and caseous necrosis. PCR for Mycobacterium tuberculosis is positive. This is genital TB. Which of the following is the most common site of genital TB in India?
  25. Regarding the diagnostic criteria for PID, the 2021 CDC guidelines made a specific update to the minimum clinical threshold. Which of the following correctly reflects this updated minimum diagnostic standard?
  26. A 29-year-old with infertility undergoes hysteroscopy showing multiple irregular intrauterine adhesions. Endometrial biopsy shows caseating granulomas with Langerhans giant cells and acid-fast bacilli on ZN staining. What is the significance of finding active (histologically confirmed) genital TB at this stage regarding fertility prognosis?
  27. A 25-year-old woman presents with pelvic pain, cervical motion tenderness, and purulent cervical discharge. She has a pelvic ultrasound showing bilateral adnexal masses with thick walls and internal echoes consistent with tubo-ovarian abscesses (TOA) measuring 5 cm on each side. She is afebrile and haemodynamically stable. According to CDC 2021 PID treatment guidelines, which is the most appropriate initial management?
  28. A 28-year-old woman with primary infertility undergoes diagnostic laparoscopy showing 'pipe-stem' fallopian tubes, caseous nodules on peritoneum, and 'tobacco-pouch' appearance of the tubes. Hysteroscopy shows synechiae and obliteration of the endometrial cavity. Endometrial biopsy confirms Langerhans giant cells with caseation necrosis. This is a confirmed case of genital tuberculosis. What is the role of anti-TB treatment in restoring her fertility?
  29. In genital tuberculosis, the gold standard for diagnosis is culture on Lowenstein-Jensen medium. However, in a patient with suspected genital TB with Asherman syndrome and amenorrhoea, which investigation provides the highest diagnostic yield?
  30. A 25-year-old presents with fever, lower abdominal pain, and cervical motion tenderness. Transvaginal ultrasound reveals a complex adnexal mass with thick walls and internal echoes (no free peritoneal fluid). She is haemodynamically stable. According to current CDC/RCOG guidelines, what is the initial management?
  31. A 32-year-old woman presents with primary infertility, oligomenorrhoea, and TB contact history. Hysteroscopy shows obliterated endometrial cavity with fibrous bands. Endometrial biopsy reveals caseating granulomas. Which histological feature on biopsy is MOST specific for endometrial tuberculosis?
  32. In endometrial tuberculosis causing infertility, the Asherman syndrome-like intrauterine adhesions develop through a specific pathological mechanism. The Fitz-Hugh–Curtis syndrome associated with PID involves what specific pathological process in the liver?
  33. In genital tuberculosis causing primary amenorrhea, which investigation would most accurately diagnose endometrial TB when gold standard culture is negative and histology is non-contributory?
  34. A 24-year-old woman with PID is started on outpatient treatment. Per CDC 2021 guidelines, which oral regimen is CURRENTLY preferred for outpatient PID treatment?
  35. Genital tuberculosis causes infertility through which mechanism that is MOST refractory to anti-tubercular therapy?
  36. A 24-year-old woman presents with lower abdominal pain, cervical motion tenderness, and adnexal tenderness. She has a 3 cm right adnexal mass on ultrasound with internal echoes and thick walls. WBC 14,200/µL, CRP 85 mg/L. She was treated outpatient with doxycycline and metronidazole 2 days ago without improvement. According to CDC 2021 STI Guidelines, what is the MOST appropriate management for this likely tubo-ovarian abscess?
  37. A 30-year-old woman with suspected genital tuberculosis undergoes hysteroscopy. Pathology of the endometrial biopsy shows granulomas with central caseation, Langhans giant cells, and acid-fast bacilli. Mycobacterial culture on Löwenstein-Jensen medium is positive at 6 weeks. Which hysteroscopic finding is MOST characteristic of endometrial TB and most accurately predicts amenorrhea?
  38. A 30-year-old presents with infertility, menstrual irregularity, and constitutional symptoms. Laparoscopy shows fimbrial occlusion with beaded tubes. Endometrial biopsy demonstrates Langhans giant cells and caseation. The investigation with highest sensitivity for confirming genital tuberculosis in this case is:
  39. A 25-year-old sexually active woman presents with lower abdominal pain, fever 38.5°C, and cervical motion tenderness on examination. Right adnexal tenderness is present. A transvaginal ultrasound shows a 4 cm right tubo-ovarian complex without complete liquefaction. She has no signs of peritonitis. Her WBC count is 15,000/µL. The MOST appropriate initial management is:
  40. A 28-year-old woman with primary infertility undergoes diagnostic hysteroscopy. Endometrial biopsy shows caseous necrosis with Langerhans giant cells on histology. Mycobacterium tuberculosis PCR on the specimen is positive. Which finding on hysteroscopy is MOST characteristic of genital tuberculosis?
  41. A 26-year-old sexually active woman presents with lower abdominal pain, mucopurulent cervical discharge, and cervical motion tenderness. She is haemodynamically stable. According to CDC 2021 guidelines, what is the minimum diagnostic criterion for initiating empiric PID treatment?
  42. A 32-year-old woman presents with infertility, menstrual irregularity, and constitutional symptoms. Hysteroscopy reveals an 'ash-leaf' pattern endometrium. Endometrial biopsy shows granulomatous inflammation. Which investigation is MOST specific for confirming genital tuberculosis?
  43. A 28-year-old woman presents with a 3-day history of lower abdominal pain, fever 38.4°C, purulent cervical discharge, and right adnexal tenderness. Transvaginal ultrasound shows a 5 cm complex thick-walled right adnexal cystic mass with internal echoes. She is haemodynamically stable. After IV antibiotics for 72 hours, there is no clinical improvement. The most appropriate next step is:
  44. A 32-year-old woman presents with primary infertility, menstrual irregularity, and a history of pulmonary tuberculosis 5 years ago. HSG shows bilateral blocked tubes with a 'tobacco pouch' appearance. Endometrial biopsy shows granulomas with caseation necrosis. Which histological feature in the endometrial biopsy is most specific for genital tuberculosis?
  45. A 22-year-old woman with PID has the classic Fitz-Hugh-Curtis syndrome. Which pathogen is most commonly responsible for this perihepatitis?
  46. In female genital tuberculosis, which part of the female reproductive tract is MOST commonly affected?
  47. A 25-year-old sexually active woman has lower abdominal pain, cervical motion tenderness, and mucopurulent cervical discharge. Her WBC is 13,000/mm³. According to CDC 2021 guidelines, empirical treatment for PID with outpatient management uses:
  48. Genital tuberculosis most commonly affects which structure of the female genital tract, and what is the hallmark pathological finding on histology?
  49. Asherman syndrome caused by genital tuberculosis is unique compared to post-curettage Asherman's in that:
  50. A 24-year-old woman undergoes laparoscopy for infertility investigation. Violin-string adhesions are found between the liver capsule and the parietal peritoneum. This laparoscopic finding is most characteristic of:
  51. A 30-year-old woman is investigated for secondary infertility. Hysterosalpingography shows a pipe-stem pattern of bilateral fallopian tubes and calcified pelvic lymph nodes. Endometrial curettage histology shows caseating granulomas. The first-line antitubercular regimen duration for genital tuberculosis under the Indian NTEP is:
  52. A 28-year-old woman presents with infertility. Hysterosalpingography (HSG) shows a classical 'golf club' or 'pipe stem' appearance of the fallopian tube with multiple constrictions. Endometrial biopsy shows epithelioid granulomas on Histopathology. Mantoux test is 18 mm. Which investigation has the HIGHEST sensitivity for confirming active genital tuberculosis in this setting?
  53. A 25-year-old woman treated for pelvic inflammatory disease (PID) 2 years ago now presents with right-sided pelvic pain and a tender right adnexal mass. Ultrasound shows a thick-walled, fluid-filled right adnexal structure 6 cm with internal echoes. WBC is 14,000/µL and CRP is 85 mg/L. The diagnosis is tubo-ovarian abscess (TOA). According to current BASHH guidelines, which is the preferred initial management?
  54. A 24-year-old woman presents with bilateral lower abdominal pain, fever, and cervical motion tenderness. On laparoscopy, fibrinous exudate covers the liver capsule and fallopian tubes bilaterally. Cervical swab grows Chlamydia trachomatis. This perihepatitis is known as:
  55. A 28-year-old woman with primary infertility undergoes laparoscopy revealing dense peritubal adhesions, tobacco-pouch appearance of tube ends, and tubercles on the peritoneum. Histology confirms caseating granulomas. What is the MOST appropriate management for her infertility?
  56. In a woman with suspected pelvic inflammatory disease (PID) who has a tubo-ovarian abscess of 4 cm detected on ultrasound, she remains febrile after 72 hours of IV antibiotics. The MOST appropriate next step is:
  57. In female genital tuberculosis, the MOST commonly affected site in the genital tract is:
  58. A 27-year-old woman with suspected genital tuberculosis undergoes endometrial sampling in the premenstrual phase. Which histological finding is PATHOGNOMONIC of genital TB on endometrial biopsy?
  59. The Fitz-Hugh-Curtis syndrome, a complication of PID, involves perihepatitis. The pathognomonic laparoscopic finding is:
  60. A woman with primary infertility and scanty menses undergoes hysteroscopy, which shows an obliterated uterine cavity with no visible ostia, pale avascular synechiae. Endometrial biopsy shows caseating granulomas. The most likely diagnosis is:
  61. A 22-year-old woman presents with bilateral lower abdominal pain, fever 38.5°C, cervical motion tenderness, and mucopurulent cervical discharge. She has an IUD in situ. Endocervical swab is pending. The Fitz-Hugh-Curtis syndrome is a complication of PID caused by perihepatitis from which organisms?
  62. In genital tuberculosis (TB), the MOST common site of involvement in the female genital tract is:
  63. CREST study on long-term sequelae of PID found that a single episode of PID increased the risk of ectopic pregnancy by what approximate factor?
  64. Fitz-Hugh–Curtis syndrome (perihepatitis) complicates pelvic inflammatory disease. Which organisms are classically associated with this condition?
  65. In genital tuberculosis, which part of the female genital tract is MOST commonly affected, and what is the characteristic HSG finding?
  66. A 25-year-old woman with PID is started on outpatient treatment. Which combination is recommended by CDC 2021 guidelines for outpatient management of PID?
  67. A 30-year-old woman with primary infertility and irregular menses undergoes hysterosalpingography showing bilateral cornual block and an irregular 'golf-club' appearance of the fallopian tubes. Endometrial biopsy shows granulomas with Langhans' giant cells. The most appropriate management is:
  68. A 24-year-old sexually active woman presents with lower abdominal pain, cervical motion tenderness, and adnexal tenderness on bimanual examination. Temperature is 38.2°C. Cervical swab for NAAT is sent. The minimum CDC diagnostic criteria for PID is:
  69. A 28-year-old woman undergoing evaluation for infertility has a hysteroscopy that reveals a Nance pattern (synechiae with ash-grey granulomatous lesions). Endometrial biopsy reveals caseating granulomas. The hallmark diagnostic test to confirm genital tuberculosis and identify drug resistance is:
  70. A 25-year-old woman has PID with a 5 cm tubo-ovarian complex on ultrasound. She is admitted and treated with IV cefoxitin plus doxycycline. After 48 hours of IV therapy, she shows clinical improvement. The MOST appropriate next step is:
  71. Genital tuberculosis is diagnosed in a woman investigated for infertility. Hystero-salpingography shows what pathognomonic features?
  72. The Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease characterised by which of the following?
  73. A 28-year-old woman with primary infertility has a hysterosalpingogram showing a 'golf-club deformity' of the fallopian tube, beaded appearance of the tubes, and a small irregular uterine cavity. Endometrial biopsy shows granulomas with Langhans giant cells. What is the recommended treatment duration?
  74. Which clinical feature most reliably differentiates a tubo-ovarian abscess (TOA) from uncomplicated PID?
  75. A 26-year-old woman is diagnosed with mild PID (no tubo-ovarian abscess) in an outpatient setting. According to CDC 2021 STI treatment guidelines, which outpatient regimen is recommended?
  76. Genital tuberculosis in a woman of reproductive age most frequently involves which anatomical site?
  77. Dip-stick test or 'Schroeder test' in genital TB refers to:
  78. A Fitz-Hugh-Curtis syndrome (perihepatitis) is a complication of PID caused most commonly by which organism, and what is the characteristic clinical finding on laparoscopy?
  79. The minimum diagnostic criteria for empirical treatment of PID according to US CDC 2021 guidelines, in a sexually active young woman presenting with pelvic pain, is:
  80. On hysteroscopy for infertility, a woman is found to have complete intrauterine adhesions (Asherman syndrome, Grade III-IV). Endometrial biopsy shows caseating granulomas, consistent with endometrial tuberculosis. After successful ATT, she undergoes hysteroscopic adhesiolysis. What is the recommended post-lysis treatment to promote endometrial regeneration?
  81. Asherman syndrome (intrauterine adhesions) can result from curettage or genital tuberculosis. Which HSG finding is MOST specific for Asherman syndrome?
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