QUESTIONNAIRE
(To Assess Knowledge Regarding PCOD among The College Girls)
Provide Tick Mark in the Appropriate Response
SECTION-A: DEMOGRAPHIC VARIABLES
1. Age in years
a. 18-19 years ( )
b. 20-21years ( )
c. Above 21 years ( )
2. Marital Status
a. Unmarried ( )
b. Married ( )
c. Widow ( )
d. Divorced ( )
3. Religion
a. Hindu ( )
b. Muslim ( )
c. Christian ( )
d. Others ( )
4. Types of Family
a. Joint Family ( )
b. Nuclear Family ( )
5. Educational Status
a. No Formal Education ( )
b. Primary Education ( )
c. Secondary Education ( )
d. Higher Education ( )
e. Graduate ( )
6. Dietary Pattern
a. Vegetarian ( )
b. Non-Vegetarian ( )
7. Menstrual Cycle
a. Regular Cycle ( )
b. Irregular Cycle ( )
8. BMI
a. 18-21 ( )
b. 22-25 ( )
c. 26-29 ( )
d. Above 30 ( )
9. Number of Children
a. One ( )
b. Two ( )
c. Above Two ( )
10. Do you have any associated disease
a. Yes ( )
b. No ( )
11. Do you like junk foods
a. Yes ( )
b. No ( )
12. Amount of water intake per day
a. 500 – 1000 ml ( )
b. 1000 – 2000 ml ( )
c. > 2000 ml ( )
13. Do you have any menstrual disorder
a. Yes ( )
b. No ( )
14. Source of Information
a. Health Personal ( )
b. Parents ( )
c. Teacher ( )
d. Mass Media ( )
e. No information ( )
15. How many times you have taken on vegetarian
a. Weekly once ( )
b. Weekly twice ( )
c. > twice in a week ( )
SECTION-B
QUESTIONNAIRE ON KNOWLEDGE REGARDING POLYCYSTIC OVARIAN
SYNDROME
1. The shape of the normal ovary
a. Small almond ( )
b. Oval ( )
c. Round ( )
d. Apple ( )
2. The female reproductive hormones are
a. Androgen ( )
b. Estrogen and progesterone ( )
c. GNRH ( )
d. Cortisol ( )
3. Polycystic Ovarian Syndrome is
a. Cardiovascular disorder ( )
b. Musculoskeletal disorder ( )
c. Hormonal disorder ( )
d. Cerebrovascular disorder ( )
4. In PCOS which of the following is formed in the ovaries
a. Cysts ( )
b. Eggs ( )
c. Fibres ( )
d. Sperm ( )
5. The percentage of women affected by PCOS
a. About 1% ( )
b. 5% to 15% ( )
c. 15% to 45% ( )
d. Above 50% ( )
6. Women’s are affected by PCOS during the age group of
a. 12-18 years ( )
b. 18-44 years ( )
c. 40-60 years ( )
d. Above 70 years ( )
7. The common features for patient’s with PCOS
a. Malnourished ( )
b. Obease ( )
c. Very tall ( )
d. Very short ( )
8. The following are the common signs and symptoms of PCOS
a. Menstrual disorder ( )
b. Infertility ( )
c. Hormonal Imbalance ( )
d. All the above ( )
9. A women with polycystic ovarian disease may have these
symptoms
a. Hirsutism ( )
b. Ovarian cysts ( )
c. Irregular menses ( )
d. All the above ( )
10. A specialist in treating women related disorder in usually a
a. Endocrinologist ( )
b. Hemtologist ( )
c. Gynaecologist ( )
d. psychiatrist ( )
11. PCOS can be confirmed by
a. Surgery ( )
b. X-ray ( )
c. Vaginal Ultrasound ( )
d. Palpation ( )
12. Patients with PCOS have elevated levels of
a. Androgen ( )
b. Hydrogen ( )
c. Nitrogen ( )
d. Amonia ( )
13. The appearance of polycystic ovarian follicles is
a. Oval in appearance ( )
b. White pearls like appearance ( )
c. Round in appearance ( )
d. Almond appearance ( )
14. Upon ultrasound evaluation a women with PCOS
a. Usually have many ovarian cysts ( )
b. Always have many ovarian cysts ( )
c. Never have many ovarian cysts ( )
d. Usually have an ovarian tumours ( )
15. The food to avoid for PCOS women’s
a. High glycemic diet ( )
b. Refined carbohydrate ( )
c. Surgery food items ( )
d. All the above ( )
16. The recommended food items women’s with PCOS
a. High fiber vegetables and lean proteins ( )
b. High glycemic food ( )
c. High in refined carbohydrate ( )
d. Sweats ( )
17. The first drug of choice for women with PCOS
a. Met formin ( )
b. Rantac ( )
c. Methergin ( )
d. Folic Acid ( )
18. Polycycstic ovarian disease causes
a. Fertility ( )
b. Infertility ( )
c. Regular Menarche ( )
d. Bleeding ( )
19. The following is not linked with PCOS
a. High blood level of androgen ( )
b. Acanthesis Nigricans ( )
c. Low blood level of thyroid hormones ( )
d. Irregular menstrual period ( )
20. Women with PCOS have higher rate of
a. Miscarriage ( )
b. GDM ( )
c. Preelampsia ( )
d. All the above ( )
21. Women with PCOS have a high risk of which one of the following
a. Impaired glucose tolerance ( )
b. Sexual Dysfunction ( )
c. Ovaries maligency ( )
d. Adrenal hyperplasia ( )
22. The treatment for PCOS include which of the following
a. Encourage weight loss ( )
b. Induce Ovulation ( )
c. Absentisam ( )
d. None of these ( )
23. In women with PCOS the hormonal imbalance interferes with the
a. Growth of release of egg from of ovaries ( )
b. Affect the sexual activity ( )
c. Affect the regular activity ( )
d. Affect the sleeping activity ( )
24. PCOS may causes secondary amenorrhea due to
a. Excessive production of estrogen ( )
b. Excessive production of FSH ( )
c. Excessive production of androgen ( )
d. All ( )
25. Main complications of polycystic ovaries syndrome
a. Endometrial cancer ( )
b. Sleep apnea ( )
c. High cholesterol ( )
d. Anxiety and depression ( )
Scoring Key
Answer key for knowledge questionnaire
Question number Answers
1 A
2 B
3 C
4 A
5 C
6 B
7 B
8 A
9 D
10 C
11 C
12 A
13 B
14 A
15 D
16 A
17 A
18 B
19 C
20 A
21 A
22 A
23 A
24 C
25 A
Scoring
Section B contains 25 questions, in that each answer carries score like
Correct answer – 1
Wrong answer – 0
The total maximum score is about 25 marks and minimum score is 0 marks
INTERPRETATION OF SCORE:
The total score is interpreted as
Score Level of knowledge
0-10 Inadequate Knowledge
11-20 Moderately adequate
21-25 Knowledge
Adequate Knowledge