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Ax Gynae Flashcards

1
Q

What’s primary dysmenorrhea

A

Lower abdominal or pelvic pain with or without radiation to back or the legs ,with initial onset 6 TO 12 MONTHS AFTER MENARCHE. Pain typically lasts for 8-72 HOURS and usually occur at the onset of menstrual flow.

Associated symptoms - back pain,headache,diarrhea,fatigue,nausea,vomiting.
To diagnose primary dysmenorrhea other causes has to be excluded like leiomyoma ,endometriosis. Etc

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2
Q

How to treat primary dysmenorrhea

A

First line is NSAIDS
Secondly hormonal contraceptives( oral,vaginal or intrauterine) but effectiveness is limited.
But if someone needs contraception as well as dysmenorrhea ,first line could be a 2-3 month trial of OCP.

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3
Q

What’s primary amenorrhea

A

Absence of menses after age of 16 in presence of normal growth and secondary sexual characteristics.

13-14 in the absence of secondary sexual characteristics

In case breast budding occurs before age of 10, amenorrhea is defined a absence of periods within next five years.

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4
Q

What’s are stages of normal puberty

A

Thlarche
Pubarche
Menarche

Breast above tanner 2 stage indicates commencement of puberty and exposure to estrogen.

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5
Q

What’s menorrhagia

A

A from of abnormal uterine bleeding ( AUB )
Periods lasting more than 7 days and/or involving blood loss more than 80mL.
Normal periods lasts for 3-6 days and blood loss less than 80mL.

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6
Q

Two types of AUB

A

1.ovulatory- abnormal volume of length of bleeding at REGULAR INTERVALS.
2. Anovulatory - irregular and unpredictable

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7
Q

Causes of ovulatory pattern

A

UTERINE problems such as
1. leiomyoma
2. endometriosis
3. adenomyosis.
4. polyps.

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8
Q

Causes of anovulatory patterns

A

HORMONE problems such as
1. PCOS
2. hypothyroidism
3. hyperthyroidism
4. hyperprolactinemia
5. cushing syndrome.

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9
Q

How to assess if the pattern of bleeding is non specific in AUB patient

A

Assess the patients as having irregular bleeding because pattern includes investigations for endometrial hyperplasia for more diagnostic safety.

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10
Q

In reproductive age with AUB what’s the first concern

A

Pregnancy ( regardless of the pattern)

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11
Q

Which USS to do if ovulatory AUB

A

Transvaginal scan is more accurate for imaging of uterine abnormalities.

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12
Q

What’s the next step if any abnormalities in endometrium

A

Endometrial curettage and biopsy

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13
Q

When to arrange LH and FSH in AUB

A

Hormone assays like LH, FSH, prolactin should be done in a Anovulatory AUB, where hormone derangements are the Morse imp underlying cause to consider.

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14
Q

What’s infertility

A

Inability for a couple to conceive after 12 MONTHS of regular unprotected sexual intercourse in women LESS THAN 35 YEARS and after 6 MONTHS of sex in women of 35y or older.

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15
Q

In general what’s the most influential factor for infertility

A

Advancement of age.

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16
Q

Risk factors of carvical cancer

A
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17
Q

COCs reduce the risk of

A

1.Ovarian cancers as they cease ovulation.

  1. Endometrial cancer by 30%. By suppression of endometrial proliferation.
  2. Also colorectal cancer risk reduced in 15-20% by reducing bile acids in women on COCs.
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18
Q

Which ca has most risk with COCs

A

Cervical cancer
Less than 5 years use - 10% increased risk
5-9 years use - 60% increased risk
More than 10 y use- doubling of risk.

Also has a slight risk on breast cancer.
Benefits of preventing unwanted pregnancy and its harms, outweigh the slight increased risk of breast cancer associated with COCs.

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19
Q

Why does atropic vaginitis occur

A

From estrogen deficiency.
Symptoms - itching burning dryness and irritation all of which can relate to dyspareunia.
Also estrogen reduction alters vaginal flora leading to bacterial overgrowth. This can cause bacterial vaginosis and vaginal discharge.

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20
Q

Main treatment of atropic vaginitis

A

Estrogen cream
As they will take some time to be effective ,lubricant cream for sexual intercourse recommended.

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21
Q

How to treat vaginal candidiasis

A

Anti fungal agents
Presentation - itching , burning , dyspareunia, INFLAMED VAGINA WITH OR WITHOUT CHEESY WHITE VAGINAL DISCHARGE

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22
Q

Why use tropical antibiotics

A

Eg metronidazole is used for CONCOMITANT bacterial infection or vaginosis in atropic vaginitis.

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23
Q

What are absolute risk factors for COCP use

A
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24
Q

Is breast cancer a RF for COCP use

A

Breast cancer his in yourself is a RF but family history of breast ca isn’t a risk factor.

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25
Q

Is obesity a RF for COCP use

A

Obesity or overweight alone isn’t a RF. But if it’s with other cvs or systemic illness it could be a RF.

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26
Q

What’s the commonest cause of vaginal bleeding / post costal bleeding in post menopausal women

A

Atropic vaginitis due to ongoing estrogen deficiency

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27
Q

Wat are causes of iregular uterine bleeding

A
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28
Q

What’s the guideline for post coital bleeding in post menopausal women

A

Should investigate with a co-test of HPV AND LBS ( liquid base cytology ) and urgent referral to gynecologist to rule out cervical cancer.

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29
Q

Commonest cause of primary amenorrhea

A

Gonadal dysgenesis such as Turner’s syndrome
Secondly mullerian agenesis

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30
Q

Features of mullerian agenesis

A

Normal height
Secondary sexual characteristics
Body hair
External genitalia
But vagina is either absent or present as a short blind ended structure without cervix at vaginal apex.

Normal 46XX Karyotype with normal hormonal profile.
Normally nonfunctional uterus but rarely uterus with functioning endometrium( periodic cyclical abdominal pain with blood accumulation in vagina,cervix or uterus.)

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31
Q

Commonest menstrual abnormality with hyperthyroidism

A

Oligomenorrhea and amenorrhea
Less commonly menorrhagia.

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32
Q

Common cause for non- menopausal hot flushes

A

Hyperthyroidism
Hypertension is another cause.

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33
Q

How does hyperprolactinemia causes secondary amenorrhea

A

By inhibiting GnRH from hypothalamus

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34
Q

Average age of normal menopause

A

50-51 years

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35
Q

What’s Primary ovarian insufficiency ( POI) / Premature overran failure ( POF )

A

Ovarian failure BEFORE 40 YEARS of age.

1.Features of secondary amenorrhea
2. symptoms of estrogen deficiency ( decreased libido and atropic vaginitis)
3. high levels of FSH ( in menopausal range)
before the age of 40 years.

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36
Q

How to diagnose POI/ POF

A

Serum FSH levels
2 values of FSH in menopausal range ( >40 U/L) measured at least 1 month apart is diagnostic of POI
Parellel serum estradiol is needed and it is reduced

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37
Q

Treatment of POI/ POF

A

all women with POF should be started with menopausal hormone replacement therapy ( HRT)
To prevent menopause complications this should be continued at least till average age of menopause 50-55 yrs

  • HRT doesn’t provide enough contraception for both POF and actual contraception. Therefore additional
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38
Q

Possible causes of secondary amenorrhea

A

Asherman syndrome.
Hormone abnormalities like pituitary tumor, hyperprolactinemia , ovarian insufficiency, PCOS.

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39
Q

Commonest risk factors of endometrial hyperplasia

A

Virtually always result from chronic exposure of endometrial tissue to estrogen ( unopposed but the counterbalancing effect by progesterone)

NEAT DOLL BC

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40
Q

What’s Depo Provera

A

It’s an injectable progesterone.Counterbalances the effects of estrogen and protective against endometrial hyperplasia

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41
Q

If first two lines failed to manage secondary dysmenorrhea what to do

A

Assess for possible causes such as endometriosis, leiomyoma, polyps and other pelvic pathologies.

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42
Q

What’s cervical ectropion

A

Single layer of columnar epithelium of the endocervix extended onto the ectrocervix and is exposed to trauma during coitus.

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43
Q

Common causes of post coital bleeding

A

<30 years - cervicitis and ectropion are commonest causes
In reproductive age (30-40) - cervical polyp is also a cause

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44
Q

How to approach primary amenorrhea

A

Diagnosis approach depends on presence or absence of secondary sexual characteristics.
In absence of such characteristics - hormonal studies including FSH ,LH ,TSH, prolactin.
In presence of characteristics - pelvic uss for uterine of menstrual outflow abnormalities.

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45
Q

Features with hypogonadotropic hypogonadism

A

Low body weight
Excessive physical exercise
Starvation
Seen is anorexia or bullemia nervosa.
It can present in primary or secondary amenorrhea.

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46
Q

what are checked By USS in primary amenorhea

A
  1. presence or absence of uterus
  2. mullerian features
  3. ovaries
  4. presence of transvaginal septum
  5. evidence of menstrual flow obstrucion
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47
Q

common etiologies of primary amenorhea

A
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48
Q

What’s the cardinal common feature of turner syndrome

A

Short stature and square appearance.

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49
Q

What are the causes of secondary amenorrhea that can present as primary amenorrhea

A

Pregnancy
Hypoparathyroidism
PCOS
Diabetes
Exogenous androgen use

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50
Q

Features of gondal dysgenesis, androgen insensitivity, HPO failure, Mullerian dysgenesis, transverse vaginal septum

A
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51
Q

How to asses bone age in CGD

A

X-ray of left hand and wrist to assess skeletal mutations.
In CGD bone age lags behind chronological age.

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52
Q

Which contraceptive is associated with Otosclerosis

A

COCP worsens otosclerosis specially if patient has experienced onset with the pregnancy or steroid use.

Non hormone methods (IUCD ) can be used in such instances.

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53
Q

Only indication to start HRT in menopausal women

A

Troublesome Vasomotor symptoms of menopause.
If HRT is not appropriate due to any reason next step is SSRI or SNRI

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54
Q

Window of emergency contraceptive methods

A

5 days or 120hours
Earlier the better.
No medical contraindications to the use of emergency contraceptive pills.

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55
Q

Management of cervical neoplasia in pregnancy

A

LSIL ( CIN 1) - same way as non pregnant women. Repeat after 12 months.
HSIL ( CIN 2,3) - referred for colposcopy. ( pregnant or non-pregnant)

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56
Q

If colposcopy is inconclusive what’s the next step

A

Should do cone biopsy.

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57
Q

What are suggested by cervical motion tenderness ( aka cervical excitation , chandelier’s sign)

A

Suggest a pelvic pathology
Classically PID or ectopic pregnancy.

If PID is suspected empirical antibiotics started after cervical swabs are taken.
If ectopic suspected next best step is to do pregnancy test and USS to exclude EP.

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58
Q

Features of ovarian cystic teratomas or ovarian dermoid cysts

A

Encapsulated tumors with mature tissue or organ components ( hair,sweat glands, blood, fat, bone, nail, eyes, cartilage)
Diameter of ovarian teratoma is usually less than 10cm.
Uncomplicated Dermoid cysts are asymptomatic and found incidentally.

59
Q

Recommendations in OCP use in hypertension

A
  • If on OCP and with hypertension the patient should started on antihypertensive agent if she insist on using the method.
    *if she’s willing to stop the OCP can use another method for contraception.
    *If BP remain high despite stopping OCP ,should start antihypertensives.Methyldopa is the preferred method ( ACE inhibitors and diuretics are contraindicated in pregnancy)
60
Q

Commonest cause of irregular heavy periods in perimenopsusal women

A

Anovulatory cycles. By far the commonest cause.

( after ovulation corpus lutium is made and it secretes progesterone which helps maintain the endometrial lining and if no pregnancy corpus luteum regresses and progesterone declines.when progesterone reduces endometrium sheds and menstruation occurs. But without ovulation unopposed estrogen causes endometrial growth. This results in unpredictable shredding of hypertrophied endometrium and irregular often heavy bleeding)

61
Q

Commonest causes of Anovulatory cycles

A

Approaching menopause and PCOS are the commonest causes.

62
Q

Commonest sites of endometriosis ( in descending order of prevalence )

A

1.Ovaries
2.Posterior cul-de-sac / pouch of Douglas
3.Broad ligament
4.Uterosacral ligament
5.Rectosigmoid colon
6.Bladder
7.Distal ureter.

63
Q

common symptoms of atropic vaginitis,

A
64
Q

common causes of postmenopausal bleeding

A
65
Q

Cause of mucopurulent greenish vaginal discharge in young patient

A

Chlamydia trochomatis
Also Trichomonas vaginalis also cause FROTHY YELLOW GREEN vaginal discharge which is OFFENSIVE.

66
Q

Discharge in candida vaginitis

A

Thick white and non offensive

67
Q

How to calculate the rhythem calculation method

A
68
Q

What are indications for hystretomy in fibroids/leiomyoma

A
69
Q

Discharge in bacterial vaginosis

A

Thin, gray-white and has fishy offensive smell.
Common with Gardnerella vaginalis and mycoplasma hominis.

70
Q

Management of fibroids/ leiomyoma

A

If child bearing is needed- GNRH agonists, followed by myomectomy.
Otherwise definitive management is hysterectomy

71
Q

Most common cause of post procedural PID

A

Vaginal pathogens ( ecoli, anaerobes, mycoplasma hominis)

72
Q

Commonest cause of Post procedural PID in a high risk of STD patient

A

Vaginal pathogens and chlamydia infection

73
Q

Most common cause of PID in sexually active women in Ausi

A

Chlamydia trachomatis and Neisseria Gonorrhea

74
Q

In a woman with classic migraine with neurological problems ,what contraception is better

A

OCP containing estrogen is absolute contraindication.
Progesterone has androgenic effect such as hirsutism, acne, and weight gain.
So the barrier method is the best management

75
Q

What’s Yasmin

A

Alternative to COCs.
Contains Drospirenon 3mg and ethinylestradiol 30mcg
It shows NO WEIGHT GAIN but slight WEIGHT LOSS IS ASSOCIATED.

76
Q

Possible symptoms of intrauterine adhesions ( following dila ration and curettage )

A

Infertility
Menstrual irregularities
Cyclical pelvic pain
Recurrent miscarriages

77
Q

What’s initial ix and gold starboard for intrauterine adhesions

A

Initially trans vaginal USS AND GOLD STANDARD is hysteroscopy

78
Q

Features of prolactinoma

A

Amenorrhea, galactorrhea, headache, visual disturbances

79
Q

What are two recommended regimens for combined HRT therapy

A
  1. Cyclical HRT with daily estrogen and MPA given only for 12 DAYS EACH MONTH.
    ( used within FIRST 1-2 YEARS OF CESSATION OF PERIODS. Unpredictable breakthrough bleeding ( side effect of progesterone) will be reduced.

2.Continuous therapy with daily estrogen and MPA -
( taking both estrogen and MPA on daily basis. Started 1-2 YEARS AFTER CESSATION OF PERIODS. Breakthrough bleeding is seen as a side effect)

80
Q

Why use paroxetine

A

It’s a preferred SSRI for patients with HOT FLUSHES of menopause if HRT is contraindicated or not recommended.

81
Q

When to use estrogen only HRT

A

It is the best- IF NO UTERUS.
If uterus in place estrogen alone increases risk of endometrial hyperplasia and cancer.

82
Q

Diagnostic criterias of PCOS

A
83
Q

What are hormonal changes in PCOS

A
  1. Low serum FSH
  2. Elevated LH
  3. Normal LH /FSH is 1:1 but in PCOS it could be 2:1 or 3:1 or normal.
  4. HIGH SERUM FREE TESTOSTERONE. ( first line investigation)
  5. Prolactin could be normal or slightly high.
84
Q

What’s bartholin cyst

A

Barrholin gland at base of bilateral labia minora.
Drains into 4 and 8 o’clock positions.
If duct is obstructed it may cause a fluid filled cyst.
If cyst is infected may cause an abscess.

85
Q

What’s bartholin abscess and how to treat

A

They are polymicrobial
Anaerobes are the commonest cause but neisseria gonorrhea and chlamydia may cause as well.
Could be due to STD or else post surgical.

Treatment -
1. Incision and drainage - high tendency of recurrence.
2. Word catheter - a balloon ripped device which is inserted to cyst cavity immediately after I&D ,inflate bulb with 4ml saline and left in place for 4 weeks. When the tract is formed properly catheter is removed.
3. Marsupializarion- if word catheter is failed
4. Excision of bartholin gland - definitive treatment.
5. Antibiotics - not generally recommended unless - suspected gonorrhea or chlamydia infection , immunosuppresion, surrounding cellulitis, systemic signs of infection.

If less than 3cm- I and D only
If more than 3 cm- ward catheter, I and d and marsupilization finally.

86
Q

RF of endometrial cancer

A

Unopposed estrogen therapy
Increasing age
Nulliparity
Chronic anovulation
Obesity
Diabetes Mellitus
Lynch syndrome/ HNPCC
BRCA1/BRCA2 genes
Early menarche
Estrogen secreting tumor
Family hx of endometrial,ovarian,colon cancer.

87
Q

Increasing and decreasing RF for leiomyoma

A

INCREASING-
1. Black race
2.family history of fibroids
3. Early menarche
4. Obesity

DECREASING-
1. Smoking - reduce estrogen levels
2. Green veges and fruits
3. Parity (>20 weeks )

  • COCP doesn’t have effect on fibroids
88
Q

What are features of turners syndrome

A
89
Q

Definition of Premenstrual syndrome ( PMS )

A

At least one symptom associated with ‘ economic or social dysfunction ‘ that occurs 5DAYS before the onset of menses and is present for at least 3 consecutive menstrual cycles.

Symptoms maybe AFFECTIVE ( irritability, anger outbursts, depression , anxiety, social withdrawal) or PHYSICAL ( abdominal bloating, headache, breast pain, heart pounding )

90
Q

Treatment of PMS

A

First line - Non drug strategies for 3 cycles ( CBT, relaxation technique , regular exercise , vitamin E, B6, Ca,Mg

Second line - low dose SSRIs ( if psychological symptoms are the main concern )
Combined new generation pill like YASMIN or CILEST ( cyclical or continuous) for persistent physical symptoms.

Third line - Estradiol patches and Oral progesterone like DUPHASTON OR MIRENA.
Higher doses of SSRIs.

Fourth line - GnRH antagonist or Danazol or HRT

Fifth line - TAH + B/L ophorectomy. + HRT

91
Q

Approach to cyclical mastalgia

A
  1. Well fitted brazzier
  2. Warm compress , ice packs or massage.
  3. Evening primrose oil

Medical management if conservative measures fails
1. PCM or NSAIDS
2. Danazol ( great efficacy against cyclical mastalgia )
3.Tamoxifen ( high risk of blood clots,strokes,uterine cancer, cataracts)

92
Q

What’s premenstrual dysphoric disorder( PMDD)

A

Severe feeling of sadness ,emotional lability, frequent tearfulness , loss of interest in daily activities, feeling overwhelmed or out of control.

93
Q

RF of ovarian cancers

A
  1. Family history of ovarian cancer
  2. Familial ovarian cancer syndromes-
    • Lynch 2 syndrome - cancers of colon, breast,endometrium,ovary with HNPCC
    • Breast ovarian cancer syndrome - BRCA1 or BRCA2 mutations.
  3. Increases with age
  4. Infertility or nulliparity
  5. Early menarche or late menopause
  6. Endometriosis
  7. Obesity
94
Q

Decreased risk of ovarian cancer -

A

Pregnancy
Use of OCPs
Breastfeeding
Tubal ligation and hysterectomy

95
Q

Homogeneous thin gray fishy smelly vaginal discharge . What?

A

Bacterial vaginosis - most commonly by Gardenella vaginalis

In microscopy bacteria attached to vagina epithelial cells suggestive of BV.

96
Q

Is BV a STD

A

Nope
Exclusively seen in sexually active women and some after menopause.

97
Q

Treatment of BV in pregnancy

A

Australian guideline ( for pregnant and non pregnant both)
1. First line - O. clindamycin 300mg/bd for 7 days
2. Second line- O. metronidazole 400mg/bd for 7 days

RECURRENCE IS HIGH in 6 MONTHS.
NOT SEEN IN MEN.

98
Q

What’s the medical management of prolactinoma

A

Hyperpeolactinemia due to prolactinoma causes high prolactin and low LH, FSH , TSH by negative feedback mechanism.

BROMOCRIPTINE —-> tumor shrinkage —-> prolactin level becomes normal —-> fertility resumes.

99
Q

What’s premenstrual dysphoric syndrome

A

Severe form of PMS — severe feelings of sadness, tearfulness, reduced concentration, fatigue, insomnia

100
Q

How to do cervical screening

A

As long as no first sexual exposure - NO SCREENING.

All vaccinated and unvaccinated women above 25 years - 5 yearly screening
Initially after 2 years of first sexual relationship ( if first time after 25 y) —-> then 5 yearly screening for HPV testing should be done. Until 70-74 y

101
Q

Homosexual women should do pap screening ?

A

Yes. Even if they haven’t had a male sexual partner before.

102
Q

If a women get LSIL in TWO consecutive Pap smears done 12 months apart, what to do next

A

Do colposcopy

103
Q

Next monitoring after management for HSIL

A
104
Q

Further action plan according to Pap smear results

A
105
Q

Which antiepileptics reduce effect of OCP

A

Phenobarbital
Primidone
Phenytoin
Carbamazepine
Oxcarabazepine
Topiramate

No effect on OCP
S valproate
Levatericetam
Gabapentine
Pregabalin
benzodiazepine

106
Q

For enzyme inducing antiepileptics what’s the first line contraception

A

IUCD( mirena ) or DepoProvera

107
Q

CI for IUCD

A
108
Q

Contraception in DVT

A

In active DVT all hormonal contraceptives are CI ( including OCP/COCP and POP)
Condoms can be used

Oh history of DVT , OCP/COCP is CI but POP can be used.

In surgery POP can be continued and and while in prolonged immobilization also continue POP.

109
Q

What causes erratic PV bleeding after starting COCP and what to do

A

In 30% women COCP use cause irratic bleeding. But sometimes SUBSIDES AFTER 3 months.

Management-
If less than 3 months- reassurance ( bleeding could resolve after 3 months)
If more than 3 months- Increase the dose of estrogen in the COCP ( eg- to 50mcg)

110
Q

What are contraindications for POP

A

Absolute-
1. Breast cancer or history
2. Undiagnosed vaginal bleeding
3. Past history of ECTOPIC pregnancy and high risk of ectopic pregnancy
4. Suspected pregnancy.

RELATIVE-
1. Viral hepatitis
2. Chronic liver disease
3. Severe arterial disease
4. Successfully treated breast ca 5 years ago.

111
Q

OCP effectiveness is reduced in

A

1.Active pill forgotten after more than 24 hrs from last pill
2. Severe diarrhea or vomiting for >24 hrs ( has the same effect as forgetting the pill)

In this situation- routinely pills taken but barrier methods or avoid sex for 7 days

112
Q

Missed OCP management

A

1.missed one pill anywhere of the pack ( more than 24 upto 48 hrs) - take pill now and continue rest of the pack , no additional contraception+ 7 DAYS BREAK.

  1. If 2 or more pills missed (>48hrs later) - LAST pill missed take now, leave earlier missed pills. Rest of the pack continued with additional barrier methods ( no sex or condoms ) for 7 days.

Depends on the place of packet-
1. Missed from 1-7 days of the pack- EM contraception if unprotected sex in pill free period or first week of pill packet.
2. Missed from 7-14 days of the pack- NO NEED OF EM CONTRACEPTION, as long as proceeding 7 pills are taken properly.
3. If missed from 15-21 days- next pack started without a break ( pill free interval omitted) EM contraception not needed.
4. If MORE THAN 7 PILLS MISSED- start again as if starting from beginning ( exclude pregnancy and start a new pack on the first day of next period)

113
Q

Features of lactational amenorrhea (LAM)

A
114
Q

Post Partum contraception methods

A
  1. Condoms
  2. POP( minipill) - after 3-4 weeks
  3. Etonorgestral implants ( implanon)- after 6 weeks postpartum
  4. Progesterone IM injection ( depo-provera or depo-ralovera) after 6 weeks
  5. Mirena( LNG IUD ) or Cu IUD-
    Within 48HOURS postpartum OR AFTER 4 WEEKS ( and after 6 WEEKS in post LSCS)
115
Q

How to avoid sex after pregnancy

A

Not within 2 weeks to avoid infection and air embolism.

Recommended after 6 weeks to avoid complications.

116
Q

Who should be given with OCP plus CONDOMS and why

A

To prevent STDs

Young <25y.
>25y but new partner.
>25y but 2 or more partners in last year.
>25y whose regular partner has multiple partners.

117
Q

How does anovulatory cycles cause heavy bleeding

A
118
Q

What’s the commonest cause of heavy irregular bleeding in perimenopause

A

Anovulatory cycles.

Endometrial hyperplasia and endometrial cancer - heavy irregular bleeding but less commoner.
Endometrial polyp- heavy menstrual bleeding but NOT IRREGULAR.

119
Q

What are PCOS Criterias

A
120
Q

What are hormonal values of FSH, LH, LH/FSH ratio, serum estrogen, serum testosterone, prolactin

A
121
Q

What’s re non pharmacological methods for PCOS

A

If <35 years and BMI >25 - weight reduction is the first line ( without pharmacological methods for 6 months)

122
Q

Pharmacological mx for PCOS

A
  1. First line- Clomiphene citrate
  2. Metformin if BMI <30
  3. CC + Metformin
  4. Gonadotropin or Laporoscopic ovarian drilling ( equals to 6 months of gonadotropins)
  5. if all fails- IVF OR Intracytoplasmic sperm injection recommended.
123
Q

Most Imp role in uterine prolapse in which ligament

A

Uterosacral ligament

124
Q

Hormone profile in menopause

A

Estrogen low
LH and FSH high
LDL rising
Bone density - low

125
Q

Should women stop HRT Before mammography due to breast tissue becoming dense with HRT?

A

Nope
Brest are dense in only 10%.

126
Q

HRT RECOMMENDED TIME ?

A

2-5 years due to high risk of breast cancer

127
Q

What’s are recommendations for post menopausal women without a UTERUS

A

Best option - estrogen alone for maximum of 7 YEARS. ( beyond that the risk increases)

Post menopausal, BMI <25 has higher risk of breast ca than HIGHER BMI WOMEN. ( less mobilization of estrogen in adipose tissue )

128
Q

Effect of HRT On cancers

A
129
Q

How to screen for breast ca in women taking HRT

A
130
Q

Risk of DVT with HRT

A

Combined HRT - 2-5 fold risk
Estrogen HRT- 1.2-1.5 fold risk
Natural progesterone - no risk

131
Q

Perimenopausal woman with Hx of breast cancer , presents with hot flushes. What to do

A

Can’t give estrogen or progesterone pills. ( even if progesterone effect on breast ca is not known)
So when HRT contraindicated SSRI can be given ( eg- paroxetine, gabapentine, venalaflaxin.

132
Q

Labia adhesions management

A
133
Q

What’s the main reason we give HRT for premature ovarian failure?

A

To prevent bone loss and osteoporosis.

Should start CALCIUM AND VIT-D as well.

134
Q

What are necessary investigations for a primary amenorrhea patient ?

A
  1. Pregnancy test.
  2. Pelvic USS
  3. FSH
  4. TSH
  5. Prolactin
135
Q

What are recommendations of RANZCOG for menopausal hormone therapy?

A
  1. Primary indication for MHT is alleviation of distressing menopause vasomotor symptoms.
  2. In women with primary ovarian insufficiency MHT should be continued until normal age of menopause.
136
Q

Commonest cause of cervicitis?

A

Chlamydia trochomatis ( vaginal flora bacteria never causes cervicitis)

137
Q

How to diagnose premature ovarian failure ?

A

FSH levels 2 in values in one month apart.

138
Q

Does topical hormones have an effect for estrogen dependent cancers ?

A

No

139
Q

Diagnostic test of endometriosis?

A

Laparoscopy

140
Q

Commonest cause of chronic pelvic pain in developed countries?

A

Endometriosis

141
Q

What’s the delay of diagnosis of endometriosis in adolescents ?

A

8-10 years

142
Q

Does medical treatment increase fertility in endometriosis? What’s the best treatment for fertility?

A

Nope
Best tx is excisional surgery

143
Q

What contraception for migraine?

A

Migraine without aura - COC ARE SAFE
Migraine with aura - COC CONTRAINDICATED
If migraine develop while on COC - stop COC. Can start POP.

144
Q

Commonest hyperplasia seen in perimenopausal women?

A

Cystic glandular hyperplasia

Gyn (1 decks)

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