Dvt Flashcards
Best day to do fsh
Day 3
Normal value less thsn 10 iu
Most common test for ovarian reserve
Best test for ovarian reserve
AMH(antimullerian hormone) 1 ng
Primary amenorrhea and raised fsh
Gonadal dysgenesis
Primary amenorrhea and low fsh
Kall mann syndrome
Normal level of fsh in
Pcos
Asherman symd
Mullerian agenesis
Amin role of fsh
Seection and growth of dominant follocle
It peaks before ovulation by progestrone
Estrogen
Under the influence of fsh ovary produce estrogen
C18 component
Endometrium proliferation
estrogen peak required for LH surge -200 pg X 48 hr
Decreased estrogem causes
Hot flishes vaginal atrophy
Estrogen levels in pcos
E1 increased
E2 normal
E2 :E1 ratio reversed
LH surge occurs
36 hrs before ovulation
Lh peak 12 hrs before ovulation
Which hormone maintain corpoluteum
Lh
Lh in pcos
Persiaitemly increasing
Persiatance of corpus liteum without pregnancy
Halbans disease
Androgen produced by
Theca cells under lh surge
Leutinized granulosa cells produce progesterone
Progesterone
C 21 compound
Causes secretory changes in endometrium
Cx mucus thick scantvagina intermediate cella
Increased basal body temp
Best test of ovulation
Serum progesterone done at day 21
Progesterone challenge test negative menas
Estrogen deficiency/endometrium/ hpo axis damage
Pct positive means
Anovulation
Peak level of progesterone seen at
8 days post ovulation
Day of ovulat
Length of menstrual cycle -14
Treatment of choice for hyperplasia without atypia
Estrogen
Androgens
C19 compounds
Produced by theca cells
Androgens not produced by ovary
DHT and DHEAS
Androgens priduced in max amount
Androstenidione
Pubic and axilliary hair produced by
Androgens or testosterones
In pcos androgens are
Mildly reduced(<200ng)
GnrH
Decapeptide
Realesed as pulsatile manner at puberty(night by decreased GABA increase in kiss petin)
Ansent gnrh in
Kallman ,anosmia
Low frequency pilses of gnrh causes
Fsh release
High frequency pilse sof gnrh causes
LH release
In case of aub isg shows a growth in uterinecavity what will you do next
Hysteroacooy(best)
Any women with more than 45 years with c/o aub ir how willk you proceed
Irrepective of usg finding do endometrial biopsy or endometrial aspiration cytology (EAC)-karmans cannula
If patient had post coital bleeding and u see visible growth or abnormal cervix
Punch biopsy
Abnormal paps
Colpobiopsy
Treatment of choice for preinvasive lesions
LEEP
If atypical galdular cells on pap smear
Colpobiopsy+endeocerbical curettage+endometrial sampling
Fibroid uterus
Enlarged uterus Heavy bleeding More than equal to 35 yrs Non tender uterus(tender if degeneration or Irregular uterus IOC- USG Treatment Asymptomatic fibroid no treatment Fibroud perimenopausal no treatment Asymptomatic fibroid desire pregnancy-no treatment (except submicosal -hysteroacopic myomevtomy Intramural blocking b/l cornu myomectomy
Investigationof choice for submicosal fibroid
Hysteroacopy
Polyp
Increased size of uterus Irregular bleding Peri and post menopausal Non tender Usg- feeder vessel sign
Ioc-hysteroscopy
Treatment of choice - polypectomy
Adenomyosis
Enlarged uterus Heavy bleeding(dysmenorrhea 40-45 Tender Globular Ioc- mri Diagnosis- HPE
Usg findings in adenomyosis
Venetian blind
Saalt pepper
Poorly defined junctional zone
Treatment of choice-hysterectomy
Treatment of symptomatic traetment
Pressure symptoms-given gnrh analogs and antagonist
If menorrhagia- intramural-ocp
Submicosal- hysteroacopic myomectomy
Endometrial hyperplasia without atypia toc
Progesterone (mirena)
Hyperplasia with atypia
Next step-
D and c with hysteroacopy
If asked toc- hysterectomy
Most common cause of post menopausal bleeding
Atrophic endometritis
Endo ca 10%
Mullerian agenesis
Ansent uterus
Breast >=thanner 2normalnpubic and axillary hair
Absent vagina46 XX
Androgen insensitivity syndrome
Abseent uterus No pibic and axillary hair Braest mor than 2 thanner Blind ending vagina 46XY Gonadectomy after piberty
Most common cause of male pseudohermaphrodite
Androgen insensitivity syndrome
Most comkon cause of female paeudohermaphrodite
CAH- congenital adrenal hyperplasia
Gonadal dusgenesis
Uterus small Abdent breasovary not visible Fsh increased Short statute- turner45 x0 Normal stature -pure gonadal dysgeneses Pure can be xx xy Xy_swyers- gonadectomy as soon as diagnosis made
Kallman
46xX Anosmia Ovaried normal Uterus present Fsh low
Imperforate hymen
Bulging memrane on l/ e
Normal uterua and normal ovaries
46 xx
Breast development presnet
Features of imperforate hymen
Hematocolpos Hematometra Cyclic pain Acute urinary retension Mx- cruciate incision
Imperforate hymen vs vaginal septum
Trnasverse septum there is no bulge
Cough impulse negative in vaginal septum
Cough impulse preseng in imperforate hymen
Investigation of choice for mullerian anomalies
3 D usg
Gold std for mullerian anomalies
Mri
If not
Then laproscopy and hysteroscopy
Dippong fundis and wide angle in
Bicotnuate uterus
Partialfusion 2 uterine horns 1 cervix
Bi cornuate mx
Strass man metroplasty
Complete failure of fusion in which uterine anomaly
Didlephius(2 uterine horns and 2 cervix)
Hoghest riak of vaginal septum
Highest risk of U/l renal agenesis(on the side of septum)
Ectopic pregnancy,evtopic ovary and u/l dysmenorrhea are characteriatic of which uterine anomalu
Unicornuate
High risk of urinary tract anomalies
Endometriosis
Uterine rupture
All mullerian anomalies have
1) Obstruction-cyclic pain,endometriosis,infection aub hemato colos and hematometra
2) urinary tract abnormalities-renal agenesis,horse shoe kidney,ipailateral
3) preg complicatins-abortion,iugr/nal presentation/pph,abnormal or prolonged labour
Most common cause of infertility
Ovarian Pcos-(who grp 2 anovulation) Doc ocps(for hirsuitism also 2 nd line spironolactone)
Doc for ovulation induction
Letrozole
More live birth rate and monofoliiculqr development
Differential diagnosis for pcos
Adult onset CAH-17 ohp test
Second line traetment for ovulation induction
Gonadotropins>lap ovarian drilling
Investyof choice for tubal patency
HSG (day 5-day 11)
Best test for tubal patency
Laparoscopic chromopertubation
Hag ahows b/l block next step
Laproscopic chromopertubation
Hag shows b/l cornual block then
Hysteroscopic pic cannulation
Bl/ hydrosalpynx toc
IVF
Next step -salpinchectomy or tubal clipping
Gentinal tb most commonly involved in which organ
Fallopian tube
Spread hematogenous
Most common presentation pain and infertility
Normal pv findings
Diagnosis of genital tb
Endomitral biopsy/PCR of menstrual blood
Choclate cyst and adhesions seen in which type of endometriosis
Moderate to severe
Treatment of choice-IVF
Donot remove choclate cyat beforeivf
Most common cause of male factor infertility
Primary hypogonadosm
Testicular/spermatogenesis/non obstructive)
Hormonal status in primary hypogonadosm
Incraesed fsh
Increased lh
Decreased testosterone
Obstructive azoospermia
All hormones are normal
Eg cystic fibrosis
Moat important hormone differentiating non obstructive and obstructive azoospermia is
Fsh
Investigation of choice for vaginal discharge
Salime microscopy
Greyiah white,Foul amelling d/c with ph more than 4.5,no pruritis
clue cells/whiff test
Bacterial vaginosis
Criteria for bacterial vaginosis
Amsel criteria 3
Doc for bacterial vaginosis
Metronidazole/clindqmycin
Important test in bac vaginosis
Gramstain
Nugent score score of 7-10
Which infection a/w preterm labour
Bacterial vaginosis
Greenish yellow foul smelling frothy discharge With pruritis,dysuria and dysparunia Ph> 4.5 O/e Strawberry cervix
Trichomoniasis
Doc metronidazole
Patient presented with pruritis and thickk curdy white scandy diacharge,ph less than 4.5
Non foul smelling
Not std
Candidiasis
Doc- fluconozole
Kit 2 green clr- secnidazole 2 gm stat+ t fluconozole 150 mg stat
Mechanism of action of emergency contraceptive
Inhibit fertilization
Most commonly used ec
LNG tab 1.5 mg (72 hrs)
Most effective ec
Cut (5days)
Moat effective hormonal ec
Ulipristal 30 mg
Pcos usg findings
12 or more follicles2-9 mm each
Volume of ovary >=10 cc
Multiple large follicles
Ovarian hyper stimulation symdrome
Highest risk for gonadotropin (hcg)
Best therapy for pcos
Recombinant fsh but costly
So hmg therapy
Late onset ohss causes
Pregnancy hcg
Hyperpigmented velvety necjk in
HAIR AN syndrome— severe pcos (it is the indication for metformin therapy)
Hyperandrogenesim,insulin resistance,acanthosia nicricans
Laparoscopic ovarian drilling
Surgical ovulation induction
4 holes 40 w current
High risk for ovarian failure
Asherman syndrome most comkon cause
D and c
Tb schistosomiasis
Ipc for asherman sydn
Hysteroscopy
Rx- adhesiolysis+ peadiatric foleys and estrogen supplements
Banana shaped uterus
Unicornuate uterus
Golf club tube appearance in hsg
Tb
Others tobacco pouch pebble stone lead pipe
Leaf kike protozoa with flagella highly motile
Trichomonas
Complicated candidiasis treatment
Boric acid
Causative organisms candida glabrata c.tropicalis
Triple line endometruim is at
Midcycle due to estrogen
Tubal ligation in which serosa opened up ligate and cut tubes and bury the stump by tubal serosa
Uchida method
Zero failure
If medial end buried under myometrium(irwing )
If make loop ligate loop and cut loop -pomoroy
Tubal ligation in which fimbriae is cut off
Kroner method
Ligate the two end and cut in between
Parkland merhod
Place pf tubal ligation
Medial 1/3 and lateral 2/3
Madlena method
Made loop crush the loop and ligate the loop
Failure rate 7%
Gollocle like arrangemnet of cells in
Granulosa cell tumor
Call exner bodies
Marker-inhibin b
Granuloma cell tumour associated with
Tumou in uterus becos mc estrogenic tumour
Tumour in children with elevated alpha feta protein and schiller duval body(pink cells inside)
Yolk sac tumour
Tumour marker for young girls with adnexal mass
LDH-dysgerminoma
Afp- yolk sac tumour
Inhibin b
Hcg choriocarcinoma embryonal ca
Signet ring cell appearance
Krukenberg tumour
Most common primary site pylorus of stomach(lymphatic route)
Poor prognonsis kidney ahaped large tumour
Investigation for figo 0-5
Saline infused sonography
Contraindication of hsg
Active tb
Ioc of endometriosis
Laparoscopy
Blue berry spots deep ,red flame lesion
Powder burn lesion seen in
Endometriosis/emdometrioma
Hole in peritoneum called
Allen master syndrome due to adhesion
Diagnosis of haemoperitoneum(ruptured ectopic)
Culdocentesis
Couvelaire uterus seen in
Abruptio placenta
Concealed abruptio
Painless profise bleeding
Placenta previa
Mx c section
Expectant manegement-macafee johnososn regimen deadline 37 week
Lamba sign in
Dichorionic dizygotic
Most common monozygotic
Mcda
Nuchal transulency assaociated with which test
Dual test
Post coital bleeding
Lesion on cervix what to do next
Direct punch biopsy
Doyens retractor
Retract anterior abdominal wall in c section
Episiotomy scissor
One narrow blade for vagina
One broad blade for perineum
Episiotomy is sutured back by
Chromic cat gut 1-0
Rapid vicoryl no 1
MVA SYRINGE(manual vacum aspiration )
2 valves
600-660 mmhg pressure
Used for mtp upto 12 wks or abortions of first trimester
Cuacos speculum
Self reataining speculum
Ayers spatula and cyto brush
For papsmear(wood) Cytobrush-for endocerviacal cytology for dysplasia scrrening
Intra decidual space/ sac sign
Earliest sign of implantion in usg
Double decidual space sign
Second sign of implantation
Double bleb sign
Amniotic sac and yolk sac
Ring of fire appearanec is seen in
Ectopic pregnancy
Also in corpus luteum
Spalding sign
Intrauterine fetal death
Sign of maceration
Velamentous placenta
Cord avulsion
Fetal distress
Fetal blood loss
APT test used to
Diffenretiate maternal blood from fetal blood
Apt test positive in
Vasa previa
Q shaped placenta
Small chorionic plate
Raised membranes all around
Unutilised desidua basalis
Circum vallate placenta
Fetus with iugr oligo preterm
Leopoeld grip
1 fundal grip
2 lateral /umbilical
3-pawlik grip one hamd used for to identify presentation
4-deep pelvic grip facing legs
Compression suture in pph
B lynch suture during c section
Pph suture in normal delivery
Haymans suture
Hegar dialatore
Rapid cervical dialatores
Used for mtp,cervical incompetence
If hegar 8 dialator inserted -hegars teat
Purse string suture at portio vaginalis
Mc donalds cerclage
Pregancy in assymetrical uterus
Angular pregnanacy
Piskacek sign
Perineal tear
1 degree- perinela skin
2-muscles also
3-anal sphincter
4-anal mucosa
Pinard maneuver
For extended legs
Maneuver for extended arm
Lovset
Pragve maneovout
After coming head is delibered
Mc roberts maneuvemsv /mauriceau smellie veit
Malar flexion shoulder traction
I maneuver for shoulder dystocia
Mc roberts maneuver
Gaskin maneuver
Knee hand postion