General/MCQs Flashcards
T/F. Diethylstilbestrol is associated with increased the risk of miscarriage and decreased risk of ectopic pregancy?
False. Diethylstibestrol increases the risk of ectopic pregnancy by 10 FOLD!!
It also increases the risk of miscarriage.
Is MRI useful to evaluate endometriosis?
Yes, it can be used to assess for deep infiltrating disease
What does raised CA-125 in pts with endometriosis signify?
That early laparoscopy may be warranted
What u/s findings suggest a diagnosis of miscarriage?
On TVS:
- Mean gestational sac diameter 25mm or more with NO obvious yolk sac.
- CRL 7mm or more with NO cardiac activity
Can repeat the u/s in 7-14 days to confirm diagnosis
Define a pregnancy of unknown viability.
On TVS there is
- a mean sac diameter of <25mm with no yolk sac or fetal pole
- CRL >7mm with no cardiac activity or gestation sac
Plan: repeat u/s in at least 7 days
Incidence of PUL?
Up to 31%
Which conditions cause undervirulization in males (XY females)?
- Anatomical testicular failure
- Enzymatic testicular failure
- 5 alpha reductase deficiency
- Complete/Partial Androgen insensitivity
What’s anatomical testicular failure?
Genetic male XY ➡️ SRY gene ➡️
testes
Testes nonfunctional ➡️ no AMH ➡️
Mullerian ducts develop ➡️ uterus, fallopian tubes, cervix, vagina
Also no testosterone as testes are nonfunctional ➡️ female phenotype and external genitalia
Management:
▪︎Rudimentary testes have 30% risk of malignancy so removal in CHILDHOOD is recommended.
▪︎oestrogen therapy starting at puberty to induce secondary sexual characteristics
What’s enzymatic testicular failure?
Male karyotype ➡️ SRY gene ➡️ testes formation ➡️ normal AMH but diminished testosterone production ➡️ NO mullerian/female reproductive organs ➡️ less DHT ➡️ Ambiguous genitalia (degrees varies based on extent of enzyme deficiencies)
— determination of sex depends on the degree of masculinization. Female gender often chosen.
What is 5 alpha reductase deficiency?
Genetic male XY ➡️ testes➡️ leading produces testosterone, sertoli produces AMH ➡️ no mullerian/female reproductive tract ➡️ testosterone converted by the little 5 alpha reductase present ➡️ less DHT ➡️ ambiguous genitalia at birth [child usu raised female] ➡️ more testosterone at puberty➡️ more virulization, usu micropenis; absent or minimal breast development
- many opt for female gender
- testes usu descended 🤔
What is androgen insensitivity?
This is rare: 1 in 60,000 male births
■X-Linked recessive
■ due to complete absence or mutation of the androgen receptor gene.
■ May be complete or partial.
Male karyotype XY ➡️ SRY gene ➡️ testes formation ➡️ testosterone from Leydig and AMH from Sertoli cells ➡️ no mullerian/female reproductive tract ➡️ testosterone converted to DHT by 5 alpha reductase ➡️ :
▪︎If absent receptors ➡️ female external genitalia develops ➡️ aromatization of excess testosterone = breast development, scant pibic and axillary hair due to lack of androgen receptors.
▪︎ If partial receptivity ➡️ ambiguous genitalia at birth [as some DHT is able to bind and have an effect] & virulization at puberty when more testosterone is produced
Management:
•Counselling
• 5% risk of testicular cancer so removal is advised.
• Oestrogen hormone replacement therapy
• Vaginal length usually adequate, but if nor can use graduated dilators using Frank’s procedure.
Frank’s procedure = a graduated series of vaginal dilators which are inserted into the vaginal dimple/canal using pressure, to expand the potential space between the rectum and bladder. It is performed by the patient and requires no anesthesia or surgery.
What scale is used to assess Androgen Insensitiviry syndrome?
Quigley score assesses the degree of virulization of genitalia
