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Gynae Flashcards

1
Q

Embryologic origin of the uterus is from?

A

Mullerian duct - paramesonephric

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2
Q

Main support of uterus is?

A

Best ans is Levatorani muscle > Next best Cardinal ligament

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3
Q

________ is not a support for Uterus?

A

Broad ligament, round ligament (not a main support)

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4
Q

Which ligament is responsible for Anteversion and Anteflexion of Uterus?

A

Round Ligament + Utero sacral

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5
Q

Epithelial lining of endocervix and uterine cavity?

A

Tall columnar Epi

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6
Q

Uterine blood supply is derived from?

A

1) Uterine a. - best ans - branch of ant division of internal iliac
2) Ovarian a - 2nd best ans - branch of abdominal aorta

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7
Q

FT are lined with?

A

Ciliated columnar epi (peg cells)

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8
Q

Main cause of transport of conceptus to uterus is?

A

Peristalsis

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9
Q

Narrowest part of FT?

A

Interstitial (intramural) - anatomical sphincter

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10
Q

Ligation is done in FT at?

A

Isthmus (symmetrical smooth muscle)

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11
Q

Widest part of FT?

A

Ampulla

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12
Q

Ectopic pregnancy is most common at which location in FT?

A

Ampulla (site of fertilization/max no of plicae or mucosal folds)

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13
Q

What is physiological sphincter in FT?

A

Isthmus

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14
Q

Ovaries are attached by _______ to the uterine fundus by the ________ to the pelvic side wall.

A

Ovarian ligament/Utero-OV ligament, Suspensory ligament (infundibulopelvic ligament).

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15
Q

Infundibulopelvic (suspensory) ligament contains?

A

Ovarian vessels
Right side vein drains into IVC and left side drains into Left renal v.

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16
Q

Normal commensal organism in vagina and pH?

A

Lactobacillus (Doerleins bacilli), Acidic pH 3.5-4.5

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17
Q

Epi lining of vagina and ectocervix?

A

Stratified squamous epithelium

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18
Q

Which 2 things are responsible for acidic pH of vagina?

A

Lactobacillus/doderleins and Estrogen

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19
Q

pH in pregnancy is?

A

4

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20
Q

________ cells are predominant with estrogen and ____________ with progesterone.

A

Superficial cells - bade bade pink cellls, piknotic nucleus - mature cells
Intermediate cells - blue colored and bigger nucleus

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21
Q

Cells found in a female with absent estrogen and progesterone and pH of vagina?

A

Parabasal cells - post menopausal or pre-pubertal females
pH is 6.5-7.5

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22
Q

Upper 1/3rd vagina is derived from?
Lower 2/3rd vagina is derived from?

A

Mullerian ducts
UGS - also makes vulva/ext. genitalia

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23
Q

Main source of vaginal secretions?

A

Cervical glands

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24
Q

Second name of Bartholin’s glands? and where do they open?

A

Greater vestibular gland - open in vestibule (b/w labia minora and hymen)

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25
Q

Bartholin’s glands are homologous to?

A

Bulbourethral glands (cowpers)

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26
Q

Bartholin’s glands open at?

A

Postero-lateral wall of vagina b/w labia minora and hymen

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27
Q

TOC Bartholin’s glands cyst symptomatic or bigger than 3 cm or abscess?

A

Incision and drainage

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28
Q

Bartholin’s glands cyst abscess clinical presentation?

A

Tender swelling
Warm
Fluctuant
Edema/erythema
SEVERE PAIN

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29
Q

Location of Gartner cyst?

A

Antero-lateral

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30
Q

PAP smear is only used for?

A

Screening

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31
Q

Best screening test for Cervical Ca?

A

HPV-DNA

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32
Q

Most cost-effective screening tool for Cervical Ca?

A

VIA
visual inspection acetic acid, 3-5%

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33
Q

Fixative used for PAP smear is?

A

95% ethyl alcohol

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34
Q

Diagnostic test for Cervical Ca or dysplasia?

A

Biopsy (Colpo biopsy)

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35
Q

Ectocervix screening is done for which Ca?
Site of specimen?

A

SCC
Transformation zone/sq col zone

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36
Q

Endocervix screening is done for which Ca?

A

Adeno-Ca

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37
Q

Woman with post coital bleeding next step?

A

P/S examination + PAP smear

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38
Q

Woman with post coital bleeding and abnormal looking cervix, next step?

A

DO NOT TAKE PAP Smear, take biopsy instead right away

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39
Q

PAP Smear can be taken?
Area of abnormal-appearing tissue that are biopsied include?

A

Any time after menses (not taken during active bleeding)
Acetowhite areas + irregular contour of surface/pale

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40
Q

___________ is applied to cervix to aid in dysplasia detection?

A

Acetic acid

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41
Q

Filter used in colposcopy?

A

Green filter - to look for abnormal vessels/neovascularization

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42
Q

LEEP second name and is TOC for?

A

LLET2, CIN 2/3: pre-invasive lesions, basement membrane will be intact

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43
Q

Hysteroscopy pressure?

A

50-70 mmhg (100 max)

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44
Q

Hysteroscopy done in which phase of menses?

A

Proliferative - follicular

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45
Q

Media used in monopolar electrical cautery?

A

Glycine (MC) - electrolyte deficient - can cause hyponatremia

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46
Q

Media used in bipolar electrical cautery?

A

Electrolyte rich - NS or RL

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47
Q

Hysteroscopy is TOC for?

A

1) Endometrial polyp
2) Asherman’s syndrome = synechiae
3) Submucosal fibroid
4) Septate uterus

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48
Q

Contraindication for Hysteroscopy?

A

Pregnancy
Pelvic infection
Pyometra (pus in uterus)
Cervical Ca

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49
Q

HSG is IOC for?
Dye used in HSG?

A

Tubal Patency (screening only HSG never diagnostic)
Iodine dye (Iopramide, Iohexol)

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50
Q

Bilateral block (any block) on HSG is followed by ___________ test and dye used is __________.

A

Laparoscopic chromopertubation test
Methylene blue

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51
Q

HSG is done on which day of menses?

A

D6-D11

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52
Q

Contraindication for HSG?

A

Pregnancy
Current infection (PID also)
Active bleeding
Active TB + untreated

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53
Q

Cannula used for HSG?

A

Leech wilkinsons (Rubin cannula old times)

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54
Q

Endometrial biopsy done in which phase and which day of menses?

A

Before menses/premenstrual/secretory/luteal
D26 (2 days before expected menses)

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55
Q

Indications for Endometrial biopsy?

A
  1. Postmenopausal bleeding ET>4 mm
  2. > 45 yo with heavy or irregular bleeding
  3. Granulosa cell tumor - secretes estrogen can cause Ca or hyperplasia
  4. Endometrial Ca risk factors (tamoxifen, obese, PCOS), Lynch HNPCC syndrome)
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56
Q

Serum FSH test day and use?

A

D3 - test of ovarian reserve MC used

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57
Q

Serum progesterone test day and use?

A

D21 - MC used test of ovulation

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58
Q

Post coital test day and name?

A

D12-D14, Sims Huhner test

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59
Q

Antral follicles count test day and use?

A

D2-3, ovarian reserve

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60
Q

Serum AMH test day and use?

A

Anytime - best test for ovarian reserve

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61
Q

Spatula used for PAP smear?

A

Ayres’s spatula side A
No air drying of slide

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62
Q

Device used for taking sample from Endocervix?

A

Cytobrush

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63
Q

Device used in HSG for pushing in the dye?

A

Leech Wilkinson’s cannula

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64
Q

Next step for B/l cornual block?

A

Lap chromo + Hysteroscopic cannulation
diagnostic theraputic

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65
Q

Best Tx for B/L cornual block?

A

IVF

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66
Q

Big and small peak in ovulation cycle graph is which gonadotrophin hormone?

A

LH - big peak
FSH - small peak

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67
Q

Two peak one before ovulation and one after ovulation, ovarian hormone during menses is?

A

Estradiol

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68
Q

One peak after ovulation ovarian hormone during menses is?

A

Progesterone

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69
Q

FSH stimulates the growth of and secretion of?

A

Growth of follicles
Secretion of Estrogen

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70
Q

LH stimulates production of?

A

Androgens via Theca cells
Androgens converted into estrogens in granulosa cells by aromatase enzymes (two cell theory)

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71
Q

LH surge is dependent on rapid rise in?

A

High Estrogen - initiates LH surge

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72
Q

Time gap b/w LH surge and ovulation

A

36 hrs

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73
Q

Time gap b/w LH peak and ovulation

A

12 hrs

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74
Q

Progesterone comes from?

A

Corpus luteum - is it maintained by Luteinizing hormone

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75
Q

What hormone maintains corpus luteum in pregnancy?

A

HCG

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76
Q

Life span of corpus luteum?

A

14 days - fixed phase in every female

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77
Q

Corpus luteum is rescued from luteolysis by?

A

HCG - maintains CL

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78
Q

Secretory phase is under the effect of?
Secretory phase HPE shows?

A

Progesterone
Subnuclear vacuolation/corkscrew glands

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79
Q

Proliferative phase is seen under the effect of?
And HPE shows?

A

Estrogen
Tall glands/Telescope

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80
Q

Cervical mucous under effect of progesterone shows?

A

Thick-viscous-scanty

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81
Q

Cervical mucous under effect of Estrogen shows?

A

Thin-watery-copious (large amount)

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82
Q

Progesterone is smooth muscle relaxant?

A

Relaxant
(Estrogen increases contractions)

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83
Q

Levels of LH and FSH in various conditions:
1. Turner syndrome
2. Gonadal dysgenesis
3. Kallmann syndrome
4. Mullerian agenesis
5. AIS:
6. Asherman syndrome
7. Sheehan syndrome
8. Imperforate hymen
9. Menopause
10. Premature ovarian failure

A
  1. Turner syndrome: Both high - Hypergonadotropic Hypogonadism
  2. Gonadal dysgenesis: Both high - Swyer syndrome (pure/complete - also Hypergonadotropic Hypogonadism)
  3. Kallmann syndrome: (no GnRH) both low, Hypogonadotropic Hypogonadism
  4. Mullerian agenesis: (No uterus and FT but normal ovary) both normal
  5. AIS: FSH normal (good negative feedback from inhibin), LH high (no testosterone negative feedback)
  6. Asherman syndrome: Both normal
  7. Sheehan syndrome: Both low - Hypogonadotropic Hypogonadism
  8. Imperforate hymen: Both normal
  9. Menopause: Both high
  10. Premature ovarian failure: Both high
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84
Q

Leydig cells produce?
Sertoli cells produce?

A

Testosterone
Inhibin (negative feedback on FSH)

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85
Q
  1. Menopause and 10. Premature ovarian failure estrogen level?
A

Low

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86
Q
  1. Sheehan syndrome estrogen level?
A

Low - no stimulus

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87
Q

Estrogen will be normal in?

A
  1. Asherman syndrome & 4. Mullerian agenesis
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88
Q

Estrogen will be decreased in?

A
  1. Turner syndrome
  2. Gonadal dysgenesis
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89
Q

PALM-COIN classification is for?
and its full form

A

For abnormal uterine bleeding
Polyp
Adenomyosis
Leiomyoma - fibroid uterus
Malignancy - hyperplasia
Coagulopathy
Ovulatory cause
Endometrial
Iatrogenic
Not yet classified

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90
Q

MC cause of abnormal uterine bleeding in adolescent girl?

A

1st ans - Anovulation
2nd - coagulation defects

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91
Q

MC cause of abnormal uterine bleeding in perimenopausal girl?

A

Anovulation

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92
Q

Bleeding pattern in PCOS?

A

Oligomenorrhea followed by amenorrhea
(ovulatory cause)

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93
Q

Iatrogenic abnormal uterine bleeding causes?

A

OCPs and IUDs

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94
Q

Test for pregnancy in female of reproductive age group?

A

HCG test

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95
Q

Fern leaf of pattern on dried cervical mucous indicates?

A

Under effect of Estrogen + NaCl
Proliferative phase - follicular

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96
Q

Which hormone increases BBT? (Basal body temperature)

A

Progesterone by 0.5’ F

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97
Q

What happened to temperature at the time of ovulation?

A

Decreased (because of Estrogen peak)

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98
Q

Primary amenorrhea diagnosed with an absence of menses by?

A

15 yrs - with secondary sexual characters present
13 yrs - without secondary sexual characters present
If there is no menses within 3 years of Thelarche

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99
Q

Primary amenorrhea + breast absent + uterus present, syndromes and test to be done?

A

Means no hormones or no ovaries
Gonadal dysgenesis/Swyer’s syndrome, Turner syndrome, Kallmann syndrome
Test: FSH

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100
Q

Primary amenorrhea + breast present + uterus absent, DD and test to be done?

A

DD: Mullerian agenesis, AIS, Imperforate hymen
Problem in outflow but hormones present
Next test: USG

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101
Q

Uterus is absent in which conditions? And pubic hair in those conditions?

A

AIS (Absent or scanty)
Mullerian agenesis (normal Pubic hair)

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102
Q

Karyotype in Mullerian agenesis?

A

46XX

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103
Q

Karyotype in AIS?

A

46XY - Sx gonadectomy

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104
Q

Blind vagina is found in?

A

AIS - undescended testis - inguinal hernia
Sx gonadectomy

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105
Q

What is partial AIS?

A

Clitoromegaly
Reifenstein syndrome

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106
Q

How do we differentiate between 5-alpha reductase deficiency and partial AIS?

A

Breast development absent in 5-alpha reductase deficiency but they also have Clitoromegaly

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107
Q

Turner syndrome characterized by:

A

Short stature
45XO
Shield shaped chest
Webbed neck/Low post hairline
No Barr body
CVS: Bicuspid aortic valve/coarctation of aorta
Normal ID
Life span low
AID: DM/Hashimoto’s/coeliac/IBD
Also knows as Hypergonadotropic Hypogonadism
TOC: HRT (E+P)

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108
Q

Kleinfelter’s syndrome characterized by:

A

Tall stature
Male gynecomastia (high risk B-Ca)
Small fibrotic testis - no spermatogenesis
LH/FSH high and testosterone low
1 Barr body present
47XXY
IQ low
Type of primary Hypogonadism

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109
Q

Karyotype Of Turner and Klienfelter?

A

45XO and 47XXY

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110
Q

Karyotype Of AIS/partial AIS, 5-alpha red, Swyer?

A

46XY

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111
Q

Karyotype Of Imperforate hymen, Kallmann, Mullerian agenesis, Asherman?

A

46XX

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112
Q

Which conditions require gonadectomy?

A

AIS/partial AIS, Swyer’s and 5-alpha def

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113
Q

Which conditions DO NOT require gonadectomy?

A

Klinefelter’s, Turner’s (only if mosaic pattern present in turner’s)

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114
Q

Kallmann syndrome characterized by:

A

Anosmia
Also called Hypogonadotropic Hypogonadism (GnRH absent)
TOC HRT- GnRH pulsatile/Inj. gonadotropins
Normal karyotype

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115
Q

Imperforate hymen characterized by:

A

History cyclical pain
Uterus present and breast normal
Blood collection in vagina (HematoColpos or hematometra)
Uterus maybe enlarged because of blood collection
Acute presentation in ER: acute urinary retention
Local finding bluish bulging membrane
Increased risk of Endometriosis - Sampsons theory
TOC cruciate incision

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116
Q

Sampsons theory says?

A

Retrograde menses

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117
Q

Transverse vaginal septum characterized by:

A

No bluish bulging membrane
Upper 1/3rd vagina - Hematometra
TOC Excision or septum
Rest same as imperforate hymen

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118
Q

First step in secondary amenorrhea?

A

Rule out pregnancy
Serum HCG test

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119
Q

Hormonal profile to be done in secondary amenorrhea?

A

FSH, TSH, Prolactin
Additionally LH, testosterone, Estradiol

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120
Q

Raised prolactin level reason in secondary amenorrhea?

A

Microadenoma
DOC Cabergoline - dopamine agonist

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121
Q

Raised FSH level reason in secondary amenorrhea?
Clinical presentation:

A

No feedback inhibition means ovary not working, MC Premature ovarian failure/Premature menopause
less than 40 age, hot flashes, vaginal atrophy, infertility

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122
Q

Normal FSH level reason in secondary amenorrhea?

A

Overy working means inhibition feedback working
key words PCOS: oligomenorrhea, hirsutism, infertility
key words Asherman: history of curettage/MTP

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123
Q

Low FSH level reason in secondary amenorrhea?

A

Functional hypothalamic amenorrhea seen in stress/athlete/psychiatry patient
Sheehan syndrome: key word PPH/BT

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124
Q

MC cause of Asherman syndrome?

A

curettage (MTP) - done for PPH

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125
Q

Normal values of FSH?

A

4-10 IU
Low = 1-3 (in pregnancy because of progesterone high)
High = more than 10

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126
Q

MC presentation of Asherman syndrome?
TOC?

A

Menstrual irregularity - amenorrhea > hypomenorrhea
Pain
Infertility
recurrent pregnancy loss
All hormones normal
46XX
TOC Hysteroscopic adhesiolysis + E2 + Pediatric foley’s catheter in uterus

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127
Q

IOC for Asherman syndrome?

A

Hysteroscopy (both diagnostic and theraputic)

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128
Q

Diagnostic criteria for PCOS?
Androgen levels in PCOS?

A

Rotterdam
Less than 150 (mild high)

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129
Q

Oligomenorrhea or amenorrhea in PCOS due to?

A

Anovulation

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130
Q

Hyperandrogenism clinical/biochemical scoring is called?

A

Ferriman gallwey

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131
Q

PCOS min cysts on USG? and ovarian volume?
Characteristic finding on USG?

A

> 20 and 10 cc
String o pearl/necklace pattern

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132
Q

Which disorder has HAIRAN syndrome?

A

POCS
HA = hyperandrogenism
IR = Insulin resistance
AN = Acanthosis nigricans

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133
Q

Which hormone is high in POCS?

A

LH high (FSH normal), testosterone high

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134
Q

Which estrogen is raised in POCS?

A

E1 - Estrone

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135
Q

DOC POCS?
DOC of hirsutism in POCS?

A

OCPs – 6 months – add spironolactone

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136
Q

DOC of infertility in POCS?

A

Letrozole > Clomiphene
Letrozole is Aromatase inhibitor

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137
Q

Second line tx of infertility in POCS?

A

Injection gonadotrophins > laparoscopic ov dvilling

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138
Q

Serum AMH levels in POCS?

A

Raised AMH/glycoprotein
Source of AMH is preantral follicles
high AMH means good outcome for IVF and increased OHSS risk

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139
Q

First visible sign of puberty?

A

Growth spurt
Thelarche = tanner 2

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140
Q

Criteria for diagnosis of precocious puberty?

A

<8 yo for girls (MC reason idiopathic or central GnRH)
<9 for boys

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141
Q

DOC Precocious puberty?

A

Continuous GnRH agonist
also used in endometriosis, hirsutism, fibroid uterus, breast and prostate ca

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142
Q

Criteria for diagnosis of delayed puberty?
DOC?

A

No thelarche by 13 in girls
No testicular enlargement by 14 in boys
MC Constitutional delay
Tx Pulsatile GnRH

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143
Q

Average age of menopause?
Age of premature menopause?

A

51
(12 months amenorrhea)
<40 premature menopause and they have >25 FSH level

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144
Q

Which Estrogen is seen in post-menopausal women?

A

E1 - from adipose tissue
(lack of E2)

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145
Q

Which Estrogen is seen in pregnant women?

A

E1

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146
Q

MC symptom of menopause?

A

Hot flashes

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147
Q

Indications of starting HRT in menopause?

A

Hot flashes (Tx transdermal HRT)
vaginal atrophy (Tx local application HRT)

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148
Q

HRT with intact uterus in premature menopause?

A

E+P - till natural menopause
(increases risk of breast Ca)

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149
Q

HRT with post hysterectomy in premature menopause?

A

only E
(Increases risk of Endometrial ca)

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150
Q

Contraindications of HRT?

A

Breast or endometrial cancer, active liver disease, active thrombosis

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151
Q

DOC for postmenopausal osteoporosis?

A

Bidphosphonates, Ca and vitamin D

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152
Q

Premature ovarian failure + infertility DOC

A

Donor ovum + IVF

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153
Q

MC cause of male infertility?

A

Primary hypogonadism (abnormal spermatogenesis)

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154
Q

Sperm volume, pH, concentration, sperm number?

A

Volume 1.5 ml
pH 7.2
Concentration 16 million per ml (total 39 million)
Sperm number 39 million

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155
Q

Total motility and progressive motility?

A

Motility 40%
Progressive motility 30%

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156
Q

Most important criteria for natural conception?

A

Sperm morphology >4%
Less means asthenozoospermia (kartagener syndrome)

157
Q

Test to differentiate between obstructive and non obstructive azoospermia?

A

LH, FSH (most imp), Testosterone

158
Q

Example of obstructive azoospermia?

A

Cystic fibrosis
(All hormones normal)

159
Q

Non obstructive azoospermia example?

A

Klinefelter syndrome
(LH, FSH high, Testosterone low)

160
Q

Rx mild oligospermia? (Count Less than 15 million)

A

Intra uterine insemination

161
Q

Rx if sperm count Less then 10 million?

162
Q

If sperm count less than 5 million rx?

163
Q

Period of spermatogenesis and sperm fertilizable life span?

A

Spermatogenesis - 72 days
Sperm fertilizable life span - 72 hours

164
Q

What enzyme is secreted in acrosomal rxn?

A

Hyaluronidase

165
Q

What comes before acrosomal reacion?

A

Capacitation - Binding to ZP - Acrosomal reaction - Zona reaction
(Zona reaction prevents polyspermy)

166
Q

Fertilizable life span of ovum?

167
Q

When is serum progesterone test for ovulation done?

A

D21 or 1 week before expected menses

168
Q

Best test for ovarian reserch?

A

AMH
(MC FSH)

169
Q

IOC for tubal patency?

170
Q

Gold standard for tubal evaluation?

A

Lap chromopertubation

171
Q

HSG shows bilateral block next step is?

A

Lapchromo + hystero-cannulation and best is IVF

172
Q

HSG shows bilateral block with hydrosalpinx IOC?

A

IVF and salpingectomy for better outcome

173
Q

GT mode of spread?

A

Hematogenous
or to uterus direct mode

174
Q

MC site is of GT?

A

GT > ampulla > isthmus

175
Q

Inital symptom of GT?

A

Infertility > Pain > Menstrual abnormality

176
Q

Diagnosis of GT?

A

Endometrial biopsy for ASB
D1 Menstrual blood for PCR analysis

177
Q

Bilateral cornual block is finding of?

178
Q

Tobacco pouch appearance and beads string, lead pipe, golf club appearance of ovary is seen in?

179
Q

Fibroid uterus MC type & presentation?

A

Intramural
Asymptomatic

180
Q

If Fibroid uterus is symptomatic MC presentation?

A

Menorrhagia = HMB

181
Q

Which fibroid is associated with infertility and recurrent pregnancy loss?

A

Submucosal

182
Q

Tx Submucosal fibroid?

A

Hysteroscopic myomectomy

183
Q

Type 0 fibroid is?

A

Pedunculated submucosal

184
Q

Type 1 fibroid is?

A

> 50% is inside canty

185
Q

Type 7 fibroid is?

A

Pedunculated subserous

186
Q

Red degeneration is seen in and presentation?
Rx?

A

In pregnancy 2nd trimester
Acute abdomen (history of fibroid)
Fever + raised TLC
Conservative management

187
Q

Uterus characteristics in fibroid?

A

Enlarged
Non-tender
Irregular
Firm
can be as big as 20 weeks pregnant woman size

188
Q

IOC fibroid?

189
Q

If Fibroid uterus is asymptomatic Rx?

A

No treatment or expectant management

190
Q

If Submucosal uterus is symptomatic or asymptomatic with infertility Rx?

A

Hysteroscopic myomectomy

191
Q

Intramural fibroids that cause bilateral cornual block + infertility rx?

A

Lap-myomectomy

192
Q

Intramural fibroids with HMB DOC?

193
Q

Drugs that do not reduce size of fibroid but reduce bleeding?

A

OCPs
Tranexa
Mirena

194
Q

Drugs that reduce size of fibroid but reduce bleeding?

A

GnRH agonist/antagonist
Ulipristal - SPRM

195
Q

Adenomyosis symptoms and age group?

A

HMB + dysmenorrhea (progressive gets worse with age)
>40

196
Q

Endometriosis age group?

A

Younger age 20-30

197
Q

Uterus with adenomyosis is?

A

Enlarged symmetrical
Globular uterus (soft and tender)
Grows only upto 10-12 weeks size

198
Q

Adenomyosis IOC?

A

TVS
MRI - junctional zone thickness
Confirmation diagnosis done with HPE

199
Q

USG finding in Adenomyosis?

A

Venetian blind bands - alt dark and white pattern on USG
Heterogenous myometrium
Salt and pepper myometrium
Poorly defined junctional zone

200
Q

TOC Adenomyosis

A

Hysterectomy

201
Q

Endometrial polyp seen in age group?

A

Peri and post-menopausal
Tamoxifen risk factor

202
Q

Symptom and USG finding of endometrial polyp?

A

Irregular bleeding Metrorrhagia
Smooth growth

203
Q

IOC Endometrial polyp?

A

TVS
Doppler - feeder cavity vessel sign

204
Q

TOC Endometrial polyp?

A

Hysteroscopy polypectomy

205
Q

MC symptom of Endometriosis?

A

Pain, dysmenorrhea secondary

206
Q

MC site of Endometriosis?

A

Ovary > Post leaf of broad ligament > pouch of Douglas

207
Q

Cause of primary dysmenorrhea?

A

Progesterone Withdrawal PGF2 alfa
Mittelschmerz pain - mid cycle pain

208
Q

MC theory of Endometriosis?

209
Q

IOC of Endometriosis?

A

Laparoscopy
BUT TVS first always

210
Q

IOC of chocolate cyst/endometrioma (adnexal mass)?

211
Q

TOC for mild-moderate pain in Endometriosis?

A

OCPs + NSAIDsT

212
Q

TOC for severe pain in Endometriosis?

A

GnRH agonist continuous

213
Q

TOC for infertility due to mild Endometriosis?

A

CC + IUI for 3 cycles

214
Q

TOC for infertility due to severe Endometriosis?

215
Q

Sx done in Endometriosis?

A

Cystectomy

216
Q

Both ovaries enlarged/kissing ovaries/bowel loops stuck TOC?

217
Q

Drugs that can’t be given in Endometriosis?

A

Estrogen
Endometriosis is an estrogen dependent disorder

218
Q

IOC Mullerian anomalies?

A

3D USG
Best: Lapro + hysteroscopy
Screening: regular USG/HSG

219
Q

Gold std IOC for Mullerian anomalies?

220
Q

Shape of external shape of Uterus in septate uterus?

A

Normal
No dip in fundus

221
Q

MC anomaly in septate uterus?

A

No dip in fundus

222
Q

Acute angle between two Uterus angles means?

A

Septate Uterus

223
Q

Septate uterus causes?

A

Recurrent pregnancy loss

224
Q

TOC septate uterus?

A

Hysteroscopy or Transcervical/resection/meteroplasty

225
Q

What we don’t do in septate uterus?

A

Strassman’s metroplasty

226
Q

Which uterine disorder has worst reproductive outcome?

A

Septate uterus

227
Q

Bicornuate uterus is caused due to?

A

Partial fusion

228
Q

Bicornuate uterus external contour?

A

Dip - deep

229
Q

Obtuse angle between 2 horns of uterus is found in?

A

Bicornuate uterus

230
Q

Unicornuate uterus is associated with?

A

Ectopic ovary/pregnancy
Has high risk of UT anomalies

231
Q

DES (Di-Delphius) causes?

A

T-shaped uterus
Clear cell adeno-ca
Hypospadias in male baby

232
Q

Sx done for Bicornuate uterus and DES?

A

Strassman’s metroplasty

233
Q

Cause of Bicornuate uterus and DES?

A

Partial fusion - Bicornuate
Complete failure of fusion - DES

234
Q

Two cervices found in which condition?

235
Q

Banana shaped deviated uterus is?

A

Uni-cornuate Uterus

236
Q

All mullerian anomalies are associated with?

A

Increased risk of endometriosis
Retrograde menses
UT anomalies

237
Q

Transverse lie is not possible in?

A

DES and uni-cornuate uterus

238
Q

DES has highest association with?

A

Vaginal septum

239
Q

MC HPV type associated with premalignant and cancerous lesions of cervix?

240
Q

MC HPV type associated with condyloma accminata?

A

HPV 6, 11
Also cause laryngeal papillomatosis

241
Q

Which HPV viral protein causes malignant transformation

242
Q

MC site for cancerous dysplasia is?

A

Transitional zone > SCJ > Ectocervix

243
Q

Cervical Ca vaccine names?

A

Gardasil- 9 (American)
Cervavac = Quadrivalent

243
Q

Cervical Ca vaccine made from which protein and its against which HPV types?

A

L1 capsid protein
6, 11, 16, 18

243
Q

Dose schedule for Cervical Ca vaccine Gardasil according to SAGE WHO?

A

<21 yo 1/2 doses
>21 yo 2 doses
Still do screening after vaccine

243
Q

Gardasil- 9 is against which HPV types?

A

16, 18, 6, 11, 31, 33, 45, 52, 58

244
Q

Side effects of Cervical Ca vaccine?

A

Syncopal attack

244
Q

HPV 16+18 %age ca?

244
Q

Dose schedule for Cervical Ca vaccine Cervavac?

A

<15 yo 2 doses (0, 6 m)
>15 yo 3 doses (0, 2, 6 m)
Still do screening after vaccine

244
Q

Cervical Ca Vaccine not given in?

245
Q

Best screening test for premalignant lesions is?

A

HPV > VIA > PAPS

246
Q

WHO Recommendation of cervical cancer for resource limited countries?

A

Start screening at: 30
Stop screening at: 50
Protocol: screen (screen triage) and treat
Interval HPV testing: 5 yearly (10 yearly)
Interval for VIA and PAPS: 3 yearly
TOC: LEEP

247
Q

MC symptom of Ca cervix?
Most specific symptom of Ca cervix?

A

Irregular bleeding
Post-coital bleeding

248
Q

MC age group of Ca cervix?

A

3-4th decade

249
Q

MC type of Ca cervix?

A

SCC > Adeno Ca

250
Q

MC site of Ca cervix?

A

Transformation Zone

251
Q

MC mode of spread?

252
Q

MC cause of death in Ca cervix?

A

Uremia (renal failure)

253
Q

Staging for Cervical Ca?

254
Q

IOC Cervical Ca?

A

MRI: parametrial spread
CTPET: LN
Bladder: cystoscopy

255
Q

Cervical Ca hydronephrosis in which stage?

256
Q

1B3 Cervical Ca stage is?

257
Q

2B Parametrium Cervical Ca stage is?

A

Parametrium spread

258
Q

3B stage Cervical Ca is?

A

Hydronephrosis/lat. pelvic wall

259
Q

4B stage Cervical Ca is?

A

Distant spread

260
Q

3A stage Cervical Ca is?

A

Lower 1/3rd vagina spread

261
Q

3C stage Cervical Ca is?

262
Q

Stage 2 Cervical Ca?

A

Upper 2/3rd vagina

263
Q

TOC stage 1a1 Cervical Ca?

A

Conization (incomplete family)
Type 1 hysterectomy - simple hysterectomy (complete family)

264
Q

TOC 1b1 Cervical Ca

A

<10 mm type 1 hysterectomy
>10 mm type 2 hysterectomy (modified radical)

265
Q

TOC 1b2 Cervical Ca?

A

Type 3 hysterectomy

266
Q

TOC beyond 1b3 Cervical Ca?

A

Chemoradiation
DOC: Cisplatin

267
Q

MC cause of post-menopausal bleeding?

A

Atrophy > Polyp > hyperplasia/cancer

268
Q

Woman presents with postmenopausal bleeding, next step?

269
Q

If on USG Endometrial thickness is more than ______ then do _____.

A

4 mm, Endometrial biopsy (IOC)

270
Q

Endometrial biopsy cannula used?

A

Karman’s cannula - India
Pipelle outside India

271
Q

MC complaint in Endometrial Ca?

A

Irregular bleeding

272
Q

Drug associated with Endometrial Ca that increases risk?

273
Q

Which ovarian ca is high risk?

274
Q

Which syndrome is high risk for Endometrial Ca?

A

Lynch/PTEN/PCOS

275
Q

Gene associated with type 1 cancer?

A

PTEN - good prognosis

276
Q

Gene associated with type 2 cancer?

A

P53 - bad prognosis

277
Q

Which Endometrial Ca has worst prognosis?

A

Clear cell ca

278
Q

TOC for hyperplasia with atypia is?

A

Hysterectomy (+BSO if post-menopausal)

279
Q

TOC for hyperplasia without atypia is?

A

Mirena > MDA (medroxyprogesterone acetate)

280
Q

Staging for Endometrial Ca is?

A

Surgical - direct spread

281
Q

TOC Endometrial Ca

A

Sx - hysterectomy + BSO
+ adjuvant chemo if stage 3/4 (carboplatin + paclitaxel)

282
Q

MC type of simple cyst mass in ovary present in women of reproductive age? TOC?

A

Follicular cyst
Expectant - follow up USG 2-3 months

283
Q

IOC for ovarian mass?

284
Q

Pelvic mass in young girls MC type?

A

Germ Cell tumors
Mostly unilateral

285
Q

Features of malignant ovarian mass on USG?

A

Solid components
think septae
Increased vascularity in septae
>10cm
Papillary excrescences
Ascites
Enlarged LN

286
Q

Ca marker for Serous cyst adenocarcinoma?

A

CA125
MC type of Ca

287
Q

Most ovarian Ca arise from?

A

Epithelial tissue 90% - P53 mutation

288
Q

Ca marker for Dysgerminoma? (germ cell)

A

LDH (raised HCg also found but never AFP)

289
Q

Ca marker for Yolk sac tumor (endodermal sinus tumor)?

A

AFP (sometimes LDH but never HCG)

290
Q

Ca marker for Choriocarcinoma (germ cell)?

291
Q

Ca marker for Mucinous? (epithelial ov-ca)

A

CA19.9 or CEA

292
Q

Ca marker for Granulosa cell tumor? (sex cord ca)

A

Inhibin (secretes Estrogen)

293
Q

What’s found in Brenner’s tumor?

A

Wallthard cell nest - transitional epi
coffee bean nucleus

294
Q

What’s found in yolk sac tumor?

A

Schiller duval bodies

295
Q

What’s found in dysgerminoma tumor?

A

Septae = have lymphocytic infiltration

296
Q

What’s found in Dermoid tumor?

A

Mature teratoma = Rokitansky protruberance

297
Q

What’s found in Kruckenberg tumor?

A

Signet ring cells

298
Q

What’s found in Granulosa cell tumor?

A

Call exner bodies = coffee bean

299
Q

What’s type in Stroma and sex cord ovarian tumor?

A

Granulosa cell
Sertoli-leydig
thecoma
fibroma - benign tumor
meigs syndrome

300
Q

Meigs syndrome present in which tumors?

A

Granulosa cell
Fibroma (MC)
Thecoma
Brenner

301
Q

What’s type in Germ cell ovarian tumor?

A

Dysgerminoma - malignant
Dermoid (benign)
EST (YST)
Chorio Ca

302
Q

What’s type in Epithelial ovarian tumor?

A

Serous (MC)
Mucinous
Brenner’s
Endometroid
Clear cell

303
Q

Features in Epithelial ovarian tumor?

A

P53 mutation
Bilateral
MC
90%

304
Q

Staging of Epithelial ovarian tumor is done?
Percentage of ovarian ca which are familial?

A

Surgical
10% - seen in 5th decade

305
Q

Familial ovarian ca gene?

A

BRCA
If positive, next step prophylactic BSO

306
Q

TOC ovarian ca?

A

Sx - TAH + BSO followed by adjuvant chemo (6 cycles)
Carboplatin + paclitaxel

307
Q

Dermoid cyst features?

A

Benign
Germ cell
unilateral
TOC ovarian cystectomy

308
Q

MC ovarian tumor in reproductive age?

A

Dermoid cyst
MC tumor to undergo torsion during pregnancy 2nd trimester

309
Q

Dysgerminoma features?

A

Red/tan
Lobulated
solid
Unilateral (Bilateral in 20% cases)

310
Q

Call exner bodies features?

A

Rosette-like cells
Granulosa cell tumor - secretes estrogen

311
Q

MC ca among Indian women?

A

Breast > cervical

312
Q

In bacterial vaginosis Lactobacilli are MC replaced by?

A

Gardnerella vaginalis

313
Q

MC complaint of bacterial vaginosis?

A

Foul smelling discharge
NO burning/itching
Thin grey/off white discharge pH > 4.5
Whiff test - 10% KOH - fishy smell
No inflammation

314
Q

Test done for bacterial vaginosis?

A

Whiff test - 10% KOH - fishy smell
Clue cells on microscopy

315
Q

Amsel criteria is used for diagnosis of?

A

Bacterial vaginosis
pH > 4.5
Grey/off white
whiff test
clue cells
ANY 3 NEEDED

316
Q

Kit for bacterial vaginosis and Trichomonas vaginalis?

A

Kit 2 - green

317
Q

Trichomonas vaginalis features?

A

Foul smelling discharge - green/yellow - frothy
Pruritus, dyspareunia, urinary symptoms
Inflammation present
Strawberry cervix
pH >4.5
Kit 2 - green
it is an STD

318
Q

Candida vaginalis features?

A

Pruritic
curdy white - no smell
pH > 4.5
Kit 2 - green

319
Q

DOC Candida vaginalis?

A

Fluconazole

320
Q

No partner treatment needed in which vaginal infection?

A

BV > candida vaginalis

321
Q

DOC Bacterial vaginosis/trichomonas vaginalis?

A

Metronidazole - can be given in pregnancy
Clindamycin

322
Q

Name of physiological discharge from vagina?

A

Leukorrhea - increased watery discharge - no bad smell
no other symptoms
pH normal

323
Q

Define PID?

A

Upper genital tract (uterus, FT, ovaries or peritoneum also sometimes)
Young girls 15-25
Polymicrobial infection

324
Q

MC causative agent of PID?

A

Chlamydia > gonorrhea (STD)
If girl virgin suspect TB

325
Q

PID symptoms?

A

Lower abdominal pain
Cervical motion/adnexal/uterine tenderness

326
Q

If woman with PIC develops right upper quadrant pain, diagnosis is?

A

Fitz hugh Curtis (perihepatitis)
Violin string adhesions between ant abdominal wall and liver capsule
Agent: Chlamydia

327
Q

IOC PID?

A

Laparoscopy
first TVS

328
Q

Kit for PID?

A

Kit 6 - yellow

329
Q

If patient comes with vaginal discharge, first thing we do is?

A

PS exam
if we find: discharge from OS/erosion/ulcer then kit 1

330
Q

Long term complication of PID?

A

Infertility - Best ans
Ectopic
Chronic pain
Hydrosalpinx

331
Q

Clue cells border features?

A

Studded border with bacteria

331
Q

Muscle in pelvic diaphragm?

A

Levator ani - three parts puborectalis, pubococcygeus and iliococcygeus

332
Q

3 main supports for Uterus are?

A

Cardinal, uterosacral and pubocervical ligament

333
Q

Cystocele location and symptoms?
Sx?

A

Upper 2/3rd anterior vaginal wall
Urinary symptoms
Sx Anterior colporrhaphy

334
Q

Rectocele location and symptoms?
Sx?

A

Lower 2/3 posterior vaginal wall
Rectal symptoms
Sx Posterior colpoperineorrhaphy

335
Q

Sx for vault prolapse?

A

Abdominal approach: Sacrocolpopexy (better)
Transvaginal approach: Uterosacral suspension (MC)

336
Q

Sx for enterocele?

A

McCalls culdoplasty

337
Q

When we do Obliterative procedure?

A

When patient has comorbidities so smaller sx needed
Leforte’s colpoclesis

338
Q

Sx for prolapse in women in reproductive age?

A

Sling sx - Shirodkar abdominal sling
Manchester = Fothergills = CV elongation, done if Utero-Cervix Length > 12.5

339
Q

Tx decubitus ulcer?
Cause of decubitus ulcer?

A

AG packing (acridine glycine packing)
Venous congestion

340
Q

MC cause of urinary incontinence in young women?
Gold standard sx?
TOC?

A

SUI
Colpo-suspension (not for vault prolapse)
TOT/TVT

341
Q

MC cause of VVF in developing countries?

A

Obstructed labor
(developed post sx)

342
Q

VVF presents after?

A

7-10 days post sx

343
Q

Continuous leakage of urine + no normal voiding indicates?

A

VVF
(in uterovaginal fistula there is normal voiding)

344
Q

IOC VVF?

A

3 swabs test
wet + stained: VVF (methylene blue dye in bladder)
only wet: Ureterovaginal

345
Q

Sx preferred for VVF?

A

Latzko (vaginal)
after 3-6 m of obstructed labor
Bladder catheter should be left for 10-14 days
this is an indication to do classical CS delivery after pregnancy
if repair fails do it again in 3 months

346
Q

After VVF avoid intercourse for at least?

A

3 months (3-6 m)

347
Q

After VVF avoid pregnancy for at least?

348
Q

When is pessary given in prolapse?

A

Inoperable
Pregnant
Puerperium
2nd degree prolapse (not yet outside vagina)

349
Q

MOA of OCPs?

A

Inhibits ovulation
LH+FSH both

350
Q

Contraindications of OCPs?

A

Diabetes with vasculopathy
Known case of Breast ca
Migraine with aura
Active liver disease
HTN
Stroke - CAD - VTE
Hepatocellular adenoma
Smoker >35 yo
Breastfeeding

351
Q

OCPs are protective for?

A

Endometrial CA
Colon CA
Ovarian CA

352
Q

OCPs are risk factor for?

A

Breast CA
Cervical CA
Hepatocellular adenoma

353
Q

Benefits of OCPs?

A

Irregular cycles
HMB
Dysmenorrhea/endometriosis
PCOS
Ovarian cyst
Hyperandrogenism - hirsutism
HRT in primary hypogonadism
Reduction of ovarian cyst + endometrial cyst

354
Q

DOC PMS?

355
Q

Minipill is a?

A

Progesterone only pill
Taken daily - 28 days at same time
28 hormonal pills

356
Q

Side effects of Progesterone only pills?

A

causes Irregular bleeding
Increases ovarian cyst
Increases acne

357
Q

MOA Progesterone only pills?

A

Alteration of cervical mucous

358
Q

Progesterone only pills are DOC for?

359
Q

What generation IUD is cooper-T?

A

2nd gen for 10 years

360
Q

What generation IUD is mirena/kyleena?

A

3rd gen for 8 years

360
Q

IUD cooper load is viable for?

360
Q

MOA IUD?

A

Inhibition of fertilization > Implantation

360
Q

Contraindications of IUD?

A

Undiagnosed abnormal uterine bleeding
Current pelvic infection
Distorted uterine cavity - even in fibroids
suspected pregnancy
Wilson’s disease for cooper-T
Breast CA for mirena

361
Q

Tubal ligation is done at which part of FT?

A

Isthmus
Effective immediately

362
Q

Name of surgery where we do Fimbriectomy?

A

Kroner’s technique

363
Q

Name of surgery where Crushing is also done?

364
Q

Best tubal ligation sx we do nowadays?

A

Modified Pomeroy - plain catgut is used

365
Q

Method used for Vasectomy?
Failure rate?

366
Q

MC side effect of Vasectomy

367
Q

Reversal rate of Vasectomy?

368
Q

LH surge is due to?

369
Q

PIPPELE is used for?

A

Endometrial biopsy

370
Q

Smoking is protective for?

A

Pre-eclampsia
Endometrial ca

371
Q

Biopsy should be done in which phase?

A

Premenstrual/pre-luteal/secretory

372
Q

Progesterone of choice for emergency contraception?

A

LNG tab MC used, up to 72 hours post coitus
1.5 mg single dose
(0.75 twice with 12 hours apart)

373
Q

Agent for CIN3/Cancer cervix is?

374
Q

Most effective emergency contraception?

A

Copper IUD - up to 120 hours/5 days or on 5th day
Ulipristal - most effective hormonal 30 mg single dose - up to 5 days

375
Q

MOA emergency contraception?

A

Delaying ovulation + preventing fertilization

376
Q

Yuzpe method of emergency contraception?

A

OCPs 100 mg EE + 0.5 mg LNG
Repeated after 12 hours

377
Q

Plan B for emergency contraception?

378
Q

Temoxifen used for treatment of?
And it increases risk of?

A

Breast cancer
Increases risk of endometrial cancer

379
Q

Ritodrine is used for?
Complications?

A

Prevent premature labor
Causes tachycardia, hypoglycemia, tremors

Gynecology (2 decks)

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