Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gynae obs And Male Reproductive > Gynae > Flashcards

Gynae Flashcards

1
Q

Name the Disorders of Sexual development

A

Complete AIS
Mullerian a-genesis

Transverse Vaginal Septum
Turner syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the Disorders of Sexual development in which breast developed and presence of pubic/axillary hair

A

Breast developed in all except TURNER syndrome

Pubic /Axillary hair in all except Complete AIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to approach Primary Amenorrhea?

A

Start with checking uterus On Pelvic U/S

-If present——>check FSH—>if increased do karyotype Or it decreased—>MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to approach primary Amenorrhea with absence of uterus on Pelvic U/S?

A

Check Karyotype and Serum testosterone

  • If XY and normal serum level—-> AIS
  • If XX—->Mullerian agensis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Important Point of Primary Amenorrhea

A
  • Isolated amenorrhea with well-developed 2* sexual characters may be considered normal up to age 16 yrs
  • Amenorrhea without proper development of 2* sexual characters—work-up should not be delayed beyond age 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Triad of AIS

Management is —->(1) Gender identity and assignment counselling

(2) patient has undescended test for which Removal of GONADs to prevent malignancy

A

Un descended testis with absence of penis/scrotum

No axillary and pubic hair but breast formation

Increase Testosterone and LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why breast developed in AIS?

A

Due to testosterone aromatisation into oestrogen result breast developmental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Triad of 5-α REDUCTASE DEFICIENCY

A

Ambiguous genitalia in Male at birth

No abnormality in internal genitalia

No breast development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does AROMATASE DEFICIENCY present?

A

virilization In both transient mother and baby with normal internal genitalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does LICHEN PLANUS present?

A

glazed, brightly erythematous lesions on the vulva with erosive (eg, ulcerated) areas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does LICHEN SCLEROSIS present on examination?

A

WHITE vulvar plaque with loss of labia minora

Vulvar dryness with intense pruritus

Perianal figure of 8 involvement
No involvement of VAGINA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to dx LICHEN SCLEROSIS?

A

DX::: Clinical but “punch biopsy” of lesion for definitive dx and to rule out malignancy.

It is premalignant for vulvar squamous cell CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to manage LICHEN SCLEROSIS?

A

high potency topical steroids e.g. clobetasol

vulvoperineoplasty (not vulvectomy) If refractory to medication OR developed severe adhesions/scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does ATROPHIC VAGINITIS present on examination?

A

Painful Sex due to decrease Vaginal diameter

Loss of Vaginal elasticity/Rugae
Thin vulvar skin with loss of minora

Vulvovgainal dryness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to manage ATROPHIC VAGINITIS(also called GU syndrome of menopause)?

A

Vaginal Moisturiser and lubricant as first line

Low dose vaginal ESTROGEN as 2nd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does CONDYLOMATA LATA present on examination?

A

Due to 2*Syphilis
Broader base with flatter surface
lobulated or plaque like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does CONDYLOMATA ACUMINATA present on examination?

A

Multiple pink Or skin coloured lesion

Exophytic / cauliflower like growth Or smooth flattened papule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to prevent CONDYLOMATA ACUMINATA ?

A

Prevention—>Vaccination / Barrier contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to t/m CONDYLOMATA ACUMINATA?

A

Chemical—>Podophyllin resin /Trichloroacetic acid (for smaller lesion)

Immunologic—>Imiquimod

Surgical—>Cryotherapy/ laser therapy/ Excision (for larger lesion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does VULVAR INTRAEPITHELIAL NEOPLASIA present on examination? (DUE TO HPV)

A

White or erythematous plaques

hyperpigmented lesions or multifocal verruciform lesions

not atrophic changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the risk factors for Vulvar cancer

A

Follows HPV infection (e.g. VIN)
OR
vulvar dystrophies (e.g. lichen sclerosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does VULVAR cancer present?

A

Typically singular, fleshy lesion on labia majora that may bleed

More common in postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Difference B/W SCC AND Clear Cell adenocarcinoma

A

SCC::
occur above 60 yrs at upper 1/3rd of posterior vaginal wall

Adenocarcinoma
Occur below 20 years at Upper 1/3rd of A nterior vaginal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors of Vaginal Cancer

A

SCC:::
HPV 16/18
Hx of cervical dysplasia or cancer
Cigarette

Adenocarcinoma:::
DES exposure in utero life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How Vaginal Cancer present?

A

Malodorous discharge

Irregular mass with plaque OR ulcer on vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the risk factors of VESICOVAGINAL FISTULA?

A

Pelvic surgery / Radiation

GU malignancy

Prolong labour / Childhood trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How to dx VESICOVAGINAL FISTULA?

A

Dye tests
cystourethroscopy
(S’times small area of granulation tissue OR hole may be seen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How vesicovaginal fistula present?

A

continuous clear vaginal leakage

dx through bladder dye testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Triad of Vaginismus / GENITO-PELVIC PAIN/PENETRATION DISORDER

A

Painful sex and pain occur with any vaginl penetration

Occur due to pelvic muscle contraction

Pain is unrelated to menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How to manage VAGINISMUS/GENITO-PELVIC PAIN/PENETRATION DISORDER?

A 
Treatment includes relaxation
Kegel exercises (to relax the vaginal  muscles)

And insertion of dilators with a gradual ↑ in size, fingers, etc. to bring about desensitization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the function of HUMAN PLACENTAL LACTOGEN?

A

insulin antagonist effect

plays an important role in nutrition of the fetus by causing maternal lipolysis and insulin resistance thus increasing delivery of fatty acids and glucose to the fetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Define INFERTILITY?

A

Primary infertility:
failure to conceive after a year of unprotected, timed sexual intercourse in nulliparous woman <35 years.

In >35 years, infertility investigation can begin after 6 mo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Test to dx infertility due to PID

A

hysterosalpingogram

laparoscopy with chromotubation to check patency of Fallopian tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Triad of PRE-MENSTRUAL SYNDROME OR PRE-MENSTRUAL DYSPHORIC DISORDER

A

Sx begin 1-2wks prior to menses and regress around the time of menstrual flow.

Sx are then absent until after next ovulation

SSRI such as fluoxetine is the first line treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the causes of Dysmenorrhea?

F-PEAD

A

F fibroids

P primary dysmenorrhea / Pelvic Infection

Endometriosis

ADenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Triad of primary dysmenorrhea

A

Occur due to Prostaglandins release from endometrium causing contractions

Normal examination findings

NSAIDs OR COCP as a first line agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Triad of Pelvic congestion syndrome

A

pelvic pain occur prior to menses

Decrease by end of menses

increase with intercourse OR during long periods of standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the causes of ACUTE ABDOMINAL/PELVIC PAIN IN WOMEN?

PROME night

A 
P PID
R ruptured ovarian cyst 
O ovarian torsion
M Mittelschmerz 
Ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does rupture Ovarian cyst present?

A

Sudden onset U/L abdominal pain with N/V

Occur following strenuous or sex

U/S shows free fluid near ovarian cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How to manage rupture Ovarian cyst?

A

Uncomplicated cyst rupture:: conservative

-Complicated cyst rupture: Unstable pt or significant hemoperitoneum—>SURGERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why Mittelschmerz pain Occur?

A

Due to enlargement of developing follicle which irritates peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How to approach ECTOPIC pregnancy?

A

Check Hemodynamic stability

If unstable—>stat surgery

If stable—>do TV U/S—>shows adnexal mass—>treat Ectopic pregnancy OR intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

IF TV U/S is non dx in suspect case of Ectopic pregnancy?

A

Check B-HCG—>If less than 1500–> re check in 2 days

-If more than 1500 recheck and do TV U/S in 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the risk factors for OVARIAN TORSION?

A

Ovarian mass

Reproductive age female

Infertility t/m with ovulation induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Triad of OVARIAN TORSION

A

Severe sudden U/L pelvic pain

with or without signs of peritonitis

Adnexal mass with absent Doppler flow to ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How to manage OVARIAN TORSION?

A

Laparoscopy with de torsion

Ovarian cystectomy

Oophorectomy if necrosis OR malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Lab findings of PCOS

A

Increase oestrogen and testosterone

Increase LH/FSH ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Triad of Functional Hypothalamic Amenorrhea

A

SxS of oestrogen deficiency

1st line treatment: cut down stressor and exercise intensity

if fails—>pulsatile GnRH considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Important Point

A

ANOVULATION IN 1ST YEAR OF MENARCHE normal to have as immature HPO axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Triad of ANOVULATION SECONDARY TO MORBID OBESITY

A

Normal FSH and LH level

Ovaries produce oestrogen

No progesterone at normal post ovulation so no menses after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the risk factors OR causes of Premature Ovarian failure?

A

chemotherapy / radiation,
mumps/ oophoritis

autoimmune ovarian failure (associated with autoimmune conditions like DM1 Hashimoto’s thyroiditis, Addison’s disease and pernicious anemia),

Turner’s syndrome /fragile X syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Important Point Premature Ovarian failure

A

Markedly increase FSH in menopausal range (defined by lab assay) in a woman under 40 with >/=3 mo of amenorrhea confirm diagnosis of premature ovarian failure—

no need to wait for 1 year to make dx to prevent osteoporosis at young age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Define AUB

A

Menstrual bleeding that is prolonged (>5 days) and heavy (>1 pad every 2 hours) with an irregular frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

T/m of Acute AUB

A

High dose Oral OR IV oestrogen
High dose COCP

High dose progestin pills
Tranexamic acid

Emergency dilation and curettage may be needed if medical treatment fail after 24-36 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the causes of AUB?

A

If post menopausal—> endometrial Ca or hyperplasia—>do TV U/S or bc

If pre menopausal—>Fibroids / ADenomyosis/ endometrial Ca or hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Physical Examination findings of ENDOMETRIOSIS

A

Immobile uterus with normal size non tender

Cervical motion tenderness with adnexal mass

Uterosacral ligament nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

US finding of Endometriosis

A

Unilocular hypoechoic adnexal mass

low level echoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How to manage ENDOMETRIOSIS?

A

Medical—>NASIDS with or without COCP

Surgery—>if medical CI then laparoscopy or removal of uterus if family completed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How to dx and manage fibroids?

A

SxS signs depends on position
Dx-> U/S

T/m—> if Asymptomatic do nothing
If symptomatic—>COCP or myomectomy, uterine artery embolization /hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Important Point of ADenomysis

A

Typically in multiparous women > 40 years

-Repeat endometrial biopsy after 3 mo to assess response to rx (IN ENDOMETRIAL HYPERPLASIA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How to Approach AUB due to ENDOMETRIAL HYPERPLASIA?

A

Take bx

-If shows—>hyperplasia without atypia—->progestin therapy

-if shows—> hyperplasia with atypia—->progestin therapy if desire of pregnancy
OR no desire/fail medical t/m—-> remove uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the indications of HPV vaccine?

A

Not indicated in pregnant female
Women age 9-26 years

Immunocompromised patient age 9-26 years
Boy age 9-21 years (upto 26 years men who are homosexual)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Cervical Cancer screen approach

A

Start at age 21

-Cytology every 3yrs age —>21-29 and 30-65years

Cytology + HPV testing every 5 years—>30-65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Cervical Cancer screening in Immunocompromised

A

Onset of sexual intercourse

Every 6 months * 2 then annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the result of PAP smear?

Cytology= PAP smear

A

atypical squamous cells
low grade squamous intraepithelial lesion LGSIL)

high grade squamous intraepithelial lesion (HGSIL)
overtly malignant cells (squamous cell CA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How to MANAGED ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE OR

LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION IN WOMEN 21-24 YEARS?

A

Repeat PAP smear at 12 months

Shows—->If ASC-H OR AGC OR HSIL——> colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How to MANAGED ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE OR
LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION IN WOMEN 21-24 YEARS?
PART 2

A

Repeat PAP smear at 12 months
If shows—->negative OR ASC-US OR LSIL

-Repeat Pap smear again at 12 months—>if shows—->ASC—->do colposcopy
If negative PAP smear negative—-> routine screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How to MANAGE ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE OR
LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION IN WOMEN >25 YEARS (Pap smear showed)

A

ASC-US—>HPV testing—> if positive—->do colposcopy

If negative—-> repeat PAP smear and HPV testing in 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How to MANAGED HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL)?

A

If age 21-24 years—->do colposcopy

  • if shows CIN 2/3 or NO CIN 2/3 age above 25—->manage per guidelines
  • if shows no CIN 2/3 age 21-24—>repeat colposcopy and cytology 2times up-to 2 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How to MANAGED HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL)?

A

If age more than 25 years ——> LEEP OR Cryotherapy

But not in postmenopausal and pregnant patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What to do if the colposcopy result is unsatisfactory Or un-visualise T-junction?

A

Do endocervical curettage

but not done in pregnancy as risk of miscarraige and preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the pap smear results which need endometrial evaluation?
VERY HY HY

A

Atypical glandular cells favor neoplastic-»> in all females

Atypical glandular cells-»> at age 35 years OR at risk for endometrial hyperplasia OR postmen female

Benign appearing endometrial cells-»> if premen female with AUB or risk for endometrial hyperplaisa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How to approach CIN3?

A

if no pregnancy-»> LEEP or conization or cryoablation

follow up with PAP smear and HPV co-testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the indication of the cervical conization?

A

CIN 2 OR 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the complications of cervical conization?

A

Cervical stenosis
Preterm birth or PPROM

2nd trimester pregnancy loss
Cervical incompetence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

How to approach non invasive cervical cancer?

A

if negative surgical margins-»> f/u with PAP smear and HPV co-testing

if positive surgical margins-»> repeat Conization if pregnancy desire OR remove uterus if no pregnancy desire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the factors which decreases the ovarian cancer?

A

BSO
Breastfeeding

Oral COCP use
Tubal ligation

Age less than 30 at first live birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

U/S findings of EPITHELIAL OVARIAN CANCER

A

Solid mass
Thick septations
Ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Physical examination findings of Ovarian cancer

A

may present with firm, non-mobile pelvic mass with nodularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Important point of ovarian cancer

A

Image guided biopsy is CONTRAINDICATED—>can cause spread of cancerous cells to entire abdominal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How to evaluate adnexal Mass in post menopausal patients?

A

If ovarian mass on U/S—->check CA-125
-if elevates—->CT/MRI check mets

-if no elevated——>check malignant features—>if present—> CT/MRI check mets otherwise serial US and CA-125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Define Epithelial ovarian Cancer

A

Epithelial ovarian cancer:
refers to malignancy involving ovary, fallopian tube and peritoneum epithelium.

Abnormality can begin at any of these sites—>presents with hallmark large ovarian mass, and widespread pelvic and abdominal mets regardless of primary origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How to manage Ovarian cancer?

A

Exp-laparotomy

After —>Chemotherapy with platinum based agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

US finding of serous ovarian Ca

A

complex mass with solid component

No calcification

hyperechoic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Emergency contraception in terms of efficacy

A

COPPER IUD»>Ulipristal pill»» LEVONORGESTREL pill»»OCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

MOA of Ulipristal

A

Antiprogestin—> delay ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Important point of COPPER IUD

A

MOST EFFECTIVE emergency and long-term contraception

Used in breast cancer patient as copper is hormone free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the benefits of ORAL CONTRACEPTIVE PILLS (OCPS)?

A

Prevention of pregnancy/ ovarian and endometrial cancer

Reduce benign breast diseases

Menstrual regulation with reduction in iron deficiency anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the CI of Oral COCP?

A

Migraine with aura
Past hx of Stroke / IHD / venous thromboembolism
Chain smoker and age above 35

Cancer Of Breast / liver
Cirrhosis
Major surgery with protracted immobilisation

Less than 3wk postpartum

90
Q

What Contraception can be used in lactating mothers?

A

Sterilization OR Barrier method

Intra-uterine devices

Progestin only pills

91
Q

Important Point of contraception in lactating mothers

A

Combined OCPS: ↓ milk production and pass in milk—effect on infant unknown

92
Q

What are the adverse effects of SELECTIVE ESTROGEN RECEPTOR MODULATOR?

A

Hot flashes

Venous thromboembolism

Ca or hyperplasia if tamoxifen use

93
Q

Important point Tamoxifen

A

Post-menopausal: 2nd line—prescribed to those who cannot use aromatase inhibitors.

94
Q

What SIDE EFFECTS OF DIETHYLSTILLBESTROL if USE IN PREGNANCY?

A

Clear cell adenocarcinoma of the vagina and cervix

Ectopic pregnancy and pre term delivery
Infertility
Structural abnormalities of female reproductive tract

95
Q

What complications occur in Male if DES is used?

A

Complications in boys exposed to DES in utero:
cryptorchidism,
microphallus,

hypospadias,
and testicular hypoplasia

96
Q

How to approach NIPPLE DISCHARGE?

A

If U/L—>patho—>U/S or Mammography if above 30yrs

or

If bloody Or serous discharge—-> patho—>U/S or Mammography if above 30yrs

97
Q

How to approach Milk non bloody nipple discharge?

A

Check palpable lump OR skin changes——>if yes—-> patho—>U/S or Mammography if above 30yrs

If NO—->physiologic discharge

98
Q

Important Point of physiologic Galactorrhea

A

Typically milky or clear but can be yellow, brown, gray or green

99
Q

What are the causes of PHYSIOLOGIC GALACTORRHEA?

HP MC

A

H hyperprolactinemia / Hypothyroidism
P Pit-prolactinoma / Pregnancy

M med
C Chest wall/nipple stimulation

100
Q

How to approach PALPABLE BREAST MASS in age above 30 years?

A

Start with mammogram/US—->if malignant features—->Core biopsy

101
Q

How to approach PALPABLE BREAST MASS in age less than 30 years?

A

Start with U/S first/mammogram
-If simple cyst—> needle aspiration

-If complex cyst/mass (solid mass)—-> image guided core biopsy

102
Q

US findings of SIMPLE BREAST CYST

A

USG: shows acoustic enhancement (indicative of fluid)

and no echogenic debris or solid components

103
Q

What type of biopsy use in breast masses?

A

Core biopsy if solid / acellular (stromal)

Excisional bx if large Or suspicious mass

FNA if suspected cystic or small mass

104
Q

What are the d/f BENIGN BREAST DISEASES ?

3F B

A

Breast cyst
Fibrocystic changes
Fibroadenoma
Fat necrosis

105
Q

Name the benign breast diseases which shows U/L single mobile well circumscribed mass

A
  • Fibroadenoma if tenderness prior to menses

- Breast cyst-> could be tenderness

106
Q

Describe Fibrocystic changes on Ex Ian bases

A

Nodulocystic masses
Multiple and diffuse
With tenderness prior to menses

107
Q

Triad of Fibroadenoma

A

Seen in less than 30 yrs of age
U/L single mobile well

circumscribed mass
Painful prior to menses

108
Q

How to manage fibroadenoma?

A

How to manage fibroadenoma?
Re-examine in next cycle—size decreases in adolescents—>observations and reassurance

U/S if persistent mass Or seen in old age

109
Q

Triad of Fat necrosis

A

Seen post trauma / surgery

Fixed irregular mass

110
Q

Mammography / US and Bx findings of Fat necrosis

A

Mammography —>calcifications
US—-> hyperechoic mass

Biopsy—> fat globules and foamy histiocytes

111
Q

Breast biopsy shows fat globules and foamy histiocytes in which condition?

A

Fat necrosis

112
Q

What are the risk factors for breast cancer?

A

Modifiable:::
Nulliparity / HRT
Alcoholic / Increase age at first birth

-Non modifiable:::
Cancer in 1st degree relative / white race
Increase age / Early menarche Or late menopause

113
Q

Important point of breast cancer t/m

A

Echo before proceeding for Trastuzumab

114
Q

Triad of Inflammatory breast cancer

A

Itching and palpable mass with nipple changed
edematous cutaneous thickening

peau d’orange appearance

115
Q

How to manage OCP induced HTN?

A

Discontinued the meds—->still persist—->diet and exercise—->still on —>low dose thiazides

116
Q

MOA of OCP induced HTN

A

estrogen mediated increase in hepatic angiotensinogen synthesis or other effects on renin-angiotensin system

117
Q

How theca lutein cyst present?

A

B/L multilocular cyst in ovaries

118
Q

U/S FINDING OF TUBO OVARIAN ABSCESS

A

multiloculated cystic adnexal mass

119
Q

How urethral diverticulum present?

A

Due to outpouching which collect urine
Palpable tender mass on the anterior vaginal wall
Associated with purulent discharge

120
Q

Risk factor of the Pelvic organ prolapse

A

Obesity
Removal of uterus

Multiparity
Postmenopausal age

121
Q

How bartholin abscess present?

A

Abscess located at the b/l posterior vulvar vestibule

At the base of labia majora (4’ and 8’ clock)

122
Q

How to manage bartholin duct cyst / abscess?

A

if symptomatic-» I and D followed by word catheter placement
otherwise no treatment if asymptomatic

123
Q

How skene gland cyst present?

A

located at lateral to urethral meatus

124
Q

How urethral prolapse present?

A

Inflamed friable tissue

Donut shaped at the urethral meatus

125
Q

Triad of Ovarian Hyperthecosis

A

virilization seen in postmenopausal female

sign of insulin resistance

Normal or decrease LH and FSH

126
Q

U/S presentation of Ovarian

A

Hyperthecosis

Solid appearing enlarged ovaries

127
Q

What is the in hospital treatment of PID?

A

1) IV Cefotetan OR Cefoxitin with docxi
or
2) IV Clindamycin with gentamicin

128
Q

Important point

A

Evaluate renal tract if patient has mullerian agenesis

129
Q

How to dx turner syndrome?

A

Start with karyotype—-»if negative but high suspicion—»FISH

130
Q

How vulvodynia (vestibulodynia) is present?

A

Painful sex due to sharp burning

pain on the vulvlar vestibule

Triggered by touch
Show redness in vestibule

131
Q

Name the test done in vulvodynia?

A

Q tip test

132
Q

US finding of Mature cystic teratoma

A

Partially calcified

Thin echogenic band

133
Q

US finding of endometrioma

A

Homogeneous cystic mass with no solid component

134
Q

US finding of serous ovarian Ca

complex mass with solid component

A

No calcification

hyperechoic

135
Q

US doppler finding of ovarian hyperstimulation syndrome

A

B/L enlarged ovaries with increased vascular permeability

136
Q

US finding of complex cystic breast mass

A

echogenic debri
thick septa
solid component

137
Q

How Recurrent cystitis is present in females?

A

More than 2 infections in 6 months OR more than 3 infections in year

138
Q

Risk factors of Recurrent cystitis

Sex active postmenpausal?

A

First UTI <15 years

spermicide use

139
Q

How to manage Recurrent cystitis?

A

Take prophylactic ABx after coitus

140
Q

Triad of Vaginismus

A

Painful sex and pain occur with any vaginal penetration

Occur due to pelvic muscle contraction

Pain is unrelated to menses

141
Q

What to evaluate in sexual assault?

A

physical and forensic Ex

Psychological assessment

142
Q

What are the consequences of sexual assault?

A

PTSD
Unintended pregnancy
STI

143
Q

How to manage sexual assault?

A

Emergency contraception

Post exposure ABx to prevent STI

Psychosocial counselling

144
Q

What are the pap smear results which need endometrial evaluation?
VERY HY HY

A

Atypical glandular cells favor neoplastic-»> in all females

Atypical glandular cells-»> at age 35 years OR at risk for endometrial hyperplasia OR postmen female

Benign appearing endometrial cells-»> if premen female with AUB or risk for endometrial hyperplaisa

145
Q

What to do if the colposcopy result is unsatisfactory Or un-visualise T-junction?

A

Do endocervical curettage

but not done in pregnancy as risk of miscarraige and preterm delivery

146
Q

How to approach CIN3?

A

if no pregnancy-»> LEEP or conization or cryoablation

follow up with PAP smear and HPV co-testing

147
Q

What is the indication of the cervical conization?

A

CIN 2 OR 3

148
Q

What are the complications of cervical conization?

A

Cervical stenosis
Preterm birth or PPROM

2nd trimester pregnancy loss
Cervical incompetence

149
Q

How to approach non invasive cervical cancer>

A

if negative surgical margins-»> f/u with PAP smear and HPV co-testing

if positive surgical margins-»> repeat Conization if pregnancy desire OR remove uterus if no pregnancy desire

150
Q

Triad of Ovarian Thecoma

A

seen in postmenopausal females

Thickness of endometrium due to estrogen

no virilization

151
Q

Important point

A

actinomycosis which colonizes intrauterine devices

may cause PID

152
Q

What are the contraindications of COPPER IUD?

A

Acute pelvic infection
wilson diseases

complicated organ transplant failure
severe uterine cavity distortion

153
Q

Important point

A

medroxyprogesterone avoided in female who doesn’t want weight gain

154
Q

Important point

A

Unexplained AUB is contraindication to IUD

155
Q

Name the IUD avoided in anemia

A

Copper IUD

156
Q

Name the IUD which given in anemic patient and also not causing weigh gain

A

Progesterone IUD

157
Q

What contraceptives are given in postpartum?

A

Non hormonal viz copper and progesterone IUD preferred in less than 1 month postpartum and breastfeeding

158
Q

Name the contraceptive given in breast cancer patient

A

Copper IUD

rest are all contraindicated

159
Q

Treatment approach of menopause

A

If mild vasomotor sx-»behavioral modification

severe vasomotor sx-»give non hormonal therapy SSRI if estrogen is contraindicated

160
Q

How to give estrogen in postmenopause female if its not contraindicated?

A

Intact uterus—> give Estrogen and progesterone

no uterus—> only estrogen

161
Q

How Gartner duct cyst present?

A

appear along the lateral aspect of the upper vagina anterior

Don’t involve vulva

162
Q

COMMON PROBLEMS RELATED TO LACTATION

Remember MEAN PG

A

M mastitis
E engorgment
A abscess
N nipple injury

P plugged duct
G galactocele

163
Q

Name the COMMON PROBLEMS RELATED TO LACTATION

MEAN PG

A

M Mastitis
E Engorgement
A Abscess
N Nipple Injury

P plugged duct
G Galactocele

164
Q

Triad of Breast Engorgement

A

B/L symmetrical fullness

without fever and erythema

Tender and warm

165
Q

Triad of Mastitis

A

U/L breast tenderness

With fever and erythema

Firm red swollen quadrant

166
Q

How to manage lactational Mastitis?

A

–Methicillin sensitive S. aureus: dicloxacillin or cephalexin

–If MRSA risk factors exist (e.g. recent antibiotic therapy, residence in long-term care facility, incarceration): clindamycin, TMP-SMX, or vancomycin

167
Q

Triad of Galactocele

A

Afebrile

Mobile Non tender mass well circumscribed

Subareolar

168
Q

Triad of Plugged duct

A

No fever

Focal tenderness

Firmness and erythema

169
Q

Clinical features of Nipple Injury

A

Abrasion, cracking, bruising blistering from poor latch

170
Q

Triad of Breast abscess

A

features of mastitis

fluctuant, tender, palpable mass

needle aspiration of breast abscess under ultrasound guidance and antibiotics as first line t/m —>if not resolved—->incision and drainage (eg surgical drainage) with packing are recommended

171
Q

Why PID is uncommon in pregnancy?

A

Cervical mucus plug protect the uterus from ascending infection

172
Q

How to approach cyclic breast Pain which is b/L and diffuse?

A

If mass on examination–>Imaging

-If no mass on examination—->observed

173
Q

How to approach non cyclic breast Pain which is U/L and focal?

A

If mass on examination—>bx and surgery consult

If no mass O/E—>imaging—>mass do bx and if no mass just observed

174
Q

Important point of cyclic breast pain

A

Due to hormonal changes and pain occurs 2 week before menses and subsides with the onset of menses

175
Q

How to manage Cyclic breast pain?

A

Reassurance in most cases

If symptomatic—> supportive bra And NSAIDs

176
Q

D/f b/w Simple and complex Breast cyst findings

A

Simple—>Thin wall fluid filled (anechoic) without solid or echogenic debri

Complex—>Thick wall sepated with solid and cystic component

177
Q

How to manage Complex Breast cyst?

A

Biopsy

178
Q

How to manage SIMPLE breast cyst?

A

If Asymptomatic—> Obs

If sxs FNA

179
Q

How to manage Symptomatic SIMPLE breast cyst?

A

Do FNA

A) If bloody aspirate—> Bx and imaging

B) If non-bloody aspirate—>if cyst resolve—>no management further OR if persist or Recurrent—> bx and imaging

180
Q

How to approach Pre menopausal Adenxal mass?

A

(1) Start with U/S and pregnancy test —-> if negative rule out ectopic pregnancy

(2) Malignant features on U/S???—-> Yes then surgery
If not —->Conservative management and repeat U/S after 6 wks

181
Q

How to Manage Migraine In pregnancy?

NI—-> no improvement

A

Non pharma like rest —->NI—-> Acetaminophen

Still NI—->Antiemetics/codeine/caffeine

Still NI —-> NASID like naproxen only in 2nd trimester

Still NI —-> Opioid

182
Q

Important point of Treatment of migraine in pregnancy

A

Metacolon used only acutely

Ergotamine is not used due to hypertonic uterine contractions and Vasoconstriction

Triptans Also not used due to above reason and LBW / Preterm birth.

183
Q

What are the complications of Oligohydramnios?

A

Preterm delivery

Umbilical cord compression

Meconium aspiration

184
Q

What are the causes of Polyhydraminos?

C MADE

A 
C congenital infection
M multiple gestation
A anencephaly
D duodenal atresia / DM
E esophageal atresia
185
Q

What are the complications of Polyhydraminos?

A

PPROM
Preterm labor

Umbilical cord prolapse
Fetal malposition

186
Q

How to Approach HSV infection in pregnancy?

A

(a)Past hx of HSV?—-> No —-> Cont prenatal care
If yes—->Give antiviral at 36 wk

(B) If active lesion /prodromal sxs during labor??—> Yes —-> do C/sec
If no —-> Vaginal delivery

187
Q

What are the causes of Hirsutism?

N-PICA

A

Non classic 21-hydrox deficiency
P PCO

I Idiopathic Hirsutism

C Cushing syndrome

A androgen secreting ovarian tumor / ovarian hyperthecosis

188
Q

Triad of Idiopathic Hirsutism

A

Hirsutism

Normal menstruation

Normal androgen level

189
Q

Triad of Non classic 21-hydrox deficiency induced Hirsutism

A

Hirsutism

Increase 17 hydroxy Progesterone

Sxs mimic like PCO

190
Q

Name the cause of Hirsutism which also show virlization

A

Cushing syndrome

A androgen secreting ovarian tumor / ovarian hyperthecosis

191
Q

What are the features of Virlization?

A

Male pattern baldness viz temporal hair loss

Increase muscle bulk

Clitoromegaly

Change of voice

192
Q

Define 2nd stage of Labor arrest

A

No fetal descent after pushing for more than 3 hrs in nulliparous
Or
More than 2hrs in multiparous

T/m is C-sec Or operative vaginal delivery

193
Q

What factors would lead to 2nd stage of Labor arrest?

A

Factor which increase women BMI

Like DM / Excessive Wt gain / Obesity

194
Q

What are the causes of 2nd stage of Labor?

MIC

A

M malposition of fetus // Maternal exhaustion

I insufficient contractions

C cephalopelvic disproportion

195
Q

Triad of Ovarian Thecoma

A

AUB due to Estrogen

Seen in post menopausal

Do not cause virlization

196
Q

Define Secondary Amenorrhea

A

1) No menses for more than 3 month with prior “REGULAR” Menses

OR

2) No Menses for more than 6 months with Prior “IRREGULAR” Menses

197
Q

How to approach Secondary Amenorrhea/AUB?

A

Regardless of Age Do B-Hcg

If age below 45 —>Do FSH, TSH and prolactin if pregnancy test came out negative

If age above 45 —>no need of FSH, TSH and prolactin if pregnancy test came out negative

198
Q

What are the risk Factor of Vulvovaginal candidasis ?

A

DM
Increase estrogen
Immunosuppression.

Menopause Decrease the risk due to low estrogen

199
Q

Important point of Benign breast disease

A

Both fibrocystic and fibroadenoma have cyclic pre menstrual tenderness

but former have multiple nodulocystic mass and later have single firm mobile solitary mass

200
Q

How to manage polyhydraminos?

A

1) Severe symptomatic preterm polyhydraminos—->aminoreduction as there is chance of preterm labor and PPROM
2) mild asymptomatic term doesn’t need treatment

201
Q

What is the category 3 FHR?

delivery the baby stat

A

If CTG shows:
1) Sinusoidal pattern

2) absent Variability with late or variable decelerations
3) absent Variability with bradycardia

202
Q

How to approach category 3 FHR?

A

Initial step is re-position mother with O2, IV fluid and stop utero tonic agents

Failed—–> C-sec stat or Vaccum assisted delivery if Cervix is 10 cm dilate.

203
Q

Important point of BPP

A

It is not useful in Intra partum period as BPP will not change the status of patient
It would delay the intervention

204
Q

Triad of Candidal mastitis

A

Seen in Diabetic 2 and Obesity patient
Shiny flaky areolar rash
Shooting pain

Dx via KOH skin scraping

205
Q

How Intertrigo present?

A

1) Macerated plaques b/w inflammatory fold
2) Satellite lesion
3) Seen in DM2 AND Obesity

206
Q

Triad of Acute fatty liver of Pregnancy

A

RUQ pain

Low PLT with deranged LFT

Low glucose

207
Q

How to manage acute fatty liver of Pregnancy?

A

Immediate delivery

208
Q

Triad of Pseudocyesis

A

Sxs like pregnancy

-Ve pregnancy test in hospital though!!

US shows empty uterus with thin endometrium

209
Q

How to manage Pseudocyesis?

A

Kinda somatization so need psychiatric evaluation

Patient had hx of infertility and pregnancy loss

210
Q

Name the condition which shows abscess located at the posterior vulvar vestibule Or at the base of labia majora (4th and 8th clock)

A

Bartholin abscess

211
Q

Name the condition which shows cyst along the lateral aspect of the upper vagina without involvement of VULVA

A

Gartner duct cyst

212
Q

Name the condition which shows vulvar white plaque worth dryness and intense pruritus with loss of labia minora
No involvement of vagina

A

Lichen sclerosis

213
Q

Name the condition which shows painful sex with decrease vaginal diameter
Loss of vaginal elasticity or Rugae

A

Atrophic vaginitis

214
Q

Name the condition which shows Exophytic Or cauliflower like growth Or smooth flattened papule

A

Condylomata acuminata

215
Q

Name the condition which shows fleshy lesion in vulva which may bleed and seen in post menopausal female

A

Vulvar cancer

216
Q

Name the condition which shows white or reddish plaques and Hyper-pigmented lesion Or multi focal verruciform lesions
Without atrophic changes

A

Vulvar intra epithelial neoplasia due to HPV

217
Q

What are the indications for hospitalisation for PID?

A

If patient unable to tolerate oral meds or non compliant to meds

Very severe presentation or developed complications of PID like TOA or perihepatitis

Pregnancy

Failed outpatient treatment

218
Q

What are the Risk factors of Endometrial hyperplasia / cancer?

KTONE (K = C)

A

All due to early Oestrogen

Chronic Ovulation Or PCOS

T tamoxifen use
O obesity
N Nulliparity
E early menarche or Late menopause

219
Q

What does meant by FHR tracing category 1?

A

Baseline HR (110-160) with moderate variability (6-25/min)

No late / variable deceleration

With or without (early decelerations)
With or without (acceleration)

220
Q

What are the contraindications of progestin IUD and copper IUD?
U-PAGED

A

U unexplained vaginal bleeding
P pregnancy

A acute pelvic Infection like PID of cervicitis
G GTD

E endometrial and cervical cancer
D distorted endometrial cavity

Gynae obs And Male Reproductive (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions