GYNE Flashcards
1
Q
MC effect of IUD insertion
A
heavy periods
2
Q
absolute contraindication for IUD insertion
A
Vaginal bleeding
3
Q
Advantages of Non scalpel vasectomy
A
Recanalization
no effect to sexual performance
hematoma formation upto 5%
4
Q
when is fertility achieved after vasectomy
A
after 3 months
5
Q
Criteria used for Bacterial vaginosis
A
Amsel Criteria:
-1. Vaginal Discharge Thin, grayish-white, and homogenous discharge.
2. Vaginal pH Greater than 4.5.
3. Fishy Odor (whiff test).
4. Clue Cells
6
Q
Medical regimen for medical abortion
A
Mifepristone 200 mg and Misoprostol 800 mcg after 48 hours
7
Q
snow storm appearance on the ultrasound of the uterus indicates
A
Hydatiform mole
8
Q
Treatment for Cervical Cancer
A
Radical hysterectomy upto Stage 2A1
Above 2A2 chemo + Radiation
9
Q
best treatment for Uterine prolapse
A
Vaginal hysterectomy with pelvic floor repair ( Ward Mayo’s Surgery)
10
Q
Muscle of the pelvic floor is
A
Levator Ani
11
Q
Ovarian cycle is initiated by which hormone
A
FSH
12
Q
hormones released by granulosa cells
A
Estrogen and Inhibin B
13
Q
LH surge is due to which hormone
A
Estrogen ( Positive feedback ) in the first half of the menstrual cycle
14
Q
which day is peak of Estrogen and LH
A
Estrogen= 12
LH = 13
15
Q
peak of progestrone is which day
A
Day 22
16
Q
time interval btw LH surge and ovulation
A
32 -36 hrs
24-36 hrs
17
Q
time interval btw LH peak and ovulation
A
10-12 hrs
18
Q
first sign of ovulation on endometrial biopsy is
A
appearance of Subnuclear vaccums
19
Q
hormones released by Corpus luteum
A
Progesterone
estrogen
inhibin a
20
Q
Lowest level of LH is seen at which day
A
Day 22
21
Q
Life span of Corpus luteum in pregnancy
A
10 -12 weeks by LH
22
Q
Normal blood loss
A
80 ml
23
Q
Average blood loss
A
30-50 ml
24
Q
menorrhagia is how much
A
more than 85ml for 7 days
25
Hypermenorrhea definition
less than 5ml or 2 days
26
metrorrhagia definition
seen in polyps , intermittent bleeding
27
which PG is released during menstruations
PDF-2a
28
MC pelvic path causing secondary dysmenorrhea is
Endometriosis
29
what is Mittelschmerz Syndrome
Mid Cycle pain ( during ovulation ).
30
types of estrogens are
E1 - esterone- MC in post menopause
E2- Estradiol- MC in pregnancy and Reproductive age
E3- Most specific in pregnancy
E4- estectrol
Order of potency E2>E1>E3.E4
31
Features of estrogen
Bone protection
cardio protective
increase clotting factors ( hence OCPs are c/i in DVT
32
Source of Progesterone
10-12 weeks is corpus luteum
after that is placenta
33
Hormone responsible for proliferation of endometrium
Estrogen
34
Support of endometrium is by which hormone
Progesterone
35
Effects of estrogen on cervix
mucus, watery, copious, elastic( Spinbarkeet)
Ferning is due to increased Es, Cl, Na
36
Which day of the cycle ferning is lost
Day 18 of cycle
37
Where should you collect sample from vagina for hormonal study
Lateral wall of vagina
38
LH to FSH ration
1:1 normally
in PCOS LH to FSH ratio is 2:1 or 3:1
39
conditions where LH and FSH is less
-Pregnancy
-Kallman syndrome ( Less GnRH)
-OCPs
-Sheehan Syndrome- Ant. Pit Gland ( Post Part hemorrhage)
40
conditions where LH and FSH is increased
menopause( less E and P) and turner syndrome( Streaked ovaries)
41
Hormonal effects of PCOS
High LH and Low FSH (3:1)
42
upper 2/3rd of vagina develops from
Mullerian duct , the lower 1/2 develops from urogenital sinus
43
If mullerian ducts are absent , what happens to Ovaries.
they still develop since it is from genital ridge
44
Remnants of Wolfian ducts
Gartner's duct
epo and para oopheron
Kobert tubercle
45
Remnants of mullerian ducts
Prostatic utricle and appendix of testis
46
Gene responsible for sex determination
SRY gene on the short arm of the Y Chromosome
-Target gene is SOX-9 gene
47
LN of Labia majora and minora is
Superficial and Deep Inguinal LNs
48
homologus organs
Clitoris>Penis from genital tubercle
Labia Majora> Scrotum from genital swellings
Labia minora> Penile Urethra from Genital fold
Prostate gland> Skene Gland
Cowper;s gland > Bartholin's gland
Gubernaculum > Round Ligaments
49
Main support of uterus
Levator Ani muscle
50
LN of Clitoris is
Rossen Muller Lymph node
51
What are the supports of the uterus
-Angle of anti flexion and anti version
-Uterosacral ligament(post)
- Cardinal ligament ( Lat) = Strongest
- Pubocervical Ligament ( Ant)
Round ligament keeps it in antiverted position ( 2nd support)
Levator ani muscle forms pelvic diaphragm
Deep transverse periani
Sub transverse peri ani
Bulbospongiosus muscle
52
Prolapse MC in
post menopausal Multiparous
53
TOC for prolapse in young female
Sling surgery or cervicoplexy
54
TOC for post partum prolapse in young female ( unfit for surgery )
Ring pesary
55
TOC for prolapse in young female, no plan for future pregnancies
Manchester surgery
56
prolapse in >40 yrs, management ?
Vaginal Hysterectomy ( Ward mayo)
57
TOC for prolapse > 65yrs
Le fort Colpoclesis
58
Test for ovulation is done on ?
Day 22
59
Prolapse of Anterior upper 2/3rd and lower 1/3rd of the vaginal prolapse is called
Upper- Cystocele
Lower - ureterocele
management is anterior colporrhaphy
60
Management for posterior vaginal wall prolapse is called
Upper 1/3rd - Moskowitz repair
Middle and lower 1/3rd - Posterior colpoperineorrhaphy
61
First visible sign of puberty
Breast budding/ Thelarche ( estrogen)
then its :
Pubarche ( tanner staging )
Adrenarche
Peak Height velocity
Last onset- Menarche
62
Definition of Precocious puberty
Thelarche at 8 yrs or Menarche at 10 yrs
Tx= continuous GnRH (leuprolide)
63
Definition of Delayed puberty
No breast at 13 yrs or no menstruation by 15 yrs
Tx= Pulsatile GnRH (leuprolide)
64
Management for Crypto menorrhea in case of primary menorrhea
Cruciate incision on the hymen
65
Female with Primary amenorrhea with no uterus and renal agenesis . What is this condition called
MRKH syndrome
66
Management for MRKH syndrome
Since there is no uterus and 2/3rd of the upper Vagina we do Vaginoplasty( Mcgndoe vaginoplasty )
67
Young female with Scanty pubic hair < breast normal with inguinal hernia and uterus is absent , what is the diagnosis and management
Testicular feminizing syndrome (46XY)
the hernia is intrabdominal testis
Tx= Gonads removed at 15
Do vaginoplasty
Give estrogen
68
MC ambiguous genitalia in males and females
Males- Testicular feminizing syndrome
Females- Congenital Adrenal Hyperplasia
69
Female with Primary amenorrhea with absent Secondary Sexual characteristics and short stature and small uterus . What is this conditions called
Turner syndrome - 45XO
Gonads are ovaries but smaller
since there is only one X
chromosomes ( Streak Gonad )
CLX- Webbing of neck, prone to cardio issues ( Bicuspid Aortic valve> Coarctation of aorta )
70
Management for Turner syndrome
Estrogen and progesterone from 12yrs
Growth hormones
Calcium and Vit D supplementation
71
MC cause of Primary Amenorrhea
Gonadal Dysgenesis > Turner syndrome
2nd= Mullerian agenesis
3rd= testicular feminizing syndrome
72
Female with normal height and absent secondary sexual characteristics , what is this condition called
Kallman Syndrome
- Hypothalamic failure - GnRH , LH, FSH are low
- Absent secondary sexual characteristics
- Anosmia
73
Most common cause for secondary amenorrhea
Pregnancy
Pathological cause is P C O S
74
Secondary amenorrhea with no bleeding after giving estrogen and progesterone
Ashermann Syndrome
- intrauterine adhesions and thin endometrium
IOC= Hysteroscopy
Tx= Hysteroscopic Adhesiolysis + IUCD insertion
E+P
75
Secondary amenorrhea with failure to lactate the baby
Sheehan's Syndrome
Postpartum necrosis of anterior pituitary gland Due to post partum hemorrhage. Both LH and FSH will decrease
76
Secondary amenorrhea with Galactorrhea and headache with visual disturbances
Prolactinoma
Increased prolactin hormone will decrease both L H and F S H
DOC= Cabergoline
IF complaint is infertility = Bromocriptine
77
Secondary amenorrhea with high LH and FSH
Premature menopause / Premature ovarian failure
78
MC cause for hirsutism
Stein Leventhal syndorme
79
Scoring used for Hirsutism
Ferriman Galleway score
80
Why does infertility happens in PCOS
No LH surge leading to anovulation. hence the follicles do not rupture
81
Ultrasound findings of PCOS
Necklace pattern
82
Criteria to diagnose PCOS
Rotterdam criteria
2 of the 3 should be there
- Hirsutism
-Menstrual irregularity
-USG ovary shows >12 follicles , size=2-9mm, Volume >10cc
83
Hormones that are higher in PCOS
Androgens, estrogens, LH, insulin LDL
84
Management of PCOS
Metformin for Insulin Resistance
irregular cycles are treated with OCP and also give O C P for hirsutism
85
First line Management of infertility in P C O S
DOC= Letrozole - aromatase (-)
2nd DOC= Clomiphene
86
2nd line Management of infertility in P C O S
HMG (synthetic LH and FSH)
Laparoscopic ovarian drilling
third line is Pulsatile GnRH
87
use of Continuous GnRH
Precocious puberty
endometriosis
Fibroids
all Hyper estrogenic conditions
88
Conformed complications of PCOS
Diabetes
obesity
Sleep apnea
89
Definition of endometriosis
Presence of endometrial tissue outside the uterus
90
Site of endometriosis
Ovary> pouch of douglas
91
MC symptom of Endometriosis
Dysmenorrhea
92
IOC for endometriosis
Laparoscopy
gunshot or powder burn appearance
93
Management of endometriosis
GnRH - leuprolide
Progesterone
Letrozole
Danazole
Gestrenione
- Can also use Mifepristone ( Causes endometrial atrophy )
can be used in Fibroids also
94
definition of adenomyosis
Endometriosis within myometrium
bulky uterus but not more than 12-14- weeks
more common in Multiparous female
95
MC symptoms of Adenomyosis
Menorrhagia and Dysmenorrhea
96
Management of Adenomyosis
Hysterectomy
2nd line is MIRENA ( Prgt IUCD levonorgestral)
97
MC pelvic tumor in female
Fibroids
MC benign tumor
Uterine fibroid is the MC,
Intramural>Submucous> Subserous
98
Max symptoms is seen with which fibroid
Submucous fibroid
99
MC symptom of fibroids
Menorrhagia
100
Fibroids with urinary symptoms are called
Cervical Fibroids
Ant. Cervical fibroids - urinary frequency
Post. Cervical fibroids- Urinary retention
101
MC degeneration in a post menopausal female
Atrophy
102
Chances of malignancy in fibroids
`0.5%
103
MC degeneration in fibroids is
Hyaline degeneration
104
Management of fibroid
Myomectomy
105
Mc degeneration or most specific in pregnancy is
Red Degeneration at 2nd trimester
106
Medical management of fibroids
Progesterone to stop bleeding
OCP
Tranexamic acid
Ulipristal - reduces the size of fibroid ( also used as an emergency contraception)
mifepristone - RU486
107
Risk of delayed menopause
the female is exposed to estrogen for a long time, predisposing them to OVARIAN CANCER and endometrial cancer
108
What is HOT flashes
it's a vasomotor symptom of menopause,, which is withdrawal from estrogen
109
What is the first line treatment of hot flashes in menopause
estrogen and progesterone
If the patient had a hysterectomy in the past only give estrogen
110
First-line treatment of osteoporosis in menopause
Bisphosphonates such as Alendronate
111
What is the use of Raloxifene
It is used for osteoporosis in menopause
112
Uses of H R T in Menopause
Hot flashes
Senile vaginitis (Dryness of the vagina)
Osteoporosis
113
What is a major side effect of Raloxifene
Hot flashes
114
Why Danazol is contraindicated in young females
It can cause hirsutism
115
A drug that causes multiple pregnancies and ovarian hyperstimulation syndrome
clomiphene
116
what are parts of the fallopian tube
interstitium> isthmus> Ampulla> infundibulum
117
rarest site of ectopic pregnancy
Intersitium= cornual ectopic pregnancy (the most dangerous)
-last for a very long time , because of the myometrium
it is the narrowest part
118
Which ectopic pregnancy lasts the longest time ?
Abdominal pregnancy
119
site of tubal ligation
Isthmus
isthmo-isthumic anastomosis for reversal or recanalization
120
important features of ampulla of F-tube
MC site of ectopic pregnancy
MC site for fertilization
Widest part
MC site for tubal abortion
MC site for Tubal TB
120
Widest part of the F-tube
Ampulla
121
Blood supply of the fallopian tube
Medially= Uterine artery
Laterally = Ovarian artery
122
Histology of HPV
large hyperchromatic nuclei and a perinuclear halo
123
Prophylaxis for PPH
Tranexamic acid 1g in 10 ml , 1ml/min
124
Cardinal movements of labor
The cardinal movements of labour are engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
125
The maximum negative pressure used in ventouse is
0.8 kg/cm
126
The best time to perform chorionic villous sampling is
11-13 weeks
127
the most common cause of postpartum haemorrhage in a grand multipara.
Uterine atony
128
Clue cells are seen in
Bacterial Vaginosis
129
Management of second twin in transverse lie
Internal podalic version
130
High HCG levels are seen in
Higher maternal plasma hCG levels- Multifetal pregnancy, erythroblastosis fetalis, gestational trophoblastic
disease, Down syndrome.
131
dose of betamethasone for lung maturity
12mg 1M 24 hourly 2 doses.
132
included in the modified biophysical score.
B-Breathing
A-Amniotic fluid volume (AFV)
T-Tone of fetus
M-Movements of fetus
N-Non stress Test (NST)
133
Examination of a patient diagnosed with threatened abortion would reveal
Examination of a patient diagnosed with threatened abortion would reveal closed cervical os with fetal cardiac
activity on USG.
134
Symptoms of magnesium sulphate toxicity
Loss of deep tendon reflexes
Decreased respiratory rate <12fmin
Urine output mL/h
Chest pain and heart block
Visual changes, flushing, muscle paralysis, and drowsiness
Measurement of serum magnesium levels is indicated to monitor magnesium toxicity if serum creatinine >1.0
mg/dL.
135
Treatment for Magnesium toxicity
* Stop magnesium therapy
* Estimation of serum magnesium and creatinine levels
* Intravenous injection of calcium gluconate 10 mL (10% solution)
136
Safest tocolytic to be used in pregnancy
Nifedipine
137
USG of missed abortion
is an empty gestational sac before 12 weeks
138
which is the longest diameter of the fetal skull
In brow presentation, the mentovertical diameter is engaged which is the longest diameter of the fetal skull. Normally,
it measures 14 cm.
139
Indications for myomectomy
Persistent uterine bleeding despite medical therapy
Excessive pain or pressure symptoms
Size > 12 weeks, patient desirous to have a baby
Unexplained infertility with distortion of the uterine cavity due to fibroid
Recurrent pregnancy wastage due to fibroid
Rapid growth during follow up
Subserous pedunculated fibroid
140
Hysterosalpingography features of genital tuberculosis(tubercular salpingitis) are:
Rigid non-peristaltic pipe-like tube (Lead pipe appearance)
Beading and variation in filling defect
Calcification of the tube
Jagged fluffiness of the tubal outline
Tobacco-pouch appearance of hydrosalpinx and pyosalpinx
Golf club appearance with slight or moderate dilatation of the ampullary portion of the fallopian tube.
Rosette type appearance secondary to multiple small diverticular like out pouching surrounding the ampulla
produced by caseous ulceration.
141
The gold standard for the diagnosis of endometriosis is
Laparoscopy
142
Similarities of Turner and Swyer's syndrome
Normal uterus and vagina with streak ovaries
143
Difference between Mature and immature teratomas
Mature teratomas are smooth outer layer with structures inside
immatures teratomas have a solid and trabeculated appearance
144
Treatment for Atrophic vaginitis
Vaginal Estrogen
145
antihormonal substance used to induce ovulation in a patient diagnosed with infertility.
Clomiphene citrate
146
ferning pattern of cervical mucus seen during which pahse of the menstrual cycle
estrogenic phase
147
Menopause is defined as cessation of menses for a period of
12 months
148
Outpatient treatment of PID
single dose of 1M ceftriaxone 250 mg + oral doxycycline 100 mg BD +/- metronidazole 400 mg BD x 14 days
single dose of 1M ceftriaxone 250 mg followed by azithromycin 1 gm per week x 2 weeks.
149
When does the ovary contain the maximum number ofoogonia?
5th month of intrauterine life
150
uterine curette used for dilatation and curettage
Sim's currette
151
Powder burn spots on pelvic viscera is indicative of
Endometriosis
152
Procedure for Cervical incompetence
McDonald's cerclage
153
Ovian mass with raised LDH
Dysgerminoma
154
The triple test findings in pregnancies with fetal Down's syndrome are
* Low MSAFP (maternal serum alpha-fetoprotein) levels, approximately 0.7 MOM (multiples of median).
* Low unconjugated estriol levels, approximately 0.8 MoM.
* High hCG levels, approximately 2.0 MoM.
155
Calorie requirements in pregnancy
0 in first
340 in second
450 in 3rd
156
the deepest part of the levator ani muscle. Injury to it can cause enterocele, cystocele, and urethral descent.
Pubococcygeus
157
A lady was discharged after a normal vaginal delivery. On third day she came back with fever, tachycardia and seizures. Fundus showed papilledema with no focal deficits. Diagnosis is:
Cortical vein thrombosis
158
Next step for postmenopausal ovarian cyst above 1 cm
CA-125
159
