GYNE Flashcards
MC effect of IUD insertion
heavy periods
absolute contraindication for IUD insertion
Vaginal bleeding
Advantages of Non scalpel vasectomy
Recanalization
no effect to sexual performance
hematoma formation upto 5%
when is fertility achieved after vasectomy
after 3 months
Criteria used for Bacterial vaginosis
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
Medical regimen for medical abortion
Mifepristone 200 mg and Misoprostol 800 mcg after 48 hours
snow storm appearance on the ultrasound of the uterus indicates
Hydatiform mole
Treatment for Cervical Cancer
Radical hysterectomy upto Stage 2A1
Above 2A2 chemo + Radiation
best treatment for Uterine prolapse
Vaginal hysterectomy with pelvic floor repair ( Ward Mayo’s Surgery)
Muscle of the pelvic floor is
Levator Ani
Ovarian cycle is initiated by which hormone
FSH
hormones released by granulosa cells
Estrogen and Inhibin B
LH surge is due to which hormone
Estrogen ( Positive feedback ) in the first half of the menstrual cycle
which day is peak of Estrogen and LH
Estrogen= 12
LH = 13
peak of progestrone is which day
Day 22
time interval btw LH surge and ovulation
32 -36 hrs
24-36 hrs
time interval btw LH peak and ovulation
10-12 hrs
first sign of ovulation on endometrial biopsy is
appearance of Subnuclear vaccums
hormones released by Corpus luteum
Progesterone
estrogen
inhibin a
Lowest level of LH is seen at which day
Day 22
Life span of Corpus luteum in pregnancy
10 -12 weeks by LH
Normal blood loss
80 ml
Average blood loss
30-50 ml
menorrhagia is how much
more than 85ml for 7 days
Hypermenorrhea definition
less than 5ml or 2 days
metrorrhagia definition
seen in polyps , intermittent bleeding
which PG is released during menstruations
PDF-2a
MC pelvic path causing secondary dysmenorrhea is
Endometriosis
what is Mittelschmerz Syndrome
Mid Cycle pain ( during ovulation ).
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
Features of estrogen
Bone protection
cardio protective
increase clotting factors ( hence OCPs are c/i in DVT
Source of Progesterone
10-12 weeks is corpus luteum
after that is placenta
Hormone responsible for proliferation of endometrium
Estrogen
Support of endometrium is by which hormone
Progesterone
Effects of estrogen on cervix
mucus, watery, copious, elastic( Spinbarkeet)
Ferning is due to increased Es, Cl, Na
Which day of the cycle ferning is lost
Day 18 of cycle
Where should you collect sample from vagina for hormonal study
Lateral wall of vagina
LH to FSH ration
1:1 normally
in PCOS LH to FSH ratio is 2:1 or 3:1
conditions where LH and FSH is less
-Pregnancy
-Kallman syndrome ( Less GnRH)
-OCPs
-Sheehan Syndrome- Ant. Pit Gland ( Post Part hemorrhage)
conditions where LH and FSH is increased
menopause( less E and P) and turner syndrome( Streaked ovaries)
Hormonal effects of PCOS
High LH and Low FSH (3:1)
upper 2/3rd of vagina develops from
Mullerian duct , the lower 1/2 develops from urogenital sinus
If mullerian ducts are absent , what happens to Ovaries.
they still develop since it is from genital ridge
Remnants of Wolfian ducts
Gartner’s duct
epo and para oopheron
Kobert tubercle
Remnants of mullerian ducts
Prostatic utricle and appendix of testis
Gene responsible for sex determination
SRY gene on the short arm of the Y Chromosome
-Target gene is SOX-9 gene
LN of Labia majora and minora is
Superficial and Deep Inguinal LNs
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
Main support of uterus
Levator Ani muscle
LN of Clitoris is
Rossen Muller Lymph node
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
Prolapse MC in
post menopausal Multiparous
TOC for prolapse in young female
Sling surgery or cervicoplexy
TOC for post partum prolapse in young female ( unfit for surgery )
Ring pesary
TOC for prolapse in young female, no plan for future pregnancies
Manchester surgery
prolapse in >40 yrs, management ?
Vaginal Hysterectomy ( Ward mayo)
TOC for prolapse > 65yrs
Le fort Colpoclesis
Test for ovulation is done on ?
Day 22
Prolapse of Anterior upper 2/3rd and lower 1/3rd of the vaginal prolapse is called
Upper- Cystocele
Lower - ureterocele
management is anterior colporrhaphy
Management for posterior vaginal wall prolapse is called
Upper 1/3rd - Moskowitz repair
Middle and lower 1/3rd - Posterior colpoperineorrhaphy
First visible sign of puberty
Breast budding/ Thelarche ( estrogen)
then its :
Pubarche ( tanner staging )
Adrenarche
Peak Height velocity
Last onset- Menarche
Definition of Precocious puberty
Thelarche at 8 yrs or Menarche at 10 yrs
Tx= continuous GnRH (leuprolide)
Definition of Delayed puberty
No breast at 13 yrs or no menstruation by 15 yrs
Tx= Pulsatile GnRH (leuprolide)
Management for Crypto menorrhea in case of primary menorrhea
Cruciate incision on the hymen
Female with Primary amenorrhea with no uterus and renal agenesis . What is this condition called
MRKH syndrome
Management for MRKH syndrome
Since there is no uterus and 2/3rd of the upper Vagina we do Vaginoplasty( Mcgndoe vaginoplasty )
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
MC ambiguous genitalia in males and females
Males- Testicular feminizing syndrome
Females- Congenital Adrenal Hyperplasia
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 )
Management for Turner syndrome
Estrogen and progesterone from 12yrs
Growth hormones
Calcium and Vit D supplementation
MC cause of Primary Amenorrhea
Gonadal Dysgenesis > Turner syndrome
2nd= Mullerian agenesis
3rd= testicular feminizing syndrome
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
Most common cause for secondary amenorrhea
Pregnancy
Pathological cause is P C O S
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
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
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
Secondary amenorrhea with high LH and FSH
Premature menopause / Premature ovarian failure
MC cause for hirsutism
Stein Leventhal syndorme
Scoring used for Hirsutism
Ferriman Galleway score
Why does infertility happens in PCOS
No LH surge leading to anovulation. hence the follicles do not rupture
Ultrasound findings of PCOS
Necklace pattern
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
Hormones that are higher in PCOS
Androgens, estrogens, LH, insulin LDL
Management of PCOS
Metformin for Insulin Resistance
irregular cycles are treated with OCP and also give O C P for hirsutism
First line Management of infertility in P C O S
DOC= Letrozole - aromatase (-)
2nd DOC= Clomiphene
2nd line Management of infertility in P C O S
HMG (synthetic LH and FSH)
Laparoscopic ovarian drilling
third line is Pulsatile GnRH
use of Continuous GnRH
Precocious puberty
endometriosis
Fibroids
all Hyper estrogenic conditions
Conformed complications of PCOS
Diabetes
obesity
Sleep apnea
Definition of endometriosis
Presence of endometrial tissue outside the uterus
Site of endometriosis
Ovary> pouch of douglas
MC symptom of Endometriosis
Dysmenorrhea
IOC for endometriosis
Laparoscopy
gunshot or powder burn appearance
Management of endometriosis
GnRH - leuprolide
Progesterone
Letrozole
Danazole
Gestrenione
- Can also use Mifepristone ( Causes endometrial atrophy )
can be used in Fibroids also
definition of adenomyosis
Endometriosis within myometrium
bulky uterus but not more than 12-14- weeks
more common in Multiparous female
MC symptoms of Adenomyosis
Menorrhagia and Dysmenorrhea
Management of Adenomyosis
Hysterectomy
2nd line is MIRENA ( Prgt IUCD levonorgestral)
MC pelvic tumor in female
Fibroids
MC benign tumor
Uterine fibroid is the MC,
Intramural>Submucous> Subserous
Max symptoms is seen with which fibroid
Submucous fibroid
MC symptom of fibroids
Menorrhagia
Fibroids with urinary symptoms are called
Cervical Fibroids
Ant. Cervical fibroids - urinary frequency
Post. Cervical fibroids- Urinary retention
MC degeneration in a post menopausal female
Atrophy
Chances of malignancy in fibroids
`0.5%
MC degeneration in fibroids is
Hyaline degeneration
Management of fibroid
Myomectomy
Mc degeneration or most specific in pregnancy is
Red Degeneration at 2nd trimester
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
Risk of delayed menopause
the female is exposed to estrogen for a long time, predisposing them to OVARIAN CANCER and endometrial cancer
What is HOT flashes
it’s a vasomotor symptom of menopause,, which is withdrawal from estrogen
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
First-line treatment of osteoporosis in menopause
Bisphosphonates such as Alendronate
What is the use of Raloxifene
It is used for osteoporosis in menopause
Uses of H R T in Menopause
Hot flashes
Senile vaginitis (Dryness of the vagina)
Osteoporosis
What is a major side effect of Raloxifene
Hot flashes
Why Danazol is contraindicated in young females
It can cause hirsutism
A drug that causes multiple pregnancies and ovarian hyperstimulation syndrome
clomiphene
what are parts of the fallopian tube
interstitium> isthmus> Ampulla> infundibulum
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
Which ectopic pregnancy lasts the longest time ?
Abdominal pregnancy
site of tubal ligation
Isthmus
isthmo-isthumic anastomosis for reversal or recanalization
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
Widest part of the F-tube
Ampulla
Blood supply of the fallopian tube
Medially= Uterine artery
Laterally = Ovarian artery
Histology of HPV
large hyperchromatic nuclei and a perinuclear halo
Prophylaxis for PPH
Tranexamic acid 1g in 10 ml , 1ml/min
Cardinal movements of labor
The cardinal movements of labour are engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
The maximum negative pressure used in ventouse is
0.8 kg/cm
The best time to perform chorionic villous sampling is
11-13 weeks
the most common cause of postpartum haemorrhage in a grand multipara.
Uterine atony
Clue cells are seen in
Bacterial Vaginosis
Management of second twin in transverse lie
Internal podalic version
High HCG levels are seen in
Higher maternal plasma hCG levels- Multifetal pregnancy, erythroblastosis fetalis, gestational trophoblastic
disease, Down syndrome.
dose of betamethasone for lung maturity
12mg 1M 24 hourly 2 doses.
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)
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.
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.
Treatment for Magnesium toxicity
- Stop magnesium therapy
- Estimation of serum magnesium and creatinine levels
- Intravenous injection of calcium gluconate 10 mL (10% solution)
Safest tocolytic to be used in pregnancy
Nifedipine
USG of missed abortion
is an empty gestational sac before 12 weeks
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.
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
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.
The gold standard for the diagnosis of endometriosis is
Laparoscopy
Similarities of Turner and Swyer’s syndrome
Normal uterus and vagina with streak ovaries
Difference between Mature and immature teratomas
Mature teratomas are smooth outer layer with structures inside
immatures teratomas have a solid and trabeculated appearance
Treatment for Atrophic vaginitis
Vaginal Estrogen
antihormonal substance used to induce ovulation in a patient diagnosed with infertility.
Clomiphene citrate
ferning pattern of cervical mucus seen during which pahse of the menstrual cycle
estrogenic phase
Menopause is defined as cessation of menses for a period of
12 months
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.
When does the ovary contain the maximum number ofoogonia?
5th month of intrauterine life
uterine curette used for dilatation and curettage
Sim’s currette
Powder burn spots on pelvic viscera is indicative of
Endometriosis
Procedure for Cervical incompetence
McDonald’s cerclage
Ovian mass with raised LDH
Dysgerminoma
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.
Calorie requirements in pregnancy
0 in first
340 in second
450 in 3rd
the deepest part of the levator ani muscle. Injury to it can cause enterocele, cystocele, and urethral descent.
Pubococcygeus
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
Next step for postmenopausal ovarian cyst above 1 cm
CA-125
