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FMGE > GYNE > Flashcards

GYNE Flashcards

1
Q

MC effect of IUD insertion

A

heavy periods

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2
Q

absolute contraindication for IUD insertion

A

Vaginal bleeding

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3
Q

Advantages of Non scalpel vasectomy

A

Recanalization
no effect to sexual performance
hematoma formation upto 5%

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4
Q

when is fertility achieved after vasectomy

A

after 3 months

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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

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6
Q

Medical regimen for medical abortion

A

Mifepristone 200 mg and Misoprostol 800 mcg after 48 hours

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7
Q

snow storm appearance on the ultrasound of the uterus indicates

A

Hydatiform mole

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8
Q

Treatment for Cervical Cancer

A

Radical hysterectomy upto Stage 2A1
Above 2A2 chemo + Radiation

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9
Q

best treatment for Uterine prolapse

A

Vaginal hysterectomy with pelvic floor repair ( Ward Mayo’s Surgery)

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10
Q

Muscle of the pelvic floor is

A

Levator Ani

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11
Q

Ovarian cycle is initiated by which hormone

A

FSH

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12
Q

hormones released by granulosa cells

A

Estrogen and Inhibin B

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13
Q

LH surge is due to which hormone

A

Estrogen ( Positive feedback ) in the first half of the menstrual cycle

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14
Q

which day is peak of Estrogen and LH

A

Estrogen= 12
LH = 13

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15
Q

peak of progestrone is which day

A

Day 22

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16
Q

time interval btw LH surge and ovulation

A

32 -36 hrs
24-36 hrs

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17
Q

time interval btw LH peak and ovulation

A

10-12 hrs

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18
Q

first sign of ovulation on endometrial biopsy is

A

appearance of Subnuclear vaccums

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19
Q

hormones released by Corpus luteum

A

Progesterone
estrogen
inhibin a

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20
Q

Lowest level of LH is seen at which day

A

Day 22

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21
Q

Life span of Corpus luteum in pregnancy

A

10 -12 weeks by LH

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22
Q

Normal blood loss

A

80 ml

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23
Q

Average blood loss

A

30-50 ml

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24
Q

menorrhagia is how much

A

more than 85ml for 7 days

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25
Q

Hypermenorrhea definition

A

less than 5ml or 2 days

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26
Q

metrorrhagia definition

A

seen in polyps , intermittent bleeding

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27
Q

which PG is released during menstruations

A

PDF-2a

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28
Q

MC pelvic path causing secondary dysmenorrhea is

A

Endometriosis

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29
Q

what is Mittelschmerz Syndrome

A

Mid Cycle pain ( during ovulation ).

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30
Q

types of estrogens are

A

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

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31
Q

Features of estrogen

A

Bone protection
cardio protective
increase clotting factors ( hence OCPs are c/i in DVT

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32
Q

Source of Progesterone

A

10-12 weeks is corpus luteum
after that is placenta

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33
Q

Hormone responsible for proliferation of endometrium

A

Estrogen

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34
Q

Support of endometrium is by which hormone

A

Progesterone

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35
Q

Effects of estrogen on cervix

A

mucus, watery, copious, elastic( Spinbarkeet)

Ferning is due to increased Es, Cl, Na

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36
Q

Which day of the cycle ferning is lost

A

Day 18 of cycle

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37
Q

Where should you collect sample from vagina for hormonal study

A

Lateral wall of vagina

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38
Q

LH to FSH ration

A

1:1 normally
in PCOS LH to FSH ratio is 2:1 or 3:1

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39
Q

conditions where LH and FSH is less

A

-Pregnancy
-Kallman syndrome ( Less GnRH)
-OCPs
-Sheehan Syndrome- Ant. Pit Gland ( Post Part hemorrhage)

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40
Q

conditions where LH and FSH is increased

A

menopause( less E and P) and turner syndrome( Streaked ovaries)

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41
Q

Hormonal effects of PCOS

A

High LH and Low FSH (3:1)

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42
Q

upper 2/3rd of vagina develops from

A

Mullerian duct , the lower 1/2 develops from urogenital sinus

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43
Q

If mullerian ducts are absent , what happens to Ovaries.

A

they still develop since it is from genital ridge

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44
Q

Remnants of Wolfian ducts

A

Gartner’s duct
epo and para oopheron
Kobert tubercle

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45
Q

Remnants of mullerian ducts

A

Prostatic utricle and appendix of testis

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46
Q

Gene responsible for sex determination

A

SRY gene on the short arm of the Y Chromosome
-Target gene is SOX-9 gene

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47
Q

LN of Labia majora and minora is

A

Superficial and Deep Inguinal LNs

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48
Q

homologus organs

A

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

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49
Q

Main support of uterus

A

Levator Ani muscle

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50
Q

LN of Clitoris is

A

Rossen Muller Lymph node

51
Q

What are the supports of the uterus

A

-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
Q

Prolapse MC in

A

post menopausal Multiparous

53
Q

TOC for prolapse in young female

A

Sling surgery or cervicoplexy

54
Q

TOC for post partum prolapse in young female ( unfit for surgery )

A

Ring pesary

55
Q

TOC for prolapse in young female, no plan for future pregnancies

A

Manchester surgery

56
Q

prolapse in >40 yrs, management ?

A

Vaginal Hysterectomy ( Ward mayo)

57
Q

TOC for prolapse > 65yrs

A

Le fort Colpoclesis

58
Q

Test for ovulation is done on ?

A

Day 22

59
Q

Prolapse of Anterior upper 2/3rd and lower 1/3rd of the vaginal prolapse is called

A

Upper- Cystocele
Lower - ureterocele
management is anterior colporrhaphy

60
Q

Management for posterior vaginal wall prolapse is called

A

Upper 1/3rd - Moskowitz repair
Middle and lower 1/3rd - Posterior colpoperineorrhaphy

61
Q

First visible sign of puberty

A

Breast budding/ Thelarche ( estrogen)

then its :
Pubarche ( tanner staging )
Adrenarche
Peak Height velocity

Last onset- Menarche

62
Q

Definition of Precocious puberty

A

Thelarche at 8 yrs or Menarche at 10 yrs

Tx= continuous GnRH (leuprolide)

63
Q

Definition of Delayed puberty

A

No breast at 13 yrs or no menstruation by 15 yrs

Tx= Pulsatile GnRH (leuprolide)

64
Q

Management for Crypto menorrhea in case of primary menorrhea

A

Cruciate incision on the hymen

65
Q

Female with Primary amenorrhea with no uterus and renal agenesis . What is this condition called

A

MRKH syndrome

66
Q

Management for MRKH syndrome

A

Since there is no uterus and 2/3rd of the upper Vagina we do Vaginoplasty( Mcgndoe vaginoplasty )

67
Q

Young female with Scanty pubic hair < breast normal with inguinal hernia and uterus is absent , what is the diagnosis and management

A

Testicular feminizing syndrome (46XY)
the hernia is intrabdominal testis

Tx= Gonads removed at 15
Do vaginoplasty
Give estrogen

68
Q

MC ambiguous genitalia in males and females

A

Males- Testicular feminizing syndrome
Females- Congenital Adrenal Hyperplasia

69
Q

Female with Primary amenorrhea with absent Secondary Sexual characteristics and short stature and small uterus . What is this conditions called

A

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
Q

Management for Turner syndrome

A

Estrogen and progesterone from 12yrs
Growth hormones
Calcium and Vit D supplementation

71
Q

MC cause of Primary Amenorrhea

A

Gonadal Dysgenesis > Turner syndrome

2nd= Mullerian agenesis
3rd= testicular feminizing syndrome

72
Q

Female with normal height and absent secondary sexual characteristics , what is this condition called

A

Kallman Syndrome
- Hypothalamic failure - GnRH , LH, FSH are low
- Absent secondary sexual characteristics
- Anosmia

73
Q

Most common cause for secondary amenorrhea

A

Pregnancy
Pathological cause is P C O S

74
Q

Secondary amenorrhea with no bleeding after giving estrogen and progesterone

A

Ashermann Syndrome
- intrauterine adhesions and thin endometrium
IOC= Hysteroscopy
Tx= Hysteroscopic Adhesiolysis + IUCD insertion
E+P

75
Q

Secondary amenorrhea with failure to lactate the baby

A

Sheehan’s Syndrome

Postpartum necrosis of anterior pituitary gland Due to post partum hemorrhage. Both LH and FSH will decrease

76
Q

Secondary amenorrhea with Galactorrhea and headache with visual disturbances

A

Prolactinoma
Increased prolactin hormone will decrease both L H and F S H
DOC= Cabergoline
IF complaint is infertility = Bromocriptine

77
Q

Secondary amenorrhea with high LH and FSH

A

Premature menopause / Premature ovarian failure

78
Q

MC cause for hirsutism

A

Stein Leventhal syndorme

79
Q

Scoring used for Hirsutism

A

Ferriman Galleway score

80
Q

Why does infertility happens in PCOS

A

No LH surge leading to anovulation. hence the follicles do not rupture

81
Q

Ultrasound findings of PCOS

A

Necklace pattern

82
Q

Criteria to diagnose PCOS

A

Rotterdam criteria

2 of the 3 should be there

  • Hirsutism
    -Menstrual irregularity
    -USG ovary shows >12 follicles , size=2-9mm, Volume >10cc
83
Q

Hormones that are higher in PCOS

A

Androgens, estrogens, LH, insulin LDL

84
Q

Management of PCOS

A

Metformin for Insulin Resistance
irregular cycles are treated with OCP and also give O C P for hirsutism

85
Q

First line Management of infertility in P C O S

A

DOC= Letrozole - aromatase (-)
2nd DOC= Clomiphene

86
Q

2nd line Management of infertility in P C O S

A

HMG (synthetic LH and FSH)
Laparoscopic ovarian drilling

third line is Pulsatile GnRH

87
Q

use of Continuous GnRH

A

Precocious puberty
endometriosis
Fibroids

all Hyper estrogenic conditions

88
Q

Conformed complications of PCOS

A

Diabetes
obesity
Sleep apnea

89
Q

Definition of endometriosis

A

Presence of endometrial tissue outside the uterus

90
Q

Site of endometriosis

A

Ovary> pouch of douglas

91
Q

MC symptom of Endometriosis

A

Dysmenorrhea

92
Q

IOC for endometriosis

A

Laparoscopy

gunshot or powder burn appearance

93
Q

Management of endometriosis

A

GnRH - leuprolide
Progesterone
Letrozole
Danazole
Gestrenione
- Can also use Mifepristone ( Causes endometrial atrophy )
can be used in Fibroids also

94
Q

definition of adenomyosis

A

Endometriosis within myometrium

bulky uterus but not more than 12-14- weeks

more common in Multiparous female

95
Q

MC symptoms of Adenomyosis

A

Menorrhagia and Dysmenorrhea

96
Q

Management of Adenomyosis

A

Hysterectomy

2nd line is MIRENA ( Prgt IUCD levonorgestral)

97
Q

MC pelvic tumor in female

A

Fibroids
MC benign tumor
Uterine fibroid is the MC,
Intramural>Submucous> Subserous

98
Q

Max symptoms is seen with which fibroid

A

Submucous fibroid

99
Q

MC symptom of fibroids

A

Menorrhagia

100
Q

Fibroids with urinary symptoms are called

A

Cervical Fibroids

Ant. Cervical fibroids - urinary frequency
Post. Cervical fibroids- Urinary retention

101
Q

MC degeneration in a post menopausal female

A

Atrophy

102
Q

Chances of malignancy in fibroids

A

`0.5%

103
Q

MC degeneration in fibroids is

A

Hyaline degeneration

104
Q

Management of fibroid

A

Myomectomy

105
Q

Mc degeneration or most specific in pregnancy is

A

Red Degeneration at 2nd trimester

106
Q

Medical management of fibroids

A

Progesterone to stop bleeding
OCP
Tranexamic acid
Ulipristal - reduces the size of fibroid ( also used as an emergency contraception)
mifepristone - RU486

107
Q

Risk of delayed menopause

A

the female is exposed to estrogen for a long time, predisposing them to OVARIAN CANCER and endometrial cancer

108
Q

What is HOT flashes

A

it’s a vasomotor symptom of menopause,, which is withdrawal from estrogen

109
Q

What is the first line treatment of hot flashes in menopause

A

estrogen and progesterone
If the patient had a hysterectomy in the past only give estrogen

110
Q

First-line treatment of osteoporosis in menopause

A

Bisphosphonates such as Alendronate

111
Q

What is the use of Raloxifene

A

It is used for osteoporosis in menopause

112
Q

Uses of H R T in Menopause

A

Hot flashes
Senile vaginitis (Dryness of the vagina)
Osteoporosis

113
Q

What is a major side effect of Raloxifene

A

Hot flashes

114
Q

Why Danazol is contraindicated in young females

A

It can cause hirsutism

115
Q

A drug that causes multiple pregnancies and ovarian hyperstimulation syndrome

A

clomiphene

116
Q

what are parts of the fallopian tube

A

interstitium> isthmus> Ampulla> infundibulum

117
Q

rarest site of ectopic pregnancy

A

Intersitium= cornual ectopic pregnancy (the most dangerous)
-last for a very long time , because of the myometrium
it is the narrowest part

118
Q

Which ectopic pregnancy lasts the longest time ?

A

Abdominal pregnancy

119
Q

site of tubal ligation

A

Isthmus

isthmo-isthumic anastomosis for reversal or recanalization

120
Q

important features of ampulla of F-tube

A

MC site of ectopic pregnancy
MC site for fertilization
Widest part
MC site for tubal abortion
MC site for Tubal TB

120
Q

Widest part of the F-tube

A

Ampulla

121
Q

Blood supply of the fallopian tube

A

Medially= Uterine artery
Laterally = Ovarian artery

122
Q
A
123
Q
A

FMGE (4 decks)

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