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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

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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

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52
Q

Prolapse MC in

A

post menopausal Multiparous

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53
Q

TOC for prolapse in young female

A

Sling surgery or cervicoplexy

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54
Q

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

A

Ring pesary

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55
Q

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

A

Manchester surgery

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56
Q

prolapse in >40 yrs, management ?

A

Vaginal Hysterectomy ( Ward mayo)

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57
Q

TOC for prolapse > 65yrs

A

Le fort Colpoclesis

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58
Q

Test for ovulation is done on ?

A

Day 22

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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

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60
Q

Management for posterior vaginal wall prolapse is called

A

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

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61
Q

First visible sign of puberty

A

Breast budding/ Thelarche ( estrogen)

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

Last onset- Menarche

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62
Q

Definition of Precocious puberty

A

Thelarche at 8 yrs or Menarche at 10 yrs

Tx= continuous GnRH (leuprolide)

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63
Q

Definition of Delayed puberty

A

No breast at 13 yrs or no menstruation by 15 yrs

Tx= Pulsatile GnRH (leuprolide)

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64
Q

Management for Crypto menorrhea in case of primary menorrhea

A

Cruciate incision on the hymen

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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

Histology of HPV

A

large hyperchromatic nuclei and a perinuclear halo

123
Q

Prophylaxis for PPH

A

Tranexamic acid 1g in 10 ml , 1ml/min

124
Q

Cardinal movements of labor

A

The cardinal movements of labour are engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.

125
Q

The maximum negative pressure used in ventouse is

A

0.8 kg/cm

126
Q

The best time to perform chorionic villous sampling is

A

11-13 weeks

127
Q

the most common cause of postpartum haemorrhage in a grand multipara.

A

Uterine atony

128
Q

Clue cells are seen in

A

Bacterial Vaginosis

129
Q

Management of second twin in transverse lie

A

Internal podalic version

130
Q

High HCG levels are seen in

A

Higher maternal plasma hCG levels- Multifetal pregnancy, erythroblastosis fetalis, gestational trophoblastic
disease, Down syndrome.

131
Q

dose of betamethasone for lung maturity

A

12mg 1M 24 hourly 2 doses.

132
Q

included in the modified biophysical score.

A

B-Breathing
A-Amniotic fluid volume (AFV)
T-Tone of fetus
M-Movements of fetus
N-Non stress Test (NST)

133
Q

Examination of a patient diagnosed with threatened abortion would reveal

A

Examination of a patient diagnosed with threatened abortion would reveal closed cervical os with fetal cardiac
activity on USG.

134
Q

Symptoms of magnesium sulphate toxicity

A

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
Q

Treatment for Magnesium toxicity

A
  • Stop magnesium therapy
  • Estimation of serum magnesium and creatinine levels
  • Intravenous injection of calcium gluconate 10 mL (10% solution)
136
Q

Safest tocolytic to be used in pregnancy

A

Nifedipine

137
Q

USG of missed abortion

A

is an empty gestational sac before 12 weeks

138
Q

which is the longest diameter of the fetal skull

A

In brow presentation, the mentovertical diameter is engaged which is the longest diameter of the fetal skull. Normally,
it measures 14 cm.

139
Q

Indications for myomectomy

A

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
Q

Hysterosalpingography features of genital tuberculosis(tubercular salpingitis) are:

A

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
Q

The gold standard for the diagnosis of endometriosis is

A

Laparoscopy

142
Q

Similarities of Turner and Swyer’s syndrome

A

Normal uterus and vagina with streak ovaries

143
Q

Difference between Mature and immature teratomas

A

Mature teratomas are smooth outer layer with structures inside
immatures teratomas have a solid and trabeculated appearance

144
Q

Treatment for Atrophic vaginitis

A

Vaginal Estrogen

145
Q

antihormonal substance used to induce ovulation in a patient diagnosed with infertility.

A

Clomiphene citrate

146
Q

ferning pattern of cervical mucus seen during which pahse of the menstrual cycle

A

estrogenic phase

147
Q

Menopause is defined as cessation of menses for a period of

A

12 months

148
Q

Outpatient treatment of PID

A

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
Q

When does the ovary contain the maximum number ofoogonia?

A

5th month of intrauterine life

150
Q

uterine curette used for dilatation and curettage

A

Sim’s currette

151
Q

Powder burn spots on pelvic viscera is indicative of

A

Endometriosis

152
Q

Procedure for Cervical incompetence

A

McDonald’s cerclage

153
Q

Ovian mass with raised LDH

A

Dysgerminoma

154
Q

The triple test findings in pregnancies with fetal Down’s syndrome are

A
  • 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
Q

Calorie requirements in pregnancy

A

0 in first
340 in second
450 in 3rd

156
Q

the deepest part of the levator ani muscle. Injury to it can cause enterocele, cystocele, and urethral descent.

A

Pubococcygeus

157
Q

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:

A

Cortical vein thrombosis

158
Q

Next step for postmenopausal ovarian cyst above 1 cm

A

CA-125

159
Q
A

FMGE (8 decks)

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