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MCC Part 1 > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Ages menarche and menopause

A

Menarche - avg. onset age 12

Menopause - avg. onset 51 yr

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2
Q

Primary vs. secondary amenorrhea

A

Primary

  • no menses by age 16 with secondary sexual characteristics
  • no menses by age 14 with normal secondary sexual characteristics

Secondary
- cessation of previously normal menses >6mo or no menses for 3+ normal cycles

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3
Q

Thelarche

A
  • breast development, begins age 9-11
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4
Q

Tanner staging for breast

A 
None
Breast bud
Increase size areola and breasts
Secondary mound of areola and papilla
Areola recessed to contour of breast
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5
Q

Tanner staging pubic hair

A

None
Downy hair along labia
Darker/coarse hair extends over pubis
Adult-type hair covers smaller areas (no thigh)
Adult hair in quantity and type, extends over thighs

(pubarche = pubic and axillary hair, age 11-12)

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6
Q

Sheehan syndrome

A

Postpartum pituitary necrosis after significant PPH (secondary amenorrhea)

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7
Q

Asherman syndrome

A

Intrauterine adhesions after endometritis, D&C, or scarring after delivery (secondary amenorrhea)

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8
Q

Dysmenorrhea

A

Painful menstruation of uterine origin

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9
Q

Turner syndrome

A

45 XO

gonadal dysgenesis

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10
Q

Swyer syndrome

A

46 XY

gonadal dysgenesis

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11
Q

PCOS diagnostic criteria

A

2/3

  • chronic anovulation
  • biochemical (elevated testosterone) or physical signs of hyperandreogenism
  • polycystic ovaries seen on ultrasound
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12
Q

Primary ovarian insufficiency (POI)

A
  • elevated FSH, decreased estrogen
  • often intermittent ovarian function (can become pregnant)
  • hormone replacement therapy until menopause
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13
Q

Functional hypothalamic amenorrhea (FHA)

A
  • decreased FSH and estrogen
  • dx exclusion
  • suppression of pulsatile GnRH secretion from hypothalamus
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14
Q

Primary dysmenorrhea

A
  • menses pain not because organic disease
  • ovulatory cycles, improves third decade and after childbirth
  • beings 6mo - 2yr after menarche
  • pain due to prolonged myometrial uterine contractions and reduced blood flow to myometrium
  • induced by increased prostaglandins production in secretory endometrium during ovulatory cycles
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15
Q

First line tx dysmenorrhea

A

NSAIDS and/or OCPs

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16
Q

Menorrhagia

A

Prolonged (>7d) or excessive (>80mL) bleeding occurring at regular intervals

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17
Q

Metrorrhagia

A

Bleeding occurring at irregular intervals

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18
Q

Menometrorrhagia

A

Excessive bleeding during normal menses and at other irregular intervals

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19
Q

Polymenorrhea

A

Bleeding at intervals <21d

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20
Q

Intermenstrual bleeding

A

Bleeding between regular cycles

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21
Q

Postcoital

A

Bleeding after vaginal intercourse

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22
Q

Postmenopausal

A

Any bleeding following menopause

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23
Q

DVB

A

Abnormal bleeding not due to organic disease (dx exclusion)

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24
Q

Change in ovarian function with perimenopause and menopause

A

Perimenopause - decrease ovarian follicle pool -> decrease inhibit -> increase FSH -> less FSH receptors in reduced follicle number -> poor dominant follicle development -> anovulatory cycles = irregular menses
Menopause - depleted ovarian reserve -> chronic anovulatory cycles -> E and P deficiency (no corpus leuteum)

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25
Q

Postmenopausal vaginal bleeding

A

Endometrial cancer until proven otherwise

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26
Q

Investigation of bleeding at >20wk gestation

A

US to r/o placenta previa BEFORE pelvic exam

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27
Q

Rx ovulatory abnormal vaginal bleeding

A

NSAIDs - endometrial PG = reduced menstrual flow
Antifibrinolytics - reduce menstrual bleeding
Mirena IUD - reversible blockade of plasminogen = reduced menstrual loss

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28
Q

Premenstrual Dysphoric Disorder

A

PMDD = severe form of PMS

  • primarily mood sx
  • > 2 consecutive cycles in premenstrual phase
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29
Q

Premenstrual Syndrome

A

At least 1 affective and 1 somatic sx during the 5d before menses in 3 prior menstrual cycles
Sx relieved within 4d menses onset

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30
Q

Barrier methods contraception (failure rate)

A

Male condom (typical 18%, perfect 2%)
Female condom (typical 21%, perfect 5%)
Diaphragm (typical 12%, perfect 6%)
Cervical Cap ( typical: multip 23%, nullip 13%; perfect multip 26%, nullip 9%)
Sponge (typical multip 24%, nullip 12%; perfect multip 20%, nullip 9%)
Spermicide (typical 28%, perfect 18%)

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31
Q

OCP effectiveness

A

Perfect use = 99.9%
Typical use = failure rate 3-8%

OCP

  • P component main reason for contraceptive effect
  • Fertility 1-3mo after d/c
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32
Q

Combined contraceptives (failure rate)

A 
Patch (typical 8%, perfect 0.3%)
Vaginal ring (typical 6%, perfect 0.3%)
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33
Q

P only contraception

A

Injectable - failure rate <0.3%/yr
Oral - failure rate typical 5-10%, perfect 0.5%

inhibits secretion of pituitary gonadotropins = suppress ovulation, increase viscosity cervical mucous, induces decidualization of endometrium

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34
Q

IUD

A
  • if pregnancy, risk of ectopic high
    Copper - failure rate 0.8%
  • foreign body reaction (sterile inflammation), copper ions affect sperm motility

LNG - failure rate 0.1%
- foreign body reaction and endometrial decidualization and glandular atrophy; endometrial E and P receptor suppression thickened cervical mucous; ovulation inhibition

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35
Q

Plan B EC

A

Levonorgestrel-only method (2 doses 750 micrograms 12h apart OR single dose 1.5mg), approved by Health Canada

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36
Q

Stillbirth

A

Death >20wk GA or weighing >500g

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37
Q

Spontaneous abortion/ miscarriage

A

Pregnancy which ends spontaneously before fetus reaches 500g or 20 wk GA

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38
Q

Intrauterine fetal demise

A

Pregnancy ends spontaneously after 10-20wk

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39
Q

How many miscarriages occur in first 12wk of pregnancy?

A

80%

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40
Q

% spontaneous abortion due to chromosomal anomalies?

A

50%

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41
Q

Types of miscarriage

A 
Missed abortion
Complete abortion
Incomplete abortion
Threatened abortion
Inevitable abortion
Septic abortion
Recurrent pregnancy loss

+/- Rhogam if Rh- mom

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42
Q

Missed abortion

A

no bleeding, cervix closed
death of fetus in uterus with retention of pregnancy
anembryonic pregnancy is type with gestational sac but no fetal pole
- watch and wait
- Misoprostol 400-800 μg PO/PV
- D&C ± oxytocin

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43
Q

Complete abortion

A

bleeding + complete passage of sac and placenta; cervix closed, bleeding stopped
spontaneous expulsion of all fetal and placental tissue before 20wk GA
- expectant management

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44
Q

Incomplete abortion

A

very heavy bleeding and cramps +/- passage of tissue; cervix open
incomplete expulsion of products of conception before 20wk GA
- watch and wait
- Misoprostol 400-800 μg PO/PV
- D&C ± oxytocin

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45
Q

Threatened abortion

A

vaginal bleeding and cramping, cervix closed and soft
bleeding during first 20wk GA without passage of tissue or cervical dilation; presence of fetal cardiac activity (high proportion of pregnancies continue)
- 30-40% all pregnancies
- watch and wait (<5% abort)

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46
Q

Inevitable abortion

A

bleeding and cramps +/- rupture of membranes; cervix external os opens when start to expel products
bleeding +/- ROM accompanied by cramping and dilation of cervix; gestational tissue may be seen through internal os
- watch and wait
- Misoprostol 400-800 μg PO/PV
- D&C ± oxytocin

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47
Q

Septic abortion

A

contents of uterus infected
infection of retained products of conception by S. aureus, GN bacilli, or GP cocci
infection can cause peritonitis and sepsis
- D&C
- IV broad spectrum antibiotics

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48
Q

Recurrent pregnancy loss

A

> =3 spontaneous consecutive first trimester losses
Investigations - thrombophilic, immunologic, endocrine (DM, thyroid, hyperprolactinemia), genetic/ chromosomal, anatomic (septate uterus, leiomyomas, intrauterine synechiae), environmental/toxicologic
-> evaluate mechanical, genetic,
environmental, and other risk factors

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49
Q

Menopause

A

12 consecutive months of amenorrhea due to loss of ovarian function

  • ovulation ceases -> ovaries stop producing estradiol and progesterone but continue to produce testosterone -> small amount of E from peripheral conversion (adipose tissue) of adrenal steroids
  • increased FSH and LH, reduced estradiol, increased vaginal pH >6
  • screen for osteoporosis
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50
Q

Osteoporosis vs osteopenia

A 
Osteoporosis = BMD >2.5 SD below young adult mean (T score at or below -2.5)
Osteopenia = BMD 1-2.5 SD below young adult mean *t score btw -1 and -2.5)
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51
Q

Osteoporosis tx

A 
Vit D + Ca++
Bisphosphonates (alendronate, risedronate)
SERMs
Calcitonin
Estrogen
52
Q

Can you rx unopposed E to women with intact uterus?

A

NO

53
Q

Can you rx P along in pt with breast CA?

A

NO

54
Q

Amsel criteria (BV)

A

3/4

  • thin homogenous vaginal d/c
  • clue cells in n/s wet mount or gram stain
  • positive Whiff test on KOH wet mount (fishy)
  • vaginal pH >4.5
55
Q

BV

A
  • G. vaginalis
  • Bacteroids
  • Peptostreptococcus
  • M. hominis

increased risk of preterm birth (tx in pregnancy)
tx - metronidazole or clindamycin

56
Q

Vaginal trichomoniasis

A

T. vaginalis
- facilitates HIV transmission, associated with PROM
- strawberry cervix on exam
tx - metronidazole

57
Q

Gonorrhea

A
  • N. gonorrhea (diplococci)
  • perihepatitis (Fitz-Hugh-Curtis)
  • can be disseminated
    incubation period 2-7d
    dx - nucleic acid testing from endocervical specimen; gram stain swab; culture
    tx- ceftriaxone 250mg IM
58
Q

Chlamydia

A
  • C. trachomatis
  • serotypes D, E, F, G, H, I, J, K (obligate intracellular bacteria)
  • often asymptomatic
    incubation period up to 6wk
    dx- nucleic acid testing assay from endocervical, urethral or urinary specimen; culture
    tx- azithromycin 1g PO
59
Q

Syphilis

A
  • painless ulcer, resolves 2-8wk
  • incubation period 3-90d
  • dark field microscopy of serous fluid form genital lesions for observation of spirochetes
    tx- benzathine penicillin or doxycycline
60
Q

Secondary syphilis

A
  • widespread symmetric maculopapular rash (palms, soles), fever, malaise, LAD, mucous lesions, condylomata late, alopecia, meningitis, headaches, uveitis, retinitis
  • incubation 2wk - 6mo
    VDRL and RPR test
61
Q

Neurosyphilis

A

Argyll-Robertson pupil
incubation 2-20yr
tx - Penicillin G

62
Q

Gumma

A
  • form of tertiary syphilis - tissue destruction in any organ
  • Pen G + treat sexual contacts last 30d
63
Q

Herpes (HSV1, HSV2) and chancroid

A

painful genital ulcers
MUST inform sexual partners from preceding 60d before sx (risk asymptotic shedding)
- culture HSV lesion, HSV PCR, NAAT assay
tx - acyclovir, famcoclovir

Chancroid - H. ducreyi (cofactor HIV)
- painful genital ulcer with granulomatous base
- incubation 5-14d
- gram stain GN coccobacilli with ‘school of fish’ pattern
tx - ciprofloxacin, erythromycin, azithromycin, ceftriaxone

64
Q

HPV

A 
warts = condyloma acuminata
Subtypes:
- low risk = 6, 11, 41, 44
- intermediate risk = 31, 33, 35
- high risk = 16, 18, 45, 56

Intraepithelial lesions on Pap -> cervical involvement (LSIL, HSIL, invasive carcinoma)
tx - Imiquimod, cryotherapy, CO2 laser ablation, excision, etc

65
Q

PID

A
  • C. trachomatis, N. gonorrhoea, other (E. coli, Peptostreptococcus, G. vaginalis, etc.)
Minimum triad
- adnexal tenderness
- cervical motion tenderness
- uterine tenderness
gold standard dx = laparoscopy

tx - ceftriaxone + doxycycline or azithromycin; levofloxacin; cefoxitin + doxycycline

66
Q

Fitz-Hugh-Curtis syndrome

A

perihepatitis resulting in adhesions between liver capsule and abdo wall; resolves with rx of PID

67
Q

Cervical CA

A

90% SCC
10% adenocarcinoma

Pap test to detect abnormal cervical cells (age 21 - 69)

  • long precancerous phase
  • HPV 16, 18 most commonly in malignant lesions
68
Q

Colposcopy

A

Magnification of transformation zone
3-5% acetic acid then Lugol solution
Biopsy of abnormal epithelium
85-95% accurate (vs. Pap 15-40% false negative)

69
Q

Molar pregnancy

A

+ B-hCG
no FHR
U/S showing snowstorm

70
Q

Leiomyoma

A

Uterine fibroid

subtypes:
- cervical, broad ligament, pedunculate subserous, subserous, submucous, interstitial or intramural, fibroid polyp pedunculate submucous

40% symptomatic: AUB, pressure/compromise of pelvic organs, increased irritative voiding sx (UTI), increase abdo size, acute pelvic pain (fibroid torsion or degeneration), infertility
60% asx: fibroid <6cm or stable size, not located in submucosa

71
Q

Imaging in pelvic masses

A

US - first choice, delineates mass qualities, assess for ascites, safe in pregnancy
CT - suboptimal for ovary, assess other organs and LN, assess retroperitoneum
MRI - identify soft tissue lesions, safe in pregnancy

72
Q

Ovarian mass lab markers

A

CA-125

  • glycoprotein produced by fetal coelomic epithelium
  • normal <35 U/mL
  • increased in epithelial cell ovarian tumors (increased in 85% ovarian CAs)
  • elevated in: fibroids, PID endometriosis, cirrhosis, adenomyosis, pregnancy, appendicitis, breast/ lung/ ovarian/ colon/ fallopian tube CAs, pancreatitis, renal failure, ascites

AFP

  • major protein in fetal serum, NOT detectable after birth
  • <5.4 ng/mL normal
  • elevated in germ cell tumors (increased in 85% germ cell tumors)
  • also elevated in dermoids, pregnancy, HCC

LDH

  • enzyme found in almost all body tissue
  • normally <250 U/L
  • elevated in dysgerminomas

hCG

  • normally produced by placenta
  • normal <5 mIU/mL
  • elevated in germ cell tumors GTD (elevated 80% germ cell tumors); also in pregnancy and marijuana use
73
Q

RF ovarian cancer

A

80% epitheial cell tumors

rf:
- FHx ovarian Ca
- excess ovulation
- increasing age
- Lynch II syndrome (familial disposition to endometrial, ovarian and GU CAs)
- BRCA1 (chr17q) and BRCA2 (chr13q) tumor suppressor gene mutations (familial breast and ovarian CA)

74
Q

Chronic pelvic pain

A
  • pain below umbilicus in pelvis
  • pain lasting >6mo
  • pain severe enough to interfere with quality of life or daily functioning
    ddx:
  • gyne (endometriosis, chronic PID, adenomyosis, leiomyomata, dysmenorrhea, etc.)
  • GI (IBS, IBD, diverticulitis, etc.)
  • uro (chronic UTIs, interstitial cystitis, etc.)
  • msk (fibro, nerve entrapment, etc.)
  • systemic (sleep disturbance, mental health)
    depression can co-excist and approx 25% pt with CPP have hx sexual/ physical abuse
75
Q

Common locations of ectopic pregnancy

A 
ampullary 70%
isthmic 12%
fimbrial 11%
ovarian 3%
other - interstitial, abdo, cervical

need b-hCG >1500 mIU/mL

76
Q

RF ectopic pregnancy

A
  • previous EP
  • current IUD
  • hx PID
  • prev. tubal surgery
  • in utero DES exposure
  • infertility
  • smoking
  • uterine structure (fibroids, adhesions, etc.)
77
Q

Management ectopic pregnancy

A

methotrexate (MTX)
- folic acid antagonist (inhibits DNA synthesis and cell reproduction)
- if: hemodynamically stable, no bleeding, <3.5cm enraptured mass, no fetal heart activity, b-hCG <5000, future fertility desired, pt compliant
monitor with weekly b-hCG until not detectable

laparoscopic surgery or laparotomy

  • salpingostomy vs. salpingectomy
  • if fail MTX or previous EP in same fallopian tube
78
Q

Types of pelvic prolapse

A

Cystocele - herniation of bladder with associated descent of anterior vaginal segment
Uterine prolapse - descent of uterus and cervix
Vaginal vault prolapse - descent of vaginal apex
Rectocele - herniation of rectum with associated descent of posterior vaginal segment
Enterocoele - herniation of small bowel with associated descent of posterior vaginal segment

79
Q

Occult/latent incontinence

A

Incompetent urethral sphincter kinked by prolapse and when prolapse is repaired it results in new onset of stress incontinence

80
Q

PVR normal vs. impaired bladder emptying

A

If initial voided volume >150mL then PVR <100mL = appropriate bladder emptying
- If PVR >100mL then impaired bladder emptying

81
Q

Muscular pelvic floor components

A

Levator and (puborectalis, pubococcygeus, iliococcygeus) and coccygeus muscles attached to bony pelvis, coccyx, scarum

82
Q

Prolapse management

A 
Conservative - f/u, behavioural changes
Nonsurgical
- Pelvic floor muscle training
- Pessaries (support and space-filling) 
Surgical
83
Q

Urinary incontinence

A

Involuntary loss of urine

84
Q

Stress incontinence (SI)

A

Involuntary leakage of urine during effort, exertion, sneezing, or coughing
tx- behavioural (lifestyle, Kegel, biofeedback), medical (?), devices (pessaries), surgical

85
Q

Urodynamic SI

A

SI confirmed during urodynamic testing by identifying leakage from urethra coincident with increased intraabdominal pressure, but in absence of bladder contraction

86
Q

Urge incontinence

A

Involuntary loss of urine with a strong desire to void
- involuntary bladder contractions (detrusor overactivity) are hallmark of dx
tx - lifestyle, behavioural (bladder retraining, Kegel, biofeedback), medical (TCAs, anticholingeric, selective B-receptor agonist), surgical (sacral nerve modulation), botox injections into bladder

87
Q

Overflow incontinence

A

Large volume of urine in bladder due to incomplete emptying

88
Q

Continuous incontinence

A

Continuous leakage of urine due to vesicovaginal fistula

89
Q

Infertility

A

Inability to conceive after 1yr of regular intercourse without contraception (unless >35, irregular/ infrequent menses, hx PID or endometriosis)
affects 15% couples (female = 50% problems, males = 35% problems, unexplained = 10-15%)

90
Q

Fecundability, fecundity

A

Fecundability - probability a single cycle will result in pregnancy (20-25%)
Fecundity - probability that a single cycle will result in a live birth

91
Q

Menstrual cycle

A

menstrual phase - 1-4d
follicular phase - 5-13d
ovulation - 14d
luteal phase 15-28d

92
Q

What rx will induce ovulation?

A

Clomiphene citrate

Gonadotropins

93
Q

IVF indications

A 
Severe tubal disease
Advanced stage endometriosis
Severe male factor
Multifactor infertility
Age-related or otherwise unexplained subfertility
POI (with young donor egg)
94
Q

Musculature of external vagina/ anus?

A
  • ischiocavernosus muscle
  • bulbospingiosus muscle
  • superficial transverse perineal muscle
  • levator ani muscle
  • external anal sphincter
95
Q

Blood supply/ sensory innervation/ lymphatics to external female genetalia?

A
  • internal pudendal artery
  • pudendal nerve
  • inguinal nodes
96
Q

Lining of vagina?

A
  • rugated squamous cell epi
97
Q

Blood supply to vagina?

A

blood supply: vaginal branch of internal pudendal artery with anastamoses from uterine, inferior vesical, and middle rectal arteries

98
Q

2 major parts of cervix? Blood supply?

A

ƒUterine corpus
Š- blood supply: uterine artery (branch of the internal iliac artery)
ƒ
Cervix
-Š blood supply: cervical branch of uterine artery

99
Q

4 uterine ligaments? Function? Blood supply?

A

Round ligament: travel from anterior surface of uterus, through broad ligaments, and
inguinal canals then terminate in the labia majora
Š- function: anteversion
Š- blood supply: Sampson’s artery (branch of uterine artery running through round ligament)

Uterosacral ligament: arise from sacral fascia and insert into posterior inferior uterus
-Š function: mechanical support for uterus and contain autonomic nerve fibres

Cardinal ligament: extend from lateral pelvic walls and insert into lateral cervix and vagina
-Š function: mechanical support, prevent prolapse

Broad ligament: pass from lateral pelvic wall to sides of uterus; contain fallopian tube, round ligament, ovarian ligament, nerves, vessels, and lymphatics

100
Q

What ligament connects ovary to pelvic wall?

A

Infundibulopelvic ligament
- continuous tissue that connects ovary to pelvic wall
ƒ- contains the ovarian artery, ovarian vein, ovarian plexus, and lymphatic vessels

101
Q

Are ureters anterior or posterior to uterine arteries?

A

Posterior

- water under the bridge

102
Q

Segments of fallopian tubes? Blood supply?

A
  • interstitial segment
  • isthmic segment
  • ampullary segment
  • infundibular segment
  • terminates at fimbriae

blood supply: uterine and ovarian arteries

103
Q

What is the mesosalpinx?

A
  • peritoneal fold that attaches fallopian tube to broad ligament
104
Q

What are the two sections in an ovary? What ligament supports the ovary? Blood supply (arteries/veins)?

A

• consist of cortex with ova and medulla with blood supply
• supported by infundibulopelvic ligament (suspensory ligament of ovary)
• blood supply: ovarian arteries (branches off aorta)
- left ovarian vein (drains into left renal vein),
- right ovarian vein (drains into inferior vena cava)

105
Q

What is the mesovarium?

A
  • peritoneal fold that attaches the ovary to the broad ligament
106
Q

Female stages of puberty?

A

“Boobs, Pubes, Grow, Flow”
Thelarche, Pubarche, Growth spurt,
Menarche

107
Q

Tanner Stage

  • Thelarche
  • Pubarche
A

Thelarche
I. None
II. Breast bud
III. Further enlargement of areola and breasts with no separation of contours
IV. 2º mound of areola and papilla
V. Areola recessed to general contour of breast – adult

Pubarche
I. None
II. Downy hair along labia only
III. Darker/coarse hair extends over pubis
IV. Adult type covers smaller area, no thigh involvement
V. Adult hair in quantity and type; extends over thighs

108
Q

What hormone triggers menses?

A

Progesterone withdrawal

109
Q

Hormones in mid-follicular phase?

A
  • Estrogen from follicles (ovary)

- Increased FSH -> acts on ovarian granulose cells

110
Q

When does the dominant follicle persist? Hormone changes?

A

Late follicular phase

  • other follicles (not dominant) undergo atresia
  • increased E from dominant follicle -> builds up endometrium
  • granulose cells luteinze -> produce P
111
Q

When do LH and FSH peak?

A

Day 14

- switch from negative to positive feedback (E and P increase LH and FSH)

112
Q

Hormones with ovulation?

A
  • E peaks -> LH surge -> ovulation
113
Q

What produces P in luteal phase?

A

Corpus luteum from dominant follicle

- P stabilizes endometrium

114
Q

Subsequent hormone changes after no fertilization?

A

Reduced P due to degeneration of corpus luteum -> P withdrawal = menses

115
Q

Normal blood loss per menses?

A

25-80 mL

116
Q

Estrogen in the menstrual cycle

- effects

A

ESTROGEN is the main hormone in the follicular/proliferative phase and is stimulated by FSH. As the level increases it acts negatively on FSH. The majority of estrogen is secreted by the dominant follicle

Estrogen effects
• On the follicles in the ovaries = reduces atresia
• On the endometrium= proliferation of glandular and stromal tissue
• On all target tissues = decreases E receptors

117
Q

Progesterone in menstrual cycle

- effects

A

PROGESTERONE is the main hormone in the luteal/secretory phase and is stimulated by LH. Increased progesterone acts negatively on LH and is secreted by the corpus luteum (remnant of dominant follicle)

Progesterone effects
• On the endometrium: cessation of mitoses (stops building endometrium up);
“Organization” of glands (initiates secretions from glands);
Inhibits macrophages, interleukin-8, and enzymes from degrading endometrium
• On all target tissues: decrease E receptors (the “anti-estrogen” effect); decrease P receptors

118
Q

Define Asherman’s syndrome

A

Adhesions within the endometrial cavity causing amenorrhea/infertility

119
Q

Sites of ectopic implantation

A

Ampullary (70%)&raquo_space; isthmal (12%) > fimbrial (11%) > ovarian (3%) > interstitial (2%) > abdominal (1%)

120
Q

When rx Methotrexate for ectopic pregnancy?

A 
<3.5 cm unruptured ectopic
AND no fetal heart rate
AND β-hCG <5,000
AND no hepatic/renal/hematological disease
AND compliance assured
AND able and willing to follow-up
121
Q

How do you confirm ovulation?

A

day 21-23: serum progesterone

122
Q

What can you use to induce ovulation?

A

clomiphene citrate (Clomid®): estrogen antagonist that causes a perceived decreased estrogen state, resulting in increased pituitary gonadotropins; causes increased FSH and LH, leading to ovulation induction (works much better if anovulatory)

123
Q

Normal semen analysis?

A

Normal Semen Analysis (WHO lower reference limits)
• Must be obtained after 2-7 d of abstinence
• Volume 1.5 cc
• Count 15 million/cc
• Vitality 58% live
• Motility 32% progressive, 40% total (progressive + non-progressive)
• Morphology 4.0% normal

124
Q

Results of increased estrogen in PCOS?

A

obesity -> increased E -> increased LH, decreased FSH -> anovulation -> infertility
-> and increased ovarian androgens -> hisuitism

125
Q

Criteria to dx PCOS (Rotterdam)?

A

Rotterdam diagnostic criteria: 2 of 3 required
ƒ- oligomenorrhea/irregular menses for 6 mo
ƒ- hyperandrogenism
Š -> clinical evidence - hirsutism or male pattern alopecia or
Š -> biochemical evidence - raised free testosterone
- polycystic ovaries on U/S

MCC Part 1 (22 decks)

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