OBG

Question 1

SRY gene

Answer 1

Present in Y chromosome and it converts epiblast into spermatogonia

Question 2

Spermatogenesis begins at and where it occurs

Answer 2

Begins at puberty
Takes place in seminiferous tubules

Question 3

Fertilizable span of sperm

Answer 3

48-72hours

Question 4

Time taken for spermatogenesis

Answer 4

70 - 75 days (72 days)

Question 5

Where does sperm attains maturity & motility

Answer 5

Maturity at Proximal end of epididymis
Motility at Distal end of epididymis

Question 6

When does Oogenesis begin?

Answer 6

Intrauterine life

Question 7

Fertilisable span of ova :

Answer 7

12-24 hours.

Question 8

Size of mature follicle :

Answer 8

18-20 mm (Graafian follicle)

Question 9

Primary oocyte gets arrested in?

Answer 9

Diplotene stage of prophase

Question 10

Secondary oocyte gets arrested in?

Answer 10

Metaphase

Question 11

Corpus luteum

Answer 11

Corpus luteum in non-pregnant females is maintained by : LH.
• Corpus luteum in pregnant females is maintained by : hCG.
• Life span of corpus luteum in non-pregnant females : 12-16 days.
• Hormone which prevents luteolysis : hCG.
• Maximum size and activity of corpus luteum is seen on : 8 days after ovulation
(D-22).

Question 12

Day 22 of menstrual cycle

Answer 12

Maximum size and activity of corpus luteum is seen on : 8 days after ovulation
(D-22).
• Maximum progesterone is seen on : D-22.
• Minimum LH & FSH is seen on : D-22.
• All tests for ovulation done on : D-22 = 1 week before menstruation.

Question 13

Mittelschmerz syndrome

Answer 13

Pain at time of ovulation (Mid cycle abdominal pain).

Question 14

Hirsutism scoring system

Answer 14

Ferriman Gallwey score → ≥8 Significant (>6 in Asian females)

Question 15

Treatment of hirsutism

Answer 15

DOC: OCP (E+P)
After 6 Months if not resolved then use Spironolactone + OCP (In case of conception,
spironolactone can affect
external genitalia of a
male fetus. Hence OCPs
are added)

Question 16

Female with hirsutism next step in investigation

Answer 16

Check testosterone levels
Normal: idiopathic
>/= 70 but <200: PCOS, late onset CAH
>/= 200: CAH, Androgen secreting tumors in ovaries

Question 17

MCC of hirsutism in young female

Answer 17

PCOS

Question 18

3rd generation progesterone

Answer 18

Third generation :
- Desogestrel
- Norgestimate
- Gestodene
• Least androgenic side effect

Question 19

4th generation progesterone

Answer 19

Cyproterone acetate (Anti androgenic)

Question 20

Clomiphene citrate

Answer 20

SERM
Use : Ovulation induction (If H PO axis intact i.e FSH-NORMAL). Most common side effect : Hot flushes.
• 2nd most common side effect :
Formation of ovarian cyst.
• Chances of multiple pregnancy : 7-10%.
• Side effect because of which its use should
be stopped immediately : Visual disturbances.
• Common S/E : Vaginal dryness

Question 21

Raloxifene

Answer 21

SERM
Use : Osteoporosis.
• Side effect : Hot flushes, vaginal dryness.

Question 22

Tamoxifen

Answer 22

SERM
USE: Breast carcinoma
S/E: hot flushes, vaginal dryness
It is teratogenic.
Minimum time gap between tamoxifen & pregnancy : 2 months
Ideal gap: 3 months

Question 23

Ospemifene

Answer 23

SERM
Management of Vaginal dryness

Question 24

Ormeloxifene

Answer 24

Component of centchroman (Chhaya)

Question 25

Abnormal uterine bleeding investigations

Answer 25

1st: UPT 2nd: TVS 3rd: Endometrial biopsy

Question 26

Indications for Endometrial biopsy in reproductive age female

Answer 26

Reproductive age : • If endometrial thickness ≥11 mm. • Risk for endometrial cancer (Using Tamoxifen). • If bleeding despite medical Rx.

Question 27

Indication for Endometrial biopsy in perimenopausal age female

Answer 27

Irrespective of USG finding Endometrial biopsy is done to all AUB females of perimenopausal age females

Question 28

Indication for Endometrial biopsy in Postmenopausal age females

Answer 28

Postmenopausal age : If endometrial thickness ≥4 mm.

Question 29

Investigation for endometrial disorder

Answer 29

IOC: Endometrial biopsy Gold standard: Fractional curettage + hysteroscopy (Indications: EB report : - Hyperplasia with atypia. - Insufficient sample. - Hyperplasia without atypia but patient continues to bleed despite Rx. • Cervical stenosis)

Question 30

C/o : 2-3 months of amenorrhea F/b Bleeding in Perimenopausal female. Endometrial biopsy showing Swiss cheese pattern

Answer 30

Metropathia hemorrhagica (Rx: Progesterone)

Question 31

Hormone replacement therapy

Answer 31

Only Indication : Severe hot flashes. If uterus is present : E + P. (↑risk of breast cancer) If uterus is absent : E only.(↑risk of endometrial cancer) M/c estrogen used in HRT : 17 β-estradiol

Question 32

Sheehan’s syndorme

Answer 32

Necrosis of anterior pituitary d/t PPH • Symptoms : - Inability to breast feed (M/c) - Persistent amenorrhea (2nd m/c) Hormonal assay: • GH : ↓(First) • LH, FSH, E : ↓ • Prolactin : ↓ • TSH : ↓(Last) MRI : Empty sella tursica

Question 33

Prolactinoma

Answer 33

Prolactin secreting pituitary adenoma • Symptoms : - Secondary amenorrhea (M/c) - Infertility (2nd m/c) - Galactorrhea - Headache, visual disturbances • LH, FSH, E : ↓ • GnRH : ↓ • Prolactin : ↑ • MRI : Space occupying lesion Note : • DOC : Cabergoline • In pregnancy & lactation : Treat only if visual disturbance +

Question 34

Primary ovarian insufficiency

Answer 34

• Absent follicles • No ovulation (↓ E & P) • Symptoms : Hot flushes, osteoporosis Hormonal assay: LH, FSH : ↑ • E, P : ↓ • AMH : ↓ ( N level : 1-3) - <1 : Suggestive of POI - <0.5 : Diagnostic of POI

Question 35

Polycystic ovarian syndrome

Answer 35

• Secondary amenorrhea • Hirsutism • Insulin resistance Hormonal assay • FSH : Normal • LH : ↑ • E : Normal/↑ • AMH : ↑ Progesterone challenge test : Positive

Question 36

Rotterdam criteria

Answer 36

Rotterdam Criteria : used in PCOS Any 2 of the following 3 should be present : 1. Androgen levels : ↑ - ↑testosterone (Biochemically) or hirsutism. 2. Ovulatory dysfunction : - Oligomenorrhea (<9 cycles/year) or amenorrhea. 3. On USG : - Follicles (In one/both ovaries) : Number ≥12, size : 2-9 mm or - Volume of ovary : ≥10cc

Question 37

Asherman syndrome

Answer 37

• Infertility • Secondary amenorrhea • Hypomenorrhea • FSH, LH : Normal • E : Normal Challenge tests : • P → Negative • E + P → Negative

Question 38

Endometrial cancer staging

Answer 38

Stage 1 : Tumor confined to uterus A. <50% myometrial involvement. B. ≥50% myometrial involvement. Stage 2 : Cervical involvement (Glands & stroma). Stage 3 : • 3A : Serosa/Adnexa involvement. • 3B : Vagina/Parametrium involvement. • 3C : LN involvement C1 : Pelvic C2 : Para aortic Stage 4 : Metastasis - 4A : Regional (Bladder/Bowel) - 4B : Distant metastasis/ Superficial inguinal node involvement.

Question 39

Cancer cervix staging

Answer 39

Stage 1: Ca limited to cervix IA: Microscopic Ca (≤5 mm deep) IA1: ≤3 mm deep IA2: 4-5 mm deep IB: Macroscopic Ca (>5 mm deep) IB1: Tumor Size ≤2 cms IB2: Tumor Size ≤4 cms IB3: Tumor Size >4 cms Stage II Cancer spread to upper vagina IIA Parametrium not involved II A1: Tumor Size ≤4 cms II A2: Tumor Size >4 cms IIB Parametrium involved Stage III Cancer spread to lower vagina III A : No involvement of pelvic side wall III B : Involvement of pelvic side wall/ hydroureter/hydronephrosis III C LN Involvement III C1: Pelvic LN involvement III C2: Paraaortic LN involvement Stage IV Metastatic IV A Regional : Bladder/rectum IV B Distant : Superficial inguinal LN involvement