Background knowledge

Question 1

How does pyelonephritis cause ARDS?

Answer 1

Endotoxins originating from gram negative bacteria cause pulmonary injury –> fluid leaks from capillaries to interstitial space

Question 2

What effect does oxytocin have on the uterus?

Answer 2

Increased contraction strength and/or frequency

Question 3

Antimullerian hormone produced by?

Answer 3

Granulosa cells

Question 4

Antimullerian hormone activity?

Answer 4

restricts progression of primordial follicle development

Inhibits sensitivity of antral follicles to FSH and inhibits aromatase activity

Question 5

Phases of menstrual cycle

Answer 5

Menstruation - days 0-7
Proliferative phase - days 7-14
[Ovulation] - day 14
Secretory phase - days 14-28

Question 6

Hormone levels during phases of menstruation

Answer 6

Menstrual phase: low E and P
Proliferative: high E
Secretory: high P

Question 7

What is a Bartholin Cyst?

Answer 7

unilateral lesion on lower vestibule adjacent to vaginal canal
Dilation of Bartholin gland
Commonly in young women
Often related to STI
Can develop into an abscess

Question 8

What is a vulval condyloma?

Answer 8

Warty neoplasm
HPV 6 or 11 (low risk)
Koilocytic change, rarely progresses to carcinoma

Question 9

Menorrhagia

Answer 9

Abnormally heavy bleeding during menstruation

Dx based on history

Question 10

Hypomenorrhea

Answer 10

Abnormally scanty periods (<2 days or <80ml)

Question 11

Amenorrhea

Answer 11

Abnormal absence of menstruation

Question 12

Dysmenorrhea

Answer 12

Painful menstruation arising due to production of local eicosanoids –> decreases uterine blood flow, increasing contraction of myometrium –> release of AA –> prostaglandin (etc) production
Therefore treated with NSAIDs to halt production of PG and TXs (thromboxanes)

Question 13

Polymenorrhea

Answer 13

Cycles <21 days

Question 14

Oligomenorrhea

Answer 14

Cycles >35 days

Question 15

Metrorrhagia

Answer 15

Bleeding in between periods

Question 16

Menometrorrhagia

Answer 16

heavy bleeding occuring irregularly and more frequently than normal

Question 17

Mechanism of OCPs

Answer 17

Estrogen: inhibits secretion of FSH –> suppress development of Graafian follicle
Progestogens: inhibit secretion of LH –> prevents LH spike and therefore ovulation. Also increases cervical mucous viscosity. Suitable for pts with HTN.

Question 18

OCP side effects

Answer 18

Weight gain, nausea, flushing, dizziness, depression, irritability, acne, pigmentation, amenorrhoea, VTE, MI, stroke

Question 19

Names of progestogen-only pills

Answer 19

Etonogestrel (Implanon)
Levonorgestrel (day after pill)
Norethisterone
Dienogest
Medroxyprogesterone

Question 20

Hormone replacement therapy

Answer 20

Premarin: Conjugated equine oestrogen –> converted to oestriol in vivo

Vaginal prep: improves lubrication and reduces dyspareunia, incontinence and atrophic vaginitis

Question 21

What is Danazol?

Answer 21

Rx: Endometriosis
MoA: Inhibits plasminogen activation and thereby prevents fibrinolysis. Antiestrogenic.
S/E: acne, hirsuitism, voices changes, oily skin