Gynae Flashcards
(389 cards)
1
Q
Embryologic origin of the uterus is from?
A
Mullerian duct - paramesonephric
2
Q
Main support of uterus is?
A
Best ans is Levatorani muscle > Next best Cardinal ligament
3
Q
________ is not a support for Uterus?
A
Broad ligament, round ligament (not a main support)
4
Q
Which ligament is responsible for Anteversion and Anteflexion of Uterus?
A
Round Ligament + Utero sacral
5
Q
Epithelial lining of endocervix and uterine cavity?
A
Tall columnar Epi
6
Q
Uterine blood supply is derived from?
A
1) Uterine a. - best ans - branch of ant division of internal iliac
2) Ovarian a - 2nd best ans - branch of abdominal aorta
7
Q
FT are lined with?
A
Ciliated columnar epi (peg cells)
8
Q
Main cause of transport of conceptus to uterus is?
A
Peristalsis
9
Q
Narrowest part of FT?
A
Interstitial (intramural) - anatomical sphincter
10
Q
Ligation is done in FT at?
A
Isthmus (symmetrical smooth muscle)
11
Q
Widest part of FT?
A
Ampulla
12
Q
Ectopic pregnancy is most common at which location in FT?
A
Ampulla (site of fertilization/max no of plicae or mucosal folds)
13
Q
What is physiological sphincter in FT?
A
Isthmus
14
Q
Ovaries are attached by _______ to the uterine fundus by the ________ to the pelvic side wall.
A
Ovarian ligament/Utero-OV ligament, Suspensory ligament (infundibulopelvic ligament).
15
Q
Infundibulopelvic (suspensory) ligament contains?
A
Ovarian vessels
Right side vein drains into IVC and left side drains into Left renal v.
16
Q
Normal commensal organism in vagina and pH?
A
Lactobacillus (Doerleins bacilli), Acidic pH 3.5-4.5
17
Q
Epi lining of vagina and ectocervix?
A
Stratified squamous epithelium
18
Q
Which 2 things are responsible for acidic pH of vagina?
A
Lactobacillus/doderleins and Estrogen
19
Q
pH in pregnancy is?
A
4
20
Q
________ cells are predominant with estrogen and ____________ with progesterone.
A
Superficial cells - bade bade pink cellls, piknotic nucleus - mature cells
Intermediate cells - blue colored and bigger nucleus
21
Q
Cells found in a female with absent estrogen and progesterone and pH of vagina?
A
Parabasal cells - post menopausal or pre-pubertal females
pH is 6.5-7.5
22
Q
Upper 1/3rd vagina is derived from?
Lower 2/3rd vagina is derived from?
A
Mullerian ducts
UGS - also makes vulva/ext. genitalia
23
Q
Main source of vaginal secretions?
A
Cervical glands
24
Q
Second name of Bartholin’s glands? and where do they open?
A
Greater vestibular gland - open in vestibule (b/w labia minora and hymen)
25
Bartholin's glands are homologous to?
Bulbourethral glands (cowpers)
26
Bartholin's glands open at?
Postero-lateral wall of vagina b/w labia minora and hymen
27
TOC Bartholin's glands cyst symptomatic or bigger than 3 cm or abscess?
Incision and drainage
28
Bartholin's glands cyst abscess clinical presentation?
Tender swelling
Warm
Fluctuant
Edema/erythema
SEVERE PAIN
29
Location of Gartner cyst?
Antero-lateral
30
PAP smear is only used for?
Screening
31
Best screening test for Cervical Ca?
HPV-DNA
32
Most cost-effective screening tool for Cervical Ca?
VIA
visual inspection acetic acid, 3-5%
33
Fixative used for PAP smear is?
95% ethyl alcohol
34
Diagnostic test for Cervical Ca or dysplasia?
Biopsy (Colpo biopsy)
35
Ectocervix screening is done for which Ca?
Site of specimen?
SCC
Transformation zone/sq col zone
36
Endocervix screening is done for which Ca?
Adeno-Ca
37
Woman with post coital bleeding next step?
P/S examination + PAP smear
38
Woman with post coital bleeding and abnormal looking cervix, next step?
DO NOT TAKE PAP Smear, take biopsy instead right away
39
PAP Smear can be taken?
Area of abnormal-appearing tissue that are biopsied include?
Any time after menses (not taken during active bleeding)
Acetowhite areas + irregular contour of surface/pale
40
___________ is applied to cervix to aid in dysplasia detection?
Acetic acid
41
Filter used in colposcopy?
Green filter - to look for abnormal vessels/neovascularization
42
LEEP second name and is TOC for?
LLET2, CIN 2/3: pre-invasive lesions, basement membrane will be intact
43
Hysteroscopy pressure?
50-70 mmhg (100 max)
44
Hysteroscopy done in which phase of menses?
Proliferative - follicular
45
Media used in monopolar electrical cautery?
Glycine (MC) - electrolyte deficient - can cause hyponatremia
46
Media used in bipolar electrical cautery?
Electrolyte rich - NS or RL
47
Hysteroscopy is TOC for?
1) Endometrial polyp
2) Asherman's syndrome = synechiae
3) Submucosal fibroid
4) Septate uterus
48
Contraindication for Hysteroscopy?
Pregnancy
Pelvic infection
Pyometra (pus in uterus)
Cervical Ca
49
HSG is IOC for?
Dye used in HSG?
Tubal Patency (screening only HSG never diagnostic)
Iodine dye (Iopramide, Iohexol)
50
Bilateral block (any block) on HSG is followed by ___________ test and dye used is __________.
Laparoscopic chromopertubation test
Methylene blue
51
HSG is done on which day of menses?
D6-D11
52
Contraindication for HSG?
Pregnancy
Current infection (PID also)
Active bleeding
Active TB + untreated
53
Cannula used for HSG?
Leech wilkinsons (Rubin cannula old times)
54
Endometrial biopsy done in which phase and which day of menses?
Before menses/premenstrual/secretory/luteal
D26 (2 days before expected menses)
55
Indications for Endometrial biopsy?
1. Postmenopausal bleeding ET>4 mm
2. >45 yo with heavy or irregular bleeding
3. Granulosa cell tumor - secretes estrogen can cause Ca or hyperplasia
4. Endometrial Ca risk factors (tamoxifen, obese, PCOS), Lynch HNPCC syndrome)
56
Serum FSH test day and use?
D3 - test of ovarian reserve MC used
57
Serum progesterone test day and use?
D21 - MC used test of ovulation
58
Post coital test day and name?
D12-D14, Sims Huhner test
59
Antral follicles count test day and use?
D2-3, ovarian reserve
60
Serum AMH test day and use?
Anytime - best test for ovarian reserve
61
Spatula used for PAP smear?
Ayres's spatula side A
No air drying of slide
62
Device used for taking sample from Endocervix?
Cytobrush
63
Device used in HSG for pushing in the dye?
Leech Wilkinson's cannula
64
Next step for B/l cornual block?
Lap chromo + Hysteroscopic cannulation
diagnostic theraputic
65
Best Tx for B/L cornual block?
IVF
66
Big and small peak in ovulation cycle graph is which gonadotrophin hormone?
LH - big peak
FSH - small peak
67
Two peak one before ovulation and one after ovulation, ovarian hormone during menses is?
Estradiol
68
One peak after ovulation ovarian hormone during menses is?
Progesterone
69
FSH stimulates the growth of and secretion of?
Growth of follicles
Secretion of Estrogen
70
LH stimulates production of?
Androgens via Theca cells
Androgens converted into estrogens in granulosa cells by aromatase enzymes (two cell theory)
71
LH surge is dependent on rapid rise in?
High Estrogen - initiates LH surge
72
Time gap b/w LH surge and ovulation
36 hrs
73
Time gap b/w LH peak and ovulation
12 hrs
74
Progesterone comes from?
Corpus luteum - is it maintained by Luteinizing hormone
75
What hormone maintains corpus luteum in pregnancy?
HCG
76
Life span of corpus luteum?
14 days - fixed phase in every female
77
Corpus luteum is rescued from luteolysis by?
HCG - maintains CL
78
Secretory phase is under the effect of?
Secretory phase HPE shows?
Progesterone
Subnuclear vacuolation/corkscrew glands
79
Proliferative phase is seen under the effect of?
And HPE shows?
Estrogen
Tall glands/Telescope
80
Cervical mucous under effect of progesterone shows?
Thick-viscous-scanty
81
Cervical mucous under effect of Estrogen shows?
Thin-watery-copious (large amount)
82
Progesterone is smooth muscle relaxant?
Relaxant
(Estrogen increases contractions)
83
Levels of LH and FSH in various conditions:
1. Turner syndrome
2. Gonadal dysgenesis
3. Kallmann syndrome
4. Mullerian agenesis
5. AIS:
6. Asherman syndrome
7. Sheehan syndrome
8. Imperforate hymen
9. Menopause
10. Premature ovarian failure
1. Turner syndrome: Both high - Hypergonadotropic Hypogonadism
2. Gonadal dysgenesis: Both high - Swyer syndrome (pure/complete - also Hypergonadotropic Hypogonadism)
3. Kallmann syndrome: (no GnRH) both low, Hypogonadotropic Hypogonadism
4. Mullerian agenesis: (No uterus and FT but normal ovary) both normal
5. AIS: FSH normal (good negative feedback from inhibin), LH high (no testosterone negative feedback)
6. Asherman syndrome: Both normal
7. Sheehan syndrome: Both low - Hypogonadotropic Hypogonadism
8. Imperforate hymen: Both normal
9. Menopause: Both high
10. Premature ovarian failure: Both high
84
Leydig cells produce?
Sertoli cells produce?
Testosterone
Inhibin (negative feedback on FSH)
85
9. Menopause and 10. Premature ovarian failure estrogen level?
Low
86
7. Sheehan syndrome estrogen level?
Low - no stimulus
87
Estrogen will be normal in?
6. Asherman syndrome & 4. Mullerian agenesis
88
Estrogen will be decreased in?
1. Turner syndrome
2. Gonadal dysgenesis
89
PALM-COIN classification is for?
and its full form
For abnormal uterine bleeding
Polyp
Adenomyosis
Leiomyoma - fibroid uterus
Malignancy - hyperplasia
Coagulopathy
Ovulatory cause
Endometrial
Iatrogenic
Not yet classified
90
MC cause of abnormal uterine bleeding in adolescent girl?
1st ans - Anovulation
2nd - coagulation defects
91
MC cause of abnormal uterine bleeding in perimenopausal girl?
Anovulation
92
Bleeding pattern in PCOS?
Oligomenorrhea followed by amenorrhea
(ovulatory cause)
93
Iatrogenic abnormal uterine bleeding causes?
OCPs and IUDs
94
Test for pregnancy in female of reproductive age group?
HCG test
95
Fern leaf of pattern on dried cervical mucous indicates?
Under effect of Estrogen + NaCl
Proliferative phase - follicular
96
Which hormone increases BBT? (Basal body temperature)
Progesterone by 0.5' F
97
What happened to temperature at the time of ovulation?
Decreased (because of Estrogen peak)
98
Primary amenorrhea diagnosed with an absence of menses by?
15 yrs - with secondary sexual characters present
13 yrs - without secondary sexual characters present
If there is no menses within 3 years of Thelarche
99
Primary amenorrhea + breast absent + uterus present, syndromes and test to be done?
Means no hormones or no ovaries
Gonadal dysgenesis/Swyer's syndrome, Turner syndrome, Kallmann syndrome
Test: FSH
100
Primary amenorrhea + breast present + uterus absent, DD and test to be done?
DD: Mullerian agenesis, AIS, Imperforate hymen
Problem in outflow but hormones present
Next test: USG
101
Uterus is absent in which conditions? And pubic hair in those conditions?
AIS (Absent or scanty)
Mullerian agenesis (normal Pubic hair)
102
Karyotype in Mullerian agenesis?
46XX
103
Karyotype in AIS?
46XY - Sx gonadectomy
104
Blind vagina is found in?
AIS - undescended testis - inguinal hernia
Sx gonadectomy
105
What is partial AIS?
Clitoromegaly
Reifenstein syndrome
106
How do we differentiate between 5-alpha reductase deficiency and partial AIS?
Breast development absent in 5-alpha reductase deficiency but they also have Clitoromegaly
107
Turner syndrome characterized by:
Short stature
45XO
Shield shaped chest
Webbed neck/Low post hairline
No Barr body
CVS: Bicuspid aortic valve/coarctation of aorta
Normal ID
Life span low
AID: DM/Hashimoto's/coeliac/IBD
Also knows as Hypergonadotropic Hypogonadism
TOC: HRT (E+P)
108
Kleinfelter's syndrome characterized by:
Tall stature
Male gynecomastia (high risk B-Ca)
Small fibrotic testis - no spermatogenesis
LH/FSH high and testosterone low
1 Barr body present
47XXY
IQ low
Type of primary Hypogonadism
109
Karyotype Of Turner and Klienfelter?
45XO and 47XXY
110
Karyotype Of AIS/partial AIS, 5-alpha red, Swyer?
46XY
111
Karyotype Of Imperforate hymen, Kallmann, Mullerian agenesis, Asherman?
46XX
112
Which conditions require gonadectomy?
AIS/partial AIS, Swyer's and 5-alpha def
113
Which conditions DO NOT require gonadectomy?
Klinefelter's, Turner's (only if mosaic pattern present in turner's)
114
Kallmann syndrome characterized by:
Anosmia
Also called Hypogonadotropic Hypogonadism (GnRH absent)
TOC HRT- GnRH pulsatile/Inj. gonadotropins
Normal karyotype
115
Imperforate hymen characterized by:
History cyclical pain
Uterus present and breast normal
Blood collection in vagina (HematoColpos or hematometra)
Uterus maybe enlarged because of blood collection
Acute presentation in ER: acute urinary retention
Local finding bluish bulging membrane
Increased risk of Endometriosis - Sampsons theory
TOC cruciate incision
116
Sampsons theory says?
Retrograde menses
117
Transverse vaginal septum characterized by:
No bluish bulging membrane
Upper 1/3rd vagina - Hematometra
TOC Excision or septum
Rest same as imperforate hymen
118
First step in secondary amenorrhea?
Rule out pregnancy
Serum HCG test
119
Hormonal profile to be done in secondary amenorrhea?
FSH, TSH, Prolactin
Additionally LH, testosterone, Estradiol
120
Raised prolactin level reason in secondary amenorrhea?
Microadenoma
DOC Cabergoline - dopamine agonist
121
Raised FSH level reason in secondary amenorrhea?
Clinical presentation:
No feedback inhibition means ovary not working, MC Premature ovarian failure/Premature menopause
less than 40 age, hot flashes, vaginal atrophy, infertility
122
Normal FSH level reason in secondary amenorrhea?
Overy working means inhibition feedback working
key words PCOS: oligomenorrhea, hirsutism, infertility
key words Asherman: history of curettage/MTP
123
Low FSH level reason in secondary amenorrhea?
Functional hypothalamic amenorrhea seen in stress/athlete/psychiatry patient
Sheehan syndrome: key word PPH/BT
124
MC cause of Asherman syndrome?
curettage (MTP) - done for PPH
125
Normal values of FSH?
4-10 IU
Low = 1-3 (in pregnancy because of progesterone high)
High = more than 10
126
MC presentation of Asherman syndrome?
TOC?
Menstrual irregularity - amenorrhea > hypomenorrhea
Pain
Infertility
recurrent pregnancy loss
All hormones normal
46XX
TOC Hysteroscopic adhesiolysis + E2 + Pediatric foley's catheter in uterus
127
IOC for Asherman syndrome?
Hysteroscopy (both diagnostic and theraputic)
128
Diagnostic criteria for PCOS?
Androgen levels in PCOS?
Rotterdam
Less than 150 (mild high)
129
Oligomenorrhea or amenorrhea in PCOS due to?
Anovulation
130
Hyperandrogenism clinical/biochemical scoring is called?
Ferriman gallwey
131
PCOS min cysts on USG? and ovarian volume?
Characteristic finding on USG?
>20 and 10 cc
String o pearl/necklace pattern
132
Which disorder has HAIRAN syndrome?
POCS
HA = hyperandrogenism
IR = Insulin resistance
AN = Acanthosis nigricans
133
Which hormone is high in POCS?
LH high (FSH normal), testosterone high
134
Which estrogen is raised in POCS?
E1 - Estrone
135
DOC POCS?
DOC of hirsutism in POCS?
OCPs -- 6 months -- add spironolactone
136
DOC of infertility in POCS?
Letrozole > Clomiphene
Letrozole is Aromatase inhibitor
137
Second line tx of infertility in POCS?
Injection gonadotrophins > laparoscopic ov dvilling
138
Serum AMH levels in POCS?
Raised AMH/glycoprotein
Source of AMH is preantral follicles
high AMH means good outcome for IVF and increased OHSS risk
139
First visible sign of puberty?
Growth spurt
Thelarche = tanner 2
140
Criteria for diagnosis of precocious puberty?
<8 yo for girls (MC reason idiopathic or central GnRH)
<9 for boys
141
DOC Precocious puberty?
Continuous GnRH agonist
also used in endometriosis, hirsutism, fibroid uterus, breast and prostate ca
142
Criteria for diagnosis of delayed puberty?
DOC?
No thelarche by 13 in girls
No testicular enlargement by 14 in boys
MC Constitutional delay
Tx Pulsatile GnRH
143
Average age of menopause?
Age of premature menopause?
51
(12 months amenorrhea)
<40 premature menopause and they have >25 FSH level
144
Which Estrogen is seen in post-menopausal women?
E1 - from adipose tissue
(lack of E2)
145
Which Estrogen is seen in pregnant women?
E1
146
MC symptom of menopause?
Hot flashes
147
Indications of starting HRT in menopause?
Hot flashes (Tx transdermal HRT)
vaginal atrophy (Tx local application HRT)
148
HRT with intact uterus in premature menopause?
E+P - till natural menopause
(increases risk of breast Ca)
149
HRT with post hysterectomy in premature menopause?
only E
(Increases risk of Endometrial ca)
150
Contraindications of HRT?
Breast or endometrial cancer, active liver disease, active thrombosis
151
DOC for postmenopausal osteoporosis?
Bidphosphonates, Ca and vitamin D
152
Premature ovarian failure + infertility DOC
Donor ovum + IVF
153
MC cause of male infertility?
Primary hypogonadism (abnormal spermatogenesis)
154
Sperm volume, pH, concentration, sperm number?
Volume 1.5 ml
pH 7.2
Concentration 16 million per ml (total 39 million)
Sperm number 39 million
155
Total motility and progressive motility?
Motility 40%
Progressive motility 30%
156
Most important criteria for natural conception?
Sperm morphology >4%
Less means asthenozoospermia (kartagener syndrome)
157
Test to differentiate between obstructive and non obstructive azoospermia?
LH, FSH (most imp), Testosterone
158
Example of obstructive azoospermia?
Cystic fibrosis
(All hormones normal)
159
Non obstructive azoospermia example?
Klinefelter syndrome
(LH, FSH high, Testosterone low)
160
Rx mild oligospermia? (Count Less than 15 million)
Intra uterine insemination
161
Rx if sperm count Less then 10 million?
IVF
162
If sperm count less than 5 million rx?
ICSI
163
Period of spermatogenesis and sperm fertilizable life span?
Spermatogenesis - 72 days
Sperm fertilizable life span - 72 hours
164
What enzyme is secreted in acrosomal rxn?
Hyaluronidase
165
What comes before acrosomal reacion?
Capacitation - Binding to ZP - Acrosomal reaction - Zona reaction
(Zona reaction prevents polyspermy)
166
Fertilizable life span of ovum?
24 hours
167
When is serum progesterone test for ovulation done?
D21 or 1 week before expected menses
168
Best test for ovarian reserch?
AMH
(MC FSH)
169
IOC for tubal patency?
HSG
170
Gold standard for tubal evaluation?
Lap chromopertubation
171
HSG shows bilateral block next step is?
Lapchromo + hystero-cannulation and best is IVF
172
HSG shows bilateral block with hydrosalpinx IOC?
IVF and salpingectomy for better outcome
173
GT mode of spread?
Hematogenous
or to uterus direct mode
174
MC site is of GT?
GT > ampulla > isthmus
175
Inital symptom of GT?
Infertility > Pain > Menstrual abnormality
176
Diagnosis of GT?
Endometrial biopsy for ASB
D1 Menstrual blood for PCR analysis
177
Bilateral cornual block is finding of?
GT
178
Tobacco pouch appearance and beads string, lead pipe, golf club appearance of ovary is seen in?
GT
179
Fibroid uterus MC type & presentation?
Intramural
Asymptomatic
180
If Fibroid uterus is symptomatic MC presentation?
Menorrhagia = HMB
181
Which fibroid is associated with infertility and recurrent pregnancy loss?
Submucosal
182
Tx Submucosal fibroid?
Hysteroscopic myomectomy
183
Type 0 fibroid is?
Pedunculated submucosal
184
Type 1 fibroid is?
>50% is inside canty
185
Type 7 fibroid is?
Pedunculated subserous
186
Red degeneration is seen in and presentation?
Rx?
In pregnancy 2nd trimester
Acute abdomen (history of fibroid)
Fever + raised TLC
Conservative management
187
Uterus characteristics in fibroid?
Enlarged
Non-tender
Irregular
Firm
can be as big as 20 weeks pregnant woman size
188
IOC fibroid?
USG
189
If Fibroid uterus is asymptomatic Rx?
No treatment or expectant management
190
If Submucosal uterus is symptomatic or asymptomatic with infertility Rx?
Hysteroscopic myomectomy
191
Intramural fibroids that cause bilateral cornual block + infertility rx?
Lap-myomectomy
192
Intramural fibroids with HMB DOC?
OCPs
193
Drugs that do not reduce size of fibroid but reduce bleeding?
OCPs
Tranexa
Mirena
194
Drugs that reduce size of fibroid but reduce bleeding?
GnRH agonist/antagonist
Ulipristal - SPRM
195
Adenomyosis symptoms and age group?
HMB + dysmenorrhea (progressive gets worse with age)
>40
196
Endometriosis age group?
Younger age 20-30
197
Uterus with adenomyosis is?
Enlarged symmetrical
Globular uterus (soft and tender)
Grows only upto 10-12 weeks size
198
Adenomyosis IOC?
TVS
MRI - junctional zone thickness
Confirmation diagnosis done with HPE
199
USG finding in Adenomyosis?
Venetian blind bands - alt dark and white pattern on USG
Heterogenous myometrium
Salt and pepper myometrium
Poorly defined junctional zone
200
TOC Adenomyosis
Hysterectomy
201
Endometrial polyp seen in age group?
Peri and post-menopausal
Tamoxifen risk factor
202
Symptom and USG finding of endometrial polyp?
Irregular bleeding Metrorrhagia
Smooth growth
203
IOC Endometrial polyp?
TVS
Doppler - feeder cavity vessel sign
204
TOC Endometrial polyp?
Hysteroscopy polypectomy
205
MC symptom of Endometriosis?
Pain, dysmenorrhea secondary
206
MC site of Endometriosis?
Ovary > Post leaf of broad ligament > pouch of Douglas
207
Cause of primary dysmenorrhea?
Progesterone Withdrawal PGF2 alfa
Mittelschmerz pain - mid cycle pain
208
MC theory of Endometriosis?
Sampsons
209
IOC of Endometriosis?
Laparoscopy
BUT TVS first always
210
IOC of chocolate cyst/endometrioma (adnexal mass)?
TVS
211
TOC for mild-moderate pain in Endometriosis?
OCPs + NSAIDsT
212
TOC for severe pain in Endometriosis?
GnRH agonist continuous
213
TOC for infertility due to mild Endometriosis?
CC + IUI for 3 cycles
214
TOC for infertility due to severe Endometriosis?
IVF
215
Sx done in Endometriosis?
Cystectomy
216
Both ovaries enlarged/kissing ovaries/bowel loops stuck TOC?
Sx
217
Drugs that can't be given in Endometriosis?
Estrogen
Endometriosis is an estrogen dependent disorder
218
IOC Mullerian anomalies?
3D USG
Best: Lapro + hysteroscopy
Screening: regular USG/HSG
219
Gold std IOC for Mullerian anomalies?
MRI
220
Shape of external shape of Uterus in septate uterus?
Normal
No dip in fundus
221
MC anomaly in septate uterus?
No dip in fundus
222
Acute angle between two Uterus angles means?
Septate Uterus
223
Septate uterus causes?
Recurrent pregnancy loss
224
TOC septate uterus?
Hysteroscopy or Transcervical/resection/meteroplasty
225
What we don't do in septate uterus?
Strassman's metroplasty
226
Which uterine disorder has worst reproductive outcome?
Septate uterus
227
Bicornuate uterus is caused due to?
Partial fusion
228
Bicornuate uterus external contour?
Dip - deep
229
Obtuse angle between 2 horns of uterus is found in?
Bicornuate uterus
230
Unicornuate uterus is associated with?
Ectopic ovary/pregnancy
Has high risk of UT anomalies
231
DES (Di-Delphius) causes?
T-shaped uterus
Clear cell adeno-ca
Hypospadias in male baby
232
Sx done for Bicornuate uterus and DES?
Strassman's metroplasty
233
Cause of Bicornuate uterus and DES?
Partial fusion - Bicornuate
Complete failure of fusion - DES
234
Two cervices found in which condition?
DES
235
Banana shaped deviated uterus is?
Uni-cornuate Uterus
236
All mullerian anomalies are associated with?
Increased risk of endometriosis
Retrograde menses
UT anomalies
237
Transverse lie is not possible in?
DES and uni-cornuate uterus
238
DES has highest association with?
Vaginal septum
239
MC HPV type associated with premalignant and cancerous lesions of cervix?
16 - MC
18
240
MC HPV type associated with condyloma accminata?
HPV 6, 11
Also cause laryngeal papillomatosis
241
Which HPV viral protein causes malignant transformation
E6 and E7
242
MC site for cancerous dysplasia is?
Transitional zone > SCJ > Ectocervix
243
Cervical Ca vaccine names?
Gardasil- 9 (American)
Cervavac = Quadrivalent
243
Cervical Ca vaccine made from which protein and its against which HPV types?
L1 capsid protein
6, 11, 16, 18
243
Dose schedule for Cervical Ca vaccine Gardasil according to SAGE WHO?
<21 yo 1/2 doses
>21 yo 2 doses
Still do screening after vaccine
243
Gardasil- 9 is against which HPV types?
16, 18, 6, 11, 31, 33, 45, 52, 58
244
Side effects of Cervical Ca vaccine?
Syncopal attack
244
HPV 16+18 %age ca?
70%
244
Dose schedule for Cervical Ca vaccine Cervavac?
<15 yo 2 doses (0, 6 m)
>15 yo 3 doses (0, 2, 6 m)
Still do screening after vaccine
244
Cervical Ca Vaccine not given in?
Pregnancy
245
Best screening test for premalignant lesions is?
HPV > VIA > PAPS
246
WHO Recommendation of cervical cancer for resource limited countries?
Start screening at: 30
Stop screening at: 50
Protocol: screen (screen triage) and treat
Interval HPV testing: 5 yearly (10 yearly)
Interval for VIA and PAPS: 3 yearly
TOC: LEEP
247
MC symptom of Ca cervix?
Most specific symptom of Ca cervix?
Irregular bleeding
Post-coital bleeding
248
MC age group of Ca cervix?
3-4th decade
249
MC type of Ca cervix?
SCC > Adeno Ca
250
MC site of Ca cervix?
Transformation Zone
251
MC mode of spread?
Direct
252
MC cause of death in Ca cervix?
Uremia (renal failure)
253
Staging for Cervical Ca?
Clinical
254
IOC Cervical Ca?
MRI: parametrial spread
CTPET: LN
Bladder: cystoscopy
255
Cervical Ca hydronephrosis in which stage?
Stage 3b
256
1B3 Cervical Ca stage is?
>4 cm
257
2B Parametrium Cervical Ca stage is?
Parametrium spread
258
3B stage Cervical Ca is?
Hydronephrosis/lat. pelvic wall
259
4B stage Cervical Ca is?
Distant spread
260
3A stage Cervical Ca is?
Lower 1/3rd vagina spread
261
3C stage Cervical Ca is?
LN
262
Stage 2 Cervical Ca?
Upper 2/3rd vagina
263
TOC stage 1a1 Cervical Ca?
Conization (incomplete family)
Type 1 hysterectomy - simple hysterectomy (complete family)
264
TOC 1b1 Cervical Ca
<10 mm type 1 hysterectomy
>10 mm type 2 hysterectomy (modified radical)
265
TOC 1b2 Cervical Ca?
Type 3 hysterectomy
266
TOC beyond 1b3 Cervical Ca?
Chemoradiation
DOC: Cisplatin
267
MC cause of post-menopausal bleeding?
Atrophy > Polyp > hyperplasia/cancer
268
Woman presents with postmenopausal bleeding, next step?
TVS
269
If on USG Endometrial thickness is more than ______ then do _____.
4 mm, Endometrial biopsy (IOC)
270
Endometrial biopsy cannula used?
Karman's cannula - India
Pipelle outside India
271
MC complaint in Endometrial Ca?
Irregular bleeding
272
Drug associated with Endometrial Ca that increases risk?
Tamoxifen
273
Which ovarian ca is high risk?
GCC
274
Which syndrome is high risk for Endometrial Ca?
Lynch/PTEN/PCOS
275
Gene associated with type 1 cancer?
PTEN - good prognosis
276
Gene associated with type 2 cancer?
P53 - bad prognosis
277
Which Endometrial Ca has worst prognosis?
Clear cell ca
278
TOC for hyperplasia with atypia is?
Hysterectomy (+BSO if post-menopausal)
279
TOC for hyperplasia without atypia is?
Mirena > MDA (medroxyprogesterone acetate)
280
Staging for Endometrial Ca is?
Surgical - direct spread
281
TOC Endometrial Ca
Sx - hysterectomy + BSO
+ adjuvant chemo if stage 3/4 (carboplatin + paclitaxel)
282
MC type of simple cyst mass in ovary present in women of reproductive age? TOC?
Follicular cyst
Expectant - follow up USG 2-3 months
283
IOC for ovarian mass?
TVS
284
Pelvic mass in young girls MC type?
Germ Cell tumors
Mostly unilateral
285
Features of malignant ovarian mass on USG?
Solid components
think septae
Increased vascularity in septae
>10cm
Papillary excrescences
Ascites
Enlarged LN
286
Ca marker for Serous cyst adenocarcinoma?
CA125
MC type of Ca
287
Most ovarian Ca arise from?
Epithelial tissue 90% - P53 mutation
288
Ca marker for Dysgerminoma? (germ cell)
LDH (raised HCg also found but never AFP)
289
Ca marker for Yolk sac tumor (endodermal sinus tumor)?
AFP (sometimes LDH but never HCG)
290
Ca marker for Choriocarcinoma (germ cell)?
HCG
291
Ca marker for Mucinous? (epithelial ov-ca)
CA19.9 or CEA
292
Ca marker for Granulosa cell tumor? (sex cord ca)
Inhibin (secretes Estrogen)
293
What's found in Brenner's tumor?
Wallthard cell nest - transitional epi
coffee bean nucleus
294
What's found in yolk sac tumor?
Schiller duval bodies
295
What's found in dysgerminoma tumor?
Septae = have lymphocytic infiltration
296
What's found in Dermoid tumor?
Mature teratoma = Rokitansky protruberance
297
What's found in Kruckenberg tumor?
Signet ring cells
298
What's found in Granulosa cell tumor?
Call exner bodies = coffee bean
299
What's type in Stroma and sex cord ovarian tumor?
Granulosa cell
Sertoli-leydig
thecoma
fibroma - benign tumor
meigs syndrome
300
Meigs syndrome present in which tumors?
Granulosa cell
Fibroma (MC)
Thecoma
Brenner
301
What's type in Germ cell ovarian tumor?
Dysgerminoma - malignant
Dermoid (benign)
EST (YST)
Chorio Ca
302
What's type in Epithelial ovarian tumor?
Serous (MC)
Mucinous
Brenner's
Endometroid
Clear cell
303
Features in Epithelial ovarian tumor?
P53 mutation
Bilateral
MC
90%
304
Staging of Epithelial ovarian tumor is done?
Percentage of ovarian ca which are familial?
Surgical
10% - seen in 5th decade
305
Familial ovarian ca gene?
BRCA
If positive, next step prophylactic BSO
306
TOC ovarian ca?
Sx - TAH + BSO followed by adjuvant chemo (6 cycles)
Carboplatin + paclitaxel
307
Dermoid cyst features?
Benign
Germ cell
unilateral
TOC ovarian cystectomy
308
MC ovarian tumor in reproductive age?
Dermoid cyst
MC tumor to undergo torsion during pregnancy 2nd trimester
309
Dysgerminoma features?
Red/tan
Lobulated
solid
Unilateral (Bilateral in 20% cases)
310
Call exner bodies features?
Rosette-like cells
Granulosa cell tumor - secretes estrogen
311
MC ca among Indian women?
Breast > cervical
312
In bacterial vaginosis Lactobacilli are MC replaced by?
Gardnerella vaginalis
313
MC complaint of bacterial vaginosis?
Foul smelling discharge
NO burning/itching
Thin grey/off white discharge pH > 4.5
Whiff test - 10% KOH - fishy smell
No inflammation
314
Test done for bacterial vaginosis?
Whiff test - 10% KOH - fishy smell
Clue cells on microscopy
315
Amsel criteria is used for diagnosis of?
Bacterial vaginosis
pH > 4.5
Grey/off white
whiff test
clue cells
ANY 3 NEEDED
316
Kit for bacterial vaginosis and Trichomonas vaginalis?
Kit 2 - green
317
Trichomonas vaginalis features?
Foul smelling discharge - green/yellow - frothy
Pruritus, dyspareunia, urinary symptoms
Inflammation present
Strawberry cervix
pH >4.5
Kit 2 - green
it is an STD
318
Candida vaginalis features?
Pruritic
curdy white - no smell
pH > 4.5
Kit 2 - green
319
DOC Candida vaginalis?
Fluconazole
320
No partner treatment needed in which vaginal infection?
BV > candida vaginalis
321
DOC Bacterial vaginosis/trichomonas vaginalis?
Metronidazole - can be given in pregnancy
Clindamycin
322
Name of physiological discharge from vagina?
Leukorrhea - increased watery discharge - no bad smell
no other symptoms
pH normal
323
Define PID?
Upper genital tract (uterus, FT, ovaries or peritoneum also sometimes)
Young girls 15-25
Polymicrobial infection
324
MC causative agent of PID?
Chlamydia > gonorrhea (STD)
If girl virgin suspect TB
325
PID symptoms?
Lower abdominal pain
Cervical motion/adnexal/uterine tenderness
326
If woman with PIC develops right upper quadrant pain, diagnosis is?
Fitz hugh Curtis (perihepatitis)
Violin string adhesions between ant abdominal wall and liver capsule
Agent: Chlamydia
327
IOC PID?
Laparoscopy
first TVS
328
Kit for PID?
Kit 6 - yellow
329
If patient comes with vaginal discharge, first thing we do is?
PS exam
if we find: discharge from OS/erosion/ulcer then kit 1
330
Long term complication of PID?
Infertility - Best ans
Ectopic
Chronic pain
Hydrosalpinx
331
Clue cells border features?
Studded border with bacteria
331
Muscle in pelvic diaphragm?
Levator ani - three parts puborectalis, pubococcygeus and iliococcygeus
332
3 main supports for Uterus are?
Cardinal, uterosacral and pubocervical ligament
333
Cystocele location and symptoms?
Sx?
Upper 2/3rd anterior vaginal wall
Urinary symptoms
Sx Anterior colporrhaphy
334
Rectocele location and symptoms?
Sx?
Lower 2/3 posterior vaginal wall
Rectal symptoms
Sx Posterior colpoperineorrhaphy
335
Sx for vault prolapse?
Abdominal approach: Sacrocolpopexy (better)
Transvaginal approach: Uterosacral suspension (MC)
336
Sx for enterocele?
McCalls culdoplasty
337
When we do Obliterative procedure?
When patient has comorbidities so smaller sx needed
Leforte's colpoclesis
338
Sx for prolapse in women in reproductive age?
Sling sx - Shirodkar abdominal sling
Manchester = Fothergills = CV elongation, done if Utero-Cervix Length > 12.5
339
Tx decubitus ulcer?
Cause of decubitus ulcer?
AG packing (acridine glycine packing)
Venous congestion
340
MC cause of urinary incontinence in young women?
Gold standard sx?
TOC?
SUI
Colpo-suspension (not for vault prolapse)
TOT/TVT
341
MC cause of VVF in developing countries?
Obstructed labor
(developed post sx)
342
VVF presents after?
7-10 days post sx
343
Continuous leakage of urine + no normal voiding indicates?
VVF
(in uterovaginal fistula there is normal voiding)
344
IOC VVF?
3 swabs test
wet + stained: VVF (methylene blue dye in bladder)
only wet: Ureterovaginal
345
Sx preferred for VVF?
Latzko (vaginal)
after 3-6 m of obstructed labor
Bladder catheter should be left for 10-14 days
this is an indication to do classical CS delivery after pregnancy
if repair fails do it again in 3 months
346
After VVF avoid intercourse for at least?
3 months (3-6 m)
347
After VVF avoid pregnancy for at least?
1-2 years
348
When is pessary given in prolapse?
Inoperable
Pregnant
Puerperium
2nd degree prolapse (not yet outside vagina)
349
MOA of OCPs?
Inhibits ovulation
LH+FSH both
350
Contraindications of OCPs?
Diabetes with vasculopathy
Known case of Breast ca
Migraine with aura
Active liver disease
HTN
Stroke - CAD - VTE
Hepatocellular adenoma
Smoker >35 yo
Breastfeeding
351
OCPs are protective for?
Endometrial CA
Colon CA
Ovarian CA
352
OCPs are risk factor for?
Breast CA
Cervical CA
Hepatocellular adenoma
353
Benefits of OCPs?
Irregular cycles
HMB
Dysmenorrhea/endometriosis
PCOS
Ovarian cyst
Hyperandrogenism - hirsutism
HRT in primary hypogonadism
Reduction of ovarian cyst + endometrial cyst
354
DOC PMS?
SSRI
355
Minipill is a?
Progesterone only pill
Taken daily - 28 days at same time
28 hormonal pills
356
Side effects of Progesterone only pills?
causes Irregular bleeding
Increases ovarian cyst
Increases acne
357
MOA Progesterone only pills?
Alteration of cervical mucous
358
Progesterone only pills are DOC for?
Lactation
359
What generation IUD is cooper-T?
2nd gen for 10 years
360
What generation IUD is mirena/kyleena?
3rd gen for 8 years
360
IUD cooper load is viable for?
5 years
360
MOA IUD?
Inhibition of fertilization > Implantation
360
Contraindications of IUD?
Undiagnosed abnormal uterine bleeding
Current pelvic infection
Distorted uterine cavity - even in fibroids
suspected pregnancy
Wilson's disease for cooper-T
Breast CA for mirena
361
Tubal ligation is done at which part of FT?
Isthmus
Effective immediately
362
Name of surgery where we do Fimbriectomy?
Kroner's technique
363
Name of surgery where Crushing is also done?
Madlener
364
Best tubal ligation sx we do nowadays?
Modified Pomeroy - plain catgut is used
365
Method used for Vasectomy?
Failure rate?
NSV
0.1%
366
MC side effect of Vasectomy
Bleeding
367
Reversal rate of Vasectomy?
50-70%
368
LH surge is due to?
Estradiol
369
PIPPELE is used for?
Endometrial biopsy
370
Smoking is protective for?
Pre-eclampsia
Endometrial ca
371
Biopsy should be done in which phase?
Premenstrual/pre-luteal/secretory
372
Progesterone of choice for emergency contraception?
LNG tab MC used, up to 72 hours post coitus
1.5 mg single dose
(0.75 twice with 12 hours apart)
373
Agent for CIN3/Cancer cervix is?
HPV18
374
Most effective emergency contraception?
Copper IUD - up to 120 hours/5 days or on 5th day
Ulipristal - most effective hormonal 30 mg single dose - up to 5 days
375
MOA emergency contraception?
Delaying ovulation + preventing fertilization
376
Yuzpe method of emergency contraception?
OCPs 100 mg EE + 0.5 mg LNG
Repeated after 12 hours
377
Plan B for emergency contraception?
LNG tab
378
Temoxifen used for treatment of?
And it increases risk of?
Breast cancer
Increases risk of endometrial cancer
379
Ritodrine is used for?
Complications?
Prevent premature labor
Causes tachycardia, hypoglycemia, tremors
