OB-GYN

Question 1

Noonan syndrome

Answer 1

• an autosomal dominant genetic disorder of congenital malformations.

The characteristic phenotypic features of Noonan syndrome are:

• characteristic facial dysmorphic features: hypertelorism, downward slanting eyelid slits, ptosis, low-set ears with a thickened rim, wide short neck, sometimes with fluff features
• organ abnormalities: defects of the cardiovascular system (especially pulmonary valve stenosis), kidney defects, cryptorchidism in boys,
• abnormalities of the skeletal system: short stature, deformities of the sternum (shoemaker’s or chicken’s chest), valgus of the elbows, scoliosis, vertebral defects (semi-circles), rib defects,
• usually a light blue color of the irises
• disorders of the lymphatic system
• tendency to ecchymosis,
• blood clotting disordershearing loss,
• deafness.

Question 2

Prader-Willi syndrome (PWS)

Answer 2

is a birth defect syndrome caused by a deletion in the long arm of the father’s chromosome 15.

The disease occurs with a frequency of 1: 10 thousand. up to 1: 50,000 live births. In older sources, the acronym -HHHO was used, derived from the words: hypotonia-hypomentia-hypogonadism-obesity, that is: muscle hypotonia, mental retardation, underdevelopment of the genital organs, obesity

. The characteristic morphological features include: bulging forehead, amygdala eyes, narrow face, small lower jaw, small hands and feet.

Question 3

Angelman syndrome

Answer 3

is a neurogenetic disorder that is caused by the inactivation of the UBE3A gene (E3 ubiquitin ligase), the product of which combines ubiquitin with a protein product to be degraded. As a result of the mutation, pathologically large amounts of protein accumulate, which disrupts the development and function of the CNS.

The syndrome is manifested by intellectual disability, seizures that are difficult to control, impaired speech development, uncontrolled bouts of laughter and movement stereotypes (the so-called happy puppet syndrome).

Question 4

Klinefelter’s syndrome

Answer 4

is a genetically determined genetic disease that belongs to numerical aberrations with at least one additional copy of the X chromosome (47 XXY).

Klinefelter’s syndrome is the most common cause of male hypogonadism, with a frequency of 1: 500-1: 1,000 live-born male newborns.

The most typical features of these patients are tall stature, feminine silhouette, long limbs and small testicles.

Question 5

Alport syndrome

Answer 5

genetically conditioned disease (type IV collagen defect)

revealed in childhood

Clinical picture of the disease:

progressive nephropathy

micro/macrohematuria

later, increasing proteinuria appears

may be accompanied by hypertension

the disease leads to end-stage renal disease

bilateral sensorineural hearing loss

eye changes:

• lenticonus
• pigmented retinal changes
• corneal ulcers

leiomiomatosis

aneurysms

Question 6

Magnesium Sulfate MOA

Answer 6

decreases uterine tone and contractions by acting as a calcium antagonist and a membrane stabilizer.

Question 7

Terbutaline MOA

Answer 7

acts by increasing conversion of ATP to cAMP, which decreases free calcium ions through sequestration in the sarcoplasmic reticulum.

Question 8

Calcium channel blockers

Answer 8

decrease intracellular calcium, which reduces uterine contractility

Question 9

Indomethacin MOA

Answer 9

blocks the enzyme cyclooxygenase and decreases the level of prostaglandins, which decreases intracellular levels of calcium and therefore decreases myometrial contractions.

Question 10

Flushing, diplopia, and headache are common side effects of

Answer 10

magnesium sulfate

Question 11

Women taking terbutaline often note

Answer 11

headache, tachycardia, and anxiety.

Question 12

Calcium channel blockers such as nifedipine can cause

Answer 12

headache, flushing, and dizziness.

Question 13

indomethacin has been associated with

Answer 13

the premature closure of the ductus arteriosus in the neonate.

Question 14

The most effective test to monitor patients for magnesium toxicity is through

Answer 14

serial DTR examination. DTRs are diminished and then lost with magnesium serum levels between 6 and 10 mg/dL.

Toxic levels of magnesium (>10 mg/dL) result in respiratory depression, hypoxia, and cardiac arrest.

Serial DTR examination is therefore a cost-effective screening test for magnesium toxicity.

Serum levels are not necessary unless there is concern for absent DTRs or patients show symptoms of respiratory depression.

Question 15

Rubin maneuver.

Answer 15

This maneuver involves pressure on either fetal shoulder to diminish the biacromial diameter in an effort to free the anterior shoulder and allow delivery of the fetus.

Question 16

McRoberts maneuver is described first and involves

Answer 16

flexing the maternal hips, which results in ventral rotation of the maternal pelvis and an increase in the size of the pelvic outlet.

It is the least invasive of maneuvers.

Next, suprapubic pressure is applied by directing force just above the pubic symphysis in an oblique direction.

The goal of this maneuver is to disimpact the anterior shoulder.

It is very important that pressure be applied obliquely to free the shoulder, because downward pressure will not change the biacromial diameter.

Question 17

Wood cork maneuver involves

Answer 17

placing a hand behind either the anterior or posterior fetal shoulder and rotating the fetus 180 degrees to lead to descent and delivery of the shoulders.

Question 18

Papillary cancer -

Answer 18

accounts for about 80% of thyroid cancers (the most common malignant thyroid cancer). Metastasis mainly through lymphathic system.

Its only symptom can be an enlarged lymph node nearby the trachea or lateral neck (this is the metastasis of occult papillary cancer).

Question 19

Follicular cancer -

Answer 19

represents about 20% of thyroid cancers, grows slowly as a single tumor.

Unlike papillary carcinoma, it rarely spreads via the lymphatic pathway (much more frequently through the bloodstream to the lungs and bones).

Question 20

Anaplastic cancer

Answer 20

• i.e. undifferentiated - accounts for about 5% of thyroid cancers and is usually present in elderly people (over 60 years of age).

It occurs on the basis of differentiated, papillary or follicular cancer, usually infiltrates surrounding tissues.

Question 21

Medullary cancer

Answer 21

• it accounts for about 5% of thyroid cancers and may be genetically conditioned (tumors usually occur bilaterally, may co-occur with parathyroid adenoma and phaeochromocytoma of the adrenal medulla).

It is metastasized by both the lymphathic and blood pathways. It grows slowly, produces and secretes CEA and calcitonin.

Question 22

The second most common thyroid cancer is:

Answer 22

Follicular cancer

Question 23

Some facts about thyroid cancer:

6 pts

Answer 23

A characteristic symptom of medullary cancer is diarrhea .

Frequent in medullary cancer is family occurrence ( RET mutation ).

Rapid progression is characteristic of anaplastic cancer.

In anaplastic cancer, the characteristic symptom is dyspnea .

Differentiated cancers can be treated with radioactive iodine .

Thyroid cancer is 4 times more common in women .

Question 24

general symptoms:

in the case of an advanced stage of the cancer, symptoms associated with infiltration of other organs or the presence of distant metastases may occur

Answer 24

fever

lack of appetite

weight loss

iron deficiency anemia

presence of blood in / on the stool

Question 25

*right colon cancer* (including caecum) Symptoms depend on the location of the cancer

Answer 25

dull ache in the area of the abdomen on the right side, near the navel or abdomen stool dark, brown or mixed with blood, anemia tumor perceptible in the middle/ lower abdomen on the right side

Question 26

*cancer of the left half of the colon* (including the sigmoid colon): Symptoms depend on the location of the cancer

Answer 26

flatulence often painful colic fresh admixture of blood in the stool change of the defecation rhythm obstruction (bloating, pain, nausea, vomiting, constipation)

Question 27

***rectal cancer*** Symptoms depend on the location of the cancer

Answer 27

admixture of bright red blood feeling of incomplete defecation, diarrhea impossible to suspend an intestinal colic causing the need to defecate abdominal pain, crotch

Question 28

*Blood group A* increases the risk of

Answer 28

***stomach cancer***

Question 29

***Antiphospholipid Syndrome (APS)*** is an autoimmune disorder associated with the presence of *antiphospholipid antibodies*, which include:

Answer 29

* anti-cardiolipin antibodies* * antibodies against β2-glycoprotein I* * lupus anticoagulant*

Question 30

***Recurrent miscarriages*** always require careful diagnostic evaluation. Causes of *recurrent miscarriages* include:

Answer 30

Anatomical factors (uterine fibroids, intrauterine adhesions, birth defects) Corpus luteum dysfunction Antiphospholipid syndrome Thyroid dysfunction Diabetes mellitus

Question 31

Most miscarriages in women with APS occur in the _______ of pregnancy. Treatment: The recommended therapy for pregnant women with APS consists of ?

Answer 31

Most miscarriages in women with APS occur in the ***first trimester*** of pregnancy. ***Treatment:*** The recommended therapy for pregnant women with APS consists of ***acetylsalicylic acid and heparin,*** which *increases the chance of giving birth to a healthy child.*

Question 32

Which of the following *changes in blood morphology* occurs in the ***second trimester*** of normal pregnancy? ***physiological hemodilution*** in pregnancy. Thus we can observe during morphological analysis:

Answer 32

* a **decrease** in _hematocrit_ value* * a **decrease** in _hemoglobin_* * a **decrease** in _platelets_* * leukocytes may be normal or slightly elevated*

Question 33

During pregnancy, there is also an increase in the production of the ***coagulation factors:*** ***Name*** * and* * we observe a **decrease in the concentation of*** **endogenous anticoagulants** such as \_\_\_ ___ and \_\_\_ This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of\_\_\_\_\_

Answer 33

***I, II, V, VII, VIII, X, XII*** and we may observe a decrease in the concentration of endogenous anticoagulants such as ***protein C and S.*** This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of ***thromboembolism.***

Question 34

*Symptoms depend on the location of the cancer*: right half of the colon - left half of the colon - rectum -

Answer 34

right half of the colon - ***increasing anemia and abdominal pain.*** left half of the colon - ***change in bowel habits, diarrhea with lots of mucus or constipation, blood in the stool.*** rectum - ***a tumor palpable during per rectum examination.***

Question 35

The most *important examination in the diagnosis of colorectal cancer* is \_\_\_\_\_\_, which allows *to visualize the tumor growing in the intestine and enables the collection of biopsies for histopathological examination.* Based on the hist-pat examination, the ***TNM classification*** is assessed. the ***"T" characteristic means:***

Answer 35

***colonoscopy*** Based on the hist-pat examination, the ***TNM classification is assessed.*** **Tis** - infiltration of the mucosa, **T1** - infiltration of the submucosa, **T2** - muscle membrane infiltration, **T3** - infiltration of periocecal / perianal tissues, **T4** - infiltration of adjacent organs / structures or visceral peritoneum.

Question 36

Colorectal cancer - most of the procedures are performed using the classic method, but ***laparoscopic operation***s are *becoming more common* depending on the location of the tumor, there are:

Answer 36

* segmental resections:* transverse colon tumors, sigmoid tumors * right hemicolectomy:* caecum tumors, ascending colon tumors * left hemicolectomy:* descending colon tumors, sigmoid tumors * dilated hemicolectomy* * Hartman's operation:* tumors of the left half of the large intestine (including sigmoid colon).

Question 37

***fetal lie***-

Answer 37

the ratio of the long axis of the fetus to the long axis of the uterus and birth canal *Possible position types:* longitudinal transverse oblique

Question 38

***position-***

Answer 38

the ratio of individual parts of the fetus to the uterus for the longitudinal position, the ratio of the fetal back to the uterus is determined in the case of transverse and oblique position - the ratio of the head of the fetus to the uterus ***setting I**-* fetal back / head on the left side ***setting II*** - fetal spine / head on the right side

Question 39

***attitude-***

Answer 39

the ratio of parts of the fetus to each other Depending on the ratio of the head to the torso while passing through the birth canal, the following arrangement can be distinguished: well-flexed deflexed

Question 40

***engagement -***

Answer 40

ratio of the leading part to the plane of the pelvic brim (measured in centimeters)

Question 41

Tay-Sachs disease (GM2 gangliosidosis)

Answer 41

- a genetically determined disease from the group of storage diseases consisting in the accumulation of fatty substance - GM2 ganglioside in nerve cells of the brain. - a rare genetic disorder passed from parents to child. It's caused by the absence of an enzyme that helps break down fatty substances. These fatty substances, called gangliosides, build up to toxic levels in the brain and spinal cord and affect the function of the nerve cells

Question 42

*Phakomatoses*

Answer 42

group of developmental disorders of tissues from three germ layers, which are manifested by changes in the skin, nervous and vascular systems and co-occurring defects of internal organs.

Question 43

***Asherman's syndrome*** is

Answer 43

adhesions in the uterine cavity that completely or partially close its lumen. This is manifested by either little or no bleeding. The most common causes of ***Asherman's syndrome are***: *curettage of the uterine cavity, endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.*

Question 44

The *Mayer-Rokitansky-Küster-Hauser syndrome*

Answer 44

*congenital syndrome characterized by aplasia of structures* originating in the ***Muller's ducts,*** i.e. the uterus and vagina. Primary amenorrhea is the most common cause of medical reports.

Question 45

***Couvelaire syndrome*** (uteroplacental stroke)

Answer 45

is a rare, life-threatening complication of pregnancy in which the detachment of the placenta is accompanied by an infiltration of the uterine muscle with blood that almost reaches the serosa.

Question 46

dehiscence

Answer 46

the splitting or bursting open of a pod or wound.

Question 47

Conditions in which the occipital softening may occur : Name 2 What leads to Rickets?

Answer 47

***rickets*** ***excessive supply of phosphates in the diet*** → phosphates bind with ionized calcium and accumulate in soft tissues → low level of calcium in the serum stimulates the secretion of PTH (secondary hyperparathyroidism) → bone calcium release → rickets

Question 48

*The Ehlers-Danlos syndrome* the following occur in the course of the disease:

Answer 48

related to, among others, ***abnormalities in morphology of collagen*** - excessive mobility in the joints (subluxation, dislocations, joint deformities, exudates) - excessive skin stretching (formation of hernia) - fragility of blood vessels (easy bruising) - problems associated with sight (myopia, retinal detachment) - no softening of the bones is found

Question 49

***Craniotabes*** Define:

Answer 49

(softening and thinning of occipital and parietal bones)

Question 50

***A dizygotic pregnancy***

Answer 50

is one in which two separate eggs were fertilized (for this to occur, polyovulation must happen) at one time. As a result, two genetically different fetuses develop. They differ in the same way as siblings from two separate pregnancies. This pregnancy will always be dichorionic and diamniotic

Question 51

***A monozygotic pregnancy***

Answer 51

is a more complicated process. It is a pregnancy in which as a result of fertilization of one egg cell by one sperm, 2 identical embryos are formed. This is done by splitting of the initially single zygote. A very important element of this division is the time from fertilization in which this division takes place:

Question 52

A very important element of this division is the time from fertilization in which this division takes place: ## Footnote * if within 4 days of fertilization:* * if between 4 and 7 days after fertilization:* * if after day 7:* * if after 13 days:*

Answer 52

* if within 4 days of fertilization* - ***it will be a dichorionic, diamniotic pregnancy*** * if between 4 and 7 days after fertilization* - ***it will be a monochorionic, diamniotic pregnancy*** * if after day 7* - ***it will be a monochorionic monoamniotic pregnancy*** * if after 13 days* - t***here is a very high risk that the fetuses will be somehow connected to each other (conjoined twins)***

Question 53

***chorion***

Answer 53

- is one of the membranes that is involved in the creation of the placenta - - it is quite significant and is related to serious consequences (which were explained in discussion under the question about TTTS)

Question 54

***amnion***

Answer 54

is also one of the fetal membranes that, when filled with fluid, creates a safe environment for the development of the embryo.

Question 55

* diaphragmatic hernia (define)* * Name two types:*

Answer 55

. This disease happens when the ***abdominal organs are displaced into the chest cavity through a hole in the diaphragm***. _2 types of diaphragmatic hernias:_ ***anterior*** - *Morgagni -* usually on the right side ***postero-lateral*** - *Bochdalek* - 90% of cases, usually on the left side

Question 56

***Anemia*** is common in pregnant women. It is diagnosed at the level of

Answer 56

hemoglobin \<11g / dl

Question 57

***non-pregnant women*** who have *anemia diagnosed* at

Answer 57

***Hb \<12 g / dl***

Question 58

In the course of pregnancy, the ***volume of blood is?*** This uneven growth leads to a ?

Answer 58

In the course of pregnancy, the volume of blood is ***increased by as much as 40-45%, and the mass of erythrocytes by 18-25%***. This uneven growth leads to a ***decrease in hematocrit and the occurrence of anemia.***

Question 59

Prader-Willi syndrome

Answer 59

is a multisystemic congenital disease, associated with genetic imprinting. The cause of the syndrome is the deletion of a Chromosome 15 fragment from the father. In the clinical picture during the neonatal period, hypotonia, lack of sucking reflex (hence feeding problems) dominate, while starting at the age of 2 years the phenotype is dominated by increased appetite, which results in the rapid development of obesity. There is also hypogonadism and intellectual disability.

Question 60

*Prader-Willi syndrome.* Characteristic features of the syndrome

Answer 60

short stature, small hands and feet, facial dysmorphia (amygdala eyelids, narrow upper lip, small lips, hypopigmentation of the skin and hair) and behavioral disorders (in this patient it may be skin picking). All these features speak for Prader-Willi syndrome.

Question 61

***Klinefelter syndrome*** characterized by

Answer 61

delayed puberty - the most common cause of hypergonadotrophic hypogonadism. Other symptoms include tall stature, female physique, gynecomastia, no voice mutation, and erection problems.

Question 62

Alström syndrome

Answer 62

is a rare genetic disease. The disease is caused by an autosomal recessive inherited mutation in the ALMS1 gene located on Chromosome 2. The main disorder is congenital retinal dystrophy which causes blindness, deafness and obesity. Photophobia and nystagmus are most commonly seen as the first symptoms of the syndrome. There is no reduced muscle tone or feeding problems.

Question 63

Carpenter syndrome

Answer 63

is one of the forms of APS-2, i.e. polyglandular (hypofunction) autoimmune syndrome type 2. It consists of: primary hypoadrenocorticism, autoimmune thyroid disease and type 1 diabetes. It manifests most often at the age of 20-40.

Question 64

The first node to drain the lymph from the tumor is called?

Answer 64

the ***sentinel node***

Question 65

*Invasive breast cancer* can also spread through the so-called?

Answer 65

***Rotter route***, i.e. the *_intermuscular route_*, then it *metastases directly* to the ***second and third degree axillary nodes***

Question 66

The most common type of malignant breast cancer? common location?

Answer 66

is ***adenocarcinoma***, its most common location is the ***superior external quadrant***.

Question 67

The ***two main types of adenocarcinoma***s are:

Answer 67

***Ductal cancer*** - which occurs in the cells lining the milk ducts of the breast (as in the case of the patient in the question) ***lobular carcinoma*** - arising in the cells of the mammary glands.

Question 68

***Malignant Primary Germ Cell Tumors*** name 6

Answer 68

Dysgerminoma Yolk sac tumor Embryonal carcinoma Polyembryoma Nongestational choriocarcinoma Mixed germ cells

Question 69

Biphasic or Triphasic Teratomas name 2

Answer 69

Immature teratoma Mature teratoma

Question 70

*Monodermal Teratomas and somatic-type Tumors associated with Dermoid Cysts* Name 6

Answer 70

Thyroid tumor Struma ovarii Carcinoid Neuroectodermal-type tumors Glioblastoma Melanoma

Question 71

treatment of *stress urinary incontinence (SUI)* is

Answer 71

***duloxetine.***

Question 72

Duloxetine (similar to venlafaxine) belongs to the drug group of \_\_\_and \_\_\_- MOA?

Answer 72

Duloxetine (similar to venlafaxine) belongs to the drug group of ***serotonin and noradrenaline reuptake inhibitors (SNRIs).*** The *proposed mechanism* for its action is probably the increase in bladder capacity and contractility of the urinary sphincter (via the noradrenergic mechanism -\> α1-adrenergic and serotonin stimulation -\> stimulation of 5HT2 receptors in the pudendal nerve). Clinical studies have shown it is highly effective compared to placebo groups. The recommended dose is ***40 mg/day.*** However, application in depression and anxiety disorders, as well as neuropathic pain in the course of diabetes, remain the main indications for duloxetine.

Question 73

Other groups of drugs used in the treatment of stress urinary incontinence include:

Answer 73

***estrogens, α2-adrenergic agonists, cholinolytics*** (e.g. oxybutynin).

Question 74

test interpretation **down syndrome**

Answer 74

low AFP, low estriol, increased hCG

Question 75

test interpretation Edwards syndrome

Answer 75

low AFP, low estriol, low hCG

Question 76

Test interpretation ***neural tube defects***

Answer 76

***high concentration of AFP***

Question 77

malignant non-epithelial tumors of the ovary Germinal tumors: *name 7*

Answer 77

dysgerminoma yolk sac tumor embryonic tumors polyembryoma choriocarcinoma teratomas: *immature & mature* mixed germinal tumors

Question 78

malignant non-epithelial tumors of the ovary Gonadal tumors: ***name 5***

Answer 78

* folliculoma* * thecoma* * fibroma* * Sertoli and Leydig cell tumors* * mixed tumors*

Question 79

*Hormonal changes in polycystic ovary syndrome (PCOS):* ***↑ LH secretion -\>***

Answer 79

↑ LH secretion → stimulation of theecal cells → ↑ androgen production

Question 80

Hormonal changes in polycystic ovary syndrome (PCOS): ↑ androgen levels →

Answer 80

↑ androgen levels → dysfunction of the hypothalamic-pituitary-ovarian axis → ↑ pulsatile GnRH secretion → ↑ LH levels → premature follicular maturation → premature estradiol peak → FSH inhibition → ↓ FSH levels

Question 81

Hormonal changes in polycystic ovary syndrome (PCOS): LH: FSH ratio?

Answer 81

ratio\> 2

Question 82

*Hormonal changes in polycystic ovary syndrome (PCOS):* increased aromatization of androgens →

Answer 82

increased aromatization of androgens → ***relative hyperestrogenism***

Question 83

Mitochondrial diseases include: Name 9

Answer 83

A syndrome of chronic progressive external ophthalmoplegia, Kearns-Sayre syndrome Mitochondrial encephalomyopathy syndrome involving the nervous system, stomach and intestines, Pearson's marrow-pancreas syndrome Myoclonic epilepsy with ragged red fibers in the muscles (MERRF syndrome) MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, occurrence of stroke-like incidents) Leber's hereditary neuropathy of optic nerve, Neurogenic myopathy with ataxia and retinal pigment degeneration, Aplastic anemia caused by chloramphenicol

Question 84

Kearns-Sayre syndrome

Answer 84

Kearns–Sayre syndrome (KSS), oculocraniosomatic disorder or oculocranionsomatic neuromuscular disorder with ragged red fibers is a mitochondrial myopathy with a typical onset before 20 years of age. KSS is a more severe syndromic variant of chronic progressive external ophthalmoplegia (abbreviated CPEO), a syndrome that is characterized by isolated involvement of the muscles controlling movement of the eyelid (levator palpebrae, orbicularis oculi) and eye (extra-ocular muscles). This results in ptosis and ophthalmoplegia respectively. KSS involves a combination of the already described CPEO as well as pigmentary retinopathy in both eyes and cardiac conduction abnormalities. Other symptoms may include cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism, and other endocrinopathies. In both of these diseases, muscle involvement may begin unilaterally but always develops into a bilateral deficit, and the course is progressive. .

Question 85

*The Lust sign*

Answer 85

is one of the symptoms characteristic of tetany. In order to observe it, you should hit a neurological hammer in the region of the common peroneal nerve. We can consider it as positive if there is sagittal muscle contraction and abduction of the foot.

Question 86

*Landau reflex*

Answer 86

appears at around 5 months of age and disappears up to 3 years old. It is examined as follows - the child should be held in the air facing the ground - the reflex can be considered present if the child lifts his head up, then bends his back and straightens the lower limbs in the hip joints.

Question 87

***Levine's sign*** means

Answer 87

showing the clenched fist on the sternum depicting the feeling of tightening while the patient describes the symptoms of angina pectoris.

Question 88

*Laseque sign*

Answer 88

is the inability to raise the lower limb in a lying position. Its presence indicates the compression of the sciatic nerve. The test is performed in a lying position on the back, the person examining lifts the lower limb of the patient by bending it in the hip joint. The occurrence of non-physiological pain (should be distinguished with pain associated with muscle contraction!) Indicates a positive sign

Question 89

***Leigh syndrome***

Answer 89

(also called *Leigh disease* and *subacute necrotizing encephalomyelopathy*) is an inherited neurometabolic disorder that affects the central nervous system. Normal levels of thiamine, thiamine monophosphate, and thiamine diphosphate are commonly found but there is a reduced or absent level of thiamine triphosphate. This is thought to be caused by a blockage in the enzyme thiamine-diphosphate kinase, and therefore treatment in some patients would be to take thiamine triphosphate daily. With Leigh's name you should associate Leigh disease, or necrotic subacute encephalopathy caused by mutations in mitochondrial DNA

Question 90

***pancreatic neuroendocrine tumor - VIP-oma***

Answer 90

→ severe diarrhea is typical, leading to electrolyte disturbances in the patient, such as hypochloridia, hypokalemia with arrhythmias and asthenia, non-respiratory acidosis.

Question 91

*pancreatic neuroendocrine tumor - glucagonoma*

Answer 91

→ it is a tumor originating from pancreatic alpha cells and secreting glucagon. Symptoms are related to the hormone secreted and include diabetes mellitus, weight loss, mucositis, diarrhea, anemia, necrolytic migratory erythema.

Question 92

*. pancreatic neuroendocrine tumor - insulinoma*

Answer 92

→ it is a neoplasm originating from β cells of the pancreatic islets. It secretes insulin, and therefore in the course of this cancer, we can expect hypoglycemic episodes in the patient and the associated disturbances of consciousness and behavior.

Question 93

***pancreatic neuroendocrine tumor - gastrinoma***

Answer 93

→ a tumor that secretes gastrin, which stimulates the production of gastric juice. The symptoms cause Zollinger-Ellison syndrome.

Question 94

*normospermia include:*

Answer 94

ejaculate volume: 1.5-6ml sperm concentration: 15-250mln / ml motility: Type A and B (progressive, rapid and slow motion)\> 32% morphology: \> 4% sperm with normal structure viability: \> 58% live sperm.

Question 95

***Aspermia -***

Answer 95

decreased volume of ejaculate: 0-0.5ml

Question 96

***Oligospermia -***

Answer 96

reduced sperm count \<15ml / ml

Question 97

***Asthenozoospemia -***

Answer 97

decreased sperm motility \<32% shows progressive movement

Question 98

***Teratozoospermia -***

Answer 98

abnormal sperm morphology: \<4% sperm with normal structure.

Question 99

*Cancer of the vulva:* ***Accounts for what %***

Answer 99

accounts for 3-8% of all malignant neoplasms of female genital organs more than 50% of cases are diagnosed after the age of 70.

Question 100

Cancer of the Vulva: There are ***2 precancerous states***

Answer 100

***hyperplastic lichen sclerosus*** (precedes keratotic cancer) ***VIN (vulvar intraepithelial neoplasia)*** (precedes squamous cell carcinoma associated with HIV infection)

Question 101

Cancer of the Vulva: ## Footnote ***histological types***

Answer 101

squamous cell carcinoma (90%) Bartholin gland cancer basal cell carcinoma adenocarcinoma melanoma sarcomas metastatic tumors

Question 102

Cancer of the Vulva: ## Footnote ***risk factors***

Answer 102

lichen sclerosus of the vulva intraepithelial neoplasia (VIN) a large number of sexual partners early age of sexual intercourse HIV and HPV infection nicotinism low socioeconomic status

Question 103

Cancer of the Vulva: ## Footnote ***treatment***

Answer 103

surgery radiotherapy chemotherapy ***the most common method is radical vulvectomy with inguinal lymph nodes removal*** ***in the case of inoperable neoplasms, systemic treatment and/or radiotherapy are used***

Question 104

Cancer of the Vulva: ## Footnote ***prognosis***

Answer 104

*tumor recurrences occur in up to 30% of patients* ***five-year survival of patients with stage FIGO I vulvar cancer is 98%, FIGO II- 85%, FIGO III- 74%, FIGO IV- 31%***

Question 105

*Mechanism of action of the estrogen component:*

Answer 105

## Footnote * FSH suppression* * inhibiting the selection and growth of the dominant follicle* * prevention of bleeding* * intensification of progestational activity*

Question 106

*Mechanism of action of the gestagen component:*

Answer 106

LH suppression effect on the endometrium thickening of cervical mucus effect on the fallopian tubes

Question 107

**menometrorrhagia**

Answer 107

- abundant, irregular, prolonged bleedings, linked to an increase estrogens blood concentration, particularly in the perimenopausal period

Question 108

*hypermenorrhoea*

Answer 108

- blood loss \>100 ml

Question 109

***hypomenorrhoea***

Answer 109

- blood loss \<30 ml

Question 110

*dysmenorrhoea*

Answer 110

- severe pain in perimenstrual period and during bleeding itself

Question 111

*algomenorrhoea*

Answer 111

- menstrual pains are accompanied by vegetative symptoms

Question 112

*metrorrhagiea*

Answer 112

- abundant, prolonged bleedings not on the time of expected menstruation - *juvenilis* - acyclic bleeding in young women \>10 days * -climacteria* - bleeding in a woman 6-12 months after menopause

Question 113

*menorrhagia*

Answer 113

- regular, cyclic, abundant, prolonged bleeding in menstruation time

Question 114

*amenorrhoea intermittens*

Answer 114

- rare bleedings in intervals lasting from 43 days to 6 months, most often, but not always, are anovulatory cycles and typically occur in women with polycystic ovary syndrome.

Question 115

# Definition ***Endometriosis***

Answer 115

**-** the occurrence of the endometrium (glandular cells and stroma) outside the uterine cavity.

Question 116

Endometriosis Surgical Treatment options:

Answer 116

* removal of isolated foci * removal of endometrial cysts * removal of the entire ovary * removal of the entire uterus with adnexa

Question 117

Endometriosis Pharmacological Tx options:

Answer 117

* **hormonal therapy:** * gonadoliberin analogs (**goserelin**) and their antagonists, e.g. **danazole** * progesterone preparations (**dienogest** , **progesterone**) * estrogen-progesterone preparations * intrauterine device with levonorgestrol * aromatase inhibitors * selective progesterone receptor modulators (SPRMs) * painkillers: * NSAIDs

Question 118

# Symptoms Endometriosis Symptoms

Answer 118

* restriction of fertility. * lower pelvic pain syndrome, painful examination, and nodular lesions palpable in the projection of the uterosacral ligaments. * painful menstruation (*dysmenorrhoea),* pains start a few days before the onset of menstruation * dyspareunia. * enlarged, tender, poorly mobile appendages.

Question 119

# Name 3 drugs Dopamine D2 receptor agonists

Answer 119

(bromocriptine, quinagolide, cabergoline)

Question 120

Dopamine D2 receptor agonists (bromocriptine, quinagolide, cabergoline) are used for:

Answer 120

Treatment of Pituitary tumors producing Prolactin

Question 121

Dopamine is a neurotransmitter responsible for:

Answer 121

* motor drive * emotional processes * **hormone secretion**

Question 122

The hormonal effect of dopamine is

Answer 122

**antagonistic** to prolactin → hence the other name for dopamine (**prolactostatin).** Dopamine agonists cause an increase in dopamine secretion, thereby enhancing its prolactin antagonism. * Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) → ↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia.

Question 123

Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) →

Answer 123

↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia

Question 124

**in the diagnosis of hyperprolactinemia-what is used as a functional test** →

Answer 124

- **metoclopradmide** is used as the functional test.

Question 125

***Metoclopramide*** acts as a dopamine receptor? MOA

Answer 125

***Metoclopramide*** acts as a *dopamine receptor* **antagonist→** action, ↑ stimulates prolactin secretion

Question 126

Physiological changes in the circulatory system during pregnancy?

Answer 126

* **↑ cardiac output and increase in sodium and water retention → ↑ blood volume → ↓ peripheral vascular resistance → ↓ blood pressure (most prominent in the 2nd trimester)** * displacement of the apex of the heart upwards and to the left (lifting the diaphragm by the enlarging uterus) * increase in heart size by about 12% * **↑ blood volume** * I trimester: ↑ volume by approx. 10-15% * **maximum volume is reached at 28-34. week of pregnancy** (increase by **40-45%** compared to the state before pregnancy) * **↑ red blood cell mass: by 20% (Bręborowicz 2010), by 30% (Bręborowicz 2015)** * mean value of hemoglobin in women at delivery - 12.5 g/dl * pathological anemia is diagnosed at hemoglobin concentration **\<11 g/dl** * increased erythropoiesis → ↑ reticulocyte count * ↑ stroke volume * I trimester: ↑ by 30-40% * the maximum value is reached **about 20 tc** * **↑ cardiac output (cardiac output) by 30-50%**

Question 127

# Define Acute pyelonephritis

Answer 127

is **a bacterial infection causing inflammation of the kidneys** and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems

Question 128

# Define Acute pyelonephritis

Answer 128

is **a bacterial infection causing inflammation of the kidneys** and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems

Question 129

# Define [Swyer syndrome](https://www.osmosis.org/learn/Amenorrhea:_Clinical_practice)

Answer 129

- also known as 46, XY complete (pure) [gonadal dysgenesis](https://www.osmosis.org/learn/Amenorrhea:_Clinical_practice) (CGD), is a rare congenital disorder of sex development. It is characterized by the failed development of the sex glands (i.e. [testicles](https://www.osmosis.org/learn/Testicular_cancer:_Nursing) or [ovaries](https://www.osmosis.org/learn/Ovarian_cancer:_Nursing)) - have an XY genetic makeup, or genotype, but develop a vagina, uterus, and Fallopian tubes instead of a penis and scrotum. - because dysgenetic gonads **do not secrete testosterone (hypogonadism)** nor anti-Müllerian hormone, Müllerian ducts' derived organs develop (female) * is characterized by a **female phenotype** , **female internal sexual organs** , normal or high growth, sexual infantilism and **primary amenorrhea**

Question 130

Granulosa cell tumor ex? Belongs to?

Answer 130

Folliculoma: * belongs to the **gonadal tumors of the ovary** * it can occur in **women of any age (only 5% are diagnosed before puberty)** * most often it occurs **unilaterally** (only 2% of tumors are bilateral)

Question 131

***granulomas secrete?***

Answer 131

**estrogens and inhibin**

Question 132

Folliculoma symptoms

Answer 132

* premature puberty in girls * change in the nature of menstruation (irregular, heavy) * coexistence of hyperplasia (25-50%) or endometrial cancer (5%) * **ascites (10%)** * symptoms of "acute abdomen" due to tumor rupture * premature puberty, change in the nature of menstruation and coexisting endometrial hyperplasia result from **increased estrogen levels** (**granulomas secrete estrogens and inhibin**) * determination of **inhibin** concentration is useful in monitoring treatment and detecting relapses

Question 133

# malignant non-epithelial tumors of the ovary **Gonadal tumors** **Name 5**

Answer 133

* folliculoma * thecoma * fibroma * Sertoli and Leydig cell tumors * mixed tumors

Question 134

# malignant non-epithelial tumors of the ovary **Germinal tumors** **Name 7**

Answer 134

* dysgerminoma * yolk sac tumor * embryonic tumors * polyembryoma * choriocarcinoma * teratomas * immature * mature * mixed germinal tumors

Question 135

# Explain CTG-Fetal **CTG:** **Acceleration-** *explain*

Answer 135

* ***short-term, transient*** FHR acceleration by at least 15 beats per minute, lasting 15 seconds or longer * periodic * episodic

Question 136

# Explain CTG-Fetal **CTG** **Deceleration -** *explain*

Answer 136

***short-term slowdown*** of the basic FHR by at least 15 beats per minute, lasting 10 seconds or longer * **early - the effect of central stimulation of the X nerve by compression of the head in the birth canal (Gaussian reflex)** * late * variable * complex

Question 137

# Define Hypothalamic-pituitary insufficiency: (classification, takes form of, causes)

Answer 137

* in the classification of menstrual disorders according to WHO, it is classified as group I * takes the form of **hypogonadotrophic hypogonadism** * There are **pituitary** and **hypothalamic** causes

Question 138

# causes of hypothalamic-pituitary insufficiency **Hypothalamic:** **Congenital**-name 3

Answer 138

* Kallmann's syndrome * isolated hypogonadotrophic hypogonadism * GnRH receptor mutation

Question 139

# causes of hypothalamic-pituitary insufficiency **Hypothalamic:** **Acquired-** **name 3**

Answer 139

* *functional hypothalamic amenorrhoea* - FHA * hypothalamic psychiatric amenorrhea * organic hypothalamic amenorrhea (post-traumatic or inflammatory tumors, damage to the hypothalamic-pituitary area)

Question 140

# causes of hypothalamic-pituitary insufficiency **Pituitary:** Name 4

Answer 140

* post-traumatic or post-inflammatory tumors, damage to the hypothalamic-pituitary area * Sheehan's syndrome * empty saddle syndrome * lymphocytic pituitary inflammation

Question 141

# diagnostics of hypogonadotrophic hypogonadism Symptoms

Answer 141

- congenital and pre-pubertal **disorders**: primary **amenorrhea**, **failure to** develop secondary sex characteristics - disorders acquired after puberty: secondary **amenorrhea**, presence of secondary sex characteristics

Question 142

# diagnostics of hypogonadotrophic hypogonadism Hormone concentration

Answer 142

**↓ levels of FSH**, LH and estradiol

Question 143

# diagnostics of hypogonadotrophic hypogonadism **progesterone test ?** **estrogen-progesterone test ?**

Answer 143

**negative** Positive

Question 144

# diagnostics of hypogonadotrophic hypogonadism gonadoliberin test ?

Answer 144

- positive for hypothalamic disorders - negative in the case of pituitary disorders

Question 145

**The disulfiram-like reaction**?

Answer 145

- symptoms induced by alcohol consumption resulting from the aldehyde dehydrogenase block, which results in the accumulation of toxic acetaldehyde. - The name comes from 'disulfiram', a drug used to treat alcoholism. - It blocks the aldehyde dehydrogenase

Question 146

# In the disulfiram-like reaction - In the disulfiram-like reaction - **Symptoms:**

Answer 146

* vasodilation (facial redness) * hypotension * increased heart rate * excessive sweating * breathing disorders * dyspnea * nausea * vomiting * anxiety

Question 147

# In the disulfiram-like reaction - **Description:** Long list of drugs with a disulfiram-like effect includes? which we use to treat?

Answer 147

***metronidazole*** ***-***which we use to treat ***genital infections*** e.g. ***T. vaginalis infection*** and ***bacterial vaginosis***.

Question 148

# Drug TX **Drug treatment of urinary tract infections in pregnant or lactating women:** **“NAAC”** most common

Answer 148

* **nitrofurantoin** * furazidine - do not use in the first trimester of pregnancy * co-trimoxazole * trimethoprim * fosfomycin (cat. B) * **amoxicillin (cat. B)** * amoxicillin with clavulanate (cat. B) * cephalexin (cat. B) * **ampicillin** * **cefuroxime (cat. B)**

Question 149

# Drug TX **Pregnant women should not use:** **name 5** **“M**y **TTSF”**

Answer 149

* ***Tetracyclines*** (damage fetal teeth and bones) * ***Trimethoprim*** (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus) * ***Sulfamethoxazole*** (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice) * ***Fluoroquinolones*** **(completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)** * ***Macrolides*** (should not be used as first-line drugs).

Question 150

# define **The triple marker?**

Answer 150

test is a non-invasive test that assesses AFP, hCG and estriol in mother's blood serum between weeks 14 and 20 of pregnancy Due to the low **sensitivity (65%)** and the late diagnostic period, it is used less frequently than the double test.

Question 151

**The double** **test?**

Answer 151

- is a non-invasive test carried out between ***11*** and ***14 weeks*** of pregnancy - It evaluates 2 *biochemical markers*: ***pregnancy plasma protein (PAPP-A) and placental gonadotropin (hCG)*** -It is characterized by early diagnosis and **high sensitivity (95%).**

Question 152

The basic parameters assessed in the spermiogram are: name 10

Answer 152

1. **Ejaculate volume** (N \>1.5 ml) 2. **Total sperm count** (N \>39 x 10^6/ejaculate) 3. **Sperm concentration** (N \>15x10^6/ml) 4. **Total sperm motility** (N \>40%) 5. **Progressive movement of spermatozoa** (N \>32%) 6. **Vitality (live spermatozoa)** (N \>58%) 7. **Percentage of sperm with normal morphology (N \>4%)** 8. **pH** (N ≥7.2) 9. **Liquefaction time of the ejaculate** (N \<60 min.) 10. **Presence of leukocytes** (N \<1x10^6/ml) **and erythrocytes** (N =none)

Question 153

# Nomenclature related to semen quality: **Teratozoospermia**

Answer 153

* **- Spermatozoa percentage with normal morphology below 4%**

Question 154

# Nomenclature related to semen quality: **Asthenozoospermia**

Answer 154

* Percentage of progressively motile (PR) spermatozoa below \<32%

Question 155

# Nomenclature related to semen quality: **Asthenoteratozoospermia**

Answer 155

* Sperm percentage with progressive movement \<32% and normal morphology \<4%

Question 156

# Nomenclature related to semen quality: **Azoospermia** -

Answer 156

* No sperm in ejaculate

Question 157

# Nomenclature related to semen quality: **Cryptozoospermia** -

Answer 157

* Spermatozoa absent from fresh preparations but observed in a centrifuged pellet

Question 158

# Nomenclature related to semen quality: **Hemospermia (hematospermia)** -

Answer 158

* The presence of erythrocytes in the semen

Question 159

# Nomenclature related to semen quality: **Leukospermia (leukocytospermia, pyospermia)** -

Answer 159

* The presence of leukocytes in the ejaculate above the limit value (N = \<1x10^6/ml)

Question 160

# Nomenclature related to semen quality: **Necrosoospermia** -

Answer 160

* A low percentage of live, and high percentage of immotile, spermatozoa in the ejaculate

Question 161

# Nomenclature related to semen quality: **Oligozoospermia** -

Answer 161

* Total sperm count below 39x10^6/ejaculate

Question 162

# Nomenclature related to semen quality: **Aspermia** -

Answer 162

* No semen due to lack of ejaculation or retrograde ejaculation

Question 163

# TX Meds What is the **"golden standard" for ovarian cancer**

Answer 163

* The ***combination*** of ***carboplatin*** and ***paclitaxel***

Question 164

# %of cases, location, TX, Recurrences of ovarian cancer:

Answer 164

* Despite the high sensitivity to chemical treatment of ovarian cancer, in about ¾ cases it recurs * The recurrence usually occurs again in the abdomen and is often multifocal * The basic method of treatment of recurrent ovarian cancer is **chemotherapy.** It is usually used as palliative treatment * Due to the usually diffuse nature of the disease, radiotherapy does not allow to effectively destroy all foci of the disease.

Question 165

**Fetus lie** *(situs)*

Answer 165

- the relation of the long axis of the fetus to the long axis of the uterus and the birth canal * longitudinal * transverse * oblique

Question 166

**Fetal position** *(positio)*-

Answer 166

* the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal * position I - spine (head) on the left side of uterus * position II - spine (head) on the right side of uterus

Question 167

**Fetal attitude** *(habitus)*-

Answer 167

* the relation between the parts of the fetus * flexed * extension

Question 168

**Insertion** *(immissio)* -

Answer 168

* relation of the leading part to the interspinal line

Question 169

# The most important systemic changes in the course of pregnancy: **cardiovascular system:**

Answer 169

* **increase in the output and the heart rate** * **reduction of peripheral resistance** * **increase in stroke volume** * **decrease in blood pressure** * **increase in blood volume:** * **40-45%** compared to a non-pregnant woman * about **50%** *(the word "about" suggests that the maximum increase in blood volume is even more than 50%)* in relation to the pre-pregnancy value * by **40%** compared to non-pregnant women * decrease in hematocrit, hemoglobin, platelets,

Question 170

# The most important systemic changes in the course of pregnancy: **coagulation system:**

Answer 170

* acceleration of blood coagulation * increase in concentration of most coagulation factors * increased tendency to thrombi

Question 171

# The most important systemic changes in the course of pregnancy: **respiratory system:**

Answer 171

* increased infrasternal angle * the diaphragm is raised by 4 cm * increased lateral dimension of chest * increased circumference of chest * respiratory rate, vital capacity (VC) of the lungs do not change * increased tidal volume (TV) * decreased total lung capacity (TLC) * alveolar ventilation increases by 70% * reduction of resistance in the airways * swelling of the mucosa of upper respiratory tract and greater predisposition to nosebleeds

Question 172

# The most important systemic changes in the course of pregnancy: **urinary tract:**

Answer 172

* increase the length and volume of the kidneys * widening of the kidney calyces * swelling of the mucous membrane of the bladder * reduction of bladder capacity * widening of the ureters * greater risk of acute pyelonephritis * increased renal perfusion and GFR (even by half) * higher frequency of urination * reduction in creatinine * reduction in Na + and K + concentrations * reduction in reabsorption of some substances from the urine (eg glucose)

Question 173

# The most important systemic changes in the course of pregnancy: **digestive system:**

Answer 173

* heartburn * change in the oral flora, but the increase in the incidence of caries is debatable * constipation * hemorrhoids * dilation of the portal vein * increase in ALP * decrease in GGTP * reduced gallbladder contractility - increased risk of urolithiasis

Question 174

# The most important systemic changes in the course of pregnancy: **endocrine system:**

Answer 174

* goiter * increase in T4 and T3 concentrations * decrease in TSH * 3-fold enlargement of the pituitary gland * increased concentration of PRL and MSH * increase in RAA activity and cortisol productio

Question 175

# The most important systemic changes in the course of pregnancy: **musculoskeletal system:**

Answer 175

* Increasing the mobility of joints and pelvis cartilage * increase in lumbar lordosis and thoracic kyphosis

Question 176

# The most important systemic changes in the course of pregnancy: **eye:**

Answer 176

* lowered intraocular pressure * thickening of the cornea * problems with accommodation

Question 177

# The most important systemic changes in the course of pregnancy: **metabolism:**

Answer 177

* additional energy expenditure * hypertrophy of pancreatic islets * increased insulin secretion * insulin resistance * postprandial hyperglycemia * fasting hypoglycemia * positive nitrogen balance * increased concentration of proteins in the blood * increase in total cholesterol, phospholipid and TAG concentrations * increase in leptin concentration * increased appetite * water accumulation

Question 178

# The most important systemic changes in the course of pregnancy: **uterus:**

Answer 178

* increase in blood flow

Question 179

**Polycystic ovary syndrome is:** **known as / characterized by / excessive production of ?**

Answer 179

**(PCOS** - *polycystic ovary syndrome),* also known as the the **Stein-Leventhal** syndrome is characterized by **menstrual disturbances,** **infertility** and **androgenization.** It affects **4-12% of** women of childbearing age, can run in families. The underlying disorder is **excessive LH secretion**, which leads to stimulation of tissue cells to increase androgen production.

Question 180

# To diagnose PCOS it is necessary to meet min. 2 of 3 Rotterdam criteria: To diagnose PCOS 2 of 3 Rotterdam criteria:

Answer 180

* *oligomenorrhoea* or *amenorrhoea* * clinical and / or biochemical features of hyperandrogenism * image of polycystic ovaries on ultrasound: * \> 12 follicles in the ovary and / or * ovarian volume\> 10 ml**To diagnose PCOS it is necessary to meet** **min. 2 of 3** **Rotterdam criteria**: * *oligomenorrhoea* or *amenorrhoea* * clinical and / or biochemical features of hyperandrogenism * image of polycystic ovaries on ultrasound: * \> 12 follicles in the ovary and / or * ovarian volume\> 10 ml

Question 181

# Polycystic ovary syndrome (PCOS - polycystic ovary syndrome) **Laboratory tests:**

Answer 181

* **↑ LH concentration** * **LH: FSH ratio\> 2** * **↑** testosterone levels (total and free) and androstenedione

Question 182

# Polycystic ovary syndrome (PCOS - polycystic ovary syndrome) **symptoms:**

Answer 182

* menstrual disorders (*oligomenorrhoea* or *amenorrhoea)* * hyperandrogenization (acne, hirsutism, alopecia) * overweight and **obesity** * hyperinsulinemia, **insulin resistance**, **type 2 diabetes** * sterility

Question 183

# Polycystic ovary syndrome (PCOS - polycystic ovary syndrome) **Complications:**

Answer 183

* hypertension * **increased risk of cardiovascular disease** * **3-fold increase in the risk of endometrial cancer** (PCOS is a state of relative hyperestrogenism due to insufficient progesterone synthesis due to lack of ovulation) **PCOS does not affect the incidence of breast and rectal cancers**

Question 184

# Neoplastic ovarian tumours tumors producing steroid hormones: * name hormones -4* * name tumors-6*

Answer 184

Hormones: ***estrogens, testosterone, androstendione, DHEA*** Tumors include: dysgerminoma, embryonal carcinoma, immature teratoma, gonadoblastoma, foliculliculoma, Sertoli-Leydig cell tumor.

Question 185

# Neoplastic ovarian tumours ***Germ cell tumors*** ***arise from?*** Name 7

Answer 185

(arise from multipotent reproductive cells or stem cells present in the ovary): * Dysgerminoma * Embryonal carcinoma * Immature teratoma * Choriocacrinoma * Endodermal sinus tumor; Yolk sac tumor * Gonadoblastoma * Polyembryoma

Question 186

# Neoplastic ovarian tumours **Gonadal tumors** ***arise from?*** ***Name 4***

Answer 186

(arise from sex cords and ovarian stroma, produce steroids): * **Thecofibroma** * Folliculoma - (also called **granulosa cell tumor**) * Sertoli-Leydig cell tumor - a tumor from Sertoli and Leydig cells * Androblastoma

Question 187

# serious complications in the newborn and child: **Sabin-Pinkerton's triad due to?** **name:**

Answer 187

1. **retinitis and chorioretinitis** 2. **intracranial calcifications** 3. **microcephaly or hydrocephalus** **Toxoplasmosis during pregnancy:**

Question 188

# Definition **Kallmann's syndrome**

Answer 188

- [genetic](https://en.wikipedia.org/wiki/Hereditary) disorder that prevents a person from starting or fully completing [puberty](https://en.wikipedia.org/wiki/Puberty). - Kallmann syndrome is a form of a group of conditions termed [hypogonadotropic hypogonadism](https://en.wikipedia.org/wiki/Hypogonadotropic_hypogonadism). - Kallmann syndrome has the additional symptom of a [total lack of sense of smell](https://en.wikipedia.org/wiki/Anosmia) (anosmia) or a [reduced sense of smell](https://en.wikipedia.org/wiki/Hyposmia) - If left untreated, people will have poorly defined [secondary sexual characteristics](https://en.wikipedia.org/wiki/Secondary_sexual_characteristics), show signs of [hypogonadism](https://en.wikipedia.org/wiki/Hypogonadism), almost invariably are [infertile](https://en.wikipedia.org/wiki/Infertile) and are at increased risk of developing [osteoporosis](https://en.wikipedia.org/wiki/Osteoporosis)

Question 189

# Definition **Sheehan's syndrome**

Answer 189

- is postpartum pituitary necrosis caused by perinatal hemorrhagic shock. - The most characteristic symptom is **the lack of lactation** resulting from a sudden decrease in the secretion of prolactin by the pituitary gland - Other symptoms of this syndrome include: **no return of menstruation after delivery**, secondary adrenal and thyroid insufficiency - they develop gradually over many months.

Question 190

# Definition **Couvelaire syndrome**

Answer 190

(uteroplacental stroke) is a rare, life-threatening complication of pregnancy in which the detachment of the placenta is accompanied by an infiltration of the uterine muscle with blood that almost reaches the serosa.

Question 191

# Definitoin **The Mayer-Rokitansky-Küster-Hauser**

Answer 191

**-** syndrome is a congenital syndrome characterized by aplasia of structures originating in the Muller's ducts, i.e. the uterus and vagina. **-** **Primary** **amenorrhea** is the most common cause of medical reports

Question 192

# Definition **Asherman's syndrome**

Answer 192

- is adhesions in the uterine cavity that completely or partially close its lumen. - This is manifested by either little or **no bleeding**. - The most common causes of Asherman's syndrome are: **curettage of the uterine cavity,** endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.

Question 193

Anti-RhD immunoglobulin is given How?

Answer 193

intramuscularly to a RhD-negative women in less than 72 hours

Question 194

# Anti-RhD immunoglobulin is given intramuscularly to a RhD-negative women in less than 72 hours: 1. delivery was physiological 2. delivery was pathological Provide dose:

Answer 194

a. 150 μg, if the delivery was physiological, b. 300 μg, if the delivery was pathological, e.g. Caesarean section, delivery of a dead fetus or multiple pregnancy, using Crede's method or manual extraction of the placenta.

Question 195

# Dose After spontaneous miscarriage or **termination of pregnancy**, invasive prenatal diagnosis (amniocentesis, chorion biopsy, cordocentesis), removal of ectopic pregnancy, in the case of a threatened miscarriage or preterm delivery, with bleeding from the genital tract and after external cephalic version:

Answer 195

a. **50 μg** until the 20th week of pregnancy, b. **150 μg** after the 20th week of pregnancy.After the birth of a RhD-positive child:

Question 196

# Definition and who is affected **Endometrial cancer**

Answer 196

* belongs to the most common malignancies affecting women and is simultaneously the **most common gynecological** cancer (except for breast cancer). * **Postmenopausal** women are typically affected. The exact etiology of this disease is still unknown, but it is known to be closely related to **hyperestrogenism** (especially unopposed by progestins).

Question 197

# Known risk factors for endometrial cancer Known risk factors for endometrial cancer include:

Answer 197

* **Metabolic syndrome and its components (overweight, obesity, diabetes, dyslipidemia)** * Tamoxifen (drug used in breast cancer) * **Polycystic ovary syndrome** * **The single-use of estrogens unopposed by progestins in hormone replacement therapy or contraception** * Early first menstruation and/or late menopause * Nulliparity, infertility * Low physical activity * Estrogen-producing tumors * Liver failure (impaired estrogen metabolism) * Genetic conditions (mutations of the PTEN, P53, HER2/neu genes)

Question 198

# Factors that reduce the risk of endometrial cancer **Factors that reduce the risk of endometrial cancer include:**

Answer 198

* **Smoking** * **Multiparity** * The use of combined therapy of progestins and estrogen in contraception and hormone replacement therapy * Late first menstrual period and/or early menopause * Acetylsalicylic acid intake

Question 199

Histological types of endometrial cancer:

Answer 199

* **Type I** - is the most common (80%), estrogen-dependent type of adenocarcinoma. It is characterized by slow progression and good prognosis * **Type II** - is unrelated to hyperestrogenism, progresses aggressively and has a poor prognosis.

Question 200

1. delivery was physiological 2. delivery was pathological Provide dose:

Answer 200

a. 150 μg, if the delivery was physiological, b. 300 μg, if the delivery was pathological, e.g. Caesarean section, delivery of a dead fetus or multiple pregnancy, using Crede's method or manual extraction of the placenta.

Question 201

# classification of endometrial cancer stages FIGO classification classification of endometrial cancer stages Stage 1

Answer 201

**Endometrial cancer** IA No infiltration or infiltration ≤50% of the thickness of the myometrium IB Infiltration \>50% of myometrium thickness

Question 202

# classification of endometrial cancer stages FIGO classification classification of endometrial cancer stages Stage 2

Answer 202

* *Infiltration of the cervical stroma but does not extend outside the** * *uterus**

Question 203

# classification of endometrial cancer stages FIGO classification classification of endometrial cancer stages Stage 3

Answer 203

**Local and regional infiltration** IIIA Infiltration of the uterine serum and/or adnexa IIIB Vaginal or parametrial involvement IIIC1 Pelvic lymph node involvement IIIC2 Para-aortic lymph node involvement

Question 204

# classification of endometrial cancer stages FIGO classification classification of endometrial cancer stages Stage 4

Answer 204

**Infiltration of the bladder and/or rectal mucosa and/or distant** **metastases** IVA Infiltrate the bladder and/or rectal mucosa IVB Distant metastases (including metastases to inguinal lymph nodes)

Question 205

# Dimensions of the fetal head: What are the **Dimensions of the fetal head:**

Answer 205

1. **Dimensions**: * diameter suboccipitobregmaticus: 9.5 cm * diameter frontooccipitalis: 12 cm * diameter mentooccipitalis: 13.5 cm

Question 206

# circumferences of the fetal head: 1. **Circumferences**:

Answer 206

* **suboccipitobregmatic**: **32 cm** **(it is the most advantageous circumference for passing through the small pelvis)** * occipitofrontal: 34 cm * occipitomental: 35 cm

Question 207

# definition Premature thelarche

Answer 207

**development of small amount of breast tissue (typically 1” or less across), typically before the age of 3 years**. The breasts do not get larger and the girl does not have a growth spurt

Question 208

**Premature puberty (*****pubertas praecox*****)**

Answer 208

Tertiary sexual characteristics appear before the age of 8. The pathomechanism is associated with too early central GnRH secretion. The clinical picture includes: - **premature development of mammary glands** - increased pigmentation of the nipple - **premature development of pubic and axillary hair** - swelling, thickening and bruising of the hymen GnRH analogues are used in the treatment

Question 209

# Definition **delayed puberty:** **Conditions that can lead to this include?**

Answer 209

when *menarche* does not occur until the age of 16, or until the age of 14, there are no signs of mammary gland development. States that can lead to this include: 1. **Gonadal dysgenesis** 2. **Congenital adrenal hyperplasia** 3. **Polycystic ovary syndrome** 4. **Androgen insensitivity syndrome**

Question 210

# Define **Mayer-Rokitansky-Kuster-Hauser** (MRKH) Syndrome TX and Procedures include ?

Answer 210

- is a defect in the inborn absence of the uterus and vagina. * Surgical treatment :* creating a vagina to enable the patient to have sexual intercourse Procedures include: * **vaginoplasty** * **traction methods (e.g. Veccheti's method)** * **vulvovaginoplasty**

Question 211

# Causes: **Recurrent miscarriages**

Answer 211

Causes of recurrent miscarriages include: * Anatomical factors (uterine fibroids, intrauterine adhesions, birth defects) * Corpus luteum dysfunction * **Antiphospholipid syndrome** * Thyroid dysfunction * Diabetes mellitus

Question 212

# Definition **Antiphospholipid syndrome (APS)**

Answer 212

**- sometimes known as Hughes syndrome** **Antiphospholipid Syndrome (APS) is an autoimmune disorder associated with the presence of antiphospholipid antibodies, which include:** * **anti-cardiolipin antibodies** * **antibodies against β2-glycoprotein I** * **lupus anticoagulant** * **disorder of the immune system that causes an increased risk of blood clots:** **Conditions:** * [DVT (deep vein thrombosis](https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/), a [blood clot](https://www.nhs.uk/conditions/blood-clots/) that usually develops in the leg * arterial thrombosis (a clot in an artery), which can cause a [stroke](https://www.nhs.uk/conditions/stroke/) or [heart attack](https://www.nhs.uk/conditions/heart-attack/) * blood clots in the brain, leading to problems with balance, mobility, vision, speech and memory

Question 213

**Antiphospholipid syndrome (APS)** ***TX and time of occurrence?***

Answer 213

Most miscarriages in women with APS occur in the first trimester of pregnancy. **Treatment:** * The recommended therapy for pregnant women with APS consists of **acetylsalicylic acid and heparin,** which increases the chance of giving birth to a healthy child.

Question 214

The occurrence of endometriosis should be taken into account in the following conditions:

Answer 214

* Reduced fertility, * Pelvic pain syndrome * Painful menstruation * Pain complaints related to intercourse (dyspareunia)

Question 215

# definition **Bacterial vaginosis** (BV)

Answer 215

- vaginal infection caused by a disturbed natural balance between bacterial populations. - The lactobacilli are gradually replaced by pathogenic strains: ***Gardnerella vaginalis, Mobiluncus, Bacteroides, Prevotella, Mycoplasms.***

Question 216

**Amsel criteria**

Answer 216

helpful in diagnosing bacterial vaginosis (BV): (3 out of 4 criteria must be met) 1. homogeneous, white and gray vaginal discharge 2. vaginal pH **\> 4.5** 3. fishy odor, increased after sexual intercourse and after alkalising vaginal secretion with 10% potassium hydroxide (KOH) 4. clue cells under the microscope (clue cells are epithelial cells coated with bacteria)

Question 217

# Bacterial vaginosis (BV) **BV treatment:**

Answer 217

1. Metronidazole (the first-line drug) 2. clindamycin

Question 218

**Risk factors for endometrial cancer:**

Answer 218

* hyperestrogenism, e.g. PCOS, childlessness, long menstrual period, use of tamoxifen, hormonally active ovarian tumors * taking estrogens without balancing action of the gestagens, * **obesity** * **hypertension** * **diabetes** * mutations in DNA repair genes (Lynch syndrome- lifetime risk is 30-60%) * early menarche * **late menopause** * infertility or the birth of only one child

Question 219

**Factors that may reduce the risk of endometrial cancer:**

Answer 219

* oral contraceptives with two-component preparations * multiparous * smoking (leads to earlier menopause, which reduces the risk of disease) * taking aspirin

Question 220

# Definition Choriocarcinoma

Answer 220

**Choriocarcinoma** is a malignant, gestational [trophoblastic](https://en.wikipedia.org/wiki/Trophoblastic) [cancer](https://en.wikipedia.org/wiki/Cancer), usually of the [placenta](https://en.wikipedia.org/wiki/Placenta). - It is characterized by early hematogenous spread to the lungs. - It belongs to the malignant end of the spectrum in [gestational trophoblastic disease](https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease) (GTD). It is also classified as a [germ cell tumor](https://en.wikipedia.org/wiki/Germ_cell_tumor) and may arise in the [testis](https://en.wikipedia.org/wiki/Testis) or [ovary](https://en.wikipedia.org/wiki/Ovary).

Question 221

# Definition **MENORRHAGIA**

Answer 221

that is, prolonged **heavy menstrual** bleeding regularly occurring, **volumetric symptoms - pollakiuria resulting from pressure on the bladder and pain.**

Question 222

# Definition Polyuria

Answer 222

Excessive urine production * Adults usually make about 3 liters of urine per day * polyuria- up to 15 liters per day * classic sign of diabetes

Question 223

# Define/Symptoms **Uterine fibroids**

Answer 223

**-** are the most common tumors of the female genital organs -Symptoms: **MENORRHAGIA** - that is, prolonged **heavy menstrual** bleeding regularly occurring, **volumetric symptoms - pollakiuria resulting from pressure on the bladder and pain** **-**profuse acyclic uterine bleeding **(metrorrhagia),** frequent urge to urinate, urinary retention, nocturia, constipation, incomplete defecation, dyschezia (unable to defecate) , primary or secondary infertility, inability to deliver pregnancy, increased risk of fetal malposition during pregnancy.

Question 224

# Definition **Premenstrual syndrome (PMS)**

Answer 224

is a recurrent, disrupting mental (mood swings, irritability) and somatic symptoms (abdominal pain, headache, fatigue, swelling of the limbs) of moderate intensity that occur in the premenstrual phase of the cycle and **disappear with the onset of menstrual bleeding**

Question 225

# Definition **unicornate uterus**

Answer 225

- congenital defect of the uterus that results from unilateral agenesis / aplasia of the Müller's duct. - The course may be asymptomatic or cause secondary dysmenorrhea. - It is associated with an increased risk of infertility, premature delivery and misplacement of the fetus

Question 226

# Definition Dysmenorrhea Primary dysmenorrhea

Answer 226

- medical term for painful menstrual periods which are caused by uterine contractions. - refers to recurrent pain Pain can typically last 12 to 72 hours, and you might have other symptoms, such as [nausea and vomiting](https://my.clevelandclinic.org/health/symptoms/8106-nausea--vomiting), fatigue, and even [diarrhea](https://my.clevelandclinic.org/health/diseases/4108-diarrhea).

Question 227

# symptoms of (PBM) symptoms of **primary dysmenorrhea (PBM)**

Answer 227

**appear about 6-12 months after the menarche**. This is due to the onset of ovulatory cycles and increased prostaglandin levels. PBM is manifested by **painful contractions of the lower abdomen** and lumbosacral area, which appear a **few hours before or immediately after menstruation and last for 48-72 hours**. Over-secretion of prostaglandins can cause systemic symptoms such as headache, **nausea and vomiting**, dizziness, diarrhea, irritability, **fatigue** and somnolence. **The general examination and gynecological examination did not reveal any organic cause** of the symptoms.v

Question 228

# Definition **Asherman's syndrome**

Answer 228

a secondary **amenorrhea** caused by intrauterine adhesions following curettage of the uterine cavity.

Question 229

# Definition **Cytology** is a

Answer 229

test used in the **secondary prevention** of cervical cancer. The purpose of this study is to detect pre-cancerous conditions that already exist. Active prophylaxis by cytological examination in Poland covers women aged 25-65 and is performed every 3 years.

Question 230

# Definiton **Colposcopy** is a

Answer 230

diagnostic examination of intraepithelial lesions of the cervix (SIL), vagina (VAIN), vulva (VIN) and invasive forms in these locations. **It is not a primary prevention method.**

Question 231

# Define Test **HPV DNA genotyping**

Answer 231

used in screening for cervical cancer, and these are **secondary prevention.**

Question 232

# Definition **Cervical conization / LLETZ** is a

Answer 232

diagnostic and therapeutic method that consists in excising a suspicious lesion with a margin of healthy tissues and subjecting the material to histological evaluation.

Question 233

# Define **The Mayer-Rokitansky-Küstner-Hauser defect syndrome** (also known as)?

Answer 233

**The Mayer-Rokitansky-Küstner-Hauser defect syndrome** (also known **congenital deficiency of the vagina and uterus or Müllerian agenesis**) affects phenotypic women with ***46XX karyotype*** and is characterized by: * **congenital absence of the vagina and uterus** * **primary amenorrhea** * **the rudimentary horns of the uterus** * properly developed ovaries and fallopian tubes with normal function * well-developed second- and third-order female sex characteristics * normal mammary glands * with female type hair

Question 234

The main causes of postmenopausal bleeding are:

Answer 234

atrophic changes in the uterine or vaginal mucosa (40-50%), endometrial cancer (10%), polyps (3%).

Question 235

# Gestational Diabetes Criteria **Criteria for diagnosis of gestational diabetes:**

Answer 235

Test duration Venous plasma glucose concentration Fasting ⩾ 92 mg / dL ⩾ 5.1 mmol / 1 in 60 min. ⩾ 180 mg / dL ⩾ 10 mmol / 1 in 120 min. ⩾ 153 mg / dL ⩾ 8.5 mmol / 1

Question 236

**Symptoms of endometriosis include:**

Answer 236

* **pain (66%)**: * chronic (often\> 6 months), * located in the lower abdomen, * in the peri-menstrual period, * **dyspareunia,** * irregular / excessive bleeding, * **fertility disorders:** * failure of the fallopian tubes, * disorder of folliculogenesis, * lack of ovulation, * luteinization of an unbroken follicle, * digestive system ailments (nausea, vomiting, satiety, flatulence, pain during defecation).

Question 237

**The gynecological causes of pelvic pain syndrome include:**

Answer 237

* Painful bladder syndrome, * **Endometriosis,** * Adenomyosis, * Muscle, * Benign tumors of the appendages, * Pelvic inflammation, * Adhesions in the smaller pelvis.

Question 238

**Markumaran** is a drug whose active ingredient is ? MOA? SE?

Answer 238

*Phenprocoumon.* It belongs to coumarin derivatives, which is a long-acting oral anticoagulant. It works by inhibiting vitamin K reductase, reducing the synthesis of vitamin K-dependent coagulation factors II, VII, IX and X, and the anticoagulant proteins C and S. As a side effect of anticoagulant therapy is an **increased bleeding predisposition.**

Question 239

# Definition **Mayer-Rokitansky 'ego-Klister-Hauser syndrome (Rokitansky syndrome, MRKH syndrome)** is

Answer 239

the most common cause of congenital ***absence of the uterus and the upper part of the vagina.*** Patients with this syndrome have ***properly developed secondary sex characteristics, normal ovaries and a normal female karyotype 46, XX.***

Question 240

# Definition **Patients with pure gonadal dysgenesis;** **46XX** **46XY**

Answer 240

**Patients with pure gonadal dysgenesis** with ***46XX karyotype*** show ***normal growth*** and **no development of secondary** and **tertiary sexual characteristics.** **\*Pure gonadal dysgenesi**s with ***46XY karyotype (Sweyer syndrome)*** is caused by a **mutation in the SRY gene**. Patients have a ***female phenotype***, ***female gender identification***, and **normal development of the mammary glands,** pubic and axillary hair with a properly developed uterus.

Question 241

# Define **Constitutional growth retardation and maturation**

Answer 241

**Constitutional growth retardation and maturation** is a variant of growth with a strong family tendency, associated with **a) delay in maturation of the hypothalamic-pituitary-gonadal axis**, accompanied by growth retardation, **b)** **lack of somatic and hormonal characteristics of puberty in girls \>13 years of age.** and boys\> 14 years old In most cases, this condition does not require treatment as children eventually achieve normal growth and sexual development.

Question 242

# Define **androgen insensitivity syndrome;**

Answer 242

**In the syndrome of total androgen resistance** in adolescence, it is the cause of primary amenorrhea, sparse axillary and pubic hair. At the same time, growth is normal and the **development of the mammary glands is only partially inhibited.** Physical examination shows a short, blind vagina, no uterus, and presence of testicles.

Question 243

# Define **Partial androgen resistance syndrome**

Answer 243

- Virilization features (micropenis, cryptorchidism, hypospadias), a hypoplastic or aplastic uterus, are noteworthy in childhood, **although breast development is usually normal.**

Question 244

# Definition ***Virilization***

Answer 244

is **a condition in which a female develops characteristics associated with male hormones (androgens), or when a newborn has characteristics of male hormone exposure at birth**

Question 245

# Name 2 **Two groups of** tocolytic drugs **are used in Poland:**

Answer 245

* oxytocin receptor antagonists; **Tractocile - the drugs of choice**, used for 48 hours. The patients tolerate it well and it is a safe drug. **Contraindication to its use are symptoms of a threat to the life of the mother or the fetus** * short-acting beta-adrenoreceptor agonists (fenoterol)-- is much less tolerated and has more contraindications, such as: heart and circulatory system diseases, glaucoma, kidney or liver failure.

Question 246

# define **Tocolytic therapy is**

Answer 246

**treatment aimed at suppressing the contractile function of the uterine muscle and thus delaying labor** This therapy helps to prevent complications related to preterm labor, such as: ***respiratory distress syndrome or bleeding into the plexuses of the lateral ventricles of the brain***. Drugs administered in steroid therapy include ***2 administration of 12 mg of betamethasone intramuscularly within 24 hours***. **Such treatment is used in** **premature rupture of membranes****, which is the cause of 1/3 of preterm labor.**

Question 247

# Name 5 Relative contraindications for reproduction in women with diabetes

Answer 247

* **Severe nephropathy (creatinine clearance \<40 ml / min, serum creatinine\> 2.5 mg / dl)** * **Uncontrolled refractory hypertension** * **Untreated proliferative retinopathy** * **Active, advanced ischemic heart disease or a history of myocardial infarction** * Autonomic neuropathy with involvement of the conduction and stimulus system of the heart or the gastrointestinal tract

Question 248

# Define **The triple test**

Answer 248

is one of the ***non-invasive methods of prenatal diagnosis*** - it is a ***screening test*** used to ***detect fetal genetic*** and ***developmental defects***. The concentration of **alpha-fetoprotein (AFP)**, **hCG** and **estriol** between 14 and 20 weeks of pregnancy is assessed

Question 249

# test interpretation Type of defect down syndrome

Answer 249

low AFP, low estriol, increased hCG

Question 250

# test interpretation Type of defect Edwards syndrome

Answer 250

low AFP, low estriol, low hCG

Question 251

# test interpretation Type of defect neural tube defects

Answer 251

high concentration of AFP

Question 252

# name 8 **The result of the triple test is influenced by many factors:**

Answer 252

* **race (higher AFP levels in black than in white)** * multiple pregnancy eg. twins/triplets etc. (↑ AFP) * **body weight** * **insulin dependent diabetes (↑ AFP)** * **smoking** * mother's age * examination using radioactive markers within the 2 weeks preceding the examination * incorrect indication of gestational age.

Question 253

# Name 4 High FSH serum levels accompanied by low estradiol levels are characteristic of:?

Answer 253

Turner syndrome; premature ovarian failure (POF); pure gonadal dysgenesis; postmenopausal period.

Question 254

**Fetus lie** *(situs)*-

Answer 254

* relationship between the longitudinal axis of fetus and the long axis of the uterus and the birth canal * longitudinal * transverse * oblique

Question 255

**Fetal position** *(positio)*-

Answer 255

relation of particular parts of the fetus to the uterus * position I - dorsal column (occiput) on the left side * position II - dorsal column (occiput) on the right side

Question 256

**Fetal position** *(positio)*-

Answer 256

relation of particular parts of the fetus to the uterus * position I - dorsal column (occiput) on the left side * position II - dorsal column (occiput) on the right side

Question 257

**Station** *(immissio)* -

Answer 257

* relationship of the fetal presenting part to the level of the ischial spines

Question 258

**Incorrect head position:**

Answer 258

* low occipito-transverse position * straight occipito-posterior/anterior position above the level of the ischial spines * occipitoposterior position

Question 259

Occiput anterior position

Answer 259

(occiput faces towards pubic symphysis) is a physiological position.

Question 260

**Langerhans cell histiocytosis**

Answer 260

abnormal clonal proliferation of [Langerhans cells](https://en.wikipedia.org/wiki/Langerhans_cell), abnormal [cells](https://en.wikipedia.org/wiki/Cell_(biology)) deriving from [bone marrow](https://en.wikipedia.org/wiki/Bone_marrow) and capable of migrating from skin to [lymph nodes](https://en.wikipedia.org/wiki/Lymph_node). Symptoms range from isolated bone lesions to [multisystem disease](https://en.wikipedia.org/wiki/Systemic_disease). * caused by the growth of **histiocytes** and **Langerhans cells** * causes the appearance of an excessive amount of cytokines and prostaglandins that lead to the formation of infiltrates * **generalized** form - most often in children **before 2 years.** * **localized** character - mostly in **older children**

Question 261

# Name **Langerhans cell histiocytosis Clinical Symptoms**

Answer 261

* **bulging of the skull** * difficult to remove **cradle cap** * **a papular effusion**on the trunk or head * red or yellow-brown * does not respond to antibacterial treatment * unresolving leaks from the ear * **gum infiltrations**, pain and teeth loss, **premature** **teething** * bulging eye / eyes * diabetes insipidus * effort dyspnoea * hemoptysis * hemorrhagic diathesis * enlargement of lymph nodes * hepato-, splenomegaly * fever * lack of appetite, weight loss * change of behavior

Question 262

# Define **Carcinoid:**

Answer 262

* **gastrointestinal tumor,** * most often located in the **appendix** : 90% according to Noszczyk, * usually less than 2 cm, too small to give metastases to the liver * other location: small intestine (terminal ileum - much more often metastasizes to the liver), esophagus, stomach, large intestine, bronchi * neuroendocrine tumor: it secretes mainly serotonin

Question 263

**The triple marker**

Answer 263

test is a non-invasive test that assesses **AFP, hCG and estriol** in mother's blood serum between weeks 14 and 20 of pregnancy. Due to the low **sensitivity (65%)** and the late diagnostic period, it is used less frequently than the double test.

Question 264

**Cell free fetal DNA in the mother's blood test**

Answer 264

A non-invasive prenatal test with the highest sensitivity, as much as **99%** in the diagnosis of chromosomal defects in the fetus is the **assessment of free fetal DNA in the mother's blood**. This test can be performed from the 10th week of pregnancy

Question 265

**The double** **test**

Answer 265

is a non-invasive test carried out between 11 and 14 weeks of pregnancy. It evaluates 2 biochemical markers: ***pregnancy plasma protein (PAPP-A) and placental gonadotropin (hCG).*** It is characterized by early diagnosis and **high sensitivity (95%).**

Question 266

**Ultrasound examination during pregnancy:**

Answer 266

* using the Doppler function assesses the flows in: * middle cerebral artery, * umbilical artery, * ductus venous, * uterine arteries, * tricuspid valve * Doppler function is also used during the diagnostics of preeclampsia, fetal distress, hemolytic anemia, IUGR, postterm pregnancy, haemorrhage during pregnancy, twin pregnancy, during NSAID treatment in pregnancy and fetal echocardiography. * it is obligatorily performed 4 or 5 times during pregnancy:

Question 267

**Double test:**

Answer 267

* performed between the 11th and the 14th week of pregnancy * we measure: PAPP-A and hCG

Question 268

**Triple test:**

Answer 268

* performed between the 14th and 20th week of pregnancy * we measure: AFP, hCG, E3

Question 269

**Quadruple test:**

Answer 269

* performed like a triple test, * measure: AFP, hCG, E3 * but additionally the concentration of inhibin A is measured

Question 270

# The proper management of Pap smear grade 3 is: PAPA I

Answer 270

Normal stratified squamous epithelial cells in the smear.

Question 271

# The proper management of Pap smear grade 3 is: PAPA II

Answer 271

Apart from the normal stratified squamous epithelial cells, there are cells of deep layers of this epithelium, glandular epithelium or elements of inflammatory exudate.

Question 272

# The proper management of Pap smear grade 3 is: PAPA III A

Answer 272

Increased inflammation without atypia. *(case from the question, since the test showed inflammation, it should be repeated after the end of anti-inflammatory treatment)*

Question 273

# The proper management of Pap smear grade 3 is: PAPA III B

Answer 273

Presence of dysplastic cells associated with cervical intraepithelial neoplasia.

Question 274

# The proper management of Pap smear grade 3 is: PAPA IV

Answer 274

The probability of pre-invasive cancer (the current pathomorphological classification does not distinguish it).

Question 275

# The proper management of Pap smear grade 3 is: PAPA V

Answer 275

Cell morphology is altered enough that there is a high probability of cancer.

Question 276

The term „sterilitas primaria” describes:

Answer 276

inability to achieve pregnancy

Question 277

***The primary cancer for metastatic ovarian cancer occurs in:***

Answer 277

1. The digestive tract (usually the stomach) - the **most common** source of metastases 2. breast 3. lungs 4. second ovary 5. endometrium (rare) 6. melanoma (rare) 7. pancreas (rare) 8. carcinoid (rare)

Question 278

The best known steroid therapy used in RDS (*respiratory distress syndrome)* prophylaxis is:

Answer 278

1. Intramuscular administration of 2 doses of 12 mg **betamethasone** at 24-hour intervals 2. Intramuscular administration of 4 doses of 6 mg **dexamethasone** at 12-hour intervals.

Question 279

**Pearl Index**

Answer 279

- the number of pregnancies per 100 women using a given method of contraception for 1 year.

Question 280

The Actual Pearl Index is the lowest for:

Answer 280

**IUD with lewonorgestrel** 0,2**0,2** **IUD Cooper T** 0,8**0,8**

Question 281

The normal sperm count (for 1mL) is:

Answer 281

20 million

Question 282

# Volume: Normospermia:

Answer 282

1.5-6 ml

Question 283

# Volume: Aspermia:

Answer 283

* 0-0.5 ml

Question 284

# Volume: Hypospermia:

Answer 284

* 0.5-1.5 ml

Question 285

# Volume: Hyperspermia:

Answer 285

\> 6 ml

Question 286

Sideropenic anemia

Answer 286

- (iron deficiency anemia) is the **most common** type of anemia occurring in pregnancy. - It is diagnosed if the concentration of Hb is lower than **11 g / dl**.

Question 287

* Anemia during pregnancy can contribute to:* * The basic treatment is oral iron preparations in a dose of ?*

Answer 287

1. miscarriage 2. premature delivery 3. IUGR 4. Intrauterine death of the fetus 5. disturbed uterine contraction function The basic treatment is oral iron preparations in a dose of 100-300 mg / 24 hours

Question 288

In the natural course of the third stage of delivery, the blood loss is

Answer 288

**150-250 ml.**

Question 289

# volume postpartum haemorrhage (PPH)

Answer 289

- defined as the loss of at least **500 ml** of blood from the genital tract **within 24 hours of delivery.** * PPH:* 1. small - 500-1000 ml 2. large -\> 1000ml: * moderate (1000-2000 ml) * heavy (\> 2000ml)

Question 290

Functions of folic acid:

Answer 290

1. role in purine synthesis 2. role in the synthesis of pyrimidines 3. involved in the transformation of amino acids 4. regulation of normal erythropoiesis

Question 291

# length of time/dosage the efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy has been confirmed as

Answer 291

- efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy - it is recommended that each woman planning pregnancy should begin folic acid supplementation at least a **month before planned fertilization and continue it until the end of the first trimester** **-**recommendation to use a constant substitution (regular intake) of **400 μg** folic acid should include all women in childbearing age, regardless of whether they plan to become pregnant.

Question 292

# length of time/dosage the efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy has been confirmed as

Answer 292

- efficacy of folic acid in the periconception period and in the first 12 weeks of pregnancy - it is recommended that each woman planning pregnancy should begin folic acid supplementation at least a **month before planned fertilization and continue it until the end of the first trimester** **-**recommendation to use a constant substitution (regular intake) of **400 μg** folic acid should include all women in childbearing age, regardless of whether they plan to become pregnant.

Question 293

Conditions in which the standard dose (400 μg) should be increased to **4 mg**. These are:

Answer 293

1. the patient gave birth in the past to a child with a neural tube defect, a cleft palate * The predicted beneficial effect of using folic acid on other pregnancy results, including preventing premature birth, increasing birth weight and placenta mass, reducing the incidence of other congenital malformations (including heart defects) has not been explicitly confirmed in well-planned clinical trials 2. the patient is using anti-epileptic medicines 3. BMI of the mother\> 30 kg / m2 4. hyperhomocysteinemia 5. Diabetes 6. Haemolytic anemia

Question 294

**Bacterial vaginosis** (**nonspecific bacterial vaginosis** )

Answer 294

- vaginal infection caused by a disturbed natural balance between bacterial populations. - The lactobacilli are gradually replaced by pathogenic strains, e.g. Gardnerella vaginalis, Mobiluncus, Bacteroides, Prevotella, mycoplasmas.

Question 295

- The lactobacilli are gradually replaced by pathogenic strains e. g.

Answer 295

Gardnerella vaginalis, Mobiluncus, Bacteroides, Prevotella, mycoplasmas.

Question 296

The **HELLP** syndrome is an acronym for English words:

Answer 296

* H - hemolysis * * E - elevated * L - liver enzymes * * L - low * P - platelets

Question 297

The HELLP syndrome is more precisely defined by the **Tennessee classification:**

Answer 297

* hemolysis (LDH\> 600 U / l, elevated total bilirubin) * elevated liver enzymes (AST\> 70 U / l) * reduced number of platelets (\<150,000)

Question 298

# define, secrete, SOM, symptoms diag **Choriocarcinoma**

Answer 298

*(choriocarcinoma) -* aggressive, highly vascularized trophoblast tumor containing tissue very similar to the syncytiotrophoblast and cytotrophoblast. * One of the most aggressive cancers * It releases large amounts of **beta-hCG** * *Symptoms:* Vomiting, hand tremors, hyperthyroidism, uterine bleeding (rare), signs of metastatic foci * The main *site of metastasis:* lungs * Metastasis through the bloodstream * Diagnosis based on an interview, subject examination, physical examination, ultrasound

Question 299

# define-value **Amniotic fluid index** (AFI) is a

Answer 299

- quantitative estimate of [amniotic fluid](https://en.wikipedia.org/wiki/Amniotic_fluid) - AFI is normally **7 to 25 cm**. - each individual pocket of fluid should be 2 to 8 cm. - Fluctuations outside of this range define *oligohydramnios* (too little amniotic fluid) or *polyhydramnios* (too much amniotic fluid).

Question 300

**In the treatment of hypertension in pregnancy what medication is absolutely contraindicated?** **Causing?**

Answer 300

***-ACE inhibitors*** **and** ***ARBs*** **are absolutely contraindicated** **-cause** ***oligohydramnios, kidney damage*** **and** ***skull hypoplasia*** **- Diuretics should also be avoided.**

Question 301

# name 6 meds....include First line drug **Pharmacological treatment of hypertension in pregnancy:**

Answer 301

* ***Methyldopa (first line drug)*** * beta-blockers: labetalol, metoprolol * calcium channel blockers: nifedipine * alpha1-blockers: prazosin * dihydralazine * magnesium sulfate

Question 302

# define congenital toxoplasmosis:

Answer 302

-hydrocephalus, retinitis, choroiditis and intracranial calcifications (the Sabin–Pinkerton triad).

Question 303

# Woman -Men **Frequency of malignant tumours -** ordered from the most common ones

Answer 303

Women -“BCLE OCT” Men -"LPCU SKL"

Question 304

**Frequency of deaths from malignant tumours** - ranked from the most common ones

Answer 304

Women - "LBCO PSC" Men - “LCPS UPK”

Question 305

# Causes of hyperprolactinemia: ***Physiological:***

Answer 305

* pregnancy * first months of breastfeeding * physical stress, e.g. pain, illness * psychological stress, e.g. difficult experiences * sleep * physical effort * protein meal * examination of mammary glands * stimulation of the nipples

Question 306

# Causes of hyperprolactinemia: ***Pathological:***

Answer 306

* prolactinoma * damage to the pituitary stalk * lymphocytic hypophysitis * pituitary injury * hypothyroidism * liver failure * kidney failure * chest wall injury * shingles * epilepsy * drugs:antipsychotics, antidepressants, prokinetics, antihypertensives, drugs used in peptic ulcer disease

Question 307

# Lasts- division **Menstrual cycle:**

Answer 307

* it lasts 28 days * division: * **ovarian** * **uterine:**

Question 308

# Menstrual cycle: **uterine:** 1. menstruation

Answer 308

* 1st-5th day of the cycle * exfoliation of the functional layer of the endometrium, the remaining basal layer is equal to 0.5mm * effect of prostaglandins

Question 309

# Menstrual cycle: 1. proliferative phase

Answer 309

* 6th-13th day of the cycle * **dependent on the growth of follicles in the ovary and the follicular secretion of estrogens** * FSH stimulates the proliferation **of ovarian granulosa cells and their ability to produce estrogens** by increasing aromatase activity → further stimulation of granulosa cell proliferation under the influence of FSH and estrogens → ↑ the number of FSH receptors * thickening of the endometrium * increased number of glands in the endometrium * increased endometrial vascularization

Question 310

# Menstrual cycle: ovulation:

Answer 310

* 14th day of the cycle * further thickening of the endometrium

Question 311

# Menstrual cycle: secretory phase:

Answer 311

* 15th-28th day of the cycle * effect of the action of progesterone secreted by the corpus luteum * further thickening of the endometrium * glands in the endometrium become corrugated * cells accumulate glycogen, lipids and proteins

Question 312

* **cervical**

Answer 312

Question 313

# Fetus and afterbirth: **Stages of prenatal development:**

Answer 313

* germinal * embryonic * fetal: * at the beginning of the fetal stage, the CRL is 33 mm

Question 314

# Afterbirth (adnexa fetalia) : *placenta*:

Answer 314

* common organ of mother and fetus * weighs 500g * the largest dimension: 20-25 cm * thickness: 2-3 cm * placenta is fully developed at the end of the first trimester * lobule is the basic functional unit of the placenta

Question 315

# Afterbirth (adnexa fetalia) : umbilical cord (funiculus umbilicalis):

Answer 315

* length: 60 cm * It includes: * one umbilical vein (because the right umbilical vein disappears at an early stage of fetal life) * two umbilical arteries * Wharton's jelly

Question 316

# Afterbirth (adnexa fetalia) : fetal membranes:

Answer 316

* amnion * chorion * allantois * yolk sac *(saccus vitellinus)*

Question 317

**Prolactinoma:**

Answer 317

* The most common pituitary adenoma * it is derived from lactotropic cells * autonomously secretes prolactin (PRL), which released in excessive amount leads to hypogonadism * hyperprolactinemia impairs pulsatile secretion of GnRH from the hypothalamus, and thus - pituitary gonadotropins (LH and FSH)

Question 318

Prolactinoma Symptoms: * in women:

Answer 318

* abnormal menstrual bleeding (oligomenorrhoea or amenorrhoea) * corpus luteum insufficiency * infertility * galactorrhoea * low libido * hypogonadism * visual impairment (pressure on the optic chiasm) * headache

Question 319

Prolactinoma Symptoms: * in men:

Answer 319

* low libido * erectile dysfunction * infertility * gynecomastia * hypogonadism (reduction of facial hair and pubic hair, reduction of muscle mass) * impaired vision (pressure on the optic chiasm) * headache

Question 320

Polycystic ovary syndrome and Cushing's syndrome may have similar symptoms. The most commonly used screening test for Cushing's syndrome

Answer 320

- screening test for Cushing's syndrome is a *dexamethasone suppression test.* - This will be the most appropriate test to differentiate these medical conditions. **1 mg dexamethasone** **suppression test** (overnight dexamethasone suppression test, low-dose dexamethasone suppression test): * administer 1 mg of dexamethasone orally before going to sleep (at 22.00-23.00) * determine the serum cortisol concentration in the morning on an empty stomach between 8:00 and 9:00 * a cortisol concentration \<1.8 μg / dl (50 nmol / L) excludes Cushing's syndrome

Question 321

# define **Placental abruption** *(ablatio placentae)*

Answer 321

- complete or partial separation of a correctly located placenta from the uterine wall with forming a retroplacental hematoma. *

Question 322

# indications for caesarean section: **Placental abruption** *(ablatio placentae)*

Answer 322

* This is a direct threat to the life of the fetus * Placental abruption is one of several (according to the Polish Gynecological Society) emergency indications for caesarean section: * umbilical cord prolapse * suspected internal haemorrhage due to uterine rupture * **placental abruption** * eclampsia * risk of eclampsia * fetal heart dysfunction

Question 323

**Gonadotropin-Releasing Hormone analogues**

Answer 323

- a group of drugs formed by the modification of the natural Gonadotropin-releasing hormone (GnRH) amino acid chain, which prolonged its half-life.

Question 324

# MOA **Gonadotropin-Releasing Hormone analogues**- MOA

Answer 324

* **Mechanism of action:** they bind to the receptors in the anterior pituitary gland, initially increasing gonadotrophin secretion, and then after about 10 days, due to down-regulation of the number of GnRH receptors, they cause a strong hypogonadotropic effect

Question 325

# Name 7 **Gonadotropin-Releasing Hormone analogues** **Group representatives**

Answer 325

* leuprolide * goserelin * buserelin * nafarelin * deslorelin * histrelin * triptorelin

Question 326

**Gonadotropin-Releasing Hormone analogues** **Indications:**

Answer 326

* breast cancer * prostate cancer * endometriosis * uterine myomas * inhibition of precocious puberty * protocols for assisted reproduction

Question 327

# SE **Gonadotropin-Releasing Hormone analogues**-

Answer 327

*(due to hypogonadotropic hypogonadism)* * hot flushes * night sweats * mood and sleep disorders * atrophic changes in the reproductive system * reduction in bone mineral density * increased risk of cardiovascular diseases

Question 328

# define **PCOS** *(* polycystic ovary syndrome) **:**

Answer 328

* also known as Stein-Leventhal syndrome * affects 4-12% of women * familial incidence * diagnosis after excluding other diseases with similar symptoms (Cushing's syndrome, hyperprolactinemia, CAH, hypothyroidism or hyperthyroidism, acromegaly, androgen secreting tumors) * increases the risk of endometrial cancer

Question 329

PCOS ## Footnote **Clinical and biochemical symptoms:**

Answer 329

* increase in LH concentration * insulin resistance * hyperinsulinemia * hyperandrogenemia: * and its clinical consequences: hirsutism, acne, baldness * overweight or obesity * menstrual cycle disorders * infertility * carbohydrate metabolism disorders * increased estrogen concentration

Question 330

**Diagnosis of PCOS:**

Answer 330

(Rotterdam Criteria, minimum 2/3) * oligoovulation or anovulation * clinical symptoms of hyperandrogenism or hyperandrogenemia * image of polycystic ovaries in ultrasound (at least 12 follicles with a diameter of 2-9 mm, volume of ovary\> 10 ml)

Question 331

PCOS ## Footnote **Treatment:**

Answer 331

1. Lifestyle modification * **body weight normalization is a basic recommendation for patients with PCOS** * permanent change of eating habits * diet * physical exercises 2. Pharmacotherapy: * *combined oral contraceptive pill* * *metformin* * antiandrogens: *spironolactone* 3. Infertility treatment: * *clomiphene citrate* (the first-line therapy in the treatment of infertility) * stimulation protocol using *gonadotrophins and GnRH analogues* (second-line therapy in the treatment of infertility) * laparoscopic treatment (third-line therapy in the treatment of infertility): * electrocautery * laser technique * in *vitro fertilization* (fourth-line therapy in the treatment of infertility)

Question 332

**Diameters and circumferences of the fetal head:** **Diameters** :

Answer 332

* suboccipitobregmatic diameter: 9.5 cm * occipitofrontal diameter: 12 cm * occipitomental diameter: 13.5 cm

Question 333

# combined contraceptive pill **Mechanism of action of the estrogen component:**

Answer 333

* FSH suppression * inhibiting the selection and growth of the dominant follicle * prevention of bleeding * intensification of progestational activity

Question 334

# combined contraceptive pill **Mechanism of action of the gestagen component:**

Answer 334

* LH suppression * effect on the endometrium * thickening of cervical mucus * effect on the fallopian tubes

Question 335

**Postpartum pituitary gland necrosis**

Answer 335

(Sheehan's syndrome) - deficiency of hormones of the anterior pituitary gland as a result of necrosis caused by hemorrhage and hypovolemic shock during or after delivery.

Question 336

# a set of symptoms caused by a deficiency of one or more pituitary hormones: ACTH:

Answer 336

* orthostatic hypotension * fainting * nausea and vomiting * anorexia * weight loss * increased body temperature * reduced skin pigmentation * a tendency to hypoglycemia (especially when GH deficiency coexists)

Question 337

# a set of symptoms caused by a deficiency of one or more pituitary hormones: GH: (symptoms of deficiency that occurred in an adult are not clear)

Answer 337

* reduction in muscle mass * fat gain (mainly visceral) * reduction in bone mineral density * hypoglycemia * hyperlipidemia

Question 338

# a set of symptoms caused by a deficiency of one or more pituitary hormones: TSH:

Answer 338

* secondary hypothyroidism - symptoms less pronounced than in primary hypothyroidism, there is no goitre

Question 339

# a set of symptoms caused by a deficiency of one or more pituitary hormones: LH and FSH:

Answer 339

* **hypogonadotropic hypogonadism** **(answer B)**: * amenorrhea * low libido * disappearance or lack of tertiary sexual characteristics (pubic hair)

Question 340

# a set of symptoms caused by a deficiency of one or more pituitary hormones: PRL:

Answer 340

* no lactation after delivery

Question 341

**Magnesium sulfate: Antidote**

Answer 341

calcium gluconate

Question 342

# "B" Bracht for "Breech" birth **The Bracht maneuver**

Answer 342

- is used in case of **breech birth.** - It consists in directing the trunk of the fetus in the direction corresponding to the pelvis leading line and applying pressure on the uterine fundus by an assisting person. - Some authors resign from applying pressure on the uterine fundus and at the final stage of delivery **administer iv 5 oxytocin units.**

Question 343

**Swyer syndrome:**

Answer 343

* a variant of **the XY** gonadal dysgenesis (male genotype) * because dysgenetic gonads **do not secrete testosterone (hypogonadism)** nor anti-Müllerian hormone, Müllerian ducts' derived organs develop (female) * is characterized by a **female phenotype** , **female internal sexual organs** , normal or high growth, sexual infantilism and **primary amenorrhea**

Question 344

# indications **Mirabegron**

Answer 344

is a strong and selective b3- adrenergic receptors agonist. **Indications:** **emergency treatment of urinary urgency, pollakiuria and / or incontinence caused by urinary urgency**, which may occur in adult patients with overactive bladder syndrome (OAB).

Question 345

disulfiram-like effect includes **metronidazole**, which we use to treat

Answer 345

treat genital infections, e.g. T. vaginalis infection and bacterial vaginosis.

Question 346

# Indications for Caesarean section in twin pregnancy (based on Bręborowicz): 1. **Elective** (absolute) indications: name 6

Answer 346

* first fetus in a non-cephalic position (presentation) * twin B\>A by 25% * monoamniotic pregnancy (c-section in 34 wk of pregnancy) * conjoined twins (c-section in 36-38 wk of pregnancy) * pregnancy ≥3 fetuses * other, see below - indications for Caesarean section

Question 347

# Indications for Caesarean section in twin pregnancy (based on Bręborowicz): 1. **Relative** indications:

Answer 347

* monochorionic-diamniotic pregnancy * TTTS * history of cesarean section * twin pregnancy \<32 week of pregnancy * primipara - despite the cephalic position of the first fetus, if the second fetus' position is non-cephalic * death of the first fetus in the third trimester

Question 348

# Indications for Caesarean section in twin pregnancy (based on Bręborowicz): 1. **Emergency** indications:

Answer 348

* "locked twins" (interlocked) * breech presentation with born lower limbs of both fetuses, with no delivery progress. (even when the fetuses are dead) * see below, indications for Caesarean section

Question 349

# Indications for caesarean section: Bręborowicz groups these indications into three stages of urgency: elective, urgent, emergent) 1. **Elective** (planned) indications:

Answer 349

* incorrect fetal position * cephalopelvic disproportion (anatomical defects of pelvis) * macrosomia \>4500g, big fetus in diabetic mother \>4250g) * thin uterine scar \<2mm * non-obstetric indications (neurological, ophthalmic, orthopedic, hematological, cardiological, psychiatrical, other)

Question 350

# Indications for caesarean section: 1. **Slightly urgent** indications**:**

Answer 350

* incorrect head position * abnormal fetal position with ongoing uterine contractions * cervical dystocia * severe pre-eclampsia * preterm delivery of a fetus for which birth via the reproductive tract is a serious risk of injury or death

Question 351

# Indications for caesarean section: 1. **Urgent** indications**:**

Answer 351

* recurrent episodes of bradycardia * late or variable decelerations with ineffective contractions that do not ensure the proper progress of delivery * deep fetal bradycardia that does not respond to conservative treatment

Question 352

# Indications for caesarean section: 1. **Emergency** indications**:**

Answer 352

* umbilical cord prolapse * suspected internal haemorrhage due to uterine rupture * premature placental abruption * eclampsia * threatening eclampsia * fetal heart dysfunction

Question 353

*menometrorrhagia*

Answer 353

* - abundant, irregular, prolonged bleedings, linked to an increase estrogens blood concentration, particularly in the perimenopausal period

Question 354

*hypermenorrhoea*

Answer 354

* *-* blood loss \>100 ml

Question 355

*hypomenorrhoea -*

Answer 355

* blood loss \<30 ml

Question 356

*dysmenorrhoea -*

Answer 356

* severe pain in perimenstrual period and during bleeding itself

Question 357

*algomenorrhoea -*

Answer 357

* menstrual pains are accompanied by vegetative symptoms

Question 358

*metrorrhagiea -*

Answer 358

* abundant, prolonged bleedings not on the time of expected menstruation

Question 359

*juvenilis -*

Answer 359

* acyclic bleeding in young women \>10 days

Question 360

*climacteria -*

Answer 360

* bleeding in a woman 6-12 months after menopause

Question 361

*menorrhagia -*

Answer 361

* regular, cyclic, abundant, prolonged bleeding in menstruation time

Question 362

*amenorrhoea intermittens* -

Answer 362

rare bleedings in intervals lasting from 43 days to 6 months, most often, but not always, are anovulatory cycles and typically occur in women with polycystic ovary syndrome.

Question 363

**Anemia during pregnancy can contribute to:**

Answer 363

1. miscarriage 2. **premature delivery** 3. **IUGR** 4. intrauterine fetal death and stillbirth 5. disturbed uterine contractility and **prolonged labour.** 6. delayed child development

Question 364

**The most common type of anemia in pregnancy:**

Answer 364

**syderopenic** (iron deficiency anemia)

Question 365

# how is it recognized - tested **syderopenic** (iron deficiency anemia)

Answer 365

* It is recognized if Hgb concentration is lower than **11 g / dl** * The longer the pregnancy lasts, the greater the risk of anemia is * The blood count is the screening test: * MCV \<80 mm3 * decreased ferritin concentration * TIBC increase * elevated transferrin * elevated sTfR

Question 366

**Treatment of preeclampsia:** it is necessary to prevent convulsions -

Answer 366

* intravenous administration of **MgSO4** Zuspan method: * initial dose 4-6g, within 20 minutes * maintenance dose 1-2g / h for\> 24h * frequent side effects, the need to monitor patellar reflex, respiratory rate and diuresis * antidote: 1g of calcium gluconate

Question 367

in order to prevent convulsions in Preeclampsia - Via *Zuspan method*: intravenous administration of **MgSO4** = antidote?

Answer 367

antidote: **1g of calcium gluconate**

Question 368

# tumors producing steroid hormones are name the steroid hormones being produced: 4

Answer 368

(estrogens, testosterone, androstendione, **DHEA**) include: **Dehydroepiandrosterone (DHEA)**, known as androstenolone, is an endogenous steroid hormone precursor. DHEA is produced in the adrenal glands, the gonads, and the brain DHEA **helps produce other hormones, including testosterone and estrogen**. Natural DHEA levels peak in early adulthood and then slowly fall as you age.

Question 369

# tumors producing steroid hormones are name the tumors producing the steroids: 6

Answer 369

dysgerminoma, embryonal carcinoma, immature teratoma, gonadoblastoma, foliculliculoma, Sertoli-Leydig cell tumor.

Question 370

# 7 "ICE D PEG" **Germ cell tumors** (from multipotent reproductive cells or stem cells present in the ovary):

Answer 370

* *Dysgerminoma* * *Embryonal carcinoma* * *Immature teratoma* * Choriocacrinoma * Endodermal sinus tumor; Yolk sac tumor * *Gonadoblastoma* * Polyembryoma

Question 371

# 4 **Gonadal tumors** (arise from sex cords and ovarian stroma, produce steroids):

Answer 371

* **Thecofibroma** * Folliculoma - (also called **granulosa cell tumor**) * Sertoli-Leydig cell tumor - a tumor from Sertoli and Leydig cells * Androblastoma

Question 372

**Kallmann syndrome**

Answer 372

- is the lack of smell sense present in over 80% of patients. - Other symptoms include hypogonadotropic hypogonadism (delayed puberty, incomplete development of sexual characteristics), bone system abnormalities, disturbances in the middle line, gynecomastia.

Question 373

# explain decreased sperm count in the semen analysis, gynecomastia was found and laboratory tests showed decreased follicle-stimulating hormone levels and increased testosterone levels. The most probable cause of the?

Answer 373

The use of Anabolic steroids -Exogenous testosterone will inhibit the nuclear axis of the pituitary gland, resulting in a decrease in endogenous testosterone production, **suppression of spermatogenesis**, and testicular atrophy.

Question 374

# name & descrive * the most common gonadal tumor

Answer 374

**Folliculoma:** (arise from sex cords and ovarian stromal cells) * the most common gonadal tumor * applies to women of all ages * usually one-sided * *secretes:* * **estrogens**: * may cause early puberty symptoms in girls * **they can cause excessive menstruation or abnormal bleeding** * they increase the risk of endometrial hyperplasia and endometrial cancer * they are not used to monitor treatment and detect relapses * **inhibin**: * a useful indicator for monitoring treatment and relapse detection * can stop menstruation * basic treatment: **surgery** * **characterized by late relapses (on average 4-6 years, but even after 30 years)** * **it easily breaks, causing peritoneal symptoms. Immediate surgery is required**

Question 375

# 10 **Drug treatment of** ***urinary tract infections*** **in _pregnant_ or _lactating women:_**

Answer 375

* **nitrofurantoin** * furazidine - do not use in the first trimester of pregnancy * co-trimoxazole * trimethoprim * fosfomycin * **amoxicillin** * amoxicillin with clavulanate * cephalexin * **ampicillin** * **cefuroxime**

Question 376

# 5 **Pregnant women should not use:**

Answer 376

* **Tetracyclines** (damage fetal teeth and bones) * **Trimethoprim** (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus) * **Sulfamethoxazole** (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice) * Fluoroquinolones **(completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)** * **Macrolides** (should not be used as first-line drugs).

Question 377

# Pregnant women should not use: symptoms **Tetracyclines**

Answer 377

* (damage fetal teeth and bones)

Question 378

# Pregnant women should not use: cause symptoms **Trimethoprim**

Answer 378

* (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus)

Question 379

# Pregnant women should not use: causing symptoms **Sulfamethoxazole**

Answer 379

* (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice)

Question 380

# Pregnant women should not use: causing symptoms Fluoroquinolones

Answer 380

* **(completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)**

Question 381

# Pregnant women should not use: causing symptoms **Macrolides**

Answer 381

(should **not be used as first-line drugs**). -Macrolide antibiotics are used for the **treatment of common bacterial infections**, such as **upper and lower respiratory infections** and **sexually transmitted diseases,** and are frequently used as **alternatives for patients allergic to penicillin.** Macrolides (such as **azithromycin, clarithromycin, and erythromycin**) are among the most commonly prescribed antibiotics during pregnancy

Question 382

**Double test:** * **performed between the what week/weeks of pregnancy?** * **evaluates two biochemical markers in pregnant blood: Name**

Answer 382

**-performed between the** 11th and the 14th week **of pregnancy** **-evaluates two biochemical markers in pregnant blood:** PAPP-A and β-hCG

Question 383

**Triple test:**

Answer 383

* performed between the **14th and 20th week** of pregnancy * we measure: * AFP * hCG * E3

Question 384

**druple test:**

Answer 384

* performed as a **triple test**, but additionally the concentration of **inhibin A is determined** * Triple test measure: * AFP * hCG * E3

Question 385

Placenta previa **-** placenta nested within the lower part of the uterus

Question 386

# risk factors: Placenta previa **-**

Answer 386

* placenta nested within the lower part of the uterus * multiparity**,** age, multiple pregnancy, cigarette smoking, fetal defects, cesarean sectio

Question 387

-Placenta previa gold standard Diagnosis, time of diagnosis, examination : name all

Answer 387

* the final diagnosis is made only in the second half of pregnancy, when the placenta is fully developed. * **Internal examination is strictly contraindicated, even during labor.** * **the golden diagnostic standard is transvaginal ultrasonography.** * **its diagnosis is an indication for hospitalization and intensive supervision of the pregnant woman and the fetus.** * perinatal mortality rate is 10 times higher than normal * the prognosis for the mother is usually good * **the first bleeding is usually painless and rather harmless**

Question 388

# Define **L**ie of the fetus

Answer 388

***(situs)*** **-** the relationship of the ***_l_**_ong_ _axis_ of the fetus to the **_l_**_ong_ _axis_ of the uterus and the birth canal* * **l**ongitudinal * transverse * oblique

Question 389

**P**osition of the fetus

Answer 389

* ***(positio)*** - the relationship of **_p_**_articular_ **_p_**_arts_ of the fetus to the uterus * position I - back (head) on the left side * position II - back (head) on the right side

Question 390

**Attitude of the fetus**

Answer 390

* ***(habitus)*** - the relationship of part of the fetus relative to self * flexed * extended

Question 391

**Presentation of the fetus**

Answer 391

* ***(immissio)*** - relationship of the presenting part to the intercostal line

Question 392

Ovarian cancer is very sensitive to chemotherapy, especially if the surgery did not leave many leftovers of the disease. *treatment regimens use & drugs with the highest activity against ovarian cancer:*

Answer 392

* * platinum derivatives: **cisplatin** and **carboplatin** - drugs with the highest activity against ovarian cancer. * ***paclitaxel*** * **The combination of** **_carboplatin_ and _paclitaxel_ is currently the _"golden standard" for ovarian_ cancer.**

Question 393

# define serological tests

Answer 393

* - **determination** of **specific antibodies** in serum in immunocompetent patients:

Question 394

# serological tests - determination of specific antibodies in serum in immunocompetent patients: **IgM**

Answer 394

- they *appear 1 week after the invasion*, reach a *maximal concentration after 1 month* and **usually disappear after 6-9 months, they can persist for many months** or years after infection

Question 395

# serological tests - determination of specific antibodies in serum in immunocompetent patients: **IgA**

Answer 395

- testify to the recent infection, *disappear earlier than IgM* (less accessible test, especially *useful in the diagnosis of infection in pregnant women* and in innate form)

Question 396

# serological tests - determination of specific antibodies in serum in immunocompetent patients: **IgG**

Answer 396

- **maximal concentration 2-3 months after infection, last a lifetime.** - When it is necessary to determine the time of infection (eg in pregnant women), the ***so-called avidity*** (*strength of binding to antigen*) **IgG antibodies (low avidity antibodies → acute phase toxoplasmosis, antibodies with high avidity → invasion before ≥20 weeks)**

Question 397

**A pap smear is a cervical cancer** screening test used in many countries, including Poland. In Poland, it is addressed to women aged **25-59** who have not had a pap smear examination performed in the last 3 years. The sensitivity of the test is about 65-70% The group of patients included in the screening every **12 months** include:

Answer 397

* HIV-positive patients * patients taking immunosuppressants * HPV-infected patients - a high-risk type

Question 398

What **is** ***not*** **a risk factor for** ***cervical cancer***

Answer 398

**-Obesity is not a risk factor for** *cervical cancer**,* -while it increases the risk (2-4 times) of **endometrial cancer.**

Question 399

# Biological effects: * **estrogen**:

Answer 399

* the development of secondary and tertiary sexual characteristics * increased uterine muscle mass * stimulation of endometrial proliferation * increasing the amount of transparent mucus * stimulating the growth and exfoliation of the vaginal epithelium * increase in libido * stimulating the growth and proliferation of tubules and follicles in the mammary gland * pro-thrombotic * increase in synthesis: * SHBG * CBG * TBG * inhibition of osteolysis * water retention in the body * beneficial effect on the emotional state

Question 400

# Biological effects: **gestagens**

Answer 400

* growth and congestion of the uterine muscle * **reduction in uterine contractility and tubal peristalsis** * **increasing the density of cervical mucus** * **increasing the synthesis of glucagon** * lowering the hypoglycemic effect of insulin * **increase in body temperature** * **diuretic action** * antiandrogenic effect * synergistic effect with estrogens on the nipple: stimulation of the growth and proliferation of tubules and follicles in the mammary gland

Question 401

HELLP

Answer 401

(**Hemolysis, Elevated Liver enzymes and Low Platelets**) syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia.

Question 402

clinical picture of **Kallmann's syndrome** includes

Answer 402

- an olfactory disorder and isolated hypogonadotropic hypogonadism- *loss of sense of smell* - **Diagnosis is possible already in the neonatal period** due to the *early manifestation of symptoms* such as ***micropenis, cryptorchidism (*****the absence of at least one testicle from the scrotum)*****, and a small volume of testicles***. - Sexual maturation usually does not occur or is stopped. - The silhouette is eunuchoidal and bone age is delayed.

Question 403

**Asherman's syndrome** is

Answer 403

- ***adhesions in the uterine cavity*** that ***completely or partially close its lumen.*** - This is manifested by either little or **no bleeding**. - The most common *causes of Asherman's syndrome* are: **curettage of the uterine cavity,** endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.

Question 404

**Sheehan's syndrome** is

Answer 404

***-******postpartum pituitary necrosis***caused by***perinatal hemorrhagic shock*****.** - The most characteristic symptom is **the lack of lactation** resulting from a *sudden decrease in the secretion of prolactin by the pituitary gland.* - Other symptoms of this syndrome include: **no return of menstruation after delivery**, secondary adrenal and thyroid insufficiency - they develop gradually over many months.

Question 405

# 5 **cardiovascular system:**

Answer 405

* **increase in the output and the heart rate** * **reduction of peripheral resistance** * **increase in stroke volume** * **decrease in blood pressure** * **increase in blood volume:**

Question 406

# Location of the uterine fundus: at the end of 16th week:

Answer 406

* 1 -2 fingers above the pubic symphysis

Question 407

# Location of the uterine fundus: at the end of 20th week:

Answer 407

* 2-3 fingers below the navel

Question 408

# Location of the uterine fundus: **at the end of 24th week:**

Answer 408

* **at the level of the navel**

Question 409

# Location of the uterine fundus: at the end of 28th week:

Answer 409

* 2-3 fingers above the navel

Question 410

# Location of the uterine fundus: at the end of 32th week:

Answer 410

* halfway between the navel and the xiphoid process

Question 411

# Location of the uterine fundus: at 36th week:

Answer 411

* adjacent to ribs (the highest location)

Question 412

# Location of the uterine fundus: at 40th week:

Answer 412

* 1-2 fingers below the ribs

Question 413

Pfannenstiel-Kerr incision or pubic incision

Answer 413

**-type of abdominal surgical incision that allows access to the abdomen**. -It is used for gynecologic and orthopedics surgeries, and it is the most common method for performing Caesarian sections today.

Question 414

**Wolff channel cells**

Answer 414

→ These are cells that transform into the vas deferens in men, while in women they are **atrophied.**

Question 415

**luteal corpuscle**

Answer 415

→ lutein-granular cysts are sent with a layer of luteinized granular cells surrounded by a thick connective tissue wall. ---Their content is usually bloody. -They can cause pain in the lower abdomen, producing hormones - ***estrogens and / or progesterone*** lead to *disorders of the menstrual cycle.*

Question 416

**fibroblast tumor**

Answer 416

**-(*****fibroma*****)** is a gonadal tumor that originates from the stroma of the ovary. - Occurs mainly in postmenopausal women and is **hormonally inactive****.** - Often however, it can be a component **of Meigs syndrome** (ovarian tumor + ascites + pleural fluid).

Question 417

Urinary Incontinence Forms:

Answer 417

* stress urinary incontinence (WNM) * urgent urinary incontinence (NNM) * overflow incontinence * non-sphincter urinary incontinence

Question 418

stress urinary incontinence (WNM)

Answer 418

* excessive mobility of the bladder neck * sphincter mechanism failure

Question 419

urgent urinary incontinence (NNM)

Answer 419

* detrusor muscle hyperactivity * low bladder wall compliance

Question 420

overflow incontinence

Answer 420

* detrusor muscle insufficiency * obstacle to outflow

Question 421

non-sphincter urinary incontinence

Answer 421

* fistula * developmental defects

Question 422

The Bishop's scale is used to: Scale: Parameters:

Answer 422

- assess the **degree of cervical ripening**. - Score on a scale **of 0 to 3 points.** is subject to **5 parameters**: * **dilatation** * shortening * **consistency** * **ratio of the cervix to the vaginal axis** * **position of the presenting part**

Question 423

Hormonal changes in **polycystic ovary syndrome (PCOS):**

Answer 423

* **↑ LH secretion** → stimulation of theecal cells → **↑ androgen production** * ↑ androgen levels → dysfunction of the hypothalamic-pituitary-ovarian axis → ↑ pulsatile GnRH secretion → **↑ LH levels** → **premature follicular maturation** → premature estradiol peak → FSH inhibition → **↓ FSH levels** * **LH: FSH ratio\> 2** * increased aromatization of androgens → **relative hyperestrogenism**

Question 424

**treatment is used in** **premature rupture of membranes**

Answer 424

Drugs administered in steroid therapy include: - ***two administration*** of ***12 mg of betamethasone*** ***intramuscularly*** ***within 24 hours***

Question 425

**Two groups of tocolytic drugs are used in Poland:**

Answer 425

* oxytocin receptor antagonists; * short-acting beta-adrenoreceptor agonists (fenoterol).

Question 426

Adenocarcinoma is the most common histological type of

Answer 426

**endometrial cancer.**

Question 427

There are two types of endometrial cancer:

Answer 427

**Type I **- estrogen-dependent – ​​glandular (Latin: adenocarcinoma endometroides ) , Type I occurs in 80% of cases **type II** - occurring without any connection with hyperestrogenism. Type II in 20% .

Question 428

What type of cell is a choriocarcinoma?

Answer 428

- Choriocarcinoma is a true malignant neoplasm of trophoblastic cells. - Approximately 50% of choriocarcinomas follow molar pregnancies, and the remainder occur after spontaneous abortions or ectopic or intrauterine pregnancies.

Question 429

Choriocarcinoma is a

Answer 429

- malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. - It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). - It is also classified as a germ cell tumor and may arise in the testis or ovary.

Question 430

Choriocarcinoma of the placenta during pregnancy is preceded by:

Answer 430

- hydatidiform mole (50% of cases) - spontaneous abortion (20% of cases) - ectopic pregnancy (2% of cases) - normal term pregnancy (20–30% of cases) - hyperemesis gravidarum

Question 431

# name 10 conditions Increased CA 125 concentrations are observed in

Answer 431

- endometriosis - uterine fibroids , - liver cirrhosis, - pelvic inflammatory diseases (PID), - endometrial, - breast, - lung - pancreatic cancer - during pregnancy - menstruation

Question 432

Hyperandrogenism is characterized by the following symptoms:

Answer 432

hirsutism, acne, alopecia .

Question 433

Tumors arising from the cells of the female gonad are:

Answer 433

- folliculloma - granulosa cell tumor - areoblastoma - fibroma

Question 434

tumors arising from cells from the male gonad are:

Answer 434

- Sertoli cell tumor - Leydig cell tumor

Question 435

Trophoblast hyperplasias include :

Answer 435

- complete mole - partial prismatic mole

Question 436

Germinoma ( dysgerminoma )

Answer 436

- large tumor (over 10 cm) with a capsule - In 90% of cases, it occurs unilaterally , but it is the only germ cell tumor that can also occur bilaterally - is the most frequently diagnosed malignant ovarian tumor in pregnant women - may develop from gonadoblastoma - the marker used to diagnose germinomas is LDH (lactate dehydrogenase) - treatment includes adnexectomy and adjuvant chemotherapy

Question 437

Teratomas There are two subgroups of teratomas:

Answer 437

- Immature teratoma ( teratoma immaturum ) - Mature teratoma ( teratoma maturum )

Question 437

# 7 facts Immature teratoma ( teratoma immaturum )

Answer 437

- malignant tumor - elements of the tumor resemble embryonic (embryonic) tissues - 1% of all malignant ovarian tumors - accounts for 10–20% of malignant ovarian tumors diagnosed before the age of 20 - it practically does not occur in postmenopausal women - it usually occurs unilaterally - less sensitive to chemotherapy than germinoma ( complete removal of all tumor foci is very important )

Question 438

Mature teratoma ( teratoma maturum )

Answer 438

- most often mild - composed of elements of three germ layers (if one tissue dominates, it may differentiate, e.g. towards ovarian goiter and cause symptoms of hyperthyroidism ) - the most common form is a dermoid cyst (ectodermal elements dominate) - usually in women of reproductive age (20–30 years) - sometimes diagnosed during pregnancy (if it is large, it may constitute an obstacle to childbirth) - treated surgically

Question 439

Yolk sac tumor

Answer 439

- malignant epithelial tumor arising from the primary yolk sac - grows very quickly (average tumor size is about 15 cm) - it develops unilaterally - it is solid, brittle and has a thin capsule - the average age of patients is 18 years (1/3 of girls are prepubescent) - secretes α-fetoprotein (AFP) - a sensitive marker used to monitor treatment

Question 440

Embryonic cancer ( carcinoma embryonale )

Answer 440

- occurs very rarely - the average age of patients is 14 years - can secrete estrogens , AFP (α-fetoprotein) and β-hCG (chorionic gonadotropin)

Question 440

Asherman's syndrome

Answer 440

- develops as a result of a single or repeated injury to the uterine lining in the course of abrasion , infection or hysteroscopic surgery - currently, one of the most common causes of Asherman's syndrome is curettage of the uterine cavity in the early postpartum period - Typical symptoms include intrauterine adhesions, scanty menstruation, amenorrhea and infertility.

Question 441

Antiphospholipid syndrome ( APS) is a

Answer 441

- systemic autoimmune disease in which the clinical picture is most important thrombotic complications and obstetric failures . - Up to 25% of unexplained recurrent miscarriages may be related to the presence of antiphospholipid antibodies (aPL). - These antibodies include: - lupus anticoagulant (LA), - anticardiolipin antibodies (aCL) - anti-B2-glycoprotein I anti bodies (aB2GPI). - aPL antibodies occur in about 5% of healthy women and in 5-50% of women with pregnancy losses

Question 442

Classification according to ASRM ( American Society for Reproductive Medicine ) – divides uterine defects into 7 classes:

Answer 442

Type 1 – agenesis or hypoplasia of structures derived from the Müllerian ducts, e.g. Mayer–Rokitansky–Küster–Hauser syndrome, Type 2 – unicornuate uterus ( uterus unicornis ), Type 3 – double uterus (uterus didelphys), Type 4 – bicornuate uterus ( uterus bicornis ), Type 5 – single uterus divided by a complete or partial septum, Type 6 – arcuate uterus ( uterus arcuatus ), Type 7 – developmental abnormalities associated with intrauterine exposure to DES (diethylstilbestrol).

Question 443

Gynecological oncology Chorionic Villus Cancer – Treatment and Monitoring | chorionic carcinoma

Answer 443

1) Chemotherapy (even in advanced stages) – methotrexate. 2) β-hCG determination : – every month for the first 2 years, – then every 6 months for the rest of your life. 3) Hormonal contraception is recommended. 4) Patients should not get pregnant during the first 2 years.

Question 444

# Gynecological oncology Ovarian tumors – Germ cell tumors of the ovary There are two subgroups of teratomas:

Answer 444

- Mature - Immature

Question 445

# Ovarian tumors – Germ cell tumors of the ovary Immature teratoma ( teratoma immaturum )

Answer 445

- Malignant tumor , - the tumor elements resemble embryonic (germinal) tissues, - 1% of all malignant ovarian tumors, - constitutes 10–20% of malignant ovarian tumors diagnosed before the age of 20 , - it is practically non-existent in postmenopausal women, - it usually occurs on one side , - less sensitive to chemotherapy than germinomas (complete excision of all tumor foci is very important).

Question 446

# Ovarian tumors – Germ cell tumors of the ovary Mature teratoma ( teratoma maturum )

Answer 446

- Mostly mild , - include *dermoid cysts* and are generally benign - may be composed of elements from three germ layers (ecto-, endo- and mesoderm) – most often it has hair, fat or teeth, - in the case of the presence of neuroectodermal tissue, it may cause symptoms, such as carcinoid syndrome in the case of serotonin production, and when thyroid tissue is present, the patient may experience symptoms of hyperthyroidism , - usually in women of reproductive age (20–30 years old), - sometimes diagnosed during pregnancy (if large, it may constitute an obstacle to delivery), - treated surgically.

Question 447

# Ovarian tumors – Germ cell tumors of the ovary germinoma ( dysgerminoma )

Answer 447

1. The second most common germ cell tumor (after teratoma) but the most common malignant tumor in this group. 2. Large tumor (over 10 cm) with a capsule. 3. In 90% of cases it occurs unilaterally , but as the only germ cell tumor it can also occur bilaterally . 4. It is the most frequently diagnosed malignant ovarian tumor in pregnant women . 5. It may occur in dysgenetic gonads (e.g. in Turner syndrome) – then it often develops on the basis of gonadoblastoma . 6. The marker used to diagnose germinomas is LDH (lactate dehydrogenase) and beta-HCG . 7. Treatment includes adnexectomy and adjuvant chemotherapy.

Question 447

# Ovarian tumors – Germ cell tumors of the ovary Yolk sac tumor

Answer 447

- The second most common malignant tumor in this group develops from cells of the primary yolk sac. - It most often occurs in children and young women – the average age of patients is 18 years (⅓ of girls are pre-pubertal). - It grows very quickly (the average size of the tumor is about 15 cm). - It develops one-sidedly . - It is solid, fragile and has a thin capsule. - Secretes α-fetoprotein (AFP) – a sensitive marker used to monitor treatment; or LDH. - May co-occur with germinomas. - All patients, in addition to surgical treatment, should also undergo chemotherapy.

Question 448

# Ovarian tumors – Germ cell tumors of the ovary Embryonic cancer ( carcinoma embryonale )

Answer 448

- It occurs very rarely . - Mainly in children and young women – the average age of patients is 14 years. - It may secrete AFP (α-fetoprotein) and β-hCG (chorionic gonadotropin), LDH and estrogens (producing symptoms of premature puberty). - It is associated with a much worse prognosis than other cancers in this group. - Treatment involves surgery and chemotherapy.

Question 449

# Ovarian tumors – Germ cell tumors of the ovary Mixed Germ Cell Tumors

Answer 449

- They contain two or more germ cell tumor elements. - The most common combination is germinomas and yolk sac cancer .

Question 450

# Ovarian tumors – Germ cell tumors of the ovary Chorionic carcinoma

Answer 450

- Most choriocarcinomas are diagnosed in the 2nd–3rd decade of life, - Chorionic carcinoma that develops unrelated to pregnancy is extremely rare – then it occurs mainly as a component of a mixed germ cell tumor .

Question 451

# Ovarian tumors – Germ cell tumors of the ovary Germ cell tumors: name 6

Answer 451

- teratoma – germinoma ( dysgerminoma ) – yolk sac cancer – embryonic cancer – mixed germ cell tumors – choriocarcinoma primarily developing in the ovary

Question 452

loooook up!!

Answer 452

Gynecological oncology Ovarian tumors – Gonadal ovarian tumors Gonadal tumors: – folliculoma – the most common! – thecoma , ​​ – nucleoblastoma ( androblastoma ), - sertolioma , - leydigoma , – gyneblastoma , – gynandroblastoma .

Question 453

# [``](http://) Diagram - uterine fibroids