Gynecology Review Flashcards - Dr. Ahmed Gaber

Practice flashcards in Q&A style covering the breadth of gynecology lecture notes, including anatomy, infections, oncology, endocrine, and general surgical procedures.

What are the four common causes of primary amenorrhea mentioned in the lecture?

1. Turner syndrome ($45 \text{ XO}$) - commonest ovarian cause; 2. Mullerian agenesis (Mayer–Rokitansky–Kuster–Hauser syndrome) - second most common ($20\%$); 3. Androgen insensitivity syndrome ($46 \text{ XY}$); 4. Cryptomenorrhea due to outflow tract obstruction.

What are 4 outflow tract disorders that cause cryptomenorrhea?

1. Imperforate hymen; 2. Transverse vaginal septum; 3. Cervical stenosis or atresia; 4. Imperfect canalization between Mullerian ducts & urogenital sinus.

List 4 clinical manifestations of an imperforate hymen.

1. Delayed menarche; 2. Cyclic abdominal pain; 3. Abdominal enlargement (pelvi-abdominal mass); 4. Urine retention due to urethral occlusion.

What are the four lines of treatment for imperforate hymen?

1. Obtain consent; 2. Cruciate incision and slow evacuation; 3. Issue a virginity certificate; 4. Treat as early as possible to prevent pelvic adhesions/infertility.

Identify 4 pathological causes of secondary amenorrhea.

1. Polycystic ovarian syndrome (PCOS) - commonest; 2. Prolactinoma ($20\%$); 3. Asherman syndrome (intrauterine synechiae); 4. Premature ovarian insufficiency ($POI, < 45 \text{ years}$); 5. Sheehan syndrome.

What 4 methods are used in the work-up of secondary amenorrhea?

1. Pregnancy test, Prolactin, and TSH; 2. Progesterone withdrawal test; 3. Estrogen + Progesterone test followed by FSH & LH; 4. GnRH infusion test and imaging ($CT/MRI$).

What are 4 clinical features associated with Turner syndrome?

1. Short stature with low posterior hair line; 2. Webbing of the neck and cubitus valgus; 3. Shield-like chest with widely-spaced nipples; 4. Coarctation of the aorta.

What are the typical investigations and results for Turner syndrome?

1. Buccal smear (Barr body $= 0$) and karyotyping ($45 \text{ XO}$); 2. Pelvic U/S and laparoscopy (streak gonads); 3. High FSH; 4. Chest X-ray (coarctation) and renal U/S.

What are the 4 common clinical findings in PCOS?

1. Infertility/sterility; 2. Obesity; 3. Hirsutism and acne; 4. Amenorrhea or dysfunctional bleeding (metrorrhagia).

Describe the hormonal assay findings and Adams criteria for PCOS on Ultrasound.

Hormonal: Raised LH/low FSH ($1:2 \text{ ratio}$), raised E1, insulin, and androgens. Adams criteria: (1) Enlarged ovaries, (2) dense central stroma, (3) 'necklace appearance' of small follicles ($2-10\,mm$).

What are the Rotterdam criteria for diagnosing PCOS?

A diagnosis requires at least 2 of 3: chronic anovulation, hyperandrogenism, and U/S picture of polycystic ovaries.

Name 4 complications of PCOS.

1. Infertility; 2. Endometrial hyperplasia or carcinoma; 3. Dysfunctional uterine bleeding; 4. Metabolic complications related to insulin resistance/obesity.

What are the medical and surgical treatments for PCOS?

Medical: Ovulation induction, anti-androgens, COCPs, and Metformin ($500\,mg/day$). Surgical: Laparoscopic ovarian drilling to reduce androgen production.

Enumerate 4 causes of hyperprolactinemia.

1. Physiological (pregnancy, lactation); 2. Drugs (anti-hypertensives, anti-psychotics); 3. Pituitary tumor (Prolactinoma); 4. Primary hypothyroidism (raised TRH).

What are the threshold values for Serum Prolactin (PRL) regarding diagnosis?

$> 29\,ng/ml$ indicates hyperprolactinemia; $\geq 100\,ng/ml$ suggests a tumor.

Name 4 drugs used to treat hyperprolactinemia.

1. Bromocriptine (Parlodel); 2. Lisuride (Dopergin); 3. Quinogolide (Norprolac); 4. Cabergoline (Dostinex).

What are the 4 main categories of female infertility and their frequencies?

1. Ovarian factor ($40\%$); 2. Tubal factor ($30\%$); 3. Uterine factor ($10-15\%$); 4. Cervical factor ($5\%$).

List 4 investigations for semen analysis (male infertility).

1. Semenogram; 2. Testicular biopsy (for azoospermia); 3. Chromosomal analysis (e.g. Klinefelter $47 \text{ XXY}$); 4. Hormonal assay (FSH, LH, Testosterone).

Define Azoospermia, Oligozoospermia, Asthenozoospermia, and Teratozoospermia.

Azoospermia: No sperms; Oligozoospermia: count $< 15 \text{ million/ml}$; Asthenozoospermia: decreased motility; Teratozoospermia: abnormal forms $> 85\%$.

What 4 tests are used to detect ovulation?

1. Basal body temperature (biphasic curve); 2. LH surge and progesterone levels; 3. Folliculometry via transvaginal ultrasound; 4. Premenstrual endometrial biopsy.

What are the 4 indications for Clomiphene citrate?

1. Intact hypothalamo-pituitary-ovarian axis; 2. Anovulatory infertility; 3. Sufficient endogenous estrogen; 4. Combined with HMG/HCG to reduce OHSS risk.

What are the 4 lines of treatment for precocious puberty?

1. DMPA every 3 months; 2. GnRH analogue monthly; 3. Treating the underlying organic cause (e.g. CNS tumor); 4. Removing a feminizing/virilizing tumor.

Describe the hormonal changes associated with menopause.

Reversed E2:E1 ratio ($1:2$), raised FSH ($\sim 30\,mIU/ml$) and LH ($\sim 20\,mIU/ml$), raised free testosterone, and decreased serum inhibin.

What are the major clinical manifestations of menopause?

1. Hot flushes (sensation of heat and cold sweating); 2. Insomnia/depression; 3. Frequency of micturition/stress incontinence; 4. Dyspareunia.

List 4 risk factors for postmenopausal osteoporosis.

1. Premature menopause; 2. Heavy smoking; 3. High caffeine intake; 4. Low body weight or lack of physical activity.

How is osteoporosis investigated and diagnosed?

DEXA (Dual-Energy X-ray Absorptiometry) scan is the main diagnostic investigation; clinical assessment for decreased height or pathological fractures is also used.

What causes endometriosis-associated infertility?

$PGF2\alpha$ causes anovulation and increased tubal/uterine motility (preventing implantation), and peritoneal macrophages engulf sperms via phagocytosis.

What are the symptoms and 'Gold Standard' investigation for endometriosis?

Symptoms: Crescendo–decrescendo dysmenorrhea, dyspareunia, infertility. Gold Standard investigation: Laparoscopy.

Define the degrees of Uterine Prolapse.

$1^{\text{st}}, 2^{\text{nd}}, \text{ and } 3^{\text{rd}}$ degree, with procidentia meaning the entire uterus including the fundus is outside the vulva.

What is the difference between Stress Incontinence and Urge Incontinence?

Stress Incontinence (SUI) is leakage on straining due to sphincter weakness; Urge Incontinence is a sudden urge with inability to delay due to an overactive bladder.

What are the three types of fibroids based on site?

1. Subserous (most liable to torsion); 2. Interstitial/Intramural (most common); 3. Submucous (most symptomatic/cause of bleeding).

What are the indications for a Myomectomy?

1. Young patient desiring fertility; 2. Infertility/RPL due to SMF; 3. Asymptomatic intramural fibroid $> 3\,cm$ before IVF; 4. Patient refusal of hysterectomy.

Explain the Methylene blue (MB) test for Vesicovaginal fistula (VVF).

$200\,ml$ of MB is injected into the bladder with 3 gauze pieces in the vagina; a blue stain on the upper/middle piece indicates VVF.

What are the absolute contraindications for Combined Oral Contraceptive Pills (COCs)?

1. Pregnancy; 2. History of venous thromboembolism (DVT/PE); 3. Breast cancer; 4. Severe liver disease; 5. Uncontrolled hypertension.

Describe Broder's classification for gynecological malignancy grading.

Grade 1: Well differentiated ($< 5\%$ undifferentiated); Grade 2: Moderately differentiated ($5-50\%$ undifferentiated); Grade 3: Poorly or Undifferentiated ($> 50\%$ undifferentiated).

What are the primary risk factors for cancer of the cervix?

Age ($45-55 \text{ yrs}$ invasive), multiparity, low socioeconomic class, and HPV types 16, 18, 31, 33 \text{ & } 35.

Distinguish between clinical and surgical staging in gynecological cancers.

Cancer of the cervix uses clinical staging, whereas cancer of the endometrium uses surgical staging.

What is 'Corpus Cancer Syndrome'?

A combination of obesity, diabetes mellitus (DM), and hypertension associated with endometrial cancer.

What is Meig's syndrome?

The triad of Fibroma of the ovary, right hydrothorax, and ascites.

Name the 4 natural barriers against ascending genital tract infections.

1. Labia apposition with acidic secretions; 2. Acidic vaginal pH (via Lactobacilli); 3. Cervical mucus plug; 4. Monthly endometrial shedding; 5. Ciliary movement of fallopian tubes.

What are the investigations for Bacterial Vaginosis?

1. Clue cells on vaginal smear; 2. Gram stain; 3. Vaginal pH $> 4.5$; 4. Positive Whiff test ($10\% \text{ KOH}$).

Briefly describe the pelvic course of the ureter and its surgical significance.

The ureter enters at the bifurcation of the common iliac artery, runs on the lateral pelvic wall, and passes under the uterine artery ('water under the bridge'). It is at risk of injury during hysterectomy.