Gynaecology – Comprehensive Review (Workbook 2024-25)

A comprehensive set of 150 question-and-answer flashcards covering embryology, anatomy, menstrual physiology, reproductive endocrinology, AUB, amenorrhoea, puberty disorders, PCOS, menopause, infertility, tubal disease, genital TB, uterine/peritoneal disorders, Müllerian anomalies, cervical screening, oncology basics, ovarian masses, benign & infectious vulvovaginal conditions, pelvic organ prolapse, urinary incontinence, fertility control and emergency contraception.

From which embryologic structure does the uterus develop?

The Müllerian (paramesonephric) ducts

What is the MAIN support of the uterus?

The pelvic diaphragm (levator ani) together with the cardinal, uterosacral and pubocervical ligaments

Which ligament maintains anteversion and ante-flexion of the uterus?

The round ligament (assisted by the uterosacral ligament)

What type of epithelium lines the endocervix and uterine cavity?

Simple columnar epithelium

What type of epithelium lines the ectocervix?

Stratified squamous epithelium

The uterine artery is a branch of which major vessel?

The internal iliac (hypogastric) artery

The fallopian tube is lined by which type of epithelium?

Ciliated columnar epithelium

What is the narrowest part of the fallopian tube?

The intramural (interstitial) portion

Where is routine tubal ligation usually performed?

At the isthmus of the tube

Most common site of tubal ectopic pregnancy?

The ampulla

Which ligament attaches the ovary to the uterus?

The ovarian ligament (proper ligament of ovary)

What does the infundibulopelvic (suspensory) ligament contain?

The ovarian artery and vein

Normal vaginal pH is maintained by lactobacilli at what range?

pH 3.5 – 4.5

Predominant vaginal smear cell under estrogen?

Superficial cells (pink, pyknotic nuclei)

Predominant vaginal smear cell under progesterone?

Intermediate cells (blue, larger nuclei)

Bartholin glands open at which clock positions?

5 o’clock and 7 o’clock positions of the vestibule

Clitoris is derived embryologically from the

Genital tubercle (homologue of the penis)

Standard fixative for a conventional Pap smear?

95 % ethyl alcohol

Most common carcinoma detected by ectocervical Pap specimen?

Squamous cell carcinoma (about 75 %)

Most common carcinoma detected by endocervical Pap specimen?

Adenocarcinoma (about 25 %)

What solution is applied to the cervix during colposcopy to highlight dysplasia?

3–5 % acetic acid

Green filter on a colposcope helps visualize what?

Abnormal cervical blood vessels

Indication for endocervical curettage during colposcopy?

Abnormal cytology such as HSIL or AGUS when squamocolumnar junction is not fully visible

LEEP is considered what type of test?

Both diagnostic and therapeutic for CIN 2/3

Ideal intra-uterine pressure for diagnostic hysteroscopy?

50–70 mm Hg (keep < 100 mm Hg)

Preferred distension medium when using monopolar cautery in hysteroscopy?

Non-electrolyte solutions (glycine or sorbitol) with fluid-deficit limit 1 L

Investigation of choice (IOC) for tubal patency?

Hysterosalpingogram (HSG)

Methylene-blue dye test for tubal block is performed during which procedure?

Laparoscopy with chromopertubation

FSH stimulates the ovarian follicle to secrete which hormone?

Estrogen (from granulosa cells)

LH directly stimulates theca interna cells to produce

Androgens (converted to estrogens by aromatase)

Which structure secretes progesterone in the luteal phase?

Corpus luteum

Normal life span of the corpus luteum (non-pregnant)?

About 14 days

Secretory endometrium on histology shows

Subnuclear vacuolation and cork-screw glands (under progesterone)

Proliferative endometrium is characterized by

Tall pseudostratified glands (‘telescope’ appearance) under estrogen

Most common cause of abnormal uterine bleeding (AUB) in adolescents & perimenopausal women?

Anovulation

First diagnostic step in secondary amenorrhoea?

Exclude pregnancy with β-hCG

Definition of primary amenorrhoea (no secondary sexual traits)?

No menses by age 13 without secondary sexual development

Most common cause of primary amenorrhoea with breasts present + uterus absent?

Müllerian agenesis (MRKH syndrome)

Typical karyotype in complete androgen insensitivity syndrome (CAIS)?

46, XY

Turner syndrome karyotype?

45, XO

Kallmann syndrome hall-mark beside amenorrhoea?

Anosmia due to GnRH deficiency

First visible sign of puberty in girls?

Breast budding (thelarche, Tanner stage 2)

Management drug of choice for central precocious puberty?

Continuous GnRH agonist therapy

McCune-Albright syndrome precocious puberty is treated with?

Aromatase inhibitors (block estrogen synthesis)

Main hormone driving peripheral conversion to DHT in hirsutism?

Androgens (particularly testosterone) converted to DHT

Scoring system for clinical hirsutism assessment?

Ferriman–Gallwey score (> 8 abnormal)

Screening test for congenital adrenal hyperplasia in hirsutism work-up?

Serum 17-hydroxyprogesterone (> 200 ng/dL suggest CAH)

Testosterone < 150 ng/dL in hirsute woman suggests?

Polycystic ovarian syndrome (PCOS)

First-line long-term pharmacologic therapy for hirsutism in PCOS?

Combined oral contraceptive pills

Diagnostic criteria for PCOS (Rotterdam) require how many of 3 features?

At least two of the three criteria

In PCOS, which gonadotropin is typically elevated?

LH (with normal FSH) resulting in high LH : FSH ratio

Most increased estrogen form in PCOS?

Estrone (E1) from peripheral aromatization in adipose tissue

Drug of choice for ovulation induction in PCOS?

Letrozole (aromatase inhibitor)

Menopause is diagnosed after how long without menses?

12 consecutive months

Most common menopausal symptom?

Hot flashes (vasomotor instability)

Absolute age cut-off defining premature menopause?

Before age 40

First-line drug class for postmenopausal osteoporosis?

Bisphosphonates (plus vitamin D/calcium)

Infertility is failure to conceive after how long in women < 35 y?

12 months of unprotected intercourse

Most common cause of male infertility?

Primary testicular (spermatogenic) failure

Ideal abstinence period before semen analysis?

About 2 days (range 2-7 days)

Asthenozoospermia refers to

Reduced sperm motility

First-line treatment when sperm count < 15 million/mL?

Intrauterine insemination (IUI)

Serum FSH day 3 value > 10 IU/L indicates?

Diminished ovarian reserve

Anti-Müllerian hormone (AMH) < 1 ng/mL suggests?

Poor ovarian reserve

Gold-standard test for tubal evaluation?

Laparoscopy with chromopertubation

Most common site of genital tuberculosis involvement?

Fallopian tube (ampulla)

Recommended management of hydrosalpinx before IVF?

Salpingectomy (improves IVF success)

Which fibroid subtype is most associated with infertility?

Submucosal fibroids (types 0, 1, 2)

Treatment of asymptomatic submucosal fibroid in infertile woman?

Hysteroscopic myomectomy

Most common presentation of Asherman syndrome?

Secondary amenorrhoea or hypomenorrhoea

Investigation of choice for endometriosis?

Diagnostic laparoscopy

First-line fertility therapy in mild endometriosis?

Clomiphene citrate (or letrozole) + IUI

Adenomyosis classical ultrasound sign?

'Venetian blind' appearance with heterogeneous myometrium

Definitive treatment of adenomyosis in women who have completed child-bearing?

Total hysterectomy

Uterine didelphys results from failure of

Complete fusion of Müllerian ducts

Angle between horns on HSG in bicornuate uterus is typically

60° (wide angle)

Most common Müllerian anomaly overall?

Septate uterus

Definitive treatment for septate uterus?

Hysteroscopic metroplasty / septal resection

Prenatal DES exposure causes which uterine malformation?

T-shaped uterus

High-risk oncogenic HPV types for cervical cancer?

HPV 16 and 18 (others include 31, 33, 45 etc.)

Target age group for routine HPV vaccination?

9–14 years (ideally before sexual debut)

Best screening test for cervical pre-cancer?

High-risk HPV DNA testing

Start and stop ages for cervical screening in low-resource WHO protocol?

Start 30 y, stop 50 y (every 5 y HPV test)

Most common clinical symptom of cervical cancer?

Irregular or post-coital bleeding

FIGO stage at which hydronephrosis appears?

Stage III (involving pelvic side wall)

Most common cause of post-menopausal bleeding?

Endometrial atrophy

Endometrial thickness on TVS warranting biopsy (> menopause)?

4 mm

Drug class increasing risk of endometrial carcinoma?

Tamoxifen (SERM)

Gene commonly mutated in Type I (endometrioid) endometrial cancer

PTEN

Gene associated with Type II serous endometrial cancer

p53

Treatment of atypical endometrial hyperplasia when fertility desired?

High-dose progestins (e.g., LNG-IUS or oral MPA)

Most common functional ovarian cyst in reproductive age?

Follicular cyst

Theca-lutein cysts are stimulated by high levels of

β-hCG (e.g., molar pregnancy)

Best predictor of malignancy on ovarian ultrasound?

Solid components with papillary projections, thick septae, ascites, high vascularity

Serum marker for epithelial ovarian cancer (especially serous)?

CA-125

Marker elevated in dysgerminoma?

LDH (± β-hCG, PLAP)

Characteristic cell pattern in yolk-sac tumour?

Schiller-Duval bodies

Dermoid cyst other name?

Mature cystic teratoma

Meigs syndrome triad?

Ovarian fibroma + ascites + pleural effusion

Percentage of ovarian cancers that are familial?

≈ 10 %