Friday, September 18, 2009
29 - Drugs Whose Effectiveness Is Influenced by Combination Oral Contraceptives
Friday, May 1, 2009
28 - Endometrial Cancer Risk Factors
Proliferation of the endometrium is under the control of estrogen, and prolonged exposure to unopposed estrogen from either endogenous or exogenous sources plays a central etiologic role. Risk factors for endometrial cancer include obesity, low fertility index, early menarche, late menopause, and chronic anovulation. Granulosa cell tumors of the ovary that secrete estrogen may present with synchronous endometrial cancers. Chronic unapposed estrogen replacement increases the risk, and women taking tamoxifen for breast cancer treatment or prevention have a twofold increased risk.
The Lynch syndrome occurs in families with an autosomal dominant mutation of mismatch repair genes MLH1, MSH2, MSH6, and PMS2, which predispose to nonpolyposis colon cancer as well as endometrial and ovarian cancer. The estimated lifetime risk for endometrial cancer is 40–60%, with a mean age around 50 years. Unlike colorectal cancer, endometrial cancer risk is not lower in MSH6 mutation carriers. Most women present with stage I disease, and the survival rate is generally good (5-year survival 88%). No unique endometrial screening strategies have been established for Lynch family gene carriers.
• Obesity
• Impaired carbohydrate tolerance
• Nulliparity
• Late menopause
• Unopposed oestrogen therapy
• Functioning ovarian tumours
• Previous pelvic irradiation
• Family history of carcinoma of breast, ovary
or colon
Tuesday, April 21, 2009
27 - Oral Contraceptive Pills Mcqs
1q: oral contraceptives ( OCPs ) give protection against all of the following except ?
a. endometrial carcinoma
b. osteoporosis
c. benign breast disease
d. hepatic adenoma
OCPs – Oral contraceptive pills give protection against the following conditions :
1. T = Thyroid autoimmune disorders
2. H = Hirsutism
3. E = Endometrial carcinoma
4. C = Colorectal cancer
5. O = Ovarian cancer
6. B = Benign Breast diseases ( fibroadenosis )
7. R = Rheumatoid arthritis
8. A = Anemia and Acne
9. S = Salpingitis ( PID )
10. U = Uterine cancer
11. F = Fibroids ( exception is submucous variety )
12. O = Ovarian cysts
13. P = Pelvic inflammatory disease
14. O = Osteoporosis and Osteopenia
15. E = Ectopic pregnancy
16. M = Mittelschmerz , Menorrhagia , Dysmenorrhea , Premenstrual Tension , Polymenorrhea .
Other important points to be remembered about OCPs is that their extensive use leads to a few diseases like :
1. Cancer cervix
2. Breast cancer
3. Pituitary adenoma
4. Hepatic adenoma
a. endometrial carcinoma
b. osteoporosis
c. benign breast disease
d. hepatic adenoma
OCPs – Oral contraceptive pills give protection against the following conditions :
1. T = Thyroid autoimmune disorders
2. H = Hirsutism
3. E = Endometrial carcinoma
4. C = Colorectal cancer
5. O = Ovarian cancer
6. B = Benign Breast diseases ( fibroadenosis )
7. R = Rheumatoid arthritis
8. A = Anemia and Acne
9. S = Salpingitis ( PID )
10. U = Uterine cancer
11. F = Fibroids ( exception is submucous variety )
12. O = Ovarian cysts
13. P = Pelvic inflammatory disease
14. O = Osteoporosis and Osteopenia
15. E = Ectopic pregnancy
16. M = Mittelschmerz , Menorrhagia , Dysmenorrhea , Premenstrual Tension , Polymenorrhea .
Other important points to be remembered about OCPs is that their extensive use leads to a few diseases like :
1. Cancer cervix
2. Breast cancer
3. Pituitary adenoma
4. Hepatic adenoma
Wednesday, March 18, 2009
26 - total laparascopic hysterectomy video
this is a beautiful video of total laparoscopic hysterectomy. it is beautifully done and beautifully explained . absolutely bloodless . observe the steps carefully
Saturday, February 14, 2009
25 - hormone therapy in gynaecology mcqs - 1
1q: HRT is helpful in all of the following except ?
- vaginal atrophy
- flushing
- osteoporosis
- coronary heart disease
answer: d . coronary heart disease .
2q: estrogen replacement for post-menopausal symptoms cause an increase in ?
- LDL
- Cholesterol
- VLDL
- Triglycerides
Answer: d . triglycerides . estrogen replacement causes an increase in HDL and triglycerides and decreases LDL levels .
3q: estrogen administration in a post menopausal woman increases the ?
- gonadotropin secretion
- LDL – cholesterol
- Bone mass
- Muscle mass
Answer: c . bone mass .
4q: all of the following appear to decrease hot flushes in menopausal women except ?
- androgens
- raloxifene
- isoflavones
- tibolone
answer: b . raloxifene .
5q: absolute contraindication of hormone replacement therapy is ?
- thrombosis
- fibrocystic disease
- fibroadenoma
- hemorrhage
answer: a . thrombosis .
6q: GnRH analogues may be given in all of the following except ?
- prostate carcinoma
- endometrial carcinoma
- fibromyoma of uterus
- precocious puberty
answer: b . endometrial carcinoma .
here is a list of all the conditions in which GnRH analogues are used :
- adenomyosis
- irritable bowel syndrome
- carcinoma breast
- DUB
- endometriosis
- fibromyoma uterus
- hirsutism
- infertility
- precocious puberty
Monday, February 9, 2009
24 - absolute contraindications of oral contraceptive pills
- carcinoma of breast and genitals
- congenital hyperlipidemia
- porphyria
- cardiac abnormalities
- moderate to severe hypertension
- previous or present history of thromboembolism
- undiagnosed abnormal uterine bleeding
- impending major surgery to avoid post operative thromboembolism
- liver diseases , hepatoma or history of jaundice during past pregnancy
Saturday, November 15, 2008
23 - AIIMS november 2008 gynaecology mcqs
163.IN Mc ROBERTS MANOEUVRE HIP IS FLEXED AGAINST MOTHERS ABDOMEN.THIS LEADS TO INJURY OF WHICH NERVE?
A. LUMBOSACRAL TRUNK
B. OBTURATOR N
C. FEMORAL N.
D. LATERAL CUTANEOUS N OF THIGH
164. ALL ARE DONE IN MANAGEMENT OF SHOULDER DYSTOCIA EXCEPT?
A. FUNDAL PRESSURE
B. Mc ROBERTS MANOEUVRE
C. SUPRAPUBIC PRESSURE
D. WOOD S MANOEUVRE
165.A 25 YEAR OLD MARRIED NULLIPARA UNDERGOES LAPROSCOPIC CYSTECTOMY FOR OVARIAN CYST WHICH ON HISTOPATH REVEALS SEROUS OVARIAN ADENOCARCINOMA.WHAT SHOULD BE THE NEXT MANAGEMENT?
A. SERIAL CA-125 AND FOLLOW UP
B. HYSTERECTOMY AND SALPINGOOOPHORECTOMY
C. HYSTERECTOMY + RADIOTHERAPY
D. RADIOTHERAPY
166. SAFEST VASOPRESSOR IN PREGNANCY IS?
A. EPHEDRINE
B. PHENYLEPHRINE
C. METHOXAMINE
D. MEPHENTINE
167.FALLOPIAN TUBE DYSMOTILITY IS SEEN IN?
A. NOONAN SYN
B. TURNER SYN
C. KARTAGENER SYN
D. MARFAN SYN
168.ALL OF THE FOLLOWING INVESTIGATIONS ARE USED IN FIGO STAGING OF CARCINOMA CERVIX EXCEPT?
A. CECT
B. IVP
C. CYSTOSCOPY
C. PROCTOSIGMOIDOSCOPY
169.CLUE CELLS ARE FOUND IN?
A. CANDIDIAL VAGINOSIS
B. BACTERIAL VAGINOSIS
C. TRICHOMONIASIS
D.
170. BEST INDICATOR OF OVARIAN RESERVE IS?
A. FSH
B. ESTRADIOL
C. LH
D. FSH/ LH RATIO
171. A PREGNANT LADY ACQUIRES CHICKEN POX 3 DAYS PRIOR TO DELIVERY.SHE DELIVERS BY
A. BOTH MOTHER AND BABY ARE SAFE
B. GIVE ANTIVIRAL TT TO MOTHER BEFORE DELIVERY
C. GIVE ANTIVIRAL TT TO BABY
D. BABY WILL DEVELOP CONGENITAL VARICELLA SYNDROME
172. EARLIEST DETECTABLE CONGENITAL MALFORMATION BY USG IS?
A. ANENCEPHALY
B. SPINA BIFIDA
C. MENINGOCOELE
D. CYSTIC HYGROMA
173.ALL OF THE FOLLOWING SHOULD BE DONE TO PREVENT THE TRANSMISSION OF HIV FROM MOTHER TO BABY EXCEPT?
A. VIT A SUPPLEMENTATION TO MOTHER
B. NO BREAST FEEDING
C. VAGINAL DELIVERY
D. ZIDOVUDINE TO MOTHER
174.A 45YR OLD LADY WITH DUB HAS 8mm THICKNESS OF ENDOMETRIUM.NEXT STEP IN MANAGEMENT?
A. HISTOPATHOLOGY’
B. HYSTERECTOMY
C. PROGESTERONE
D.OCP
175. ALL ARE TRUE ABOUT PCOD EXCEPT?
A. PERSISTENTLY ELEVATED LH
B. INCREASED LH/FSH RATIO
C. INCREASED DHEAS
D. INCREASED PROLACTIN
176.A FEMALE AT 37 WKS OF GESTATION HAS MILD LABOUR PAIN FOR 10 HOURS AND CERVIX IS PERSISTENTLY 1cm DIALATED NON EFFECED.WHAT WILL BE NEXT APPROPRIATE MANAGEMENT?
A. SEDATION AND WAIT
B. AUGMENTATION WITH SYNTOCINON
C. CESAREAN SECTION
D. AMNIOTOMY
177.A WOMAN COMES WITH OBSTRUCTED LABOUR AND GROSSY DEHYDRATED INVESTIGATIONS REVEAL FETAL DEMISE.WHAT WILL BE THE MANAGEMENT?
A. CRANIOTOMY
B. DECAPITATION
C. CESAREAN SECTION
D. FORCEPS EXTRACTION
178.INVESTIGATION OF CHOICE IN CHOLESTASIS OF PREGNANCY?
A. BILIRUBIN
B. BILE ACIDS
C. ALK PHOSPHATASE
D. ALT&AST
179.A FEMALE HAS HISTORY OF 6 WEEKS AMENORRHOEA,USG SHOWS EMPTY SAC,SERUM BETA HCG -1000IU.WHAT WOULD BE NEXT MANAGEMENT?
A. MEDICAL MANAGEMENT
B. REPEAT HCG AFTER 48 HOURS
C. REPEAT HCG AFTER 1 WEEK
to view all the 200 mcqs of AIIMS november 2008 click here
Monday, August 4, 2008
22 - carcinoma cervix staging
STAGE I : carcinoma strictly confined to the cervix
STAGE II : cancer spread beyond the cervix , but not to pelvic wall or lower third
Of vagina .
STAGE III : tumor extends to the lateral pelvic wall , involves the lower third of
Vagina and/or causes hydronephrosis or non functioning kidney .
STAGE IV : tumor extends beyond true pelvis .
STAGE I has IA and IB . IA has IA 1 and IA2 , IB has IB 1 and IB 2 .
STAGE II has IIA and IIB
STAGE III has IIIA and IIIB
STAGE IV has IVA and IVB .
STAGE IA – microinvasive carcinoma , stromal invasion not exceeding 5.0 mm
From the base . lateral spread not exceeding 7.0 mm . vascular or
Lymphatic involvement does not alter classification .
Stage IA 1 – measured stromal invasion of less than 3.0 mm in depth and less than
7.0 mm in horizontal spread .
Stage IA 2 – measured stromal invasion between 3-5 mm in depth and not exceeding
7.0 mm in horizontal spread
STAGE IB - clinically visible lesion confined to the cervix or microscopic lesion
Greater than stage IA 2 .
Stage IB 1 – clinically visible lesion 4.0 cm or less in size
Stage IB 2 – clinically visible lesion more than 4.0 cms in dimension
STAGE IIA – tumor without parametrial invasion (vagina lower third not involved)
STAGE IIB – tumor with parametrial invasion (vagina lower third not involved)
STAGE IIIA – tumor involves lower third of the vagina , no extension to the lateral
Pelvic wall
STAGE IIIB – tumor extends to pelvic wall and / or involves kidney .
STAGE IVA – tumor involves bladder / rectum or spreads beyond the pelvis
STAGE IV B – widespread tumor with distant metastases
Friday, April 25, 2008
21 - endometriosis
Endometriosis introduction :
Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.
Endometriosis lesions can be found anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, and on the pelvic sidewall. Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum.
In addition, it can be found in caecarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum.
In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain.
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.
Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis."
It is estimated that 30-40% of women with endometriosis are infertile.
If you or someone you care about has endometriosis, it is important to research the disease as much as possible. Many myths and misconceptions about endometriosis still persist, even in medical literature. For many women, management of this disease may be a long-term process. Therefore, it is important to educate yourself, take the time to find a good doctor, and consider joining a local support group.
Symptoms of endometriosis :
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, however a woman with endometriosis may also experience pain at other times during her monthly cycle.
For many women, but not everyone, the pain of endometriosis can unfortunately be so severe and debilitating that it impacts on her life significant ways.
Pain may be felt:
before/during/after menstruation
during ovulation
in the bowel during menstruation
when passing urine
during or after sexual intercourse
in the lower back region
Other symptoms may include:
diarrhoea or constipation (in particular in connection with menstruation)
abdominal bloating (again, in connection with menstruation)
heavy or irregular bleeding
fatigue
The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis are subfertile.
When a woman or a girl has decided that she wishes to discuss her symptoms with a physician, she may benefit from preparing for this consultation by using the aid, your first consultation, which highlights the questions a doctor may ask her. By assessing the responses, it will help her physician to evaluate her symptoms, and together they can decide the right treatment plan for her.
What causes endometriosis?
Several different hypotheses have been put forward as to what causes endometriosis. Unfortunately, none of these theories have ever been entirely proven, nor do they fully explain all the mechanisms associated with the development of the disease. Thus, the cause of endometriosis remains unknown.
Most researchers, however, agree that endometriosis is exacerbated by oestrogen. Subsequently, most of the current treatments for endometriosis attempt to temper oestrogen production in a woman's body in order to relieve her of symptoms. At the moment there are no treatments, which fully cure endometriosis.
Several theories have become more accepted, and reality is that it may be a combination of factors, which make some women develop endometriosis.
Metaplasia
Metaplasia means to change from one normal type of tissue to another normal type of tissue. It has been proposed by some that endometrial tissue has the ability in some cases to replace other types of tissues outside the uterus.
Some researchers believe this happens in the embryo, when the uterus is first forming. Others believe that some adult cells retain the ability they had in the embryonic stage to transform into reproductive tissue.
Retrograde menstruation
This theory was promoted by Dr. John Sampson in the 1920s. He surmised that menstrual tissue flows backwards through the fallopian tubes (called “retrograde flow”) and deposits on the pelvic organs where it seeds and grows. However, there is little evidence that endometrial cells can actually attach to women’s pelvic organs and grow. Years later, researchers found that 90% of women have retrograde flow. But since most women don’t develop endometriosis, some doctors have concluded that something else (perhaps an immune system problem or hormonal dysfunction) may be the trigger for endometriosis. The Retrograde Menstruation Theory also doesn’t explain how endometriosis develops in women who’ve had a hysterectomy or a tubal ligation nor why, in rare cases, men have developed endometriosis when they’ve been treated with oestrogen after prostate surgery.
Genetic predisposition
Studies have shown that first-degree relatives of women with this disease are more likely to develop endometriosis. And when there is a hereditary link, the disease tends to be worse in the next generation.
An ongoing worldwide study called the International Endogene study is conducting research based on the blood samples from sisters with endometriosis in hopes of isolating an endometriosis gene.
DEC 2006Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15
OCT 2005Researchers identify one gene's critical role in the human embryo implantation process
AUG 2005First report of linkage to a major locus for endometriosis
Lymphatic or vascular distribution
Endometrial fragments may travel through blood vessels or the lymphatic system to other parts of the body. This may explain how endometriosis ends up in distant sites, such as the lung, brain, skin, or eye.
Immune system dysfunctions
Some women with endometriosis appear to display certain immunologic defects or dysfunctions. Whether this is a cause or effect of the disease remains unknown.
Environmental influences
Some studies have pointed to environmental factors as contributors to the development of endometriosis, specifically related to the way toxins in the environment have an effect on the reproductive hormones and immune system response, though this theory has not been proven and remains controversial.
Diagnosing endometriosis
There is no simple test that can be used to diagnose endometriosis. In fact, the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue. This is what is known as "the golden standard".
However, this is an expensive, invasive proceduce. Furthermore, if the surgeon is not a specialist in endometriosis s/he may not recognise the disease, which can result in a "negative" diagnosis.
In addition, the woman/girl may not want to have surgery.
This makes diagnosis a challenge, and therefore an experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis through talking with the woman/girl and obtain a history of her symptoms. For this to be effective, it is important that the woman/girl is honest with her physician about all of her symptoms and the pattern of these.
To aid her in preparation for this consultation she can consult the questionnaire, your first consultation, which will help her in preparing for the questions her doctor may ask her - and, in turn, help him/her in determining whether her symptoms may be due to endometriosis (not all pelvic pain, nor fertility issues, are caused by endometriosis).
There are other tests, which the gynaecologist may perform. These include ultrasound, MRI scans, and gynaecological examinations. None of these can definitively confirm endometriosis (though they can be suggestive of the disease), nor can they definitively dismiss the presence of endometriotic lesions/cysts.
The fact that there is no non-invasive, definitive diagnostic method for endometriosis is as frustrating for clinicians as it is for women with the disease.
Treatments for endometriosis
Since the cause of endometriosis remains unknown, a treatment which fully cures endometriosis has yet to be developed, and there is no overwhelming medical evidence to support one specific type of endometriosis treatment over another.
Chosing a treatment therefore comes down to the individual woman's needs, depending on her symptoms, her age, and her fertility wishes. She should discuss these with her physician so that they, together, can determine, which long term, holistic, treatment plan is best for her individual needs. For many women, this can be a combination of more than one treatment over longer periods of time.
Pain killers
Pain is the most common symptom for many women with endometriosis.
Pain killers vary from simple analgesics (such as aspirin and paracetamol), through compound analgesics (which are a combination of either aspirin or paracetamol and a mild narcotic such as codeine) and narcotic analgesics (similar to morphine), through to non-steroidal anti-inflammatory drugs (such as nurofen, ponstan, voltaren, etc).
More about painkillers
Hormonal treatments
Most researchers agree that endometriosis is exacerbated by oestrogen. Subsequently, hormonal treatments for endometriosis attempt to temper oestrogen production in a woman's body and thereby relieve her of symptoms.
Hormonal therapy may include birth control pills, progestins, a class of drugs known as GnRH-agonists, and danazol (though this is seldom used any more).
The combined oral contraceptive pill
Progestins
Mirena
GnRH-agonists
Danazol
Aromatase inhibitors [still somewhat experimental]
Hormonal therapies have varying degrees of side effects, and unfortunately, whatever pain relief that is achieved tends to be only temporary for many girls and women.
TIPS for dealing with side effects associated with drug treatments
Surgery
Most doctors agree that laparoscopic surgery is the only definitive way to diagnose endometriosis. In many cases, the disease can be diagnosed and treated in the same procedure.
The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions.
Today, most endometriosis surgery is being done through the laparoscope, although a full abdominal incision called a laparotomy may still be required in rare cases for extensive disease or bowel resections.
More about laparoscopic surgery
Although women with endometriosis are often told that hysterectomy is the “definitive” solution for endometriosis, the disease can recur even after a hysterectomy.
More about hysterectomy
Nutritional therapy
The correct balance of daily nutrients are essential for all of us. Proper nutrition helps improve our general health.
For a woman with endometriosis it may also increase her ability to tolerate medical treatments, increase her ability to deal with potential side effects of treatment, increase her energy, and enhance her ability to think clearly. Nutritionists can work with women and girls with endometriosis to put together an appropriate dietary plan.
More about dietary modification to alleviate endometriosis symptoms
Complementary therapies
Given the chronic and stubborn nature of endometriosis, there may be times when it is beneficial to explore therapies beyond the medical mainstream. Whilst there is no clinical evidence as to the effectiveness of these therapies, many women with endometriosis have had good symptom relief by using homeopathy, osteopathy, herbs, and Traditional Chinese Medicine.
Physiotherapists (physical therapists) can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.
A multi-disciplinary approach
To provide holistic treatment to women and girls with endometriosis, a team of medical professionals may be involved in providing care, including: - general practitioners- gynaecologists- surgeons (from a number of disciplines)- reproductive endocrinologists- immunologists- nutritionists/dieticians- nurses- psychologists- counsellors- pain specialists- physiotherapists
All of these disciplines can play an important role in providing an individualised treatment plan for a woman or girl with endometriosis.
Finally, please remember that endometriosis affects more than just the physical body. It often affects women and girls in profound emotional ways as well. Psychologists and counsellors can play an important role by helping women and girls cope with the feelings of confusion, disbelief, chronic pain, infertility, and frustration that often accompany this disease.
Support groups also play a vital role in learning to cope with endometriosis and may be able to provide information about national or regional centres, who specialise in the treatment of endometriosis.
Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.
Endometriosis lesions can be found anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, and on the pelvic sidewall. Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum.
In addition, it can be found in caecarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum.
In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain.
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.
Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis."
It is estimated that 30-40% of women with endometriosis are infertile.
If you or someone you care about has endometriosis, it is important to research the disease as much as possible. Many myths and misconceptions about endometriosis still persist, even in medical literature. For many women, management of this disease may be a long-term process. Therefore, it is important to educate yourself, take the time to find a good doctor, and consider joining a local support group.
Symptoms of endometriosis :
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, however a woman with endometriosis may also experience pain at other times during her monthly cycle.
For many women, but not everyone, the pain of endometriosis can unfortunately be so severe and debilitating that it impacts on her life significant ways.
Pain may be felt:
before/during/after menstruation
during ovulation
in the bowel during menstruation
when passing urine
during or after sexual intercourse
in the lower back region
Other symptoms may include:
diarrhoea or constipation (in particular in connection with menstruation)
abdominal bloating (again, in connection with menstruation)
heavy or irregular bleeding
fatigue
The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis are subfertile.
When a woman or a girl has decided that she wishes to discuss her symptoms with a physician, she may benefit from preparing for this consultation by using the aid, your first consultation, which highlights the questions a doctor may ask her. By assessing the responses, it will help her physician to evaluate her symptoms, and together they can decide the right treatment plan for her.
What causes endometriosis?
Several different hypotheses have been put forward as to what causes endometriosis. Unfortunately, none of these theories have ever been entirely proven, nor do they fully explain all the mechanisms associated with the development of the disease. Thus, the cause of endometriosis remains unknown.
Most researchers, however, agree that endometriosis is exacerbated by oestrogen. Subsequently, most of the current treatments for endometriosis attempt to temper oestrogen production in a woman's body in order to relieve her of symptoms. At the moment there are no treatments, which fully cure endometriosis.
Several theories have become more accepted, and reality is that it may be a combination of factors, which make some women develop endometriosis.
Metaplasia
Metaplasia means to change from one normal type of tissue to another normal type of tissue. It has been proposed by some that endometrial tissue has the ability in some cases to replace other types of tissues outside the uterus.
Some researchers believe this happens in the embryo, when the uterus is first forming. Others believe that some adult cells retain the ability they had in the embryonic stage to transform into reproductive tissue.
Retrograde menstruation
This theory was promoted by Dr. John Sampson in the 1920s. He surmised that menstrual tissue flows backwards through the fallopian tubes (called “retrograde flow”) and deposits on the pelvic organs where it seeds and grows. However, there is little evidence that endometrial cells can actually attach to women’s pelvic organs and grow. Years later, researchers found that 90% of women have retrograde flow. But since most women don’t develop endometriosis, some doctors have concluded that something else (perhaps an immune system problem or hormonal dysfunction) may be the trigger for endometriosis. The Retrograde Menstruation Theory also doesn’t explain how endometriosis develops in women who’ve had a hysterectomy or a tubal ligation nor why, in rare cases, men have developed endometriosis when they’ve been treated with oestrogen after prostate surgery.
Genetic predisposition
Studies have shown that first-degree relatives of women with this disease are more likely to develop endometriosis. And when there is a hereditary link, the disease tends to be worse in the next generation.
An ongoing worldwide study called the International Endogene study is conducting research based on the blood samples from sisters with endometriosis in hopes of isolating an endometriosis gene.
DEC 2006Significant evidence of one or more susceptibility loci for endometriosis with near-Mendelian inheritance on chromosome 7p13-15
OCT 2005Researchers identify one gene's critical role in the human embryo implantation process
AUG 2005First report of linkage to a major locus for endometriosis
Lymphatic or vascular distribution
Endometrial fragments may travel through blood vessels or the lymphatic system to other parts of the body. This may explain how endometriosis ends up in distant sites, such as the lung, brain, skin, or eye.
Immune system dysfunctions
Some women with endometriosis appear to display certain immunologic defects or dysfunctions. Whether this is a cause or effect of the disease remains unknown.
Environmental influences
Some studies have pointed to environmental factors as contributors to the development of endometriosis, specifically related to the way toxins in the environment have an effect on the reproductive hormones and immune system response, though this theory has not been proven and remains controversial.
Diagnosing endometriosis
There is no simple test that can be used to diagnose endometriosis. In fact, the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue. This is what is known as "the golden standard".
However, this is an expensive, invasive proceduce. Furthermore, if the surgeon is not a specialist in endometriosis s/he may not recognise the disease, which can result in a "negative" diagnosis.
In addition, the woman/girl may not want to have surgery.
This makes diagnosis a challenge, and therefore an experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis through talking with the woman/girl and obtain a history of her symptoms. For this to be effective, it is important that the woman/girl is honest with her physician about all of her symptoms and the pattern of these.
To aid her in preparation for this consultation she can consult the questionnaire, your first consultation, which will help her in preparing for the questions her doctor may ask her - and, in turn, help him/her in determining whether her symptoms may be due to endometriosis (not all pelvic pain, nor fertility issues, are caused by endometriosis).
There are other tests, which the gynaecologist may perform. These include ultrasound, MRI scans, and gynaecological examinations. None of these can definitively confirm endometriosis (though they can be suggestive of the disease), nor can they definitively dismiss the presence of endometriotic lesions/cysts.
The fact that there is no non-invasive, definitive diagnostic method for endometriosis is as frustrating for clinicians as it is for women with the disease.
Treatments for endometriosis
Since the cause of endometriosis remains unknown, a treatment which fully cures endometriosis has yet to be developed, and there is no overwhelming medical evidence to support one specific type of endometriosis treatment over another.
Chosing a treatment therefore comes down to the individual woman's needs, depending on her symptoms, her age, and her fertility wishes. She should discuss these with her physician so that they, together, can determine, which long term, holistic, treatment plan is best for her individual needs. For many women, this can be a combination of more than one treatment over longer periods of time.
Pain killers
Pain is the most common symptom for many women with endometriosis.
Pain killers vary from simple analgesics (such as aspirin and paracetamol), through compound analgesics (which are a combination of either aspirin or paracetamol and a mild narcotic such as codeine) and narcotic analgesics (similar to morphine), through to non-steroidal anti-inflammatory drugs (such as nurofen, ponstan, voltaren, etc).
More about painkillers
Hormonal treatments
Most researchers agree that endometriosis is exacerbated by oestrogen. Subsequently, hormonal treatments for endometriosis attempt to temper oestrogen production in a woman's body and thereby relieve her of symptoms.
Hormonal therapy may include birth control pills, progestins, a class of drugs known as GnRH-agonists, and danazol (though this is seldom used any more).
The combined oral contraceptive pill
Progestins
Mirena
GnRH-agonists
Danazol
Aromatase inhibitors [still somewhat experimental]
Hormonal therapies have varying degrees of side effects, and unfortunately, whatever pain relief that is achieved tends to be only temporary for many girls and women.
TIPS for dealing with side effects associated with drug treatments
Surgery
Most doctors agree that laparoscopic surgery is the only definitive way to diagnose endometriosis. In many cases, the disease can be diagnosed and treated in the same procedure.
The success of surgery depends greatly on the skill of the surgeon and the thoroughness of the surgery. The aim is to remove all endometriosis lesions, cysts, and adhesions.
Today, most endometriosis surgery is being done through the laparoscope, although a full abdominal incision called a laparotomy may still be required in rare cases for extensive disease or bowel resections.
More about laparoscopic surgery
Although women with endometriosis are often told that hysterectomy is the “definitive” solution for endometriosis, the disease can recur even after a hysterectomy.
More about hysterectomy
Nutritional therapy
The correct balance of daily nutrients are essential for all of us. Proper nutrition helps improve our general health.
For a woman with endometriosis it may also increase her ability to tolerate medical treatments, increase her ability to deal with potential side effects of treatment, increase her energy, and enhance her ability to think clearly. Nutritionists can work with women and girls with endometriosis to put together an appropriate dietary plan.
More about dietary modification to alleviate endometriosis symptoms
Complementary therapies
Given the chronic and stubborn nature of endometriosis, there may be times when it is beneficial to explore therapies beyond the medical mainstream. Whilst there is no clinical evidence as to the effectiveness of these therapies, many women with endometriosis have had good symptom relief by using homeopathy, osteopathy, herbs, and Traditional Chinese Medicine.
Physiotherapists (physical therapists) can develop a programme of exercise and relaxation techniques designed to help strengthen pelvic floor muscles, reduce pain, and manage stress and anxiety. After surgery, rehabilitation in the form of gentle exercises, yoga, or Pilates can help the body get back into shape by strengthening compromised abdominal and back muscles.
A multi-disciplinary approach
To provide holistic treatment to women and girls with endometriosis, a team of medical professionals may be involved in providing care, including: - general practitioners- gynaecologists- surgeons (from a number of disciplines)- reproductive endocrinologists- immunologists- nutritionists/dieticians- nurses- psychologists- counsellors- pain specialists- physiotherapists
All of these disciplines can play an important role in providing an individualised treatment plan for a woman or girl with endometriosis.
Finally, please remember that endometriosis affects more than just the physical body. It often affects women and girls in profound emotional ways as well. Psychologists and counsellors can play an important role by helping women and girls cope with the feelings of confusion, disbelief, chronic pain, infertility, and frustration that often accompany this disease.
Support groups also play a vital role in learning to cope with endometriosis and may be able to provide information about national or regional centres, who specialise in the treatment of endometriosis.
20 - endometriosis mcqs - part 1
1Q- a 36 yr old woman completed her treatment for endometriosis 6 months back .during t/t suffered from bouts of depression,weight gain, menorrahagia ,she now complains of amenorrhea.what is the management?
a- danazol
b- estrogen
c- expectant management
d- progesterone
e- Gnrh anologues
the ans given is progestrone,could any one tell why? read the theory part of endometriosis before u answer ..... click here
a- danazol
b- estrogen
c- expectant management
d- progesterone
e- Gnrh anologues
the ans given is progestrone,could any one tell why? read the theory part of endometriosis before u answer ..... click here
Thursday, February 28, 2008
19 - endometrial carcinoma - FIGO staging
The International Federation of Gynecology and Obstetrics (FIGO) staging system for carcinoma of corpus uteri is as follows:
- Stage IA - Tumor limited to endometrium
- Stage IB - Invasion to less than one half the myometrium
- Stage IC - Invasion to more than one half the myometrium
- Stage IIA - Endocervical glandular involvement only
- Stage IIB - Cervical stromal invasion
- Stage IIIA - Tumor invades serosa and/or adnexa and/or positive peritoneal cytology.
- Stage IIIB - Vaginal metastasis
- Stage IIIC - Metastases to pelvic and/or para-aortic lymph nodes
- Stage IVA - Tumor invasion of bladder and/or bowel mucosa
- Stage IVB - Distant metastases including intra-abdominal and/or inguinal lymph nodes.
Monday, January 21, 2008
18 - gynaecology mcqs - 121 to 130
Question 121 :
Intrauterine pregnancy rate after linear salpingostomy is approximately
a) 35%
b) 45%
c) 60% * * Right
d) 75%
e) 90%
Question 122 :
All of the following are necessary for the treatment of ectopic pregnancy with MTX EXCEPT
a) Unruptured
b) No pain * * Right
c) Hemodynamically stable
d) Normal blood count & liver enzymes
Question 123 :
Which of the following side effects is least common with cisplatin
a) Thrombocytopenia
b) Hypomagnesimia
c) Cardiac toxicity * * Right
d) Neuropathy
e) High frequency hearing loss
Question 124 :
Perforation tends to occur earliest when an ectopic pregnancy is located in which portion of fallopian tube ?
a) Isthmic * * Right
b) Interstitial
c) Ampullary
d) Infundibular
e) No difference
Question 125 :
The rate of disappearance of hCG is most rapid in which condition
a) Induced abortion
b) Spontaneous abortion c) Complete removal of ectopic pregnancy by resection d) Complete removal of ectopic pregnancy by linear salpingostomy
e) No difference * * Right
Question 126 :
Which is the least frequent site of an ectopic pregnancy
a) Fallopian tube
b) Cervix
c) Ovary
d) Abdominal cavity
e) Between the leaves of broad ligament * * Right
Question 127 :
What treatment is recommended for a complete tubal abortion when the fallopian tube appears undamaged, there is no further bleeding, and product of gestation have been expelled
a) Non operative treatment
b) Evacuation of production of gestation and blood clots from pouch of Douglas and peritoneal cavity * * Right
c) Removal of the abortion and clots and incision in tube for exploration
d) Removal of abortion and clots and salpingectomy
e) Removal of abortion and clots and salpingo oophorectomy
Question 128 :
Which is not an indication for chemotherapeutic treatment of postmolar trophoblastic disease
a) Abnormal hCG regression curve
b) Presence of metastasis
c) Uterine infection * * Right
d) Uterine haemorrhage
e) Tissue diagnosis of choriocarcinoma
Question 129 :
Incidence of all of the following conditions are increased in tamoxifen users EXCEPT
a) Cervial dysplasia * * Right
b) Endometrial polyps
c) Endometrial hyperplasia
d) Uterine fibroids
e) Endometrial adenocarcinoma
Question 130 :
Women with postmenopausal bleeding need endometrial sampling if endometrial on gynae USG is thicker than
a) 1mm
b) 2mm
c) 5mm * * Right
d) 8mm
e) 10mm
Intrauterine pregnancy rate after linear salpingostomy is approximately
a) 35%
b) 45%
c) 60% * * Right
d) 75%
e) 90%
Question 122 :
All of the following are necessary for the treatment of ectopic pregnancy with MTX EXCEPT
a) Unruptured
b) No pain * * Right
c) Hemodynamically stable
d) Normal blood count & liver enzymes
Question 123 :
Which of the following side effects is least common with cisplatin
a) Thrombocytopenia
b) Hypomagnesimia
c) Cardiac toxicity * * Right
d) Neuropathy
e) High frequency hearing loss
Question 124 :
Perforation tends to occur earliest when an ectopic pregnancy is located in which portion of fallopian tube ?
a) Isthmic * * Right
b) Interstitial
c) Ampullary
d) Infundibular
e) No difference
Question 125 :
The rate of disappearance of hCG is most rapid in which condition
a) Induced abortion
b) Spontaneous abortion c) Complete removal of ectopic pregnancy by resection d) Complete removal of ectopic pregnancy by linear salpingostomy
e) No difference * * Right
Question 126 :
Which is the least frequent site of an ectopic pregnancy
a) Fallopian tube
b) Cervix
c) Ovary
d) Abdominal cavity
e) Between the leaves of broad ligament * * Right
Question 127 :
What treatment is recommended for a complete tubal abortion when the fallopian tube appears undamaged, there is no further bleeding, and product of gestation have been expelled
a) Non operative treatment
b) Evacuation of production of gestation and blood clots from pouch of Douglas and peritoneal cavity * * Right
c) Removal of the abortion and clots and incision in tube for exploration
d) Removal of abortion and clots and salpingectomy
e) Removal of abortion and clots and salpingo oophorectomy
Question 128 :
Which is not an indication for chemotherapeutic treatment of postmolar trophoblastic disease
a) Abnormal hCG regression curve
b) Presence of metastasis
c) Uterine infection * * Right
d) Uterine haemorrhage
e) Tissue diagnosis of choriocarcinoma
Question 129 :
Incidence of all of the following conditions are increased in tamoxifen users EXCEPT
a) Cervial dysplasia * * Right
b) Endometrial polyps
c) Endometrial hyperplasia
d) Uterine fibroids
e) Endometrial adenocarcinoma
Question 130 :
Women with postmenopausal bleeding need endometrial sampling if endometrial on gynae USG is thicker than
a) 1mm
b) 2mm
c) 5mm * * Right
d) 8mm
e) 10mm
17 - gynaecology mcqs - 111 to 120
Question 111 :
GnRH agonists successfully reduce fibroid & total uterine size in what percentage of patients
a) 30%
b) 50%
c) 60%
d) 70%
e) 95% * * Right
Question 112 :
Menstrual regulation can be performed upto
a) 6 wks * * Right
b) 12 wks
c) 18 wk
d) 20 wks
Question 113 :
Straussman operation consists of
a) Unification of seperate uterus * * Right
b) Sling operation for prolapse
c) Tightening of cervical os
d) None of the above
Question 114 : Perforation of the uterus while doing endometrial biopsy in non pregnant uterus, needs
a) Laparoscopy
b) Observation * * Right
c) Immediate laparotomy
d) Hysterectomy
Question 115 :
After fertilization, ova is embedded in the endometrium on which day ?
a) 2nd day
b) 4th day
c) 6th day * * Right
d) 10th day
Question 116 :
Time taken by the spermatatozoa to reach ampulla of the fallopian tube after ejaculation is
a) 20 mins
b) 30 mins
c) 60 mins * * Right
d) 2 hrs
Question 117 :
Least common type of ut anomaly in patients with RPL
a) Unicornuate * * Right
b) Arcuate
c) Septate
d) Bicornuate
e) Didelphys
Question 118 :
The first trimester spontaneous abortion rate is highest for patients with which type of ut anomalya) Unicornuate
b) Arcuate
c) Septate * * Right
d) Bicornuate
e) Didelphys
Question 119 :
The gold standard in diagnosing ectopic pregnancy
a) Laparoscopy * * Right
b) Culdocentesis
c) Beta HCG
d) USG
e) Progesterone
Question 120 :
What is the most common side effect with MTX therapy for ectopic pregnancy
a) Transient pelvic pain 3 - 7 days after starting treatment * * Right
b) Stomatitis
c) Bone marrow suppression
d) Gastritis
GnRH agonists successfully reduce fibroid & total uterine size in what percentage of patients
a) 30%
b) 50%
c) 60%
d) 70%
e) 95% * * Right
Question 112 :
Menstrual regulation can be performed upto
a) 6 wks * * Right
b) 12 wks
c) 18 wk
d) 20 wks
Question 113 :
Straussman operation consists of
a) Unification of seperate uterus * * Right
b) Sling operation for prolapse
c) Tightening of cervical os
d) None of the above
Question 114 : Perforation of the uterus while doing endometrial biopsy in non pregnant uterus, needs
a) Laparoscopy
b) Observation * * Right
c) Immediate laparotomy
d) Hysterectomy
Question 115 :
After fertilization, ova is embedded in the endometrium on which day ?
a) 2nd day
b) 4th day
c) 6th day * * Right
d) 10th day
Question 116 :
Time taken by the spermatatozoa to reach ampulla of the fallopian tube after ejaculation is
a) 20 mins
b) 30 mins
c) 60 mins * * Right
d) 2 hrs
Question 117 :
Least common type of ut anomaly in patients with RPL
a) Unicornuate * * Right
b) Arcuate
c) Septate
d) Bicornuate
e) Didelphys
Question 118 :
The first trimester spontaneous abortion rate is highest for patients with which type of ut anomalya) Unicornuate
b) Arcuate
c) Septate * * Right
d) Bicornuate
e) Didelphys
Question 119 :
The gold standard in diagnosing ectopic pregnancy
a) Laparoscopy * * Right
b) Culdocentesis
c) Beta HCG
d) USG
e) Progesterone
Question 120 :
What is the most common side effect with MTX therapy for ectopic pregnancy
a) Transient pelvic pain 3 - 7 days after starting treatment * * Right
b) Stomatitis
c) Bone marrow suppression
d) Gastritis
16 - gynaecology mcqs - 101 to 110
Question 101 :
Radiotherapy is indicated in Endometrial Ca in following situation EXCEPT
a) Preop radiotherapy followed by TAH + BSO
b) Postop adjuvant radiotherapy after TAH + BSO
c) Primary treatment for medically inoperable
d) To specifically treat pelvic side wall involvement * * Right
e) Vaginal recurrence after hysterectomy
Question 102 :
Invasive molar tissue is most commonly found in
a) Myometrium * * Right
b) Vaginal wall
c) Ovary
d) Liver
e) Lungs
Question 103 :
Which method of terminating a molar gestation is never indicated
a) Suction curettage
b) Prostaglandic
c) Hypertonicsaline * * Right
d) Hysterotomy
e) Hyterectomy
Question 104 : The following are the risk factors for H mole EXCEPT
a) Maternal age > 40 yrs
b) Prior h/o H mole
c) Prior h/o term pregnancy * * Right
d) Prior h/o spontaneous abortion
Question 105 :
Treatment of choice for 30 years old para 1 with stress incontinence is
a) Pelvic floor exercise * * Right
b) Bladder training
c) Mechanical incontinence device
d) Kelly's repair
e) Sling operation
Question 106 :
Treatment of choice for a 55 yrs old multipara with 3rd degree prolapse uterus with cystocele with rectocele with stress incontinence
a) Vaginal hysterectomy with pelvic floor repair
b) Kelly's repair
c) a) + b) * * Right
d) a) + colposuspension
Question 107 :
Best treatment for severe stress incontinence without prolapse is
a) Pelvic floor exercise
b) Kelly's repair
c) Burch colposuspension * * Right
d) MMK operation
e) Urethral collagen implant
Question 108 :
Diagnosis of genuine stress incontinence is made by which of the following before taking the patient for surgery
a) History
b) Subjective demonstration of stress incontinence
c) Objective demonstration of stress incontinence
d) Urodynamic studies * * Right
Question 109 :
The commonest cause of stress incontinence is
a) Constipation
b) Raised intra abdominal pressure
c) Congenital weakness of sphincter
d) Childbirth trauma * * Right
e) Estrogen deficiency
Question 110 :
The amount of progesterone released per day by the progesterone releasing IUCD ( Progestarest ) is
a) 60 mugm
b) 65 mugm * * Right
c) 70 mugm
d) 75 mugm
Radiotherapy is indicated in Endometrial Ca in following situation EXCEPT
a) Preop radiotherapy followed by TAH + BSO
b) Postop adjuvant radiotherapy after TAH + BSO
c) Primary treatment for medically inoperable
d) To specifically treat pelvic side wall involvement * * Right
e) Vaginal recurrence after hysterectomy
Question 102 :
Invasive molar tissue is most commonly found in
a) Myometrium * * Right
b) Vaginal wall
c) Ovary
d) Liver
e) Lungs
Question 103 :
Which method of terminating a molar gestation is never indicated
a) Suction curettage
b) Prostaglandic
c) Hypertonicsaline * * Right
d) Hysterotomy
e) Hyterectomy
Question 104 : The following are the risk factors for H mole EXCEPT
a) Maternal age > 40 yrs
b) Prior h/o H mole
c) Prior h/o term pregnancy * * Right
d) Prior h/o spontaneous abortion
Question 105 :
Treatment of choice for 30 years old para 1 with stress incontinence is
a) Pelvic floor exercise * * Right
b) Bladder training
c) Mechanical incontinence device
d) Kelly's repair
e) Sling operation
Question 106 :
Treatment of choice for a 55 yrs old multipara with 3rd degree prolapse uterus with cystocele with rectocele with stress incontinence
a) Vaginal hysterectomy with pelvic floor repair
b) Kelly's repair
c) a) + b) * * Right
d) a) + colposuspension
Question 107 :
Best treatment for severe stress incontinence without prolapse is
a) Pelvic floor exercise
b) Kelly's repair
c) Burch colposuspension * * Right
d) MMK operation
e) Urethral collagen implant
Question 108 :
Diagnosis of genuine stress incontinence is made by which of the following before taking the patient for surgery
a) History
b) Subjective demonstration of stress incontinence
c) Objective demonstration of stress incontinence
d) Urodynamic studies * * Right
Question 109 :
The commonest cause of stress incontinence is
a) Constipation
b) Raised intra abdominal pressure
c) Congenital weakness of sphincter
d) Childbirth trauma * * Right
e) Estrogen deficiency
Question 110 :
The amount of progesterone released per day by the progesterone releasing IUCD ( Progestarest ) is
a) 60 mugm
b) 65 mugm * * Right
c) 70 mugm
d) 75 mugm
15 - gynaecology mcqs - 91 to 100
Question 91 :
The standard Cu 250 IUCD is appropriate for a uterus having uterocervical length of
a) 5 - 8 cm
b) 6 - 9 cm * * Right
c) 7 - 10 cm
d) 8 - 11 cm
Question 92 :
An ideal candidate for the use of IUCD as a contraceptive method should have all of the following EXCEPT
a) Nulliparous * * Right
b) One child
c) Normal menstrual cycle
d) Monogamous relationship
Question 93 :
The commonest complication of laparoscopic ring tubal ligation is
a) Failure of sterilization
b) Menstrual abnormality
c) Mesosalpingeal bleeding * * Right
d) Bowel injury
e) Wound infection
Question 94 :
Which of the following cancidates will be immediately eligible for sterilization
a) Women having uncontrolled diabetes
b) Women having Hb less than 6
c) Past h/o treated pulmonary koch's * * Right
d) Febrile patient
Question 95 :
After vasectomy , a backup contraceptive method is required for how many weeks
a) 8 wks
b) 10 wks
c) 12 wks * * Right
d) 14 wks
Question 96 :
AFP is most often useful for monitoring the response to treatment of which germ cell tumor
a) Dysgerminima
b) Immature teratoma
c) Endodermal sinus tumor * * Right
d) Choriocarcinoma
Question 97 :
Granulosa cell tumor are associated with all EXCEPT
a) Isosexual precoerty
b) Endometrial hyperplasia & adenocarcinoma
c) Present most commonly before the age of 5 * * Right
d) Vaginal bleeding
Question 98 :
Combination chemotherapy regimen in Ca ovary
a) Is the treatment of choice for most patients with residual disease following surgery * * Right
b) Less toxic than single agent therapy
c) Less expensive than single agent therapy
d) Produces better results if it is a combination containing cyclophosphamide
e) None of the above
Question 99 :
The following are the pathological features of an ovary , EXCEPT
a) Round shape with irregular internal or external outline
b) Thick septae of > 5mm
c) Size more than 10 cm
d) Volume 5 to 15 ml - right
Question 100 : The following are the factors associated with CIN EXCEPT
a) Onset of coitus at early stage
b) Multiple sexual partners
c) Lower socioeconomic status
d) Nulliparity * * Right
e) H/o veneral disease
The standard Cu 250 IUCD is appropriate for a uterus having uterocervical length of
a) 5 - 8 cm
b) 6 - 9 cm * * Right
c) 7 - 10 cm
d) 8 - 11 cm
Question 92 :
An ideal candidate for the use of IUCD as a contraceptive method should have all of the following EXCEPT
a) Nulliparous * * Right
b) One child
c) Normal menstrual cycle
d) Monogamous relationship
Question 93 :
The commonest complication of laparoscopic ring tubal ligation is
a) Failure of sterilization
b) Menstrual abnormality
c) Mesosalpingeal bleeding * * Right
d) Bowel injury
e) Wound infection
Question 94 :
Which of the following cancidates will be immediately eligible for sterilization
a) Women having uncontrolled diabetes
b) Women having Hb less than 6
c) Past h/o treated pulmonary koch's * * Right
d) Febrile patient
Question 95 :
After vasectomy , a backup contraceptive method is required for how many weeks
a) 8 wks
b) 10 wks
c) 12 wks * * Right
d) 14 wks
Question 96 :
AFP is most often useful for monitoring the response to treatment of which germ cell tumor
a) Dysgerminima
b) Immature teratoma
c) Endodermal sinus tumor * * Right
d) Choriocarcinoma
Question 97 :
Granulosa cell tumor are associated with all EXCEPT
a) Isosexual precoerty
b) Endometrial hyperplasia & adenocarcinoma
c) Present most commonly before the age of 5 * * Right
d) Vaginal bleeding
Question 98 :
Combination chemotherapy regimen in Ca ovary
a) Is the treatment of choice for most patients with residual disease following surgery * * Right
b) Less toxic than single agent therapy
c) Less expensive than single agent therapy
d) Produces better results if it is a combination containing cyclophosphamide
e) None of the above
Question 99 :
The following are the pathological features of an ovary , EXCEPT
a) Round shape with irregular internal or external outline
b) Thick septae of > 5mm
c) Size more than 10 cm
d) Volume 5 to 15 ml - right
Question 100 : The following are the factors associated with CIN EXCEPT
a) Onset of coitus at early stage
b) Multiple sexual partners
c) Lower socioeconomic status
d) Nulliparity * * Right
e) H/o veneral disease
14 - gynaecology mcqs - 81 to 90
Question 81 :
Endometrial Carcinoma with vaginal metastasis is staged as
a) II b
b) III a
c) III b----------------------------------------------
d) III c
e) IV a
Question 82 :
Stress urinary incontenence is characterised by involuntary loss of urine with all of the following EXCEPT
a) Coughing
b) Exercising
c) Laughing
d) Sleeping---------------------------------------- *
e) Sneezing
Question 83 :
The following are associated with increased incidence of recurrent pregnancy loss EXCEPT
a) Presence of thyroid antibodies----------------------------------- *
b) Polycystic ovarian disease
c) Overt diabetes mellitus
d) Partial HLA homozygosity
e) Balanced translocation in either patient
Question 84 :
Management of proximal tubal occlusion is all EXCEPT
a) Transcervical canulation---------------------------------- *
b) Intramural isthmic anastomosis
c) Uterotubal implantation
d) Isthmic - Isthmic anastomosis
Question 85 :
Which of the following is most reliable in diagnosing ovarian malignancy ?
a) Medical history
b) Plain Xray
c) Physical examination
d)USG-----------------------------------
e) Cytology from ovarian cyst fluid
Question 86 :
Which of the following is not associated with an increased risk for ovarian carcinoma ?
a) Radiation exposure-------------------------------------- *
b) Nulliparity
c) A diet low in fibre and Vit A.
d) Familial tendency
e) Peutz - Jeghers Syndrome
Question 87 :
Approximately 75 - 80% of ovarian tumors originate from
a) Epithelium----------------------------- *
b) Stroma
c) Germ cells
d) Mesoderm
e) Unclassified tissue
Question 88 : Side effects of Gn RH agonists includes all of the following EXCEPT
a) Hot flashes
b) Vaginal dryness
c) Bone resorption & osteoporosis
d) Headache
e) Decreased high density lipoproteins--------------------------------------------
Question 89 :
The least common side effect caused by GnRH agonists
a) Decreased libido---------------------------------- *
b) Vasomotor symptoms
c) Headache
d) Vaginal dryness
e) Mood changes
Question 90 : Least expensive hormonal regimen for treatment of pelvic pain caused by endometriosis
a) Danazol
b) Medroxy progesterone----------------------------
c) Nafarclin
d) Buscrelin
e) Leuprolide
Endometrial Carcinoma with vaginal metastasis is staged as
a) II b
b) III a
c) III b----------------------------------------------
d) III c
e) IV a
Question 82 :
Stress urinary incontenence is characterised by involuntary loss of urine with all of the following EXCEPT
a) Coughing
b) Exercising
c) Laughing
d) Sleeping---------------------------------------- *
e) Sneezing
Question 83 :
The following are associated with increased incidence of recurrent pregnancy loss EXCEPT
a) Presence of thyroid antibodies----------------------------------- *
b) Polycystic ovarian disease
c) Overt diabetes mellitus
d) Partial HLA homozygosity
e) Balanced translocation in either patient
Question 84 :
Management of proximal tubal occlusion is all EXCEPT
a) Transcervical canulation---------------------------------- *
b) Intramural isthmic anastomosis
c) Uterotubal implantation
d) Isthmic - Isthmic anastomosis
Question 85 :
Which of the following is most reliable in diagnosing ovarian malignancy ?
a) Medical history
b) Plain Xray
c) Physical examination
d)USG-----------------------------------
e) Cytology from ovarian cyst fluid
Question 86 :
Which of the following is not associated with an increased risk for ovarian carcinoma ?
a) Radiation exposure-------------------------------------- *
b) Nulliparity
c) A diet low in fibre and Vit A.
d) Familial tendency
e) Peutz - Jeghers Syndrome
Question 87 :
Approximately 75 - 80% of ovarian tumors originate from
a) Epithelium----------------------------- *
b) Stroma
c) Germ cells
d) Mesoderm
e) Unclassified tissue
Question 88 : Side effects of Gn RH agonists includes all of the following EXCEPT
a) Hot flashes
b) Vaginal dryness
c) Bone resorption & osteoporosis
d) Headache
e) Decreased high density lipoproteins--------------------------------------------
Question 89 :
The least common side effect caused by GnRH agonists
a) Decreased libido---------------------------------- *
b) Vasomotor symptoms
c) Headache
d) Vaginal dryness
e) Mood changes
Question 90 : Least expensive hormonal regimen for treatment of pelvic pain caused by endometriosis
a) Danazol
b) Medroxy progesterone----------------------------
c) Nafarclin
d) Buscrelin
e) Leuprolide
13 - gynaecology mcqs - 76 to 80
Question 76
A 28-year-old woman develops the sudden onset of severe lower abdominal pain. On physical examination there is tenderness to palpation of the right lower quadrant. Laboratory studies show her serum pregnancy test is positive. An ultrasound scan does not reveal a gestational sac in the uterus, but there is a right adnexal mass. The development of these findings is most closely related to past infection with which of the following organisms?
A Treponema pallidum
B Human papillomavirus
C Neisseria gonorrheae
D Candida albicans
E Group B Streptococcus
-----------------------------------------------------
(C) CORRECT. Many cases of pelvic inflammatory disease (PID) are due to gonorrhea. The tubal scarring from the inflammation leads to an increased risk for ectopic pregnancy(A) Incorrect. Syphilis can produce a chancre of the external genitalia or cervix.(B) Incorrect. HPV is associated with increased risk for squamous epithelial dysplasias.(D) Incorrect. Candida is the cause for vaginitis.(E) Incorrect. This organism presents the greatest risk as an intrauterine infection resulting in stillbirth in the third trimester.
-------------------------------------------------------
Question 77
A 45-year-old woman has had irregular menstrual periods for the past 9 months. On physical examination she has an enlarged uterus. An ultrasound scan shows a 9 cm solitary, solid mass in the uterus. A total abdominal hysterectomy is performed. Gross examination of the irregular reddish-tan mass located in the myometrium shows bundles of smooth muscle cells along with heterogenous elements of pleomorphic cartilaginous cells. There are also areas with poorly differentiated gland formation. Mitotic figures are frequent. Which of the following neoplasms is she most likely to have?
A Leiomyosarcoma
B Sarcoma botryoides
C Malignant mixed mullerian tumor
D Endolymphatic stromal myosis
E Leiomyoma
---------------------------------------------------------
(C) CORRECT. The malignant mixed mullerian tumor typically has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues.(A) Incorrect. The leiomyosarcoma is distinguished from a leiomyoma by the cellularity and the mitotic rate, but it is composed only of cells resembling smooth muscle.(B) Incorrect. Sarcoma botryoides is a rare neoplasm most likely to occur in the vagina of a child. It is composed of primitive cells most resembling an embryonal rhabdomyosarcoma.(D) Incorrect. This rare condition consists of endometrial stromal cells extending into the body of uterus and beyond.(E) Incorrect. A leiomyoma should not have a significant mitotic rate.
------------------------------------------------------------
Question 78
A 72-year-old woman has been feeling tired for the past year. She has had episodes of vaginal bleeding during this time. On physical examination there are no abnormal findings. Laboratory studies show Hgb 9.1 g/dL, Hct 26.5%, MCV 72 fL, platelet count 158,000/microliter, and WBC count 7150/microliter. An endometrial biopsy is performed and on microscopic examination shows atypical adenomatous hyperplasia. Which of the following is the most likely risk factor for development of her disease?
A Human papillomavirus infection
B Long term use of an intrauterine contraceptive device
C Chronic endometritis
D Pelvic inflammatory disease
E Unopposed estrogenic stimulation
---------------------------------------------------------------
(E) CORRECT. The unopposed estrogen drives the hyperplasia, which if atypical carries an increased risk for development of an endometrial adenocarcinoma.(A) Incorrect. HPV infection mainly produces lesions of squamous epithelium of external genitalia and cervix, such as dysplasias and carcinoma.(B) Incorrect. An IUD can cause endometritis, but not a preneoplastic lesion.(C) Incorrect. Chronic endometritis is not generally known as an antecedent to preneoplastic or neoplastic conditions.(D) Incorrect. PID can produce inflammation with scarring, mainly of tubes and ovaries.
-------------------------------------------------------------------
Question 79
A 56-year-old G0 P0 woman reports vaginal bleeding in the past 2 months. Her last menstrual period was 6 years ago. On physical examination there are no abnormal findings. Which of the following procedures is most appropriate to perform on this woman?
A Endometrial biopsy
B Pap smear
C Vaginal culture
D Colposcopy
E CT scan
-----------------------------------------------------------------------
(A) CORRECT. This history points to a possible endometrial carcinoma, and nulliparity increases the risk.(B) Incorrect. CIN is less likely than an endometrial lesion in this setting.(C) Incorrect. An infection would be unlikely to cause bleeding.(D) Incorrect. This will show cervical lesions, not endometrial.(E) Incorrect. The possible causes of uterine bleeding cannot be distinguished by CT (or MRI) scan.
------------------------------------------------------------------------
Question 80
A 50-year-old woman has experienced mild pelvic discomfort for 3 months. On physical examination there are bilateral adnexal masses. A pelvic CT scan reveals irregular unilocular cystic, bilateral mass lesions in the region of the ovaries. One is 10 cm and the other is 8 cm in size. Which of the following types of neoplasm is most likely to be present in this woman?
A Mature cystic teratoma
B Serous cystadenocarcinoma
C Endometrioid carcinoma
D Fibrothecoma
E Mucinous cystadenoma
-----------------------------------------------------------------------------
(B) CORRECT. Ovarian serous tumors are bilateral more often than other ovarian tumors. Serous cystadenocarcinomas are bilateral in about 2/3 of cases.(A) Incorrect. Teratomas of the ovary are bilateral in about 10 to 15% of cases.(C) Incorrect. These are bilateral in about 40% of cases; however, they tend to be solid masses.(D) Incorrect. These are unlikely to be bilateral; they are solid masses(E) Incorrect. Benign mucinous ovarian tumors are bilateral in about 5% of cases. Malignant mucinous ovarian tumors are bilateral about 20% of the time. They tend to be multilocular.
------------------------------------------------------------------------------
A 28-year-old woman develops the sudden onset of severe lower abdominal pain. On physical examination there is tenderness to palpation of the right lower quadrant. Laboratory studies show her serum pregnancy test is positive. An ultrasound scan does not reveal a gestational sac in the uterus, but there is a right adnexal mass. The development of these findings is most closely related to past infection with which of the following organisms?
A Treponema pallidum
B Human papillomavirus
C Neisseria gonorrheae
D Candida albicans
E Group B Streptococcus
-----------------------------------------------------
(C) CORRECT. Many cases of pelvic inflammatory disease (PID) are due to gonorrhea. The tubal scarring from the inflammation leads to an increased risk for ectopic pregnancy(A) Incorrect. Syphilis can produce a chancre of the external genitalia or cervix.(B) Incorrect. HPV is associated with increased risk for squamous epithelial dysplasias.(D) Incorrect. Candida is the cause for vaginitis.(E) Incorrect. This organism presents the greatest risk as an intrauterine infection resulting in stillbirth in the third trimester.
-------------------------------------------------------
Question 77
A 45-year-old woman has had irregular menstrual periods for the past 9 months. On physical examination she has an enlarged uterus. An ultrasound scan shows a 9 cm solitary, solid mass in the uterus. A total abdominal hysterectomy is performed. Gross examination of the irregular reddish-tan mass located in the myometrium shows bundles of smooth muscle cells along with heterogenous elements of pleomorphic cartilaginous cells. There are also areas with poorly differentiated gland formation. Mitotic figures are frequent. Which of the following neoplasms is she most likely to have?
A Leiomyosarcoma
B Sarcoma botryoides
C Malignant mixed mullerian tumor
D Endolymphatic stromal myosis
E Leiomyoma
---------------------------------------------------------
(C) CORRECT. The malignant mixed mullerian tumor typically has malignant components that are both epithelial and stromal. The stromal component does not always resemble just smooth muscle but may have sarcomatous elements resembling other mesodermal tissues.(A) Incorrect. The leiomyosarcoma is distinguished from a leiomyoma by the cellularity and the mitotic rate, but it is composed only of cells resembling smooth muscle.(B) Incorrect. Sarcoma botryoides is a rare neoplasm most likely to occur in the vagina of a child. It is composed of primitive cells most resembling an embryonal rhabdomyosarcoma.(D) Incorrect. This rare condition consists of endometrial stromal cells extending into the body of uterus and beyond.(E) Incorrect. A leiomyoma should not have a significant mitotic rate.
------------------------------------------------------------
Question 78
A 72-year-old woman has been feeling tired for the past year. She has had episodes of vaginal bleeding during this time. On physical examination there are no abnormal findings. Laboratory studies show Hgb 9.1 g/dL, Hct 26.5%, MCV 72 fL, platelet count 158,000/microliter, and WBC count 7150/microliter. An endometrial biopsy is performed and on microscopic examination shows atypical adenomatous hyperplasia. Which of the following is the most likely risk factor for development of her disease?
A Human papillomavirus infection
B Long term use of an intrauterine contraceptive device
C Chronic endometritis
D Pelvic inflammatory disease
E Unopposed estrogenic stimulation
---------------------------------------------------------------
(E) CORRECT. The unopposed estrogen drives the hyperplasia, which if atypical carries an increased risk for development of an endometrial adenocarcinoma.(A) Incorrect. HPV infection mainly produces lesions of squamous epithelium of external genitalia and cervix, such as dysplasias and carcinoma.(B) Incorrect. An IUD can cause endometritis, but not a preneoplastic lesion.(C) Incorrect. Chronic endometritis is not generally known as an antecedent to preneoplastic or neoplastic conditions.(D) Incorrect. PID can produce inflammation with scarring, mainly of tubes and ovaries.
-------------------------------------------------------------------
Question 79
A 56-year-old G0 P0 woman reports vaginal bleeding in the past 2 months. Her last menstrual period was 6 years ago. On physical examination there are no abnormal findings. Which of the following procedures is most appropriate to perform on this woman?
A Endometrial biopsy
B Pap smear
C Vaginal culture
D Colposcopy
E CT scan
-----------------------------------------------------------------------
(A) CORRECT. This history points to a possible endometrial carcinoma, and nulliparity increases the risk.(B) Incorrect. CIN is less likely than an endometrial lesion in this setting.(C) Incorrect. An infection would be unlikely to cause bleeding.(D) Incorrect. This will show cervical lesions, not endometrial.(E) Incorrect. The possible causes of uterine bleeding cannot be distinguished by CT (or MRI) scan.
------------------------------------------------------------------------
Question 80
A 50-year-old woman has experienced mild pelvic discomfort for 3 months. On physical examination there are bilateral adnexal masses. A pelvic CT scan reveals irregular unilocular cystic, bilateral mass lesions in the region of the ovaries. One is 10 cm and the other is 8 cm in size. Which of the following types of neoplasm is most likely to be present in this woman?
A Mature cystic teratoma
B Serous cystadenocarcinoma
C Endometrioid carcinoma
D Fibrothecoma
E Mucinous cystadenoma
-----------------------------------------------------------------------------
(B) CORRECT. Ovarian serous tumors are bilateral more often than other ovarian tumors. Serous cystadenocarcinomas are bilateral in about 2/3 of cases.(A) Incorrect. Teratomas of the ovary are bilateral in about 10 to 15% of cases.(C) Incorrect. These are bilateral in about 40% of cases; however, they tend to be solid masses.(D) Incorrect. These are unlikely to be bilateral; they are solid masses(E) Incorrect. Benign mucinous ovarian tumors are bilateral in about 5% of cases. Malignant mucinous ovarian tumors are bilateral about 20% of the time. They tend to be multilocular.
------------------------------------------------------------------------------
12 - gynaecology mcqs - 71 to 75
Question 71
25-year-old woman is G2 P1. Her first pregnancy resulted in a normal term birth. Now at 15 weeks gestation, a prenatal checkup reveals that she has a blood pressure of 140/90 mm Hg. An ultrasound is performed that reveals no fetal cardiac motion. Misoprostol induction is performed for termination of the pregnancy. Examination of the malformed stillborn fetus reveals that it is small for gestational age and has 3,4 syndactyly bilaterally, an indented nasal bridge, and a two vessel cord. The placenta is small for gestation and has scattered 0.5 cm grape-like villi. A chromosome analysis performed on the placental tissue will most likely demonstrate which of the following karyotypes?
A 46, XX
B 69, XXY
C 45, X
D 47, XX, +18
E 23, X
F 47, XYY
G 47, XXX
--------------------------------------
(B) CORRECT. In a partial mole, a fetus is present but malformed and small for gestational age. Only occasional villi, or none at all, may be grape-like, but there is trophoblastic proliferation typical of molar pregnancy.(A) Incorrect. The 46, XX karyotype would be appropriate for a normal female fetus. It could also be seen with a complete mole in which no fetus would be present.(C) Incorrect. The 45, X karyotype is seen with Turner syndrome, one of the more common chromosomal abnormalities seen with fetal losses. It is not accompanied by placental changes of molar pregnancy.(D) Incorrect. Trisomy 18 leads to an abnormal appearing fetus with clenched hands (not syndactyly), and the placenta may be small, but does not show changes of molar pregnancy.(E) Incorrect. The 23, X karyotype is that of an unfertilized ovum or a sperm.(F) Incorrect. This karyotype is indicative of Klinfelter syndrome, seen in nearly normal appearing males with oligospermia.(G) Incorrect. This is the 'superfemale' karyotype with only mild mental retardation.
------------------------------------------
Question 72
A 16-year-old girl has not begun menstruation. Physical examination reveals that she has breast development, but a short vagina and no palpable uterus or adnexa, only bilateral inguinal masses. She appears otherwise normally developed. Which of the following laboratory tests would be most appropriate to order on this girl?
A Chromosome analysis
B Serum estrogen
C Assay for luteinizing hormone
D Serum cortisol
E Serum testosterone
F Magnetic resonance imaging of brain
---------------------------------------------------
(A) CORRECT. The findings point to testicular feminization (androgen insensitivity syndrome), with a karyotype of 46, XY. The inguinal masses are the testes.(B) Incorrect. This would be more useful for workup of secondary amenorrhea.(C) Incorrect. This would be more useful for workup of secondary amenorrhea.(D) Incorrect. A serum cortisol would be useful for workup of congenital adrenal hyperplasia.(E) Incorrect. This is more useful for workup of male infertility or developmental problems.(F) Incorrect. It is unlikely that her problems can be explained by a neoplasm of the brain, including the pituitary.
-----------------------------------------------
Question 73
A 38-year-old healthy woman has had a white, curd-like vaginal discharge for the past week. There is no bleeding. A Pap smear demonstrates normal appearing squamous epithelial cells along with scattered neutrophils and budding cells with pseudohyphae. Which of the following infectious agents is most likely to be present in this woman?
A Treponema pallidum
B Neisseria gonorrhea
C Chlamydia trachomatis
D Herpes simplex virus
E Escherichia coli
F Gardnerella vaginalis
G Trichomonas vaginalis
H Candida albicans
I Human papillomavirus
--------------------------------------------------
(H) CORRECT. Vaginal yeast infections are quite common. Fungal vulvovaginitis is the second most common cause of vaginal infections in the U.S. (Bacterial vaginosis is the most frequent cause).(A) Incorrect. This is the causative agent for syphilis, which as a primary lesion causes a hard chancre.(B) Incorrect. Gonorrhea is more of a cause for vaginitis in children.(C) Incorrect. Chlamydia trachomatis is a sexually transmitted disease that is unlikely to produce a marked vaginal exudate.(D) Incorrect. HSV infection leads to the recurrent appearance of crops of painful vesicles, typically on the external genitalia.(E) Incorrect. Gram negative enteric bacterial infections are not common at this site.(F) Bacterial vaginosis is caused by overgrowth of a variety of bacteria (Gardnerella vaginalis, Prevotella, Mobiluncus, Peptostreptococcus, Mycoplasma hominis, etc.) in the vagina. It differs from fungal vulvovaginitis in that (1) there is usually a rather unpleasant and quite noticeable 'fishy' odor; (2) the vaginal discharge is homogenous, lower in viscosity, and uniformly coats the vaginal walls; and (3) the vaginal pH is usually >4.5.(G) Incorrect. Trichomonas vulvovaginitis is caused by the protozoan Trhicomonas vaginalis. It differs from fungal vulvovaginitis in that there is a profuse, homogenous vaginal discharge that usually has a yellow or greenish-yellow color. Vaginal pH is usually > 5.0, and the 'fishy' odor may or may not be present. Trichomonas vulvovaginitis is diagnosed by observation of motile trichomonads and large numbers of PMNs in a vaginal smear.(I) Incorrect. HPV is a cause for condyloma and for squamous dysplasias and carcinomas, not vaginosis.
------------------------------------------------
Question 74
A 35-year-old woman has had dull pelvic pain for 4 months. A pelvic examination reveals a normal appearing cervix, a normal sized uterus, and a large tender right adnexal mass. Ultrasound reveals an 8 cm cystic, fluid-filled mass involving the right adnexal region. At laparotomy, there are many filmy fibrous adhesions in the pelvis. The mass is excised and on gross examination is found to have a thin wall and is filled with purulent exudate. Microscopically, there are thin remnants of fallopian tube and ovary comprising the wall of the mass, with numerous neutrophils filling the lumen. Which of the following infectious agents is most likely to have produced these findings?
A Human papillomavirus
B Mycobacterium tuberculosis
C Trichomonas vaginalis
D Candida albicans
E Neisseria gonorrheae
----------------------------------------------
(E) CORRECT. She has findings of pelvic inflammatory disease complicated by a tubo-ovarian abscess. These are potential complications of sexually transmitted diseases caused by gonorrhea or chlamydia most often.(A) Incorrect. HPV is a sexually transmitted disease that affects the external genitalia and cervix.(B) Incorrect. Tuberculosis is a rare infection of the female genital tract that can produce a chronic endometritis or a chronic salpingitis.(C) Incorrect. Trichomonal infections are not very severe. They typically involve the vagina.(D) Incorrect. Yeast infections are a nuisance, but not severe, and involve the vagina.
-----------------------------------------------
Question 75
Abnormal uterine bleeding for the past 5 months prompts a 62-year-old woman to see her physician. She has never been pregnant and went through menopause 10 years previously. On physical examination her BMI is 33. There are no abnormal findings on physical examination. An endometrial biopsy is performed and on microscopic examination shows a well-differentiated endometrial adenocarcinoma. Which of the following ovarian neoplasms is she most likely to have?
A Papillary serous cystadenocarcinoma
B Krukenberg tumor
C Mucinous cystadenoma
D Granulosa cell tumor
E Immature teratoma
--------------------------------------------------
(D) CORRECT. She could have an ovarian tumor producing estrogen, and the granulosa cell tumor is most likely to do that, of the ones listed.(A) Incorrect. Cystadenocarcinomas are epithelial tumors unlikely to secrete estrogen.(B) Incorrect. A Krukenberg tumor represents metastatic disease of the ovary, most often from a gastrointestinal malignancy (such as primary gastric adenocarcinoma).(C) Incorrect. Cystadenomas, which are of epithelial origin, are not likely to secrete estrogen.(E) Incorrect. Immature teratomas contain primitive elements with neural differentiation and are unlikely to secrete estrogens.
-------------------------------------------------------
25-year-old woman is G2 P1. Her first pregnancy resulted in a normal term birth. Now at 15 weeks gestation, a prenatal checkup reveals that she has a blood pressure of 140/90 mm Hg. An ultrasound is performed that reveals no fetal cardiac motion. Misoprostol induction is performed for termination of the pregnancy. Examination of the malformed stillborn fetus reveals that it is small for gestational age and has 3,4 syndactyly bilaterally, an indented nasal bridge, and a two vessel cord. The placenta is small for gestation and has scattered 0.5 cm grape-like villi. A chromosome analysis performed on the placental tissue will most likely demonstrate which of the following karyotypes?
A 46, XX
B 69, XXY
C 45, X
D 47, XX, +18
E 23, X
F 47, XYY
G 47, XXX
--------------------------------------
(B) CORRECT. In a partial mole, a fetus is present but malformed and small for gestational age. Only occasional villi, or none at all, may be grape-like, but there is trophoblastic proliferation typical of molar pregnancy.(A) Incorrect. The 46, XX karyotype would be appropriate for a normal female fetus. It could also be seen with a complete mole in which no fetus would be present.(C) Incorrect. The 45, X karyotype is seen with Turner syndrome, one of the more common chromosomal abnormalities seen with fetal losses. It is not accompanied by placental changes of molar pregnancy.(D) Incorrect. Trisomy 18 leads to an abnormal appearing fetus with clenched hands (not syndactyly), and the placenta may be small, but does not show changes of molar pregnancy.(E) Incorrect. The 23, X karyotype is that of an unfertilized ovum or a sperm.(F) Incorrect. This karyotype is indicative of Klinfelter syndrome, seen in nearly normal appearing males with oligospermia.(G) Incorrect. This is the 'superfemale' karyotype with only mild mental retardation.
------------------------------------------
Question 72
A 16-year-old girl has not begun menstruation. Physical examination reveals that she has breast development, but a short vagina and no palpable uterus or adnexa, only bilateral inguinal masses. She appears otherwise normally developed. Which of the following laboratory tests would be most appropriate to order on this girl?
A Chromosome analysis
B Serum estrogen
C Assay for luteinizing hormone
D Serum cortisol
E Serum testosterone
F Magnetic resonance imaging of brain
---------------------------------------------------
(A) CORRECT. The findings point to testicular feminization (androgen insensitivity syndrome), with a karyotype of 46, XY. The inguinal masses are the testes.(B) Incorrect. This would be more useful for workup of secondary amenorrhea.(C) Incorrect. This would be more useful for workup of secondary amenorrhea.(D) Incorrect. A serum cortisol would be useful for workup of congenital adrenal hyperplasia.(E) Incorrect. This is more useful for workup of male infertility or developmental problems.(F) Incorrect. It is unlikely that her problems can be explained by a neoplasm of the brain, including the pituitary.
-----------------------------------------------
Question 73
A 38-year-old healthy woman has had a white, curd-like vaginal discharge for the past week. There is no bleeding. A Pap smear demonstrates normal appearing squamous epithelial cells along with scattered neutrophils and budding cells with pseudohyphae. Which of the following infectious agents is most likely to be present in this woman?
A Treponema pallidum
B Neisseria gonorrhea
C Chlamydia trachomatis
D Herpes simplex virus
E Escherichia coli
F Gardnerella vaginalis
G Trichomonas vaginalis
H Candida albicans
I Human papillomavirus
--------------------------------------------------
(H) CORRECT. Vaginal yeast infections are quite common. Fungal vulvovaginitis is the second most common cause of vaginal infections in the U.S. (Bacterial vaginosis is the most frequent cause).(A) Incorrect. This is the causative agent for syphilis, which as a primary lesion causes a hard chancre.(B) Incorrect. Gonorrhea is more of a cause for vaginitis in children.(C) Incorrect. Chlamydia trachomatis is a sexually transmitted disease that is unlikely to produce a marked vaginal exudate.(D) Incorrect. HSV infection leads to the recurrent appearance of crops of painful vesicles, typically on the external genitalia.(E) Incorrect. Gram negative enteric bacterial infections are not common at this site.(F) Bacterial vaginosis is caused by overgrowth of a variety of bacteria (Gardnerella vaginalis, Prevotella, Mobiluncus, Peptostreptococcus, Mycoplasma hominis, etc.) in the vagina. It differs from fungal vulvovaginitis in that (1) there is usually a rather unpleasant and quite noticeable 'fishy' odor; (2) the vaginal discharge is homogenous, lower in viscosity, and uniformly coats the vaginal walls; and (3) the vaginal pH is usually >4.5.(G) Incorrect. Trichomonas vulvovaginitis is caused by the protozoan Trhicomonas vaginalis. It differs from fungal vulvovaginitis in that there is a profuse, homogenous vaginal discharge that usually has a yellow or greenish-yellow color. Vaginal pH is usually > 5.0, and the 'fishy' odor may or may not be present. Trichomonas vulvovaginitis is diagnosed by observation of motile trichomonads and large numbers of PMNs in a vaginal smear.(I) Incorrect. HPV is a cause for condyloma and for squamous dysplasias and carcinomas, not vaginosis.
------------------------------------------------
Question 74
A 35-year-old woman has had dull pelvic pain for 4 months. A pelvic examination reveals a normal appearing cervix, a normal sized uterus, and a large tender right adnexal mass. Ultrasound reveals an 8 cm cystic, fluid-filled mass involving the right adnexal region. At laparotomy, there are many filmy fibrous adhesions in the pelvis. The mass is excised and on gross examination is found to have a thin wall and is filled with purulent exudate. Microscopically, there are thin remnants of fallopian tube and ovary comprising the wall of the mass, with numerous neutrophils filling the lumen. Which of the following infectious agents is most likely to have produced these findings?
A Human papillomavirus
B Mycobacterium tuberculosis
C Trichomonas vaginalis
D Candida albicans
E Neisseria gonorrheae
----------------------------------------------
(E) CORRECT. She has findings of pelvic inflammatory disease complicated by a tubo-ovarian abscess. These are potential complications of sexually transmitted diseases caused by gonorrhea or chlamydia most often.(A) Incorrect. HPV is a sexually transmitted disease that affects the external genitalia and cervix.(B) Incorrect. Tuberculosis is a rare infection of the female genital tract that can produce a chronic endometritis or a chronic salpingitis.(C) Incorrect. Trichomonal infections are not very severe. They typically involve the vagina.(D) Incorrect. Yeast infections are a nuisance, but not severe, and involve the vagina.
-----------------------------------------------
Question 75
Abnormal uterine bleeding for the past 5 months prompts a 62-year-old woman to see her physician. She has never been pregnant and went through menopause 10 years previously. On physical examination her BMI is 33. There are no abnormal findings on physical examination. An endometrial biopsy is performed and on microscopic examination shows a well-differentiated endometrial adenocarcinoma. Which of the following ovarian neoplasms is she most likely to have?
A Papillary serous cystadenocarcinoma
B Krukenberg tumor
C Mucinous cystadenoma
D Granulosa cell tumor
E Immature teratoma
--------------------------------------------------
(D) CORRECT. She could have an ovarian tumor producing estrogen, and the granulosa cell tumor is most likely to do that, of the ones listed.(A) Incorrect. Cystadenocarcinomas are epithelial tumors unlikely to secrete estrogen.(B) Incorrect. A Krukenberg tumor represents metastatic disease of the ovary, most often from a gastrointestinal malignancy (such as primary gastric adenocarcinoma).(C) Incorrect. Cystadenomas, which are of epithelial origin, are not likely to secrete estrogen.(E) Incorrect. Immature teratomas contain primitive elements with neural differentiation and are unlikely to secrete estrogens.
-------------------------------------------------------
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