2. Primary amenorrhea is when girls fail to menstruate by 16 years of age.
3. Secondary amenorrhea is absence of menstruation for more than 6 months in a normal female of reproductive age that is not due to pregnancy, lactation or menopause.
4. Oligomenorrhea is defined as irregular periods at intervals of more than 35 days with only 4-9 periods a year.
5. Menorrhagia is defined as a blood loss of greater than 80ml per day.
6. Dysmenorrhea is defined as painful menstruation.
7. Most common pituitary cause of amenorrhea = prolactinoma (pituitary adenoma).
8. Most common cause of secondary dysmenorrhea = endometriosis
9. Most common cause of anovulatory subfertility = polycystic ovary syndrome.
10. Rotterdam criteria is used for diagnosis of PCOS = Consist of irregular or absent ovulations, signs of hyperandrogenism (acne, hirsutism, alopecia), polycystic ovaries on pelvic US.
11. Postmenopausal bleeding is defined as vaginal bleeding after menopause.
12. Most common cause of postmenopausal bleeding = atrophic vaginitis.
13. Premenstrual syndrome is defined as occurance of cyclic somatic, psychological & emotional symptoms during the luteal phase of menstrual cycle & regress after the cessation of menstruation.
14. Most common cause of premenstrual syndrome = idiopathic.
15. Most prominent symptoms of premenstrual syndrome = irritability, tension, dysphoria.
16. COCPs contain a combination of synthetic estrogen (ethinylestradiol) & progesterone.
17. Mechanism of action of COCPs = inhibition of ovulation via negative feedback inhibition of FSH & LH, make endometrium atrophic & prevent implantation, make cervical mucus thick & prevent sperm penetration.
18. COCPs should be taken daily for 21 days followed by 7 pill-free days.
19. Progesterone only preparations contain only progesterone & are extremely safe for the women who has cardiovascular risk factors.
20. Mechanism of action of progesterone only preparations = make endometrium atrophic & prevent implantation, make cervical mucus thick & prevent sperm penetration.
21. Types of progesterone only preparations = progesterone only pills, injectable progestrogens (Depo-Provera : IM injection of depot medroxyprogesterone acetate), subdermal implants (Implanon : etonorgestrel, inserted subdermally in upper arm), hormone releasing intrauterine system.
22. Intrauterine contraception is ideal for women who want a long term contraception independent of intercourse & where regular compliance is not required.
23. Two types of intrauterine contraception = Copper bearing IUDs & Hormone releasing IUDs (Levonorgestrel releasing intrauterine system, also called Mirena IUS).
24. Barrier methods for contraception = male condoms, vaginal diaphragm.
25. Emergency contraception is used after intercourse has taken place & before implantation has occured, it is also known as morning after pills & postcoital contraception. It has two types : hormonal emergency contraception (single oral dose of 1.5 mg levonorgestrel, taken within 72h of unprotected intercourse) & copper bearing IUCDs (should be inserted within 120h of unprotected intercourse)
26. Sterilization is the permanent method of contraception, ideal for older couples who are sure that they have completed their families. It has 2 types : male sterilization (vasectomy) & female sterilization (tubal ligation).
27. Induced abortion is defined as deliberate termination of pregnancy in a manner that assures the embryo or fetus will not survive, it is also called termination of pregnancy.
28. Suction & curettage (D&C) is the method of choice in first trimester abortion.
29. Dilatation & evacuation (D&E) is the method of choice in second trimester abortion.
30. Female sterilization can be performed 6-8weeks after an abortion.
31. Subfertility is defined as failure to concieve within 1 year of unprotected regular sexual intercourse.
32. Fecundability is the likelihood of conceiving within one menstrual cycle.
33. Most important factor that reduces the chance of spontaneous conception = female age >35 years.
34. Clomiphine citrate is an anti estrogenic agent used for ovulation induction.
35. Pulsatile GnRH can be given as injection for clomiphine resistant cases.
36. Gold standard investigation for assessment of tubal patency = laparoscopy & dye test.
37. Serum FSH is elevated in testicular failure.
38. Medications which can cause male subfertility = Alcohol, anabolic steroids (anti-spermatogenics), cimetidine, spironolactone (anti-androgenics), alpha & beta blockers, antidepressents (cause ejaculatory dysfunction).
39. In Vitro fertilization involves extraction of oocytes, fertilization in laboratory & transcervical transfer of embryo into uterus.
40. Most common complication of IVF = ovarian hyperstimulation syndrome.
41. Intrauterine insemination is most successful if it is combined with ovarian stimulation to produce upto 3 mature follicles.
42. Preimplantation genetic diagnosis is a technique used to identify genetic defects in embryos created through IVF before pregnancy.
43. Abortion refers to expulsion of products of conception before 24th week of gestation.
44. Early pregnancy miscarriage (first trimester miscarriage) refers to miscarriage before 12th week of gestation.
45. Most common cause of early pregnancy miscarriage = Trisomies.
46. Late pregnancy miscarriage (2nd trimester miscarriage) refers to miscarriage occurs between 12-24 weeks of gestation.
47. Early pregnancy miscarriage is more common than late pregnancy miscarriage (usually occurs during 1st months after LMP).
48. Threatened abortion refers to painless vaginal bleeding, cervical os is closed & normal US findings.
49. Inevitable Abortion is irreversible condition, characterized by heavy profuse vaginal bleeding, uterine cramping, cervical os is open ( progressive dilatation : pathognomic sign), no products of conception has been passed.
50. Incomplete abortion refers to heavy, profuse vaginal bleeding, severe uterine cramping, leading to cervical dilatation (os open), with passage of some but not all products of conception.
51. Complete abortion refers to vaginal bleeding, uterine cramping leading to cervical dilatation with passage of All the products of conception. Transvaginal US shows empty uterus.
52. Missed abortion refers to a gestational sac containing a dead embryo/fetus before 20 weeks gestation without clinical symptoms of expulsion, characterized by brownish vaginal discharge, no bleeding cramping or cervical dilatation, US shows intrauterine gestational sac with no embryo or with 6mm embryo but no heart activity.
53. Ectopic pregnancy defined as implantation of a conceptus outside the uterine cavity, characterized by classical triad of amenorrhea, vaginal bleeding, abdominal pain & classical sign of adnexal or cervical motion tenderness.
54. Most common site of Ectopic pregnancy = Ampulla of tubes.
55. Gold standard investigation for ectopic pregnancy = laparoscopy
56. Clinical features of ruptured ectopic pregnancy = unilateral severe abdominal pain, internal bleeding, hypovolemia, abdominal guarding, rigidity, shoulder tip pain & collapse.
57. Most common cause of ectopic pregnancy = PID.
58. Arias-stella reaction seen in ectopic pregnancy (endometrium undergoes focal decidua changes).
59. Hydatidiform mole is characterized by cystic swelling of chorionic villi accompanied by trophoblastic proliferation.
60. Two types of hydatidiform mole = Complete mole (androgenetic mole, diploid, karyotype 46 XX, diffuse & circumferential trophoblastic proliferation, no fetal parts are present, beta HCG markedly elevated) & Partial mole (triploid mole, karyotype 69 XXY, focal or slight trophoblastic proliferation, fetal parts may be present, beta HCG is slightly elevated).
61. Most common presentation of hydatidiform mole = first trimester vaginal bleeding.
62. Diagnostic mehod of choice for hydatidiform mole = Ultrasound (snow storm appearance).
63. Suction & curettage is the method of choice for the treament of hydatidiform mole.
64. Invasive mole refers to a mole that penetrates & perforate the uterine wall by invasion of myometrium by hydropic chorionic villi, accompanied by trophoblastic proliferation. It is manifested by vaginal bleeding & irregular uterine enlargement, always associated with persistent elevated HCG level, most commonly metastasis to lungs & brain, treated by Che chemotherapy plus hystrectomy.
65. Endometriosis is defined as presence of endometrial surface epithelium or endometrial glands & stroma outside the confines of uterus. It is estrogen-dependent, characterized by infertility, secondary dysmenorrhea, deep dyspareunia, dysuria & dyschezia. Most common site (ovaries), gold standard investigation (laparoscopy), definitive treatment (hystrectomy, bilateral salpingo-oophorectomy).
66. Most popular theory for endometriosis = Sampson's theory (retrograde menstruation & implantation).
67. endometriosis in ovary often associated with Endometriomas (chocolate cysts), appear as Powder burn lesions on laparoscopy.
68. Adenomyosis is defined as the presence of endometrial glands deep within myometrium, common in multiparous women, present with diffuse involvement of myometrium (if the focal involvement, called adenomyoma), most common symptoms (severe secondary dysmenorrhea, menorrhagia, dyspareunia), investigation of choice (MRI), Definitive treatment (hystrectomy).
69. Endometrial polyps are focal overgrowth of endometrium contain variable amount of glands, stroma & blood vessels. It presents with menorrhagia, IMB, PCB, lower abdominal pain, treatment by hysteroscopic resection or polypectomy.
70. Uterine fibroid is a benign uterine smooth muscle tumor also called uterine leiomyoma. It is estrogen dependent, most comon in nulliparous women, 5 types (submucosal, intramural, subserous, cervical, pedunculated), it presents with menstrual disturbance, pressure symptoms, menorrhagia, subfertility, definitive diagnosis is achieved by Biopsy, can be treated by myomectomy, uterine artery embolization & hystrectomy.
71. Asherman's syndrome is defined as presence of adhesions & fibrosis within the uterine cavity due to scars, also called uterine synechiae or intrauterine adhesions. Most common cause (over vigorous uterine curettage), treatment by insertion of IUCDs (lippes loop) or hysteroscopic lysis of intrauterine adhesions.
72. Urgency means a sudden desire to void.
73. Urge incontinence is an involuntary loss of urine associated with a strong desire to void.
74. Overflow incontinence occurs without any detrusor activity when bladder is over-distended.
75. Frequency is defined as the passing of urine more than 7 times a day.
76. Urodynamic stress incontinence refers to involuntary loss of urine during increase abdominal pressure in the absence of a detrusor contraction, also called genuine stress incontinence.
77. Most common cause of stress incontinence = due to childbirth.
78. Pelvic floor excercies are the mainstay of conservative treatment for stress incontinence.
79. Most effective surgical treatment for stress incontinence = colposuspension.
80. Detrusor over activity is also called unstable bladder or detrusor instability, most common cause (idiopathic), most common symptom (urgency), diagnosis by urodynamic studies, treatment by bladder retaining & anticholinergic medications.
81. Retention with overflow refers to incontinence when intravesical pressure from overdistended bladder exceeds uretheral pressure, also called hypotonic incontinence. Symptoms are (stress incontinence, poor stream, incomplete bladder emptying, straining to void), neurological examination shows decrease pudendal nerve sensation, treatment by cholinergic & alpha adrenergic blocker.
82. Vesio-vaginal fistula is defined as an abnormal opening b/w urinary tract & vagina, diagnosis by intravenous urography (carmine dye), treatment by surgical repair of fistula.
83. Cystometry is the most fundamental investigation of bladder function.
84. Uroflowmetry is non-invasive procedure for the measurement of urine flow rate. Normal flow curve is bell-shaped (abnormal when flow rate <15ml/s).
85. Cystourethroscopy establish the presence of disease in urethra or bladder.
86. Ultrasound is used to check for congenital abnormalities, calculi & tumors.
87. Videocystourethrography is used to diagnose trabeculation, bladder diverticulum, vesico-ureteric reflux.
88. MRI is used for characterization of renal & pelvic masses & tumor staging.
89. Uterovaginal prolapse is defined as protrusion of uterus beyond its normal confines, more common in multiparous. It has 3 types : anterior vaginal prolapse (urethrocele, cystocele, cystourethrocele), posterior vaginal wall prolapse (rectocele, enterocele), apical vaginal prolapse (uterovaginal, vault).
90. Most common cause of uterovaginal prolapse = vaginal delivery (increase with parity).
91. Grading of uterovaginal prolapse into : 1st degree (descent within vagina), 2nd degree (descent to introitus), 3rd degree (descent outside the introitus).
92. Most common symptom of uterovaginal prolapse = feeling of a lumo coming down.
93. Conservative treatment of uterovaginal prolapse = pessaries (ring pessary, shelf pessary, hodge pessary, doughnut pessary)
94. Surgical management of uterovaginal prolapse = Anterior colporrhaphy (most suitable for cystourethrocele), posterior colporrhaphy (most suitable for rectocele), vaginal hystrectomy combined with support of vault to uterosacral ligaments (for uterovaginal prolapse), manchester "fothergill" repair (for those women who want to preserve her uterus, may be combined with anterior & posterior colporrhaphy), sacrohysteropexy (for women who wants to preserve her uterus, it involves attachment of synthetic mesh from uterocervical junction anterior longitudinal ligament of sacrum & closure of pouch of douglas), sacrocolpoplexy (for vault prolapse, abdominal procedure) & sacrospinous ligament fixation (vaginal procedure).
95. Menopause refers to cessation of menstrual cycle & is said to have occured after 6 months of secondary amenorrhea in a women aged 45 years or over (average age of 51 years), caused by ovarian failure leading go estrogen deficiency.
96. Early menopause = before 45 years of age. Common Causes (premature ovarian failure, resistant ovary syndrome).
97. First endocrine change in menopause is a fall in inhibin production by ovary.
98. Symptoms of menopause = vasomotor symptoms (hot flushes, night sweats are classical symptoms), sexual dysfunction, psychological symptoms, cardiovascular disease (MI & stroke), urogenital atrophy, osteoporosis.
99. Only indication for HRT in menopause = vasomotor symptoms.
100. HRT should be used in lower dosage & for shortest duration, optimally the use of HRT should not exceed 4 years.
101. Selective estrogen receptor modulators (SERMs) have protective estrogenic actions on skeleton while avoiding two side effects of HRT (vaginal bleeding & risk of breast cancer).
102. Raloxifene is the first SERM licensed for the prevention & treatment of osteoporosis (bone agonist effect but endometrial & breast antagonist effects).
103. Tamoxifen has endometrial & bone agonist effects.
104. Pelvic inflammatory disease is the complication of STDs in female reproductive organs. (Ascending infection)
105. Most common cause of PID = Chlamydia & N. gonorrhea.
106. Most common feature of PID = Bilateral lower abdominal pain, cervical excitation, adnexal tenderness, vaginal discharge.
107. PID usually diagnosed clinically (Gold standard investigation : laparoscopy)
108. Treatment of PID = Macrolide or tetracyclin + metronidazole with parenteral ceftriaxone or cefoxitin (for 2 weeks).
109. Complications of Tubo-ovarian abscess, fitz-hugh curtis syndrome, recurrent PID, chronic pelvic pain, ectopic pregnancy, infertility, subfertility.
110. Vaginal candidiasis = Organism : candida albicans, white, curdy vaginal discharge with itching, diagnosis by microscopy & culture, treatment by topical imidazole or fluconazole (contraindicated in pregnancy).
111. Bacterial vaginosis = Organism : Gardnerella vaginalis, commonest cause of abnormal vaginal discharge, offensive fishy off white vaginal discharge (whiff test), diagnosis by "clue cells" on microscopy (Amsel criteria), treatment by metronidazole or clindamycin, complications (pelvic infection, 2nd trimester miscarriage, preterm rupture of membranes, preterm delivery, HIV).
112. Chlamydia trachomatis = most common cause of STDs, cervicitis with mucopurulent vaginal discharge, diagnostic test (NAAT), treatment by doxycycline (contraindicated in pregnancy) or Azithromycin.
113. Gonorrhea = STD, caused by Neisseria gonorrhea (gram negative diplococci), cervicitis with or without mucopurulent vulvo vaginal discharge, diagnostic test (NAAT), Treatment by parenteral third generation cephalosporin + Azithromycin.
114. Trichomoniasis = organism : Trichomonas vaginalis, cause punctate hemorrhages on cervix (strawberry appearance), offensive frothy greenish vaginal discharge, itching. Diagnosis by microscopy & culture (gold standard), treatment by metronidazole.
115. Genital herpes = organism : HSV-II, superficial tender multiple ulcers with regional lymphadenopathy, diagnosis by viral culture of vesicle fluid (gold standard), PCR is the investigation of choice, treament by acyclovir or valaciclovir.
116. Syphilis = STDs caused by Trepenoma pallidum, primary syphilis (chancre), secondary syphilis (condyloma lata : "money spots" & snail tracks ulcers on mucosa), tertiary syphilis (gummata), diagnosis by dark fiked microscopy, treatment by penicillin (drug of choice).
117. Human papillomavirus = subtypes 6 & 11 cause genital warts (condylomata acuminate), subtypes 16 & 18 cause flat warts & associated with CIN & cervical neoplasia, diagnosis clinically or biopsy (cauliflower like mass), treatment by topical application of podophyllin (first line treatment). podophyllotoxin is contraindicated in pregnancy
118. Gregg's triad is found in fetal infection due to rubella = triad of cardiovascular defects, eye defects, sensorineural deafness.
119. Most common sequelae of congenital rubella syndrome (congenital deafness).
120. Zigzag skin lesions are found in fetus with varicella (chickenpox), diagnosis of varicella in pregnancy comfirmed by electron microscopy or culture.
121. Molluscum contagiosum = pearly, painless lesion caused by poxvirus.
122. lymphogranuloma venerum = groove sign (caused by L1-L3 serotypes of chlamydia trachomatis)
123. chancroid = painful ulcer with ragged edges caused by haemophilus ducreyi
124. Granuloma inguinale = beefy red vascular ulcer, caused by klebsiella granulomatis.
Difference between Adenomyosis & Fibroid
Adenomyosis =
symmetrical enlargement of uterus
Soft & tender uterus.
Fibroid =
Asymmetrical enlargement of uterus,
Firm & non tender uterus.
