Principles 2

Question 1

Menorrhagia: is blood loss of >_____ mL or >_____ days per period

Answer 1

80; 8

Question 2

Etiology of menorrhagia
Uterine ________ (particularly submucous)
__________
Endometrial ________
Coagulation disorders e.g.___________
_________________ disease
Endometrial or cervical _________
________ disease
Intrauterine _____________

Answer 2

fibroid ; Adenomyosis

polyps; von willebrand disease

Pelvic inflammatory; carcinoma

Thyroid; contraceptive device

Question 3

In menorrhagia ,

If no pathology can be identified despite appropriate investigation; then diagnosis is __________________ formerly dysfunctional uterine bleeding (DUB)

Likely cause: disordered endometrial ____________________ and abnormalities of endometrial ___________ development

Answer 3

bleeding of endometrial origin (BEO)

prostaglandin production

vascular

Question 4

__________ is the commonest cause of chronic anovulation

Answer 4

PCOS

Question 5

The persistent anovulation in PCOS can lead to: _____________ ovaries, _______________, or ________________ etc.

Answer 5

enlarged polycystic

secondary amenorrhea

oligomenorrhea, infertility

Question 6

PCOS is associated with ___________ serum luteinizing hormone level, ________ resistance and increased risk of _____________________ , as well as cardiovascular events

Answer 6

elevated; insulin

type 2 diabetes mellitus

Question 7

Clinical features of PCOS

___________ or __________
____________
________/__________
_________ of voice
Obesity
Recurrent _________
Acanthosis nigricans
- Asymptomatic

Answer 7

Oligomenorrhea or amenorrhea

Hirsutism; Subfertility / infertility

Deepening; miscarriage

Question 8

Rotterdam criteria for diagnosis of PCOS (______ out of the 3 below)

________ or _____________
Clinical and/ or biochemical signs of _____________
_________________ on ultrasound and exclusion of other etiologies

Answer 8

2

Oligo- or anovulation

hyperandrogenism

Polycystic ovaries

Question 9

Uterine fibroid: is a _________ of uterine ________________

Answer 9

benign tumor

smooth muscle

Question 10

The most common tumor in women, especially blacks is??

Answer 10

Fibroid

Question 11

Uterine Fibroid is _______-dependent; thus, ___________________________

Answer 11

estrogen

grows only in reproductive years

Question 12

• Risk factors of uterine fibroid

-________ race
-_______ parity/nulliparity
- ___________
-___________ state
-_________ use

Answer 12

Black

Low; obesity

Hyperestrogenic; COCP

Question 13

Classification of uterine fibroid
_________ - 75%
___________ - 15%
___________ - 5%
- Intraligamentary
Pedunculated
parasitic
Polypoidal
Cervical

Answer 13

Intramural

Subserous; Submucosal

Question 14

Degenerative changes in fibroid : ________ degeneration, ______ degeneration, ________ degeneration,
calcification, atrophic changes, sarcomatous changes (rare) etc.

Answer 14

hyaline; red; cystic

Question 15

Degenerative changes in fibroid

• Hyaline degeneration: occurs when the fibroid gradually ________________________ , causing development of _________ usually at the center

Answer 15

outgrows its blood supply

necrosis

Question 16

most common Degenerative change in a fibroid is??

Answer 16

Hyaline

Question 17

Degenerative changes in fibroid

Cystic degeneration: is the appearance of _____________________ within the fibroid, due to ___________ of the areas of hyaline changes

Answer 17

central cystic spaces
liquefaction

Question 18

Degenerative changes in fibroid

Red degeneration: classically occur in __________ trimester, due to _________________________ to the fibroid, causing ischemia.

Manifests as _________ , tenderness
over the fibroid, mild pyrexia, leukocytosis and frequent vomiting

Answer 18

mid second

acute disruption of blood supply

acute pain

Question 19

Clinical features of fibroid

-____________ (about 75% of cases)
- Abdominal _________ (most common)
- Abdominal ______ (may be due to red degeneration, infection, torsion etc.)
-__________________ (menorrhagia, metrorrhagia)
- Others: ________,__________,__________ symptoms

Answer 19

Asymptomatic; swelling

pain; Abnormal uterine bleeding

dysmenorrhea ; dyspareunia

pressure

Question 20

Ways by which uterine fibroid may cause infertility

-__________________________________ (by cervical or cornual fibroid)
-Due to increased _____________, sperms have to travel a longer distance
-The associated _________ may reduce coital frequency per cycle

Answer 20

Blockage of sperm movement

surface area

menorrhagia

Question 21

Effects of fibroid on pregnancy
Pregnancy ______
________ and —————— lie
_______ for date uterus
Difficulty in palpating fetal part
__________ and __________
- Poor uterine contractility leading to _____________
-____________ labor from cervical fibroid
-_______________ due to poor uterine contractility
- Slow _________ of the uterus

Answer 21

wastage

Malpresentation ; abnormal

Large; Placenta previa ; abruptio placenta

prolonged labor; Obstructed

Post-partum hemorrhage

involution

Question 22

Effect of pregnancy on fibroid
- Changes in the ______ of fibroid
Become more _____
Degenerative changes especially ______ degeration
_________ of the pedunculated type in puerperium
- Fibroid may become _______ in puerperium

Answer 22

size; soft; red

Torsion; infected

Question 23

MVA: is a safe and effective method of ____________ with the use of a _________ plastic _________

Answer 23

uterine evacuation

hand- held

aspirator

Question 24

Indications MVA

_________ abortion (< ____ weeks)
_________ abortion (< ____ weeks)
Endometrial _________
____________________ (BEO)

Answer 24

Incomplete abortion (< 12 weeks)
Missed abortion (< 12 weeks)
Endometrial biopsy
Bleeding of endometrial origin (BEO)