IOCs for various conditions

• fibroid - USG
• tubal payency- HSG
• Mullerian anomalies - MRI
• Endometriosis - Laproscopy
• post coital bleeding - PAPS
• post menopausal bleeding - endometrial biopsy
• pid - USG
• adenexal mass - USG
• amenorrhoea - hormonal asessment
• molar - USG
• Ectopic - TVS
• ovulation - follicular monitoring
• hirsutism with menstrual irregularity- -serum testosterone
• AUB USG
• Adenomyosis - MRI
• ovarian reserve - FSH
• VVF - Cystoscopy

Ovarian masses

Ovarian cysts:

Follicular cyst -
Associated with hyperestrogenism, endometrial hyperplasia.

Theca-lutein cyst -
Due to gonadotropin stimulation.
Associated with choriocarcinoma and hydatidiform moles.

Ovarian neoplasms

Risk increase with -
. advanced age,
. infertility,
. endometriosis,
. PCOS,
. genetic predisposition (BRCA-1 or BRCA-2 mutation, Lynch syndrome, strong family history).

Risk decreses with -
. previous pregnancy,
. history of breastfeeding,
. OCPs,
. tubal ligation.

Benign ovarian neoplasms

1) Serous cystadenoma
. Lined with fallopian tube–like epithelium.

2) Mucinous cystadenoma
. Lined by mucus-secreting epithelium .

3) Endometrioma

Endometriosis (ectopic endometrial tissue) within ovary with cyst formation.
“Chocolate cyst”— endometrioma filled with dark, reddish-brown blood.

4) Mature cystic teratoma (dermoid cyst)

Germ cell tumor.
A monodermal form with thyroid tissue(struma ovarii) uncommonly presents with hyperthyroidism .

5) Brenner tumor

Looks like Bladder ( both contains B )
“Coffee bean” nuclei on H&E stain.

6) Fibromas

Bundles of spindle-shaped fibroblasts.
Meigs syndrome—triad of ovarian fibroma, ascites, hydrothorax.

7) Thecoma

Like granulosa cell tumors, may produce estrogen.
Usually presents as abnormal uterine bleeding in a postmenopausal woman.

Malignant ovarian neoplasms

1) Granulosa cell tumor :

- Most common malignant stromal tumor.
- Often produces estrogen and/or progesterone and presents with postmenopausal bleeding,
- sexual precocity (in pre-adolescents),
- breast tenderness.

- Histology shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles).

2) Serous cystadenocarcinoma
Most common malignant ovarian neoplasm,
Psammoma bodies.

3) Mucinous cystadenocarcinoma
Pseudomyxoma peritonei–intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

4) Immature teratoma
Aggressive, contains fetal tissue, neuroectoderm.

5) Dysgerminoma

Equivalent to male seminoma .
Sheets of uniform “fried egg” cells .
hCG, LDH = tumor markers.

6) Yolk sac (endodermal sinus) tumor

Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children.
Schiller-Duval bodies (resemble glomeruli) .
AFP = tumor marker.

7) Krukenberg tumor

GI malignancy that metastasizes to ovaries > mucin-secreting signet cell adenocarcinoma.

Most commons from OBG

Most common site for genital tb-BILATERAL ALWAYS FT-ampulla(2md mc-endometrium-direct spread(mcq)
Mc route for spread of genital tb-haematogenous>direct (least-ascending)
Lest common for genital tb-vulva vagina
Mc mentsrual irregularity in genital tb-oligo/amenn. (1st irregularity-MENORHAGIA)
Finding in patient of genital tb----
1)mc-NORMAL PELVIC EXAM.  
2)least common-presence of adnexal mass
Mc finding of gen tb in ADOLSCENT GIRL-bilateral adnexal mass
Mc reason for abnormal post-coital test-improper timing(DNB)
Mc method for increasing sperm conc in IUI(t/t of immunological infertility) - sperm swim up technique
Mc site of endometriosis-ovary
Mc theory explaining endometriosis-retrograde mc(sampsons theory)
2nd most accepted-coelomic theory
Endometrios mc gene assosiated(genetic theory) - K-ras
Mc symptom of endometriosis-pain>infertility
Mc mullerian anomaly -bicornuate uterus
Mc mullerian anomaly assosiated with 1)abortion-septate.  
2)infertility-unicornuate
3)highest obs complication-unicornuate
4)ectopic ovary-unicornuate
5)urinary tract anomalies-unicornuate

 Mc cancer women in india-cervical
Mc histology cx carcinoma 
sqammous cell ca 70%(specific risk factor-smoking)
Adeno ca 30%(ocp use of 5yrs)
Mc hpv ca cervix 16,18
16- more sensitive (squammous cell ca)
18-more specific (adeno)
Ca cervix mc
presenting complaint-irregular bleeding
Specific comp-post coital bleeding
Route of spread-lymphatics
LN mc-obturator (point A brachy)
Sentinel LN -paracervical (point B)
 Mc ovarian cancer-epithelial ovarian ca(serous cystadeno ca -70%)
Risk of ovarian cancer increases every year after 35yrs
Cancers-
epithelial-bilateral,6-7th decade,post menopausal,highest mortality rate among all gynaec ca
Mucinous-4-5 decade
Germ cell-10-20yrs of age,UNILATERAL,
Sex cord-unilateral,any age (mc-perimenopausal),risk assosiated-endomet ca
Mc ovarian tumour-serous cystadenoma
Mc ovarIan In pregnancy
tumour-dermoid
Cancer-dygerminoma
Dysgerminoma-
radiosensitive
Germ cell tumour which can be bilateral 20%
Frequently occurs with gonadoblastoma
Equals to seminoma in males
Best prognosis
Most rapidly growing tumour-endodermal sinus tumour(worst prog)
Highest risk of torsion-dermoid
Mc cause of post mentrual bleeding
WORLDWIDE-senile endometritis
INDIA-cervix ca
Mc cause of pyometra
WORLDWIDE-endometrial ca
INDIA- cervix ca(as its treatment may also cause pyometra)
Mc type of DUB-anovulatory
Mc GTN after molar preg-invasive
Mc surgery done for prolapse-posterior colpoperineoraphy
Mc pelvic tumour-fibroid
Mc fibroid-intramural
Mc symptom of fibroid-mennorhagia
Mc fibroid to cause uterine inversion-fundal fibroid
Mc symptom of fundal fibroid-mennorhagia
Fibroid-
mc degeneration-hyaline
Least common-sarcomatous
Mc indiation for transabdominal hystrectomy(TAH)-fibroid uterus
Highest risk of ectopic in all IUD-progetacert
Emergency contraceptive MOST effective-IUCD
MC EC used-Lng tablet
Least failure-unilateral cautery
Highest failure-bilateral cautery
Least failure among surgical-uchida>erwing>pomeroy

Numbers in OBG

AbdominalTB- present in genital tb patients-45%
Patients of genital TB infertile: 40-80%(mc presenting complaint of genital tb -INFERTILITY >pain)
Incidence of genital tb in patients with infertility-17%
Mullerian anomaly assosiation with urinary tract abnormality-30%
Risk of endometriosis is 7 times more if 1st degree relative is affeced with endometriosis
Patient with history of ovarian ca in 1st degree relatives,so risk of ovarian cancer-7%(dnb 2014)
Recurrence rate ater incision and drainage of endometrial cyst-50%(€€therefore best t/t - cystectomy)
Rate for conversion to frank camcer
cin-1 : 1%
Cin-2 :5%
Cin-3 : >12%(22)
Cin 1 conver to CIS -11%
Cin 1 time to regress to normal-2yrs
Protection rate of hpv vaccine-70%
Risk of involvement of ovaries in ca cx-11%
BSO can reduce the risk of breast ca by 50%
Dermoid always benign but risk of cancer -less than 2%
Risk for lifetime
brca 1-ovarian ca-35-45%
Hnpcc-endometrial ca-75%
Post mentrual bleeding patients developing endometrial ca-10%
any abnormal uterine bleeding above 40yrs endometrial ca should be ruled out therefore endometrial biopsy to be done rather than PAP
Endometrial hyperplasia(pre invasive)
simple withOUT atypia-1% risk for endometrial ca
Complex WITHOUT atypia-3%
Simple with atypia-8%
Complex with atypia-20%
(Without atypia progestrogens to be given for MINIMUM 14 days)
Use of OCP for 5yrs decrease the risk ovavarian ca by 50%
Molar preg
partial-90% triploidy 10% tetra
Complete 80-90% monospermic 46xx,10% 46xy
Complete mole associated with-
pre eclamsia-27%
Hyperemesis-25%
Hyperthyroidism-7%
Trophoblastic embolization-2%
Theca letin cysts -50%
Partial mole to 
gtn-4%
Chorioca-<1%
Complete mole to
gtn-15-20%
Chorioca-4%
Hcg levels becum normal in 
partial-7weeks
Complete-9weeks
40%ovulate after taking POP
NORMAL MC BLOOD LOSS-35ml
Blood loss after cuT-80ml
Post placental IUD insertion within 10mins
Post placental sterlization within 48hrs(ideal),can be done upto 7 days.if not done in first 7 days do after 6 weeks.
Expulsion rate
cuT 5%
IUD-10%
Memory time-5min
Mini lap-3-4cm incision
FT damaged in mod. Pomeroy-3cm
Gas for pnemoperitoneum-2L,pressure-15mmhg(co2)
Rate of ectopic post sterlization-10%
Risk of ectopic
highest-bipolar cautery
Lowest-mod. Pomeroy

Average liquefaction time for semen-20min
Maximum time for liquefaction-60min
Speed of sperm in female tract-3mm/sec
Who parameters
Vol->1.5 ml ,ph >7.2
Sperm concentntration 15 million
Sperm count 39 million
Total motility 40%
Forward motility 32%
Wbc -lessthan 1 million 
Normal morphology 4%
40% ppl taking POP ovulate normally
Safe period of POP-3hrs
Safe period of cerazette is 12hrs

Hcg

10 Question: Regarding HCG true is all except (PGI) Options:
(1 ) A glycoprotein
(2 ) Has 2 subunits
(3 ) Secreted by trophoblast
(4 ) Alpha subunit is specific✅

HCG :
1. HCG is secreted by Trophoblast cells

2. It is a glycoprotein with high Sialic acid concentration

3. Synthesized by syncytiotrophoblast

4. Has two subunits –

a) Alpha sub-unit – similar biologically to LH, FSH, TSH

b) Beta Sub-unit – unique to HCG

5. Similar structurally to FSH

6. Molecular weight of Alpha – 18000;
Beta – 28000

7. Half life of Beta HCG – 24 hrs

8. HCG is primarily Lutinizing and Leutrotrophic and has little FSH cativity

9. Doubling time of HCG – 1.4 – 2 days

10. Detected in Maternal serum as early as 8 days by immunoassay

11. Level is 100 IU/L

12. Maximum levels of 10,0000IU/L at 8 – 10 weeks (70days)

13. Falls till 18th weeks and remains at low level of 10,000 till term.

14. High levels seen in – Hydatidiform mole; Multiple pregnancy; Down’s syndrome

15. HCG disappears from circulation by 2 weeks following delivery

Other actions of HCG :
1. Sustains Corpus leuteum
2. Stimulates Leideg cells of male fetus to produce testosterone and there by induces development of male external genitalia
3. Immuno-suppressive action helps in the maintenance of pregnancy

Cinical condition where Beta- HCG levels are low are :

1. Threatened / Spontaneous abortion
2. Ectopic pregnancy
3. Trisomy 18 (Edward syndrome)

Rest in all it is increased ! List for Increased Beta-HCG :
1. Pregnancy
2. Successful therapeutic insemination
3. Hydatidiform mole
4. Choriocarcinoma
5. Multifetal pregnancy
6. Erythroblastotic fetus
7. Down syndrome
8. Ovarian and testicular tumour
9. Certain neoplasm of lung, stomach, and pancreas !

PCOD

In PCOD
E1 ⏫
E2 ⏬
E2:E1 ⏬
E1:E2 ⏫
LH ⏫
FSH N-⏬
FSH : LH ⏬
LH : FSH ⏫
Testosterone ⏫
SHBG ⏬

Halban

HALBAN IN OBG
Halban disease :: corpus luteal defect
Halban theory :: metastatic theory to explain endometriosis
Halban sign :: symmetrical enlargement of uterus in adenomyosis

Drugs of choice for gynaecological urology

DOC for stress incontinence-  pseudoephedrine
DOC for urge incontinence-  oxybutinin
DOC for overflow incontinence-  Bethanachol
DOC for post op urinary retention-  Bethanachol

Obstetrics and Gynecology

UPDATE 19 OBGY
IOCs for various conditions
fibroid - USG
tubal payency- HSG
Mullerian anomalies - MRI
Endometriosis - Laproscopy
post coital bleeding - PAPS
post menopausal bleeding -
endometrial biopsy
pid - USG
adenexal mass - USG
amenorrhoea - hormonal asessment
molar - USG
Ectopic - TVS
ovulation - follicular monitoring
hirsutism with menstrual irregularity- -serum testosterone
AUB USG
Adenomyosis - MRI
ovarian reserve - FSH
VVF - Cystoscopy

Half lives of iucd

Important shelf-lives of contraceptives you need to know.
(Shelf-life is only important for IUDs)
1. Copper IUDs - 3-5 yrs
2. Progestasert - 1 year
3. CuT 200 - 4 years
4. Nova T - 5 yrs
5. LNG IUD - 7-10 yrs
6. CuT 380A - 10 yrs

OBG: Rapid Fire:-

OBG: Rapid Fire:-

1. Cyclical hematuria suggests which type of fistula in females:
Uterine-vesical

2. Commonest site of secondary metastasis in Choriocarcinoma:
Lungs

3. Treatment of inevitable abortion in 10th week of pregnancy: Dilatation & evacuation

4. Commonest site of ectopic pregnancy:
Ampulla

5. Alpha-fetoprotein is low in:
Down syndrome

6. Heart disease having highest mortality in pregnancy:
Eisenmenger’s complex

7. Trial of labor is CONTRAINDICATED in:
Previous 2 or more Cesarean section

8. Commonest cause of breech presentation is:
Prematurity

9. Low Forceps are applied when the station of head is:
+2

10. Maximum breast milk secretion occurs at which month:
3 months

11. Use of steroids in neonates is required in:
Bronchopulmonary dysplasia

12. Karyotype in androgen insensitivity syndrome: 46XY

13. Size of uterus:
3 x 2 x 1 inches.

14. Stress incontinence is best corrected by:
Bladder neck repair

15. Gonococcal infection spreads by:
Involvement of adjacent structures/ Ascending route

16. OCP of choice in lactation period:
Minipill/ progesterone only pill

17. A woman has 20 ml menstrual blood loss every 35 days. She suffers from: Oligomenorrhea

18. MC site of Endometriosis:
Ovary

19. Commonest ovarian tumour complicating pregnancy:
Dermoid

20. Most definitive clinical sign of pregnancy is:
Fetal heart sounds

2. Involution of the uterus is completed by:
6 weeks

22. Earliest indication of concealed acute bleeding in pregnancy is:
Tachycardia 

23. A patient presents at 28 weeks gestation with severe abdominal pain, bleeding and hypertension. The most likely diagnosis is:
Accidental hemorrhage

24. Feature suggestive of ectopic pregnancy in a young woman with acute abdomen:
Amenorrhoea,
Abdominal pain,
Vaginal bleeding.

25. MC type of pelvis associated with direct OccipitoPosterior position is:
Anthropoid

26. Most unfavorable presentation for vaginal delivery is:
Mento-posterior

27. Deep Transverse Arrest is commonly seen in which type of pelvis:
Android

28. An absolute indication for Classical Caesarean section is:
Central placenta previa

29. Best contraceptive method in a patient with heart disease is:
Barrier methods

30. MC complication of IUCD is:
Bleeding

31. Antituberculous drug CONTRAINDICATED in pregnancy:
Streptomycin, pyrazinamide

32. Safest drug in pregnancy is:
INH (also rifampicin)

33  Antithyroid of choice in pregnancy:
Propylthiouracil (also methimazole)

34. Chorionic villous sample is done at what time:
10-12 weeks

35. Fetus in a diabetic mother are at risk of developing which cardiac lesions: 
ASD, VSD, COA

36. Menopausal hormonal change:
Increased Gonadotropins, Decreased estrogen

37. Progesterone is produced by: Granulosa luteal cells (corpus luteum)

38. Procedure of choice to diagnose uterus didelphis is:
Hysterosalpingography

39 Rarest complication in a fibroid uterus is: Sarcomatous change (0.5%)

40. Cryptomenorrhoea occurs due to:
Imperforate hymen

41. MC complication of an ovarian tumour is:
Torsion

42. MC complication of cryotherapy is:
Watery discharge

43  Most effective drug in Sheehan’s syndrome is:
Corticosteroids

44. MC indication of In-Vitro Fertilization is:
Abnormality of fallopian tube

45. Jaundice at birth or within 24 hours of birth is commonly due to:
Erythroblastosis fetalis

46. Genetic disorders are diagnosed at 11 weeks of pregnancy by:
Chorionic villous biopsy

47. Abnormal alpha -fetoprotein is seen in:
Open neural tube defects,
multiple gestation

48. Weight of placenta at term is: 500 gm

49. Associated with oligohydramnios:
Renal agenesis

50. Treatment of a 40 year old P(4+2) female, who has been diagnosed to H. mole is:
Total hysterectomy

51. Management of Choriocarcinoma is:
Methotrexate

52. Ectopic pregnancy is MC in:
Previous history of recurrent PID

53. In puerperium, uterus becomes a pelvic organ after:
2 weeks

54. PIH can be predicted by which test:
Gant’s rolling over test

55. Prognosis in Rh-incompatibility depends on:
Serum bilirubin

56. Anti-hypertensive NOT given in pregnancy:
ACE inhibitors

57. Antimalarial of choice in pregnancy:
Chloroquine

58. Pap smear in pregnancy is:
Routine as a part of screening

59. Fetal scalp pH: 7.3

60. Earliest conclusive evidence of intrauterine death:
Intra-aortic gas

61.  Fetal blood loss in abnormal cord insertion is seen in:
Vasa previa

62. Fetal scalp edema on USG is suggestive of:
Rh incompatibility

63. Drug which may be used for post-coital contraception:
RU 486/ mifepristone

64. Activity of corpus luteum activity is maintained by:
LH

65. Hormone responsible for positive ‘Fern test’ is:
Estrogen

66. Drug used for induction of ovulation:
Clomiphene, Tamoxifen

67. Ovarian tumour likely to involve the opposite ovary by metastasis:
Granulosa cell tumour

68. Pelvic Ca which can cause Krukenberg’s tumour:
Ovarian Ca

69. LEAST observed laboratory finding in neonatal sepsis:
Neutrophilia

70. Site of fertilization:
Ampulla

71. Peak growth velocity in adolescent girls is seen just after:
Appearance of pubic hair and axillary hair

72. Phocomelia is:
Defect in long bones

73. Progress of labor is charted on:
Partogram

74. Score for checking need of induction of labor:
Bishop score

75. Shortest diameter for fetal skull:
1. Bimastoid
2. Bitemporal

76. MC heart disease associated with pregnancy:
Mitral stenosis 

77. Common congenital malformation seen in a diabetic pregnant woman: 
Cardiac defects 

78. Feature of a contracted pelvis has a transverse diameter of:
10 cm

79. Type of pelvis associated with increased incidence of ‘Face to pubis’ delivery:
Anthropoid

80. Manoeuvre used for delivering after coming head of breech presentation is:
Burn Marshall technique

81. Rupture of membrane is said to be premature when it occurs at:
Prior to 1st stage of labor

82. Likely size of uterus at 8 weeks post-partum is:
100 gm

83. Post-partum decidual secretions are referred to as:
Lochia

84. IUGR is defined when:
Birth weight below 10th of the average gestational age

85. IUCD with half life of 10 years:
Cu T 380A

86. Asymptomatic carriage of gonococcal infection in female is commonly seen in:
Endocervix

87. Primary amenorrhoea with 45 XO, short stature suggest:
Turner syndrome

88. Karyotype of Klinefelters syndrome 47XXY

89. Carcinoma cervix extends upto lateral pelvic wall. The stage would be:
Stage III

90. A 42 year old female P3+0+0+3 is found to have carcinoma in situ. Best treatment would be:
Hysterectomy

91. Masculizing/ virilizing tumour of ovary:
Arrhenobloastoma

92. Best prognosis for reversibility is seen in which type of female sterilization:
Isthmic-isthmic type

93. A middle aged female presents with increasing visual loss, breast enlargement & irregular menses. Investigation of choice would be: 
Serum prolactin

94. Failure rate of Pomeroys method:
0.4%

95. Copper eluted from Cu T daily:
50 microgram

96. Antispermal antibodies in cervical mucus can be checked by:
Post coital test

97. Genital ridge forms:
Ovary

98 Length of fallopian tube: 10 cm

99. Platelet count in pregnancy:
Decreases

100. Which disease carries high chances of transplacental transfer in first trimester:
Rubella

BACTERIAL VAGINOSIS

BACTERIAL VAGINOSIS

-formerly termed nonspecific vaginitis, Haemophilus vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge
-Characterized by symptoms of vaginal malodour and increased white discharge
-MC cause of vaginitis
-Not sexually transmitted
- Increased risk of other infections like HIV,C.trachomatis,N.gonorrhea and risk of preterm delivery
-Culture of discharge- G.vaginalis,Mycoplasma hominis,several anerobic bacteria like Prevotella

-Absence of Lactobacillus which is the MC organism of normal vaginal microbiota

-Criteria-AMSEL’s(any 3 of 4)
1-objective signs of increased vaginal discharge
2-discharge of pH>4.5
3-distinct fishy odor when secretions mixed with 10%KOH(Whiff test+70%cases)
4-Clue cells and absence of WBCs on microscopy of secretions with normal saline 1:1(most specific criteria)

-Modified Amsels use any 2 of 4 criteria
-Fishy odour is due to volatile amines mainly trimethylamine
-Clue cells are vaginal epithelial cells coated with coccobacillary organisms(>20% diagnostic)
-NUGENTS score>7 is diagnostic of BV

-TT-Oral metronidazole 500mg twice daily for 7 days
2%clindamycin cream or 0.75%metronidazole gel can also be used.

-Newer test BVBLUE Rapid Diagnostic test for BV- detects sialidase activity
--Only Bacteria resistant to metronidazole treatment and recurrence of BV- Atopobium vaginae

"MOST COMMON" FACTS -

MC invasive gynecologic malignancy : Endometrial malignancy
MC islet cell tumor in MEN 1 : Gastrinoma
MC islet cell tumor of the pancreas : Insulinoma.
MC joint involved in synovial osteochondromatosis : Knee
MC lesion to cause expansion of paranasal sinus : Mucocele
MC lethal bone dysplasia : Osteogenesis imperfecta
MC lobe affected in bronchial atresia : Left upper lobe.
MC location for a cephalhematoma : Parietal
MC location for a gastric diverticulum : Posterior wall of the gastric fundus.
MC location for a pilocytic astrocytoma : Cerebellum
MC location for a solitary myeloma of the bone : Spine
MC location for a synovial sarcoma : Knee

MOST COMMON IN GYNECOLOGY:

MOST COMMON IN GYNECOLOGY:
1. Cystic Swelling of vulva- Bartholin’s cyst
2. Gestational trophoblastic disease following hydatiform mole- Invasive mole
3. Gestational trophoblastic disease- Hydatiform mole
4. Cause of post menopausal bleeding in India – Carcinoma Cervix
5. Cause of post menopausal bleeding in western country- Carcinoma endometrium
6. Agent responsible for carcinoma cervix- Squamous cell carcinoma- HPV-16
7. Agent responsible for carcinoma cervix- Adeno carcinoma- HPV-18
8. Agent responsible for carcinoma cervix- Over all – HPV-16
9. Ovarian cyst to undergo torsion- Benign cystic teratoma
10. Mullerian Anamoly is- Bicornuate uterus
11. Malignant germ cell tumor of ovary- Dysgerminoma
12. Cause of 1ST trimester abortion- Chromosomal abnormality
13. Cause of mid trimester abortion – Cervical incompetence
14. Cause of female pseudohermaphroditism- Congenital adrenal hyperplasia
15. Cause of hirsutism- PCOD
16. Genital prolapsed- Cystocoele
17. Cause of primary amenorrhoea- Gonadal dysgenesis > ROKYTANSKY KUSTER HOUSER
SYNDROME
18. Cause of death in Carcinoma cervix- Renal Failure
19. Symptom/sign of PCOD- Hirsutism
20. Cause of precocious puberty- Constitutional
21. Site of metastasis of choriocarcinoma- Lungs
22. Site of genital TB- Fallopian tube
23. Cause of polyhydramnios- Anencephaly
24. Cause of ectopic Pregnancy- PID (salpingitis)
25. Type of pelvis associated with direct occipito posterior position- Anthropoid
26. Type of pelvis associated with face to pubis- Anthropoid
27. Type of pelvis associated with deep transverse arrest- Anthroid
28. Complication of ovarian tumor- Torsion
29. Complication of cryotherapy- Watery discharge
30. Indication of IVF- Tubal factor
31. Cardiac lesion in pregnancy- Mitral Stenosis
32. Congenital cardiac lesion in pregnancy- ASD
33. Mutation in ovarian cancer- P53
34. Malignant tumor of ovary- Serous cysadenocarcinoma
35. Cause of Asherman’s syndrome- D&C for PPH
36. Cause of DIC in pregnancy- Abruptio Placenta
37. Primary Brain Neoplasm in pregnancy- Gliomas

Types of Pelvis

Normal Pelvis

Naegele's pelvis(congenital oblique pelvis)..

one ala of sacrum is absent.

Robert's pelvis (congenitaly contracted) both ala of sacrum is absent

Rachitic pelvis=flat
- softening of the bone
- dec ant post dia of the inlet.
- increased AP diameter of outlet
- increased AP diameter of outlet and increased TV diameter due to baby delayed walking and sitting on ischial tuberosities.

Osteomalacic pelvis
- softening of bone due to Ca and vit D def in elderly ES multipara.
- in the standing position
- head of femur and sacral promaontary is pushed.
- rectus abdominus pull
-triradiate pelvis.

NAMED SURGERIES N GYNAEC

McIndoe's vaginoplasty- vaginal atresia
strassman's utriculoplasty-bicornuate uterus
jone's&tomkins-septate uterus
latzkos,chassar moir,martius' graft-VVF
boari flap-ureteric fistulae
kelley,pacey,marshall marchetti krantz,burch colposusp,razz n stamey modified slings-stress incontinence
fentons perineotomy-rigid hymen causing vaginissmus
mayos hysterectomy,fothergills/manchester,shirodhkar,Leforts, slings-purandre&mhatre,shirodkar,khanna, virkud,neeta warty,mangeshkar's- uterine prolapse
pomeroy,uchida,madlener,irwing,aldridge-sterilization
moschowitz-enterocele
gilliams,baldy webster- retroverted uterus
o sullivans method, spinnellis- inverted uterus
hysterectomy-wertheim's, meig obayashi,schauta, taussigs lymphadenectomy-ca cervix

Obs

OBSTETRICS AND
GYNAECOLOGY:🔵🔵
Bagel sign:
Ultrasonographic sign. Gestational
sac in the adnexa with hyperechoic
ring
Ball Sign:
Radiological sign of intrauterine
fetal death. X-ray shows crumpled
up spine of the fetus..
Banana Sign:
Ultrasound sign in open spina
bifida. Shows abnormal anterior
curvature of cerebellum. Due to the
associated Arnold-Chiari
malformation.
Chadwick’s Sign:
Bluish hue to the vestibule and
anterior vaginal wall. Seen in first
trimester of pregnancy. Cause is
increased blood flow to the pelvic
organs. Also known as jacquemier’s
Sign.
Cullen Sign:
Bluish discoloration of skin around
umbilicus. Occurs due to intra
peritonealhemorrhage. Seen in
ruptured ectopic pregnancy.
Double Bubble Sign:.
Useful in prenatal diagnosis of
duodenal atresia. Duodenal atresia
usually presents with
polyhydramnios and produces
dilatation of stomach and first part
of duodenum
Double decidual sac Sign:
Normal Ultrasonographic
appearance of intrauterine
gestational sac. Seen as
twoconcentric echogenic rings
separated by a hyperechoic space.
Goodell Sign:
Marked softening of the cervix in
contrast to non pregnant state.
Also due toincreased blood flow.
Hegar Sign:
An indication of Pregnancy.
Softening of the lower parts of the
uterus enablesapproximation of
vaginal and abdominal fingers in
bimanual pelvic examination.
Vaginalfingers are placed in the
posterior fornix and abdominal
hand pressed down behind
theuterus.
Jacquemier’s sign: Refer
Chadwick
SignKustner’s Sign:
Sign of placental separation. On
pushing the uterus upwards does
not move thecord with it due to
the separation.
Ladin’s Sign:
Softening in the midline of the
uterus anteriorly at the junction of
the uterus andcervix. It occurs at
about 6 weeks gestation
Lambda Sign:
Ultrasonographic sign seen in
dichorionic pregnancies. Due to
the chorionic tissuein between the
two layers of the membrane
between the twins.
Lemon Sign:
Ultrasound sign in open spina
bifida. Shows abnormal anterior
curvature of cerebellum. Due to the
associated Arnold-Chiari
malformation.
Osiander’s Sign:
Pulsations in the lateral fornix due
to the increased vascularity.
Palmer’s Sign:
Regular rhythmic contractions of
uterus felt as early as 6-8 weeks .
It is a sign of pregnancy.
Piskacek’s Sign:
Asymmetric growth occurs to the
uterus in initial stages of
pregnancy due to thelateral
implantation of the blastocyst. The
area of implantation feels soft
compared tothe other parts.
Robert’s Sign:
Radiological sign of intrauterine
fetal death. X-ray shows presence
of gas in thefetal great vessels.
Earliest radiological sign of
intrauterine fetal death
Schroder’s Sign:
A sign of placental separation.
Uterus rises up when the
separated placenta ispassed
downwards.
Spalding Sign:
Sign of intrauterine fetal death.
Overlapping of skull bones after
fetal demise.Observed by
ultrasonogrm.
Stallworthy’s Sign:
Slowing of fetal heart rate on
pressing the head down I to the
pelvis and promptrecovery on
release of pressure is termed
Stallworthy’s sign. This sign is
suggestive of posterior placenta
praevia.
Stuck Twin Sign:
Seen in twin to twin transfusion
syndrome. Due to the severe
oligohydramniossmaller twin is
held in a fixed position along the
uterine wall. This is called stuck
twinsign.
‘T’ Sign:
Ultrasonographic sign seen in
monochromic twins. As the
intertwin membranedoes not have any chorionic tissue it gives rise to ‘T’ sign in ultrasound

Diameters of pelvis

Diameters of Pelvis :
1. INLET:
a) AP Diameter : Obstetric conjugate – 10-10.5 cm (This is calculated by subtracting 1.5 to 2 cm from Diagonal conjugate) (Also most important Diameter of pelvic Inlet (UPSC))
b) AP Diameter :

True conjugate – 11 cm

c) AP Diameter :
Daigonal conjugate – 12 cm (This can be measured clinically)

d) Oblique Diameter : 12 cm

e) Transverse Diameter : 13-13.5 cm

2. Mid PELVIS :

a) AP Diameter: 11.5 cm

b) Interspinous Diameter : 10 cm

3. OUTLET : a) AP Diameter : 9.5 – 11.5 cm

b) Intertuberous Diameter is : 11 cm

Fetal Skull Diameter : 1. Bimastoid diameter : 7.5 cm

2. Bitemporal diameter : 8 cm ----------- (Smallest diameter)

3. Super subparietal diameter : 8.5 cm

4. Biparietal diameter : 9.5 cm Transverse diameters of fetal skull is smaller than Transverse diameter .

AP diameters of fetal skull :

1. Suboccipito bregmatic (9.5 cm) – Complete Flexion (Attitude) – Vertex (presentation)
2. Suboccipito frontal (10 cm) – Incomplete Flexion (Attitude) – Vertex (Presentation)

3. Occipito-frontal (11.5 cm) – Marked deflexion (Attitude) – Vertex (Presentation)

4. Mento-Vertical (14 cm) – Partial extension (Attitude) – Brow (Presentation) ----(Longest diameter)

5. Sub-mento vertical (11.5 cm) – Incomplete extension (Attitude) – Face (Presentation)

6. Sub-mento bregmatic (9.5 cm) – Complete flexion (Attitude) – Face (Presentation)

Vaginal PH

Newborn infant    4.5-7
6wk old child      7
Puberty  changes from  Alkaline to acidic
Reproductive age grp  4-5.5
Pregnancy   3.5-4.5
Late menopausal  6-8

Gyn

Dutta
Endometrl biopsy-reg cycl 21-23
Irregulr-wthn 24hrs f mens
Cervix-22
Vaginl cytology-25-26
Prog-21
Fsh,lh-2,3