Done by : Abdul Hakeem hady.
Gynecology slides
1.What is diagnosis?
2. Mention two preventive measures to avoid
development of this condition.
3.What is treatment?
Osteoporosis of the bone .
Prevention : 1. Avoid smoking . 2. Diet rich with calcium and vitamin D . 3 Exercise
Treatment :
1. Bisphosphonates are the most common medications prescribed for osteoporosis treatment.
These include:
Alendronate
Risedronate
2. Estrogen
what is showing in the slide?
What are the radiological criteria of malignancy?
Ovarian cyst
Criteria :
1)
Multi-locular cyst . 2) Evidence of solid areas . 3) Evidence of metastases
4) Presence of ascites . 5) Bi-lateral lesions.
What is showing in the slide? Utrine prolapse
Mention its grades. (( grade 3 to 4 ))
Procidentia
Enumerate the predisposing factors ?
1) Obesity . 2) chronic coughing . 3) multipara . 4) chronic constipation . 5) aging and menopause . 6) large tumor .
Dx : CA of cervix .
What is the name of this instrument? Pipelle.
For what it is used? Used for endometrial biopsy (( sample)) .
Mention two other investigations used for the same purpose.
1) dilation and curettage. 2) Transvaginal u\s . 3) hysteroscopy .
The patient have 2 miss period, she have positive B.HCG presented as acute abdomen .
ECTOPIC PREGNANCY
Laproscopy done for her, what is the finding?
Out line the treatment options?
1) conservative … if : 1) less than 3 cm . 2) near to hospital and well educated . 3) B.HCG less than 1000 .
4) no sign and symptom of acute abdomen .
2) medical Rx : methotrexate … if : 1) G.sac less than 3 cm . 2) B.HCG less than 3000 . 3) no sign of rupture .
4) not contraindicated to mehtotrexate.
Side effect of methotrexate : GIT upset , photosensitivity … etc
3) surgical : by open laparotomy or by laparoscopy. (( salpingectomy , slapingotomy and salpingestomy )).
Indication : 1) not respond to medical . 2) G.sac more than 4 cm . 3) sign of rupture . 4) B.HCG >5000.
What is the name of the procedure?
Conventional cervical (Pap) smear test.
For what it is used?
1-For screening of malignant and premalignant conditions.
2-For checking degree of infection (HPV- 16-18-31-35).
If the result is abnormal what is the next investigation?
Colposcopy.
What is this abnormality? Anterior vaginal wall prolapsed
Mention the predisposing factors ?
1) Obesity . 2) chronic coughing . 3) multipara . 4) chronic constipation . 5) aging and menopause . 6) large tumor .
What is the management? Anterior colporraphy .
What is this procedure? laparoscopic ovarian drilling .
For what it is used? For poly cystic ovary syndrome .
Enumerate the hormonal changes that occur in this case?
1) testosterone , LH & FSH ratio , serum prolactine (( all increase )) . 2) serum esradiol and estron increase .
What is the abnormality? Imperforated hymen
Mention the typical presentation for this patient?
primary amenorrhea, intermittent cyclical abdominal pain (dysmenorrhea), difficulty with micturition and defecation,
retention of urine in some cases,
Normal stature and have normal secondary sexual characteristic
What is the management?
1-History ==> primary amenorrhea, intermittent cyclical abdominal pain (dysmenorrhea), difficulty with micturition and
defecation, retention of urine in some cases.
2- Examination ==> Normal stature and have normal secondary sexual characteristic, abdominal mass, vulval inspection (tense
bluish bulging membrane), rectal examination (mass at the vagina).
3- Investigations ==> US, Laparoscopy, Laparotomy.
4- Treatment ==> After explanation of the condition and obtaining parents consent, a cruciate incision (+) in the hymen allows
drainage of the retained menstrual blood, also give antibiotics.
What is this investigation?
What is the abnormality showing?
Enumerate the criteria for observation management to this abnormality?
\
What is this investigation? Ultrasanograhy .
What is the abnormality showing? ovarian cyst
Enumerate the criteria for observation management to this abnormality?
What is this operation? Abdominal Hysterectomy .
Enumerate the advantages and the disadvantages of this operation?
Advantage : 1)
relieves abnormal uterine bleeding which is painful and distressing.
2)
prevents uterine cancer.
3)Hysterectomy for fibroids in the uterus offers great relief to those who have symptoms like bleeding, cramps,
urinary problems etc.
Disadvantage :1) infection ( septicemia ) . 2) damage to near by organ . 3) risk of adhesion . 4) DVT .
5) risk of anesthesia .
What is this drug? DANAZOL
Mention two indications to its use? 1)
Endometriosis . 2) Fibrocystic Breast Disease. 3) Hereditary Angioedema
.
Enumerate three side effects to its use?
Weight gain, acne, flushing, sweating, voice changes (hoarseness, change in pitch), abnormal growth of body hair (in
women), vaginal dryness/irritation, or decreased breast size
and dark color urine .
What is showing in the slide? Utrine Curette .
For what it is used?
1-To curette out the products of conception in cases of missed or incomplete conception.
2-To curette out endometrium in cases of endometrial diseases for diagnostic and therapeutic purposes (in case of
infertility, postmenopausal bleeding, endometrial cancer).
3-For checking curettage: done 1 week after evacuation of H.mole.
Mention the name of other tools used in the same procedure?
1) sim's speculum. 2) sponge forcipes . 3) cervical dilator 4) curette .
Enumerate the complications of this procedure?
Hemorrhage, sepsis, perforation of the uterus, vigorous curettage lead to amenorrhea due to total removal of
endometrium (Asherman's syndrome).
-what is this dermalological lesion? Acanthosis nigricans
-Where it is occur? Occur in PCOS AT the axilla , neck and under the breast .
-What other clinical feature that can occur in the same patient?
1) hirsutism . 2) alopecia . 3) acne . 4) obesity . 5) sub-fertility.
-What is the cause?
Insulin resistance
,
Hormonal disorders
,
Certain drugs and supplements
&
Cancer
.
-what is the name of this micro-organism? Trichimonas.
-Give the clinical features. : 1) frothy yellowish green offensive discharge . 2) strawberry cervix . 3) dysuria.
4) vulval itching and soreness.
-What is the drug of choice? Metronidazole .
what is showing in the slide? Laparoscope .
What are the advantages ?
1)
Smaller incision
. 2) less adhesion . 3) reduce risk of hemorrhage . 4)
Less pain
. 5) less hospital stay .
Contraindication :1) multiple abdominal surgery . 2) big abdominal mass ( tumor ) . 3) cardiopulmonary ds.
4) para umbilical hernia . 5) intestinal obstruction .
what is showing in the slide? Pessary. (( ring and shelf ))
Mention the indications to its use? 1) pelvic organ prolapsed . 2) urinary incontinence . 3)
Cystocele
.
What is this drug?
Goserelin
(
injectable gonadotropin releasing hormone superagonist (GnRH agonist) )
.
Enumerate 4 indications to its use? 1) prostatic cancer . 2) breast cancer . 3) endometriosis . 4)
Mention 2 important side effects of this drug? headache, vasodilatation, and diaphoresis.
-what is showing in the slide? Hysteroscopy .
-Mention 3 indication . : 1) Endometrial polyp.2) Abnormal uterine bleeding. 3) recurrent miscarriage .
4) removal of missed lobe of IUD . 5) Asherman's syndrome .
-Mention 3 complications of the procedures?
1) uterine perforation. 2) fluid over load . 3) bleeding . 4) injury to adjacent organ . 5) infection .
-what is the name of the procedure?
Colposcopy
.
-What is the indication?
1-Indicated for further investigation of smear abnormalities.
2-It has been used to examine the cervix in detail to:
*Identify dysplastic abnormalities on the ectocervix.
*Exclude an invasive process.
*Allow the accurate localization of the abnormal epithelium.
What are the methods of this exam? 1-Saline method. 2-Classical or extended method. 3-Iodine test method.
Pregnant woman presented with vaginal bleeding , and she pass grape like substance per vagina, which is
showing in the slide .
What Is the most likely diagnosis? Complete hydatidiform mole .
Mention three risk factors for its occurance. : 1) previous history of H.M . 2) age <15 or >40 yr .
3) dietary deficiency ( folic acid & Vit A ) .
What is showing in the slide? Dermoid cyst (( benign tumor of ovary )) .
Mention three clinical presentation.
• Abdominal pain and tenderness .
• Abnormal vaginal bleeding.
• Difficulties in urinating if the cyst puts pressure on the bladder.
• Nausea, sometimes accompanied by vomiting.
What is the name of this procedure? Curettage
Mention three complications.
Hemorrhage, sepsis, perforation of the uterus, vigorous curettage lead to amenorrhea due to total removal of
endometrium (Asherman's syndrome).
This instruments used during…………..operation. >>>> (( laparoscope & hysteroscopy )) operation .
Mention five contraindications to its use.
Contraindication :1) multiple abdominal surgery . 2) big abdominal mass ( tumor ) . 3) cardiopulmonary ds.
4) para umbilical hernia . 5) intestinal obstruction .
What is the name of this test? Hysterosalpingiography (( bicornuate uterus ))
Give two indication for its use :
1) in detecting tubal patency.
2) Congenital anomaly in uterus .
3) infertile women.
Contraindications : , pregnancy , active pelvic infection , recent uterine or tubal surgery.
Complication : spread of infection.
What is showing in the slide? Copper IUCD .
Mention three contraindications to its use :
1) abnormal uterine bleeding. 2) fibroid causing distortion of endomaterial cavity . 3)
Uterine anomalies .
4)
Active infection , if IUD Increased risk of actinomyces. 5)
gynecologic malignancy. 6) previous C .S .
Side effect ; Bleeding and pain , Infection(PID) , Perforation , Expulsion & ectopic pregnancy .
What is this drug? COCP ( ethinylestradiol and levonorgestrel)
Enumerate 5 contraindications to its use?
1)
- significant hypertension. 2) Acute or severe liver disease . 3) Breastfeeding <6 weeks post-partum .
4)
Focal migraine with aura . 5)
Oestrogen-dependent neoplasms, particularly breast cancer .
Enumerate 5 side effects to its use?
1-Venous thromboembolism . 2) Arterial disease (risk of H.T & MI ). 3)
Breast cancer & Cervical cancer.
4)
Loss of libido. 5) Irregular bleeding and vaginal discharge .
What is this surgical specimen? hysterectomy of uterus with H . mole
What are the indication of this procedure?
1) Old age . 2) invasive tumor . 3) carcinoma . 4) complete her family . 5) curettage lead to uncontrolled bleed.
What is the instument?
Bi-valve or Cusco’s speculum
For what it is used?
1-For examination of cervix, fornices, lateral vaginal wall.
2-When the biopsy is to be taken from the cervix.
3-For cauterization of cervical erosions.
4-For insertion of IUCD.
5-For some investigations like (cotton for high vaginal swap, pap smear).
WHAT is the name of other tool used for the same purpose?
According to what you want to use ( e.g tenaculum ).
What is the procedure showing in this slide? Hysteroscopy
What is the abnormality? Fibroid or polyp (( عاالكثرfibroid )) .
What are the complication of this procedure?
1) uterine perforation. 2) fluid over load . 3) bleeding . 4) injury to adjacent organ . 5) infection .
What is this instrument? Hagar's dilator
For what it is used?
1) Dilation of cervix and curettage . 2) Cervix biopsy . 3) Hysteroscopy. 4) Induction of labor .
Complication :
1) Trauma lead to utrine perforation … etc .
2) Bleeding due to cervical laceration .
What is showing in the slide?
Enumerate 5 causes?
What is the lesion? Genital herpes.
What is the causative agent? herpes simplex
Out line the treatment.
1) Supporative care (( analgesia , soothing agent , topical bathing ))
2) Oral Aciclovir (( 200 5x \day for 5 day ))
What is the lesion?
Bartholi
n's cyst
What is the commonest causative agents? neisseria gonorrhea
Outline the treatment.
1-pain medicine such as ibuprofen to relieve pain
2-Sitz baths
3-Surgical drainage
4-Antibiotics
5-Marsupialization
.
What is this condition? hypertrichosis
What drugs causing hypertrichosis?
can caused by drugs (phenytoin, ciclosporin, glucocorticoids).
What is this chart?
Functional bladder capacity.
What Information obtainable from a chart?
1) Volumetric summary of diurnal urinary frequency. » Volumetric summary of nocturnal urinary frequency.
2) Quantification of total fluid intake.
3) Distribution of fluid intake throughout the day.
4) Total voided volume and diurnal distribution of voiding.
5) Evaluation of the severity of urinary incontinence.
This is U/S of a patient presented with oligomenorrhea
and infertility.
1. What is this gynecoiogical problem?
2. List 3 other possible clinical presentation of this
condition?
3. List 2 main hormonal changes?
Poly cystic ovarian syndrome.
Presentation : 1) hirsutism . 2) obesity . 3) recurrent abortion . 4) acanthosis Nigricans .
Hormonal change : 1) testosterone , LH & FSH ratio , serum prolactine (( all increase )) .
2) serum esradiol and estron increase . 3) decrease SHBG.
Rotterdam criteria for diagnosing PCOS:
1) Oligomenorrhea or amenorrhea .
2) Clinical or biochemical signs of hyperandrogenism.
3) Ultrasound: increased stromal thickness and increased ovarian volume (>10 cm3) (specific for PCOS), and the
presence of 12 or more follicles measured 2-9 mm in diameter.
What is this picture? Injectable periurethral bulking agents.
What are the most commonly used periurethral bulking agents?
• glutaraldehyde cross-linked bovine collagen;
• macroparticulate silicon particles) (Macroplastique , Uroplasty Ltd).
Subcutaneous fat, although cheap, has poor efficacy and therefore has lost popularity
For whom it is appropriate?
• frail, elderly, or unfit women
• women who have had other multiple failed procedures.
List its complications?
are uncommon and minor. Dysuria, urinary tract infection and retention requiring overnight catheterization are
occasionally encountered.
WHAT IS THE NAME OF THIS TEST? ferning test
WHAT DOES IT INDICATE?
1) ovulation and fertility .
2) detect rupture of membrane .
The endometrium has 3 phases during the menstrual cycle are menstrual , proliferative and secretory .
Main hormone in phase follicular is estrogen , main hormone in phase luteal is progesterone
What is this condition? Ruptured ectopic pregnancy .
Enumerate 5 risk factors?
1) pelvic inflammatory disease . 2) old age . 3) IUCD . 4) history of endometriosis. 5) previous ectopic pregnancy.
List 2 main investigatory methods for diagnosis? 1). B.HCG elevated (( 60%)) every 48 hr . 2) ultrasound.
This Woman complain of painful swelling at one side of introitus.
1. What is the most common diagnosis?
2. What is your line of management?
Coropurus leuteal cyst
