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Description

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. 


Instruction

This quiz consists of 10 multiple-choice questions. To be successful with the weekly quizzes, it’s important to thoroughly read chapter 5 in the textbook.  It will also be extremely useful to study the key terms at the end of the chapter and review the Test Your Knowledge activity at the end of the chapter. Keep the following in mind:

  • Multiple Attempts – You will have three attempts for this quiz with your highest score being recorded in the grade book.
  • Timing – You will need to complete each of your attempts in one sitting, as you are allotted 30 minutes to complete each attempt.
  • Answers – You may review your answer-choices and compare them to the correct answers after your final attempt.

To start, click the “Take the Quiz” button. When finished, click the “Submit Quiz” button.


Time Left: 30:00
Q. 1

Characteristic features of Rokitansky — Kuster Hauser syndrome are all of the following except :

 A

Absent uterus

 B

Absent vagina

 C

Anovulation

 D

46 — XX

Q. 1

Characteristic features of Rokitansky — Kuster Hauser syndrome are all of the following except :

 A

Absent uterus

 B

Absent vagina

 C

Anovulation

 D

46 — XX

Ans. C

Explanation:

Anovulation

Mayer Rokitansky Kuser Syndrome (MRKH) is the complete failure in the development of the mullerian ducts resulting in absence of the fallopian tubes, uterus and most of vagina° (as of vagina is formed by Mullerian duct).

Mayer Rokitansky-Kuster Hauser syndrome

Karyotype = 46 XX°

Phenotype = Female

Associated abnormalities are :

  • Renal ectopy and agenesis (Horse shoe shaped kidney)°
  • Skeletal abnormalities° (most common – scoliosis)
  • Cardiac anomalies.°

Clinical features :

  • Patient present between 15-18 years of age with primary amenorrhoea.° (eugonadotropic amenorrhea).
  • Secondary sexual characteristics are normal° as ovaries are normal (because of their separate embryonic origin, so ovulation is also normal.)
  • P/V = Vagina is felt like a blind pouch and uterus is absent.°
  • Findings are confirmed by USG.°
  • Ideal method for demonstrating Uterine malformations is MRI.°

Management :

  • Repair of vaginal agenesis done either by frank dilatation or vaginoplasty.
  • Vaginoplast should onl be performed when the girls is just married or about to be marripri  

Frank Dilatation :

This non-surgical procedure consists of a woman applying gradual pressure with progressively increasing dilators over the mullerian pit for 15 minutes twice a day. An indentation is created by the end of 3 to 6 month. Some have satisfactory intercourse, but in many, vaginal size is inadequate and they need a surgical procedure eventually.

Surgical management : Vaginoplasty either by Mc Indoe operation

Differential Diagnosis :

  • Testicular feminization syndrome.
  • Mayer Rokitansky-Kuster Hauser syndrome can be differentiated from testicular feminizing syndrome on the basis of :
Q. 2

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Q. 2

Hysteroscopy is used in all EXCEPT :

 A

Uterine synechiae

 B

Abnormal vaginal bleeding

 C

Infertility

 D

None

Ans. D

Explanation:

None

Q. 3

The Colposcopic features suggestive of malig­nancy are all except :

 A

Condyloma

 B

Vascular atypia

 C

Punctation

 D

White epithelium

Q. 3

The Colposcopic features suggestive of malig­nancy are all except :

 A

Condyloma

 B

Vascular atypia

 C

Punctation

 D

White epithelium

Ans. D

Explanation:

White epithelium

Q. 4

Metropathica hemorrhagica is best treated by :

 A

Curettage of uterus

 B

Progestogen

 C

Estrogen

 D

Clomiphene

Q. 4

Metropathica hemorrhagica is best treated by :

 A

Curettage of uterus

 B

Progestogen

 C

Estrogen

 D

Clomiphene

Ans. B

Explanation:

Ans. is b i.e. Progestogen    

Metropathia hemorrhagica is a specialised form of DUB. Mostly seen in premenopausal women.

Maximum age incidence : between ages 40 – 45 years.

Pathology :

Changes in the Uterus : Symmetrical enlargement of the uterus to a size of 8 – 10 weeks due to hypertrophy of muscles.

Changes in Endometrium : Naked eye appearance : Endometrium looks thick, congested and often polypoidal.

Microscopic appearance :

  • Hyperplasia of all endometrial components.
  • Intense cystic glandular hypertrophy.
  • Some glands are small and some large giving appearance of “swiss cheese°.
  • Glands are empty and lined by columnar epithelium.
  • Secretory changes are absent.°
  • Follicular cysts containing estrogen present on ovaries.

Sign and Symptom : Patient complains of excessive painless bleeding (Anovular bleeding).

Treatment :

  • In DUB due to anovular causes : Progesterones are the mainstay of therapy.
  • They diminish the effects of estrogen on target cells by inhibiting oestrogen receptors.

To stop Acute severe bleeding :

  • Norethisterone (5 mg tab.) is given thrice daily till bleeding stops. Then norethisterone is stopped resulting in withdrawl bleeding (after 2-4 day). This is called as Medical curettage.
  • Thereafter cyclical progesterone – MPA (Medroxy Progesterone Acetate) 10 mg or Norethisterone 5 mg is given from day 5 – day 25 of the cycle for 3 cycles.
Q. 5

First site to be affected in genital tuberculosis :

 A

Ovary

 B

Cervix

 C

Fallopian tube

 D

Vagina

Q. 5

First site to be affected in genital tuberculosis :

 A

Ovary

 B

Cervix

 C

Fallopian tube

 D

Vagina

Ans. C

Explanation:

Fallopian tube

Q. 6

Transverse vaginal septum corresponds to :

 A

External Os

 B

Vesical neck

 C

Bladder base

 D

Hymen

Q. 6

Transverse vaginal septum corresponds to :

 A

External Os

 B

Vesical neck

 C

Bladder base

 D

Hymen

Ans. A

Explanation:

External Os

If there is a disorder in fusion of downgrowing Mullerian duct and upgrowing derivative of urogenital sinus. It results in Transverse vaginal septum which causes imperforate vagina (or vaginal agenesis).

In a series reported :

–       46% septa were located in upper part.° Ott ti2v-a        

–       40% septa were located in middle part.°

–       14% septa were located in lower part.°

The upper part corresponds to external os therefore it is the option of choice.

Transverse vaginal septum can present either  in :

A. Neonatal age group ?

  • The placental transfer of estrogen results in stimulatin the •lands of the endocervix which results in formation of Mucocolpos it can present as :
  1. abdominal tumour.°
  2. can compress the ureter resulting in hydroureter followed by hydronephrosis.°
  3. can compress the rectum resultina in obstioation / intestinal obstruction.°

B. At puberty ?

  • Patient can present with Primary amenorrhea (actually called as Cryptomenorrheaa as uterus menstruates normally but blood does not come out due to outflow Tract obstruction).°
  • Secondary sexual characteristics are normal.°
  • Due to Cryptomenorrhoea, blood gradually collects and distends first the vagina (hematocolpos)° then cervix uterus (hematocervix and hematometra) and finally the tube (hematosaipinx)°. All these present as pelvic/ abdominal tumour.
  • The abdominal tumour can irritate the bladder followed by compression of internal urinary meatus leading to

complete retention of urine (This occurs 3 – 4 years after the onset of hidden menstruation and therefore patient is generally aged 15 – 18 years°).

  • Patient may complain of monthly cyclic pain (backache I lower abdomen pain).°

Management ?

  • Once the diagnosis of cryptomenorrhea is made, surgical treatment is urgently required° since every menstrual episode further dilates the genital tract and threatens permanent impairment of reproductive function.
  • Obstruction at the level of the cervix is managed by uterovaginoplasty. If uterovaginoplasty is unsuccessful hysterectomy is performed.
  • When the outflow menstrual blood is prevented by a thick vaginal membrane at any level, incision followed

by covering the deficiency with either vaginal epithelium or skin grafting is done.

  • When the obstructing membrane is thin and low down, the membrane is merely excised.°
Q. 7

All of the following are features of mullerian agenesis except :

 A

46 XX karyotype

 B

Normal breast development

 C

Absent vagina

 D

Ovarian agenesis

Q. 7

All of the following are features of mullerian agenesis except :

 A

46 XX karyotype

 B

Normal breast development

 C

Absent vagina

 D

Ovarian agenesis

Ans. D

Explanation:

Ans:D.)Ovarian agenesis

Mullerian agenesis

  • It is Mayer Rokitansky-Kuster Hauser syndrome. .
  • Müllerian agenesis is a congenital malformation characterized by a failure of the Müllerian duct to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. Müllerian agenesis (including absence of the uterus, cervix and/or vagina) is the cause in 15% of cases of primary amenorrhoea.
  • Because ovaries do not develop from the Müllerian ducts, affected women might have normal secondary sexual characteristics but are infertile due to the lack of a functional uterus.

Signs and Symptoms:

  • An individual with this condition is hormonally normal; that is, the person will enter puberty with development of secondary sexual characteristics including thelarche and adrenarche (pubic hair). The person’s chromosome constellation will be 46,XX. At least one ovary is intact, if not both, and ovulation usually occurs. Typically, the vagina is shortened and intercourse may, in some cases, be difficult and painful. Medical examination supported by gynecologic ultrasonography demonstrates a complete or partial absence of the cervix, uterus, and vagina.

Classification:

  • Typical MRKH – Isolated uterovaginal aplasia/hypoplasia
    • Prevalence – 64 percent
  • Atypical MRKH – Uterovaginal aplasia/hypoplasia with renal malformation or uterovaginal aplasia/hypoplasia with ovarian dysfunction
    • Prevalence – 24 percent
  • MURCS syndrome – Uterovaginal aplasia/hypoplasia with renal malformation, skeletal malformation, and cardiac malformation
    • Prevalence – 12 percent
Q. 8

Find the wrong match :

 A

Brenner’s tumor – puffed wheat nuclei

 B

Krukenberg tumor – Signet ring appearance

 C

Granulosa cell tumor – Cell exner bodies

 D

Gonadoblastoma – Reinke’s crystals

Q. 8

Find the wrong match :

 A

Brenner’s tumor – puffed wheat nuclei

 B

Krukenberg tumor – Signet ring appearance

 C

Granulosa cell tumor – Cell exner bodies

 D

Gonadoblastoma – Reinke’s crystals

Ans. D

Explanation:

Gonadoblastoma – Reinke’s crystals

Q. 9

In menopause, not seen is :

 A

↓ FSH

 B

Cholestsrol

 C

 Androgen

 D

↓ Cholesterol

Q. 9

In menopause, not seen is :

 A

↓ FSH

 B

Cholestsrol

 C

 Androgen

 D

↓ Cholesterol

Ans. A

Explanation:

↓ FSH

Q. 10

Ovulation occurs due to :

 A

Midcycle FSH surge

 B

High prolactin level

 C

Midcycle LH surge

 D

a and c both

Q. 10

Ovulation occurs due to :

 A

Midcycle FSH surge

 B

High prolactin level

 C

Midcycle LH surge

 D

a and c both

Ans. D

Explanation:

a and c both

Q. 11

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Q. 11

The ovarian cycle is initiated by :

 A

FSH

 B

Oestrogen

 C

LH

 D

Progesterone

Ans. A

Explanation:

FSH

Initiated by the release of FSH (From Anterior pituitary)
FSH stimulates the Growth of Multiple Follicles (Folliculogenesis)

Selection of a dominant Follicle (Graffian Follicle), by day 5-7.
Graffian Follicle acquires FSH receptors on Granulosa cells and LH receptors on Theca cell.
Under the influence of FSH, Graffian follicle secretes 178 estradiol (Day 7)
178 estradiol causes

4,                                                                   i                                                                    4,

Proliferative changes              Negative feedback on FSH                    Positive feedback on LH therefore

in the endometrium                                                                                      LH increases in amount.

Decreased Amount of FSH                      Increased LH leads to :

 

 

Production of androgen from Theca cells

which is converted peripherally to estrogen therefore Estrogen peak occurs (48 hours before ovulation)

LH surge (32-36 hours before ovulation) & LH peak (10-16 hours before ovulation) 1

Ovulation Occurs (14 days prior to next cycle)

Formation of corpus luteum & 2nd phase of ovulatory cycle i.e. Luteal Phase begins.

Secretes Progesterone

 

Stimulates Endometrium to undergo secretory changes 1.

In absence of Fertilisation corpus luteum degenerates

 

Oestradiol                          Progesterone                         Inhibin

(inhibin      FSH production)

(Leads to menstruation in menstrual

cycle) & will release the negative                         Increased FSH as

feedback on GnRH, therefore                               compared to LH increases GnRH pulses

L

Another follicular phase begins


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