Practice Test

7 – 9 days

“From the time a fertilized ovum enters the uterine cavity from the fallopian tube (which occurs 3-4 days after ovulation) until the time ovum implants (7-9 days after ovulation) the uterine secretions called uterinemilk provide nutrition for the early dividing ovum^“

“At the time of implantation, on days 21-22 of menstrual cycle the predominant morphologic feature is edema of the endometrial stroma.”

Important facts :

• Oogenesis begins in ovary at 6-8 weeks of gestation.°
• Maximum number of oocytes (6-7 million) are attained at 20 weeks of gestation.°
• All the primary oocytes in the ovary of a newborn are arrested In the late prophase (of meiosis) till puberty.°
• At puberty as a result of mid cycle preovulatory surge, meiosis is resumed and compTetedjust prior to ovulation.°
• Therefore first polar body is released just prior fo ovulation
• The second division starts immediately after_ it and is arrested in metaphase.°
• At the time of fertilization second division is completed which results in the release of oocyte and second polar body.
• Therefore second polar body release occurs only at the time of fertilisation.°
• LH surge preceedes ovulation by 34-36 hours.^o
• LH peak preceedes ovulation by 10-16 hours.^o
• Prior to ovulation :- Follicle reaches a size of 18-20mm.

                                    – Endometrium is 9-10 min trick.^o

                                    – Endometrium show triple line on USG.^o

• Ovulation occurs 14 days before the next menstruation.°
• Maximum action of corpus luteum is at 22 day of menstruation° (following which it starts regressing ~ 8 years after ovulation).°
• In absence of fertilisation and implanation the corpus leteum persists for 12-14 days.^o
• Maximum growth of corpus lutem of pregnancy is at 8th week of gestation and degenerates at 6  months of gestation.^o
• Fertilisation occurs in the ampullary part of fallopian tube.°
• Fertilised egg enters the uterus on day 18 – 19 of the cycle.°

Accompanied by ovulation

Primary to secondary spermatocyte

Ans. is b and c i.e. Maximum in number at 5th month of the fetus; and ls in the prophase arrest

The process involved in the development of mature ovum is called Oogenesis.
The primitive germ cells take their origin from the yolk sac at about the end of 3rd week and migrate to the developing gonadal ridge, at aboul the end ol 4th week.

Oogenesis :

        ↓

Enters the gonad of a genetic female & differentiate into

        ↓

       ↓ Mitosis (not meiosis, as given in option)

        ↓                                            (At birth no more mitosis occur & all oogonium are replaced by primary oocyte)

Enters I^st meiotic division

   ↓

Anested in prophase

   ↓

I^st meiotic division is completed after puberty, just prior to ovulation^o

                                            ↓ releasing

             ___________________________________________

    ↓                                    ↓

                 ↓ 2^nd meiotic oivision

Arrested in metaphase

      ↓ At the time of  Fertilisation

       _________________________________

  ↓                           ↓

lmportant facts

• Oogenesis begins in the ovary at 6-8 A weeks of gestation^o
• Maximum number of oocytes/oogonia are in the ovary at 5^th month of ddvelopment^o (20 weeks of gestation)^o.
• Al birth total content ol both ovaries is 2 million primary oocytes.^o
• At puberty is further decreased and is  ~ 300000 – 500000, of which only 500 are distined to mature during an individual’s life time.^o

8

The secretion of cervix are akaline and has a pH of 7.8.

• The glands of cervix are racemose in type and secrete mucus with a high content of fructose which renders it attractive to sperm.

Zona basalis

Surgery done

Galactorrhea refers to mammary secretion of milky fluid which is not physiological (not related to pregnancy or needs of child) and is persistent and sometimes excessive.

• Colour of fluid : Usually white, but can be yellow/green (local breast disease).
• Hormonally induced secretions come from multiple duct openings in contrast to pathological discharge that usually comes from a single duct.
• lt can be bilateral or unilateral
• Any galactorrhea demands evaluation in a multiparous woman and if atleast 12 months have elapsed since the last pregnancy or weaning in a parous woman.

Differential diagnosis of Galactorrhea :

The bastc mechanism ts tncteased release ol prolactin or depletion of dopamlne.

Clinical problem of Galactorrhea :

The clinical problems related to galactorrhea are related to hyperprolactinemia like :

• Menstrual cycle disturbances^o leading to oligo-ovulation, corpus luteum insufficiency and amenorrhea.
• Mild hirsutism.^o
• HYPerinsulinemia.^o

Treatment of Galactorrhea :

^{Ireatment of Choice / Drug of Chorbe : Dopamine agonists viz Bromocriptine / Pergolide / Cabergoline.}

ln case of pituitary tumors : Treatment of Choice is medical management with dopamine agonist but in
case medical management tails, Transsphenoidat resection of tumor can be done which is more successful
in case of Microprolactinomas than larger tumors (Macro Protactinomas

Surgery is one of the treatment modalities but not the IoC and since no other option is conect so, for this
question it is our option of choice.

FSH

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

Interstitial portion

Important Facts about Fallopian Tube :

1. Length = 4 inches or 10 – 12 cms.

2. Parts are : a. Interstitium (Intramural) : 1.8 cm long and 1 mm diameter (narrowest part°). It has no longitudinal muscles, only circular muscles are present.°

1. Isthmus 3.5cm long and 2mm in diameter.°
2. Ampulla : widest° and longest part° 6-7.5cm and fertilization occurs here°
3. Fimbria/infundibulum°

3. Blood supply – Tubal branch of ovarian and uterine artery.°

4. Lymphatics – Via ovarian vessels to para-aortic nodes and uterine vessels to internal iliac nodes.°

5. Histologically – Fallopian tubes have unique type of cells called as Peg cells° whose function is not known.°

Also know : Friends, some other measurements are commonly asked in PGME exams from female genital Tract. I am listing a few of them :

Structure                                                                            Measurement

• Isthumus which forms Inw^pr laprinp ^gpam^pnt       5-6mmt)
• Female urethra                                                       35-40 mm°
• Posterior vaginal wall                                            11.5 cms
• Anterior vaginal wall                                              9 cms
• Uterus(Nulliparous)                                               8 cm X 6 cm X 4 cm
• Cervix                                                                     2.5- 3.5 cms
• Ovary                                                                      3.5 cms length