Menorrhagia

Menorrhagia

Q. 1

Sucheta, a 29 year old nulliparous women com­plains of severe menorrhagia and lower abdomi­nal pain since 3 months. On examination there was a 14 weeks size uterus with fundal fibroid.

The treatment of choice is :

 A

Myomectomy

 B

GnRH analogues

 C

Hystrectomy

 D

Wait and watch

Q. 1

Sucheta, a 29 year old nulliparous women com­plains of severe menorrhagia and lower abdomi­nal pain since 3 months. On examination there was a 14 weeks size uterus with fundal fibroid.

The treatment of choice is :

 A

Myomectomy

 B

GnRH analogues

 C

Hystrectomy

 D

Wait and watch

Ans. A

Explanation:

Ans. is a i.e. Myomectomy  

First lets see whether we would like to go for medical management or surgical intervention. The patient is presenting with :

  •  Severe menorrhagia°
  • Chronic lower abdomen pain°
  • Size of fihroici = 14 weekca

These 3 indications are strong enough for surgical intervention. Other indications for surgical Management are :

  • Acute pain in abdomen as in Torsion of pedunculated fibroid or prolapsing submucosal fibroid°
  • Pressure symptoms like constipation°
  • Dysuria°
  • Infertilty (when other causes of infertility have been ruled out) and habitual abortion caused by submucous fibroid.°

Now comes the question – whether Myomectomy or hysterectomy should be done.

Indication of Myomectomy : Myomectomy is specifically indicated in an infertiie woman or woman desirous of bearing child and wishing to retain her uterus.

Since, our patient, Sucheta is just 29 years and Nulliparous – Myomectomy should be done.


Q. 2

Fundal myomas commonly present as :

 A

Inversion of uterus

 B

Dysmenorrhoea

 C

Urinary retention

 D

Menorrhagia

Q. 2

Fundal myomas commonly present as :

 A

Inversion of uterus

 B

Dysmenorrhoea

 C

Urinary retention

 D

Menorrhagia

Ans. D

Explanation:

Ans. is d i.e. Menorrhagia

I know many of you might be thinking – Inversion of uterus is the correct option. It is correct that.

Inversion of uterus occurs in a fundal submucous fibroid polyp when it is being extruded. But chronic inversion of the uterus as such is a rare entity. Most common symptom of fundal fibroid like other fibroids is menstrual irregularity­menorrhagia.

The Bottom line is :

  • Most common fibroid causing inversion of uterus is fundal submucous firboid.°
  • But most common symptom of fundal submucous fibroid is menorrhagia.°



Q. 3

Intersitial myomas predispose to menorrhagia by:

 A

Inhibiting uterine contractility

 B

Degeneration

 C

Erosion of endometrial mucosa

 D

Mechanism not known

Q. 3

Intersitial myomas predispose to menorrhagia by:

 A

Inhibiting uterine contractility

 B

Degeneration

 C

Erosion of endometrial mucosa

 D

Mechanism not known

Ans. A

Explanation:

Inhibiting uterine contractility


Q. 4

A 30 year old, para two, with two live children has menorrhagia for 2 years. She was ligated 4 years back. On investigation she is found to have a 2 cm X 2 cm submucous myoma. What will be the best management option for her :

 A

Total abdominal hysterectomy

 B

Danazol 400mg twice daily for 3 months

 C

Gn RH analogues

 D

Hysteroscopic myoma resection

Q. 4

A 30 year old, para two, with two live children has menorrhagia for 2 years. She was ligated 4 years back. On investigation she is found to have a 2 cm X 2 cm submucous myoma. What will be the best management option for her :

 A

Total abdominal hysterectomy

 B

Danazol 400mg twice daily for 3 months

 C

Gn RH analogues

 D

Hysteroscopic myoma resection

Ans. A

Explanation:

Total abdominal hysterectomy


Q. 5

Puberty menorrhagia is treated by :

 A

Progesterone

 B

Progesterone and estrogen

 C

GnRH analogues

 D

All

Q. 5

Puberty menorrhagia is treated by :

 A

Progesterone

 B

Progesterone and estrogen

 C

GnRH analogues

 D

All

Ans. D

Explanation:

Ans. is a, b and c i.e. Progesterone; Progesterone & estrogen; and GnRH analogues 

Most common cause of puberty menorrhagia is Anovulatory cycles – so the girl should be managed initially with

–   Explanation                             – Reassurance                                – Mefenamic acid &

–    Psychological support           – Correction of anaemia                   tranexemic acid

  • In refractory cases: potent progesterone eg. Medroxy progesterone acetate is given until bleeding stops.
  • Progesterone and oral contraceptive pills both are used during episodes of bleeding and later to regularize and control menstrual bleeding.
  • Oestrogen therapy alone yields very good results but is not recommended due to its high dose and side effects and is reserved only for emergency situations.
  • Danazol is contraindicated in young girls as it causes hirsutism.
  • In case hormone therapy fails, curettage of endometrium ican be done to rule out genital TB, (seen in 4% of these young girls) or presence of intrauterine clots.

Use of GnRH analogues :

“For adolescent patients with coagulopathies or malignancy requiring chemotherapy, long term therapeutic amenorrhea with menstrual suppression using GnRH analogues can be achieved.” 

Other therapies :

  • Desmopressin – synthetic analogue of vasopressin is given in case of Von Willebrand disease.
  • In patients not responding to medical therapy – Mirena IUCD is inserted. It causes thining of the endometrium.
  • Rarely when uterine arterio venus aneurysm exists, embolisation of uterine artery is done

Q. 6

A 45 year old female presenting with dysmenorrhoea & menorrhagia most probably has :

 A

DUB

 B

Endometriosis

 C

Fibroid

 D

B and C both

Q. 6

A 45 year old female presenting with dysmenorrhoea & menorrhagia most probably has :

 A

DUB

 B

Endometriosis

 C

Fibroid

 D

B and C both

Ans. D

Explanation:

Ans. is d i.e. Endometriosis; and Fibroid (Most probably)

Well friends, here we will have to weigh each option one by one.

Option “a”  DUB              

  • Especially metropathia hemorrhagica is seen in age group 40 – 45 years which coincides with the age of the patient given in the question.
  • But in DUB (as 80% cases are due to anovulatory bleeding) pain is characteristically absent. Bleeding is always painless and acyclical and continues for 2 – 8 days. In about half the cases it is preceded by a short period of amenorrhea (Metropathia Haemorrhagica).

So, option “a” is ruled out.

Option “b” : Endometriosis

Dysmenorrhea (Secondary and Progressive in nature) and menstrual irregularities including menorrhagia are specifically seen in endometriosis.    

As far as age is concerned.

“Active endometriosis is seen most commonly between the ages of 30 and 40 years. It can however occur at any time between the menarche and the menopause, even before the age of 20 years.”

Option “c”         Fibroid

  • Age group : Seen in women of child bearing age group. Seen in 40% of women above the age of 40 years.
  • Fibroids most commonly cause symptoms between the ages of 35 and 45 years. (So age is consistent with the patients age).
  • Fibroid uterus causes menorrhagia and dysmenorrhea so, the possibility of fibroid is high. 

Option “d” : Endometrial carcinoma

  • It is not a case of endometrial Ca because, endometrial Ca is common in 55 – 60 years 
  • Patient presents with irregular and heavy cycles.

The lower abdominal pain in advanced stage is due to parametrial involvement. (Not dysmenorrhea) .


Q. 7

Which of the following is not indicated in menorrhagia :

 A

NSAID’s

 B

Clomiphene

 C

Norethesterone

 D

Tranexamic acid

Q. 7

Which of the following is not indicated in menorrhagia :

 A

NSAID’s

 B

Clomiphene

 C

Norethesterone

 D

Tranexamic acid

Ans. B

Explanation:

Ans. is b i.e. Clomiphene

Clomiphene is mainly indicated in anovulatory infertility and PCOD.

Medical management of menorrhagia :

  • NSAID’s or prostaglandin synthetase inhibitors
  • Hormones : — Progesterones  — Combined OCP

— Danazol  — Gestrinone, GnRH agonist

— Mifepristone (In Menorrhagia due to fibroids)

  • Antifibrinolytic drugs : Act by inhibiting plasminogen activators, reducing the accelerated fibrinolytic activity found in menorrhagic women.e.g. : Tranexamic acid
  • Ethamsylate : Acts by decreasing capillary fragility.
  • GnRH agonist : They induce down regulation of pituitary with an initial agonist phase followed by down regulation causing hypoestrogenism which results in amenorrhea in 90% cases.
  • SERM-Ormeloxiphene:lt is an antagonist to uterine and breast tissue by its antiestrogenic effects and agonist to bone and CVS.
  • Seasonale-It is a new drug with estrogen & progesterone combined.lt is given daily for 84 days & a gap of 6 days is given after that during which menstruation occurs.



Q. 8

Which one of the following is the primary treatment of puberty menorrhagia in a 16 years old girl with 3 gm% Hb ?

 A

Dilatation and curettage with blood transfusion

 B

Danazol with blood transfusion

 C

Progestogen with blood transfusion

 D

A combination of estrogen and progesterone with blood transfusion

Q. 8

Which one of the following is the primary treatment of puberty menorrhagia in a 16 years old girl with 3 gm% Hb ?

 A

Dilatation and curettage with blood transfusion

 B

Danazol with blood transfusion

 C

Progestogen with blood transfusion

 D

A combination of estrogen and progesterone with blood transfusion

Ans. D

Explanation:

Ans. is d i.e. A combination of estrogen and progesterone with blood transfusion  

Management of Puberty Menorrhagia

Since, it is not mentioned in the question, whether the girl is having severe bleeding / moderate bleeding and I.V. conjugated estrogen with blood transfusion is not given in the options, combination of Estrogen and Progesterone is the next best option.

The girl has Hb = 3 gm%. So, blood transfusion should be done.


Q. 9

Commonest condition associated with menorrhagia is :

 A

Adenomyosis

 B

Fibroid

 C

Granulosa cell tumour

 D

Polycystic ovary 

Q. 9

Commonest condition associated with menorrhagia is :

 A

Adenomyosis

 B

Fibroid

 C

Granulosa cell tumour

 D

Polycystic ovary 

Ans. B

Explanation:

Fibroid


Q. 10

In perimenopausal women with menorrhagia we rule out all carcinoma except :

 A

Ovary

 B

Uterus

 C

Fallopian tube

 D

Endometrium

Q. 10

In perimenopausal women with menorrhagia we rule out all carcinoma except :

 A

Ovary

 B

Uterus

 C

Fallopian tube

 D

Endometrium

Ans. A

Explanation:

Ovary


Q. 11

Which of the following IUD is used for patients with menorrhagia :

 A

CuT 250

 B

Multiload

 C

Nova T

 D

Progestasert (Levonorgestrel)

Q. 11

Which of the following IUD is used for patients with menorrhagia :

 A

CuT 250

 B

Multiload

 C

Nova T

 D

Progestasert (Levonorgestrel)

Ans. D

Explanation:

Progestasert (Levonorgestrel)


Q. 12

Which is true regarding retroverted uterus :

 A

Causes menorrhagia

 

 B

Associated with endometriosis

 C

It is a cause of infertility

 D

All

Q. 12

Which is true regarding retroverted uterus :

 A

Causes menorrhagia

 

 B

Associated with endometriosis

 C

It is a cause of infertility

 D

All

Ans. D

Explanation:

Ans. is a, b and c i.e. Associated with endometriosis; It is a cause of infertility; Causes menorrhagia; and Associated with PID

The usual position of the uterus is one of anteversion and anteflexion, in which the body of the uterus is bent forward at its junction with cervix.

Retroversion is a condition in which axis of cervix is directed upward and backward (instead of forward).

Causes

  • Seen in 20% of patients                                      Mobile retroversion               Fixed retroversion
  • Retroversion can never be                                  • Prolapse                              • PID

congenital (it is always developmental)                        • Puerperium                          • Pelvic tumors

malformation as the uterus is without                           • Fibroid                                   • Chocolate cyst of ovary

version and flexion at birth.                                          • Ovarian cyst                          • Pelvic endometriosis

                                                                                      (pushes uterus backward)

Symptoms :

  • Mobile retroversion is usually symptomless, main disadvantage being increased risk of perforation of the uterus at the time of instrumentation.

Symptoms which can be seen are :

  • Spasmodic dysmenorrhea°
  • Pelvic congestion syndrome causing :

– Congestive dysmenorrhea

–        Polymenorrhagia

–        Premenstrual low backache

–    Dyspareunia (it is the most specific and genuine complain in case of retroversion)

–        Leucorrhoea

  • Infertility as cervix is directed forward away from the seminal pool and the ejaculation of semen directly into the external os.
  • Abortion : can cause abortion between 10th to 14th week.

Treatment :

  • If retroversion is mobile no treatment is required.
  • In patient complaining of dyspareunia backache with retroverted uterus Hodge pessary may be used to keep uterus in anteverted position.
  • Surgical management : – Modified Gilliams operation

Plication of round ligament°

Baldy webster open9tion°


Q. 13

All are true about in puberty menorrhagia Except:

 A

Associated with anovulatory bleeding

 B

Endometrial biopsy confirms diagnosis

 C

Routine screening for bleeding disorder is done

 D

Hematinics & Hormone therapy is the treatment of choice

Q. 13

All are true about in puberty menorrhagia Except:

 A

Associated with anovulatory bleeding

 B

Endometrial biopsy confirms diagnosis

 C

Routine screening for bleeding disorder is done

 D

Hematinics & Hormone therapy is the treatment of choice

Ans. B

Explanation:

Endometrial biopsy confirms diagnosis REF: Novak’s gynecology 13′ edition – page 152

Causes of mennorhagia in adoloscese

  • Anovulatory bleeding
  • Pregnancy-related Bleeding
  • Exogenous Hormones
  • Hematologic Abnormalities
  • Infections
  • Anatomic Causes Obstructive or partially obstructive genital anomalies typically present during adolescence. mUllerian abnormalities, such as obstructing longitudinal vaginal septa or uterus didelphisolycystic ovarian syndrome

Diagnosis

  • Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse.
  • Laboratory Testing In addition to a pregnancy test, laboratory testing should include a complete blood count with platelets, coagulation studies, and bleeding time.
  • Thyroid studies also may be appropriate. A complete pelvic examination is appropriate if the patient has been sexually active, is having severe pain, or an anomaly is suspected.
  • Cultures for gonorrhea and testing for chlamydia infection are appropriate if the patient has been sexually active. Some young teens who have a history that is classic for anovulation, who deny sexual activity, and who agree to return for follow-up evaluation may be managed with a limited gynecologic examination and pelvic ultrasonography
  • Imaging Studies If the pregnancy test is positive, pelvic imaging using ultrasonography may be necessary to confirm a viable intrauterine pregnancy and rule out a spontaneous abortion or ectopic pregnancy. If a pelvic mass is suspected on examination, or if the examination is inadequate (more likely to be the case in an adolescent than an older woman) and additional information is required, pelvic ultrasonography may be helpful

Management

  • Management of bleeding abnormalities related to pregnancy, thyroid dysfunction, hepatic abnormalities, hematologic abnormalities, or androgen excess syndromes should be directed to treating the underlying condition. Oral contraceptives can be extremely helpful in managing androgen excess syndromes. After specific diagnoses have been ruled out by appropriate laboratory testing, anovulation or dysfunctional bleeding becomes the diagnosis of exclusion.

Q. 14

A woman is said to be have menorrhagia if the menstrual blood loss is MORE than:

 A

20 ml

 B

40 ml

 C

60 ml

 D

80 ml

Q. 14

A woman is said to be have menorrhagia if the menstrual blood loss is MORE than:

 A

20 ml

 B

40 ml

 C

60 ml

 D

80 ml

Ans. D

Explanation:

Menorrhagia is defined as loss more than 80 ml of blood per cycle and frequently producing anemia. Predictors of menorrhagia includes bleeding resulting in iron deficiency anemia or a need of transfusion, passage of clots more than 1 inch diameter and changing pad or tampon more than hourly. 
  • Normal menstrual bleeding last for an average of 5 days with a mean blood loss of 40 ml.
  • Menorrhagia is defined as bleeding between periods.
  • Polymenorrhea is defined as bleeding that occurs more often than every 21 days.
  • Oligomenorrhea is defined as bleeding that occur less frequently than every 35 days.
Ref: Konkle B. (2012). Chapter 58. Bleeding and Thrombosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

Q. 15

32 year old lady presented with menorrhagia and dysmenorrhea. What is the definitive treatment of adenomyosis?

 A

Mifepristone

 B

Oral progestins

 C

Hysterectomy

 D

Conservative resection

Q. 15

32 year old lady presented with menorrhagia and dysmenorrhea. What is the definitive treatment of adenomyosis?

 A

Mifepristone

 B

Oral progestins

 C

Hysterectomy

 D

Conservative resection

Ans. C

Explanation:

Hysterectomy is the definitive treatment and as with other conditions, the type of surgical procedure depends on uterine size and associated uterine or abdominopelvic pathology.

Endometrial ablation or resection using hysteroscopy has been used to successfully treat dysmenorrhea and menorrhagia caused by adenomyosis.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


Q. 16

A 27 year old nulliparous woman complains of severe menorrhagia and lower abdominal pain since 4 months. On examination there is a 9 wks size uterus with fundal fibroid. The treatment of choice is:

 A

Myomectomy

 B

GnRh analogues

 C

Hysterectomy

 D

Wait and watch

Q. 16

A 27 year old nulliparous woman complains of severe menorrhagia and lower abdominal pain since 4 months. On examination there is a 9 wks size uterus with fundal fibroid. The treatment of choice is:

 A

Myomectomy

 B

GnRh analogues

 C

Hysterectomy

 D

Wait and watch

Ans. A

Explanation:

Resection of tumors is an option for symptomatic women who desire future childbearing or for those who decline hysterectomy.

This can be performed laparoscopically, hysteroscopically, or via laparotomy incision, and each is described in detail in the surgical atlas.

Myomectomy usually improves pain, infertility, or bleeding.

Menorrhagia improves in approximately 70 to 80 percent of patients following tumor removal.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 9. Pelvic Mass. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


Q. 17

Which of the following is not indicated in menorrhagia:

 A

NSAID’s

 B

Clomiphene

 C

Norethesterone

 D

Tranexamic acid

Q. 17

Which of the following is not indicated in menorrhagia:

 A

NSAID’s

 B

Clomiphene

 C

Norethesterone

 D

Tranexamic acid

Ans. B

Explanation:

The chief use of clomiphene citrate is in sterility due to failure of ovulation.

Ref: Essentials of Medical Pharmacology By K D Tripathi, 6th Edition, Page 303 ; Reproductive Endocrinology for The MRCOG and Beyond By Adam H. Balen, 2007, Page 60 ; Textbook of Gynaecology By Shaw, Soutter, Stanton, 2nd Edition, Page 435 ; Shaw’s Textbook of Gynaecology, 12th Edition, Page 242


Q. 18

A patient comes to you with history of frequent cycles with heavy bleeding. This condition is called:

 A

Menorrhagia

 B

Polymenorrhea

 C

Polymenorrhagia

 D

Metrorrhagia

Q. 18

A patient comes to you with history of frequent cycles with heavy bleeding. This condition is called:

 A

Menorrhagia

 B

Polymenorrhea

 C

Polymenorrhagia

 D

Metrorrhagia

Ans. C

Explanation:

Menorrhagia  –  regular cycles with prolonged or heavy bleeding

  • Polymenorrhea  –  frequent cycle with normal bleeding
  • Polymenorrhagia  –  frequent cycles with heavy bleeding
  • Menorrhagia  –  Inter menstrual bleeding
Also know
  • Normal cycle   –    21 – 35 days ( frequency)
  • Normal duration   –     2 – 8 days 
  • Normal volume  –    15 – 80 ml
 
Ref: Essentials of Gynaecology by Lakshmi Seshadri, Edition 1, page – 105.

Q. 19

Which of the following treatments for menorrhagia is NOT supported by evidence?

 A

Tranexamic acid

 B

Ethamsylate

 C

Combined OCP

 D

Norethindrone

Q. 19

Which of the following treatments for menorrhagia is NOT supported by evidence?

 A

Tranexamic acid

 B

Ethamsylate

 C

Combined OCP

 D

Norethindrone

Ans. B

Explanation:

Etamsylate does not have a clinical role in the treatment of menorrhagia.
Its effectiveness varies in randomized trials, and ranges from no reduction in flow to a 50-percent decrease.
 
Medical Treatment of Menorrhagia:
 
Acute Treatment
  • Premarin
  • Combination oral contraceptive pills (COCs)
Chronic Treatment
  • Mefenamic acid
  • Naproxen
  • Ibuprofen
  • Flurbiprofen
  • Meclofenamate
  • COCs
  • Tranexamic acid
  • Norethindrone
  • Danazol
  • GnRH agonists
  • LNG-IUS
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 8. Abnormal Uterine Bleeding. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Q. 20

A 48 years old female suffering from severe menorrhagia (DUB) underwent hysterectomy. She wishes to take hormone replacement therapy. Physical examination and breast are normal but X-ray shows osteoporosis. The treatment of choice is:

 A

Progesterone

 B

Estrogen progesterone

 C

Estrogen

 D

None

Q. 20

A 48 years old female suffering from severe menorrhagia (DUB) underwent hysterectomy. She wishes to take hormone replacement therapy. Physical examination and breast are normal but X-ray shows osteoporosis. The treatment of choice is:

 A

Progesterone

 B

Estrogen progesterone

 C

Estrogen

 D

None

Ans. C

Explanation:

Osteoporosis in this patient is due to estrogen deficiency. Estrogens are efficacious when administered orally or transdermally.

Various types of estrogens (conjugated equine estrogens, estradiol, estrone, esterified estrogens, ethinyl estradiol, and mestranol) reduce bone turnover, prevent bone loss, and induce small increases in bone mass of the spine, hip, and total body.

The effects of estrogen are seen in women with natural or surgical menopause and in late postmenopausal women with or without established osteoporosis.

Ref: Lindsay R., Cosman F. (2012). Chapter 354. Osteoporosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.


Q. 21

A 30 yr old multipara, hypertensive woman complaints of menorrhagia. Which is best treatment for her?

 A

Combined pills

 B

MIRENA

 C

Hysterectomy

 D

Transcervical resection of endometrium

Q. 21

A 30 yr old multipara, hypertensive woman complaints of menorrhagia. Which is best treatment for her?

 A

Combined pills

 B

MIRENA

 C

Hysterectomy

 D

Transcervical resection of endometrium

Ans. B

Explanation:

MIRENA is a levonorgestrel containing IUD particularly in elderly parous women assuming that they have no history of PID, ectopic pregnancy, leukemia, sickle cell disease or valvular heart disease.

In this patient MIRENA is the best treatment for her.

It is an effective alternative to hysterectomy to reduce heavy vaginal bleeding.

IUD is not indicated for young nulliparous women due to the potential for dysmenorrhea and high risk of STD.

Combined OCP is a well accepted and safe method of contraception for teens.


Q. 22

The true regarding adenomyosis is:

 A

More common in nullipara

 B

Progestins are the agents of choice for medical management

 C

Presents with menorrhagia, dysmenorrhia, and an enlarged uterus

 D

More common in young women

Q. 22

The true regarding adenomyosis is:

 A

More common in nullipara

 B

Progestins are the agents of choice for medical management

 C

Presents with menorrhagia, dysmenorrhia, and an enlarged uterus

 D

More common in young women

Ans. C

Explanation:

Adenomyosis is a condition characterized by the presence of ectopic glandular tissue found in muscle.

It usually refers to ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus).

The condition is typically found in women between the ages of 35 and 50. Patients with adenomyosis can have dysmenorrhea & menorrhagia. In adenomyosis, basal endometrium penetrates into hyperplastic myometrial fibers.

Therefore, unlike functional layer, basal layer does not undergo typical cyclic changes with menstrual cycle. Ref: Current Obstetrics and Gynecology By Gita Ganguly Mukherjee, Sudip Chakravarty, Bhaskar Pal, et al, Jaypee Brothers, Medical Publishers, 2007, Page 274


Q. 23

The coagulation profile in a 13-year old girl with Menorrhagia having von Willebrands disease is ‑

 A

Isolated prolonged PTT with a normal PT

 B

Isolated prolonged PT with a normal PTT

 C

Prolongation of both PT and PTT

 D

Prolongation of thrombin time

Q. 23

The coagulation profile in a 13-year old girl with Menorrhagia having von Willebrands disease is ‑

 A

Isolated prolonged PTT with a normal PT

 B

Isolated prolonged PT with a normal PTT

 C

Prolongation of both PT and PTT

 D

Prolongation of thrombin time

Ans. A

Explanation:

Ans. is ‘a’ i.e., Isolated prolonged PTT with a normal PT

Von Willebrand’s factor acts as a plasma carrier of factor VIII and circulates in the blood as factor VIII-VWF complex. Its deficiency therefore impairs the intrinsic pathway of coagulation and prolongs the PTT as the intrinsic pathway of coagulation remains unimpaired, PT is not altered.

i) Bleeding time

  • It is a not a test for coagulation rather it tests the ability of the vessels to vasoconstrict and the platelets to form a hemostatic plug.

o It is the time taken for a standardized skin puncture to stop bleeding.

o Normal reference value is between 2-9 minutes.

  • Prolongation generally indicates the defect in platelet number or function.

ii) Prothrombin time (PT)

o This assay tests the extrinsic and common coagulation pathway.

  • So, a prolonged PT can result from deficiency of factor V, VII, X, prothrombin or fibrinogen.

iii) Partial thromboplastin time (PTT)

o This assay tests the intrinsic and common coagulation pathways.

  • So, a prolonged PTT. Can results from the deficiency of factor V, VIII, IX, X, XI, XII, prothrombin or fibrinogen.

iv) Thrombin time

  • It is the time taken for clotting to occur when thrombin is added to the plasma.

o It tests the conversion of fibrinogen to fibrin and depends on adequate fibrinogen level.

o Prolonged thrombin time results from decreased level of fibrinogen.


Q. 24

What is thelUCD of choice in women with menorrhagia?

 A

Lippe’s loop

 B

Copper-T 200

 C

Copper-T 3 8 OA

 D

Progesterone containing IUCD

Q. 24

What is thelUCD of choice in women with menorrhagia?

 A

Lippe’s loop

 B

Copper-T 200

 C

Copper-T 3 8 OA

 D

Progesterone containing IUCD

Ans. D

Explanation:

Ans. is ‘d’ i.e., Progesterone containing IUCD 


Q. 25

A 43-year-old woman presented with mild pelvic discomfort, menorrhagia and irregular menstruation for recent 6 months. Physical examination found a firm, non-tender lower abdominal mass arising from the pelvis. Laboratory investigations were unremarkable. Cervical smear did not reveal any malignant cells or atypia. A KUB was performed as an initial investigation.What can be the possible diagnosis?

 

 A

Bladder Carcinoma

 B

Bladder Stones

 C

Endometrial Carcinoma

 D

Uterine Fibroid

Q. 25

A 43-year-old woman presented with mild pelvic discomfort, menorrhagia and irregular menstruation for recent 6 months. Physical examination found a firm, non-tender lower abdominal mass arising from the pelvis. Laboratory investigations were unremarkable. Cervical smear did not reveal any malignant cells or atypia. A KUB was performed as an initial investigation.What can be the possible diagnosis?

 

 A

Bladder Carcinoma

 B

Bladder Stones

 C

Endometrial Carcinoma

 D

Uterine Fibroid

Ans. D

Explanation:

Ans:D.)Uterine Fibroid.

Image shows:KUB shows a large calcified mass in the pelvis (arrows), which is typical for a large calcified fibroid.

UTERINE FIBROID

  • Uterine leiomyoma, also known as uterine fibroid, is benign and the most common gynaecological neoplasm.
  • When they are symptomatic, their usual presentations include: suprapubic mass, pain or menorrhagia.
  • A leiomyoma may undergo calcification as it degenerates, and become visible on plain radiograph.
  • The diagnosis is usually made on ultrasound . On USG, it appears as a well-defined hypoechoic mass in the myometrium of the uterus.

Other differentials of pelvic calcification in a female include dermoid , bladder stones  and phleboliths.



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