Gynaecology Pg No 101 -110
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Questions and Answers

Which of the following is NOT a common clinical finding associated with prolactinoma?

  • Diarrhea (correct)
  • Secondary amenorrhea
  • Galactorrhea
  • Visual disturbances

    • A microadenoma is defined as a tumor size greater than or equal to 1 cm.

    False

    What is the first-line medical treatment for symptomatic prolactinoma?

    Cabergoline

    A patient with a macroadenoma may experience __________ due to pressure on surrounding structures.

    <p>headache</p> Signup and view all the answers

    Match the following types of adenoma with their characteristics:

    <p>Microadenoma = Tumor size &lt; 1 cm Macroadenoma = Tumor size ≥ 1 cm</p> Signup and view all the answers

    What is the maximum recommended dose of Enclomiphene for treatment?

    <p>150mg OD</p> Signup and view all the answers

    Intrauterine insemination (IUI) carries a high risk of teratogenicity.

    <p>False</p> Signup and view all the answers

    What is the drug of choice for managing elevated prolactin in all females?

    <p>Cabergoline</p> Signup and view all the answers

    What is the typical duration for administering Enclomiphene?

    <p>5 days, day 5-9</p> Signup and view all the answers

    Elevated prolactin can lead to increased levels of estrogen in females.

    <p>False</p> Signup and view all the answers

    The half-life (T1/2) of Enclomiphene is approximately ______.

    <p>2 weeks</p> Signup and view all the answers

    What are the common treatments for hypothyroidism mentioned in the content?

    <p>Thyroxine</p> Signup and view all the answers

    Match the adverse effects with their corresponding descriptions:

    <p>Hot flushes = Mild to moderate due to decreased estrogen Ovarian Hyperstimulation syndrome (OHSS) = Least common adverse effect Multiple pregnancies = Occurs in 7-10% of cases Visual disturbances = Includes diplopia and scotoma, requiring immediate stoppage</p> Signup and view all the answers

    Elevated prolactin levels in males and females lead to infertility and decreased levels of ________ in females.

    <p>estrogen</p> Signup and view all the answers

    Match the following conditions to their respective effects on hormone levels:

    <p>Elevated PRL = Decreased GNRH Hypothyroidism = Increased TSH Lactation = Increased PRL Amenorrhea = Increased androgens</p> Signup and view all the answers

    What is the minimum duration of absence of menstruation to be classified as secondary amenorrhea?

    <p>90 days</p> Signup and view all the answers

    Lactation can cause secondary amenorrhea due to increased levels of Prolactin.

    <p>True</p> Signup and view all the answers

    Name one investigation used to assess levels of prolactin in suspected cases of secondary amenorrhea.

    <p>Serum prolactin</p> Signup and view all the answers

    Absence of menstruation for ≥ 90 days in a previously menstruating female is referred to as __________.

    <p>secondary amenorrhea</p> Signup and view all the answers

    Match the following causes of secondary amenorrhea with their descriptions:

    <p>Pregnancy = Permanent cessation of menstruation Lactation = Hormonal influence due to breastfeeding Hyperprolactinemia = Elevated prolactin levels affecting menstrual cycles Thyroid disorders = Disruption of hormonal balance affecting menstruation</p> Signup and view all the answers

    What is the first-line drug used for ovulation induction?

    <p>Letrozole</p> Signup and view all the answers

    Clomiphene citrate is a steroidal medication used for inducing ovulation.

    <p>False</p> Signup and view all the answers

    What is the typical rate of ovulation achieved with clomiphene citrate treatment?

    <p>80%</p> Signup and view all the answers

    Clomiphene citrate can lead to ________ cervical mucus, which can be unfavorable for pregnancy.

    <p>thick</p> Signup and view all the answers

    Match the management step with its respective treatment:

    <p>1st Step = Advice weight loss and trial of natural conception 1st Line Management = Pharmacological therapy 2nd Line Management = Laparoscopic ovarian drilling 3rd Line Management = Pulsatile GnRH or IVF</p> Signup and view all the answers

    What is the primary indication for using glucocorticoids such as dexamethasone in the management of PCOS?

    <p>Clomiphene-resistant PCOS with increased androgen levels</p> Signup and view all the answers

    Laparoscopic ovarian drilling has a risk of multiple pregnancies associated with it.

    <p>False</p> Signup and view all the answers

    What is the purpose of using metformin in patients with clomiphene-resistant PCOS?

    <p>To address insulin resistance</p> Signup and view all the answers

    The recommended power for laparoscopic ovarian drilling is _____ watts.

    <p>40</p> Signup and view all the answers

    Match the following treatments with their indications in PCOS:

    <p>CC + Glucocorticoids = Clomiphene resistant PCOS + ↑ Androgen CC + Metformin = Clomiphene resistant PCOS + Insulin resistance OCPs (with CC) = To decrease LH and androgens hMG = Hypogonadotropic hypogonadism</p> Signup and view all the answers

    What is one of the advantages of using Oral Contraceptive Pills (OCPs) in the treatment of PCOS?

    <p>Protects against endometrial cancer</p> Signup and view all the answers

    Medroxyprogesterone acetate (MPA) is considered the drug of choice for regularizing cycles in PCOS.

    <p>False</p> Signup and view all the answers

    What is the duration of treatment for OCPs?

    <p>21 days with 1 week off</p> Signup and view all the answers

    The primary hormone combination in OCPs for treating PCOS is _____ and _____ to facilitate ovarian suppression.

    <p>Estrogen, Progesterone</p> Signup and view all the answers

    Match the treatment with its effect in PCOS:

    <p>OCPs = Regularizes cycles and reduces androgens MPA = Facilitates withdrawal bleeding Estrogen + Progesterone = Leads to ovarian suppression Progesterone = Used cyclically every 12-14 days</p> Signup and view all the answers

    Which of the following statements accurately describes metformin's role in managing PCOS?

    <p>Metformin is an insulin sensitizer that may aid in weight loss.</p> Signup and view all the answers

    Oral contraceptives are indicated in all PCOS cases, including those resistant to clomiphene.

    <p>False</p> Signup and view all the answers

    Name one drug that is contraindicated in the treatment of hirsutism.

    <p>Danazol</p> Signup and view all the answers

    The condition caused by an androgen producing ovarian tumor is called ______.

    <p>hirsutism</p> Signup and view all the answers

    Match the following drugs to their respective characteristics regarding ovulation induction:

    <p>Clomiphene citrate = SERM capable of ovulation induction Tamoxifen = SERM capable of ovulation induction Raloxifene = SERM capable of ovulation induction Ormeloxifene = SERM that does not cause ovulation induction</p> Signup and view all the answers

    What is the primary mechanism of action of Clomiphene Citrate?

    <p>Blocking estrogen receptors in the hypothalamus</p> Signup and view all the answers

    Letrozole is associated with a higher risk of multiple pregnancies compared to Clomiphene Citrate.

    <p>False</p> Signup and view all the answers

    What is the starting dose of Letrozole for ovulation induction?

    <p>2.5 mg OD</p> Signup and view all the answers

    Clomiphene Citrate is the first-line treatment for __________ induction.

    <p>ovulation</p> Signup and view all the answers

    Match the drug with its corresponding side effect:

    <p>Clomiphene Citrate = Vaginal dryness Letrozole = Headaches</p> Signup and view all the answers

    What is the most common symptom associated with Asherman syndrome?

    <p>Menstrual irregularities</p> Signup and view all the answers

    Hysteroscopic Adhesiolysis is a management technique used for Asherman syndrome.

    <p>True</p> Signup and view all the answers

    Name one investigation used to identify Asherman syndrome.

    <p>Hysterosalpingography (HSG)</p> Signup and view all the answers

    In Asherman syndrome, the hormone profile usually shows normal levels of _____ and _____ during investigations.

    <p>LH</p> Signup and view all the answers

    Match the type of test with its significance in Asherman syndrome:

    <p>TVS = First investigation Hysterosalpingography = Moth eaten appearance Progesterone Challenge Test = Negative result in Asherman syndrome Estrogen &amp; Progesterone treatment = Builds endometrium</p> Signup and view all the answers

    Study Notes

    Clomiphene Citrate (CC)

    • Selective Estrogen Receptor modulator (SERM)
    • Non-steroidal, centrally acting anti-estrogenic drug
    • Blocks estrogen receptors in hypothalamus and pituitary
    • Increases LH and FSH levels by falsely interpreting decreased estrogen levels
    • Binds to peripheral estrogen receptors in the Endometrium, Cervix
    • Causes endometrial thinning, thick cervical mucus, unfavorable for pregnancy
    • Ovulation rate: 80%
    • Pregnancy rate: 5-10%
    • Used as a first-line ovulation induction drug

    Second Line Management of Clomiphene Resistant PCOS

    • Clomiphene Citrate + Glucocorticoids (Dexamethasone): indicated for clomiphene resistant PCOS with elevated androgens
    • Clomiphene Citrate + Metformin: indicated for clomiphene resistant PCOS with insulin resistance
    • Oral Contraceptives (OCPs): for 2 months, decreases LH levels and Androgen
    • HMG: 75 IU LH + 75 IU FSH + impurities, indicated for hypogonadotropic hypogonadism, DOC for ovulation induction
    • Recombinant Inj FSH: Purified form of FSH, expensive
    • Laparoscopic ovarian drilling: burns ovarian stroma, destroys theca cells, decreases Androgens, no risk of multiple pregnancies or OHSS
    • IVF in PCOS: indicated for women >35 years with other factors contributing to infertility

    Mechanism of Action of OCPS

    • Estrogen + Progesterone leads to ovarian suppression, causing anovulation and reduction in Androgens
    • Endometrial thinning occurs due to progesterone
    • Progesterone is used cyclically every 12-14 days in the second half of the cycle
    • Medroxyprogesterone acetate (MPA) can be used for 5 days, facilitates withdrawal bleeding

    Advantages of OCPS in PCOS

    • Regularizes menstrual cycles
    • Treats hirsutism
    • Contraceptive benefit
    • Protects against endometrial cancer

    Disadvantages of MPA

    • Does not regularize menstrual cycles
    • No protective effect on endometrium, less than 12 days

    Drugs Contraindicated in PCOS and Infertility

    • Spironolactone: Anti-androgenic
    • Oral Contraceptives (OCPs): Except in clomiphene resistant cases

    Management of Insulin Resistance

    • DOC: metformin
    • Helps in weight loss
    • Mild anti-hirsutism action
    • Decreases the chance of gestational diabetes mellitus in PCOS
    • Can be continued during pregnancy
    • Decreases the risk of OHSS

    Causes of Hirsutism

    • PCOS: Most common cause
    • Idiopathic hirsutism
    • Androgen producing ovarian tumor
    • Androgen producing adrenal tumor
    • Cushing syndrome: Hirsutism + Diabetes/Hypertension
    • Pregnancy luteoma: Hyperplastic mass of luteinized ovarian cells (not a true tumor)
    • Theca lutein cysts: Due to ↑ hCG (similar to a subunit of LH)
    • Hyper prolactinemia

    Drugs Contraindicated in Hirsutism

    • Danazol
    • Gestrinone

    Clomiphene vs Letrozole

    Clomiphene

    • SERM
    • Centrally acting
    • Blocks receptors in hypothalamus and pituitary
    • Increases LH and FSH
    • Starting dose: 50mg
    • Maximum dose: 150mg
    • T1/2: 2 weeks
    • Follicular development: Multifollicular
    • Risk of multiple pregnancies: 7-10%
    • Effect on endometrium and cervix: Blocks estrogen receptors
    • Live birth rate: ↑
    • Side effects: Hot flushes, vaginal dryness
    • Teratogenicity: No effect, increased chances of pregnancy
    • Uses: DOC for ovulation induction, DOC for PCOS
    • Pre-requisite: Intact HPO axis + Normal FSH levels

    Letrozole

    • Aromatase inhibitor
    • Peripherally acting
    • Decreases androgen aromatase
    • Decreases estrogen
    • Starting dose: 2.5 mg OD
    • Maximum dose: 7.5 mg OD
    • Follicular development: Monofollicular + Multifollicular
    • Risk of Multiple Pregnancies: 3-7%

    Asherman Syndrome

    • Intrauterine adhesions and thin, defective endometrium
    • Highest risk: Curettage done postpartum
    • Causes: Excessive curettage, D&C (Dilation & Curettage)
    • Symptoms: Menstrual irregularities, infertility, 2° Amenorrhea, Hypomenorrhea, 2° Dysmenorrhea, Recurrent abortions, Schistosomiasis, removal of retained tissue, genital TB
    • Investigation: TVS or hormonal test, hysterosalpingography (moth-eaten appearance)
    • 2° Amenorrhea Investigations: UPT, LH, FSH, Estrogen, Prolactin, TSH, Progesterone Challenge/withdrawal Test, Progesterone & Estrogen withdrawal Test
    • Management: Hysteroscopic Adhesiolysis, Intra uterine insertion of Foley's catheter, Estrogen & Progesterone x 3 months

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    Description

    Explore the use of Clomiphene Citrate (CC) as a first-line treatment for ovulation induction in PCOS patients. This quiz covers its mechanism of action, effectiveness, and second-line management strategies when faced with resistance. Test your knowledge on related therapies combining glucocorticoids and metformin.

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