Gynaecology Pg No 31 -40

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Questions and Answers

At what week of intrauterine life does the complete fusion of Mullerian ducts occur?

10 weeks (correct)

5 months

18 weeks

20 weeks

The septa resolves to form a single uterine cavity by 18-20 weeks of intrauterine life.

True

From which embryonic structure do the ovaries develop?

genital ridge

The lower 2/3rd of the vagina develops from the __________.

urogenital sinus Signup and view all the answers

Match the following mullerian malformations with their classifications:

Class I = Mullerian agenesis Class II = Unicornuate uterus Signup and view all the answers

Which of the following is a use of MRI in gynecological investigations?

Visualizing parametrial involvement in cervical cancer Signup and view all the answers

Transvaginal ultrasound (TVS) is easy to perform in postmenopausal females.

False Signup and view all the answers

What is the transitional zone (TZ) size indicative of adenomyosis on MRI?

≥ 12mm Signup and view all the answers

The _____ is the best investigation for soft tissue evaluation in gynecological conditions.

MRI Signup and view all the answers

Match the following conditions with their corresponding imaging technique:

Adenomyosis = MRI Uterine fibroids = Ultrasound Endometrial carcinoma = MRI Mullerian malformation = MRI Signup and view all the answers

Which of the following characteristics distinguishes a cystocele from Gartner's cyst?

Present rugosities Signup and view all the answers

Gartner's cyst is typically located on the posterior wall of the vagina.

False Signup and view all the answers

What is the management approach for an asymptomatic Gartner's cyst?

No intervention Signup and view all the answers

The __________ is responsible for forming the majority of the female internal genitalia.

Fallopian tube Signup and view all the answers

Match the following conditions to their descriptions:

Gartner's Cyst = Swelling in the antero-lateral wall of the vagina Cystocele = Prolapse of the anterior vaginal wall Bartholin's cyst = Cyst located outside the vestibule Management of symptomatic Gartner's cyst = Cyst removal Signup and view all the answers

What classification represents the mildest form of defect in female reproductive organs?

Class VI Signup and view all the answers

The T-shaped uterus is a common finding associated with in-utero exposure to DES.

True Signup and view all the answers

What is the most common cancer associated with vaginal adenosis?

Clear cell carcinoma Signup and view all the answers

In the classification of defects, the defect known as __________ is described as having a flat-topped uterus.

arcuate uterus Signup and view all the answers

Match the following features with their respective defects:

Arcuate uterus = Best reproductive outcome Hypoplastic uterus = Most common uterine finding with DES exposure T-shaped uterus = Most specific finding with DES exposure Cervical hoods = Associated with vaginal adenosis Signup and view all the answers

Which duct is responsible for developing female internal genitalia?

Mullerian Duct Signup and view all the answers

The Wolffian Duct primarily contributes to the development of female reproductive organs.

False Signup and view all the answers

What are the remnants of the Wolffian Duct found in females called?

Epo-ophoron, Para-ophoron, Gartner's duct Signup and view all the answers

At ___ weeks, the Mullerian Duct forms internal genital organs in females.

9 Signup and view all the answers

Match the following ducts with their corresponding origins:

Mullerian Duct = Paramesonephric duct Wolffian Duct = Mesonephric duct Epo-ophoron = Cranial remnant of the Wolffian Duct Gartner's Duct = Remnant of the mesonephric duct Signup and view all the answers

What is a characteristic feature of a bicornuate uterus?

Divided fundus Signup and view all the answers

A septate uterus has a divided fundus.

False Signup and view all the answers

What is the approximate distance between the horns of a bicornuate uterus?

24 cm Signup and view all the answers

An __________ uterus appears split into two separate compartments.

Uterine didelphys Signup and view all the answers

Match the uterine shapes with their descriptions:

Normal = Typical pear-shaped uterus Didelphys = Uterus split into two compartments Unicornuate = Uterus with only one horn Septate = Uterus with a central septum dividing it Signup and view all the answers

What is the primary purpose of SIS (Saline Infusion Sonography)?

To evaluate uterine cavity pathology Signup and view all the answers

Hysterosalpingography (HSG) can be performed on a patient who is currently pregnant.

False Signup and view all the answers

What type of dye is used in the Hysterosalpingography procedure?

Water-soluble, iodinated radio-opaque dye Signup and view all the answers

During the SIS procedure, saline appears __________ on ultrasound.

black Signup and view all the answers

Match the following procedures with their primary indications:

SIS = Polyps and Submucous fibroids HSG = Evaluate tube patency TVS = Assess ovarian masses MRI = Soft tissue evaluation Signup and view all the answers

What is one of the primary uses of Hysterosalpingography (HSG)?

To evaluate the patency of the fallopian tubes Signup and view all the answers

Hysteroscopy is primarily a therapeutic procedure that eliminates all uterine pathologies.

False Signup and view all the answers

Name one possible filling defect that can be identified during an HSG procedure.

Polyp Signup and view all the answers

_________ media is used to visualize the uterine cavity during hysteroscopy.

Distension Signup and view all the answers

Match the following distension media with their type.

CO₂ = Gaseous Distension Media Ringer's lactate = Electrolyte rich Distension Media 1.5% Glycine = Electrolyte deficient Distension Media Normal saline = Electrolyte rich Distension Media Signup and view all the answers

What defect is characterized by the presence of both Mullerian ducts but only fusion in the vagina and cervix?

Bicornuate uterus Signup and view all the answers

A uterine defect with a longitudinal septum can be identified using 2 LW cannulae during a HSG procedure.

True Signup and view all the answers

What classification represents the defect known as a septate uterus?

Class V Signup and view all the answers

In a uterus diadelphys, the uterus has __________ halves, and the vagina is divided accordingly.

two Signup and view all the answers

Match the following uterine defects with their classifications:

Uterus diadelphys = Class II Bicornuate uterus = Class IV Septate uterus = Class V Longitudinal septum = Class III Signup and view all the answers

Which of the following complications can occur with electrolyte deficient media during a procedure?

Water intoxication Signup and view all the answers

Electrolyte rich media can be used with both unipolar and bipolar instruments.

True Signup and view all the answers

What is the maximum pressure inside the uterus during a procedure?

150 mmHg Signup and view all the answers

In cases of water intoxication due to electrolyte deficient media, symptoms like __________ and confusion may occur.

delirium Signup and view all the answers

Match the following instruments with their respective characteristics:

Electrolyte Rich Media = Can lead to uterine perforation Electrolyte Deficient Media = Can lead to water intoxication Laparoscopy = Invasive procedure to visualize the exterior of the uterus Hysteroscopy = Used to see the interior of the uterus Signup and view all the answers

Study Notes

Gartner's Cyst

A swelling found on the antero-lateral wall of the vagina
Differentiate from Bartholin's cyst, located outside the vestibule, and cystocele, a prolapse of the anterior vaginal wall
Can be asymptomatic or cause difficulty with intercourse
Management includes observation for asymptomatic cysts and surgical removal for symptomatic cysts

Female Internal Genitalia

Composed of fallopian tubes, uterus, cervix, and vagina
Develops from the fusion of the Mullerian ducts
Initially located lateral to the vagina, then fuse from inferior to superior
The septum resolves, forming a single uterine cavity, and the fundus of the uterus becomes dome-shaped

Development of Female Internal Genitalia

Full fusion of Mullerian ducts completes by 10 weeks of intrauterine life
A single uterine cavity forms by 18-20 weeks of intrauterine life
Endometrium differentiation occurs by 20 weeks of intrauterine life
Ovaries develop from the genital ridge
The lower 2/3rd of the vagina develops from the urogenital sinus

Mullerian Malformations

Result from defects in the formation and fusion of Mullerian ducts
Often involve lateral fusion defects
Classified by the World Health Organization (WHO) and American Society for Reproductive Medicine (ASRM)

USG in Gynecology

First-line investigation for pelvic pathology, uterine pathology, atypical uterine bleeding, and Mullerian malformations
3D USG used for Mullerian malformation visualization

MRI in Gynecology

Non-invasive and safe for pregnant women
Best for soft tissue evaluation
Helps differentiate between endometrium and myometrium
Effectively visualizes the Transitional Zone (TZ)

MRI Drawbacks

Transvaginal ultrasound (TVS) is difficult in cases of vaginal narrowing, such as in virgin females and postmenopausal women

MRI Uses

Adenomyosis: Endometrium grows inside the myometrium, TZ size ≥ 12mm
Endometrial carcinoma: Visualizes myometrial involvement
Cervical cancer: Evaluates parametrial involvement
Mullerian malformations: MRI is the gold standard

Hysteroscopy and HSG

Hysteroscopy: A procedure to visualize the interior of the uterus for diagnosis and treatment
Hysterosalpingography (HSG): X-ray procedure using contrast dye to visualize the uterus and fallopian tubes, assessing tubal patency and identifying filling defects

HSG Uses

Evaluates fallopian tube patency
Identifies Mullerian malformations
Visualizes filling defects within the uterine cavity

HSG Filling Defects

Polyp
Fibroid
Asherman's syndrome: Multiple, irregular filling defects
Genital tuberculosis: Used in conjunction with anti-tuberculosis treatment to evaluate tube patency

Hysteroscopy Advantages

Direct visualization of the uterine cavity
Diagnostic and therapeutic

Hysteroscopy Disadvantages

Cannot be used therapeutically

Hysteroscopy Procedure

Patient position: Lithotomy
Pain relief: Paracervical block with 1% xylocaine (diagnostic), general or regional anesthesia (therapeutic)
Distension media: Gaseous (CO2) or liquid (absorbed by the body, requiring careful consideration)

Distention Media

Electrolyte rich media: Ringer's lactate (RL), Normal saline (NS); Active space: Can be used with both unipolar and bipolar instruments, potential for uterine perforation
Electrolyte deficient media: 1.5% Glycine, 3% Sorbitol, 5% Mannitol; Can be used only with both unipolar and bipolar instruments, risk of water intoxication and hyponatremia
Normal uterine pressure: 75-80mmHg, maximum: 150mmHg

Hysteroscopy Contraindications

Pregnancy
Pelvic infections
Cervical issues
Cardiopulmonary disease

Laparoscopy

Invasive procedure to visualize the exterior of the uterus
Left and right sides of the patient correspond to the observer's left and right

Laparoscopy Indications

Infertility
Endometriosis
Chronic pelvic pain
Combined with hysteroscopy for comprehensive evaluation

Laparoscopy Gold Standard

Pelvic inflammatory disease (PID)
Tubal palsy: Laparoscopic chromopertubation

Saline Infusion Sonography (SIS)

Procedure to visualize the uterine cavity using saline and ultrasound
Used to diagnose polyps or submucous fibroids

SIS Procedure

Foley's catheter distends the uterine cavity
Saline, which appears black on ultrasound, is infused
Pathology is visualized against the black saline background

HSG Procedure

Water-soluble, iodinated radio-opaque dye (e.g., urograffin) is injected into the uterus via a cannula
Serial X-rays are taken to track the dye's path
Done in the pre-ovulatory phase (Day 7-10)

HSG Contraindications:

Pregnancy
Active pelvic infection
Active genital tuberculosis (TB)

Uterine Shapes

Normal: Pear-shaped
Didelphys: Split into two separate compartments
Arcuate: Flattened or curved fundus with a deeper curvature in the center of fundus
Unicornuate: One horn
Bicornuate: Two distinct horns
Septate: A central septum divides the uterus into two chambers

Bicornuate vs. Septate Uterus

Feature	Bicornuate Uterus	Septate Uterus
Fundus	Divided	Normal
Dye	Cannot differentiate	Normal

HSG Dye

Can delineate different sections of the uterus
May not completely separate compartments in bicornuate and septate uteri

Angles and Distance Between Uterine Horns

Obtuse angle and 24 cm distance between horns: Likely indicates bicornuate uterus
Acute angle and 10 cm distance between horns: May be indicative of septate uterus

Table of Uterine Defects

Class	Defect	Called As	Diagram	Comment
II	Bilateral MD present, but fail to fuse or Fusion occurs only in the region of the vagina	Uterus diadelphys; Fundus: two halves; Vagina: two halves or Single	Diagram of a uterus with two halves separated by a midline septum	Complication: Transverse lie. On HSG: 2 LW cannulae for an external os; 2 vaginas.
III	Longitudinal septum		Diagram of a uterus with a longitudinal septum	2 LW cannulae; Obstructed hemivagina
IV	Both MD present, only vagina & cervix fused	Bicornuate uterus; Fundus: two; Cervix: one; Vagina: one	Diagram of a bicornuate uterus	Fundus of uterus: Divided in two. On HSG: Doesn't visualize top of fundis; Cannot differentiate between bicornuate & septate uterus.
V	Both MD present, fusion occurs, septa fails to resolve	Septate uterus	Diagram of a septate uterus	Exteriorly: uterus appears normal. Interiorly: Septa present; Fundus: Not divided; Incomplete septa; Complete septa.

Electrolyte Rich vs Deficient Distention Media

Electrolyte Rich Media: Can be used only with bipolar instruments; Active space; Can lead to uterine perforation; Stop procedure when fluid deficit = 2.5L
Electrolyte Deficient Media: Can be used only with both unipolar and bipolar instruments; Risk of water intoxication (e.g., nausea, vomiting, headache); Hyponatremia can occur (e.g., delirium, confusion) except with mannitol; Stop procedure when fluid deficit = 1L

Invasive Procedures

SIS: Saline Infusion Sonography; Procedure to visualize the uterine cavity using saline and ultrasound; Used to diagnose polyps or submucous fibroids
HSG: Hysterosalpingography; Procedure to visualize the uterus and fallopian tubes using X-ray with contrast dye; Used to assess tubal patency and identify filling defects

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Description

Explore the intricate details of the female internal genitalia, including the formation of structures such as the fallopian tubes, uterus, cervix, and vagina. Understand the differences between Gartner's cyst and other types of cysts, as well as the timeline of development concerning the fusion of Mullerian ducts. This quiz is essential for those studying gynecology or reproductive biology.