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What type of drug is Ulipristal?
Mifepristone is also known as RU486.
True
What are two indications for the use of Ulipristal?
Fibroid, Emergency contraceptive
Mifepristone is used for ______ abortion.
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Match the following drugs with their characteristics:
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What is the term for absence of menstruation for 3 months?
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Metrorrhagia is defined as irregular bleeding that occurs between menstrual cycles.
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What is considered heavy menstrual bleeding in terms of blood volume?
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A menstrual cycle length of less than 24 days is referred to as ________ menses.
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Match the following characteristics with their respective criteria:
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Which of the following is a structural cause of atypical uterine bleeding?
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Anovulation is classified under non-structural causes of atypical uterine bleeding.
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What alteration in hormone levels is associated with endometrial causes of atypical uterine bleeding?
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The clinical features of endometrial etiology include cyclical heavy menstrual bleeding and a normal-sized uterus on ______.
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Match the following conditions with their clinical features:
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What is the average duration of menstruation for a normal menstrual cycle?
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Oligomenorrhea is characterized by a menstrual cycle length of less than 24 days.
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What percentage of females have a 28-day menstrual cycle?
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Menorrhagia is defined by a volume of blood loss of __________.
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Match the types of menstrual abnormalities with their characteristics:
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Which hormone has the longest half-life?
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Nulliparity is considered a protective factor against hyperestrogenic states.
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Name one common condition associated with hyperestrogenic states.
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_____ is a protective factor against hyperestrogenic states that involves giving birth to multiple children.
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What is the primary function of estrogen in relation to FSH and LH?
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FSH is associated with positive feedback in the reproductive cycle.
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Match the hormone with its type of receptor:
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What hormone is primarily responsible for the negative feedback effect on FSH?
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The hormone that is essential for the regulation of the menstrual cycle and is produced by the ovaries is called ______.
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Match the hormones with their associated functions:
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Which of the following is the most common cause of menorrhagia in puberty?
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Dysfunctional Uterine Bleeding (DUB) accounts for 80% of ovulatory cases.
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What is one hormonal condition that can lead to anovulation related to increased prolactin levels?
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Increased adipose tissue can lead to increased ______ levels in obese females.
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Match the following conditions to their description:
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Which of the following is a possible risk associated with postmenopausal hormone replacement therapy (HRT)?
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Progesterone has no effect on breast milk secretion.
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What hormone is responsible for increasing the motility of the fallopian tubes?
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An increase in estrogen can lead to _____ closure of the epiphysis and result in short stature.
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Match the hormone with its respective effects:
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Which of the following statements about hormonal effects on clotting factors is correct?
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Decreased estrogen levels in menopausal females decrease bone mineral density.
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What is the impact of thromboembolic risks associated with estrogen in smokers aged 35 and above?
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Which of the following signs is NOT typically associated with PCOS?
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CBC and Hb levels are not important for assessing the severity of the problem in general gynecology.
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Name one instrument used for endometrial sampling.
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A per vaginal and pelvic examination is not performed in ______ adolescent.
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Match the following investigations with their purposes:
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Which of the following medications is an aromatase inhibitor?
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Raloxifene is indicated for the treatment of endometrial cancer.
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What is the primary action of selective estrogen receptor modulators (SERMs)?
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Danazol has an anti-estrogenic action and __________ side effects.
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Match the following drugs with their main indications:
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Study Notes
Ulipristal
- Selective Progesterone Receptor modulator (SPRM)
- Used to treat fibroids and as an emergency contraceptive
Mifepristone
- Progesterone antagonist
- Also known as RU486
- Indicated for medical abortion and fibroids
Abnormal Menstrual Cycles
- Metrorrhagia: Irregular or intermenstrual bleeding
- Amenorrhea: Absence of menstruation for 3 months
- Frequent Menses: Cycles shorter than 24 days
- Infrequent Menses: Cycles longer than 38 days
- Heavy Bleeding: Blood loss exceeding 80 mL
- Light Bleeding: Blood loss less than 5 mL
- Prolonged Bleeding: Duration of flow exceeding 8 days
- Shortened Bleeding: Duration of flow less than 4.5 days
- Irregular Cycles: Variation in cycle length exceeding 20 days
- Intermenstrual Bleeding: Acyclical bleeding with normal menstrual pattern
- Heavy Menstrual Bleeding: Excessive bleeding interfering with quality of life
Atypical Uterine Bleeding (AUB)
- Any menstrual bleeding deviating from normal characteristics
- Two major categories: Structural and Non-Structural
Structural Causes of AUB
- P: Polyp
- A: Adenomyosis
- L: Leiomyoma
- m: Malignancy (cervical or endometrial cancer) and Endometrial hyperplasia
- Represented as AUB-P, AUB-A, etc.
Non-Structural Causes of AUB
- C: Coagulopathy
- O: Ovulatory dysfunction (Anovulation)
- E: Endometrial causes
- I: Iatrogenic (caused by medical interventions like IUD or oral contraceptives)
- N: Not otherwise classified
Endometrial Etiology of AUB
- Cause: Endometritis
- Clinical Features: Cyclical heavy menstrual bleeding and normal uterine size on ultrasound
- Pathogenesis: Altered PGE1: PGE2 ratio, increased fibrinolytic activity, normal progesterone levels
- Ovulatory Etiology: Anovulation and estrogen breakthrough bleeding leading to irregular, heavy, painless cycles
- Clinical Features: Heavy bleeding and oligomenorrhea (infrequent periods)
Characteristics of a Normal Menstrual Cycle
- Cycle Length: 24 to 38 days
- Blood Loss: 20 to 80 mL
- Duration of Bleeding: 4.5 to 8 days
- Cycle-to-cycle Variation: 2 to 20 days
Abnormal Menstrual Cycles - Old Terminologies
- Oligomenorrhea: Cycles longer than 38 days (previously longer than 35 days)
- Polymenorrhea: Frequent short cycles
- Menorrhagia: Heavy blood loss exceeding 80 mL and longer duration of bleeding (exceeding 8 days)
- Hypomenorrhea: Light blood loss (less than 20 mL) and short duration of bleeding (less than 2 days)
Menstrual Cycle Phases
- Ovarian Cycle: Follicle growth, ovulation, corpus luteum growth, and degeneration of corpus luteum
- Uterine Cycle: Cyclical growth and shedding of endometrium
Estrogen Effects on Various Systems
- Vaginal Cytology: Used to test for ovulation. Predominant superficial cells on cytology can indicate ovarian tumors
- Breast: Ductal development, fat deposition, and milk secretion during lactation. Increases risk of breast cancer in postmenopausal women. Oral contraceptives are contraindicated during lactation, but progesterone-only contraceptives are preferred.
- Fallopian Tube: Increased motility.
- Salt and Water: No mentioned effect.
- Bones: Increases bone mass and mineralization, decreases calcium levels, and closes epiphysis of long bones.
- Clotting Factors: Increases risk of thrombosis, venous thromboembolism, coronary artery disease, and stroke. Increased risk for women who smoke and are over 35.
Progesterone Effects on Various Systems
- Vaginal Cytology: No mentioned effect.
- Breast: Glandular development (no effect on breast milk)
- Fallopian Tube: Decreased motility (contributes to failure of progesterone-containing contraceptives)
- Salt and Water: No mentioned effect.
- Bones: No mentioned effect.
- Clotting Factors: Progesterone-only contraceptives can be used in patients with thrombosis history due to its clotting factor effects.
Effects of Estrogen and Progesterone: Additional Details
- Precocious Puberty: Increased estrogen can lead to premature epiphysis closure and short stature.
- Menopausal Females: Decreased estrogen leads to lowered bone mineral density, increasing risk of osteoporosis.
- Arrows: Indicate causal relationships between hormones and their effects. ("↑" indicates an increase, "↓" indicates a decrease)
- Clotting Factors: Factors II, VII, VIII, and X are mentioned with their influence on thrombosis.
- Oral Contraceptives and HRT: Affect the risk of thrombosis.
Location of Receptors
- Membrane-Bound Receptors: GNRH, LH, and FSH
- Intranuclear Receptors: Estrogen, Progesterone, and Androgens (enter the nucleus for action)
Half-Life of Hormones and Drugs
- GNRH: 3-4 minutes
- Oxytocin: 3-4 minutes
- LH: 20 minutes
- FSH: 3-4 minutes
- Letrozole: 48 hours
Hyperestrogenic States
- Increased estrogen levels can cause:
- Precocious puberty
- Endometriosis
- Fibroids
- Endometrial causes of AUB
- Ovarian cancer
Common Risk Factors for Hyperestrogenic States
- Nulliparity (never given birth)
- Obesity (increased androgens)
- Early menarche (menstrual onset)
- Late menopause
Protective Factors Against Hyperestrogenic States
- Pregnancy
- Multiparity (multiple births)
- Physical activity
- Smoking (inhibits aromatase enzyme, reducing local estrogen production)
Active Space (Not Defined in Given Text)
Basal Body Temperature
- Not described in given text
- Likely relates to ovulation detection methods using body temperature changes
FSH and LH
-
Estrogen:
- FSH: Negative feedback on FSH production
-
LH:
- Prior to Ovulation: Estrogen stimulates LH surge
- After Ovulation: Estrogen inhibits LH production
Atypical Uterine Bleeding (AUB)
- Puberty: Most common menorrhagia cause. Possible link between anovulation and coagulopathy.
- Perimenopausal Females: Can experience bleeding due to anovulation.
- Obese Females: Increased estrogen and lack of LH surge due to continuous LH stimulation.
- PCOS (Polycystic Ovary Syndrome).
- Androgen Excess: Follicle toxicity affecting maturation and leading to anovulation
- Hypothyroidism: Can contribute to hormonal imbalances and anovulation.
- Hyperprolactinemia: Increased prolactin due to decreased GNRH negative feedback, leading to decreased LH and FSH, resulting in anovulation, decreased progesterone, secondary amenorrhea, and infertility.
Lactational Amenorrhea
- Associated with increased prolactin levels
Dysfunctional Uterine Bleeding (DUB)
- Abnormal bleeding without pelvic pathology, medical/endocrine pathology, or coagulopathy.
- Anovulatory DUB: Accounts for 80% of cases.
- Ovulatory AUB: Represents 20% of cases.
Evaluation of AUB
- History: Age, age of menarche, parity (number of pregnancies), menstrual parameters (regularity, frequency, duration, volume), intermenstrual bleeding, post-coital bleeding.
- Other Considerations: History of coagulation disorders, symptoms (vaginal discharge, dysmenorrhea, dyspareunia, infertility), recent abortions, IUD insertion.
-
Additional Notes:
- AUB-D: Anovulatory uterine bleeding with detected pathology.
- AUB-E/AUB-N: Ovulatory uterine bleeding with or without diagnosed pathology.
Medications (General Gynecology)
- Not explicitly detailed in the provided text
- Specific medicine names may be mentioned elsewhere in the source
Examination (General Gynecology)
-
General Examination:
- Vitals
- Pallor
- Thyroid Enlargement
- BMI
- Signs of PCOS: Hirsutism (excess body hair), Acanthosis nigricans (skin darkening), acne
- Abdominal Examination: Examination for lumps
- Per Speculum Examination: Examination for growths
-
Bimanual Pelvic Examination:
- Size of uterus
- Contour of uterus
- Tenderness
- Fixity
- Adnexal mass (ovary or fallopian tube) / Tenderness
- Per Vaginal & Pelvic Examination: Not performed in virgin adolescents.
Investigations (General Gynecology)
- CBC & Hb level: Used to determine severity of bleeding.
- BT, CT, APTT: Done in cases with puberty menorrhagia, low platelet count, or family/personal history of coagulation disorders.
- UPT: Urine pregnancy test.
- Cervical Cytology: Done in sexually active females.
- USG: Ultrasound to detect structural lesions.
- Hysteroscopy Indications: Intracavitary lesions on USG, intermenstrual bleeding, uterine polyps, history of curettage and AUB (to rule out Asherman Syndrome: Intrauterine adhesions)
- Endometrial Sampling/Biopsy/Aspiration Cytology: Used to diagnose endometrial pathology.
Instruments (General Gynecology)
- Worldwide: Pipelle and Vabra aspirator.
- India: Karman's cannula.
Pharmacological Management of AUB
- Progesterone: First-line treatment, downregulates estrogen receptors.
- Letrozole: Aromatase inhibitor (blocks conversion of androgens to estrogens).
- Danazol: Anti-estrogenic action with androgenic side effects (e.g., hirsutism).
- GnRH Agonists (Continuous): Used for management.
- GnRH Antagonists: Best choice for treatment.
SERMs (Selective Estrogen Receptor Modulators)
-
Clomiphene Citrate:
- Used for ovulation induction
- Adverse Effects: Hot flashes, miscarriages, vaginal dryness, twin pregnancy, ovarian cysts, visual disturbances.
- Advantages: No risk of endometrial cancer.
-
Raloxifene: Used for osteoporosis and breast cancer.
- Adverse Effects: Hot flashes, vaginal dryness.
-
Tamoxifen: Used for breast cancer.
- Adverse Effects: Hot flashes, vaginal dryness, endometrial cancer, teratogenic (causes birth defects, requires a 3-month gap between use and pregnancy).
Other SERMs
- Ospemifene: Treat vaginal dryness.
- Razedoxifine: Management of hot flashes (SERM and estrogen combination)
- Ormeloxifine: Used as a contraceptive.
- Centchroman (Chhaya): SERM component.
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Description
This quiz covers essential concepts related to Ulipristal and Mifepristone, key medications used in gynecology. It further delves into various menstrual cycle abnormalities and atypical uterine bleeding. Test your knowledge on these vital topics on women's health.
