Important

OSCE Exam

Topicsazem Gamal

any RamadanHBy:

PCO pathogenesis = Androgens

1.Stromal Hyperplasia 2.DM & obesity 3.Adrenal androgens

High Androgen

High LH <-- Incresed Eostrogen Low FSH

○ Anovulation

○ LH surge(NO) Multiple follicles

○ Follicle Get older(larger & thinner) Cysts

○ Progesterone (low) No secretory changes Vagina No intermediate cells

-ve spinnbarkeit

No endometrial secretory chnages

Hirsutism

Rotter dam (2 of three) = Not

madame ^_^ its adam (man)

Ameno or oligo

Androgenic cp or lab

Adams criteria

CUPS 10 /10

○ C Cortex (10 follicles + 10 mm )

○ U Uterine hyperplasia e D&C

○ P Pearly white e laprascope

Treatment CP (Anovulation +Androgens) Abortion

○ Infertility

○ Menstrual Changes

○ Cause CP Male (Androgens) (Acne –Hirsutism – Seborrhea)

Cause:○ Pathological

Ovarian axis (local) FSH (HMG)

Adrenal Androgens & Aromatase defect (Link) Diane

Obesity &DM (Sys) Metformin

Complications○ Local

Ovary axis (poly cystic) Drilling

Uterus Endometrial carcinoma hystrectomy or D&C

Tracts Bleeding COC

○ Sys Alertness,Body built ,colors & decubitus obesity & acnthosis

Vital Data temp not cyclic (anovulation)

Other Organs DM & IHD

Link ○ Endocrine Androgens (Acne –Hirsutism – Seborrhea) Diane & COC

Trichomonas

Cause

•Trichomonas vaginalis

•STD

CP

•Frothy & profuse Discharge

•Pain & post coital bleeding

•Straw berry vagina

Invs

•Papanicalou culture

•Wet mount

TTT•Metronidazole

Candidal Dirty woman

Cause

•Candida albicans (+ tropicalis &crusie)

•Abuse of Pills & Bad hygiene & Immunocomp

•Second MC

CP

•Severly Itchy

•Malodorous & Curds Discharge

•Sever inflamm – Bleeding upon removal of curds

Invs

•PH <4.5(acidic)

•Hyphae (KOH)

•Sabaraud agar (gram +ve)

TTT

•Ketoconazole + local Mycostatin

•Avoid predispos

•Treat husband

Clue cellsHyphae

Curds

Vaginosis Clean woman

Cause

•Gardinella Vaginalis + Peptococci +Bacteroid

•Abuse of Pills & Douches & Immunocomp

•Most common

CP

•Asymp

•Fishy & excessive Discharge

•No inflamm –No Pus –No itching

Invs

•PH >4.5 alkaline

•Whiff test هبو

•Clue cells Epithelium +Cocci (gram –ve)

TTT

•Metronidazole + clindamycin + Ampicillin

•Avoid predispos

•Avoid sex (no partener ttt)

Clue cells

Thin Creamy

Wiff test

EndometriosisMarylin Monroe امتعت الناس وعاشت لتتألم وماتت من غير ما تخلف

Cause

•Cancer Like

•Sampson (retrograde mensis)

•Metaplasia

•Hematogenous Spread

CP

•Marylin Monroe

•Pain (cyclic) and all over (Dysuria-Dyspareunia)

• Infertility

•Menstrual symp

Complication

• Frozen pelvis

• Infertility (assosciation)

• Hydronephrosis (fibrosis)

Invs

•Remember Cancer like :

•Biopsy is must by laprascope

•Burnt powder - Chocolate cyst

•CA125 (follow Up)

•CT

TTT

•Acc to CP –Site & Parity desire

•No need to peg NSAIDS

•Nedd COCP continous followed by pregnancy or IVF

•Old hystrectomy

•Surgey Must ovarian chocolate cyst

Chocolate cyst

Burnt Powder

MC site Ovary

Site

Intrauterine adenomyosis

Extrauterine

Ligamentary – ovarian

Extrapelvic

Umbilicus – Nose

Note Stage Superficial implants <5

Stage II

Deep implants 5-15

Stage III

Dense adhesions 15-40

Stage IV

Complete post sac obliteration > 40

Grading

Acc to

Size Adhesions Depth

Leiomyoma

Cause

•Fibroblast origin & Smooth Ms origin

•20 % of females 40 years aged 80%(77%) hystrectomy found

•Reproductive age (can be in post meno!!?)

CP

All or none

•Asymp Most common

•Pain all types ( Spasmodic – ischemic ..etc)

•Menstrual symp all types (contact – menorrhagia – metrorrhagia)

•Infertility & recurrent abortion(sub mucous)

Complications

•Pressure (obstrcuted labour –Uropathy – Rupture uterus – Pelvic congestion (leucorrhea))

•Pathological Traumatic (Red degeneration (pregnancy) – ( Myxomatous degen (post menopausal) – (calcification (woumb stone) & Vascular (torsion & telangiectasia) & Infalmmatory & Metabolic (polycythemia) & Malignant (leiomyosarcoma & Pseudo meigs)

•Prolapse may lead to chronic inversion

Invs

•Radio

•US –X ray – CT

•IVP – HYCOSY

•Lab

•CBC –RFT

•Interventional

•Hysteroscope – D&C (for endomerial hyperpalsia) – laprascope

TTT

•Acc to age & parity & site

•Surgical No No You should know

•No surgery small mass & large patient (old) & asymp

•No Myomectomy Numerous – profuse (bleeding)- malignant –post menopause

•You should know : anemia correction and minimal manipulation & bonnie hood

•Medical Red degenration mainly medical NSAIDS red needs rest - Danazole – Anemia correction

MC symptom bleeding

MC presentation Asymp

MC site

Corporeal (95%) MSM

(Mural then serous then Mucous)

MC complication

Hyaline degenration

Note Sub mucous

Small but early bleeding

Sub serous

Mainly large & late presentation

Cervical & ligamentous

Affect UretersEarly symptoms Rapid growing

Note

Cervical type Four %

Faster

Failure of Myomectomy

Why

Narrow space & richest in blood X corporeal ..may be parasitic & pedunculated

Pregnancy Bleeding

EarlyBefore 28th week

رحم مليان

Vesicular Mole

جسمةكبير وابه

بيفضيرحم

Miscarriage

Open OS

Painful

In Evitable

Resuscitate & terminate

Excessive bleeding

Hgic Shock(tachycardia )

Complete separation of conceptus

Septic

Resuscitate (+ AB + Antiserum + ATN) &

terminate

Excessive Discharge

E coli commonest

Septic Shock (bradycardia)

Occur e any type

Iatrogenic opening(Abortion)

Closed OS

No Pain

Threatened

Conservative Resusc

Rest (No sex)Pain (valium)

Pad No Prog (masking

effect)No PV

Viable fetus

Continuing pregnancy

vaginal fresh blood

Missed

Dead fetus

Evacuation

Regressing Pregnancy

Brun juice

رحم فاضي

Ectopic Pregnancy

صغير وعامل أزمة

Any Time

General causes

DIC جبهث وجمىت

Amniotic embolism جسرق وجمىت

Bleeding tendency (hepatic failure)جصفر وجمىت

Gynecologic

Genital Tracts TVIDM

Late

After 28th week

رحم مليان

APH

Placenta فىق

(abruption)

Painful Sudden

PIH Primae

Dangerous triad

Mainly termination Vaginal better

Complication

Maternal Pressure

above amniotic Below bleeding Sides Shocks

Vasa Previa

Rupture of fetal vessels

80% mortality

Placenta جحث

(previa)

Painless Recurrent

DM Multigravida

Large baby & exhausted placental

bed

Mainly conservative

ComplicationFetal

presentation

بيفضيرحم

IPH

Continouation

or Beginning

رحم فاضي

PPH

Placntaفىق

Accreta

Uterine AtonyUterine Rupture

Placenta جحث

Retained parts

Early

رحم فاضي

Ectopic

صغير وعاملة أزمة

MC cause

Infections

(PID)

Peripheral Pain

Early presentation <8 weeks

Tubal 95 %Extra tubal (ovarian)

cervical !!! Severe bleeding

Empty Uterus

Tubal fetal sac & parts

Mainly medical MethotrexateWeekly dose + monitoring

Surgical if medical contraindicated

Complications

Abnormal Sites ovarian

(Spiegelberg)in ovary & ovary tissue in & tube

intact & in ligament

رحم مليان

Vesicular

جسمةكبير وابه

MC cause

Chromosomal

Central Pain

Early preganacy Symp

Complete Paternal

Diploid

IncompleteMixed

Triploid Missed abortion like

Filled uterus (complete Snow Storm + No fetal

parts)

Ovarian theca lutein cyst spontaneous remission

Mainly Surgical Evacuation

Medical Methotrexate

e indication only Single dose

Complications

Abnormal Site (invasive Mole)

Abortion

Spontaneous20 %

50% chromosomal

Fetal

1st trim

2nd trim

Recurrent> 3 times consec

1 %

50% idiopathic

1st trim

2nd trim

Iatrogenic

Mainly Maternal causes

Complications

Fetal abnormalities IUGR

IUFD

Preterm labour

Cong malformation

Maternal Pre eclampsia

Placenta Previa

Poly hydraminos

Pyelo nephritis

labor 1st

PROM

2nd Prolonged

3rd Post partum Hge

Clinical types of

Palcenta previa Minor

○ Lateralis

○ Marginalis

Major

○ Partial

○ Complete central

Accidental hge Revealed

Concealed

Mixed

Rare abortion Recurrent & induced

Complete & incomplete

DD of abortion

○ Metropathia hemorrhagica (ameno then bleeding)

○ Membranous dysmenorrhea

○ Note both –ve pragnacy test

Ectopic Un disturbed

Acute

Chronic

Vesicular Mole complete & incomplete

Invasive

Malignant (metastatic & Non)

Termination Types

Vaginal better in accidental Hge (due to DIC) Vaginal indication X ceserian

○ No distress فيك صحت○ Fit for induction تقذر تزق○ No assosc obstetric condition (No obstruction)

..سالكت السكت

Ceserian better e previa السكت مسذودة

D&C (better in abortion)

Suction (better in septic abortion & Vesicular mole) (due to soft uterus)

Diagnosis

US

HCG

Progesterone

CBC

RH

Bleeding in woman

Either

Local genital Child FB

Young Pregnancy complications

Old Endometrial cancer till proved otherwise MC atrophic vaginitis

General

Hormonal DUB (not due to local or general)

○ D Dys hormonal

○ U uterine prostaglandins

○ B Bills

Hormonal Unopposed oestrogen (Anovular)

○ Schroeder

○ Threshold

Un sufficient progesterone (ovular) Follicular phase Functional (regular)

○ Mid cyclic

○ Poly menorrhea (inc No.)

Luteal phase Irregular

○ Halban غلبان

Types

Oligo No.

Hypo amount

Poly No

Menorrh amount

Metro Regularity

DUB

Ovular Schroeder

• Continuous Ovary Growth & func

• Amenorrhea then bleeding

• Painless

• Profuse bleeding

Anovular

Halban

• Early Degeneration

• Amenorrhea then bleeding

• Painful غلبان

• Mild bleeding