1.

First group of menstrual disturbance by WHO etiopathogenesis

2.PCOS recognitional criteria
3.Symptoms of the syndrome of PCO
4.Hyperprolactinemia causes

1
Menarche ..1 menstruation
menopause last menstruation
Amenorrhea , absence of menstruation in a women of reproductive age
Oligomenorrhea ..rare menses (intervals exceeding 35 to 6 months )
Hypomenorrhea .reduction in amount of menstrual bleeding and period
polimenorrhea .frequent menses
Hypermenorrhea the opposite of hypomenorrhea
Dysfunction uterine bleeding , its irregularity without organic pathology

2
.chronic anovulation or infrequent ovulation
androgen excess
metabolic abnormalities
Hyperinsulinemia (50%)
periperal tissue resistance to insulin
polycistycs ovaries are seen by Ultrasound

NIH and Rotterdam criteria
Two of three criterias has to be met .
In 1990 a consensus workshop sponsored by the NIH suggested that a patient has PCOS if she
has all of the following:
1. oligoevaluation
2. signs of adrogen excess(clinical or biochemical)
3. other entities are excluded that would cause polycystic ovaries

3.
clinical symptoms :
oligomenorrhea ,amenorrhea
acne , hirusitism
obesity and infertility

4.
adenoma or microademoa
thyroid gland insuff .TRH increase
Drugs forex.
estrogens , methyldopa , tranquilizers , chlorpromazine (antipsycotic)
chronic stress
inadequate regression after labour

5. IUI= Intrauterine insemination
-Cervical factor
- Chronic unovulation
- Male factor
- Immunologic disorders
- Endometriosis
-Idiopathic infertility

6. IVF= In vitro fertilization
- Partial /complete tubal obliteration
- Chronic unovulation
- Male factor
- Immunologic disorders
- Endometriosis
-Idiopathic infertility

7. Diagnostics:
-Hysterosalpingography
-Laparoscopy
-Hysteroscopy
-Semen analysis
-USG
-Hormonal diagnostics, like for instance disorder in ovulation and endometriosis


8. Early sings:
- Pain in lower abdomen
-Inflammation
-Pain while urinating
-Vaginal bleeding
-Pain while having bowel movement

Late sings:
-External bleeding
-Internal bleeding may cause:
*Lower back, abdominal, pelvic pain
*Shoulder pain
*Cramping or tenderness on one side of pelvis



9. Risk factors for ectopic pregnancy:
1.salpingitis;PID (30-50%)- Chlamydia trachomatis. Cause scarring&damage-> fertilized ovum
cannot passage through the tube to the endometrial cavity
2. ART:
- ovarian stimulation
- embryo transfer reflux
3.operations:
- Surgery of fallopian tubes(pyosalpinx)
- plastic reconstruction of fallopian tubes
4.previous ectopic pregnancy
5.age 35-45
6.contraception
7.endometriosis
8.congenital defects of fallopian tubes
9.smoking
10.multiparous woman
11.black and hispanic women
12.idiopathic


10 .Diagnosis of ectopic pregnancy
1.pregnancy test : detects level of beta-hCG (positive if >25mIU/ml)
2. USG
- 5weeks of pregnancy -visible one USG
- enlarged size of fallopian tube
- empty uterine cavity
- thick endometrium


11. +12.
Many women with uterine myoma (fibroids) have no symptoms and never require treatment.
However, 1 out of 4 women of childbearing age do suffer significantly from myoma (fibroid)
symptoms. Uterine myoma symptoms may vary depending on the location, size and number of
myoma (fibroids).
The most common symptom of uterine myoma (fibroids) is:
Heavy and prolonged bleeding Menorrhagia.This may also involved clotting and pain.
Chronic iron deficiency anemia may result from this extensive bleeding. Abnormal bleeding is
the primary uterine myoma symptom requiring women to seek medical advice.
Other uterine myoma (fibroid) symptoms may include:
Pain in the back of legs This uterine myoma (fibroid) symptom appears as the fibroids press
on nerves that extend to the pelvis and legs.
Secondary amenorrhea
An abnormally enlarged abdomen--this may be mistaken for weight gain or pregnancy.
Pelvic pain or pressure This symptom may appear as a result of the bulk or weight of the
myoma (fibroids) pressing on other structures in the pelvic area.
Pressure on the bladder This uterine myoma (fibroid) symptom can cause frequent
urination, urinary incontinence or urine retention.
Hydroureter or hydronephrosis from pressure on the ureters as they traverse the pelvic brim.
Pressure on the bowel This can lead to constipation and/or bloating. The constipation may
be exacerbated by iron supplements taken for the anemia caused by excessive bleeding.
Lower back pain
Dyspareunia Reproductive problems can also be another uterine myoma (fibroid) symptom.
Infertility, recurrent miscarriage, or premature labor during pregnancy can be caused by
uterine myoma.
A feeling of pressure or fullness in the lower abdomen
Dull,intermittent,low midline cramping(labor-like) pain - prolapse of
submucous/subendometrial myoma through the internal os of the cervix.


21. Symptoms of endometriosis:
Severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or
premenstrual symptoms with or without abnormal bleeding, infertility, chronic fatigue.

22 Microscopic seed:
Not sure what is ment here, could be bout one of the theories behind the pathogenesis:
Metastatic spread. How it is possible to have endometriosis in brain, lungs, appendix, scars,
umbilicus, bladder etc. Justified by the expression of CA19.9 in the endometriosis tissue. The
same marker is also found in cancers with metastatic potensial, hence it could mean that
endometriosis has a metastatic potential.

23 Treatment of endometriosis:
Endometriosis :
presence of normal endometrial mucosa (glands and stroma) abnormally implanted in locations
other than the uterine cavity.
This tissue, possessing the same steroid receptors as normal endometrium, is capable of
responding to the normal cyclic hormonal milieu.
Microscopic internal bleeding, with the subsequent inflammatory response, neovascularization,
and fibrosis formation, is responsible for the clinical consequences of this disease.
Treatment:
Medications: Aromatase inhibitors, metalloprotease inhibitors, Antiprogestin, SPRM, SERM,
immunomodulatory agents + pain killers: NSAIDS, OC, Danazol, GnRH analogues, progestagens
Surgical: Excision, coagulation, dissection of adhesions, hysterectomy with adnexa. Cystectomy
if ovarian endometriomas >4cm

24 Causes of obstruction of ovarian tube:
Her er det jo bare til bruke fantasien. Eg. Inflammation (PID or in abdomen), tumors, tumor of
surrounding organs, adhesions


25) (innsetting) intravaginal- mech of anticonception:
- Contraceptive vaginal ring: contains the hormones estrogen & progesterone. It releases a
continous low dose of hormones that stops the ovaries from releasing an egg each month.
- Diaphragm: barrier method.
- Cervical cap: barrier method.

26) Failure of result of cytology:
Not sure what they want here,a cause can be not collected enough cells?
And if the name of the pat is not written on the glass slide, they throw it away and you dont get
the results..

27) Incontinence- classification, symptoms, diagnosis:
types: 1: stress incontinence. Because of increased pressure f.exp when the pat coughs.
2: urge incontinence. no apparent reason..
3: mixed.
diagnosis: stress test, cystoscopy= insert a tiny camera into urethra, urodynamics= measure
pressure.

28) Conception: ulcers, ectopia, oligomenorrhea, azoospermia, aih:
? dont understand this question..maybe the question here should be mention some causes of
problems with conception, and these are the answers?

29 Risk factors of endometrial carcinoma
- obesity
- null parity
- late menopause
- anovolatory cycles
- PCOS
- ovarian tumors
- Hyperthyroidism
- Hyperprolactinemia

30 Poly cystic ovary image in USG (what do you see in USG)
- bilateral enlarged ovaries
- Shapes change from ovoid to spherical.
- Ovarian volume increase as much as 6 mL.
- multiple small follicles
- increased stromal echogenicity

31 BV causes and symptoms
- Symbiotic infection of anaerobic bacteria.
- Gardnerella, Mobilunculus, Mycoplasma hominis,
- Imbalance between anaerobes/aerobes
- Decreased counts of Lactobacillus
symptoms:
- homogenous discharge
- Fishy odor

32 Hormonal profil diagnostics in PCOS
- Elevated LH serum level
- Elevated LH/FSH ratio
- Elevated androstendion serum level
- Elevated total testosterone serum level
- Elevated estrone serum level
- Decrease SHGB

33 Menopause definition and symptoms
Def:
- Is a physiologic process, part of aging. Involves a woman's reproductive system, after
which theres no menstruation ( permanent amenorrhea).
- Is diagnosed after 12months of amenorrhea.
- The mean age is 51 years.
symptoms:
- All the signs and symptoms result from decrease estradiol-17B production by ovarian
follicles.
- Catogories of the symptoms:
1. Vasomotor disturbances
- hot flushes, night sweats, palpitations, headaches, muscle aches
2. organ atrophy
- vaginal dryness, atropy, dyspareunia
- urinary incontinence, dysuria, inf
- breast atrophy
- skin dryness and thinning, brittle nails
3. changes in mood and ibido
- anxiety, insomnia, depression, irritability
- inability to concentrate, lack of energy
4. Accelerated bone mineral loss
- Osteoporosis
5. Coronary artery disease (long term)

34. Endometrial cancer risk factors and symptoms
R: Any factor that increases exposure to unopposed estrogen.
Obesity
Early menarhe
Late menopause
Nulliparty
Chronic anovulation
Exogenous estrogen or tamoxifen
Dm
Hypothyroidism
Hyperparathyroidism
Lynch type 2 syndrome
R: - oral contraceptives
high parity
pregnancy
smoking
Symptoms: Abnormal vaginal bleeding
postmenopausal bleeding
acyclic bleeding
heavy or prolonged bleeding
ill-smeling leucorrheas
pelvic pain
ascites
35. Diagnostic method in mechanical infertility
Salpingography
Laparoscopy
Hysteroscopy

36. Differential ectopic pregnancy
Acute PID
Adnexal torsion
Spontaneous abortion
Ruptured corpus luteum
Molar preganacy
Any other reason for acute abdomen: eg.appendicitis, pancrastitis, peritonitis
37. Treatment of patient after menopause with bleeding
goal of treatment should be to arrest bleeding, replace iron loss to avoid anemia and prevent
future bleeding. Do endometrial sampling!
Resection of leiomyomas (if that is tha case)
Uterine artery embolization
Endometrial ablation
Hysterectomy

17. Vag hemorrhage:
MENS!! -> putt inn tampong

og

Causes: Hormonal: anovulation (from estrogen or prog) gives eventual endometrial shedding ->
bleeding
Neoplasms: endometrial carcinoma, cervical carcinoma (postcoital), fibroids, polyps
Trauma: ...
Bleeding disorders
Obstetric complications (miscarriage, ectopic pregnancy, gestational neoplasia)
Ovarian cyst rupture
Treat: pr cause

18. Disturbances in menstruation
Due to hormonal disturbance -> pregnancy, oral contraceptives, pituitary probs, adrenal
overprod. of androgens, thyroid disorders, stromal ovarian tumors

19.Cyst in the ovary vs. ovarian ca differention
Age!! for epithelial ca, mean age above 60. Obs, ovarian germ cell ca can occur even
premenstuation. In ca, tumor usually irreg, firm, non-tender. Check usg for typical apperance of
physiologic ovarian cysts, and cystic syndroms. Generalized symptoms indicating peritoneal
dissemination means ca.such as abdomnial diffuse symptoms. DO BIOPSY

20. Endometriosis - patho
Endometrial tissue metastasizes to localized area in vincinity around pelvis. The spread is prob.
via hema or lymph. Earlier they thought endometrial cells fell backwards into pelvic cavity
through fallopian tubes. Risk factors: early and heavy menses.

13. Laparoscopy and hysteroscopy diagnostic indications
Laparoscopy- may be recommended to look at the outside of the uterus, fallopian tubes,ovaries
and internal pelvic area ,
Can help diagnose gynecological problems including endometriosis, uterine fibroids and other
structural abnormalities,
ovarian cyst, adhessions(scar tissue) and ectopic pregnancy .If the patient has pain , history of
past pelvic infections or
symptoms suggestive a pelvic disease , and sometimes recommended after completing initial
ifertility evaluation in both
partners. usually performed soon after the menstruation ends

Hysteroscopy - a useful procedure to evaluate women with infertility, recurrent miscarriages or
abnormal uterine bleeding.
It`s used to examine the uterine cavity and is helpful in diagnosing abnormal uterine conditions
such as fibroids protruding
into the uterine cavity, scarring, polyps and congenital malformations

14. Laparoscopy and hysteroscopy surgery indications
Laparoscopy- Removing adhesions(scar tissue) from around the fallopian tubes and
ovaries, opening blocked tubes, removing ovarian cysts ,fibroids on the uterus,
diseased ovaries ,treating ectopic pregnancy . endometriosis can be removed or
ablated from the outside of the uterus, ovaries or periteneum.
Hysteroscopy - removing fibroids, scar tissue , polyps and some structural
abnormalities ( uterine septum) from the inside of the uterus

15. The way of examination, how would you examine in HSG
Hysterosalpingogram is a fertility test used to detect uterine and fallopian health,the
HSG test uses a X-ray technology to create a picture of the uterus and the fallopian
tube , colored dye is injected into the uterus, this dye then travels up through the
fallopian tubes and out into the abdominal cavity ,it allowes to determine if any
damage to the reproductive system

16. Biosynthesis of the vagina and the stages of freshness(purification) in the
vagina
low vaginal Ph 3,8-4,5 , lactobacillus , macrophages and fluid containg IgG and IgA
29 Risk factors of endometrial carcinoma
- obesity
- null parity
- late menopause
- chronic anovolation
- PCOS
- ovarian tumors
- Hypothyroidism
- Hyperprolactinemia

30 Poly cystic ovary image in USG (what do you see in USG)
- bilateral enlarged ovaries
- Shapes change from ovoid to spherical.
- Ovarian volume increase as much as 6 mL.
- multiple small follicles
- increased stromal echogenicity

31 BV causes and symptoms
- Symbiotic infection of anaerobic bacteria.
- Gardnerella, Mobilunculus, Mycoplasma hominis,
- Imbalance between anaerobes/aerobes
- Decreased counts of Lactobacillus
symptoms:
- homogenous discharge
- Fishy odor

32 Hormonal profil diagnostics in PCOS
- Elevated LH serum level
- Elevated LH/FSH ratio
- Elevated androstendion serum level
- Elevated total testosterone serum level
- Elevated estrone serum level
- Decrease SHGB

33 Menopause definition and symptoms
Def:
- Is a physiologic process, part of aging. Involves a woman's reproductive system, after
which theres no menstruation ( permanent amenorrhea).
- Is diagnosed after 12months of amenorrhea.
- The mean age is 51 years.
symptoms:
- All the signs and symptoms result from decrease estradiol-17B production by ovarian
follicles.
- Catogories of the symptoms:
1. Vasomotor disturbances
- hot flushes, night sweats, palpitations, headaches, muscle aches
2. organ atrophy
- vaginal dryness, atropy, dyspareunia
- urinary incontinence, dysuria, inf
- breast atrophy
- skin dryness and thinning, brittle nails
3. changes in mood and ibido
- anxiety, insomnia, depression, irritability
- inability to concentrate, lack of energy
4. Accelerated bone mineral loss
- Osteoporosis
5. Coronary artery disease (long term)

25) (innsetting) intravaginal- mech of anticonception:
- Contraceptive vaginal ring: contains the hormones estrogen & progesterone. It releases a
continous low dose of hormones that stops the ovaries from releasing an egg each month.
- Diaphragm: barrier method.
- Cervical cap: barrier method.

26) Failure of result of cytology:
Not sure what they want here,a cause can be not collected enough cells?
And if the name of the pat is not written on the glass slide, they throw it away and you dont get
the results..

27) Incontinence- classification, symptoms, diagnosis:
types: 1: stress incontinence. Because of increased pressure f.exp when the pat coughs.
2: urge incontinence. no apparent reason..
3: mixed.
diagnosis: stress test, cystoscopy= insert a tiny camera into urethra, urodynamics= measure
pressure.

28) Conception: ulcers, ectopia, oligomenorrhea, azoospermia, aih:
? dont understand this question..maybe the question here should be mention some causes of
problems with conception, and these are the answers?