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Jeffcoates 7th/ed pp 450-1; William Gynae 1st/ed p 96 Fluctuant non-tender swelling at the introitus suggests a diagnosis of bartholins cyst erectile dysfunction shake recipe effective cialis 10 mg. Treatment of choice is Marsupialization: It is preferred over traditional exicision operations erectile dysfunction treatment phoenix order cialis with amex. Shaw 14th/ed p 17 Uterine artery is a branch of anterior division of internal iliac artery erectile dysfunction causes stress buy discount cialis 20mg on-line. Part of vagina Upper3/5ths Lower1/5th Hymen Epitheliumofthevaginaandportiovaginalispartofcervix Fibromuscularlayerofvagina Vaginalintroitus 19. Intramural part Development Mullerianducts Urogenitalsinus Junctionofmullerianductsandurogenitalsinus Endodermofurogenitalsinus Mesodermoffusedcaudalpartofmullerianducts Ectodermofgenitalfolds Ref. JohnHopkinsmanualofhumanfunctionalanatomyp144 Anatomical sphincter of fallopian tube is intramual part Physiological sphincter: is Isthmus part 20. Dutta Gynae 6th/ed p 1 All options are correct with respect to labia except: Option d because it is round ligament and not broad ligament which terminates at its anterior end. Vaginal axis lies parallel to the uterus and at right angles to the plane axis of inlet Ref. The long axis of the vagina almost lies parallel to the plane of the pelvic inlet and at right angles to that of the uterus (not vice versa). The maternal estrogen circulating the newborn maintains the vaginal defence for 10 days. High level of circulating estrogen increase the vaginal defence during puberty, pregnancy and in premenstrual phase. Dutta Gynae 6th/ed p 11,12 Ovary measures about 3 cm in length, 2 cm in breadth and 1 cm in thickness. The ovary is attached to the posterior layer of the broad ligament by the mesovarium, to the lateral pelvic wall by infun-dibulopelvic ligament and to the uterus by the ovarian ligament. There are small collection of cells called "hilus cells" which are homologous to the interstitial cells of the testes. Venous drainage is through pampiniform plexus, to form the ovarian veins which drain into inferior vena cava on the right side and left renal vein on the left side. Surrounded by peritoneum on all sides except along the line of attachment of mesosalpinx Ref. Serous: Consists of peritoneum on all sides except along the line of attachment of mesosalpinx. Changes occur in the tubal epithelium during menstrual cycle but are less pronounced and there is no shedding during menstrual cycle (option c is incorrect). They are situated in the medial three-fourth of the upper free margin of the broad ligaments. Each tube has got two openings, one communicating with the lateral angle of the uterine cavity, called uterine opening and measures 1 mm in diameter, the other is on the lateral end of the tube, called pelvic opening or abdominal ostium and measures about 2 mm in diameter. The abdominal ostium is surrounded by a number of radiating fimbriae, one of these is longer than the rest and is attached to the outer pole of the ovary called ovarian fimbria. It is attached at the cornu of the uterus below and in front of the fallopian tube.
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Jeffcoate 7th/ed p 116-118 If precocious puberty is associated with delayed bone age it suggests primary hypothyroidism erectile dysfunction quitting smoking order generic cialis pills. Novak 15th/ed p 1023 Precocious puberty with bony dysplasia and cafe au lait spots points towards incure in McCune-Albright syndrome as the diagnosis erectile dysfunction treatment new york buy generic cialis from india. Vulvovaginitis Postmenopausal Vaginitis/Atrophic/Senile Vaginitis Vulvovaginitis Vulvar and vaginal inflammation Vaginitisinpostmenopausalfemalesiscalledasatrophicvaginitis impotence kidney stones purchase 10 mg cialis fast delivery. Symptoms: It is insidious in onset Mostly asymptomatic May present with mucopurulent discharge Dysuriaandfrequencyofmicturitionwith bacteriuria < 105 organisms/ml of urine is pathognomic of chlamydia infection in young sexually active females. Repeat testing done 3 weeks after treatment is recommended for pregnant women only. Broad spectrum antimicrobial therapy should be started and appropriate imagingstudiesobtained. Aggressive treatment in these seriously ill patientsmayleadtodecreaseinmortalityandmorbidityinthisdisease. A patient with discharge per vagina was evaluated and on endocervical biopsy Chlamydia was found. In hysterosalpingography, fallopian tubes are seen beadedinappearancewithclubbingoffimbrialendand ampulla. A young lady presents to your office with complain of copious vaginal discharge, but there is no cervical discharge on per speculum examination. In a patient with pelvic inflammatory disease due to tuberculosis,whichofthefollowingstatementsistrue Genital tuberculosis is always secondary and the tubesareinvariablytheprimarysites d. Current Diagnosis and Treatment Sexually Transmitted Diseases, p227 Pubiclice,acommonconditioniscausedbythecrablouse,Phthirus pubis. Bluish-gray macular lesions secondary to deep dermal hemosiderin deposition from the bites of the louse, known as maculae cerulean,maybenotedinpatientswithestablishedinfestation. Therefore, all partners with whom the patient has had sexualcontactwithintheprevious30daysshouldbeevaluatedandtreated,andsexualcontactshouldbeavoideduntil allpartnershavesuccessfullycompletedtreatmentandarethoughttobecured. Current Diagnosis and Treatment Sexually Transmitted Diseases, p94, 95 Theconditionshowninthefigureisvulvarwarts. Park 19th/ed p 278, 20th/ed p 289 Fungal Candida Ectoparasites Phthirus pubis Sarcoptes scabei 116 Self Assessment & Review: Gynecology 2. Shaw 15th/ed p 146; Williams Gynae 1st/ed p 64, 65; Jeffcoates 7th/ed p 340-342 Ref.
As such adenomyosis is not given as a cause of infertility but if you go through the chapter of adenomyosis: Jeffcoate 7/e erectile dysfunction icd 9 code 2012 buy cialis online pills, p 382 says (In chapter on Adenomyosis): "The patient may also complain of infertility" erectile dysfunction treatment covered by medicare order cheap cialis. Novak 14th/ed p 1227 Certain Infections cause Intrauterine synechiae or asherman syndrome thus leading to infertility like impotence yohimbe order cialis 20 mg mastercard. These disorders are generally among the most easily diagnosed and most treatable causes of infertility. Relatively poor prognosis is observed in male factor infertility and tubal factor infertility. InfertilityQ is either due to blockage of fallopian tubeQ or due to loss of tubal function even if tubes are patent. Q Tubercular endometritis causes uterine scarring which destroys the endometrium leading to synechia formation (Asherman syndrome) and infertility. Pathophysiology: It is the result of scanty or poorly vascularized and dysfunctional endometrium resulting from trauma. Etiology: Asherman syndrome: "Generally is the result of an overzealous post partum curettage resulting in intrauterine scarification. Leon Speroff 7th/ed p 417 Most common etiology is: D and C done for post partum haemorrhage. Infertility (it results due to absence of viable endometrium for implantation as well as from obstruction of fallopian tubes). Hysterosalpingography: (X-ray dye test) and saline hysterosalpingogram (fuid ultrasound) demonstrate filling defect. Following surgery some method is used to keep the walls of the uterus apart in the immediate postoperative period to minimize the chances of recurrence. Antibiotics are administered prior to the procedure and continued for approximately 10 days after the surgery. Postoperative treatment with exogenous estrogens is given to promote rapid reepithelialization and reduce the risk of recurrent adhesion. Note: For the diagnosis of luteal phase defect endometrial biopsy is done between day 24-26 of the menstrual cycle or 2 to 4 days before anticipated menstruation. The tissue obtained is subjected to polymerase chain reaction test instead of culture.
An indicator of considerably increased incidence of major malformation of the fetus d impotence exercises buy cialis on line. An indicator of considerably increased incidence of major malformation of the fetus Ref: Williams Obs 23/e erectile dysfunction treatment nasal spray buy cialis 2.5mg with mastercard, p 582 eb oo ks SingleUmblicalArtery m erectile dysfunction doctor delhi cialis 10mg low price. Most comman method of separation fre Ref: Williams obs 23/e, p 147 oo ks ks Placental Separation: fre fre ok s ks oo oo eb o eb eb m m m m eb oo Also Remember: the plane of separation runs through deep spongy layer of decidua basalis. Weighted by this hematoma, the placenta descends, drags the membranes, and peels them from their uterine attachment. Consequently, the glistening amnion, covering the placental surface, presents at the vulva. The retroplacental hematoma either follows the placenta or is found within the inverted sac. In this process, known as the Schultze mechanism of placental expulsion, blood from the placental site pours into the membrane sac and does not escape externally until after extrusion of the placenta. In the other method of placental extrusion, known as the Duncan mechanism, the placenta separates first at the periphery. As a result, blood collects between the membranes and the uterine wall and escapes from the vagina. In this circumstance, the placenta descends sideways, and the maternal surface appears first". They are separated by: sf oo k oo oo Together called as placental barrier or membrane (0. Excretion by fetal kidneys; Maternal hemostasis; Fetal intestinal absorption; Fetal membraneabsorptionandFetalsweating Ref. By the beginning of second trimester, it consists largely of extracellular fluid which diffuses through the fetal skin, and thus reflects the composition of fetal plasma". After 20 weeks, however, the cornification of fetal skin prevents this diffusion and amniotic fluid is composed largely of fetal urine. Q Option "e" Anencephaly Inanencephaly(ormeningomyeloceleorspinabifida) Meninges are exposed Increasetransudationoffluidfromexposedmeninges Polyhydramnios (Option "e" is correct). Renalagenesis Already explained co m m co fre fre fre m m m oo ks oo oo eb eb eb yy Temperatureatwhichsalineisinfused=370C. The needle should be advanced slowly with continuous ultrasound visualization and when its tip has reached the interface between the fetus and the membranes warmed saline solution should be infused. A normal fetus will swallow the infused fluid, and its bladder will be easily seen with ultrasound after 20 minutes. Before ending the amnioinfusion, 1 ml of indigo carmine is injected inside the amniotic sac. The patient is instructed to wear a tampon for a few hours following the procedure and observe for evidence of blue discoloration. Besides the above mentioned therapeutic indications it can be used for diagnosis of: i.
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