for okay so good afternoon welcome back all of you to the G ATP session the session of G which is especially for the fmg students but if any neat PG students are attending then you are also going to benefit from it although you have to study one level higher than this but this is basic what you also need to know right so equally it can be attended by both the fmg bachas and by the ne Bas right now first I want to know that am I Audible and am I visible properly to all of you it's buffering it's on my end it's not showing any buffering B I'm sure just check your internet connection check your internet connection tell me for all of you is it buffering it's fine ma'am yes ma'am yesam everything is good AA shubam in heart disease of mother uh it's forceps which are preferred heart disease of mother may P May fetal distress May in all of them it is forceps which is preferred right okay now coming to gy part uh the PDF of the session the blank PDF of the session is there on the tri s telegram group and it is there on the ctg telegram group as well so if anyone is wanting the blank PDF you can download it from there as far as the annotated P PDF is concerned once the session is over towards the night I am going to upload the annotated PDF so immediately messages ma'am immediately annotated though immediately annotated though I will send the annotated PDF but it will take me some time right so as of now we are going to start with gy and the blank PDF is there on the trip s telegram group and on the ctg telegram group when we are talking about gy the first important thing which you have to revise is the hormones and the menstrual cycle part of it in your fmg exam sometimes they ask you direct questions on the menstrual cycle qu and I'm going to teach you only I'm going to revise only that much what is required at this point of time right uh but then it is going to take some time so coming to important points on menstrual cycle oogenesis begins in so oogenesis please remember it begins in intrauterine life whereas spermatogenesis begins at the time of puberty then fertilizable span of the OVA what is the fertilizable span of the OVA fertilizable span of OVA is 12 to 24 hours if you have to choose between 12 to 24 hours then it is 24 hours what is the size of a mature follicle size of the mature follicle is 18 to 20 mm instead of writing mature follicles the term graffian follicles can also be written right now please remember there are various stages through which a follicle is going to De pass so that it becomes a graffian follicle P to understand what is a follicle I'm sure all of you remember I have told you in class it is a primary uite surrounded by follicular cells a primary oite surrounded by follicular cells and these follicular cells they then differentiate into granulosa cells and thka cells GC is granulosa cells and TC is thka cells so this structure is what is called as a follicle now sometimes they uh yes Dr prti it is going to be available even after the session is over till your exams are not over it is going to be available there okay now till the time uh a folicle f cavity whenever you start seeing a Cav it inside the follicle right then it is called this cavity is the anal cavity and then the follicle is called as anal follicle so sometimes anal follicle any follicle with a cavity inside is an antral follicle and anal follicle graian follicle now uh just one request to all of you bet when I am teaching if you are going to ask me so many questions my entire flow gets disrupted right my attention goes towards your questions so neither I will be doing Justice to answering your questions because I will be ignoring them and in the meantime my flow will also get broken so I will give you enough time to ask questions to me whether it is related to marrow whether it is related to One Touch whether it is related to whether these sessions are enough or not I will give you enough time to ask questions to me before I say I end the session but it's my request that when I am teaching right please at that point of time don't ask me such questions my entire flow is going to get disrupted okay okay now when are the follicles maximum follicles are maximum in fifth month of intrauterine life that is at 20 20 weeks of intrauterine life at that time the number of follicles is 11 to 12 million follicles right so sorry it's 6 to 7 million follicles 6 to 7 million follicles then at the time of birth at the time of birth it is 1 to 2 million follicles so that means follicles they are undergoing a programmed cell death up up say the follicles die at puberty the number of follicles is 4 to 5 lakh and what do you understand by menopause menopause yeah which is now called menopause is a condition where there are no more follicles when there are no more follicles in the ovary that condition is called as menopause right so these are all very very important questions which they keep on asking you then related to menstrual cycle they ask you questions on ovulation what is meant by ovulation ovulation means when a primary uite changes into secondary uite and a follicle changes into Corpus lthium that is what is called as your ovulation now all of you know that ovulation happens because of LH surge now the question which they ask you is LH surge occurs due to LH surge occurs due to so LH surge occurs due to what hormone which hormone is responsible for LH surge this is your pyq who's going to answer that LH surge occurs because of which hormone who's going to answer that quickly tell me LH surge occurs because of which hormone your pyq excellent AG whoever is AG excellent it is estrogen estrogen right LH surge happens due to estrogen so estrogen PE and then LH Peak right now the question which they ask you is see understand if this is the place where ovulation is happening right they ask you what is the time gap between LH surge and ulation LH surge the time when LH begins to increase so when LH begins to increase ovulation what is the time gap between LH surge and ovulation what's the time gap between LH surge and ovulation 24 best answer is 32 to 36 hours if 32 to 36 hours is not given second best answer is 2 24 to 36 hours best answer 20 32 to 36 hours if that is not given then 24 to 36 hours right now this point over here is when LH is maximum that is LH Peak so if they ask you what is the time gap between LH Peak and ovulation what has happened to my pencil wait just hold on B one second just one second there is some problem some issue with my apple pencil huh got it now tell me what is the time gap between LH Peak and ovulation it is 10 to 12 hours 10 to 12 hours third important question what is the time gap between estrogen Peak and LH Peak what is the time gap between estrogen Peak and LH Peak estrogen Peak and LH Peak this in Peaks be what is the time Gap this what is this time Gap who's going excellent who's this n i very good it is 14 to2 4 hours very good the time gap between estrogen Peak and LH surge is 14 to 24 hours okay now day of ovulation they ask you questions on day of ovulation so whenever we have to calculate the day of ovulation it is 14 days prior to the next menstruation or if you want to calculate the day of ovulation whatever is the length of the cycle given to you from that you have to subtract 4 and you will get the day of ovulation for example if the length of the cycle given to you is 40 days then the date of ovulation is going to be 40 - 14 which is Day 26 right that is how you have to calculate the day of ovulation right okay then as I told you ovulation means primary oite is going to get converted into secondary oite and your follicle that gets converted into corpus lthium now the questions which they ask you on Corpus lthium number one question is Corpus luum in a nonpregnant female is maintained by so in a nonpregnant female Corpus lutetium is maintained by which hormone in a non-pregnant female Corpus lutetium is maintained by which hormone tell quickly ji LH excellent excellent priu Anu Mohammad it is LH C function in pregnancies done by same function in pregnancy done by um Krishnan mini sundan whatever your name is I'm so sorry to pronounce it bet I would want that once these sessions are over in OBG especially you know there are some answers which you are giving wrong I'm not demotivating you but you are actually trying to give the answers that is making me happy so session please go through these sessions twice if you go through these sessions twice then you will not have any difficulty take now Corpus Lum in pregnancy all of you have said that it is maintained by HCG lifespan of Corpus litium in a non-pregnant female life span of Corpus luum in a non-pregnant female what is the lifespan of Corpus luum in a non-pregnant female uh ranan Kumar 10 to 12 Days take anyone else 12 to 14 days priyansu very good 12 to 14 days excellent hormone which prevents luteolysis which hormone prevents luteolysis so Corpus lutetium is about to die hormone Corpus Lum Co pre it prevents Corpus luum from dying which is that hormone which is that hormone which prevents Corpus lutetium from dying 12 to 14 12 to 16 both are correct answers it's okay now tell me which hormone prevents Corpus litium from dying so proud of all of you it is HCG Corpus litium is about to die but AG female pregnant then HCG prevents Corpus litium from dying when is the maximum size and activity of Corpus litium seen on this same question can be asked is that during a men menual cycle when are the levels of progesterone maximum question I when are the levels of progesterone maximum Yeah question I when is the size and activity of Corpus litium maximum what is your answer going to be it is going to be dat 22 of the cycle day 22 of the cycle bet this session is also for nepg and I will do I told you I am going to do an image based session for npg I will definitely do that right that is 8 days after ovulation so please understand this question can be asked in four formats they can ask you that during a menstrual cycle when is the size of Corpus luum maximum or maximum or activity of Corpus L lithium maximum answer is 8 days after ovulation that is day 22 of the cycle same question can be asked when are the levels of progesterone maximum now when the levels of progesterone are maximum progesterone has a negative feedback on LH and FSH so same question can be asked that when are minimum levels of LH and FSH seen in a cycle then also your answer is going to remain the same that it is seen on day 22 of the cycle same question and what is that whenever in an infertile couple I want to know whether the female is ovulating or not I have to check progesterone present so all the tests for ovulation they are done on day 22 of the cycle same question can be asked in four different formats so as I was telling you all the tests for ovulation they are done on day 22 let us talk about what are the tests for ovulation number one what are the hints in the qu in the history of the patient which tell you that your patient is ovulating number one if you ask your patient and she says that she's having regular Cycles so these are all indirect evidences whenever they ask you a question what is the indirect evidence of ovulation so history based evidence is indirect evidence of ovulation and so that means she's ovulating why because Jo an ovulatory Cycles remember an ovat Cycles they are irregular characteristic anov Cycles they are always irregular number two anovulatory cycles are painless right and number three and ulatory Cycles May there is going to be estrogen breakthrough bleeding they are due to estrogen breakthrough bleeding right progesterone progesterone withdrawal is not responsible for them so normally when when a female is menstruating normal menstruation is because of progesterone withdrawal and progesterone withdraw remember normal menstruation normal menstruation normal menstruation is due to Progesterone withdrawal and progesterone withdrawal there is vasospasm why because we all know progesterone is a smooth muscle relaxant to be prester withdraw conri pgf 2 Alpha release and it is this pgf2 Alpha which leads to pain that is disman so this means young girl and she's saying that she's having dis minoria indirectly I come to know oh her Cycles are OV right but female pain so always she's having an ovary Cycles her female threshold to feel the pain right so pain that is an Evidence of ovulation pain is not an Evidence of an ulation I hope this point is clear to all of you f that doesn't mean all of them are having Cycles but yes pain then definitely that means she's having ovulatory Cycles clear to all of you yes so indirect evidence of ovulation is if a female is having regular Cycles or if there is Michelle Ms syndrome what is Michelle Ms Syndrome again a very important question Michelle Ms syndrome means that there is pain due to ovulation some females have pain due to ovulation my voice is breaking is there some unstable internet connection um I don't know I I am sorry but but I can't help it at this point of time so in Michelle M syndrome typically a female will complain of mid cycle pain midcycle pain right whenever a female has disys minoria or Prem menr rual syndrome all these are indirect evidence of ovulation right as I told you anovulatory Cycles are due to estrogen breakthrough and they are not because of progesterone withdrawal they are painless irregular and they are associated with heavy bleeding okay now coming to the tests of for ovulation you test I'm going to tell you which are the test for ovulation they tell you in a retrospective manner female ovulate and all these tests are done on day 22 of the cycle first test is basil body temperature Test please remember progesterone increases the basil body temperature right that is why AG up any female around the mid cycle if her basal body temperature increases it means that that she is ovulating if her basal body temperature doesn't increase that means her uh she's having anovulatory Cycles number one number two test is cervical mucus study uh Menan sagit this is for both of you both both fmgs and pgs can attend this session coming to cervical mucus study please remember under the effect of estrogen question cical mucus characteristic under the effect of estrogen under the effect of estrogen survical mucus is profuse watery elastic and it can be stretched this is called as spin bar ke right PG question but this time I don't know why I feel is say be can be asked in fmg and that is why all the dbmci students and all the dbmci students you are going to write this point if I have not made you write it earlier write this point that cervical mucus will be profuse watery elastic and it can be stretched that is what is called as spin bar KET under microscope you get a fern like appearance furning appears on day seven of the cycle right under the effect of progesterone cervical mucus is thick scanty viscous it cannot be stretched and the ferning disappears by day 17 of the cycle or day 18 of the cycle right so ferning is going to disappear clear copied all of you please write it under the effect of estrogen cervical mucus thin first half of the cycle everything is happening in such a manner sperm easily that is why you get that cervical mucus is profuse watery elastic and it can be stretched second half of the cycle May everything is happening in such a manner keep by chance fertilization so that is why cervical mucus becomes thick scanty viscous take okay now that is so if you do a cervical mucus study you can come to know whether a female has ovulated or not right ferning appears on day seven or day eight of the cycle and it disappears by day 1 18 or 18 of the cycle it's one and the same thing right you can pgs I have made you write day eight you don't continue with day eight because William says days day eight fmgs you continue with day seven hardly matters because data says day seven take okay now vaginal epithelial study vaginal epithelial study may remember under the effect of estrogen under the effect of estrogen the cells which you are going to get will be superficial cells and under the effect of progesterone the cells which you get are intermediate cells so again vaginal epithelial study can help me knowing whether a female has ovulated or not now my next question to you is now my next question to you is that from where are you going to take a sample for vaginal epithelial study from where are you going to take a sample sample con wall of vagina sample has to be taken from lateral wall of vagina take then you can do endometrial biopsy endometrial biopsy can also tell you right that whether a female has ovulated or not under the effect of estrogen the glands which you get are very simple tubular glands simple tubular glands whereas under the effect of progesterone the glands which which you get are coiled glands and these coiled glands are called as screw appearance of the glands screw appearance of glands or this is also called as Sawtooth appearance of gland screw appearance of gland or Sawtooth appearance of gland then serum progesterone levels you can check the serum progesterone levels on day 22 please remember endometrial biopsy is not done for this purpose I could have done this but it is not done for this purpose number one number two endometrial biopsy indication these days is for diagnosis of genital TB for for diagnosing genital TB I am going to do endometrial biopsy right okay then you can check serum progesterone levels this is the best test for ovulation if question comes what is the best or the easiest test to know whether a female is ovulating or not it is serum progesterone levels easy blood and prester levels 22 of the cycle progesterone levels high that means she has ovulated other progesterone levels low that means she has not ovulated very very simple test right but all these tests which we have done till now all of them are the tests which are in a retrospective manner telling you that a female has ovulated or not suppose I want to predict ovulation I want to tell the time of ovulation in my patient are there any tests which can which can help me in telling my patient that this time you are going to ovulate or this day you are going to ovulate so tests which can predict ovulation there are two tests which can predict ovulation what are those two tests number one what is that test anyone can tell me two tests which can predict ovulation let me see who's going to answer dbmci versus students urinary L search excellent urin AR LH surge right this is urinary LH kit urine pregnancy K say we have urinary LH surge right to what a female has to do is she has to take her urine and she has to put it in this kit and if you get two lines that means urine May L UR ovulation will happen after 24 hours blood May LH surge to ovulation will happen after 32 to 36 hours urine LH surge then ovulation is going to happen after 24 hours right second Point second test is follicular monitoring follicular monitoring now follicular monitoring is a special type of TVs in which you are going to study only the follicles right now this TVs is done from day 10 onwards and you have to do it on Alternate days and you have to check the size of the follicle every day every day you will see that the size of the follicles is increasing right every day you see that the size of the follicle increases by 1 to 2 Mill mm per day ultimately the size is going to become 18 to 20 mm b or more than 17 B that's one and the same thing right so it becomes 18 to 20 mm per day and a say the size of the follicle decreases right that is going to tell you that she has ovulated there will be fluid in pouch of Douglas and there is going to be triple lay endometrium so these are the signs which tell you that ovulation has happened right why am I getting fluid and pouch of Douglas because I told you anal cavity fluid so once the follicle is going to rupture that fluid in anal cavity is going to come into the pouch of Douglas so these are signs of ovulation coming to management of an ovulation so once I know whether my female my patient is not ovulating now what I'm am I going to do please remember if they ask you the most easily treatable form most easily treatable form of infertility most easily treatable form of infertility um Nani I'll just now tell you something R Jana AB you are right but I'll come to your point also most easily treatable form of infertility what is that that is an ovulation an ovulation me simply you have to give a drug small tiny little drug you have to give tablet and your patients infertility is treated right Nishant size of the dominant follicle is 18 to 20 mm right now Nanny your point beta triple Le endometrium is characteristic of late proliferative phase and it is going to stay there till the time of ovulation so ovulation time per be you are going to get a triple Le endometrium as I have told all the nepg students in my marrow lectures and in dbmci PH Toof face class that whenever they give you a triple lay endometrium car image on ultrasound and they ask you this is characteristic of the best answer is late proliferative phase but if that is not given second best answer is ovulatory Phase right okay now coming to uh fmgs forget about it but you don't have to listen to what just now I said take coming to drug of choice for an ovulation simple question I drug of choice for an ovulation it is Chopin citrate drug of choice for an ulation due to PCOS if this question comes then you have to mark the answer as letrozol followed by chomen citrate right then that is your um for anovulation treatment of anovulation now another cause of infertility in a female which is related to ovary is premature menopause premature menopause is also called as primary ovarian in insufficiency that's the new name for premature menopause POI right now question IA what are the tests which tell you that there is decreased ovarian reserve what do you understand by the term decreased ovarian reserve decreased ovarian reserve means that you have to tell whether the follicles in the ovary are decreased or not right now before I tell you what are the tests which are done to know whether the follicles are adequate in the ovary or follicles have decreased as I told you every month the number of follicles is decreasing so has it decreased so much that now a patient has become infertile that is what is meant by the tests for ovarian reserve before that a very important concept you have to remember and that is FSH acts on granite granulosa cells in female and from granulosa cells is released inhibin B from granulosa cells is released estrogen and from the granulosa cells of the anal follicle and the granulosa cells of preantral follicle antim malarian hormone is released three hormones are released by granulosa cells inhibin B estrogen and antim malarian hormone anti hormone granosa C anal folle and preal folle granulosa cells I'll write this properly otherwise you will not understand it just let me write it properly antril follicle and preanal follicle right so the granulosa cells of anal follicle and pre-anal follicle they release an imian hormone inban B and estrogen they have a negative feedback on FSH right another important point is LH acts on Thea cells and from thka cells in females from puberty onwards androgens are produced right so now understand in a patient in a female in whom there are less follicles inhibin B levels will be decreased estrogen levels will be decreased antim malarian hormone levels will be decreased FSH levels would be increased because the negative feedback on FSH would be gone right so FSH levels would be high so the tests which we do for ovarian reserve the time for doing these tests is day two or day three of the cycle you can check inhibin levels inhibin levels will be decreased you can check FSH levels FSH levels would be increased how much increased please remember K values remember FSH normal FSH values are 1 to 10 international units if FSH values they become more than equal to 40 to 45 international units that is diagnostic of menopause yeah premature or menopause they are diagnostic of menopause or premature menopause what is anal follicle count anal follicle count I am counting the number of follicles on ultrasound so this is on ultrasound you have to count the number of follicles again on Counting the number of follicles they would be decreased so these are the tests for ovarian reserve number one inhibin levels number number two FSH levels number three an uh anal follicle count you test which have to be done on day two or day three of the cycle there is one test which can be done on any day of the cycle that is antim malarian hormone levels because antim malarian hormone can be done on any day of the cycle that is why it is the best test for ovarian reserve values of antim malarian hormon remember it is between 1 2 3 I mean it's 1-3 don't say 1 2 3 1-3 if it is less than one that indicates POI that is menopause yeah premature menopause and if it is more than three right if it is more than three it indicates pcus please remember in PCOS there are many follicles follicles poly cystic ovarian syndrome and actually they are not cysts fcl when there are going to be many follicles they will release a lot of amh so amh levels are high in PCOS amh levels are less in premature menopause yeah menopause take okay now antim malarian hormone this is what I have written over here also it is a glycoprotein which is produced by the granulosa cells of preanal and natural follicles its normal values are 1 to three if it is less than one that means it's a poor ovarian reserve if it is high it is seen in pcus clear to all of you show me a thumbs up if you've understood till here now one of the test which is outdated for ovarian reserve is Chopin citrate challenge test so just the name ke this is an outdated test for ovarian ovarian reserve question question all of the following our tests for decreased ovarian reserve or for ovarian reserve except us except answer they are going to give you a list of tests all of the following tests are done for ovarian reserve except except answer serum progesterone levels please remember serum progesterone levels it is a test for an ovulation it is not a test for ovarian reserve gu confuse they are going to confuse you all of the following tests are done for ovarian reserve except option a inin option b FSH option C progesterone option D amh and confused so remember progesterone is not a test for ovarian reserve serum progesterone is a test for anovulation serum progesterone right on most of the time serum progesterone options but if serum progesterone is not given in your answers then look for estrogen estrogen estrogen generally test in a menopausal female it would be decreased but that is not a very good test right question is this which has come in your pyqs which of the following in best measures ovarian reserve which of the following best measures ovarian reserve tell me as I told you the best test is anti-an hormone why it's the best because it can be done on any day my next question to you is what is the management of infertility due to decreased ovarian reserve what is the management of infertility due to decreased ovarian reserve female follicles how can I make her conceive what can I do I can take donor X plus I can go for IVF so I will do IVF with the help of donor X excellent excellent smart surgeon right coming to dis manoria dis manoria P questions are asked in fmg as as well as neat PG now there is something which is primary dis minoria why is primary dis minoria happening primary disor is happening because of the release of pgf2 alpha primary dmenor may you are going to get a young girl and young girl is going to say she's going to complain of pain right and she is going to say it leave aside the 6 months one year period when I started my minarchy say ever since my minarchy I'm having pain so she complains of pain since minarchy this pain as I told you there is no pathology for responsible for this pain primary disor because of pgf2 alpha CES there is no problem in the in the female there is no pathology which is causing this pain right and that is why we will have a young girl who's going to say which time to pain because at that time she would be having anov Cycles so 6 months one year P after that she's having a lot of pain this pain begins with Menses or just before the periods and it is going to decrease within 72 hours of the periods P centralized pain and suprapubic pain this pain decreases after physical activity after marriage and child birth right and is pain relieve we can tell her to use nades or we can advise her to use OES why we advise her to use OES to make the Cycles an ovulatory right so dis manoria drug of choice is OES clear to all of you dis manoria it is OES bet methanic acid is not now the drug of choice Nets but drug of choice Nets can be used but drug of choice is OES take now coming to secondary dis manoria secondary dis manoria is congestive dis manoria secondary dis manoria just hold on one second uh sir I am in a live session can I give you a call after that yes sir right so coming to secondary dis manoria secondary dis manoria is congestive disys manoria secondary disys manoria there has to be some reason for the pain right that is some pelvic pathology which is causing pain that is secondary disys manoria and most of the times it is endometriosis most common cause of secondary dmenor is endometriosis of in case of secondary dmenor in case of secondary dis minoria you will have a reproductive age female right a reproductive age female who is going to say that all of a sudden she has started having pain earlier there was no pain earlier there was no pain but now she's having pain right 30 35 years ke female 4 years female complain right that is secondary dis manoria secondary disor pain occurs much before the Menses and it remains there even after the onset of period so please understand secondary dis manoria May more than half of the cycle goes in pain right there is nothing like that within 72 hours of the onset of periods female pain relieve nothing like that happens right pain is localized and pain progressively increases very very important point and per vaginal examination May suppose your question saysex Mass feel adex tenderness feel anything you know any abnormal per vaginal finding if they give you that means it is second secondary dis minoria whether they say utrine tenderness be any abnormal finding if you are getting on per vaginal examination that means it is secondary dis minoria in secondary dis minoria you have to treat the cause clear to all of you my next question to you over here is related to causes of CH this I'll ask you when I'm doing endometriosis and fibroid reion then I'll ask you that okay now tell me coming to puberty let's talk about puberty tell me what is the normal age of puberty in a female normal age of puberty in females what's the normal age of puberty in females 13 years that's the normal age of puberty pru very good shuk bad J concept sub clear normal age is 10 and a half years 10 and a half years that's the normal age of puberty in females 13 years that is delayed puberty normal age of puberty is 10 and a half years and when puberty happens at 10 and a half years minari minari after 2 years that is 12 and A2 years right okay now coming to precautious puberty when do you say a what is the normal age of puberty in males 11 and 1/2 years take now what is precautious puberty precautious puberty is when in females puberty happens at less than 8 years that is precautious puberty uh I will be providing the annotated PDF don't worry what is precautious menstruation precautious menstruation is when menstruation happens at less than 10 years right when precautious puberty uh prec when minari happens at less than 10 years that is precautious menstruation please remember precautious puberty is more common in females than in males most common cause of precautious puberty is idiopathic but 10% cases May 10% cases of precautious puberty are due to brain tumors they are due to brain tumors like h Moma that is why whenever you have a patient of precautious puberty you should rule out brain tumors and the investigation which you have to do is MRI MRI it has to be done in all patients of precautious puberty right what is the drug of choice for precautious puberty drug of choice for precautious puberty is continuous GnRH continuous GNR that's the drug of choice for precautious puberty now there is one syndrome which I want all of you to know right so what is that syndrome which leads to precautious puberty Mech cun albite syndrome mecun albite syndrome mecun Albrite syndrome May what do you get in mecun albite syndrome you get precocious puberty you get Cafe o spot on skins skin may you get Cafe o spots and Bone lesions what what are those bone lesions polyostotic lesions polyostotic bone lesions right so this is mecun albite syndrome clear to all of you yes then coming to delayed puberty delayed puberty if in females puberty has not happened till 13 years that is what is fibrous dysplasias B yeah you call it as polyostotic fibrous dysplasias perfect perfect prachi perfect surui right what is the most common cause AA please remember delayed puberty is more common in boys than in girls so it's more common in males than in females most common cause of delayed puberty is Con constitutional delay constitutional delay and what is the drug of choice for delayed puberty drug of choice for delayed puberty is pulsatile GnRH pulsatile GNR always remember whenever you are giving G&R in a pulsatile manner it is going to increase estrogen whenever you give G&R in a continuous manner it is going to decrease estrogen right then what is the sequence of puberty in females what is the sequence of puberty so first sign of puberty in females is growth spurt I don't want any of you to tell me in the chat box pediatric hardly matters in this case I am a little dominant that you are going to write what I am telling you you are going to answer what I am Telling You growth spurt don't tell me Pediatrics but you are going to Mark the answer as growth SP because Williams is saying growth SP right so the first sign of puberty is growth spurt the first visible sign or the first specific sign or the most specific sign is thearchy tar right Vijay that is what I was telling you chat Bo Mark what I am telling you write what I am telling you take I mean not because I am telling you because Williams is saying that the latest edition of Williams says that then after thari what will be the sign after thari you are that thearchy is breast buding breast buding then then you are going to have puar what is puar appearance of pubic hair appearance of pubic hair right then you are going to have Peak height velocity and then there is going to be minari right what is the first sign of puberty in males it's testicular enlargement CH now coming to Tanner staging Tanner stage one or two means that it is underdeveloped breast underdeveloped or less developed breast less developed or underdeveloped breast and pubic hair whenever your question says Tanner stage four or five what does that mean that means welld developed breast welldeveloped breast yeah welldeveloped pubic hair you don't need to know the full staging you just have to remember this Tanner stage one or two is underdeveloped or less developed breast and pubic hair and Tanner stage four or five means welldeveloped right now if your question says secondary sexual characteristic are present whenever your question says secondary sexual characteristic present that means breast is present right and that means estrogen is normal because the hormone which is responsible for breast development is estrogen right whenever your question says secondary sexual characteristic absent that means breast absent and that means estrogen is decreased right right so breast absent estrogen decreased breast present estrogen levels are normal now if your question says pubic hair and axillary hair are normal that means androgens are normal why because the hormone responsible for pubic hair and axillary hair in a female is also Androgen right so whether it is a male or whether it is a female for pubic hair and axillary hair development which hormone is required Androgen is required now whenever your question says that there is a female who has come to you with primary amoria with batal inguinal hernia term bilateral ininal hernia actually it is not bilateral inguinal hernia actually they are undes ended testes these are small small hints which you have to remember because I know all of you are so confused whenever you get questions related to primary or secondary dis minor uh primary or secondary aoria so these are the hints which are going to tell you to how you are going to come to a diagnosis so whenever your question is saying that there is primary amoria with bilateral inguinal hernia that means they are undescended testes and that means carot type is 46 XY a 46xy individual female 46xy F right there can be only two situations one is Androgen insensitivity syndrome and the other one is s syndrome c those situations as far as fmg exams are concerned there will be only two situations a question will come that a female is coming to you with primary amoria with bilateral inguinal hernia so either your answer has to be Androgen in Sensitivity Syndrome or your answer has to be swi syndrome Cho answer Androgen insensitivity syndrome question may they will say breast is well developed swi syndrome May breast is not developed second important thing Androgen insensitivity May uterus is absent swies May uterus present and now your questions are super easy for you to solve the moment your question says bilateral inguinal hernia immediately you have to think about only two things either you are dealing with Androgen insensitivity syndrome or you are dealing with sers syndrome Androgen insensitivity syndrome question may they are going to say breast is welldeveloped uterus absent swies May breast not developed uterus present clear to all of you yes now some other Concepts because now what is happening these days now they are asking you questions related to hormones they will ask you primary amoria secondary amoria LH levels sa FSH levels sa so you have to have a clear understanding of the hormone and that is why quickly we are going to revise hormones in females hypothalamus say what is released hypothalamus releases GNR this is going to be released at puberty right and this G&R is going to be released in a pulsatile manner now this G&R is going to act on anterior pituitary and from anterior pitutary FSH and LH will be released now FSH is going to act on the ovary and from the granulosa cells it is going to release inhibin and it is going to release estrogen LH is going to act on the ovary it will bring about ovulation and because it brings about ovulation progesterone is formed this is what is happening in females please remember estrogen always always estrogen will have a negative feedback on FSH always right estro EST usually estrogen usually has a negative feedback on LH but only in one condition there is one exception and that exception is when estrogen levels are more than 200 P when estrogen levels are more than 200 P for 48 hours Bal this class is useful for nset or not uh AB noret don't do it for net just now right netally I'll take a different class this is a gy class and this is too much of gy for net net estrogen levels more than equal to 200 P for 48 hours it leads to LH surge that is the time when it is going to increase LH otherwise normally estrogen has a negative feedback on both LH and FSH only in one condition estrogen has a positive feedback on LH and that is when the value when the values of estrogen are more than 200 picr for 48 hours right as far as progesterone is concerned progesterone in low low concentration has a positive feedback on LH and FSH in high concentrations it has a negative feedback on LH and FSH right coming to prolactin please remember you both important prolactin has a negative feedback on GNR this is the reason why during lactation there is a manoria this is the reason why if there is a prolactin secreting tumor if there is a prolactin secreting tumor it is going to lead cause a minoria because it is going to decrease G&R GNR decrease to automatically LH decrease automatically FSH decrease to neither there is going to be estrogen nor progesterone so obviously female will not ovulate clear to all of you yes now coming to males in males hypothalamus will again just females May hypothalamus releases G&R at the time of puberty in males also hypothalamus will release G&R at the time of puberty which is going to act on pitutary from pitutary FSH and LH would be released right of FSH is going to act on ctoi cells so in the testes we have two types of cells CI cells and leig cells satoli cells are the ones which release inhibin leic cells under the effect of LH LH acts on leic cells and it produces testosterone right now testosterone effect L FSH inhibin always has a negative feedback on FSH testosterone overall please remember testosterone always has a negative feedback on both LH and FSH right testosterone will have a negative Fe feedback on both LH and FSH now comes a very very important question what is the first stimulus for the testes to release testosterone in intra utrine life please remember ovaries silent inut life ovaries sorry ovaries never form any hormone in intrauterine life but testes are active in intrauterine life also so they ask you which is that first simulus for the testes to release testosterone in intrauterine life nbano very very good don't say it is LH LH is not the first stimulus LH act leic cells to release testosterone but it is not the first stimulus first stimulus always is HCG that is why we say HCG and LH are functionally the same hormone because both of them have same functions right clear to all of you any confusion still here any confusions no quickly in the comment section tell me then I'm going to go to G&R and then we are going to proceed with primary amoria and how you are going to approach questions related to primary am minoria no confusions shuk thank you for confirming Baki just show me your thumbs up so that I come to know that there are no confusions great CH now let us talk about G&R this G&R which I'm telling you is a synthetic G&R which we prepare in the um Industries right so GNR synthetic G&R this you can give in a pulsatile manner this is GNR analog please remember G&R analoges when you are giving in a pulsatile manner they will increase LH they will increase FSH and they will increase estrogen so when do you use pulsatile G&R whenever whenever levels of estrogen are less I can give G&R in a pulsatile manner so it is used for management of delayed puberty and for management of calman syndrome what is calman syndrome calman syndrome is a condition where there is hypothalamic failure there is hypothalmic failure there is decreased GnRH so common sense tells me if there is decreased GnRH so obviously I can give G&R in a pulsatile manner right okay ma'am which subunit of HCG similar to LH remember it is the beta subunit which is the specific subunit Alpha subunit of HCG is similar to LH FSH and TSH right now coming to continuous G&R whenever the same G&R when you are going to give it in a continuous manner it is going to decrease one second it is going to decrease oh yeah it will decrease LH it will decrease FSH and it will decrease estrogen not only it is going to decrease estrogen Rogen because LH acts on the Thea cells to release androgens so it will also decrease Androgen production by the ovary whatever is being produced by the ovary will decreased and that is why continous GNR is used in the management of precautious puberty continuous G&R is used for managing hottism because in hirsutism Androgen levels are high the moment Androgen levels decrease then your heroism is treated and it is used for management of fibroid and endometriosis why for the management of fibroid and endometriosis because both of them are hyperestrogenic conditions both of them are hyperestrogenic conditions and both of them estrogen levels are high so the moment I decrease estrogen levels they will become normal whether it is endometriosis whether it is fibroid Isa you can use this in males for management of prostate cancer right for the management of prostate cancer also you can use continuous GnRH clear to all of you now coming to primary amorin question Dr kunj prajapati Dr kunj prajapati I am not saying ke hirsutism drug of choice is G&R I am saying that one drug which can be used to manage hirsutism is G&R continuous GNR continuous GNR the levels of LH will decrease and when the levels of LH will decrease it will not stimulate the cells to release androgens so automatically heroism treat patience I will also talk to you about the drug of choice for heroism ABA I will clear all your doubts coming to primary amoria now definition of primary amoria say many questions are asked please remember primary amoria means if a female has not experienced monarchy by 15 years of age if there is breast present breast present here and she has not experienced minarchi by 15 years breast absent and she has not experienced manarchy by 13 years so there are two definitions one is if breast is present and if she's not experienced minarchy by 15 years then we call it as primia minoria or if breast is absent and if she has not experienced minari by 13 years then that is primary amoria second definition just now I was telling you that whenever whenever a female has breast budding that is whenever there is puar huh puar that is puberty and sorry puber thari and minari may there is a difference of two years whenever a female is going to have onset of puberty 2 years B she's going to have menstruation but suppose a female has developed breast and three years have passed until now she has not had minarchy then also that is primary aoria so once breast appears within 2 years she should be having minarchy now I'm saying 3 years have passed breast a breast development but the patient did not have any minarchi that is also primary amoria both these definitions are very very important right what is secondary amoria secondary amoria means a female was menstruating normally and all of a sudden now for past 3 months she's not having menstruation that is secondary aoria or overall in a year a female should have 12 Cycles now if she is having less than nine Cycles then also that should be investigated because that comes under olig manoria right that's not normal having less than nine Cycles in a year is not normal and that again should be investigated clear to all of you so all these definitions you have to remember take questions answer I know this is again a pain point for all of you that how are you going to answer questions related to primary amoria so I'm going to make it again very easy for you I'm going to make you write in a tabulated form that question answer right so we are going to learn it like maths multiplication tables question to my answer has to be this if you've understood what I taught you in class very good if you are a Maro subscriber dbmci student I teach all this in class so you know the concept behind it but if you are not my student then again whether you are my student or not is table memorize and all your answers will be here whenever your question says that there is primary amoria and your question says that there is cyclical pain in abdomen cyclical pain in abdomen J he word a it means that your patient is having hidden menstruation that means there is cryp cryptoria cryptoria right cryptoria means hidden menstruation so the patient is menstruating properly but the menstrual blood is unable to come out why does this happen the most common reason for this is imperforate Hyman right further your question is going to say that uterus is present other than just saying uterus is present your question can say uterus is enlarged why is it enlarged because of blood that is because of hematometra right your question will say they in cryptoria patient normally menstruate right LH FSH levels are absolutely normal breast is absolutely normal pubic hair and axillary hair are AB absolutely normal one more thing with which a patient of cryptoria can come to you is she can come to you with complain of urinary retention why because there is blood inside the vagina there is blood inside the uterus both of them when there is blood inside the vagina it can press the urra so urra press there can be urinary retention now as I told you the most common cause of cryptoria is imperforate himman how do you come to know that they are talking about imperforate Hyman the hint in the question will be that they are going to say that her Hyman is tensed and bulging her Hyman is tensed and bulging then they can say that there is a bluish Hyman blue colored diyman is because of the collected blood right other causes of cryptoria are transverse vaginal septum in transverse vaginal septum you will never have a bluish Hyman you will never have a tensed bulging Hyman okay so look at the question which is asked and these questions are asked so many times in your papers as well a young girl who has not attained minarchi complains of cyclical pain in abdomen as I told you the moment they say cyclical pain in abdomen it means they are talking about cryptoria on examination her breast development was normal local examination has been shown in the image what are you saying you are seeing over here that there is tensed bulging Hyman there is a tensed bulging Hyman as I told you whenever you get a tensed bulging Hyman uh collected blood will appear blue in color right then this is imperforate Hyman what is the management of imperforate hman management of imperforate Hyman many times they ask you and that is you have to give a cruciate incision on the Hyman you have to give a cruciate incision on the Hyman clear to all of you yes okay now now they have started showing you images of Hyman also this is what what are you saying beta investigation investigation huh if you are a n PG student and they ask you that on clinical examination how to differentiate between uh imperforate hon and transverse vaginal septum then please remember in imperforate hon cough impulse is present in transverse vaginal septum cough impulses not present number two you have to remember that if they ask you what is the investigation of choice to differentiate between them normally you can differentiate between them clinically but if you have to answer an investigation of choice then that is MRI right that is for npg not required for fmgs now they show you the Hyman and they ask you the types of Hyman so in the types of Hyman this is how a normal Hyman appears to you right this is imperforate Hyman as you can see there is no opening this is imperforate hman over here you are getting a Septa in between the hman so this is a septate hman very very important then they show you the seeve like hman CH so SE like Hyman that is CRI form Hyman right clear to all of you so this is the images which they show coming to question number two now if they say that there is a female who has come to you with primary amoria and with uterus present now absent breast and pubic hair this is how the question is going to be that primary amoria uterus present absent breast and pubic hair remember cryptoria is uterus present breast present pubic hair present right now they are saying that there is primary amoria uterus present but breast and pubic hair are not present now in this case you have to see because they can be multiple conditions one condition if they say LH and FSH are decreased now the moment they say LH and FSH decreased that means they are talking about calman syndrome LH FSH decreased okay here I'm writing lhf LH FSH decreased means they are talking about calman syndrome take so when your question says that breast development absent pubic hair absent LH FSH levels less L FSH levels less hypothalamus problem and hypothalamus which problem can lead to primary amoria calman syndrome what do you understand by calman syndrome calman syndrome means that there is hypothalmic failure now the question is going to say that height of the patient is normal and an additional feature which is going to be present will be an osmia uh Mika don't say that tall height it's not tall height it's normal height right why we are stressing on normal height because Turner syndrome May height is short that is why y we stress that there is normal height it's not tall height okay and there will be an osmia that is inability to smell so whenever you are getting a scenario like this primary amoria uterus present breast absent LH FSH decreased right that height of the patient normal that means they are talking about calman syndrome as I told you g it's very easy to talk about management why because whatever is deficient you have to give that Calvin syndrome g g in pulsatile manner so pulsatile GN RH right now calman syndrome about now suppose they say the same question primary amoria uterus present breast absent pubic hair absent but now they are saying LH FSH increased here please remember B whenever LH FSH H is increased and estrogen is decreased it is called as hypergonadotropic hypogonadism gonad hypergonadotropic hypogonadism problem is in ovary right be problem hypothalamus pit whenever the problem is in hypothalamus or the problem is in pitutary LH FSH levels will be low and that is called as hypogonadotropic hypogonadism whenever problem is in ovary whenever problem is in ovary understand estrogen come because estrogen come negative feedback on LH and FSH will be gone so LH and FSH would be high so whenever your question is saying estrogen come here L FSH high right now you are going to say mamen question definitely estrogen come because they are saying absent breast right the moment they say absent breast I told you it means they are saying estrogen come right so whenever LH FSH estrogen all of them are decreased the problem is hypothalamus pitutary whenever LH FSH high estrogen decreased problem is in ovary right now in ovary the problem could be gonadal dis Genesis what can be the problem gonadal dis Genesis gonadal dis Genesis can be of two types Turner syndrome Swire syndrome AG question short sture that means it is Turner syndrome question normal sture that means s syndrome Turner syndrome carot type is 45x o s syndrome is 46 XY 46 x y right okay now so whenever as I told you whenever your question says that LH FSH levels are high estrogen less uterus present right and short stature short sture means Turner syndrome carot type 45 XO because carot type is 45x O that means both X chromosomes are not present X chromosomes proper development of ovary K internal syndrome because both X chromosomes are not present that is why the ovaries are not welld developed and that is what is called as streak ovaries remember streak ovaries should not be removed is ala in these patients you are going to get a additional findings of Turner syndrome what are additional findings of turn Turner syndrome in pathology you have read webbing of neck low posterior hairline Shield shaped chest heart problems right then diabetes Hashimoto thyroiditis streak ovaries ovaries are not developed properly OV properly develop both X chromosomes are required for proper development of ovary in syndrome because only one X chromosome is present so ovaries are not welld developed and that is streak ovary that is why estrogen levels are decreased and that is why breast development is absent because ovaries are not developed that is why Androgen levels are decreased and that is why pubic hair is not developed is that clear to all of you yes then same question AG I and the say that there is a female who has come to you with primary amoria uterus present of uterus present cryptoria uterus present calman syndrome uterus present Turners and swies now your question is saying breast development absent question breast development absent that means cryptoria gone now I'm thinking about Calvin now I'm thinking about Turners I'm thinking about wires okay further your question says LH FSH levels High J question LH FSH High I am thinking only about ovarian problems which could be Turner which could be sers and question normal sture normal St to Turners out and swies in in s syndrome karot type is 40 6X y y as I told you be question may male any male who's coming to you with primary amoria your question will always say that there is bilateral inguinal hernia question bilateral excuse me bilateral linal her short bilateral her is that clear to all of you short St Turners bilateral inguinal Heria towi normal sture clear to all of you are you all understanding then in this case this bilateral inguinal hernia they are actually undescended testes and undescended testes can are premalignant they are premalignant right they can undergo malignancy that is why you have to do gonadectomy right you have to do GCT me so syndrome patient I have to remove those test clear yes so I have to do a gonadectomy any confusions no next very important question Sr y Gene is located on where is Sr y Gene located it is located on short arm of Y chromosome which end distal end distal end of short arm of Y chromosome take so I'm quickly recapping this for you patient comes to you with primary amoria uterus present uterus present think of only four things cryptoria Calin syndrome Turner syndrome swi syndrome right cryptoria K patient cyclical pain in abdomen Cryptor patient breast development normal pubic hair normal LH FSH normal Calvin syndrome patient LH FSH decreased Calvin syndrome patient an osmia and calman syndrome patient height of the patient normal right lhf decreased so breast development would be absent right then com swies and Turners swies and Turners may be breast development absent but LH FSH levels would be high Turner syndrome patient may they will give you short sture the moment they say short sture you come to know it is Turner syndrome s syndrome ke patient may they are always going to say that we are um com I get conf I get my mind gets diverted what is what was I telling you s syndrome patient may they will always say that there is bilateral inguinal hernia right so whenever they say bilateral inguinal hernia then you have to take it as X yot type and that is okay chromosome short arm short of Y chromos short arm of Y chromosome primary amoria with uterus absent primary amoria with uterus absent B simple either it is Malian a Genesis or Androgen insensitivity syndrome Androgen insensitivity syndrome May again what is what are they going to say Androgen in Sensitivity Syndrome May again they are going to say that bilateral inguinal hernia is present bilateral ininal hernia present right Marian aesis Marian aesis they will always say that uterus is absent breast and pubic hair both are welld developed Marian a Genesis that means both Marian ducts are absent both Malian ducts absent means we are dealing with Mia a Genesis now when both Marian ducts are absent ovaries are normal why are ovaries normal because ovaries develop from genital Ridge right so o ovary is normal because ovary is normal LH levels FSH levels and estrogen levels all of them are normal so breast development be normal pubic hair be normal so if you get a question which say is uterus absent breast normal pubic hair normal don't no normal LH FSH estrogen normal that means you are dealing with Marian a Genesis be normal breast be normal pubic hair be normal in some cases they can say a small blind vagina present so confus all of you know upper part of vagina develops from Marian duct to obviously small blind vagina present H H then your question can say renal anomalies are present so Marian duct is also responsible for formation of re some parts of renal system so renal anomalies can also be present right now now if your question says breast to well developed but pubic hair scanty so your question will say t breast corresponds to Tanner stage four or five and pubic hair corresponds to Tanner stage one or two then it means they are talking about Androgen insensitivity syndrome in Androgen in Sensitivity Syndrome the karot type is 40 6X y right additional features which they are going to tell you are there is by lateral inguinal hernia and sometimes in these patients also a small blind vagina can be seen as I told you whenever your question says primary amoria with bilateral inguinal hernia you have to think about 46xy 46xy May uterus present means swies syndrome uterus absent means Androgen insensitivity syndrome okay now let us see a few questions which have been asked in your exam so you a 16-year-old female visits gyop with complaint of cyclical pain in abdomen cyclical pain in abdomen what do you think about you quickly you have to think about cryptoria and cryptoria most common cause imperforate hman her General examination shows normal breast development normal pubic hair development local examination shows bluish bulging Hyman per rectal examination May uterus is palpable most appropriate management what is the management of imperforate hman what is the management cruciate incision question done next pyq a mother brings her 18 years old child to gyop who has not attained minarchi normal LH FSH of your question is saying normal LH FSH normal breast development and pubic hair development small blind vagina absent uterus cotype 46xx absent uterus 46 XX Marian a Genesis as I told you Marian a Genesis May LH FSH everything would be normal in case of Malian a Genesis breast development will also be normal pubic hair will be normal in Androgen insensitivity syndrome breast is pres breast is well developed pubic hair is not welld developed take so answer is Marian a Genesis I hope now now you people have become slightly confident in primary amoria s questions related to primary Amor answer J say WR yes or no say or say better I couldn't have told you then I'm going to go to secondary amoria so let's talk about secondary amoria now secondary amoria maybe you have to think about problems related to hypothalamus problems related to pitutary problems related to ovary and problems related to uterus secondary amoria first I would like to tell you the causes please remember most common cause secondary imor Meo most common cause of secondary amoria is pregnancy right then the other causes May causes related to hypothalamus causes related to hypothalamus are excessive exercise right excessive dieting that is anorexia excessive eating that is bulimia then causes related to pitutary causes related to pit one is shean syndrome and the other one is prolactinoma then causes related to ovary causes related to ovary be PC and premature menopause then cause related to uterus cause related to uterus is Asher m and Syndrome from our physiology knowledge and I told you be problem hypothalamus pit LH FSH estrogen all these are going to be decreased problem OV LH FSH will be increased estrogen will be decreased be problem uterus LH normal FSH normal estrogen normal PCOS is a problem of ovary but in case of PCOS please remember PCOS patients May FSH is normal LH is high right so that is what you have to remember about PC so all this is something which we will we' understood because we know ke hypothalamus pitutary and ovary what kind of hormones they are releasing and what kind of negative feedbacks are are there right now based on this let's quickly talk about secondary amoria in secondary amoria the most common cause is pregnancy that is why the first test which you have to do whenever whenever there is a patient coming to you with secondary amoria the first test which you have to do is urine pregnancy test in case of pregnancy placenta is forming estrogen so estrogen is increased placenta is forming progesterone so progesterone is increased both estrogen and progesterone have a negative feedback on LH and FSH so LH and FSH are decreased your question will tell you some are the symptoms of pregnancy and up would be positive so that is about pregnancy then let's talk about premature menopause premature menopause case premature menopause it is also called as primary ovarian insufficiency POI when do you call it as premature menopause when menopause is happening at less than 40 years now there are no more follicles in the ovary because there are no more follicles estrogen decreased progesterone decreased LH FSH increased but up is positive uh upup is negative your question will say up negative LH FSH increased J be question K FSH increased and secondary amoria this is the only condition FSH high and patient will have secondary amoria whenever your question is saying FSH levels high that means the problem is in ovary right and that means the problem is premature menopause okay then comes PCOS PCOS patients May the problem is an ovulation right in a patient of PCOS estrogen level can be normal or it could be increased progesterone levels are decreased FSH levels are normal LH levels are high please remember normally normally LH is to FSH is 1 is to 1 in a patient of PCOS LH is to FSH becomes 2 is to 1 or 3 is to 1 right PCOS patient may they also going to say that there was hottism or they may talk about irregular Cycles they may talk about obesity all these things can be present in your question right then coming to prolactinoma prolactinoma is a prolactin secreting pitutary tumor as I told you prolactin has a negative feedback on G&R so whenever there is going to be a prolac laoma LH and FSH levels will be decreased problem hypothalamus pit to always LH FSH would be decreased problem OV that is premature menopause to FSH would be increased right now because LH and FSH are decreased I I have to think about problems related to hypothalamus and pitutary what are the hints in the question which will tell me that they are talking about prolactinoma please remember because prolactinoma is a prolactin secreting pitutary tumor that is why due to pressure symptoms pit tumor question patient has headache right because pitutary is very near to optic chasma to question visual disturbances because it is secreting prolactin so question gor question secondary amoria with headache visual disturbances galoria that means you are talk they are talking about prolactinoma now what is the most common symtom of prolactinoma questiona that what is the most common symptom of prolactinoma please do not say galoria galoria is not the most common symptom of uh um prolactinoma most common symptom of prolactinoma is secondary amoria secondary amoria that's the most common symptom of pro prolactinoma right then when am I I'm am going to do MRI in a patient of prolactinoma I am going to get a space occupying leion space occupying leion right coming to shean syndrome in shean syndrome what is there there is necrosis of the anterior pitutary gland due to phph right again because the problem is in pitutary so LH FSH levels will be decreased how am I going to come to a conclusion that there is shean syndrome because your question is going to say that your patient was unable to feed the baby patient deliver but she's she was unable to feed the baby right then I come to know that there was shean syndrome when I'm going to do MRI I am going to get empty cell Tura empty cell Tura right inability to breastfeed the baby that is the complaint with which a patient of shean syndrome is going to come to you right then comes Asher man syndrome in asherman syndrome you are getting a lot of additions inside the uterus there are intra utrine sinia or intra utrine additions because is my hypothalamus normal pitutary normal ovary normal so L FSH estrogen everything will be normal hint in the question given to you would be they are going to say that there is history of previous curage right or your question can say estrogen plus progesterone challenge test negative whenever your question says estrogen and Preston challenge test negative it means they are talking about Asher man syndrome right this is how you differentiate between progesterone test negative estrogen and progesterone challenge test negative now come to these questions these are which of the following is not a cause of secondary amoria is shean syndrome a cause of secondary amoria yes asherman yes Turners no calans no right then they asked match the condition with appropriate hormone levels how are you going to match it with hormone levels asherman syndrome LH FSH and estrogen everything normal shean she P problem so LH decreased FSH decreased estrogen decreased then PCOS PCOS FSH normal right LH high and estrogen is also normal or estrogen can be high so let us see premature ovarian failure premature ovarian failure LH FSH both would be high so L FSH both High I'm marking it as POI only L and FSH decre normal right estrogen be normal instead of normal they have written it as decrease but that is the only option which is remaining so I'm going to mark that as the answer right rule out answers clear to all of you yes okay now look at this question a 24-year-old female this is again your pyq a 24y old female attends gyop with secondary amoria she has history of previous DNC so she has history of DNC her FSH levels are six international units six international units normally FSH 1 to 10 6 absolutely normal so absolutely normal levels of FSH and she has previous history of DNC asherman syndrome clear to all of you yes any confusions no CH coming to a few important pyq single liners which they ask you what is the best method of sex determination best method for sex determination is karyotyping right if Y chromosome is present then we say that we are dealing with male if Y chromosome absent then the female then the sex of the patient is female right what is the most commonly used method most commonly used method is by looking at external genitalia right then what is bar bodies bar bodies is another method of sex determination where the number of X chromosomes minus 1 is equal to the number of bar body now over here I want to tell you carot typing is the best method so according to karot typing if Y chromosome is present we call them as males if by chromosome absent females so if I ask ask you according to karot type Turner syndrome babies are male babies or female babies Turner syndrome is 45 XO that means Y chromosome absent Y chromosome absent to they will be females very good Klein felter syndrome Klein felter syndrome 47 xxy you male way female way Klein felter syndrome males or females 47 xxy pranu very good to Klein felter syndrome babies will be male babies why because Y chromosome is AB uh Y chromosome is present right and now let us talk about bar bodies bar bodies May a normal male May who is 46 XY what will be the number of bar bodies zero right a normal female normal female who is 46xx one AB I told you Turner syndrome female Turner syndrome how many bar bodies am I going to get zero that is the problem with bar Body Bar body say you cannot come to know the sex because Turner syndrome we take them as females but bar body is telling me that they are males because bar body is zero similarly Klein felter syndrome kleim filter syndrome Co we take them as males right they are 47 xxy but the number of bar body will be one so bar body gives you false results same question has been asked in your exam this is your pyq in which of the following condition there will be false positive bar body false positive that they are actually males but they are having a positive bar body in which condition are you going to get a false positive bar body you are going to get it in Klein filter's syndrome are you understanding false positive false that is false positive right okay now similarly if they are ask you false negative false negative result false negative result Turners May Turners may actually I should have been getting one bar body but I get a negative result and this negative result is a false negative result clear to all of you then then comes homologous structures homologous structures are those structures which develop from the same embryological origin right so if embryological structure is genitals um THB say this has gone out of my mind just hold on genital swelling genital folds and penis and clitorus develop from it has slipped my mind I'm not getting that term in my mind penis and clitorus they develop from you will have to help me I've just forgotten that term it slipped out of my mind tubercle yes thank you so much Tule R bet R say ovary and testes develop genital tubercle thank you thank you so much shank thank you so genital tubercle genital Ridge genital Ridge say ovary and testes develop it's genital tubercle so if the embryological structure is genital Tule and M's genital Tule is going to form penis in females it is going to form clitorus right so they are homologous organs because both penis and clitorus are developing from genital tubercle then genital swellings genital swelling in males it is going to form scrotum in females it is going to form labia majora right then genital folds genital folds in males is going to form penile urethr in females labia minora right now the so these are homologous structures in glands I want you to remember in males prostate gland is homologous too which gland and females skin glands yeah paral glands right then C gland carer's gland is also called as bulbo urethal gland bulbo urethal gland in males is homologous to barolin glands in females clear so these are homologous structures which are present in males and females next question what is the most common cause of ambiguous genitalia what is ambiguous genitalia when by looking at the genitalia you cannot decide the sex of the baby so what is the most common cause of ambiguous genitalia in a female if they ask you this question or if they ask you what is the most common cause of female pseudo hermaphroditism whether they say female pseudo hermaphroditism or whether they ask you most common cause of ambiguous genitalia in females answer lth very good answer is congenital adrenal hyperplasia most common enzyme deficiency leading to congenital adrenal hyperplasia 21 Alpha hydroxy enzyme deficiency right so most common enzyme deficiency leading to congenital adrenal hyperplasia is 21 Alpha hydroxylase what is the most common cause of ambiguous genitalia in males it is partial Androgen in Sensitivity Syndrome options May partial Androgen insensitivity syndrome that's the best answer partial word then you are going to Mark the answer as Androgen insensitivity syndrome but if word partial is given then yes you have to mark it as partial Androgen insensitivity syndrome right now all of you know that in intrauterine life in males and females we have both the pairs of duct wolfi and duct and molian duct in males what does wolfian duct do mulian duct it leads to the formation of male internal genital organs and what are male internal genital organs s e seminal vesicles ejaculatory duct epididymus and V difference seminal vesicles epid us ejaculatory duct and vast deference mulian duct regresses in males and when Marian duct regresses in males it is going to leave certain remnants what are the remnants of molian duct in males very very important question number one prostatic utricle prostatic utricle and number two is appendix of testes appendix of testes the other name for appendix of testes is hydrated of Morag hydrated of Morag right so this is how the ducts are going to behave in males in contrast to this in females it is the wolfian duct which is going to regress when wolfian duct is going to regress it is going to form remnants and what remnants it is going to form it is going to form eoon paron and Gartner duct Gartner duct it is malarian duct which is going to form female internal genital organs what female internal genital organs it is going to form it will form fallopian tube it will form uterus cervix and upper vagina please remember from where do ovary develop ovary develop from gen ital rid ovary has nothing to do with Marian duct and that is why in Marian a Genesis when both Malian ducts are absent still ovaries are normal right from where does lower vagina develop lower vagina develops from COV vaginal bulb COV vaginal bulb it comes from urogenital sin urogenital sinus right now next and a very very important question which you get is on barolin CY this over here is a Bartholin Cy whenever you see a cyst which is present between labia majora and labia minora please remember it has to be a Bartholin cyst right anytime if you are getting a cyst between between Majora and minora it has to be Bartholin cist and nothing else right I just want all of you to remember that management of Bartholin cyst if the cyst is asymptomatic and it is less than 3 cm then no management conservatively he manage if it is is more than equal to 3 cm incision and drainage if it is a barolin absis then again incision and drainage if it is recurrent barolin cyst recurrent barolin cyst then in that case you have to go for maril ization management of barolin mariliz the answer has changed barolin cysta management now is incision and drainage recurrent barolin cysta mariliz clear to all of you yes understood what is the other name for Bartholin gland the other name for barolin gland is greater vestibular gland right that's the other name for Bartholin gland so this is what you had to remember in the female external genitalia and internal genitalia Development coming to syndromes in gy um I think your Orthopedic session is also scheduled is it for 5:00 or 4:00 if it is for 5:00 I'll take a 15 minutes break just let me ask hold on just let me check when is your next session planned 5:00 so your next session is planned at uh 5:00 yeah it's it's at 5:00 so in that case uh can we take a 10 minutes break I want to have some water right so you also have some water tea and we continue because we are on page number 20 session right not even half I have 48 pages to tell you and this is just now page number 20 so let's take a 10 minutes break and then we meet again this is 3:30 and I am going to see you at 345 yes let's meet at 3:45 and we continue the session at 3:45