Add បន្ថែម , តែមិនទាន់បញ្ចូល

Add បន្ថែម , តែមិនទាន់បញ្ចូល
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This patient has a presentation that is most consistent with perimenopausal hot flashes (or hot

flushes as they are sometimes called). The exact pathophysiology that underlies the hot flash is

not known. However, it is known that women at the menopause and men that undergo

orchiectomies experience these symptoms. Therefore, it is assumed that it is the removal of

normal levels of sex steroids from the circulation that results in the hot flash. These hot feelings

are experienced as a flushing that can last from several seconds to many minutes. The first-line

treatment for most women is with hormone replacement therapy.

This patient has a presentation that is most consistent with ovarian hyperstimulation syndrome

(OHSS). OHSS most often occurs in patients undergoing ovulation induction with

gonadotropins, although it can also occur with use of clomiphene citrate. The signs and

symptoms of OHSS run a spectrum depending on whether the disease is mild, moderate, or

severe. In mild OHSS, the ovaries are less than 5 cm, and the patient has mild weight gain and

pelvic discomfort. In moderate OHSS, the ovaries can be up to 10 cm in diameter, and the patient

has at least a 10-pound weight gain, nausea, and vomiting. In severe OHSS, the ovaries are

greater than 10 cm, with ascites, hydrothorax, hemoconcentration, and oliguria. Management

depends on the severity of the syndrome, with mild cases being managed conservatively and

more severe cases being managed more aggressively with the possible need for paracentesis,

thoracentesis, or surgery. Pelvic or abdominal examinations should not be performed if OHSS is

on the differential diagnosis because examination can lead to rupture of the ovarian capsule.

Evaluation should be done with a careful ultrasound examination.

Cystic teratoma = dermoid

La contraception est une question de confiance. Chaque méthode de contraception est caractérisée par un chiffre appelé «indice de Pearl» (IP). Il correspond au nombre total de grossesses non désirées survenant chez 100 femmes durant 12 mois d’utilisation de la méthode en question. Ce taux d’échec est un indicateur de la sécurité d’une méthode. Plus la valeur de l’indice est basse, plus la méthode est fiable. Voici un exemple concret: si 100 couples utilisent le préservatif en tant que moyen de contraception pendant une année et que parmi eux on observe la survenue de trois grossesses durant cet intervalle, alors le préservatif a un indice de Pearl de 3.


Pilule oestro-progestative (POP)

PA = paquet d'année

K = cancer

FCV = Frottis cervico vaginal

deep venous thrombosis (DVT)

This patient has a presentation and findings that are most consistent with androgen

insensitivity syndrome (also called testicular feminization syndrome). These patients are

genotypically male (46, XY) but phenotypically female because they have a defect that prevents

normal androgen receptor function. The androgen receptor gene is located on the X chromosome

and various defects in the gene (e.g., absence of the gene or abnormalities in the androgen

binding domain of the receptor) can lead to this syndrome. Patients with androgen insensitivity

are amenorrheic and have no internal female structures. Testes rather than ovaries are present.

These patients also have minimal axillary and pubic hair. They do experience abundant breast development at puberty, as testosterone is unable to suppress the formation of breast tissues. These patients also tend to be very tall with big hands and feet and long arms. Testes should be removed after pubertal development is completed, as many of these patients will develop gonadal malignancies after puberty. 

Asherman syndrome (choice A) is amenorrhea caused by intrauterine

adhesions. These adhesions typically develop after curettage and infection of the uterus.

Kallmann syndrome (choice B) is amenorrhea caused by hypogonadotropic hypogonadism. It is

associated with anosmia, color blindness, and facial deformities. Patients have normal female

structures. 

Patients with polycystic ovarian syndrome (choice C) usually have the characteristics of oligomenorrhea, hirsutism, infertility, and obesity. This patient has none of these characteristics. 

Patients with Turner syndrome (choice E) have a 45, X genotype. They are

phenotypically females, often with small stature, short necks, and wide chests. This patient has aeunuchoid phenotype

estrogen replacement therapy (ERT)

Le stérilet au cuivre, que les gynécologues appellent Dispositif Intra-Utérin (DIU), se présente sous la forme d’un T d’environ 3 cm que l’on place dans l’utérus. Un fil de cuivre est enroulé autour de la tige. Il ne contient pas d’hormones. Donc le DIU au cuivre n'influence pas l’ovulation ou la sécrétion des hormones féminines responsables du cycle menstruel. Il rend les règles plus longues et plus abondantes, surtout pendant les premiers mois. Son principale rôle est toxique sur les spermatozoïdes en les rendant moins mobiles et moins viables dans l’utérus. Ceci les empêche de remonter dans la trompe qui abrite l’ovule fécondable.