OB/GYN Quiz Week 3

Which of the following is not a diagnostic criteria in the diagnosis polycystic ovary syndrome?

17-hydroxyprogesterone > than 200 ng per deciliter

You are seeing a 21-year-old female in your office because of a six year history of oligomenorrhea and slowly worsening facial hair growth. Her menses began at age 14 years and were always irregular. She has gained weight at a rate of approximately 4.5 kg (10 lb) per year since her menses started and her facial hair has become progressively thicker since age 18 years. In the last year she has only had about four or five periods. She is sexually active but does not want to become pregnant at this time. Her family history is noncontributory, and she takes no medications. On physical examination, vital signs are normal, and her BMI is 30. You note prominent terminal hairs on the upper lip, chin, upper cheeks, and chest; there is also thick hair from the pubis to the umbilicus. Her pelvic examination and Pap smear are normal. Which of the following findings below would be consistent of this patient's diagnosis?

All of the above

According to the Staging of Reproductive Aging workshop (STRAW+10), the menopause transition is divided into the early and late phases based on cycle length and ovarian endocrine function. Which of the following statements below is correct?

All of the above are correct

You are seeing 28-year-old white female in clinic because her and her husband have been unable to conceive after about a year of trying. She denies any past medical history and takes no medications. She began menstruating at age 14 years, and menses have always been irregular. There is no family history of infertility or premature menopause. On physical examination, temperature is normal, blood pressure is 114/62 mm Hg, pulse rate is 78/min, respiration rate is 14/min, and BMI is 30.4. She has acne, and facial hair. Her thyroid gland is non palpable. Visual field testing yields normal results. Her serum testerone level is elevated at 130 ng/dL. What is the most likely cause of her infertility?

Anovulation

You are seeing a 13 year old female in your office because she has had heavy menstrual bleeding and mild pelvic cramping over the five days. Her last menstrual period was six weeks ago. Her mother notes she has always been irregular since she started menstruation 8 months ago. She denies breast tenderness, bloating, mood swings, or abnormal cramping. She has no past medical or family history and takes no medications. The patient is not sexually active. Her BMI is 25 and she appears healthy. Her vitals signs and physical exam are both unremarkable and the patients mother refused a pelvic examination. Her urine pregnancy test is negative. What is the most likely cause of her heavy irregular bleeding?

Anovulation

You are seeing a 52-year-old white female with prior past medical history in your clinic because of hot flashes and night sweats over the last six months. She still has periods but they are very irregular and light. She is inquiring you about hormone replacement therapy but wants to try a nonprescription treatment first. Her physical examination, including vital signs, is normal. Which of the following is the most appropriate recommendation for this patient?

Black cohosh

You are seeing a 56-year-old female in your office to discuss hormone therapy. She has been on combined continuous hormone therapy for six years now after her prior PCP started her on it after she went through menopause. This therapy is associated with a reduced risk for which one of the following?

Bone fracture

You are seeing a 48-year-old black female in your clinic as she has been complaining of more for frequent hot flashes and night sweats that interfere with her work and sleep. She has not had a menstrual cycle for 5 months. Her past medical history is noncontributory, and she takes no medications. Physical examination, including vital signs, is normal. What laboratory tests are there to aid in the diagnosis of menopause?

Both A and C

Which of the following statements is true regarding the treatment of atrophic vaginitis?

In women with an intact uterus, progestin treatment is not needed for short term local estrogen treatment

Which of the following forms of birth control is associated with a lower incidence of gynecological cancer?

Combined oral contraceptives

You are seeing a previously healthy 31-year-old nulliparous female who was referred to you by her PCP as she has had a one-year history of painful periods and painful intercourse. Her pain has now become so bad that she avoids intercourse and no longer finds it pleasurable. Her last menstrual period was 20 days ago and her menses are typically 30 days apart. She denies prior STDs in the past. On exam her vitals are within normal limits. Physical examination reveals mild lower abdominal tenderness in both lower quadrants, and bilateral adnexal tenderness on pelvic examination. Cervix is closed and there is no friability, uterus is normal in size with some uterosacral ligament nodularity. What is the most likely diagnosis?

Endometriosis

You are seeing a 52-year-old white female in your office today for a routine examination. She is a vegetarian and has past medical history of hyperlipidemia but is on no medications. Today she states that she is been having irregular menses and occasional hot flashes for the past eight months. She denies any past surgeries and takes no medications. She is a very stressful job and drinks 2 to 3 cups of coffee every morning. She does not smoke, but she does drink four to five, 12 ounce beers a day for the past 20 years. On exam her vitals and blood pressure are all within normal limits. She is 5 foot 4 and weighs 180 pounds (BMI is 30.9). You inform her that she's probably reaching menopause, and that she will be at increased risk of developing osteoporosis. Which of the following is the most significant risk factor for the development of osteoporosis in this patient?

Excessive alcohol use

You are seeing a 27-year-old white female who presents with recurrent irritability, lack of sleep, lack of motivation and terrible mood swings. She having this for years but her condition has significantly worsened in the past year as she just got married last fall and it causing a lot of problems. Her symptoms are worse ten days prior to her menstrual period and are gone by day two of her period. She has tried several measures without success, including birth control pills, various herbal preparations, and counseling at a woman's health center. Which one of the following is most likely to improve her symptoms?

Fluoxetine (Prozac, Serafem) for the last 2 weeks of the menstrual cycle

You are seeing a 40-year-old female who is G2P2 who is status post vaginal delivery and desires postpartum tubal ligation. Which of the following is the most likely delayed complication of this procedure?

Future ectopic pregnancy

You are seeing a 24-year old female who is presenting with painful intercourse. She notes being a virgin up until recently getting into a relationship with her boyfriend of four months. She states that she has pain is so severe upon penetration that it causes her to tense up and now will avoid all sexual contact. She has no past medical history and takes no medications. She denies any symptoms of depression. Her vaginal exam shows no obvious abnormalities to the outer vestibule and speculum exam is almost impossible as she is very tense in her perineal muscles. What is the most likely diagnosis?

Genito-pelvic penetration disorder

Which one of the following associated conditions is most frequently present in woman vulvar cancer?

Human papillomavirus

You are seeing a 42-year-old female in the office because she has not had a period in over 5 months. Prior to this her periods were regular every 28-30 days. She has taken at least 4 pregnancy tests and they have all been negative. She denies other symptoms like weight loss/gain or fatigue. She has no prior past medical history and takes no medications. She has never had a uterine procedure or surgery. She is currently sexually active with her husband. Her vital signs and physical examination including pelvic examination are normal. You obtain an in office pregnancy test which is again negative. Her serum labs including prolactin, follicle-stimulating hormone, and thyroid-stimulating hormone levels are all normal. During her next visit you perform a Pelvic ultrasonography which shows a normal uterus and two normal appearing ovaries. You proceed with a progesterone challenge, which fails to cause endometrial bleeding within 1 week of completing the course of the medication. What is the most likely diagnosis?

Hypothalamic amenorrhea

Which of the following factors is unlikely to increase the risk of subsequent development of pelvic organ prolapse?

Hysterectomy

You are seeing a previously healthy 31-year-old nulliparous female who was referred to you by her PCP as she has had a one-year history of painful periods and painful intercourse. Her pain has now become so bad that she avoids intercourse with her husband and no longer finds it pleasurable. Her last menstrual period was 20 days ago and her menses are typically 30 days apart. She has a history of pelvic inflammatory disease at age 22. She was married once before and it ended as there was a lot of stress surrounding the fact she was unable to pregnant. On exam her vitals are within normal limits. She is 5 feet 6 inches tall and weighs 122 pounds. Physical examination reveals mild lower abdominal tenderness in both lower quadrants, and bilateral adnexal tenderness on pelvic examination. Cervix is closed and there is no friability, uterus is normal in size with some uterosacral ligament nodularity. A pelvic ultrasound shows a normal ovaries bilaterally. You start her on OCP's along with NSAIDs for pain and her next follow up 8 months later she reports no improvement in her symptoms. If she chooses a surgical option, which of the following procedure is the best option for this patient?

Laser ablation

You are seeing a 54-year-old female in your office who is complaining of a 6-month history of vaginal itching and painful intercourse despite the use over-the-counter topical therapies. She has past medical history of hyperlipidemia and hypertension. On pelvic examination the external genitalia show loss of the labia minora and the vulvar skin appears thin and pale. Her vagina is mildly atrophic, but appears uninvolved. What is the most likely diagnosis in this patient?

Lichen sclerosus

The most frequently reported symptom of vulvar cancer is which one of the following?

Longstanding pruritus

You are seeing a 23-year-old non-obese white female because of amenorrhea over the last 5 months. Her first period was at age 13 years and she had normal periods until college and was started on an oral contraceptive because of heavy bleeding. She has since gotten married and wants to get pregnant and stopped her OCP's about 5 months ago but has had no menses since that time. There is no family history of infertility or premature menopause. She denies abnormal hair growth but does note some recent new nipple discharge. On physical examination, her vital signs are normal. Her body mass index is 23.2. Upon inspection you note no signs of hirsutism. Examination of the thyroid gland and visual field testing are normal. Pelvic examination is normal, and a pregnancy test result is negative. Laboratory studies show her thyroid-stimulating hormone 1.5 μU/mL (0.5-5.0 μU/mL), prolactin of 200 ng/ml (less than 20 ng/mL), and follicle-stimulating hormone is 20 mU/ml (follicular or luteal phase, 5-20 mU/mL); midcycle peak, 30-50 mU/mL (30-50 units/L); postmenopausal, greater than 35 mU/mL (35 units/L). Which of the following is the most appropriate next diagnostic test?

Magnetic resonance imaging of the pituitary gland

You are seeing 28-year-old white female in clinic because of amenorrhea the last four months. She denies any past medical history and takes no medications. She began menstruating at age 14 years, and menses have always been regular every 28 days. She reports no recent weight gain, voice change, or facial hair growth; she says she may even have lost some weight recently and tends to feel warm. She is not sexually active. There is no family history of infertility or premature menopause. On physical examination, temperature is normal, blood pressure is 114/62 mm Hg, pulse rate is 78/min, respiration rate is 14/min, and BMI is 23.4. She has no acne, hirsutism, or galactorrhea. Her thyroid gland is slightly enlarged. Visual field testing yields normal results. Results of standard laboratory studies are normal, including thyroid-stimulating hormone and free thyroxine (T4 ) levels; a human chorionic gonadotropin level is negative for pregnancy. Which of the following is the most appropriate first step in evaluation?

Measurement of serum follicle stimulating hormone and prolactin levels

You are seeing an 18-year old female who is presenting with dysfunctional uterine bleeding (abnormal uterine bleeding) as she notes prolonged, frequent menses with moderate flow. Her pregnancy test is negative and physical exam is unremarkable. Her vital signs are normal and she is currently not bleeding. What is the most appropriate management of this patient?

Oral contraceptives and observation

A 22-year-old white female presents to you for a routine physical examination. During the review of systems her only complaint is recurrent lower abdominal pain and cramps that occur around the onset of menstruation. She reports that pain has been present to some degree with most of her periods since about six months after menarche when she was thirteen. Each episode lasts about 1-2 days and is somewhat relieved by rest and acetaminophen. She denies any sexual activity. Her physical examination is within normal limits. Which one of the following management choices would be appropriate at this time?

Naproxen

You are seeing a 17-year-old female in your clinic with her mother to discuss the possibility of starting oral contraceptives as she recently started becoming sexually active. She has no significant past medical or family history. Her urine pregnancy test is negative. In addition to appropriate counseling, which one of the following should be done before prescribing oral contraceptives?

No further evaluation at this visit unless indicated by history

Which of the following is true of Premenstrual dysphoric disorder

Patients must have a symptom free postmenstraul week (follicular phase)

Which of the following is true of Premenstrual dysphoric disorder?

Patients must have a symptom free postmenstrual week (follicular phase)

You are seeing a previously healthy 24-year-old nulliparous female who was referred to you by her PCP as she has had a one-year history of painful periods and painful intercourse. Her pain has now become so bad that she avoids intercourse with her husband and no longer finds it pleasurable. Her last menstrual period was 20 days ago and her menses are typically 30 days apart. She has a history of pelvic inflammatory disease at age 22. On exam her vitals are within normal limits. She is 5 feet 6 inches tall and weighs 122 pounds. Physical examination reveals mild lower abdominal tenderness in both lower quadrants, and bilateral adnexal tenderness on pelvic examination. Cervix is closed and there is no friability, uterus is normal in size with some uterosacral ligament nodularity. A pelvic ultrasound shows a normal ovaries bilaterally. In addition to starting her on her NSAIDs for pain, what is the best treatment option for this patient?

Oral contraceptives

You are seeing a previously healthly 20-year old female in your office because she has not had her period over the last few months since she was started on combined oral contraception agent five months ago before leaving for college. She noted having her menses the first two months after starting the medication but has not had one since. She currently denies nausea, vomiting, or abdominal pain. Her menarche was at age 15 and she has had irregular periods since. Her physical exam in unremarkable. What is the next step in management?

Order urine beta-HCG

Women who use a low-dose estrogen oral contraceptives, what is found in the low dose estrogen combination oral contraceptives (COC), have a 50% lower risk of which of the following cancer?

Ovarian

Which of the following statements regarding Urinary incontinence is not true?

Overflow and functional incontinence are most common causes in females

You are seeing a 64-year-old female who presents to your office with worsening urinary incontinence over the last year. She notes increasing urinary frequency and urgency. She went to the ER a week ago for the same thing and they found she had a mild cystocele and rectocele. Her urinalysis there was unremarkable. You perform a post-void residual which shows 400 cc. What is the most likely diagnosis in this patient?

Overflow incontinence

You are seeing an elderly female patient who presents with urinary frequency and urge incontinence. Her pelvic examination and urinalysis is unremarkable. A cystometrogram reveals uninhibited detrusor contractions upon filling consistent with destrusor instability. What is the best treatment for this patient?

Oxybutynin

You are seeing a 78-year old female who is presenting with worsening urinary incontinence over the last few months. She notes the loss of urine accompanied or preceded by strong desire to void along with frequency and nocturia. She has a past medical history of uncontrolled hypertension and prior stroke. Her only medications are lisinopril and a baby aspirin. Her physical exam is unremarkable. Which of the following statements regarding treatment for this patients symptoms is False?

Oxybutynin immediate release is the first line preferred pharmacological therapy

You are seeing a female patient in clinic who wants to be started on oral contraceptives for birth control. Which of the following would make this patient a better candidate for a progestin-only pill?

Prior pulmonary embolism

You are seeing a 34-year-old white female in the office because she has not had her menses in almost 5 months. Her first period was at age 13 years and she has had normal periods since. She has been on oral contraceptives for the last 10 years but has since recenlty gotten married and wants to get pregnant so she stopped her OCP's about 5 months ago but has had no menses since that time. There is no family history of infertility or premature menopause. She denies galactorrhea or abnormal hair growth. On physical examination, her vital signs are normal. Her BMI is 25. There are no signs of acne or hirsutism. Her thyroid gland and visual field testing are normal. Pelvic examination is normal, and a pregnancy test is negative. You obtain serum labs which show a TSH 2.8 μU/mL (normal 0.5-5.0 μU/mL), prolactin of 12.8 ng/ml (normal is less than 20 ng/mL), and follicle-stimulating hormone is 20 mU/ml (follicular or luteal phase, 5-20 mU/mL); midcycle peak, 30-50 mU/mL (30-50 units/L); postmenopausal, greater than 35 mU/mL (35 units/L). What is the most appropriate next diagnostic test?

Progestin withdrawal challenge

You are seeing a 64-year old G0 female who is presenting presenting for a routine evaluation and physical. She denies any current symptoms including vaginal bleeding or discharge. She has a past medical of hypertension and takes lisinopril. She is a never smoker and does not drink alcohol. She went through menopause at age 50. All of her Pap smears have been normal with the last being two years ago. She states her maternal aunt died of endometrial cancer and is concerned about getting it and what she can do to screen for prevention. Her physical exam is unremarkable and pelvic exam shows vulvovaginal atrophy and a normal appearing nulliparous cervix. What is the best step in management of this patient?

Routine health maintenance

You are referred a 15-year old female by her pediatrician for amenorrhea and lack of secondary sexual characteristics such as underdeveloped breasts, and lack of pubic and axillary hair. She has no past medical of family history and takes no medications. You order a pelvic ultrasound which shows a normal appearing uterus. What is the next best step in management?

Serum FSH level

Which of the following is not true regarding menopause?

Smokers typically have a later onset of menopause

A 54-year-old black woman has been successfully treating her vasomotor symptoms with estrogen-only hormone therapy for the last 2 years. Her hot flashes are severe and affect the quality of her life. She underwent hysterectomy for benign fibroids at the age of 48. She is concerned about long-term side effects of the hormone therapy and wonders if she should discontinue the estrogen. In discussing the risks and benefits of treatment with her, which of the following statements is true?

Studies have suggested that younger hormone therapy users have a lower death rate, even with long-term use

You are seeing a 16 year-old female who is brought to your office by her mother because she has not started her menstrual cycle yet. has no prior past medical history and has been healthy. She started to develop breast buds about a year ago and has scant pubic hair. She denies sexual activity. Her mother's menarche occurred at age 15. Her current height is 62 inches (5ft 2in) and she weighs 105 lb.Which one of the following is true in this case?

The patient will likely start her periods within a year

0/1 You are seeing a 28-year old white female who presents with acute onset of left lower quadrant pain that radiates into her left pelvis over the last 2 days as well as vaginal discharge. Her last menstrual period was two weeks ago and she denies a past history of prior STDs. She is in a monogamous relationship with her boyfriend of two years. What is the best initial imaging choice in this patient?

Transvaginal ultrasonography with doppler

You are seeing a 28-year old white female who presents with acute onset of left lower quadrant pain that radiates into her left pelvis over the last 2 days as well as vaginal discharge. Her last menstrual period was two weeks ago and she denies a past history of prior STDs. She is in a monogamous relationship with her boyfriend of two years. What is the best initial imaging choice in this patient?

Transvaginal ultrasonography with doppler

You are seeing a 30-year-old black female in your office who is interested use of oral contraceptive use but worried about potential risks involved with their use. Which of the following is true regarding risks associated with oral contraceptive use?

Use of oral contraceptives have an increased risk of venous thromboembolism