Chapter1 womens health

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Chapter1 womens health
2010-09-06 21:57:32
Women\'s Health core curriculum

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  1. Which is the most reliable method for diagnosing endometriosis?
    a. Pelvic MRI
    b. Hysteroscopy
    c. Laparoscopy
    d. Transvaginal pelvic US
    e. A thorough history of the nature of pelvic pain symptoms
    • Endometriosis- occurence of ectopic endometrial tissue outside uterus.
    • most common sites: ovaries, pouch of douglas, uterosacral ligaments, broad ligaments
    • epi: 1 in 6
    • c. Laparoscopy - most reliable diagnosis for primary or secondary dysmenorrhea.
  2. Which of the following is supported by the strongest evidence of effectiveness for treatment of premenstrual syndrome?
    a. SSRIs
    b. evening primrose oil
    c. pyridoxine (vit B6)
    d. progesterone
    e. spironolactone
    • PMS:
    • - breast tenderness
    • - fluid retention and wt gain
    • - headaches
    • - aching joints
    • a. SSRI
    • - GnRH agonists 'medical oophorectomy' gives useful prediction of response to surg oophorectomy. (controversial... excessively invasive)
    • the rest - no evidence.
    • may also give
    • - spironolactone for fluid retention
    • - bromocriptine or evening primorse oil for breast tenderness
  3. Which of the following is the most effective non-surg option for ovulatory dysfunctional uterine bleeding?
    a. NSAIDs
    b. Tranexamic acid
    c. Short-course progesterone
    d. Levonorgestrel intrauterine system
    e. Transcervical resection of the endometrium
    • ovulatory dysfunctional uterine bleeding- regular HMB (menorrhagia)
    • anovulatory dysfunctional uterine bleeding - irregular HMB
    • intermenstrual bleeding - between expected menstrual periods
    • d. levonorgestrel intrauterine system (LNG-IUS)
    • Other options
    • - Tranexamic acid - an antifibrinolytic agent. -4x daily during menstruation
    • - NSAIDS (mefanamic acid) during menstruation
    • - cyclical oral progestogens - methodroxyprogesterone acetate or norethisterone
    • - long course oral progestogen
    • - OCP
  4. Which of the following is a characteristic feature of Turner's syndrome?
    a. Karyotype of 46XX
    b. Tall stature
    c. Hyperprolactinaemia
    d. Web neck
    e. VSD
    • Turner's syndrome 45XO
    • - short stature
    • d. web neck
    • - lymphoedema
    • - coarctation of aorta
    • - scoliosis
  5. Which of the following scenarios would be cause for concern in a 14yo girl?
    a. height of 150cm
    b. Breasts which are smaller than those of her peers
    c. Absence of any signs of pubertal development
    d. Widespread pubertal hair extending onto the medial surface of the thighs and causing embarrassment when swimming
    e. Absence of menses, but with hair and breast secondary sexual characteristics well developed
    c. Absence of any signs of pubertal development
  6. A 16yo girl comes to see you w her mother because she has not yet had a period. O/E, she is short in stature and there is no secondary sexual development. What is the most likely diagnosis?
    a. Prolactinoma
    b. Congenital adrenal hyperplasia
    c. Imperforate hymen
    d. Turner's syndrome
    e. Mosaic 46XY/45XO
    • d. Turner's syndrome
    • Delayed puberty is absence of 2ndary sexual characteristics by 14y.
    • causes of delayed pub:
    • - hypergonadotrophic hypogonadism
    • - ovarian failure w abN or N karyotype (turners)
    • - hypogonadoptrophic hypogonadism
    • - reversible
    • - phys/constitutnl delay
    • - wt loss/anorexia
    • - primary hypothyroidism
    • - prolactinomas and other pituitary adenomas
    • - CAH
    • - irreversible
    • - GnRH deficiency
    • - Craniopharyngioma
    • -Euogonadism
    • - Mullerian agenesis
    • - Androgen insensitivity syndrome
    • - Imperforate hymen
  7. A 30yo woman presents w a 6/12 hx of amenorrhoea and a vague hx of hot flushes. Which of the following statements is incorrect?
    a. b-HCG is useful to exclude pregnancy
    b. FSH is useful to diagnose ovarian failure
    c. If the FSH is >40 IU/L, clomiphene can be given to induce ovulation
    d. If the FSH is >40 IU/L, a karyotype is indicated
    e. A family hx is relevant
    • c. If the FSH is >40 IU/L, clomiphene can be given to induce ovulation (incorrect)
    • FSH>40 diagnosis POF.
    • causes:
    • - genetic - Turners or family hx.
    • - autoimmune - assoc w thyroid
    • - iatrogenic - surgery, radiotx, chemotx
  8. A 30yo woman presents w a 6/12 hx of amenorrhea and a vague hx of hot flushes. Which of the following statements is incorrect?
    a. Ovarian resistance syndrome is a possible diagnosis
    b. A prolactinoma should be excluded.
    c. Thyroid disease should be excluded if ovarian failure is diagnosed
    d. Long-term oestrogen/progesterone substitution is contraindicated in case of ovarian failure
    e. Pregnancy is the most common cause of amenorrhoea in this age group
    • Ovarian resistance syndrome- found in approx 20% of pts with POF.
    • characterized by: amenorrhoea, endogenous hypergonadotropinaemia, and resistance to exogenous gonadotropins
    • Prolactinoma: - benign tumour of pituitary gland - produces prolactin - amenorrhea (hyperprolactinemia disrupts pituitary gonadotropin secretion leading to hypogonadism)
    • d. Long-term hormone tx that does not prevent conception is indicated until the age of natural menopause is reached.
  9. The US diagnosis of polycyctic ovaries is based upon which of the following parameters?
    a. An ovarian volume > 12cc
    b. Any ovarian abnormality that contains more than one follicle larger than 15mm in diameter
    c. Ten follicles (usually 8-10mm in diameter) arranged peripherally around a dense core of ovarian stroma
    d. Multiple ovarian follicles in an enlarged ovary
    e. Follicles larger than 20mm in diameter that persist longer than 3/12
    c. Ten follicles (usually 8-10mm in diameter) arranged peripherally around a dense core of ovarian stroma
  10. A 25yo woman menstruating every 3-4/12 has noticed increasing acne and hirsutism over the previous year. Her serum testosterone is elevated, as is a measurement of 17a-hydroxyprogesterone. What is the usual managment?
    a. Prescribe a COCP containing cyproterone acetate.
    b. Perform an adrenal stimulation test.
    c. Reassure her that the diagnosis of PCOS does not necessarily need treatment.
    d. Prescribe an aldosterone antagonist
    e. Use depilatory agents to control hirsutism
    • Signs and symptoms only of adronergic hormones (steroids synthesized by the adrenal cortex)
    • b. Perform an adrenal stimulation test.
    • assesses fn of the adrenal glands stress response by measuring the adrenal response to ACTH
  11. Which of the following is the single most useful investigation in a woman presenting with hirsutism and oligomenorrhea?
    a. serum-free testosterone
    b. total testosterone
    c. SHBG
    d. Ovarian US
    e. DHEAS
    • hirsutism and oligomenorrhea - likely PCOS:
    • d. Ovarian US
    • DHEAS(Dehydroepiandrosterone Sulfate): testosterone, & other androgens used to evaluate adrenal fn and to distinguish androgen-secreting conditns that are caused by the adrenal glands from those that originate in the ovaries or testes
    • Sex hormone-binding globulin (SHBG): glycoprotein that binds to sex hormones, specifically testosterone and estradiol.
    • Conditions with low SHBG: PCOS, diabetes, and hypothyroidism.
    • Conditions with high SHBG: pregnancy, hyperthyroidism, and anorexia nervosa.
  12. Cyproterone acetate is effective in reducing hirsutism because it is which of the following?
    a. A strong progestogen and acts by androgen receptor blockade
    b. An oestrogen and suppresses ovarian function
    c. An insulin-sensitising agent
    d. An aldosterone antagonist
    e. A depilatory agent
    • a. A strong progestogen and acts by androgen receptor blockade
    • depilatory agent: nair