Gynecology Long Exam 4

GYNECOLOGY LONG EXAM 4

PRECOCIOUS PUBERTY, HYPERANDROGENISM, PCOS 1. The following are true regarding puberty except: a. This is a time of accelerated linear skeletal growth b. Development of secondary sexual characteristics c. Menarche occurs before the appearance of axillary or pubic hair d. Wide range of ages 2. Precocious puberty is described as the following except: a. A relatively common disorder b. Appearance of any secondary characteristics at an early stage c. Diminished growth due to premature closure of epiphyseal plate d. Most are GnRH dependent 3. Majority of the cause of GnRH dependent a. Unknown 4. The most common cause of GnRH independent precocious puberty a. Functioning ovarian tumor b. McCune Albright syndrome c. Exposure to Estrogen or testosterone d. Tumors of adrenal or pituitary 5. Primary emphasis in the diagnosis of precocious puberty a. Rule out life-threatening neoplasm of the ovary, adrenal glands, or CNS (second emphasis: delineate the speed of the maturation process) 6. Goal of therapy in precocious puberty include: a. Reduce gonadotropin secretion. b. Reduce or counteract the peripheral actions of sex steroid c. Decrease growth rate to normal and slow skeletal maturation d. All of the above 7. The most important in the medical management of GnRH precocious puberty is: a. Change growth pattern 8. Classic definition of PCOS will include a. Anovulatory b. Irreg periods c. Androgenism d. All of the above 9. Ultrasound finding in PCOS are the following except a. A dominant follicle 17mm b. Ovarian 7.5 cubic mm ldmf2012

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c. Pearl string appearance 10. Central pathophysiology of PCOS a. Insulin resistnace 11. 25 year old, infertile, BMI 32, sonography >13 follicles in ovary. Diagnostic test except: a. OGTT b. Serum testosterone c. Triglyceride, lipid d. Urinalysis 12. First management to case 11 a. Encourage weight loss 13. PCOS most important long term consequence of PCOS a. Ovarian cancer 14. Androgen mostly provided by ovaries a. Testosterone 15. Treatment of idiopathic hirsutism due to peripheral androgen a. Spironalactone 16. The following produce testosterone except: a. Testes b. Ovaries c. Adrenal d. pituitary 17. The following are signs of hyperandorogenism except: a. Hirsutism b. Alopecia c. Dysmenorrhea d. Glucose intolerance 18. Tumor producing testosterone a. Fibroma b. Brenners tumor c. Corpus luteum cyst d. Theca lutein cyst 19. Treatment for hyperandrogenism except a. OCP b. Surgery c. Diet and exercise d. Testosterone

MENOPAUSE 20. Natural menopause is cessation of menstruation secondary a. Bilateral oophorectomy b. Hysterectomy c. Changes in reproductive physiology due to advanced age d. Due to organic pathology 21. Mean age of menopause a. 35-45 b. 35 – 55 c. 60-65

22. The following speed up menopause except: a. Underweight b. Smoking c. Disease the damage ovaries d. Overweight 23. Premature ovarian failure causes premature menopause because a. Depletes follicle before age 40 24. Perimenopause is a time of irregular menstruation ... this is influenced by the following except a. Elevated FSH b. Decrease inhibin c. Decrease estradiol d. Elevated LH 25. Pathognomonic symptom of menopause due to change in hypothalamic thermoregulation a. Hot flushes 26. Initial endocronilogic changes in menopause a. Decrease ovarian inhibin, increase FSH 27. Treatment of menopause include the ff except a. Hysterectomy b. Fractional D&C c. HRT d. OCP 28. Which organ fails in POF a. Ovaries 29. Hormone slightly deficient in menopausal woman a. 17 beta progesterone 30. Anatomic changes in menopausal women except a. Vaginal shortens and narrows b. Vaginal lining becomes thinner and pale c. Decreased rugae and elasticity, vaginal surface becomes smooth d. Cervix does not atrophy 31. Menopausal women usually experience dyspareunia due to a. Decrease in Estrogen production 32. All are true regarding HRT for menopausal woman except a. Txt of choice for vasomotor sx b. Both for primary and secondary prevention of CVD c. Osteoporosis prevention d. Reduce endometrium carcinoma .. 33. Care of menopausal women except a. FBS according b. Mammography every 1-2 yrs for 40-50, annually after 50 c. CT scan every year d. Pap smear every 1-2 yrs dpending of age 34. True of HRT for menopausal treatment a. Treatment of acute vasomotor symptoms b. Start with highest dose c. Given to all women menopause ldmf2012

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INFERTILITY 35. Major cause of infertility a. Male factor b. Pelvic factor c. Ovulatory factor d. All of the above 36. Assessment of ovulation except a. LH b. Serum pg c. Semen analysis d. Ultrasound 37. Requirement for semen collection a. Abstain for 2-3 days b. Collection in a glass after masturbation c. Do not use condom d. All of the above 38. Initial screening for the evaluation of infertility tubal pathology a. Hysterosalphingogram 39. Qualities of post coital test except a. Poor predictor of infertility b. In vivo collection of sperm and cervical mucus in action c. Test male factor 40. Component of basic infertility work up except a. Semen analysis b. Post coital test c. Hystosalphingogram d. Laparoscopy 41. 30 nmol/L proof of ovulation a. Progesterone 42. Accurate non invasive way of documenting ovulation a. Ultrasound 43. Normal semen paramaters except a. Ejaculate 2-5 ml b. < 20 Million/liter c. Mobility >50% d. Normal morphology >60% 44. Parameter of semen analysis a. Liquefaction b. Semen volume c. Seminal leukocyte d. AOTA A. B. C. D. E. F.

OVULATION OOCYTE QUALITY TUBAL FACTOR UTERINE FACTOR MALE FACTOR UNEXPLAINED

45. 25 Year old, G2P2, appendectomy, non smoker, non alcoholic drinker, healthy husband

 Tubal factor

46. 29 G5P1, usually common spontaneous abortion, not carry pregnancy, miscarriage 10-14 weeks. Irregularly enlarged uterus.  Uterine factor

47. G1P0 spontaneous abortion 2 year s ago, secondary infertility, pelvic utz – central follicles,  Ovulation

48. Vasectomy  Male factor  ovulation

49. 22 yearold. Infertile for 18 mos, irregular bleeding, 45 periods per year. 5’2’’. 201 lbs weight, hair growth in abdomen

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