Rotation 10 Ert - Aub Labor Menopause
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- 1.
Which of the following hormones does not decrease significantly in the first two years after a woman goes through menopause?
- A.
Thyroxin (T4)
- B.
Prolactin
- C.
Testosterone
- D.
Progesterone
- E.
17-Beta-estradiol
Correct Answer
C. TestosteroneExplanation
Testosterone does not decrease significantly in the first two years after a woman goes through menopause. While the levels of other hormones such as thyroxin, prolactin, progesterone, and 17-Beta-estradiol decrease after menopause, testosterone levels remain relatively stable. This is because testosterone is produced by the ovaries as well as the adrenal glands, and the adrenal glands continue to produce testosterone even after menopause. Therefore, testosterone levels do not experience the same significant decline as other hormones during this period.Rate this question:
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- 2.
Studies show that nearly 90% of woman experience hot flushes during menopause. What percent of these woman experience more than 10 hot flushes per day?
- A.
10%
- B.
18%
- C.
33%
- D.
60%
- E.
87%
Correct Answer
C. 33%Explanation
According to studies, it has been found that nearly 90% of women experience hot flushes during menopause. The question asks for the percentage of these women who experience more than 10 hot flushes per day. Since the answer is 33%, it can be inferred that approximately one-third of women who experience hot flushes during menopause have more than 10 of them per day.Rate this question:
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- 3.
All of the following central pathophysiologic mechanism have been implicated as a potential cause of vasomotor symptoms EXCEPT?
- A.
Serotonergic
- B.
Autonomic
- C.
Noradrenergic
- D.
Thermoregulation
- E.
Neurogenic
Correct Answer
E. NeurogenicExplanation
Neurogenic mechanisms have not been implicated as a potential cause of vasomotor symptoms. Vasomotor symptoms, such as hot flashes and night sweats, are commonly associated with hormonal changes during menopause. Serotonergic, autonomic, noradrenergic, and thermoregulation mechanisms have all been linked to vasomotor symptoms. However, there is limited evidence supporting a direct role of neurogenic mechanisms in causing these symptoms.Rate this question:
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- 4.
Premarin (Conjugated Estrogen) is a commonly used form of systemic hormone replacement therapy. This agent is best categoried or derived from what source?
- A.
Animal derived
- B.
Phytoestrogen
- C.
Synthetic xeno estrogen
- D.
Mycoestrogen
- E.
None of the above
Correct Answer
A. Animal derivedExplanation
Premarin (Conjugated Estrogen) is derived from animal sources. It is made from the urine of pregnant mares, hence the name "Premarin" which stands for "pregnant mare's urine". This hormone replacement therapy is derived from the estrogen found in the urine of these animals.Rate this question:
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- 5.
The Women's health Initiative (WHI) was a randomized, prospective, research study evaluating the effects of systemic hormone replacement therapy in postmenopausal woman. The study concluded woman taking combine hormone replacement therapy demonstrated a higher risk of all the following conditions and events EXCEPT?
- A.
Breast Cancer
- B.
Venous thromboembolism (VTE)
- C.
Coronary Heart Disease
- D.
Stroke
- E.
Colon Cancer
Correct Answer
E. Colon CancerExplanation
The Women's Health Initiative (WHI) study found that women taking combined hormone replacement therapy (HRT) had a higher risk of developing breast cancer, venous thromboembolism (VTE), coronary heart disease, and stroke. However, the study did not find a higher risk of colon cancer in women taking HRT.Rate this question:
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- 6.
This agent is a novel hormonal replacement agent approved by the FDA in 2013. It is unique in that it contains Bazedoxifene which is best categorized as?
- A.
A Selective-Estrogen Receptor Modulator
- B.
A Progesterone
- C.
A Testosterone Derivative
- D.
An Estrogen Agonist/ Antagonist
- E.
A Gonadotropin Releasing Analogue
Correct Answer
D. An Estrogen Agonist/ AntagonistExplanation
Bazedoxifene is best categorized as an Estrogen Agonist/ Antagonist because it acts as both an agonist and antagonist at estrogen receptors. It has agonistic effects on bone and lipid metabolism, while antagonistic effects on breast and uterine tissues. This unique mechanism of action makes it a suitable option for hormonal replacement therapy.Rate this question:
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- 7.
HRT regimens with testosterone have been studied and have shown benefit relating to what condition/symptoms?
- A.
Improving lipid panel
- B.
Improving libido
- C.
Decreasing breast cancer risk
- D.
Improvement in skin health (acne and hirsuitism)
- E.
None of the above
Correct Answer
B. Improving libidoExplanation
Hormone replacement therapy (HRT) regimens with testosterone have been studied and have shown benefit in improving libido. Testosterone is known to play a role in sexual desire and function, and HRT with testosterone can help address decreased libido in individuals. This suggests that HRT with testosterone may be an effective treatment option for individuals experiencing a decrease in sexual desire or arousal.Rate this question:
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- 8.
All of the following non-hormonal agents, although not necessarily FDA approved for the indication, have demonstrated some efficacy in managing menopausal vasomotor symptoms EXCEPT?
- A.
Paroxitene (Paxol®)
- B.
Gabapentin (Nuerontin®)
- C.
Ospemifene (Osphena®)
- D.
Clonodine (Catapress®)
- E.
Desfenlafaxine (Prestiq®)
Correct Answer
C. Ospemifene (Osphena®)Explanation
Paroxetine (Paxil®), Gabapentin (Neurontin®), Clonidine (Catapres®), and Desvenlafaxine (Pristiq®) have all shown some efficacy in managing menopausal vasomotor symptoms, while Ospemifene (Osphena®) has not. This suggests that Ospemifene may not be as effective in treating these symptoms compared to the other agents listed.Rate this question:
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- 9.
A 55 year-old female, with menopause at age 51, presents with 10 months of vaginal itching, burning, and superfical dyspareunia. Examination reveals the following. She denies vasomotor symptoms and has a positive family historyof breast cancer. The best step in managing this patient is?
- A.
Vulvar biopsy
- B.
Empiric treament with Lotrisone (Clortrimazole + Betamethsone) cream for 3 months and re-evaluation
- C.
Initiation of vaginal and vulvar estrogen with followup in 6 months
- D.
Start systemic hormone replacement therapy and followup on symptoms in 2 months.
- E.
Refer to gynecologic oncology for assessment and wide local excision of the vulva
Correct Answer
A. Vulvar biopsyExplanation
The patient's symptoms of vaginal itching, burning, and superficial dyspareunia, along with a positive family history of breast cancer, raise concern for a possible vulvar malignancy. Therefore, the best step in managing this patient is to perform a vulvar biopsy. This will help to determine the cause of her symptoms and guide further management, including referral to gynecologic oncology if necessary.Rate this question:
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- 10.
In regards to complementary botanicals and similar products used for the treatment of vasomotor symptoms which of the following statements is true?
- A.
Most of the complementary therapies that have been marketed for the treatment of vasomotor symptoms are approved and well tested by the FDA in regards to efficacy and safety.
- B.
A cochrane database meta-analysis confirmed significant benefit with the use of phytoestrogens when adminitistered in high doses only
- C.
Specific products found to offer the greatest benefit in managing vasomotor symptoms include Ginseng and Saint John's Wort.
- D.
Black Cohosh has demonstrated potential benefit in managing vasomotor symptoms but has also been shown to cause liver toxicity.
- E.
Lifestyle modification including optimization of diet and weight bearing exercise has shown good benefit in managing the frequency and intensity of vasomotor symptoms.
Correct Answer
D. Black Cohosh has demonstrated potential benefit in managing vasomotor symptoms but has also been shown to cause liver toxicity.Explanation
Black Cohosh has demonstrated potential benefit in managing vasomotor symptoms but has also been shown to cause liver toxicity. This statement is true because Black Cohosh has been studied for its effectiveness in treating vasomotor symptoms, such as hot flashes and night sweats. It has shown potential benefits in reducing these symptoms. However, it has also been associated with liver toxicity, which means that it can cause damage to the liver. Therefore, while it may be effective in managing vasomotor symptoms, caution should be exercised when using Black Cohosh due to its potential side effects on the liver.Rate this question:
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- 11.
All of the following agents are classified as Selective Estrogen receptor modulators (SERMs) EXCEPT?
- A.
Raloxifene (Evista ®)
- B.
Clomiphene Citrate (Clomid®)
- C.
Tamoxifene (Nolvadex®)
- D.
Letrozole (Femora®)
- E.
Ospemifene (Osphena®)
Correct Answer
D. Letrozole (Femora®)Explanation
Letrozole (Femora®) is not classified as a Selective Estrogen receptor modulator (SERM) because it is an aromatase inhibitor, not a modulator of estrogen receptors. SERMs, on the other hand, selectively modulate estrogen receptors in different tissues, acting as estrogen agonists or antagonists depending on the specific tissue. Raloxifene, Clomiphene Citrate, Tamoxifene, and Ospemifene are all examples of SERMs as they interact with estrogen receptors in various tissues, exerting estrogenic or antiestrogenic effects.Rate this question:
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- 12.
This over the counter agents is classified as a non-hormonal vaginal moisturizer and may be used as an alternative to topical estrogen for the management of postmenopausal vaginal atrophy and dyspareunia?
- A.
Replens
- B.
Vagifem
- C.
Vagisil
- D.
Astroglide
- E.
Mineral Oil
Correct Answer
A. ReplensExplanation
Replens is classified as a non-hormonal vaginal moisturizer and can be used as an alternative to topical estrogen for managing postmenopausal vaginal atrophy and dyspareunia. It helps to relieve dryness, itching, and discomfort in the vaginal area by moisturizing and rejuvenating the vaginal tissues. Unlike hormonal treatments like Vagifem, Replens does not contain estrogen and is therefore suitable for individuals who cannot or do not want to use estrogen-based therapies. Vagisil, Astroglide, and Mineral Oil are not specifically indicated for managing postmenopausal vaginal atrophy and dyspareunia.Rate this question:
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- 13.
A 22 year-old primigravid patient with a fetus estimated to weigh 3400 grams receives epidural anesthesia at 6cm dilation. An arrest of dilation ensues and she is treated with oxytocin augmentation. At full dilation the fetal position is occiput posterior with a -1 station. Pitocin is continued resulting in contractions that occur every 2 minutes and last a full minute. She is pushing with each contraction and the fetal monitor tracing is category I. Three hours later the presentation and station are unchanged but caput and molding of the fetal head is at a +2 station. The next best step in management is?
- A.
Allow the patient to continue pushing and completely discontinue epidural
- B.
Insert an intrauterine pressure catheter and calculate montevideo units (MVUs)
- C.
Arrange for operative vaginal delivery using vacuum device
- D.
Arrange for primary cesarean delivery
- E.
Increase oxytocin with close monitoring of fetal monitor strip
Correct Answer
D. Arrange for primary cesarean deliveryExplanation
The next best step in management is to arrange for a primary cesarean delivery. This is because the patient has been pushing for three hours without any progress in fetal position or station. Additionally, there is caput and molding of the fetal head at a +2 station, indicating prolonged and difficult labor. These factors suggest that a vaginal delivery may not be successful and could lead to complications for both the mother and the baby. Therefore, a primary cesarean delivery is the most appropriate course of action in this situation.Rate this question:
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- 14.
This image demonstrates a fetus with what presentation?
- A.
Vertex
- B.
Military
- C.
Face
- D.
Brow
- E.
Sinciput
Correct Answer
C. FaceExplanation
This image demonstrates a fetus with a face presentation.Rate this question:
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- 15.
The stage of labor that begins when cervical dilation is complete and ends with the delivery of the fetus is which of the following?
- A.
First stage
- B.
Second stage
- C.
Third stage
- D.
Fourth stage
- E.
Second (latent)and third (active) stage
Correct Answer
B. Second stageExplanation
The second stage of labor begins when cervical dilation is complete and ends with the delivery of the fetus. This stage is characterized by strong contractions and the descent of the baby through the birth canal. It is during this stage that the mother actively pushes to help deliver the baby.Rate this question:
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- 16.
A 25 year-old, G2P1, presents at 41 weeks gestation. Her cervix is unfavorable with a Bishop score of 3. You counsel her on induction of labor and the use of intravaginal misoprostil (Cytotec) as preinduction cervical ripening agent. The most common complication of this agent is?
- A.
Chorioamnionitis
- B.
Uterine tachysystole
- C.
Chemical vaginitis
- D.
Maternal nausea and vomiting
- E.
Vaginal bleeding
Correct Answer
B. Uterine tachysystoleExplanation
Uterine tachysystole is the most common complication of intravaginal misoprostol (Cytotec) as a preinduction cervical ripening agent. Uterine tachysystole refers to excessive uterine contractions that occur too frequently, last too long, or are too intense. This can lead to decreased blood flow to the placenta, which can result in fetal distress. It is important to monitor the patient closely for signs of uterine tachysystole and adjust the dosage or discontinue the medication if necessary. Other complications listed, such as chorioamnionitis, chemical vaginitis, maternal nausea and vomiting, and vaginal bleeding, are less commonly associated with the use of misoprostol.Rate this question:
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- 17.
Which of the following is a physiologic change associated with an intravenous bolus of oxytocin?
- A.
Increase blood pressure
- B.
Decreased cardiac output
- C.
Increased heart rate
- D.
Increased body temperature
- E.
Decrease in oxygenation
Correct Answer
C. Increased heart rateExplanation
An intravenous bolus of oxytocin is known to stimulate the release of oxytocin receptors in the heart, leading to an increase in heart rate. Oxytocin is a hormone that plays a role in various physiological processes, including cardiovascular regulation. When administered intravenously, oxytocin can have a direct effect on the heart, causing an increase in heart rate. This is a physiologic change that is associated with the administration of oxytocin.Rate this question:
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- 18.
The attached figure represents a fetal head in which position?
- A.
Left Occiput Posterior (LOP)
- B.
Left Occiput Anterior (LOA)
- C.
Right Occiput Posterior (ROP)
- D.
Right Occiput Anterior (ROA)
- E.
Right Occiput Transverse (ROT)
Correct Answer
D. Right Occiput Anterior (ROA) -
- 19.
A 32 year-old primigravid woman present at 39 weeks gestation with frequent uterine contractions and pain over the past 6 hours. On repeated examinations, the cervix is 1 cm dilated and 70% effaced with the fetal vertex at a -3 station. The fetal heart rate tracing is reassuring. The best next step in management is....?
- A.
Oxytocin administration
- B.
Expectant Management
- C.
Artificial rupture of membranes
- D.
Initiate oxytocin induction
- E.
Offer elective primary cesarean section delivery
Correct Answer
B. Expectant ManagementExplanation
In this scenario, the woman is at 39 weeks gestation with frequent uterine contractions and pain, but the cervix is only 1 cm dilated and 70% effaced with the fetal vertex at a -3 station. The fetal heart rate tracing is reassuring, indicating that the baby is tolerating the contractions well. Given these findings, expectant management is the best next step. This means that the woman should be monitored closely for progress in labor, with continued assessment of cervical dilation and fetal well-being. Oxytocin administration, artificial rupture of membranes, and initiating oxytocin induction are all interventions that may be considered if there is inadequate progress in labor. Offering elective primary cesarean section delivery is not indicated based on the information provided.Rate this question:
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- 20.
Delaying cord clamping after delivery by 3 minutes has been encouraged by some because it provides an additionasl 80 mg of blood to the neonate. The possible disadvantage of this includes which of the following?
- A.
Exsanguination
- B.
Hyperbilirubinemia
- C.
Hypoglycemia
- D.
Meconium Aspiration syndrome
- E.
Postpartum uterine atony and hemorrhage
Correct Answer
B. HyperbilirubinemiaExplanation
Delaying cord clamping after delivery by 3 minutes can lead to hyperbilirubinemia in the neonate. Hyperbilirubinemia is a condition characterized by an excessive amount of bilirubin in the blood, which can cause jaundice. Delaying cord clamping allows more blood to flow from the placenta to the neonate, increasing the amount of bilirubin that needs to be processed by the newborn's liver. This can result in a buildup of bilirubin and subsequent hyperbilirubinemia.Rate this question:
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- 21.
The following diagram demonstrates a vaginal laceration that occurs in about 1-2% of vaginal deliveries? It is associated with all of the following EXCEPT?
- A.
Primiparity
- B.
Macrosomia
- C.
Vaginal birth after cesarean section (VBAC)
- D.
Operative vaginal delivery
- E.
Persistent occiput posterior position
Correct Answer
C. Vaginal birth after cesarean section (VBAC)Explanation
Vaginal laceration during childbirth is a common complication that occurs in about 1-2% of vaginal deliveries. It is associated with several factors, including primiparity (being a first-time mother), macrosomia (having a large baby), operative vaginal delivery (using instruments to assist in delivery), and persistent occiput posterior position (the baby's head facing the mother's abdomen). However, vaginal birth after cesarean section (VBAC) is not associated with an increased risk of vaginal laceration.Rate this question:
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- 22.
Compared with mediolateral episiotomy, the main drawback of midline epsiotomy is which of the following?
- A.
Surgical repair is more difficult
- B.
It is more likely to extend into a fourth degree laceration
- C.
It is more likely to break down
- D.
There is decrease blood loss
- E.
Less pleasing cosmetic result.
Correct Answer
B. It is more likely to extend into a fourth degree lacerationExplanation
The main drawback of midline episiotomy is that it is more likely to extend into a fourth degree laceration. This means that the incision made during the episiotomy can potentially tear further, leading to a more severe injury. This can result in complications and a longer healing process for the patient.Rate this question:
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- 23.
Hemabate (Carboprost®) is a uterotonic commonly used for postpartum atony. It is categorized as a prsotanoid and more specifically contains?
- A.
Prostaglandin PG E2
- B.
Prostaglandin PG F2 Alpha
- C.
Leukotriene (LTC4)
- D.
Thromboxane (TXA2)
- E.
Ergot Alkaloid
Correct Answer
B. Prostaglandin PG F2 AlphaExplanation
Hemabate (Carboprost) is a uterotonic medication commonly used to treat postpartum atony, which is the failure of the uterus to contract after childbirth. It is categorized as a prostaglandin and more specifically contains Prostaglandin PG F2 Alpha. Prostaglandins are hormone-like substances that play a role in various physiological processes, including uterine contractions. Prostaglandin PG F2 Alpha helps to stimulate uterine contractions and reduce bleeding after childbirth.Rate this question:
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- 24.
All EXCEPT which of the following definitions of abnormal bleeding is true?
- A.
Metrorrhagia describes intermenstrual bleeding
- B.
Oligomenorrhea refers to cycles with intervals that are shorter than 35 days
- C.
Hypomenorrhea refers to menses with diminished or shortened interval
- D.
Menorrhagia is defined as prolonged or heavy cyclic menstruation
- E.
Amenorrhea is a term for the absence of menses
Correct Answer
B. Oligomenorrhea refers to cycles with intervals that are shorter than 35 daysExplanation
Oligomenorrhea refers to cycles with intervals that are longer than 35 days, not shorter.Rate this question:
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- 25.
A 33 year-old, G2P2, present to your office with post-coital bleeding. Pelvic examination is unremarkable including speculum and bimanual examination. You perform a pap smear. Which of the following may also be reasonable in the evaluation of this patient's complaint?
- A.
Colposcopy
- B.
LEEP procedure of the cervix
- C.
Cystoscopy
- D.
Proctoscopy
- E.
CT Scan or MRI of the pelvis
Correct Answer
A. ColposcopyExplanation
Colposcopy may be reasonable in the evaluation of this patient's complaint of post-coital bleeding. Colposcopy is a procedure that allows for a closer examination of the cervix, vagina, and vulva using a special magnifying instrument called a colposcope. It can help identify any abnormal areas or lesions that may be causing the bleeding. This procedure is often performed when a pap smear shows abnormal results or when there are other concerning findings during a pelvic examination. It can provide more detailed information about the cause of the bleeding and guide further management or treatment options.Rate this question:
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- 26.
The mechanisms that normally stop menstrual blood loss include all of the following EXCEPT?
- A.
Localized vasoconstriction
- B.
Formation of platelet plug
- C.
Vascular fibrin disposition
- D.
Fibrinolysis
- E.
Myometrial contractions
Correct Answer
E. Myometrial contractionsExplanation
Myometrial contractions are not a mechanism that normally stops menstrual blood loss. During menstruation, the myometrium, which is the muscular layer of the uterus, relaxes to allow the shedding of the endometrial lining. It is the other mechanisms mentioned, such as localized vasoconstriction, formation of platelet plug, vascular fibrin disposition, and fibrinolysis, that help to stop menstrual blood loss by promoting clotting and closing off blood vessels.Rate this question:
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- 27.
A 37 year-old G3P3, present for metrorrhagia that has been present for 6 months. She is not interested in hormonal therapy and has been trying to conceive over that time period. She undergoes a sonohysterogram (SIS) in the office which demonstrates the following finding. You counsel the patient on the benefits of surgical management. The patient is best counselled to undergo what procedure?
- A.
Dilation and curettage under ultrasound guidance
- B.
Hysteroscopy, operative myomectomy, and dilation and curettage
- C.
Hysteroscopy, myomectomy, and endometrial ablation
- D.
Hysterescopy, polypectomy, and dilation and curettage
- E.
Laparoscopic/Robotic myomectomy
Correct Answer
B. Hysteroscopy, operative myomectomy, and dilation and curettageExplanation
The patient is best counseled to undergo hysteroscopy, operative myomectomy, and dilation and curettage. This is because the sonohysterogram shows a finding that suggests the presence of uterine fibroids, which could be causing the metrorrhagia. Hysteroscopy allows for direct visualization and removal of the fibroids, while operative myomectomy involves removing the fibroids surgically. Dilation and curettage may also be performed to remove any remaining tissue or address any other uterine abnormalities. This combination of procedures would address the underlying cause of the metrorrhagia and also improve the patient's chances of conceiving.Rate this question:
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- 28.
A 46 year-old, G3P2012, present with symptoms of menorrhagia and mild anemia. Her last gynecologic exam was 10 years ago at which time she was told her pap smear was abnormal. She has not been seen for this complaint in the past and has a benign past medical, surgical and social history. The test that is least likely to explain this patient's bleeding dysfunction is?
- A.
Transvaginal ultrasound
- B.
Thyroid function studies
- C.
Cervical pap smear
- D.
Endometrial biopsy
- E.
Coagulation profile (PT/PTT/INR)
Correct Answer
E. Coagulation profile (PT/PTT/INR)Explanation
The patient's symptoms of menorrhagia and mild anemia suggest a possible bleeding dysfunction. The least likely test to explain this would be a coagulation profile (PT/PTT/INR), as the patient's past medical, surgical, and social history is benign, indicating no known bleeding disorders. The other tests, such as transvaginal ultrasound, thyroid function studies, cervical pap smear, and endometrial biopsy, are more relevant in investigating the cause of the bleeding dysfunction.Rate this question:
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- 29.
A 41 year-old, G4P4, presents with a two year history of menorrhagia, worsening dysmenorrhea, and dyspareunia that started soon after the delivery of her last child 3 years ago. Her examination reveals a smooth, slightly enlarged, and tender uterus. She notes that she recently had an MRI performed of her pelvis by another physician. You are able to review the images which demonstrate the following. What is this patients most likely diagnosis?
- A.
Intramural Leiomyoma
- B.
Leiomyosarcoma
- C.
Adenomyosis of the uterus
- D.
Endometrial polyp
- E.
Hematometra
Correct Answer
C. Adenomyosis of the uterusExplanation
The patient's history of menorrhagia, worsening dysmenorrhea, and dyspareunia, along with a slightly enlarged and tender uterus on examination, are suggestive of adenomyosis of the uterus. Adenomyosis is a condition where the endometrial tissue grows into the muscular wall of the uterus, causing symptoms such as heavy menstrual bleeding, pelvic pain, and enlargement of the uterus. The fact that the patient recently had an MRI performed suggests that the imaging findings support the diagnosis of adenomyosis.Rate this question:
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- 30.
All of the following are considered risk factors for Type I endometrial cancer in a patient with postmenopausal bleeding EXCEPT?
- A.
Morbid obesity
- B.
Use of Tamoxifen for breast cancer
- C.
Nuliparity
- D.
Tobacco use
- E.
History of polycystic ovary syndrome (PCOS)
Correct Answer
D. Tobacco useExplanation
Tobacco use is not considered a risk factor for Type I endometrial cancer in a patient with postmenopausal bleeding. The other options, such as morbid obesity, use of Tamoxifen for breast cancer, nulliparity, and history of polycystic ovary syndrome (PCOS), are all known risk factors for Type I endometrial cancer.Rate this question:
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- 31.
A 19 year-old presents for annual examination and desire for contraception. She describes cyclic periods that occur monthly and last 5 days. You start her on combination oral contraceptive pills (COCs) and she returns to your office in 3 months complaining of light but irregular bleeding since starting her pills. What is the best plan of care in this case?
- A.
Based on her symptoms and concerns switch her to a progestin only contraceptive agent
- B.
Provide her with counseling and reassurance and continue her current COCs
- C.
Her symptoms likely reflect endomyometrial pathology and ultrasound and/or SIS should be considered
- D.
Hormonal inbalance that requires use of a higher dose pill and/or different progestational agent
- E.
Although only 19, based on symptoms, perform pap and reflex HPV testing to exclude cervical neoplasm
Correct Answer
B. Provide her with counseling and reassurance and continue her current COCsExplanation
The best plan of care in this case is to provide the patient with counseling and reassurance and continue her current combination oral contraceptive pills (COCs). This is because her symptoms of light but irregular bleeding are common side effects of starting COCs and usually resolve within the first few months. It is important to reassure the patient and provide counseling about the expected side effects of COCs. Switching her to a progestin-only contraceptive agent or considering endomyometrial pathology or hormonal imbalance would not be necessary at this point. Performing a pap and reflex HPV testing to exclude cervical neoplasm is also not indicated based on her symptoms.Rate this question:
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- 32.
A 38 year-old G4P2 presents to the ED stating that she has had heavy bleeding for 9 days. Her pulse is 110, blood pressure is 80/60, and pelvic examination is normal with significant bleeding from the cervical os. A pregnancy test is negative, hemoglobin is 9.8 grams with a hematocrit of 28.8%. The most beneficial treatment for this patient with bleeding is?
- A.
Oral Premarin, 2.5mg daily, x 14 days
- B.
Dilation and Curettage
- C.
Medroxyprogesterone acetate, 20mg daily, x 10 days
- D.
Leuprolide Depo, 11.25 mg IM, immediately
- E.
Combined Oral contraceptive pills (COCs), 3 tablets daily per day, for 7 days
Correct Answer
B. Dilation and Curettage -
- 33.
This agent is indicated for menorrhagia and functions as an inhibitor of fibrinolysis, reducing menstrual blood loss by 60%, in woman with abnormal uterine bleeding?
- A.
Mefenamic acid (Ponstel®)
- B.
Methylergonovie (Methergine®)
- C.
Tranexamic Acid (Lysteda®)
- D.
Leuprolide Depo (Lupron®)
- E.
Meloxicam (Mobic®)
Correct Answer
C. Tranexamic Acid (Lysteda®)Explanation
Tranexamic Acid (Lysteda®) is the correct answer because it is indicated for menorrhagia, which is excessive menstrual bleeding. It functions as an inhibitor of fibrinolysis, which means it prevents the breakdown of blood clots. By reducing fibrinolysis, Tranexamic Acid reduces menstrual blood loss by 60% in women with abnormal uterine bleeding. Mefenamic acid, Methylergonovie, Leuprolide Depo, and Meloxicam are not indicated for menorrhagia or do not function as inhibitors of fibrinolysis.Rate this question:
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- 34.
Which of the following statements regarding the use of the demonstrated device for the treatment of abnormal uterine bleeding is true?
- A.
The Mirena and Skyla both contain the hormone agent Etonorgesterol
- B.
The Copper T (Paragard®) IUD is equally effective as the Mirena in controlling bleeding dysfunction and can be used for up to 10 years
- C.
Progesterone containing IUDs are contraindicated in all woman with a prior history of pelvic inflammatory disease
- D.
Pogesterone containing IUD will result in amonorrhea in approximately 75% of users
- E.
The Mirena IUD is FDA approved for birth control, as well as, the management of heavy menstrual bleeding
Correct Answer
E. The Mirena IUD is FDA approved for birth control, as well as, the management of heavy menstrual bleedingExplanation
The statement that The Mirena IUD is FDA approved for birth control, as well as the management of heavy menstrual bleeding is true. This means that the Mirena IUD is not only effective as a contraceptive method but also as a treatment option for women experiencing heavy menstrual bleeding. The FDA approval ensures that the device has undergone rigorous testing and is considered safe and effective for these purposes.Rate this question:
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.jpg "This agent is a novel hormonal replacement agent approved by the FDA in 2013. It is unique in that it contains Bazedoxifene which is best categorized as?")
.jpg "A 55 year-old female, with menopause at age 51, presents with 10 months of vaginal itching, burning, and superfical dyspareunia. Examination reveals the following. She denies vasomotor symptoms and has a positive family historyof breast cancer. The best step in managing this patient is?")
.jpg "This image demonstrates a fetus with what presentation?")
.gif "The attached figure represents a fetal head in which position?")
.jpg "The following diagram demonstrates a vaginal laceration that occurs in about 1-2% of vaginal deliveries? It is associated with all of the following EXCEPT?")
.jpg "A 37 year-old G3P3, present for metrorrhagia that has been present for 6 months. She is not interested in hormonal therapy and has been trying to conceive over that time period. She undergoes a sonohysterogram (SIS) in the office which demonstrates the following finding. You counsel the patient on the benefits of surgical management. The patient is best counselled to undergo what procedure?")
.jpg "A 41 year-old, G4P4, presents with a two year history of menorrhagia, worsening dysmenorrhea, and dyspareunia that started soon after the delivery of her last child 3 years ago. Her examination reveals a smooth, slightly enlarged, and tender uterus. She notes that she recently had an MRI performed of her pelvis by another physician. You are able to review the images which demonstrate the following. What is this patients most likely diagnosis?")
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Mar 20, 2023Quiz Edited by
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Feb 24, 2015Quiz Created by
Cak3420
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