Gynecological Cases PDF

- A 35-year-old woman presents with heavy menstrual bleeding and pelvic pressure. On examination, her uterus is enlarged but nontender. An ultrasound shows a well-defined mass within the uterine wall. - - What is the most...

- A 35-year-old woman presents with heavy menstrual bleeding and pelvic pressure. On examination, her uterus is enlarged but nontender. An ultrasound shows a well-defined mass within the uterine wall. - - What is the most likely diagnosis? enlarged , firm - Uterine fibroid uteene steeding - - Endometrial hyperplasia heavy - Ovarian cyst - Pelvic inflammatory disease A 42-year-old woman reports experiencing prolonged, heavy periods for the past year, along with frequent urination. Ultrasound reveals a large submucosal fibroid. What is the best initial treatment option? - Hormonal therapy (e.g., GnRH agonists) - Endometrial ablation - Hysterectomy - Chemotherapy A 30-year-old woman is undergoing an evaluation for infertility. Hysterosalpingography shows distortion - of the uterine cavity by a mass. Which condition should be considered in the differential diagnosis? > - - Submucosal uterine fibroid - Ectopic pregnancy - Ovarian cyst - Endometriosis A 45-year-old woman presents with sudden-onset pelvic pain, nausea, and fever. She has a known history of uterine fibroids. On examination, she has a tender, firm mass. What is the most likely complication? - Degenerating fibroid - Ectopic pregnancy - Ovarian torsion - Pelvic inflammatory disease A 38-year-old woman presents with a history of heavy menstrual bleeding and pelvic discomfort. - - Physical examination reveals an enlarged, irregular uterus. What is the next best step in confirming the diagnosis? - Pelvic ultrasound - Colposcopy - Endometrial biopsy - Laparoscopy A 40-year-old woman with multiple fibroids complains of severe menstrual pain and increasing abdominal size. She wishes to preserve her fertility. What is the most appropriate treatment option? - Myomectomy - Hysterectomy - Uterine artery embolization - Endometrial ablation A 50-year-old woman with large fibroids presents with symptoms of urinary frequency and incomplete - > - bladder emptying. What is the most likely mechanism for her symptoms? -- - Compression of the bladder by the fibroid - Infection of the urinary tract - Hormonal imbalance - Neurogenic bladder dysfunction A 45-year-old woman with a history of uterine fibroids presents with irregular bleeding and anemia. - - What is the initial management? - Iron supplementation and hormonal therapy - Uterine artery embolization - Immediate hysterectomy - Chemotherapy A 35-year-old woman presents with heavy bleeding, pelvic pain, and anemia. Imaging reveals multiple fibroids. She prefers a minimally invasive approach. What is the most suitable treatment? - - Uterine artery embolization - Hysterectomy - Hormonal therapy - Myomectomy A 32-year-old pregnant woman is diagnosed with a large intramural fibroid during her first trimester. - - She reports mild pelvic pain. What is the best initial management? - Conservative observation - Immediate surgery - Radiation therapy - Endometrial ablation Uses of magnetic resonance imaging in gynecologic malignancies include all of the following EXCEPT: All of the above Assessment of local tumor extension in the evaluation of cervical cancer Determination of lymph node metastasis in highgrade endometrial carcinoma Evaluation of indeterminate adnexal masses or ovarian cystic masses that measure > 7 cm Early pregnancy loss is most common in women with which of the following? - Systemic lupus erythematosus with antiphospholipid antibodies Polycystic ovarian syndrome Well-controlled type 2 diabetes mellitus Human immunodeficiency virus (HIV) infection Sonographically, endometriomas are typically described by which of the following? - Cystic with diffuse internal low-level echoes Solid with intracystic blood fow Solid with diffuse internal low-level echoes Cystic with focal hyperechoic internal echoes Mature ovarian cystic teratomas account for approximately one in five ovarian neoplasms. Which of the following statements regarding this ovarian tumor is true? Mature cystic teratomas often undergo torsion, but cyst rupture is rare. Mature solid teratomas are malignant tumors that arise from the proliferation of multiple germ cell lines. Teratomas frequently cause immune-mediated encephalitis, a complication due to tumor-produced antibodies against N-methyl-D-aspartate receptors. Microscopically, endodermal elements predominant, creating a tumor that contains sebaceous and sweat glands, hair, and fatty secretions, which are responsible for their classic sonographic appearance. Which of the following tumor antigens is correctly paired with its ovarian tumor or malignancy? Cancer antigen 19-9 (CA19-9)—mucinous epithelial ovarian carcinoma α- fetoprotein (AFP)—dysgerminoma β-human chorionic gonadotropin—granulosa cell tumor Lactate dehydrogenase—yolk sac tumor and embryonal cell carcinoma With a newly diagnosed pelvic mass in a premenopausal woman, which o the following clinical criteria should prompt referral to a gynecologic oncologist? Ascites Patient’s history of breast cancer Cancer antigen 125 (CA125) level of 40 U/mL (normal < 35 U/mL) All of the above All of the following are side effects of aromatase inhibitors EXCEPT: Hyperglycemia - - Vaginal atrophy Vasomotor symptoms Ovarian cyst formation Although causes of chronic pelvic pain fall within a broad spectrum, which of the following is commonly diagnosed? All of the above Endometriosis Interstitial cystitis Irritable bowel syndrome Patient complaints suggestive of interstitial cystitis commonly include all of the following EXCEPT: Stress urinary incontinence Pelvic pain Urinary urgency Urinaryfrequency Considered diagnostic of interstitial cystitis during cystoscopy, this reddish- - brown mucosal lesion can have small vessels radiating from a central scar. - What is this typical lesion called? Hunner ulcer Vesicovasculitis Submucosal hemorrhage Bladder wall glomerulation Which of the following statements is FALSE regarding the development of the hypothalamic–pituitaryovarian axis in the female fetus and neonate? T e gonadotropin-releasing hormone (GnRH) “pulse generator” remains functionally dormant until several months after birth. By 5 months’ gestation, 6 to 7 million oocytes have been created from accelerated germ cell division. At birth, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations rise and remain high during the first 3 months of life. Neonatal breast budding, minor uterine bleeding, and transient ovarian cysts may occur as a normal response to initially high gonadotropin levels A fetal ovarian mass is noted as an incidental finding during third-trimester - - - sonographic assessment of fetal growth. T4 e female infant is delivered at term without incident. Lower abdominal fullness is palpated during neonatal - examination, and transabdominal sonography shows a 4.2-cm simple right - ovarian cyst. T e infant is afebrile and in no distress. What is the most - appropriate management of this ovarian mass? Observation with repeat sonography No further surveillance Percutaneous cyst aspiration Surgery if unresolved within 2 months Which of the following statements is true regarding polycystic ovarian syndrome? It is the most common cause of chronic anovulation. Patients typically present with amenorrhea. It is characterized by hypogonadotropic hypogonadism. It is characterized by persistently depressed estradiol levels. An 18-year-old nulligravida presents with primary amenorrhea. She reports vaginal bleeding following a progesterone withdrawal test. Which of the following conditions is most likely to be her diagnosis? Polycystic ovarian syndrome Müllerian agenesis Hypothalamic amenorrhea Premature ovarian failure Which of the following is NOT a component of the Rotterdam criteria for diagnosing polycystic ovarian syndrome (PCOS)? Peripheral distribution of ovarian follicles on sonography Oligoovulation or anovulation Polycystic appearing ovaries on sonography Clinical or biochemical signs of hyperandrogenism What is the most common endocrine disorder of reproductive-aged women? Polycystic ovarian syndrome Hypothyroidism Type 2 diabetes mellitus Congenital adrenal hyperplasia First-degree male relatives of women with polycystic ovarian syndrome have been shown to have higher circulating levels of which hormone? Dehydroepiandrosterone sulfate (DHEAS) Testosterone Androstenedione Dihydrotestosterone In polycystic ovarian syndrome, altered gonadotropinreleasing hormone (GnRH) pulsatility leads to what predominant change in hormone levels? Increased luteinizing hormone Decreased estrone Decreased testosterone Increased follicle-stimulating hormone CHAPTER 17 In addition to insulin, which of the following hormones stimulates increased - testosterone production by the ovaries in polycystic ovarian syndrome? - Luteinizing hormone Inhibin Estradiol Follicle-stimulating hormone Which of the following statements is true regarding sex hormone-binding globulin (SHBG)? It binds most of the circulating testosterone. It is produced by the adrenal gland. Its synthesis is increased by insulin. Its synthesis is increased by testosterone.