LE 1 Flashcards
(93 cards)
1
Q
- HPO axis controls the predictability of:
A. Ovarian cycle
B. Pregnancy cycle
C. Uterine cycle
D. Menstrual cycle
A
D. Menstrual cycle
2
Q
- Neurohormonal pathway of GnRH
A
Anterior medial tubule to anterior pituitary gland
3
Q
- An 18 year old presents with hypogonadrotropic hypogonadism and absence of sense of smell. Result:
A
Failure of migration of GnRH neurons to the olfactory placode
4
Q
- Which of the following best describes gonadotrophins?
A
Large glycoproteins molecules secreted by the anterior pituitary
5
Q
- The secretion of gonadotrophins is characterized by:
A. Basal levels all throughout fetal life with activation to produce adult levels at the time of puberty
B. Progressively increasing levels from fetal to adult levels at puberty
C. May reach adult levels during fetal life and at birth, remain low until the
onset of puberty
D. Progressively declining levels from fetal life, will only reach adult levels
at the time of each menstrual cycle
A
A. Basal levels all throughout fetal life with activation to produce adult levels at the time of puberty
6
Q
- Hemorrhagic conditions affecting the blood supply of the anterior pituitary will manifest as low levels of the following
A. FSH, LH, TSH, ACTH
B. FSH, LH, Prolactin, Oxytocin
C. FSH, LH, TSH, ADH
D. FSH, LH, Oxytocin, ADH
A
A. FSH, LH, TSH, ACTH
7
Q
- Which of the following statements best describes the pattern of gonadotrophin secretion?
A. To ensure adequate supply, gonadotrophins are secreted in constant amounts
B. There is a steady state amount of gonadotrophins throughout the menstrual cycle
C. Gonadotrophin secretion varies in amplitude and frequency throughout the menstrual cycle
D. The secretion of gonadotrophins is unaffected by steroid hormone levels
A
C. Gonadotrophin secretion varies in amplitude and frequency throughout the menstrual cycle
8
Q
- Gonadotrophins are structurally similar to:
A. Prolactin and cortisol
B. TSH and HCG
C. TRH and ACTH
D. Estradiol and progesterone
A
B. TSH and HCG
9
Q
- The two cell hypothesis of steroid production occurs at the level of the
A. Hypothalamus
B. Pituitary
C. Ovary
D. Uterus
A
C. Ovary
10
Q
- If an aromatase inhibitor is administered to a woman who is in her follicular phase of the menstrual cycle, which steroid hormone level would be affected?
A. Estradiol
B. Progesterone
C. Testosterone
D. Cortisol
A
A. Estradiol
11
Q
- Which of the following physiologic processes are controlled by estrogen and progesterone?
A. Folliculogenesis and endometrial maturation
B. Folliculogenesis and gametogenesis
C. Gametogenesis and endometrial maturation
D. Gametogenesis and development of secondary sexual characteristics
A
A. Folliculogenesis and endometrial maturation
12
Q
- Menstruation is a coordinated and periodic event that is characterized by the following, except:
A. Interaction of the hypothalamo-pituitary-ovarian axis
B. Irregular cycles during the first 2 years
C. Regular cycles from menarche until few years to menopause
D. Average onset is at 10 years old
A
D. Average onset is at 10 years old
13
Q
- A 12 year old child is brought by her anxious mother. She had her menarche at 11 years old but subsequent menses came at an interval of every 2 months. How would you advise this patient?
A. Adolescents have irregular cycles during the first 2 years from menarche
B. This child should have had regular monthly cycles from the time of menarche
C. There is a need to conduct an investigation at this point
D. The hormonal panel of this child should be checked
A
A. Adolescents have irregular cycles during the first 2 years from menarche
14
Q
- The 2 phases of menstruation:
A. Follicular and Luteal
B. Follicular and Secretory
C. Proliferative and Secretory D. Proliferative and Luteal
A
A. Follicular and Luteal
15
Q
- What is the prerequisite hormonal change necessary for ovulation to occur?
A. Increasing levels of estradiol leading to the LH surge
B. Increasing levels of progesterone leading to the LH surge
C. Declining levels of FSH leading to the LH surge
D. Declining levels GnRH leading to LH surge
A
A. Increasing levels of estradiol leading to the LH surge
16
Q
- Events occurring in the follicular phase, except:
A. Recruitment of cohort of antral follicles
B. Selection of leading follicle
C. Growth of the dominant follicle
D. Development of the corpora lutea
A
D. Development of the corpora lutea
17
Q
- Ovulation occurs at mid-cycle and is characterized by:
A. Detachment of the cumulus from the granulosa cells
B. Detachment of the cumulus from the basement membrane
C. Demise of the corpus luteum
D. Degeneration of the corpora albicans
A
A. Detachment of the cumulus from the granulosa cells
18
Q
- The uterine endometrium undergoes cyclical changes as a direct response to:
A. Pulsatile GnRH secretion
B. Steadily increasing levels of gonadotrophin
C. Changing levels of ovarian steroids
D. Diminishing levels of activing and inhibin
A
C. Changing levels of ovarian steroids
19
Q
19. A 21-year old consults at your clinic regarding the regularity of her menstrual period, you advise that menses should come at an interval of: A. >35 days B. <21 days C. Every 60-90 days D. 21-35 days
A
D. 21-35 days
20
Q
- Menstruation is a physical event that is:
A. Predictable and cyclical
B. Probable and conditional
C. Irregular and unpredictable
D. Affected by emotions and stress
A
A. Predictable and cyclical
21
Q
- Hypothalamic GnRH neurons are concentrated mostly in what area?
A. Median basilar
B. Posterior
C. Arcuate nucleus
D. Ventrobasilar
A
C. Arcuate nucleus
22
Q
- GnRH is a peptide hormone that:
A. Is secreted into the hypophyseal portal circulation to the anterior pituitary
B. Is secreted into the hypophyseal portal circulation into the posterior pituitary
C. Is secreted via direct vascular connections into the anterior pituitary
D. Is secreted via direct vascular connections into the posterior pituitary
A
A. Is secreted into the hypophyseal portal circulation to the anterior pituitary
23
Q
- GnRH affects the synthesis and secretion of the following hormones directly
A. TSH and TRH
B. FSH and LH
C. ACTH and prolactin
D. Testosterone and testolactone
A
B. FSH and LH
24
Q
- Luteinizing hormone acts on the ovarian thecal cells to:
A. Stimulate estradiol production
B. Stimulate androgen production
C. Down regulate estradiol production
D. Down regulate androgen production
A
B. Stimulate androgen production
25
25. Follicle stimulating hormone acts on the ovarian granulosa cells to:
A. Stimulate estradiol production
B. Stimulate androgen production
C. Down regulate estradiol production
D. Down regulate androgen production
A. Stimulate estradiol production
26
26. A 25 year old G1 on her 12th week of the pregnancy has to undergo an operation to remove an ovarian cyst. On ultrasound, the cyst to be removed is on the same side as the corpus luteum. What medication would be necessary to give in case of inadvertent damage to the corpus luteum?
A. Estradiol supplementation
B. Progesterone supplementation
C. Folic acid supplementation
D. Testosterone supplementation
B. Progesterone supplementation
27
27. True about the luteinizing hormone except:
A. Expressed on theca cells and granulosa cells during all stages of follicular development
B. Induce ovulation by luteolysis through plasminogen activators
C. Is responsible for progesterone production by corpus luteum
D. Main action is androgen synthesis
A. Expressed on theca cells and granulosa cells during all stages of follicular development
28
28. True about follicle stimulating hormone except:
A. Receptors are expressed on granulosa cells
B. Responsible for follicular development and maturation
C. Activates aromatase enzyme necessary for estrogen production
D. Downgrades LH receptor production on granulosa cells
D. Downgrades LH receptor production on granulosa cells
29
29. The physiologic appearance of vaginal bleeding occurs due to:
A. Absence of fertilization
B. Spasm of spiral arteries
C. Demise of the corpus luteum
D. All of the above
D. All of the above
30
30. In adolescents, normal menstrual bleeding is characterized by the following except:
A. Cycle interval of 21-42 days
B. Duration of 3-7 days
C. Average blood loss per cycle of 30-80 ml
D. Occurrence of mid cycle bleeding
D. Occurrence of mid cycle bleeding
31
31. Which hormonal event precedes menstruation?
A. Withdrawal of ovarian steroids
B. Unoppressed estrogen production
C. LH surge
D. Inadequate progesterone production
A. Withdrawal of ovarian steroids
32
32. The following characterize the self-limiting nature of menstruation, except:
A. Hemostatic plug formation occurs at the functional layer B B. Vasoconstriction occurs at the baseless layer
C. A higher thromboxane than prostacyclin level is found
D. Decreased PGF alpha to PGE ratio is found
D. Decreased PGF alpha to PGE ratio is found
33
33. Acute abnormal uterine bleeding is characterized by:
A. An episode of moderate bleeding that does not require immediate intervention
B. An episode of heavy bleeding that requires immediate intervention
C. Two or more episode of moderate bleeding that requires immediate intervention
C. Two or more episode of moderate bleeding that requires immediate intervention
34
34. A 24 year old G2P2 has been on progestin only pills for contraception which she takes with good compliance every day, reports noticing brown to red episodic staining of her underwear. What can this be due to?
A. Prolonged estrogen exposure
B. Prolonged progesterone exposure
C. Abrupt fall in estrogen levels
D. Abrupt fall in progesterone levels
B. Prolonged progesterone exposure
35
35. Abnormal uterine bleeding may be due to the following, except:
A. Anatomic conditions of the reproductive tract
B. Medical conditions
C. Conditions associated with pregnancy
D. Vaginal lacerations
D. Vaginal lacerations
36
36. Abnormal uterine bleeding secondary to the ovulatory dysfunction is due to the following, except:
A. Immaturity of the HPO axis
B. Reduced synthesis of prostaglandin F2 alpha
C. Increased number of uterine spiral arteries
D. Relative deficiency of thromboxane
C. Increased number of uterine spiral arteries
37
37. For a patient in the reproductive age presenting with vaginal bleeding, this
diagnostic exam should be done first?
A. CBC with platelet count
B. Coagulation test
C. Pregnancy test
D. Transvaginal ultrasound
C. Pregnancy test
38
38. A 31 year old non pregnant woman consults for heavy menses for this month. On your physical exam, abdomen is soft and non-tender, no masses palpated. On pelvic exam, cervix is smooth and closed and corpus small with no adnexal menses. What diagnostic exam would you request next?
A. Speculum exam
B. Transvaginal ultrasound
C. MRI
D. CT scan
B. Transvaginal ultrasound
39
39. In the medical management of this woman’s acute abnormal bleeding, the following may be used, except:
A. High dose estrogens
B. Antifibrinolytics
C. NSAIDs
D. GnRH
D. GnRH
40
40. In the medical management of chronic abnormal bleeding, the following may be used, except:
A. High dose estrogens
B. Antifibrinolytics
C. NSAIDs
D. GnRH
A. High dose estrogens
41
41. The expected sequence of appearance of pubertal signs are as follows:
A. Breast budding, pubic hair, growth spurt and menarche
B. Breast budding, menarche, pubic hair and growth spurt C. Menarche, breast budding, pubic hair and growth spurt D. Growth spurt, breast budding, pubic hair and menarche
A. Breast budding, pubic hair, growth spurt and menarche
42
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42. The sequence of pubertal signs in females appear within how many years?
A. 2
B. 2.5
C. 4
D. 4.5
```
D. 4.5
43
43. The onset of menarche is affected by:
A. Increasing weight gain thereby attaining critical weight for menses tooccur
B. Increasing dietary intake of estrogen rich foods
C. Increasing secretion of sex steroids
D. Increasing pulsatile secretion of gonadotrophins
D. Increasing pulsatile secretion of gonadotrophins
44
44. Puberty is characterized by the following, except:
A. Appearance of secondary sexual characteristics
B. Maturation of HPO axis
C. Attainment of the capacity for reproduction
D. Gradual follicular depletion and atresia
D. Gradual follicular depletion and atresia
45
45. The concordance of onset of puberty among mother and daughter pairs and sisters is best explained by:
A. Genetics
B. Psychological state
C. Concordance of geographic location
D. Nutritional status
A. Genetics
46
46. In evaluating for development of secondary sexual characteristics for classification according to Tanner pubertal staging, the following are examined:
A. Breast and axillary hair
B. Breast and pubic hair
C. Height velocity and breast
D. Height and pubic hair
B. Breast and pubic hair
47
47. According to Tanner staging, an adolescent with separation of breast contour and pubic hair thick and midline in distribution would be classified as:
A. B2 and PH2
B. B2 and PH3
C. B3 and PH4
D. B3 and PH5
C. B3 and PH4
48
48. Refers to the increase in gonadal estrogen thereby stimulating breast development and female fat distribution:
A. Adrenarche
B. Gonadarche
C. Menarche
D. Thelarche
B. Gonadarche
49
49. A distressed mother came to your clinic together with her 10 year old daughter. She claims that she had noted the development of her daughter’s breast at 9 years old. She is worried how come there is no menses yet when she herself (the mother) had her own menstruation at 10 years old. You advise:
A. There is a need to evaluate as it is expected that as mother and daughter they should have menses at the same time
B. There is a need to evaluate as breast appearance should occur at the same time as menses
C. No need to evaluate as it can be expected that her child will have menses within 2-3 years
D. No need to evaluate as it can be expected that her child will have menses within 4.5 years
D. No need to evaluate as it can be expected that her child will have menses within 4.5 years
50
50. You are evaluating a 15 year old patient presenting with primary amenorrhea, which of these sexual characteristics will be most helpful in your evaluation?
A. Breast and ovaries
B. Breast and uterus
C. Breast and pubic hair
D. Breast and onset of menarche
C. Breast and pubic hair
51
51. A 17 year old female patient who never had menses comes for evaluation. On examination, breasts and pubic hair are Tanner stage 1. Your initial working diagnosis would be?
A. Immature HPO axis
B. Primary amenorrhea
C. Secondary amenorrhea
D. Premature ovarian failure
B. Primary amenorrhea
52
52. A 21 year old female patient had her menarche at 16 years old, reports that menses became irregular for the past 2 years. Upon further questioning, you elicit that the longest interval between menses is 6 months. Your initial classification/diagnosis is?
A. Immature HPO axis
B. Primary amenorrhea
C. Secondary amenorrhea
D. Premature ovarian failure
C. Secondary amenorrhea
53
53. Absence of menstruation may be physiologic in the following, except:
A. Pregnancy
B. Breastfeeding
C. PCOS
D. Menopause
C. PCOS
54
54. A 35 year old ho had her last delivery 5 years ago underwent bilateral tubal ligation and is not presently using any medications, complains of not having her menstrual periods for the past 9 months. What can explain her condition?
A. Pregnancy
B. Menopause
C. Breastfeeding
D. Premature ovarian failure
D. Premature ovarian failure
55
55. Primary amenorrhea is defined as no menses by the age of _ in the absence of secondary sexual characteristic.
A. 12
B. 13
C. 14
D. 15
B. 13
56
56. In the presence of secondary sexual characteristics, the age at which primary amenorrhea is diagnosed is:
A. 12.5
B. 14.5
C. 16.5
D. 18.5
C. 16.5
57
57. The most common genetic cause of primary amenorrhea is:
A. Pure gonadal dysgenesis
B. Turner’s syndrome
C. Mayer Rokitansky Kuster Hauser syndrome
D. Testicular feminization syndrome
B. Turner’s syndrome
58
58. The most common anatomic cause of primary amenorrhea is:
A. Pure gonadal dysgenesis
B. Turner’s syndrome
C. Mayer Rokitansky Kuster Hauser syndrome
D. Testicular feminization syndrome
C. Mayer Rokitansky Kuster Hauser syndrome
59
59. The most common female endocrinologic disorder causing primary or secondary amenorrhea:
A. Hypothyroidism
B. Hyperprolactinemia
C. PCOS
D. Pituitary adenoma
C. PCOS
60
60. A 32 year old presents with absence of her menstruation since she underwent a dilatation and curettage for her last 2 pregnancies. What can explain this condition?
A. Sheehan’s syndrome
B. Simmond’s syndrome
C. Asherman’s syndrome
D. Mayer Rokitansky Kuster Hauser syndrome
C. Asherman’s syndrome
61
61. Patients diagnosed with Mullerian agenesis would have the following, except:
A. XX karyotype
B. XY karyotype
C. Normal breast and ovarian development
D. Failure of the development of the uterus and vaginal
B. XY karyotype
62
62. A 26 year old never had menses, has Tanner stage 4 breasts and female external genitalia. Karyotyping shows 46 XY. Your diagnosis is?
A. Turner’s syndrome
B. Androgen insensitivity syndrome
C. Mayer Rokitansky Kuster Hauser syndrome
D. Polycystic Ovary syndrome
B. Androgen insensitivity syndrome
63
63. You are examining a patient with Turner’s syndrome, these patients characteristically have:
A. Infantile breast and uterus
B. Infantile breast and presence of an adult uterus
C. Absent breast and uterus
D. Absent breast and infantile uterus
D. Absent breast and infantile uterus
64
64. A 36 year old previously regularly menstruating woman came in for consult complaining of absence of menstruation for the past 6 months. On careful history, she had received chemotherapy for an ovarian malignancy in the past year. The most likely diagnosis of her secondary amenorrhea is:
A. Ashermann’s syndrome
B. Sheehan’s syndrome
C. Primary ovarian insufficiency D. Menopause
C. Primary ovarian insufficiency
65
65. Hypothalamic causes of secondary amenorrhea include the following, except:
A. Post pill amenorrhea
B. Weight loss of >25% of body weight
C. Chromophobe adenoma
D. Stress
C. Chromophobe adenoma
66
66. Premature ovarian failure may be secondary to the following, except:
A. Autoimmune disease
B. Interruption of ovarian blood supply
C. Chemotherapy
D. Use of oral contraceptive pills
D. Use of oral contraceptive pills
67
67. A 15 year old patient is brought in by her aunt. She has never had menses but complains on cyclic lower abdominal discomfort every month. She is complaining of that same discomfort now. Upon examination, abdomen is soft and non-tender. There are normal external genitalia with a bulging violaceous area in between the labia minora. Your primary impression is:
A. Mayer Rokitansky Kuster Hauser syndrome
B. Turner’s syndrome
C. Imperforate hymen
D. Cervical agenesis
C. Imperforate hymen
68
68. A 25 year old patient consults for amenorrhea of 9 months. Pregnancy test is negative and on physical examination, you have elicited a visual field defect and the presence of milky discharge on both breasts. You are entertaining the diagnosis of:
A. Mayer Rokitansky Kuster Hauser syndrome
B. Androgen insensitivity
C. Prolactinoma
D. Polycystic Ovary syndrome
C. Prolactinoma
69
69. Polycystic ovary syndrome is characterized by:
A. Oligo-ovulation or anovulation
B. Hyperandrogenism
C. UTZ findings of >10 peripherally located cysts <1 cm
D. All of the above
A. Oligo-ovulation or anovulation
70
70. Polycystic ovary syndrome is an endocrinopathy that is:
A. Aggravated by obesity and hyperinsulinemia
B. Corrected by initial surgical intervention i.e. laparoscopic ovarian drilling
C. Diagnosed by ultrasound findings alone
D. All of the above
A. Aggravated by obesity and hyperinsulinemia
71
71. The following are true of Polycystic ovary syndrome, except:
A. May present with primary or secondary amenorrhea
B. May present with oligo-ovulation or anovulation
C. May have increased risk for endometrial cancer and diabetes mellitus
D. May have increased risk for ovarian cancer and diabetes mellitus
D. May have increased risk for ovarian cancer and diabetes mellitus
72
72. The following is true about functional hypothalamic amenorrhea, except:
A. Occurs in the absence of pituitary, ovarian and uterine abnormalities
B. Occurs in the presence of use of certain drugs and very
strenuous exercise
C. Due to abnormality of cyclic GnRH secretion
D. Due to abnormal cyclic LH pulsatility
B. Occurs in the presence of use of certain drugs and very
| strenuous exercise
73
73. A 38 year old G3P3 reports regular menstrual interval and duration but notices vaginal spotting a few days before and in between menses. Pelvic examination is normal. On transvaginal ultrasound there is a 1.3 X 1.2 cm hyperechoic mass within the endometrial cavity. Your impression is:
A. Intramural myoma
B. Adenomyosis
C. Polyp
D. Hyperplasia
C. Polyp
74
74. This woman is bothered by her intermittent vaginal bleeding and the finding of a mass on ultrasound. She would like it to be removed. What procedure can you recommend to address her concerns?
A. Endometrial biopsy
B. Saline infusion sonography C. Hysteroscopy
D. Total hysterectomy
C. Hysteroscopy
75
75. A 48 year old woman, G5P5 experiences heavy menstrual bleeding for the past 6 months accompanied by pelvic pain during menses. On pelvic exam, the uterus is globularly enlarged to 14 weeks size. You proceed to request for an ultrasound which revealed an enlarged uterus with thickened and coarse anterior and posterior myometrial walls. Your impression is:
A. Intramural myoma
B. Adenomyosis
C. Polyp
D. Hyperplasia
B. Adenomyosis
76
76. Menopause is a normal, natural event, defined as the final menstrual period (FMP), confirmed after _ year/s of no menstrual bleeding.
A. 2 years
B. 1 year
C. 3 years
D. 5 years
B. 1 year
77
77. Osteoporosis is defined as T score of:
A. ≤ -2.5
B. Between -1.0 and -2.5
C. -1.0
D. -2.0
A. ≤ -2.5
78
78. Normal bone density is defined as T score of:
A. ≤ -2.5
B. Between -1.0 and -2.5
C. -1.0
D. -2.0
C. -1.0
79
79. Which of the following is standard of care for detection of osteopenia and osteoporosis?
A. Bone X-ray
B. Dual Energy X-ray Absorptiometry (DEXA) scans
C. CT scan
D. MRI
B. Dual Energy X-ray Absorptiometry (DEXA) scans
80
80. Which of the following is considered as adjunct in osteoporosis treatment?
A. Estrogen
B. Tibolone
C. Estrogen-progesterone
D. Calcium
D. Calcium
81
81. Breast cancer screening mammography is recommended for postmenopausal women every _ years.
A. 1 year
B. 2 years
C. 3 years
D. 5 years
B. 2 years
82
82. At what age is colonoscopy or fecal occult blood test, sigmoidoscopy, or barium enema recommended for screening colorectal cancer among postmenopausal women?
A. 40 years old
B. 45 years old
C. 50 years old
D. 60 years old
C. 50 years old
83
83. When recommending hormonal therapy for menopause, women with a uterus need to take this additional hormone to estrogen in order to protect the uterus.
A. Progesterone
B. Tibolone
C. Parathyroid hormone
D. Selective estrogen modulator (SERM)
A. Progesterone
84
84. True or False: Estrogen has no protective effect in women with established coronary disease.
A. True
B. False
A. True
85
85. Which of the following patients will most likely experience symptoms of surgical menopause?
A. A 35 year old nulligravid who underwent total hysterectomy for abnormal uterine bleeding
B. A 40 year old G3P3 (3003) who underwent total hysterectomy with bilateral salphingooophorectomy for myoma uteri
C. A 37 year old nulligravid who underwent ovarian cystectomy due to dermoid cyst
D. A 32 year old nulligravid who underwent myectomy for a symptomatic myoma uteri
B. A 40 year old G3P3 (3003) who underwent total hysterectomy with bilateral salphingooophorectomy for myoma uteri
86
86. A 45 year old G2P2 (2002) underwent total hysterectomy with bilateral salphingooophorectomy for abnormal uterine bleeding secondary to myoma uteri. Immediately post-op, what type of hormonal therapy is advisable for the patient to protect her from vasomotor symptoms, early onset cardiovascular disease, dementia and osteoporosis?
A. Estrogen only
B. Estrogen + progesterone
C. Testosterone only
D. Either A or B
A. Estrogen only
87
FOR NUMBERS 87-91 PLEASE REFER TO THE CASE OF PATIENT ANA
Ana, a 30 year old nulligravid came to your clinic complaining of secondary amenorrhea for 1 and a half years. She also noted experiencing hot flashes, night sweats, mood swings, irritability, and vaginal discomfort. Serum FSH levels is 50 mIU/L.
```
87. What is your diagnosis?
A. Iatrogenic menopause
B. Premature ovarian insufficiency/syndrome
C. Surgical menopause
D. Induced menopause
```
88. The advent of vasomotor symptoms experienced by patient Ana is precipitated mainly due to which of the following mechanism?
A. Fall in progesterone levels
B. Fall in estrogen levels
C. Damage in the pituitary thermoregulatory zone
D. Decrease in testosterone levels
89. What is the recommended work-up for patient Ana to determine the etiology of her condition?
A. Diagnostic laparoscopy to check on the ovaries
B. DEXA scan
C. Screen for thyroid, adrenal, and other autoimmune disorders
D. No need for work-up, may proceed with treatment immediately
90. What is the recommended treatment for patient Ana?
A. Hormonal therapy/estrogen replacement until the approximate time of natural menopause
B. Bisphosphonates
C. Calcitonin
D. Parathyroid hormone
91. If patient Ana consults; expresses her desire to have a child, what is the best, most efficacious treatment option for her?
A. Advise patient Ana that she is still capable of spontaneous pregnancy without any medical intervention
B. Fertility pills/injection
C. Oocyte (egg) donation
D. Sperm donation
87 B. Premature ovarian insufficiency/syndrome
88 B. Fall in estrogen levels
89 C. Screen for thyroid, adrenal, and other autoimmune disorders
90 A. Hormonal therapy/estrogen replacement until the approximate time of natural menopause
91 C. Oocyte (egg) donation
88
92. A sexually active 66 year old G3P3 (3003) came to your clinic with chief complaint of vulvovaginal dryness and dyspareunia. Her last normal menses was 17 years ago. What is the best treatment option for this patient?
A. Oral or systemic hormonal replacement therapy
B. Local vaginal estrogen
C. Testosterone tablets
D. Bisphosphonates
B. Local vaginal estrogen
89
93. Your 60 year old aunt consulted you for a central DEXA scan reading which she obtained from her annual medical check-up. It showed the following readings: T score: -1.8; Z score: -2.6. What is your interpretation of her results?
A. Normal
B. Osteopenia
C. Osteoporosis
D. Osteochondritis
B. Osteopenia
90
FOR NUMBERS 94-97 PLEASE REFER TO THE CASE OF PATIENT CECILIA Patient Cecilia, a 70 year old G6P6 (6006) came to your clinic for consult regarding an Osteoporosis reading on her central DEXA report. She has been working as a farmer in a sugarcane plantation in Tarlac for more than 50 years. She has a history of smoking for 2 pack years but stopped 20 years ago. She has been maintained on low dose glucocorticoids for the past 5 years due to an autoimmune disorder. She looks slightly pale, with a hemoglobin level of 10 mg/dL.
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94. Which of the following is considered as patient Cecilia’s risk factor for a possible osteoporotic fracture in the future?
A. Anemia
B. Past smoking history
C. Multiparity
D. Long-term use of glucocorticoids
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95. Which of the following treatment options would be best for patient Cecilia?
A. Bisphosphonates
B. Calcium
C. Systemic/oral hormone replacement therapy
D. Vitamin D
96. Which of the following laboratory work-ups would be best to monitor patient Cecilia’s response to osteoporosis treatment?
A. Dual Energy X-ray Absorptiometry (DEXA) scans
B. Serum bone turnover markers
C. Serum estrogen levels
D. Quantitative computed tomography
97. If patient Cecilia’s DEXA scan only showed “osteopenia” in the final report, which of the following factors will convince you to start her on osteoporosis drug therapy?
A. Patient’s history of fall injury a year ago
B. 10-year FRAX risk of major osteoporotic fracture of at least 20%
C. Patient’s history of wrist fracture
D. Patient’s advanced age should warrant immediate osteoporotic drug
therapy
94 D. Long-term use of glucocorticoids
95 A. Bisphosphonates
96 B. Serum bone turnover markers
97 B. 10-year FRAX risk of major osteoporotic fracture of at least 20%
91
98. Why are menopausal women at risk for cardiovascular disease?
A. Prostacyclin production decreases, endothelin levels increase
B. Prostacyclin production increases, endothelin levels decrease
C. Vasomotor responses to acetylcholine are dilatory
D. Increased nitric oxide synthetase activity
A. Prostacyclin production decreases, endothelin levels increase
92
99. What is the effect of hormone/estrogen therapy for older women with established coronary disease?
A. Hormone/estrogen therapy stabilizes coronary artery plaque destabilization and thrombosis
B. Hormone/estrogen therapy prevents further plaque formation
C. Hormone/estrogen therapy may lead to plaque destabilization and thrombosis
D. Hormone/estrogen therapy dissolves plaque formation in coronary arteries
C. Hormone/estrogen therapy may lead to plaque destabilization and thrombosis
93
100. Premature ovarian failure or premature ovarian insufficiency (POI), is defined as hypergonadotropic ovarian failure occurring prior to age _ years old.
A. 40
B. 45
C. 50
D. 35
A. 40
