Obgyn - Pediatric and Adolescent gynecology (33) Flashcards
OBG - 1.1
What is the effect that counts for the differentiation of the gonads?
A) testosterone
B) estrogen
C) sex chromosome
D) hypophyseal hormones
ANSWER
C) sex chromosome
EXPLANATION
Differentiation of the gonads occurs after the 7th pregnancy week from the „indifferent” gonads determined by the sex chromosomal complex. The differentiation toward testis is initiated by a material encoded by the short arm of the Y-chromosome (TDF: testis determining factor). In the absence of a functional Y-chromosome the gonad will develop to ovary.
OBG - 1.7
In case of primary amenorrhea the first step after general gynecological examination should be:
A) clomiphene test
B) genetical screening
C) estrogen-progesterone test
D) gonadotropin stimulation test
ANSWER
C) estrogen-progesterone test
EXPLANATION
The coordinated operation of the hypothalamus-pituitary-ovary-endometrial axis is essential for regular menstruation. Checking the function of the peripheral target organ should start with clarifying the disturbances in the system. In case of primary amenorrhea the first step to do after general gynecological examination is to induce “withdrawal bleeding” by performing the estrogen-progesterone test. With a responsive endometrial layer, menstruation should appear after the exogenous hormone effect finishes.
OBG - 1.8
Which of the followings is not progesterone effect?
A) endometrial proliferation
B) increase of basal body temperature
C) development of breast acinars
D) endometrial secretion
ANSWER
A) endometrial proliferation
EXPLANATION
Cyclic genital function in women is fundamentally influenced by estrogen and progesterone. Typical progesterone effects are basal body temperature elevation and endometrial secretion, whereas endometrial proliferation occurs in the first half of the cycle due to estrogen action.
OBG - 1.9
In adolescents, secondary amenorrhea is defined as missing the menstrual period for at least:
A) 2 months
B) 4 months
C) 6 months
D) 12 months
ANSWER
C) 6 months
EXPLANATION
In adolescence, regular menstrual cycles develop gradually with the hypothalamic-pituitary-ovary-endometrial axis. Delicate disturbances may still occur in the system at this age, but most of these cases gradually disappear spontaneously. The specificity of this period is also reflected in the definition that in adolescents we are talking about secondary amenorrhea when the period is missing for at least 6 months, in contrast with adulthood, where this time-interval is only 3 months.
OBG - 1.10
The estimated amount of an average menstruation is about:
A) 10-15 ml
B) 25-50 ml
C) 75-100 ml
D) 100-120 ml
ANSWER
B) 25-50 ml
EXPLANATION
The amount of menstrual bleeding can be estimated based on the number of bleeding days, the presence of larger blood clots and the number of used pads/tampons. The average amount is approximately 25-50 ml. Women using oral contraceptives usually have less menstrual bleeding than women with non-hormonal intrauterine devices.
OBG - 1.11
The origin of lutein cells:
A) theca externa
B) theca interna
C) granulosa cells
D) corona radiata
ANSWER
C) granulosa cells
EXPLANATION
Stromal cells outside the basal lamina create the theca externa and interna. Lutein cells form from the granulocyte cells within the basal membrane.
OBG - 1.12
The most frequent malignant tumor in adolescents is:
A) cervical cancer
B) clear cell adenocarcinoma of the vagina
C) ovarian cancer
D) rhabdomyosarcoma
ANSWER
C) ovarian cancer
EXPLANATION
Malignant tumors of female genital organs in adolescence are rarely seen. Endometrial cancer does not occur at all, cervical cancer is extremely rare at this age group, although the early start of sexual activity allows early HPV exposure in the latter group. Malignant ovarian tumors are the most common, but these are age-specific tumors (granulosa cell tumor, dysgerminomas, etc.), not characteristic for adults. The clear-cell adenocarcinoma of the vagina may occur where diethylstilbestrol treatment has been routinely used in cases of threatening abortion. Fortunately, in Hungary this therapy was not used.
OBG - 1.13
A 17-year-old girl underwent transabdominal ultrasound scan due to the reason of cystopyelitis. A simple ovarian cyst measuring 4,5 x 3,5 cm was detected. The next step in the management should be:
A) start to use combined oral contraceptive pill
B) repeat the ultrasound scan after 1 month
C) ultrasound guided transvaginal/transabdominal punction
D) laparoscopy
ANSWER
B) repeat the ultrasound scan after 1 month
EXPLANATION
Most of the ovarian cysts seen in adolescents are simplex functional retention cysts. Vast majority of them are absorbed within 1 to 2 months, and generally no intervention is needed within a diameter of 5 cm. Larger cysts can be also observed without any risk in the patient does not have any complain. Ultrasound evaluation should be repeated one month later and further steps should be decided afterwards. Ovarian cysts occur less frequently when taking oral contraceptive pills, but in case of an existing cyst the onset of the tablet has not been proven effective. Ultrasound guided transvaginal/transabdominal puncture is an easy-to-perform, less invasive procedure for treating persistent or growing cysts, but recurrence is very common, so laparoscopic cystectomy can be suggested as a definitive solution.
OBG - 1.14
Which of the following is not characteristic for Turner’s-syndrome?
A) pigmented nevus
B) hypoplastic fingernails and toenails
C) incidence is increasing in newborns with maternal age
D) high-arched roof of mouth
ANSWER
C) incidence is increasing in newborns with maternal age
EXPLANATION
In addition to the typical symptoms described by Turner in 1938, several other minor features can be found in the syndrome, such as pigmented nevus, hypoplastic nails and arcuated palate, but X-monosomy is the consequence of an abnormality in spermatogenesis, so the frequency with maternal age does not increase significantly.
OBG - 1.15
Which of the followings is not characteristic for polycystic ovarian syndrome?
A) increased GnRH pulsatoric frequency
B) increased LH/FSH ratio
C) increased estradiol/estron ratio
D) increased DHEAS level (dehydroepiandrosterone-suphate)
ANSWER
C) increased estradiol/estron ratio
EXPLANATION
LH-hypersecretion is a diagnostic criteria in polycystic ovarian syndrome, while hyperandrogenism is responsible for hirsutism. Recent data have demonstrated increased GnRH pulsation frequency. Estradiol level is decreased in polycystic ovarian syndrome.
OBG - 1.16
With a short history of existing acute abdominal complaints, a 16-year virgin girl was admitted. Based on the complaints and the physical examination, diagnostic laparoscopy was performed and the torsion of the right adnexa was detected with blue-colored ovaries. The best solution during surgery:
A) salpingo-oophorectomy
B) detorsion of the ovary and wait until normal color returns
C) converting to laparotomy, detorsion and resection of the ovary
D) converting to laparotomy, salpingo-oophorectomy
ANSWER
B) detorsion of the ovary and wait until normal color returns
EXPLANATION
Possible complications of ovarian cysts are: rupture, bleeding and adnexal torsion. The torsion of the adnexa may also occur in case of a healthy ovary, but most often the cystic ovary (and the Fallopian-tube) are torquated. Due to anatomical conditions, young people are at increased risk. In case of suspected adnexal torsion, surgical intervention is indicated, as its persistence may cause irreversible damage to the adnexa. First, venous flow decreases, the adnexa swells and then arterial blood supply is damaged. Early surgery and resolving the torquation is the only way to save the ovary. According to the principles of minimally invasive surgery, laparoscopy is the optimal solution. Based on the available data, resection of smaller cysts is not necessarily recommended; recurrent torsion practically does not occur. Of course, larger cysts can be removed, and if the technical conditions are not met, laparotomy is the solution to be chosen. However, we must always strive for the conservation of the ovary.
OBG - 1.18
Which of the followings is frequently related to hematometra?
A) polycystic ovarian syndrome
B) hirsutism
C) endometriosis
D) adnexal torsion
ANSWER
C) endometriosis
EXPLANATION
During adolescence those developmental disorders where the menstrual fluid pathway is blocked can result hematometra. In older age, closure of the cervix after cervical surgeries can cause similar problems. In these cases, the menstrual secretion appears in the abdominal cavity through the Fallopian tube. Endometrial parts here can be implanted and may lead to the development of endometriosis.
OBG - 1.19
Which organs are formed from the Müllerian-tube?
1) the fallopian tubes
2) lower third of the vagina
3) uterus
4) ovaries
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
The Müllerian-tube is formed in the sixth embryonic week. It is bypassing the Wolffian-tube medially and the lower part of it is united with the contralateral Müllerian-tube. This union will form the uterovaginal canal, of which the uterus, the upper two-third of the vagina and the two Fallopian tubes will develop.
OBG - 1.20
Mild hirsutism is influenced favorably by combined oral contraceptives because:
1) LH-regulated androgen produce is decreased
2) SHBG level elevates
3) free testosterone level decreases
4) androgen produce of the suprarenal gland is decreased
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
The main effect of oral contraceptives is blocking ovulation, but they have a lot of beneficial and some unfavorable side effects. One of the preferred side effects is the beneficial effect on mild hirsutism, which is resulted by several pathways: decreasing LH-regulated androgen production, increasing SHBG levels, decreasing free testosterone levels and decreasing androgen production of the adrenal gland.
OBG - 1.21
Diagnostic criteria of bacterial vaginosis:
1) greyish-white adherent vaginal secretion
2) positive KOH-test (amin-test)
3) presence of „clue-cells”
4) vaginal pH is less than 4,5
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
ANSWER
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
Bacterial vaginosis is a common form of vulvovaginitis. Its essence is a significant increase in the number of anaerobe bacteria due to changes in the endogenous flora of the vagina. To set up the diagnosis the classic four criteria are: greyish-white adhesive vaginal secretion, positive KOH test (amin-test), presence of “clue cells” and vaginal pH above 4.5. Of these, the nature of the secretion and the immediate pH-test can help in quick diagnosis.
