Women's Health Questions

•A 16-year-old girl seeks your consult in clinic complaining of irregular menstrual periods. Menarche was at 12 years of age with current cycles at 28 to 60 day intervals. Each menstrual cycle lasts for 3 to 7 days and she uses 3-5 moderately soaked pads per day. Past medical history and family history are both unremarkable. On physical examination, she is stout with a BMI Z score of +3 for her age and has excessive facial and body hair. What syndrome does the patient most likely to have?

• Cushing Syndrome

• Polycystic Ovarian Syndrome

• Prader-Willi Syndrome

• Pseudohypoparathyroidism

A 17-year-old girl presents to the clinic with her mother for evaluation of irregular menses over the past year. Menarche occurred at 12 years of age with regular menstrual flow and an average cycle length of 30 days. About one year ago, her cycles became irregular, and for the past six months they have ceased completely. She is on the track team and has been running more competitively this year. Her mother is concerned about recent weight loss. The patient notes some increased stress lately since she is in the process of applying to college, but denies any other complaints. She has no significant medical or surgical history, and growth and development have been normal. She is sexually active. BP is 90/60 mm Hg, HR is 55 beats per minute, height is 66 inches, weight is 108 pounds, and BMI is 17.4 kg/m2. Physical exam is notable for normal secondary sexual characteristics and the absence of acne, striae, or hirsutism. Which of the following is the most appropriate diagnostic measure?

• Human chorionic gonadotropin

• Prolactin

• Testosterone

• Thyroid Stimulating Hormone

A 24-year-old woman presents to the office for hirsutism and irregular menses. She typically has five to six menses a year, and her last menses was 3 months ago. She is sexually active and does not desire pregnancy. Physical exam reveals moderate hirsutism on her upper lip and chin, a body mass index of 28 kg/m2, and a normal pelvic exam. Her lab results include a negative urine human chorionic gonadotropin, normal serum thyroid-stimulating hormone and prolactin levels, and total testosterone 60 ng/dL. Which of the following is the best first-line treatment plan for the suspected diagnosis?

• Clomiphene

• Leuprolide

• Spironolactone

• Hormonal Contraceptives

Answer explanation

Polycystic Ovary Syndrome (PCOS)

Amenorrhea, obesity or overweight, hirsutism

PE will show bilateral ovarian enlargement, acanthosis nigricans

Labs will show high LH to FSH, androgen excess

Most commonly caused by insulin resistance

Treatment is combination oral contraceptive pills, lifestyle changes, metformin

Most common cause of infertility

During the menstruation section of a gynecologic history, you determine your 36-year-old patient’s menstrual periods are increasing in length from 4 days to 8 days, even though she still cycles every 28 days. She also reports more blood flow than typical during the first 3 days of these new 8-day periods. Which of the following terms correctly defines this abnormal uterine bleeding?

• Polymenorrhea

• Menometrorrhagia

• Menorrhagia

• Metrorrhagia

A 62-year-old African-American woman complains of a tender, itchy, red breast. She states she first noticed an erythematous area six weeks ago, and since then, the involved area has spread rapidly. Examination of the breast reveals the findings seen above with associated warmth of the skin and axillary lymphadenopathy. Which of the following is the best diagnosis?

• Breast abscess

• Eczema of the Breast

• Inflammatory Breast Cancer

• Mastitis

A 50-year-old woman presents to the clinic with reports of insomnia and fatigue. She is perimenopausal and shares that she has been experiencing worsening and bothersome hot flashes on a nightly basis. Her medical history includes venous thromboembolism of the right calf and controlled hypertension. She currently takes lisinopril 20 mg and a multivitamin. Which of the following is the most appropriate therapy for her symptoms?

• Conjugated estrogen 0.45 mg and medroxyprogesterone 1.5 mg daily

• Estradiol 0.1 mg cream daily

• Melatonin 5 mg at bedtime

• Venlafaxine 37.5 mg daily

Answer explanation

Patients with contraindications to hormone replacement therapy, such as that in the vignette above, are candidates for alternative medications, including the selective serotonin and norepinephrine reuptake inhibitor, venlafaxine at a starting dose of 37.5 mg daily. Other alternative medications include gabapentin and clonidine

Which dietary supplement has been shown to improve vasomotor symptoms in menopausal women?

A 28-year-old woman presents with three weeks of bilateral clear nipple discharge in the absence of breast tenderness or lumps. A review of systems is positive for daily headaches and physical exam is notable for bilateral peripheral visual field cut. Which of the following tests is most likely to be abnormal?

• Breast Ultrasound

• Liver Enzymes

• Mammography

• Prolactin

A 50-year-old woman with a history of total hysterectomy 4 years ago presents to the clinic for a follow-up for hot flashes and night sweats. At the last visit 3 months ago, her follicle-stimulating hormone was found to be 60 international units/L, and she was started on transdermal estradiol 0.25 mg. Today, she reports slight improvement in her symptoms. What is the best next step in managing this patient’s vasomotor symptoms?

• Increase transdermal estradiol to 0.5 mg

• Switch to injectable estradiol cypionate 5 mg monthly

• Add oral micronized progesterone 200 mg daily for 12 days per month

• Switch to oral estradiol 1 mg daily

Which of the following serum biomarkers would most likely be elevated in a patient with epithelial ovarian carcinoma?