LE3 Gyne Flashcards
- Max GnRH pulse frequency happens at what phase?
A. Follicular phase
B. Luteal phase
C. Medullary phase
D. Ovulatory phase
A. Follicular phase
Rationale: Maximal GnRH pulse frequency occurs during the follicular phase, which is crucial for stimulating LH secretion needed for follicular maturation.
- Gonadotropin-dependent follicle:
A. Primordial follicle
B. Primary follicle
C. Pre-antral follicle
D. Secondary/Antral follicle
D. Secondary/Antral follicle
Rationale: The secondary or antral follicle is the first to become gonadotropin-dependent, requiring FSH and LH for its growth and maturation.
- The ovaries secrete:
A. Estrogen
B. Progesterone
C. Androstenedione
D. All of the above
D. All of the above
Rationale: The ovaries secrete estrogen, progesterone, and androstenedione as part of their role in regulating the menstrual cycle and reproductive health.
- TRUE regarding the process of a dominant follicle in the menstrual cycle:
A. Promotes cell multiplication
B. Has a well-vascularized theca cell layer
C. Increases estradiol secretion
D. All of the above
D. All of the above
Rationale: A dominant follicle promotes granulosa cell multiplication, has a well-vascularized theca cell layer, and increases estradiol secretion, contributing to its selection as the dominant follicle.
- This hormone entirely acts on granulosa cells:
A. FSH
B. LH
C. Progesterone
D. Estradiol
A. FSH
Rationale: FSH exclusively acts on granulosa cells, stimulating their proliferation and aiding in the aromatization of androgens to estrogens.
- This is a potent physiologic inhibitor of GnRH and gonadotropin secretion:
A. Estradiol-17B
B. Progesterone
C. LH
D. FSH
B. Progesterone
Rationale: Progesterone is a potent inhibitor of GnRH and gonadotropin secretion, particularly during the luteal phase, helping to suppress further ovulation.
- A 22-year-old medical student is experiencing mild hypogastric pain radiating to the LLQ at midcycle. Because she listened to the lecture on the menstrual cycle, she understands that the following statements are TRUE regarding ovulation, EXCEPT:
A. Signifies follicular rupture
B. Occurs 32 hours after the initial rise of LH surge
C. Occurs 32 hours after estradiol peak
D. Occurs 12-16 hours after LH surge peak
C. Occurs 32 hours after estradiol peak
Rationale: Ovulation occurs approximately 32 hours after the initial rise of LH surge, or 12-16 hours after the LH surge peak. It is not dependent on the estradiol peak directly.
- An infertile couple comes to your clinic due to infertility. Which of the following tests can be checked for ovarian reserve?
A. FSH
B. AMH
C. Inhibin B
D. All of the above
D. All of the above
Rationale: Ovarian reserve can be assessed by measuring FSH, AMH, and inhibin B levels, as each reflects different aspects of follicle health and quantity.
- Which of the following tests can denote ovarian aging?
A. FSH
B. AMH
C. Inhibin B
D. Antral follicle count
A. FSH
Rationale: Elevated FSH levels measured on days 2-3 of the menstrual cycle are indicative of diminished ovarian reserve, suggesting ovarian aging.
- Osteopenia is defined as:
A. T-score above -1
B. T-score between -1 and -2.5
C. T-score below -2.5
D. T-score between -0.5 and -1
B. T-score between -1 and -2.5
Rationale: Osteopenia is defined by a T-score between -1 and -2.5, indicating bone density that is lower than normal but not low enough to be classified as osteoporosis.
- A 69-year-old woman is seeking hormone replacement therapy (HRT). HRT is contraindicated in which of the following situations?
A. History of breast cancer
B. Severe osteoporosis
C. Menopausal symptoms causing severe distress
D. Decreased bone mineral density
A. History of breast cancer
Rationale: HRT is contraindicated in patients with a history of breast cancer due to the risk of hormone-dependent tumor growth.
- Which of the following patients will most likely experience surgical menopause?
A. 32-year-old who underwent laparoscopic tubal ligation
B. 38-year-old nulligravid who underwent total hysterectomy with bilateral salpingo-oophorectomy
C. 40-year-old who had a unilateral oophorectomy
D. 45-year-old who underwent hysterectomy without oophorectomy
B. 38-year-old nulligravid who underwent total hysterectomy with bilateral salpingo-oophorectomy
Rationale: Surgical menopause occurs when both ovaries are removed, resulting in a sudden loss of estrogen production. This patient had both ovaries removed, leading to surgical menopause.
- A 45-year-old woman underwent a total hysterectomy with bilateral salpingo-oophorectomy. Immediately after post-op, what is the best treatment advisable to this patient?
A. Estrogen alone
B. Estrogen and progesterone
C. Progesterone alone
D. No hormonal treatment
A. Estrogen alone
Rationale: After hysterectomy with bilateral salpingo-oophorectomy, estrogen is given for hormone replacement without the need for progesterone since there is no uterus to protect from endometrial hyperplasia.
- Brenda wants to conceive through oocyte donation. Which of the following statements is true regarding oocyte donation?
A. It is the first line of treatment for infertility
B. It is done only after multiple IVF failures or other second-line treatment failures
C. It is not recommended for women over 40
D. It is only done for women with premature ovarian failure
B. It is done only after multiple IVF failures or other second-line treatment failures
Rationale: Oocyte donation is typically considered after other treatments, such as multiple IVF cycles, have failed.
- Fatima has vulvovaginal itching. What is the most appropriate treatment?
A. Oral estrogen
B. Topical estrogen
C. Antihistamines
D. Oral progesterone
B. Topical estrogen
Rationale: Topical estrogen is used for vulvovaginal itching associated with atrophic changes, as it helps to improve the local tissue condition without systemic effects.
- Osteoporosis is defined as:
A. T-score between -1 and -2.5
B. T-score below -2.5
C. T-score above -1
D. T-score between -0.5 and -1
B. T-score below -2.5
Rationale: Osteoporosis is defined by a T-score below -2.5, indicating significantly reduced bone density and increased fracture risk.
- Which test can help confirm the beginning of menopause?
A. LH
B. Estrogen
C. FSH
D. Progesterone
C. FSH
Rationale: Elevated FSH levels (≥30 mIU/mL) are used to confirm menopause, especially when accompanied by the absence of menses for at least 12 months.
- A 76-year-old G2P2 (2002) was referred to you by an orthopedic surgeon due to osteoporosis and recurrent hip fractures. Which of the following treatments would be most appropriate for this patient?
A. Hormone replacement therapy
B. Bisphosphonates
C. Calcium supplementation alone
D. Denosumab
B. Bisphosphonates
Rationale: Bisphosphonates are commonly used for the prevention and treatment of osteoporosis, as they help to increase bone mass and reduce the risk of fractures.
- Why do patients with testicular feminization (androgen insensitivity syndrome) develop breasts?
A. Elevated androgen levels
B. Increased prolactin production
C. Absence of androgen action allows estrogen to stimulate breast development
D. Deficiency of luteinizing hormone
C. Absence of androgen action allows estrogen to stimulate breast development
Rationale: In androgen insensitivity syndrome, the absence of effective androgen action allows even low levels of estrogen to stimulate breast development. This condition results from mutations in the androgen receptor gene.
- Why is the length of the luteal phase approximately 14 days?
A. Because the corpus luteum’s life span is limited to about 14 days
B. Due to the variability in ovulation timing
C. It depends on the length of the follicular phase
D. It is influenced by the hypothalamic-pituitary axis
A. Because the corpus luteum’s life span is limited to about 14 days
Rationale: The luteal phase lasts approximately 14 days because the corpus luteum, which forms after ovulation, has a life span of about 14 days. If pregnancy does not occur, it degenerates, leading to a decrease in progesterone and the onset of menstruation.
- In a septate uterus, the septum has poor blood supply and contains fibrous and/or myometrial tissues. Which of the following statements is TRUE?
A. The septum has an adequate blood supply
B. The septum contains glandular tissue
C. The septum contains fibrous and/or myometrial tissues with poor blood supply
D. The septum is made up entirely of normal endometrial tissue
C. The septum contains fibrous and/or myometrial tissues with poor blood supply
Rationale: In a septate uterus, the septum is composed of fibrous or myometrial tissue with a poor blood supply, which can contribute to implantation failure or recurrent pregnancy loss.
- A 2-year-old asymptomatic child was brought to the clinic due to fusion of labia minora. What is the best management?
A. Surgical separation
B. Topical estrogen cream
C. Oral estrogen
D. No treatment needed
B. Topical estrogen cream
Rationale: Labial adhesion in a young child can often be treated with topical estrogen cream, which helps to soften and separate the fused labia. Surgery is typically reserved for cases where medical treatment fails.
- What is the effect of estrogen on bone formation?
A. Decreases osteoblast activity
B. Promotes osteoblast activity
C. Increases osteoclast activity
D. Has no effect on bone cells
B. Promotes osteoblast activity
Rationale: Estrogen promotes osteoblast activity, which helps in bone formation and maintenance. This is why decreased estrogen levels during menopause can lead to reduced bone density and osteoporosis.
- Screening for colorectal cancer starts at what age?
A. 40
B. 45
C. 50
D. 60
B. 45
Rationale: Regular screening for colorectal cancer is recommended to start at age 45, according to the U.S. Preventive Services Task Force. Early detection and removal of polyps can significantly reduce the risk of developing colorectal cancer.
- Which of the following has no risk factor for cancer?
A. Simple fibroadenoma
B. Complex fibroadenoma
C. Duct papilloma
D. Atypical lobular hyperplasia
A. Simple fibroadenoma
Rationale: Simple fibroadenomas are considered benign with no associated increased risk of breast cancer, whereas complex fibroadenomas, duct papillomas, and atypical lobular hyperplasia are associated with a slightly increased risk of developing breast cancer.
- Majority of malignancies occur in what quadrant?
A. Upper inner
B. Upper outer
C. Lower outer
D. Lower inner
B. Upper outer
Rationale: The majority of breast malignancies occur in the upper outer quadrant, which contains the most glandular tissue.
- Which of the following is TRUE regarding acute mastitis?
A. It is most clinically important form of mastitis
B. It occurs exclusively in non-lactating women
C. It does not require treatment
D. It is a painless condition
A. It is most clinically important form of mastitis
Rationale: Acute mastitis is the most clinically significant form of mastitis and occurs mainly during breastfeeding, often requiring antibiotics for treatment.
- The pathophysiology of this condition is caused by dilatation and shortening of the breast duct:
A. Fibrocystic change
B. Duct ectasia
C. Mastitis
D. Fibroadenoma
B. Duct ectasia
Rationale: Duct ectasia is characterized by the dilatation and shortening of the breast duct, often leading to periductal inflammation and sometimes nipple discharge.
- A 28-year-old patient with a history of seatbelt injury presents with a lump on her breast. What is the most likely etiology?
A. Fibroadenoma
B. Fat necrosis
C. Duct papilloma
D. Mastitis
B. Fat necrosis
Rationale: Fat necrosis commonly results from trauma, such as a seatbelt injury, and can present as a palpable lump in the breast.
- A firm, rubbery breast mass is a common finding in which condition?
A. Fibroadenoma
B. Fibrocystic disease
C. Duct papilloma
D. Phyllodes tumor
B. Fibrocystic disease
Rationale: Fibrocystic disease is a non-proliferative condition that often presents with firm, rubbery masses in the breast. These changes are benign and common in reproductive-aged women.
- Fibroadenoma that is predominantly fibrotic:
A. Pericanalicular
B. Intracanalicular
C. Giant
D. Complex
A. Pericanalicular
Rationale: Pericanalicular fibroadenomas are characterized by prominent fibrotic stroma, leading to more fibrosis compared to intracanalicular types. The pericanalicular type has more stromal proliferation, whereas the intracanalicular type has less fibrosis and compresses the ductal elements.
- Which benign tumor may present with bloody discharge?
A. Duct papilloma
B. Fibroadenoma
C. Sclerosing adenosis
D. Phyllodes tumor
A. Duct papilloma
Rationale: Duct papilloma, a benign tumor of the breast ducts, may present with serous or bloody nipple discharge.
- Which of the following statements is TRUE about Phyllodes tumor?
A. It can be diagnosed clinically without histology
B. It is always benign
C. It can only be distinguished by histology
D. It does not recur after excision
C. It can only be distinguished by histology
Rationale: Phyllodes tumors are a spectrum of fibroepithelial tumors that can be benign, borderline, or malignant. They can only be definitively distinguished from other fibroepithelial lesions by histology.
- Age of peak incidence of breast cancer:
A. 30-39
B. 40-49
C. 50-59
D. 60-69
C. 50-59
Rationale: The peak incidence of breast cancer occurs between the ages of 50-59, with the highest age-specific incidence rate observed in this group.
- Who is most at risk for breast cancer?
A. Male, 30, with a sister who has breast cancer
B. Female taking oral contraceptives
C. Female undergoing radiotherapy for Hodgkin’s disease
D. Female, 25, no known risk factors
C. Female undergoing radiotherapy for Hodgkin’s disease
Rationale: Females are more at risk of breast cancer than males. Additionally, patients who have undergone high-dose radiotherapy for Hodgkin’s disease have an increased risk of developing breast cancer, which is higher than that of women taking oral contraceptives or without known risk factors.
- Most common site of metastasis for breast cancer, EXCEPT:
A. Lungs
B. Cerebrospinal fluid (CSF)
C. Brain
D. Bone
B. Cerebrospinal fluid (CSF)
Rationale: Common sites of metastasis for breast cancer include the lungs, bones, brain, liver, and skin. The CSF is not a common site for breast cancer metastasis.
- A 50-year-old presents with bilateral breast masses that are fixed and firm. UTZ shows BI-RADS 4. What is the most likely diagnosis?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Fibroadenoma
D. Ductal carcinoma in situ (DCIS)
B. Invasive lobular carcinoma
Rationale: Invasive lobular carcinoma is more likely to present with bilateral and multicentric involvement compared to invasive ductal carcinoma, which is often unilateral. A BI-RADS 4 score indicates suspicion for malignancy, requiring biopsy.
- Who among the following can screening be recommended for?
A. Female, no risk factors, 55 years old
B. Female, no risk factors, 45 years old
C. Female, no risk factors, 30 years old, desires to undergo mammography
D. A & B
D. A & B
Rationale: Breast cancer screening is recommended for women aged 50 and older, as well as those aged 45-49. Routine screening is not typically recommended for women under 40 without known risk factors, as the benefits do not outweigh the risks. However, mammography may be considered for women over 40 based on individual risk assessment and clinical decision.
- A 3 cm tumor within ipsilateral movable lymph nodes with no metastasis is classified as:
A. T1 N1 M0
B. T2 N1 M0
C. T2 N2 M0
D. T3 N1 M0
B. T2 N1 M0
Rationale: A 3 cm tumor falls under T2, and the presence of movable lymph nodes classifies it as N2. Since there is no evidence of metastasis, M0 is used.
- A UTZ finding shows BI-RADS 0. What is the next step?
A. Mammography
B. No additional imaging needed
C. Needs additional imaging
D. Biopsy
C. Needs additional imaging
Rationale: A BI-RADS 0 finding means that the imaging is incomplete, and additional imaging is needed to provide a final assessment.
- The following are indications for lymph node biopsy, EXCEPT:
A. Women with tumors > 3 cm
B. Women with multicentric/multifocal tumors
C. Women with clinically involved nodes
D. Pregnant or breastfeeding women
C. Women with clinically involved nodes
Rationale: Women with clinically positive nodes usually proceed directly to axillary dissection rather than a biopsy for further evaluation. Lymph node biopsy is indicated for assessment of axillary status in specific situations, such as in tumors greater than 3 cm or multifocal disease.
- Surgical management that involves removal of muscles:
A. Modified radical mastectomy
B. Lumpectomy
C. Simple mastectomy
D. Radical mastectomy
D. Radical mastectomy
Rationale: Radical mastectomy involves the removal of the entire breast, levels I, II, and III of the axillary lymph nodes, and the chest wall muscles beneath the breast.
- Who would you recommend adjuvant chemotherapy for?
A. Patients with ≥ 4 lymph nodes involved
B. Patients with positive surgical margins
C. Patients with T3 and T4 tumors
D. A and B Only
D. A and B Only
Rationale: Adjuvant chemotherapy is recommended for patients with positive margins and those with ≥ 4 positive lymph nodes. T3 and T4 tumors may also benefit from adjuvant chemotherapy, depending on the individual case.
- Adjuvant radiotherapy is recommended in women who underwent breast-conserving surgery because the local recurrence rate is:
A. 10-15%
B. 25-35%
C. 40-50%
D. 60-70%
B. 25-35%
Rationale: After breast-conserving surgery, the risk of local recurrence is 25-35%, making adjuvant radiotherapy an important component of treatment to reduce this risk.
- What is the minimal follow-up for primary breast cancer?
A. Every 3 months for the first year, then annually
B. Every 3 months for the 1st year, then six monthly for 5 years, then annual review thereafter
C. Six-monthly for 5 years, then annual review thereafter
D. Annually from diagnosis
B. Every 3 months for the 1st year, then six monthly for 5 years, then annual review thereafter
Rationale: For patients with primary breast cancer, follow-up should be every 3 months for the first year, every six months for the next five years, and annually thereafter to monitor for recurrence and manage side effects of treatment.
- What is the most significant prognostic indicator for breast cancer?
A. Her2 positive
B. (+) Axillary LN
C. Estrogen Receptor (+)
D. Progesterone Receptor (+)
B. (+) Axillary LN
Rationale: The involvement of axillary lymph nodes is the most significant prognostic factor for breast cancer, as it correlates with the risk of recurrence and overall survival.
- Which statement about ductal carcinoma in situ (DCIS) is correct?
A. It invades beyond the basement membrane
B. It does not go through the basement membrane
C. It is always symptomatic
D. It is a benign condition
B. It does not go through the basement membrane
Rationale: DCIS is a non-invasive form of breast cancer that is confined to the ductal system and does not penetrate the basement membrane, making it an early-stage cancer.
- What finding is indicative of breast cancer?
A. Nipple retraction
B. Peau d’orange
C. One breast is larger than the other
D. A and B only
D. A and B only
Rationale: Nipple retraction and peau d’orange are classic signs of breast cancer. Nipple retraction occurs when the tumor involves the ducts, while peau d’orange results from obstruction of lymphatic drainage.
- Which of the following statements about fibrocystic changes is TRUE?
A. The cysts are lined with epithelium
B. It always progresses to cancer
C. It only affects postmenopausal women
D. It causes bloody nipple discharge
A. The cysts are lined with epithelium
Rationale: Fibrocystic changes involve cysts that are lined with epithelial cells. These changes are common and benign, particularly in women of reproductive age.
- Which of the following are the most important and clinically useful risk factors for breast cancer?
A. Smoking, alcohol, and obesity
B. Age, gender, and family history in immediate relatives
C. Nulliparity, high-fat diet, and early menarche
D. Exercise, diet, and breastfeeding
B. Age, gender, and family history in immediate relatives
Rationale: Age, female gender, and family history of breast cancer in immediate relatives are key risk factors that have a significant impact on the risk of developing breast cancer.
