Obgyn - Menstrual disorders

Question 1

OBG - 2.2
Which are the physiological states of amenorrhea?
A) before puberty
B) during pregnancy
C) while breastfeeding
D) after the menopause
E) all of them

Answer 1

ANSWER
E) all of them
EXPLANATION
The physiological states of amenorrhea are before puberty, after the menopause, during pregnancy and breastfeeding.

Question 2

OBG - 2.3
Which is the most common cause of secondary amenorrhea?
A) hypothalamo-hypophyseal
B) ovarian
C) uterine
D) vaginal
E) adrenal

Answer 2

ANSWER
A) hypothalamo-hypophyseal
EXPLANATION
The most common cause of secondary amenorrhea is hypothalamo-hypophyseal with 61%, not included the hyperprolactinaemia, which represents further 18%. The uterine cause represents only 9%.

Question 3

OBG - 2.5
Which are the symptoms of premenstrual syndrome?A) increased irritability, psychic instability
B) predisposition to depression
C) painful breast tension
D) headache and back pain
E) any of them can appear in various degrees

Answer 3

ANSWER
E) any of them can appear in various degrees
EXPLANATION
This condition has an endocrine and psychosomatic origin. The changing levels of estrogen and progesterone have effect on mood and pain through neurotransmission modulation in the central nervous system.

Question 4

OBG - 2.6
Which can cause Asherman’s syndrome?
A) infections leading to endometrial sclerosis (e.g. genitalis tuberculosis)
B) ovarian dysfunction
C) destruction of the endometrial basal layer (e.g. after curettage of the uterus)
D) all of them are correct
E) A and C

Answer 4

ANSWER
E) A and C
EXPLANATION
In the Asherman’s syndrome, the front and back walls of the uterus stick to one another, which leads to amenorrhea. The most common cause of this condition is iatrogenic because of the destruction of the endometrial basal layer e.g. after curettage of the uterus. Genital tuberculosis may also lead to Asherman’s syndrome through the infection-related endometrial sclerosis, but it’s uncommon nowadays.

Question 5

OBG - 2.7
Characteristics of the normal menstual cycle, except:
A) The typical length of the period is 21 to 35 days
B) The blood loss is no more than 80 ml
C) it may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains
D) the estimation of the blood loss is subjective, and has a large interpersonal variation

Answer 5

ANSWER
C) it may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains
EXPLANATION
The normal menstrual cycle can range in length from 21 days to about 35 days, where the blood loss is no more than 80 ml. The estimation of the blood loss is complicated, because it is subjective, and has a large interpersonal variation.

Question 6

OBG - 2.8
Management of abnormal uterine bleeding in adolescents:
A) it is a temporary condition, neither the excessive and prolonged bleeding require treatment
B) may be caused by neoplasms, in order to receive histologic diagnosis curettage needed to perform
C) continuous or cyclic progesterone therapy and oral contraceptives
D) in case of frequent and excessive bleeding, anticoagulants may be effective
E) all of the treatments are correct

Answer 6

ANSWER
C) continuous or cyclic progesterone therapy and oral contraceptives
EXPLANATION
The abnormal uterine bleeding in adolescents is usually due to hormonal disturbances, so curettage is not recommended. The initial treatment, especially in case of excessive and prolonged bleeding are cyclic progesterone therapy, ovulation induction or oral contraceptives,

Question 7

OBG - 2.9
Characteristics of dysmenorrhea, except:
A) The most characteristic symptom is the lower abdomen pain, other symptoms may include nausea and vomiting
B) The main symptom is nausea and vomiting, and the lower abdomen pain is an often co-occuring symptom
C) The symptoms may occur even after the first childbirth
D) The symptoms may occur after the menarche
E) The symptoms occur primarily in the anovulatory cycles

Answer 7

ANSWER
E) The symptoms occur primarily in the anovulatory cycles
EXPLANATION
The most characteristic symptom of dysmenorrhea is the lower abdomen pain, other symptoms may include headache, nausea and vomiting. It can be classified as either primary or secondary based on the absence or presence of an underlying cause. The most common cause of secondary dysmenorrhea is organic, it may occur even after the first childbirth. The symptoms does not occur in the anovulatory cycles because of the low prostaglandin level of the endometrium.

Question 8

OBG - 2.10
Characteristics of an endometrial polyp, except:
A) benign mass in the inner lining of the uterus
B) can lead to infertility
C) the prevalence increases with age
D) the mass is benign, malignant transformation is not possible
E) can removed by hysteroscopic resection

Answer 8

ANSWER
D) the mass is benign, malignant transformation is not possible
EXPLANATION
The endometrial polyp is a benign mass in the inner lining of the uterus. Polyps are usually benign, but the prevalence increases with age, and the risk of malignant transformation is above 50% after the age of 65. Polyps can be surgically removed by curettage or hysteroscopy.

Question 9

OBG - 2.11
Which are the characteristic symptoms of the adenomyosis?
A) dysmenorrhea
B) hypermenorrhea
C) infertility is a main symptom
D) uterine enlargement
E) all of the symptoms are characteristic
F) only A) and C) are correct

Answer 9

ANSWER
E) all of the symptoms are characteristic
EXPLANATION
The endometrial tissue infiltrates the myometrium deeply, causing dysmenorrhea and hypermenorrhea. The uterus is usually uniformly enlarged.

Question 10

OBG - 2.12
This manner can be used in the diagnosis of endometriosis:
A) physical examination
B) ultrasound examination
C) MRI
D) laparoscopy
E) all of them are correct

Answer 10

ANSWER
E) all of them are correct
EXPLANATION
After suspecting endometriosis based on the medical history and a physical examination,ultrasound examination and MRI is advocated. Laparoscopy is the gold standard to diagnose endometriosis. If the growths are not visible, a biopsy may be taken to determine the diagnosis.

Question 11

OBG - 2.13
Which treatment is not recommended in menorrhagia?
A) Combined oral contraceptive pills
B) Intrauterine system that contains progestogen
C) NSAIDs
D) Endometrial resection
E) In case of unsuccessful initial treatment, surgery can be an effective second line treatment
F) Copper intrauterin device (IUD)

Answer 11

ANSWER
F) Copper intrauterin device (IUD)
EXPLANATION
In the treatment of menorrhagia, combined oral contraceptive pills have an efficiency of about 50-60%. The IUS has about 90%, and the NSAIDs have about 25% of efficiency. If the initial therapy is unsuccessful, endometrial ablation is recommended. Copper intrauterin devices can increase the amount of bleeding, therefore they are not recommended

Question 12

OBG - 2.14
Which are the main symptoms of premenopause?
A) abnormal uterine bleeding
B) anovulatory cycles
C) reduction of fertility, then infertility
D) A), B) and C) are all correct
E) Vulvovaginal atrophy

Answer 12

ANSWER
D) A), B) and C) are all correct
EXPLANATION
The female reproductive organs are not atrophic before menopause but the other symptoms are characteristics. The estrogen level continuously decreases after the menopause, leading to atrophy of the female reproductive organs.

Question 13

OBG - 2.19
Which cannot cause dysmenorrhea?
A) endometriosis
B) adenomyosis
C) leiomyoma
D) cervical stenosis
E) long-term combined oral contraceptives

Answer 13

ANSWER
E) long-term combined oral contraceptives
EXPLANATION
The level of prostaglandines -responsible for the dysmenorrhea- is decreased in anovulatory cycles. Therefore the continuous use of oral contraceptives relieves or terminates dysmenorrhea.

Question 14

OBG - 2.22
After menarche in case of imperforated hymen, the following can be seen:
A) Haematocolpos
B) mucocolpos
C) urinal retention
D) neither of them
E) A and C

Answer 14

ANSWER
E) A and C
EXPLANATION
After menarche the imperforated hymen first results heamatocolpos, which causes urinary disorder and retention due to the pressure applyed to the urethra and the bladder. Mucocolpos appears before the menarche, because of the obstruction of the the secretion.

Question 15

OBG - 2.25
What is hypomenorrhoea?
A) period last longer with more bleeding
B) regular, but shorter menstruation with light bleeding
C) period is between 30 and 120 days
D) more than 120 days between two menstruations
E) less then 25 days between two menstruations

Answer 15

ANSWER
B) regular, but shorter menstruation with light bleeding
EXPLANATION
regular, but shorter menstruation with light bleeding

Question 16

OBG - 2.26
What is menorrhagia (hypermenorrhea)?
A) painful menstruation
B) shorter menstruation with less bleeding than usual
C) longer (>7 days) mentruation with more bleeding (>80ml) than usual
D) more than 120 days between two menstruations
E) less then 25 days between two menstruations

Answer 16

ANSWER
C) longer (>7 days) mentruation with more bleeding (>80ml) than usual
EXPLANATION
Heavy bleeding, which last longer than usual

Question 17

OBG - 2.27
What is oligomenorrhea?
A) more than 35 days between two menstruations
B) shorter menstruation with less bleeding than usual
C) longer menstruation with more bleeding than usual
D) less than 120 days between two menstruations
E) less than 25 days between two menstruations

Answer 17

ANSWER
A) more than 35 days between two menstruations
EXPLANATION
In oligomenorrhea the periods are longer than 35 days

Question 18

OBG - 2.28
What is polymenorrhea?
A) period is between 35 and 90 days
B) shorter menstruation with less bleeding than usual
C) longer mentruation with more bleeding than usual
D) more than 120 days between two menstruations
E) less then 21 days between two menstruations

Answer 18

ANSWER
E) less then 21 days between two menstruations
EXPLANATION
In polymenorrhoea the periods are shorter than 21 days.

Question 19

OBG - 2.30
What is menorrhagia (hypermenorrhoea)?
A) withdrawl bleeding after oestrogen and/or progesteron therapy
B) regular, light bleeding
C) irregular menses
D) normal menstruation with cramps
E) regular menses with significant bleeding

Answer 19

ANSWER
E) regular menses with significant bleeding
EXPLANATION
Menorrhagia (hypermenorrhoea) heavy bleeding with regular periods (>80 ml blood and/or > 7 days), with normal ovulatory cycle.

Question 20

OBG - 2.31
Does the GnRH puls frequency change in different parts of the normal menstruational period?
A) higher in follicular phase
B) higher in luteal phase
C) no difference

Answer 20

ANSWER
A) higher in follicular phase
EXPLANATION
The GnRH pulsfrequency is more frequent in the follical phase , unlike in the lutal phase, in which it is less frequent.

Question 21

OBG - 2.32
What’s the cause of the raised temperature in the second half of the menstruational period?
A) progesteron increases the metabolism
B) oestrogen increases the metabolism
C) combined effect of progesteron and oestrogen increase the metabolism
D) progesteron stimulates the thermoregulation centre
E) prolactine stimulates the thermoregulation centre

Answer 21

ANSWER
D) progesteron stimulates the thermoregulation centre
EXPLANATION
The thermogenic effect of progesterone is responsible to the higher basic temperature, which last about 10 days and causes the characteristic biphase cycle.

Question 22

OBG - 2.33
Which sympthom does not fit in PCO syndrome?
A) obesity
B) polycystic ovaries with ultrasound
C) increased hair growth
D) oligomenorrhoea
E) seborrhoea
F) hyperbilirubinaemia

Answer 22

ANSWER
F) hyperbilirubinaemia
EXPLANATION
The PCO syndrome is the group of symptoms with characteristic ultrasound image, increased hair growth due to testosterone production and seborrhoea on the skin, oligo-, or amenorrhea and obesity. No effect on the bilirubin metabolism.

Question 23

OBG - 2.34
Hysteroscopy is suitable for detecting the cause of irregular uteral bleeding in following:
A) Focal lesion of the endometrium
B) developmental failure of the uterus
C) endometrial polyp
D) submucosal leiomyomas
E) All of them

Answer 23

ANSWER
E) All of them
EXPLANATION
During hysteroscopy the uterine wall and the source of the bleeding can be visualised.

Question 24

OBG - 2.35
Contraindication(s) of hysteroscopy:
A) retroflected uterus
B) uterinal septum
C) heavy uterinal bleeding
D) acut pelvic inflammatory diases
E) all of them
F) C and D answers are correct

Answer 24

ANSWER
F) C and D answers are correct
EXPLANATION
Neither the retroflexion nor the uterine septum are not contraindications of hysteroscopy. Acute pelvic inflammation or heavy bleeding are contraindications.

Question 25

OBG - 2.36
Recommended drugs to treat dysmenorrhea:
A) hormonal contraceptive pills
B) inhibitors of the prostaglandine synthesis
C) terbutalin or phenoterol
D) Diazepam
E) A and B
F) all of them are correct

Answer 25

ANSWER
E) A and B
EXPLANATION
The prostaglandins play a huge role in the developing of dysmenorrhea. So the inhibitors of the prostaglandin synthesis and hormonal contraceptives (by interrupting the ovulation they decrease the prostaglandin emission) treat the cause unlike fenoterol or diazepam.

Question 26

OBG - 2.38
What is the LH:FSH ratio in PCO syndrome?
A) 1:4
B) at least 3:1
C) 1:1

Answer 26

ANSWER
B) at least 3:1
EXPLANATION
Physiologically the LH/FSH ratio is 2:1. In PCO syndrome is rather 3:1 or above.

Question 27

OBG-2.39-2.42
Match the following situatons with the proper reactions.
A) Stop taking the pills, then continue taking them after 7 days
B) Continue taking the pills as usual
C) You have to continue taking the pills and combine it with another contraceptive methode
D) Take 1 more pill
E) Stop taking the pills and medical examination is needed

OBG - 2.39 - Nausea during the first period of using the tablets
OBG - 2.40 - Scratching all over the body
OBG - 2.41 - Missed one day taking the tablet
OBG - 2.42 - Light bleeding during the second part of the menstruational period

Answer 27

ANSWER
OBG - 2.39 - Nausea during the first period of using the tablets - B)
OBG - 2.40 - Scratching all over the body - E)
OBG - 2.41 - Missed one day taking the tablet - C)
OBG - 2.42 - Light bleeding during the second part of the menstruational period - B)

Question 28

OBG-2.43-2.48
What are the usual hormone changes in PCO syndrome?
A) increased
B) decreased
C) no change

OBG - 2.43 - Testosterone
OBG - 2.44 - Androstendion
OBG - 2.45 - TSH
OBG - 2.46 - SHBG
OBG - 2.47 - insulin
OBG - 2.48 - LH/FSH ratio

Answer 28

ANSWER
OBG - 2.43 - Testosterone - A)
OBG - 2.44 - Androstendion - A)
OBG - 2.45 - TSH - C)
OBG - 2.46 - SHBG - B)
OBG - 2.47 - insulin - A)
OBG - 2.48 - LH/FSH ratio - A)

Question 29

OBG - 2.49
In case of primer amenorrhea genetical examination has to be done, in order to indentify the disease.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 29

ANSWER
A) both are correct, there is a causal relationship between the two,
EXPLANATION
More than 30% of primer amenorhea is caused by genetical failure. Among these, Turner-syndrome (45 X0) is most common one, so during examination genetical examination is always recommended.