Reproductive Clinical Cases

Question 1

What are the symptoms of Imperforated hymen?

Answer 1

14 yo girl. Abdominal pain. Monthly abdominal pain associated with urinary retention and constipation over past 3 months. Episodes take 3-5 days to resolve. No menarche. Breast development to Tanner Stage 4. Enlarged uterus. Protruding mass at the introitus.

Question 2

What is the embryology of Imperforated hymen?

Answer 2

Failure of inferior end of the vaginal plate to perforate.

Question 3

What is the therapy for Imperforated hymen?

Answer 3

Surgery to relieve the obstruction

Question 4

What are the long-term reproductive issues associated with Imperforated hymen?

Answer 4

There are no issues. Reproduction should be normal.

Question 5

What are the symptoms of Turners Syndrome 45, XO?

Answer 5

Pregnancy complicated by a second trimester ultrasound showing nuchal thickening and lucency. No amniocentesis. Nuchal changes resolved during third trimester. Infant has 2 out of 6 harsh systolic murmur and edema on the dorsal of the feet. Mild webbing of the neck, low posterior hairline and widely spaced nipples.

Question 6

What is the cause of a 2 out of 6 harsh systolic murmur in Turner Syndrome?

Answer 6

Aortic stenosis with bicuspid aortic valve.

Question 7

Why is there no secondary sexual development when this patient reaches the age of 13?

Answer 7

Lack of estrogen from ovarian failure. This means there is also very little chance of a viable ovum being produced.

Question 8

A patient has Turner Syndrome and long-term hormonal therapy is instituted. How would you counsel the patient for reproductive concerns?

Answer 8

Pregnancy is nearly impossible and adoption should be considered. No pregnancy without extensive workup and IVF.

Question 9

What are the symptoms of an incarcerated inguinal hernia?

Answer 9

4 mo girl. Bilious vomiting, lethargy and refusal to eat. Past 2 days irritable and decreased feeding with bilious vomiting. High pulse, RR, slightly elevated temp and hypotension. 0.5 cm firm mass on the right just lateral to the pubic bone.

Question 10

What is the embryology behind Incarcerated inguinal hernia?

Answer 10

Failure of closure of the processes vaginalis.

Question 11

What is the acute management for Incarcerated inguinal hernia?

Answer 11

Attempt to reduce the hernia manually. Won’t completely resolve on its own so you will need to refer them to surgery eventually.

Question 12

If acute management of incarcerated inguinal hernia fails, what is the definitive therapy?

Answer 12

Surgical consult and surgery.

Question 13

What other findings might be present at surgery in a patient with incarcerated inguinal hernia?

Answer 13

Ovary is located in the hernia sac. Not as common for girls to get hernias.

Question 14

What is the embryology behind bicornate uterus?

Answer 14

Incomplete fusion of inferior paramesonephric ducts.

Question 15

What could cause these symptoms? 33 weeks gestation with preterm labor. Ultrasound shows mild oligohydramnios, breech positioning and suspected growth retardation. Delivered by C-section after 48 hours of labor..

Answer 15

Bicornate uterus.

Question 16

Infant born to woman with bicornate uterus has birth weight less than 10th percentile (SGA). What could explain this?

Answer 16

Decreased space within the uterine cavity.

Question 17

How might future pregnancies to a woman with a bicornate uterus be affected?

Answer 17

There will continue to be higher risk for infertility, miscarriage and malpresentation.

Question 18

What symptoms are associated with Penoscrotal hypospadias?

Answer 18

Pregnancy has first trimester bleeding which resolved spontaneously. Penis appeared small in newborn with ventral bend (chordee). Urethra could not be identified at the tip of the glans. Urine was noted to come from the base of the penis at the level of the scrotum. Testes palpable and of normal size.

Question 19

What is the embryology behind penoscrotal hypospadias?

Answer 19

Failure of fusion of the urogenital folds.

Question 20

What is the appropriate therapy for penoscrotal hypospadias?

Answer 20

Eventual surgery to lengthen the urethra and straighten the penis. Wait until 6-12 or 9-12 months. No circumcision until surgery.

Question 21

How would you counsel the family about penoscrotal hypospadias?

Answer 21

This is a common problem (he sees once per month) but sporadic and recurrence is unlikely.