A 17-year-old white female presents with new-onset left-sided lower abdominal pain. Color flow Doppler ultrasonography, in addition to pelvic ultrasonography, would be most useful for evaluating:
Correct Answer A:
Color Doppler flow studies are useful for evaluating blood flow to the ovary in possible cases of adnexal or ovarian torsion. Adnexal torsion is a surgical emergency.
Pelvic ultrasonography, preferably with a vaginal probe, can be beneficial in the workup of ruptured ovarian cyst, pelvic abscess, and pelvic inflammatory disease without abscess. The Doppler flow study is not required with these conditions.
A 27-year-old sexually active woman presents to your office for evaluation. She hasn’t had her period for the last 3 months. Prior to that time, they were regular, every 28 days, with a light flow lasting for 4 days.
In your initial evaluation of her condition, which of the following serum tests is most important?
Correct Answer D:
The number one reason for absence of periods in a sexually active woman is pregnancy. Although this is not yet by definition secondary amenorrhea (> 6 months of amenorrhea in a woman who has had prior menses), ruled out pregnancy is the first step that should be taken (choice D).
→ Prolactin (choice A) would be ordered in a patient with galactorrhea and oligomenorrhea or amenorrhea.
→ Luteinizing hormone (choice B) is not a usual test in the workup of amenorrhea.
→ Although abnormalities in thyroid function (choice C) can lead to amenorrhea, in a patient with normal cycles until 3 months ago, this diagnosis would be unlikely.
→ This patient has no other symptoms of premature menopause (hot flashes etc) to order FSH levels (choice E).
Mixing vaginal discharge with potassium hydroxide (KOH) creates an odor that is helpful in diagnosing:
Bacterial vaginosis is due to an overgrowth of anaerobic bacteria, replacing the normal peroxide-producing lactobacillus species. The discharge is described as thin and gray-white in color. It is mildly adherent to the vaginal walls on speculum exam. In the presence of basic environment (semen, KOH), the aromatic amines are released, giving rise to the characteristic fishy odor.
B. In order to create an odor with a strong base, there must be aromatic amines present. These are created by certain anaerobic bacteria.
C. See answer to B.
D. See answer to B.
E. See answer to B.
Due to an abnormal Pap smear suggestive of dysplasia, a 36-year-old woman is referred for evaluation. You colposcopic exam is unsatisfactory since the entire transformation zone cannot be seen. The endocervical curettage result is negative for dysplasia, and the biopsy sample reveals CIN III.
Your next step is to:
Conization of the cervix should be performed because the transformation zone or the lesion cannot be visualized entirely (unsatisfactory colposcopy). The procedure is done to rule out occult invasive disease.
A. A biopsy is positive for CIN III. Excision of the transformation zone is required (cone biopsy).
B. Even if the repeat ECC is negative, there is still the indication for cervical conization with the CIN biopsy result.
C. See answer to A.
E. The purpose of the cervical conization is to rule out an occult malignancy. If a hysterectomy is done, and an invasive carcinoma is found, the wrong procedure may have been done, and the patient’s final prognosis may be worse.
Which one of the following fetal ultrasound measurements gives the most accurate estimate of gestational age in the first trimester (up to 14 weeks)?
Because the growth pattern of the fetus varies throughout pregnancy, the accuracy of measurements and their usefulness in determining gestational age and growth vary with each trimester. Crown-rump length (choice D) is the distance from the top of the head to the bottom of the fetal spine. It is most accurate as a measure of gestational age at 7-14 weeks. After that, other measurements are more reliable. In the second trimester, biparietal diameter and femur length are used. During the third trimester, biparietal diameter, abdominal circumference, and femur length are best for estimating gestational age.
→ Femur length (choice A) and Biparietal diameter (choice B) are used in the second trimester
→ Abdominal circumference (choice C) is used in the third trimester
→ Sacral length (choice E) has not been shown to improve assessment gestational age beyond the above biometries but it may be useful when other biometries are difficult to attain such as uteroplacental insufficiency or fetal abnormalities.
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