2013 batch review
OBG REVIEW (Yang Shen Laoshi) [7mcq, 1case] 1. A 19-years old patient presents to your office with primary amenorrhea. She has normal breast and pubic hair development, but the uterus and vagina are absent. Diagnostic possibilities include which of the following? (C) A. XYY syndrome B. Gonadal dysgenesis C. Mullerine agenesis D. Klinefelter syndrome E. Turner syndrome 2. Which of the following is the good-prognosis designation of patients with GTN (Gestational Trophoblastic Neoplasia) (E) A. Brain or Liver metastase B. Onset following term gestation C. Prior unsuccessful chemotherapy D. Serum β- HCG titters greater than 4000IU/L E. None of them 3. Which of the following management fits for choriocarcinoma best? (D) A. Hysterectomy B. Chinese medicine C. Immunotherapy D. Chemotherapy E. Radiation therapy 4. Endodermal sinus tumours are identified by secretion of which of the following tumour markers? (C) A. HCG B. CEA C. AFP D. CA-125 E. LDH 5. Which of the ovarian tumours is the most is the most sensitive to radiation therapy? (C) A. Teratoma B. Serous cystadenocarcinoma C. Dysgeminoma D. Mucinous cystadenocarcinoma E. Brenner tumour 6. Which of the following conditions can be diagnosed with a hysterosalpingogram? (B) A. Endometriosis B. Hydrosalpinx C. Sub-serous fibroids D. Minimal pelvic adhesion E. Ovarian cyst
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2013 batch review
7. Which condition is usually associated with uterine prolapse? (A) A. Childbirth injury to the endopelvic fascia B. Chronic bronchitis & bronchiectasis C. Ovarian tumours D. Sacral nerve disease, especially injury to S1-S4 E. Congenital weakness in the pelvic fascia support 8. The most common cause of depression is? Libido
CASE 76 year old postmenopausal female with past medical history of aortic stenosis, hypertension, coronary artery disease & chronic kidney disease presented to clinic after an incidental finding of pelvic mass. She has routine renal ultrasounds to monitor her kidney disease and at her most recent scan showed a complex appearing mass in her pelvis. She had a follow up vaginal ultrasound which showed a “3.0 x 3.0 x 3.2 cm complex cystic right ovary”. Her CA125 was 210 preoperatively and on Gyn exam she had a firm mass felt more on the right that was approximately 4x5 cm. 1. What are the necessary examinations for her preoperative evaluation? 2. What is the possible primary diagnosis for the case? Please find the evidence that either supports or refuses the validity. 3. Due to her medical comorbidities she was planned for a laparoscopic bilateral salphingooophorectomy, however upon visualization of the mass it appeared to be approximately 10 cm and completely replaced both ovaries with solid & cystic structure. Frozen sections were read as a ovarian papillary serous carcinoma. What’s the optimal procedure for her? Pelvic MR.Chest and Abdominal CT Scan. Cardiac function, pulmonary function, ECG Blood tests (Blood routine test, liver and kidney functions, coagulation function, blood type) Any other tumour markers (AFP, HE-4, CEA, CA199) Primary diagnosis: Ovarian carcinoma B-US showed complex cystic ovary Elevated CA125 titers Gyn examination mentioned a firm mass on the right Staging Surgery (Laparoscopic, Pelvic and Para-aortic lymph node dissection, omentectomy, appendectomy and total abdominal hysterectomy and bilateral salpingo-oophorectomy)
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