NMS Q&A Family Medicine

Gynecology in Mature Adults 133amenorrhea listed here will produce a positive responseto this challenge (bleeding upon withdrawal)?(A) Asherman syndrome(B) Anovulatory cycle(C) Gonadal agenesis(D) Ovarian failure(E) Menopause16 You are evaluating a 38-year-old woman who stoppedhaving periods 8 months ago. She has normal secondarysexual development and shows no evidenceof virilization. Her pelvic exam shows a normal cervixand fundus and no adnexal masses. Her urinebeta-human chorionic gonadotropin (hCG) test isnegative. Her thyroid-stimulating hormone andserum prolactin levels are normal. She does not haveuterine bleeding during the withdrawal phase of aprogestin challenge, but does bleed after being onconjugated estrogen (1.25 mg) for 21 days with aprogestin agent added on the last 5 days. Folliclestimulatinghormone (FSH) and LH are both elevated.Which of the following is the most likelydiagnosis?(A) Hypothalamic amenorrhea(B) Asherman syndrome(C) Premature ovarian failure(D) Anovulatory cycle(E) PCOS17 A 25-year-old woman who is a ballet dancer has feltthe need to lose weight to remain competitive. Herheight is 5 ft 4 in. (1.63 m) and her weight is 95 lb(43 kg), yet she feels she needs to lose more weight.Her menstrual periods have become scant and infrequentduring the past year. Her last menstrual periodwas more than 3 months ago. You suspect that she hasanorexia. Which of the following is a likely finding?(A) Normal serum estrogen level(B) Osteoporosis(C) Sedentary lifestyle(D) Healthy dentition(E) Elevated FSH and LH levels18 A 28-year-old woman who has never been pregnantmissed a menstrual period 4 weeks ago, an unusualcircumstance for her. She has been using a barriermethod of contraception. Until the past week shenoticed nausea, but yesterday she passed much bloodand now says she feels better, although she is stillbleeding. Her beta-hCG level was 2,500 mIU, but thetest was repeated 48 hours later and the level found tobe 1,000 mIU. Pelvic examination is negative for adnexalmass and tenderness. Transvaginal pelvic ultrasoundreveals intrauterine tissue. You diagnose missedspontaneous abortion. The patient’s vital signs are normaland her hemoglobin is within normal limits. Sheis not seriously concerned and in little pain. Which ofthe following is the best decision for management inthe near future?(A) Expectant observation(B) Intravaginal misoprostol, 800 g(C) Surgical evacuation of the uterus(D) Naproxen, 500 mg twice daily if needed tocontrol uterine cramps(E) Initiation of oral contraceptive medication