PANCE Reproductive System 2 — Questions and Answers
Question 1: A 28-year-old woman presents with cyclic pelvic pain, dyspareunia, and infertility. Laparoscopy reveals powder-burn lesions on the peritoneum. Which mechanism best explains her infertility?
- Anovulation due to elevated prolactin
- Distorted pelvic anatomy and inflammatory cytokines impairing implantation (Correct answer)
- Cervical stenosis blocking sperm entry
- Autoimmune destruction of oocytes
Correct answer: Distorted pelvic anatomy and inflammatory cytokines impairing implantation
Endometriosis causes infertility through distorted pelvic anatomy, peritoneal inflammation, and cytokine-mediated impairment of fertilization and implantation.
Question 2: A 35-year-old G2P1 at 36 weeks gestation presents with painless bright red vaginal bleeding. Fetal heart tones are reassuring. What is the most likely diagnosis?
- Placental abruption
- Placenta previa (Correct answer)
- Vasa previa
- Uterine rupture
Correct answer: Placenta previa
Painless bright red vaginal bleeding in the third trimester is the hallmark of placenta previa, where the placenta overlies the cervical os.
Question 3: A 19-year-old male presents with a painless testicular mass. Serum AFP is markedly elevated. Which tumor type is most likely?
- Seminoma
- Embryonal carcinoma
- Yolk sac tumor (Correct answer)
- Leydig cell tumor
Correct answer: Yolk sac tumor
Yolk sac tumors (endodermal sinus tumors) are the most common testicular tumor in young males and are associated with markedly elevated AFP.
Question 4: A 52-year-old postmenopausal woman is found to have a unilocular, thin-walled 4 cm ovarian cyst on transvaginal ultrasound. CA-125 is normal. What is the most appropriate next step?
- Immediate surgical resection
- Repeat ultrasound in 6-12 weeks (Correct answer)
- CT abdomen and pelvis
- Laparoscopic biopsy
Correct answer: Repeat ultrasound in 6-12 weeks
A simple unilocular cyst ≤5 cm with normal CA-125 in a postmenopausal woman warrants surveillance with repeat ultrasound in 6-12 weeks per ACOG guidelines.
Question 5: A 24-year-old woman on combined oral contraceptives for 3 years presents for a routine visit. Which absolute contraindication should prompt you to discontinue her OCP?
- Mild migraines without aura
- History of migraine with aura (Correct answer)
- Irregular menstrual cycles
- Family history of ovarian cancer
Correct answer: History of migraine with aura
Migraine with aura is an absolute contraindication to combined estrogen-containing contraceptives due to increased risk of ischemic stroke.
Question 6: A 38-year-old woman is diagnosed with BRCA1 mutation. She has completed childbearing. Which risk-reduction strategy has the greatest absolute reduction in ovarian cancer risk?
- Annual pelvic ultrasound and CA-125 screening
- Oral contraceptive use for 5 years
- Risk-reducing bilateral salpingo-oophorectomy (Correct answer)
- Prophylactic tamoxifen
Correct answer: Risk-reducing bilateral salpingo-oophorectomy
Risk-reducing bilateral salpingo-oophorectomy reduces ovarian cancer risk by >95% in BRCA1 carriers and is the most effective prevention strategy.
Question 7: A 31-year-old man and his partner have been trying to conceive for 18 months. Semen analysis shows count 8 million/mL, motility 25%, normal morphology 3%. Which condition should be excluded first?
- Klinefelter syndrome
- Varicocele (Correct answer)
- Retrograde ejaculation
- Congenital absence of vas deferens
Correct answer: Varicocele
Varicocele is the most common correctable cause of male infertility and should be the first diagnosis excluded with scrotal ultrasound and physical exam.
PANCE Reproductive System 2
A 28-year-old woman presents with cyclic pelvic pain, dyspareunia, and infertility.
Laparoscopy reveals powder-burn lesions on the peritoneum.
Which mechanism best explains her infertility?