PANCE Reproductive System 3 — Questions and Answers
Question 1: A 26-year-old woman at 32 weeks gestation develops sudden onset severe headache, visual disturbances, and BP 158/106 mmHg. Urinalysis shows 3+ proteinuria. Which complication must be urgently assessed?
- HELLP syndrome (Correct answer)
- Gestational hypertension
- Chronic hypertension with superimposed preeclampsia
- Eclampsia
Correct answer: HELLP syndrome
The combination of preeclampsia symptoms with severe features warrants urgent CBC, LFTs, and LDH to rule out HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).
Question 2: A 17-year-old female presents with primary amenorrhea, no breast development, and streak gonads on ultrasound. Karyotype is 45,X. Which associated cardiac defect must be screened for?
- Tetralogy of Fallot
- Bicuspid aortic valve and coarctation of the aorta (Correct answer)
- Ventricular septal defect
- Patent ductus arteriosus
Correct answer: Bicuspid aortic valve and coarctation of the aorta
Turner syndrome (45,X) is associated with bicuspid aortic valve in ~30% and coarctation of the aorta in ~10% of patients, requiring cardiac screening.
Question 3: A 45-year-old woman presents with menorrhagia and pelvic pressure. Uterus is 14-week size on exam. Ultrasound shows multiple intramural masses. What is the most appropriate first-line pharmacologic treatment?
- GnRH agonist indefinitely
- Combined oral contraceptives
- Levonorgestrel IUD (Correct answer)
- Danazol
Correct answer: Levonorgestrel IUD
The levonorgestrel IUD (Mirena) is first-line pharmacologic therapy for fibroid-related menorrhagia, reducing bleeding by up to 90%.
Question 4: A 22-year-old sexually active woman has a positive urine hCG. Transvaginal ultrasound shows no intrauterine gestational sac, and serum hCG is 2,400 mIU/mL. What is the most appropriate next step?
- Repeat hCG in 48 hours (Correct answer)
- Administer methotrexate immediately
- Diagnostic laparoscopy
- Perform dilation and curettage
Correct answer: Repeat hCG in 48 hours
With hCG below the discriminatory zone (~3,000 mIU/mL), no intrauterine sac is expected; repeat hCG in 48 hours assesses rise pattern to distinguish ectopic from early intrauterine pregnancy.
Question 5: A 60-year-old man presents with gynecomastia, small firm testes, and infertility. Karyotype reveals 47,XXY. Which hormone pattern is expected?
- Elevated FSH and LH, low testosterone (Correct answer)
- Low FSH and LH, low testosterone
- Normal FSH and LH, normal testosterone
- Elevated testosterone, low FSH
Correct answer: Elevated FSH and LH, low testosterone
Klinefelter syndrome causes primary testicular failure with elevated gonadotropins (FSH, LH) due to absent feedback, and low testosterone.
Question 6: A 33-year-old woman presents with cyclic mastalgia, nipple discharge, and palpable breast nodularity that varies with her menstrual cycle. What is the most likely diagnosis?
- Fibroadenoma
- Fibrocystic breast changes (Correct answer)
- Intraductal papilloma
- Phyllodes tumor
Correct answer: Fibrocystic breast changes
Fibrocystic breast changes are the most common benign breast condition, characterized by cyclic pain, nodularity, and cyst formation that fluctuates with the menstrual cycle.
Question 7: A 29-year-old pregnant woman at 28 weeks is found to have Rh-negative blood type. Her partner is Rh-positive. What is the correct management?
- Administer Rh immunoglobulin at 28 weeks and within 72 hours postpartum if infant is Rh-positive (Correct answer)
- No treatment needed until delivery
- Administer Rh immunoglobulin only postpartum
- Check maternal antibody titers monthly and treat if positive
Correct answer: Administer Rh immunoglobulin at 28 weeks and within 72 hours postpartum if infant is Rh-positive
Standard protocol is Rh immunoglobulin at 28 weeks gestation and again within 72 hours of delivery if the neonate is Rh-positive to prevent isoimmunization.
PANCE Reproductive System 3
A 26-year-old woman at 32 weeks gestation develops sudden onset severe headache, visual disturbances, and BP 158/106 mmHg.
Urinalysis shows 3+ proteinuria.
Which complication must be urgently assessed?