PANCE Reproductive System 4 — Questions and Answers
Question 1: A 55-year-old woman presents with postmenopausal bleeding. Endometrial biopsy shows grade 1 endometrioid adenocarcinoma. Which is the most significant risk factor she likely has?
- Prior tamoxifen use
- Unopposed estrogen exposure (Correct answer)
- BRCA2 mutation
- Chronic pelvic inflammatory disease
Correct answer: Unopposed estrogen exposure
Unopposed estrogen exposure (obesity, anovulation, exogenous estrogen without progesterone) is the most common risk factor for type I endometrioid endometrial carcinoma.
Question 2: A 16-year-old girl presents with severe dysmenorrhea since menarche. Pelvic exam is normal. NSAIDs provide minimal relief. What is the most appropriate next treatment?
- Laparoscopy to rule out endometriosis
- Combined oral contraceptive pills (Correct answer)
- Opioid analgesics
- GnRH agonist therapy
Correct answer: Combined oral contraceptive pills
Combined oral contraceptives are second-line therapy for primary dysmenorrhea after NSAIDs fail, suppressing ovulation and reducing prostaglandin-mediated uterine cramping.
Question 3: A 34-year-old G1P0 at 41 weeks gestation has a Bishop score of 3. Induction of labor is planned. Which agent is most appropriate for cervical ripening?
- Oxytocin IV infusion
- Misoprostol intravaginally (Correct answer)
- Castor oil orally
- Amniotomy alone
Correct answer: Misoprostol intravaginally
Misoprostol (PGE1 analogue) applied intravaginally is effective for cervical ripening in an unfavorable cervix (Bishop score <6) prior to labor induction.
Question 4: A 44-year-old woman is newly diagnosed with stage II cervical cancer. HPV genotyping shows HPV-18. Which treatment modality is most appropriate?
- Radical hysterectomy alone
- Concurrent cisplatin-based chemotherapy and radiation (Correct answer)
- Radiation alone
- Cone biopsy with close surveillance
Correct answer: Concurrent cisplatin-based chemotherapy and radiation
Stage II cervical cancer is treated with concurrent cisplatin-based chemoradiation, which improves survival compared to radiation alone.
Question 5: A 25-year-old man presents with bilateral cryptorchidism corrected at age 4 and now seeks fertility counseling. What is the most appropriate initial test?
- Serum testosterone level
- Testicular biopsy
- Semen analysis (Correct answer)
- Scrotal ultrasound
Correct answer: Semen analysis
Semen analysis is the first-line test for evaluating male fertility because it directly assesses sperm count, motility, and morphology.
Question 6: A 32-year-old woman with PCOS desires contraception and treatment of acne and hirsutism. Which combined oral contraceptive ingredient provides the most anti-androgenic benefit?
- Levonorgestrel
- Norgestrel
- Drospirenone (Correct answer)
- Norethindrone
Correct answer: Drospirenone
Drospirenone has anti-androgenic and antimineralocorticoid properties, making it the preferred progestin component for PCOS patients with hyperandrogenic symptoms.
Question 7: A 38-year-old woman at 20 weeks gestation undergoes amniocentesis. Which complication should be discussed as the most significant risk?
- Preterm labor
- Pregnancy loss (~0.1-0.3%) (Correct answer)
- Fetal limb reduction defects
- Placental abruption
Correct answer: Pregnancy loss (~0.1-0.3%)
The primary risk of mid-trimester amniocentesis is pregnancy loss, occurring in approximately 0.1-0.3% of procedures when performed by experienced operators.
PANCE Reproductive System 4
A 55-year-old woman presents with postmenopausal bleeding.
Endometrial biopsy shows grade 1 endometrioid adenocarcinoma.
Which is the most significant risk factor she likely has?