PANCE Reproductive System 5 — Questions and Answers
Question 1: A 72-year-old man has a PSA of 18 ng/mL. Prostate biopsy shows Gleason score 4+4=8 in 8 of 12 cores. Bone scan shows no metastases. Which treatment is most appropriate?
- Active surveillance
- Radical prostatectomy or radiation with androgen deprivation therapy (Correct answer)
- Androgen deprivation therapy alone
- Observation with PSA monitoring
Correct answer: Radical prostatectomy or radiation with androgen deprivation therapy
High-risk localized prostate cancer (Gleason ≥8, PSA >20, or clinical T3) requires definitive local therapy (surgery or radiation) combined with androgen deprivation therapy.
Question 2: A 23-year-old woman presents with 3 months of secondary amenorrhea, galactorrhea, and headache. MRI shows a 12 mm pituitary mass. What is first-line treatment?
- Transsphenoidal surgery
- Bromocriptine or cabergoline (Correct answer)
- Radiation therapy
- Combined oral contraceptives
Correct answer: Bromocriptine or cabergoline
Dopamine agonists (cabergoline preferred over bromocriptine) are first-line treatment for prolactinomas regardless of size, effectively normalizing prolactin and reducing tumor size.
Question 3: A 19-year-old sexually active woman is diagnosed with her second episode of chlamydial cervicitis within 6 months. Her partner was treated after the first episode. What additional step is most critical now?
- Switch to a different antibiotic class for treatment
- Test for HIV and other STIs (Correct answer)
- Initiate long-term suppressive azithromycin
- Refer for colposcopy
Correct answer: Test for HIV and other STIs
Repeat STI infections increase risk of HIV and other sexually transmitted infections, making comprehensive STI testing including HIV essential at this visit.
Question 4: A laboring patient at 8 cm dilation has a Category III fetal heart rate tracing (sinusoidal pattern). What is the immediate next step?
- Amnioinfusion
- Apply fetal scalp electrode for better monitoring
- Prepare for emergent cesarean delivery (Correct answer)
- Administer terbutaline and reassess
Correct answer: Prepare for emergent cesarean delivery
A sinusoidal fetal heart rate pattern is a Category III (abnormal) tracing indicating severe fetal compromise requiring emergent cesarean delivery.
Question 5: A 48-year-old woman presents with hot flashes, vaginal dryness, and irregular menses for 8 months. FSH is 62 mIU/mL. She has no uterus. Which hormone replacement is appropriate?
- Combined estrogen-progestin therapy
- Estrogen-only therapy (Correct answer)
- Progestin-only therapy
- Testosterone supplementation
Correct answer: Estrogen-only therapy
Women without a uterus require estrogen-only hormone therapy; adding progestin is unnecessary and provides no benefit since endometrial protection is not needed.
Question 6: A 30-year-old woman at 10 weeks gestation is found to have a complete hydatidiform mole on ultrasound with a 'snowstorm' appearance. After suction curettage, what is the most important follow-up?
- Repeat ultrasound in 4 weeks
- Serial serum hCG monitoring until undetectable (Correct answer)
- Chest CT to rule out metastases
- Immediate chemotherapy with methotrexate
Correct answer: Serial serum hCG monitoring until undetectable
Serial serum hCG monitoring is mandatory after molar evacuation to detect persistent gestational trophoblastic neoplasia, which occurs in ~15-20% of complete moles.
Question 7: A 26-year-old woman with no prenatal care delivers a term infant. The neonate develops purulent conjunctivitis at 5 days of life. Gram stain shows intracellular gram-negative diplococci. What is the treatment?
- Topical erythromycin ointment
- IV ceftriaxone (Correct answer)
- Oral azithromycin
- Topical ciprofloxacin drops
Correct answer: IV ceftriaxone
Neonatal gonococcal ophthalmia (caused by N. gonorrhoeae presenting at 2-5 days) requires IV ceftriaxone because topical therapy alone is insufficient for this serious infection.
PANCE Reproductive System 5
A 72-year-old man has a PSA of 18 ng/mL.
Prostate biopsy shows Gleason score 4+4=8 in 8 of 12 cores.
Bone scan shows no metastases.
Which treatment is most appropriate?