PANCE Reproductive System 5

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?

Accepted Answer

Radical prostatectomy or radiation with androgen deprivation therapy

Answer

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?

Accepted Answer

Bromocriptine or cabergoline

Answer

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?

Accepted Answer

Test for HIV and other STIs

Answer

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?

Accepted Answer

Prepare for emergent cesarean delivery

Answer

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?

Accepted Answer

Estrogen-only therapy

Answer

Women without a uterus require estrogen-only hormone therapy; adding progestin is unnecessary and provides no benefit since endometrial protection is not needed.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Reproductive System 5