QUESTION: 149

OCs cause leiomyomata to grow more rapidly.
Leiomyomata not removed by hysterectomy may eventually degenerate into malignant tumors (i.e., leiomyosarcoma).
Submucosal fibroids are more likely to cause painful, heavy periods than are subserosal fibroids.
Leiomyomata occur in up to 5% of all women.
Typical bleeding abnormalities seen with uterine fibroids are heavy menstrual bleeding as well as frequent intermenstrual bleeding episodes.

Answer(s): C

Explanation:

Leiomyomata lead to more hysterectomies than any other gynecologic condition and can be found in up to 50% of all women. Most are asymptomatic, but symptoms can include heavy menstrual bleeding, pelvic pain, "pressure symptoms," and even preterm birth. Symptoms depend on where the fibroids are located-- those closest to the endometrial cavity cause more problems with bleeding and dysmenorrhea, while those closest to the serosa can be expected to cause more pressure symptoms such as bladder frequency or constipation. However, the typical bleeding disturbance associated with uterine fibroids is heavy regular bleeding as opposed to bleeding or spotting between periods, which deserves separate evaluation.
Leiomyosarcomas are malignant tumors that appear very similar to benign leiomyomata-- however, they are now felt to arise de novo and not from degeneration of a benign fibroid. Leiomyomata do seem to respond to sex steroids but oral contraceptives do not cause more rapid growth or regression.

Reveal Solution Next Question

QUESTION: 150

A 38-year-old G4P3013 woman is seeing you for her annual gynecologic examination. She has no specific complaints, but notes that her menses have gradually become heavier over the past 23 years. Your pelvic examination is normal aside from an enlarged uterus, which you estimate at 12 weeks' size. Office ultrasonography confirms that she has multiple uterine fibroids. Which of the following statements is true regarding leiomyomata?

Your patient comes back 6 months later with a calendar demonstrating continued worsening of her menstrual bleeding, now 10 days in duration and requiring one pad hourly during her heaviest days. Which of the following statements are true regarding treatment of leiomyomata?

Because fibroids are responsive to sex steroids, treatment with GnRH agonists (e.g., leuprolide) will produce up to a 50% reduction in volume.
Treatment with leuprolide appears to be long lasting, making this an attractive alternative to hysterectomy or myomectomy.
Myomectomy (i.e., removal of uterine fibroids without removal of the uterus) is replacing hysterectomy as it is associated with less complications and less blood loss.
Because it requires no abdominal or uterine incisions, uterine artery embolization is the preferred method of treatment for women who desire future pregnancy.
Any leiomyoma larger than 5 cm should be removed by either hysterectomy or myomectomy to rule out leiomyosarcoma.

Answer(s): A

Explanation:

As mentioned, leiomyomata account for more hysterectomies than any other gynecologic disorder, but alternative treatments continue to be explored. Myomectomy (e.g., removal of uterine fibroids) can be performed via laparotomy, laparoscopy, hysteroscopy, or even vaginally. However, it is generally not considered a "simpler" or safer procedure than hysterectomy, and bleeding can be excessive. Uterine artery embolization is an angiographic procedure currently reserved for women who do not desire future pregnancy, as the effects of embolizing both uterine arteries and then allowing pregnancy is uncertain.
GnRH agonists are useful in reducing uterine bleeding and reducing fibroid volume up to 50%, but this effect is short-lived and completely reversible. Therefore, this therapy is useful as an adjunct to surgery in improving hemoglobin or allowing a vaginal approach rather than abdominal. No specific size limit exists for removal of a single myoma.

Reveal Solution Next Question

QUESTION: 151

You are seeing a 38-year-old woman for her annual gynecologic examination. She asks you for some information regarding the HPV vaccine and whether you think it would be appropriate for her 17-year- old daughter. Which of the following statements regarding the quadrivalent human papillomavirus vaccine and HPV is true?

The vaccine is recommended for women ages 1126 but can be given as young as age 9.
After vaccination, women no longer need routine Pap smears.
The vaccine is given every month for 3 months.
The vaccine is prepared from the proteins of four oncogenic (e.g., high-risk for cervical cancer) strains of HPV.
Women with a prior history of abnormal Pap smears are not candidates for vaccination.

Answer(s): A

Explanation:

The quadrivalent human papillomavirus (under the name Gardasil) was licensed for use in June 2006. It is currently recommended for routine vaccination of young women ages 1112 with "catch-up" vaccination for women 1326. It can be given as young as age 9. The vaccine is three separate 0.5-mL doses, given at 0, 2 and 6 months apart. If one dose is delayed, there is no need to restart the schedule. Rather, the doses should be given as soon as possible. The vaccine is targeted against the L1 proteins of HPV types 6, 11, 16, and 18. HPV 6 and 11 are "low-risk" strains causing genital condylomata, and HPV 16 and 18 are "high-risk" oncogenic strains responsible for 70% of all cervical cancer. Guidelines for screening for cervical cancer have not changed--patients should still be advised to have routine Pap smear screening and HPV screening as indicated. Women with a prior history of abnormal Pap smears are still candidates for the vaccine, as it is unlikely that they have been exposed to all four strains.

Reveal Solution Next Question

QUESTION: 152

A19-year-old primigravid woman at 39 weeks' gestation is in active labor, and her cervix is 4 cm dilated, 90% effaced. Her amniotic membranes have been ruptured for 4 hours. Contractions are strong at 2- to 3- minute intervals and of 60- to 70-second duration. For the past 30 minutes, repetitive variable decelerations of the fetal heart rate have occurred. They have lasted 6090 seconds, and the fetal heart rate has dropped as low as 60 beats per minute (BPM). You explain that there is a risk that the baby will become hypoxic and recommend a cesarean section. She refuses. Which of the following is the most appropriate course of action?

obtain permission for the cesarean section from her mother
perform a cesarean section as an emergency
obtain a court order permitting a cesarean section
counsel her carefully about the fetal risks but accede to her wishes
assign her care to another obstetrician

Answer(s): D

Explanation:

In many states, a pregnant woman under the age of 21 years is considered an emancipated minor and is the only person who may make legal decisions pertaining to the pregnancy. Although an immediate cesarean section is indicated because of the severe fetal heart rate decelerations, to perform it without her permission violates the ethical principle of autonomy. This is a principle that states that human beings should have their wishes respected as autonomous persons if they are capable of self- determination.
Obtaining a court order may fulfill the ethical principle of beneficence, a physician acting to do no harm and to help the patient. In this situation, the ethical (moral) decision is complicated by a conflict between beneficence and autonomy. However, proceeding with a cesarean section exposes the obstetrician to a legal charge of battery. Assigning her care to another physician is a standard and accepted solution when there is a moral conflict between patient and physician. However, this is not an acceptable option in an emergency situation. The obstetrician is at risk for abandonment. Although not a satisfying choice, the choice most ethically sound is to counsel her carefully, but eventually accede to her wishes. Placing her in the lateral position, giving her oxygen by mask, and providing adequate intravenous hydration should be instituted to minimize the risk of fetal hypoxia.

Reveal Solution Next Question

Free STEP2 Exam Braindumps (page: 38)

QUESTION: 149

Explanation:

QUESTION: 150

Explanation:

QUESTION: 151

Explanation:

QUESTION: 152

Explanation: