Following tubal ligation what percentage of pregnancies are ectopic?
Answer(s): C
Following tubal ligation pregnancy occurs about 1% of the time. This depends on the method used and the expertise of the surgeon. In general, 30% of pregnancies following tubal ligation are ectopic. A patient who presents with a positive pregnancy test following tubal ligation should be considered an "ectopic until proven otherwise."
A 31-year-old female presents to her physician complaining of rapid onset of hirsutism, deepening of the voice, irregular menses, clitoral enlargement, and acne. Which of the following is the most likely cause of this clinical presentation?
Answer(s): D
Androgen excess syndromes are common and usually characterized by one or more of the following problems: hirsutism, acne, weight gain, or irregular menses. PCOS is the most common disorder of androgen excess. Other syndromes that often result in signs and symptoms of androgen excess in adults include Cushing syndrome and late-onset congenital adrenal hyperplasia. The classic presentation of a patient with an androgen-secreting tumor of the ovary or adrenal gland involves the rapid onset of symptoms. Late-onset congenital adrenal hyperplasia and an androgen-secreting tumor are the only disorders of androgen excess usually resulting in clitoromegaly.
A23-year-old female presents to her obstetrician gynecologist (OB/GYN) complaining of inability to conceive. She has regular menstrual cycles, and her husband's semen analysis is normal. She undergoes a hysterosalpingogram that shows evidence of bilateral distal tubal obstruction. Which of the following is the most likely cause of acquired tubal damage?
Answer(s): B
PID is the most common cause of Fallopian tube damage. It is a polymicrobial infection that originates from upward spread of infecting organisms through the cervix and into the uterus, Fallopian tubes, or peritoneal cavity. The two most common pathogens are Neisseria gonorrhea and Chlamydia trachomatis; however, microorganisms that comprise the vaginal flora (e.g., anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric gram-negative rods, and Streptococcus agalactiae) also have been associated with PID. Symptoms of PID include lower abdominal pain, dyspareunia, fever, back pain, and vomiting, as well as symptoms of lower genital tract infection such as abnormal vaginal discharge or bleeding, itching, and odor. In some women, symptoms are mild or even absent. Risk factors for PID include the presence of a sexually transmitted infection, a previous episode of PID, sexual intercourse at an early age, high number of sexual partners, and alcohol use. Empiric treatment of PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination:cervical motion tenderness OR uterine tenderness OR adnexal tenderness. Other common causes of acquired tubal damage include endometriosis, previous pelvic surgery, and a ruptured appendix.
A 17-year-old female presents with delayed puberty. Her mother reports her daughter has never menstruated. On examination, the patient is 59 in. (4 ft 11 in.) tall and is shown in Figure. Which of the following tests is most likely to confirm the diagnosis?
Answer(s): A
Numerous causes lead to delayed puberty. Common features of Turner syndrome include short stature, sexual infantilism, "shield" chest, "webbed" neck, high arched palate, increased carrying angle of the arms (cubitus valgus), short fourth metacarpal, and streak gonads. The diagnosis of Turner syndrome requires the presence of typical phenotypic features and the complete or partial absence of a second X chromosome. Diagnosis should be considered in individuals with primary or secondary amenorrhea and in adult women with unexplained infertility, particularly when such individuals also are short in stature. Although the FSH would be elevated in Turner syndrome, it would not differentiate among the many causes of ovarian failure. In childhood, GH therapy is standard to prevent short stature as an adult. Estrogen replacement therapy usually is required, but starting too early can compromise adult height. Estrogen usually is started from age 12 to 15 years
In order to prevent unintended pregnancy following an episode of unprotected intercourse, by when is it recommended that "emergency" oral contraception should be initiated?
The U.S. Food and Drug Administration (FDA) has approved the use of oral contraceptives as an effective method of postcoital contraception, often termed emergency contraception. The most common regimens involve two to four oral contraceptive tablets, depending on the dosage of the brand used, repeated 12 hours later. Progestin-only regimens are also highly effective. Initiating treatment greater than 72 hours after the event of unprotected intercourse is associated with a lower success rate.
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