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MRCOG PART 2 SBAs and EMQs

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EMQ1480
SBA2068
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Amenorrohea

Amenorrohea Posted by ghada S.

Dear Paul :  could you please explain this Q                                                                                           Options for Questions 4-4

A

Prolactinoma

B

Pre-mature ovarian failure

C

Turners syndrome

D

Ovarian hyper-stimulation syndrome

E

Polycystic ovary syndrome

F

Hypothyroidism

G

Cushings syndrome

H

Congenital adrenal hyperplasia

I

Hypothalamic amenorrhoea

J

Hyperthyroidism

K

Androgen insensitivity syndrome

L

Pure gonadal dysgenesis

 

 

Instructions:For each of the case histories described below, choose the single most likely cause of menstrual abnormalities from the above list. Each option may be used once, more than once, or not at all.

Explanation

Question 4

A 25 year old medical student attends the gynaecology clinic because she has not had a period for 12 months. Menarche was at the age of 13 and she is otherwise asymptomatic and healthy. Her BMI is 19 and she is a member of the rowing team, practising 5 times a week. She denies any recent weight loss or abnormal eating behaviour and has normal secondary sexual characteristics. Random endocrine profile is as follows: FSH = 5.5mIU/ml, LH = 4.0mIU/ml, progesterone = 1.2ng/ml, prolactin = 56ng/ml, testosterone = 1.2pg/ml. Thyroid function tests and pelvic ultrasound scan are normal.

 

In hypothalamic  amenorrhoea there is decreased GnRH & consequently reduced FSH, but in this woman FSH is 5.5 & not hypogonadotrophic  hypogonadism ?? Is her serum prolactin level normal? so why does she has hyperprolactineamia?? Is it because hypothalamus is not working properly so dopamin is not produced??

QTHE SAME QUESTION WITH DIFFERENT ANSWERS???

Options for Questions 7-8

A

In-vitro fertilisation

B

Intra-uterine insemination

C

Laparoscopy and dye test

D

Laparoscopic ovarian drilling

E

Clomephene citrate

F

Gonadotrophin induction of ovulation

G

Metformin

H

Carbegolline

I

Oocyte donation

J

Weight reduction

K

Weight gain

L

Measure serum androgen concentrations

 

 

Instructions:For each of the case histories described below, choose the single most appropriate initial management from the above list. Each option may be used once, more than once, or not at all.

Question 1

A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH = 3.5mIU/ml, FHS = 5.0mIU/ml, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner's semen analysis is normal. Hystero-salpingogram confirms bilateral patent fallopian tubes.

 

Question 7

A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH = 3.5mIU/ml, FHS = 5.0mIU/ml, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner?s semen analysis is normal. Hystero-salpingogram confirms bilateral patent fallopian tubes.

 
Attia.R Posted by Attia R.
I think above two questions are same but one is corrected and other still not updated after new guidance.
Posted by Farrukh G.

Thanks - we will find and delete the duplicate.