AAFP Board Review – Gyn | with complete solutions 2023/24

AAFP Board Review – Gyn | with complete solutions 2023/24 36-year-old obese female presents to your office with a chief complaint of amenorrhea. On examination you note hirsutism and body acne. She is on no medications and a pregnancy test is negative. Serum testosterone is at the upper limits of normal and TSH is within normal limits. In addition to weight loss and exercise, which one of the following would be the most appropriate initial management? (check one) A. High-dose combined oral contraceptives B. Progestin-only contraceptives C. Metfo - C. Metformin (Glucophage) PCOS characterized by hyperandrogenism, polycystic ovaries on pelvic ultrasonography, and ovulatory dysfunction. Hyperandrogenism and either polycystic ovaries or ovulatory dysfunction are necessary to make the diagnosis. The first-line recommendation in obese patients is lifestyle modification, but metformin may improve abnormal menstruation (SOR A). Low-dose combined oral contraceptives are more frequently used to reduce the risk of endometrial cancer in patients with chronic anovulation and the resulting unopposed estrogen secretion. A 30-year-old female comes to your office because she is concerned about irregular menses (fewer than 9/year), acne, and hirsutism. Her BMI is 36.0 kg/m2. She has no other medical problems and would like to have a baby. Her fasting blood glucose level is 140 mg/dL. Which one of the following would be the most appropriate treatment for this patient's condition and concerns? (check one) A. Lifestyle modification only B. Lifestyle modification and pioglitazone (Actos) C. Lifestyle modificatio - C. lifestyle modification + Metformin This patient has classic features of polycystic ovary syndrome (PCOS). The diagnosis is based on the presence of two of the following: - oligomenorrhea or amenorrhea - clinical or biochemical hyperandrogenism - polycystic ovaries visible on ultrasonography. In a 27-year-old white female with irregular menstrual cycles and infertility, which one of the following would be more indicative of Cushing's syndrome rather than the more common polycystic ovarian syndrome? (check one) A. Easy bruising B. Acne C. Hirsutism D. Androgenic alopecia E. Acanthosis nigricans - A. Easy bruising - also moon facies, buffalo hump, abdominal striae, hypertension, and proximal myopathy suggest Cushing's syndrome. - very rare compared to polycystic ovarian syndrome, routine screening is not indicated in women with hypoandrogenic anovulation A 19-year-old college freshman consults you at the request of her cross-country coach because she has not had a period in 2 of the last 3 months. She notes that her current training regimen is much more intense than in high school last year. She has an appropriate body image and denies caloric restriction. A pregnancy test at the student health center was negative. On examination she is lean and highly trained. Her examination is otherwise normal. Which one of the following would be the most ap - C. increase calorie intake - exercise-related oligomenorrhea - Menstrual problems in athletes do correlate with bone density loss and impaired recovery from exercise - menstrual irregularity of varying severity is extremely common in female distance runners - The main issue in well-nourished female athletes seems to be that energy intake is not increased to match energy expenditures at high levels of training Not Hormonal manipulation - does not affect bone density, though it may produce withdrawal bleeding Not Bisphosphonate therapy - not recommended in women of child-bearing age. Which one of the following is the most appropriate first-line therapy for primary dysmenorrhea? A. Combined monophasic oral contraceptives B. Combined multiphasic oral contraceptives C. Subdermal etonogestrel (Nexplanon) D. Intramuscular medroxyprogesterone (Depo-Provera) E. NSAIDs - E. NSAIDs - 1st line A 13-year-old female is being evaluated for primary amenorrhea. On examination she has short stature, a webbed neck, and a low hairline. A physical examination reveals no signs of pu