EBCOG P1 – 3 Month – General gynecology – Day 5 EMQ

A.Pituitary Adenoma
B.Pelvic inflammatory disease
C.Prolactinoma
D.Androgen Insensitivity syndrome
E.Premature ovarian Insufficiency
F.Pregnancy
G. Tuberculosis
H.Fitz-Hugh-Curtis syndrome
I. Endometriosis
J.polycystic ovarian syndrome .
K. Mayer–Rokitansky–Küster–Hauser syndrome.
L. Left Hydrosalphynx
M. Gonorrohoea
N.Bilateral Hydrosalphynx
O.None of the above


The following scenarios explain various women with amenorrhea and Infertility.
Choose the option corresponding to the scenario .each option can be done once or more than once or none at all .

1. Mrs. A 30-year-old woman is referred for management of infertility. After menarche at age 12, menses occurred irregularly for a year and then became regular. She initiated use of oral contraceptive pills at the age of 18, then stopped at age 27 to try to conceive. Evaluation revealed presenting with amenorrhoea for 3 months,complaints of headache . On further evaluation her

FSH 2 IU/mL
LH 7 IU/mL
TESTOSTERONE 15 ng/dl
PROLACTIN 1500 ng/mL
Beta Hcg - 5 mIU/mL
What is the Cause of her infertility ?

2. Mrs. B, 32yearold with secondary amenorrhoea 4months ,presented with infertility , who intentionally lost 12kgs BMI;26,FHS:56Iu/L, LH: 43 IU/L
   Estradiol ;25mmol
   Probable reason for her Infertilty

3.Mrs. C , 18 year old , presents with normal secondary sexual characters .She says she has never got her periods but want to become pregnant .Ultrasound shows absent uterus , her Karyotyping is enclosed

4.Mrs.X 32yearold with secondary amenorrhoea of 2 months Her FSH level is 3 mIu//ml
LH levels 1.5 IU/L
Estradiol-250pg/ml

She complains of tiredness and easy fatigability Cause of amenorrhea

A. TSH
B. Prolactin levels
C. Pregnancy test
D. FSH
E. Ultrasound
F. Karyotyping
G. MRI
H. CT scan
I. Serum DHEA -S levels
J.Testosterone

Choose the most appropriate investigation for the following questions once or more than once or not at all:
5.Ms. Anne 15 year old, has presented with primary amenorrhoea, on examination ,her BMI was 29 and was found to have absent secondary sexual characteristics. The investigation of choice is

6.Ms. Mary , 15 year old, has presented with failure of onset of puberty with a height of about 130and is weighing 54kgs. She was examined and found to have tanners stage 1 breast development with widely spaced nipples. She also has cubitus valgus

7.Ms.Mary 15 year old, has presented with primary amenorrhoea. she gives a history of weight gain, lethargy and tiredness. She has nausea and vomiting .There No history of cyclical abdominal pain, visual disturbances. The appropriate investigation is

A . Ovarian hyperthecosis
B. Polycystic ovary syndrome
C. Premature ovarian failure
D. Turner's syndrome
E. Androgen insensitivity syndrome
F Prolactin secreting adenoma
G.Drug-induced hyperprolactinaemia
H Post-pill amenorrhoea
I.Depo-medroxyprogesterone acetate induced amenorrhoea
J. Unexplained infertility
K. Late onset congenital adrenal hyperplasia
L. Rokitansky syndrome
M. Androgen secreting tumour
N. Cushing's syndrome Drug-induced hyperprolactinaemia
0. Asherman's syndrome
P. Sheehan's syndrome

8. A healthy 35 yr old with secondary infertility. Her only child was delivered by CS for placenta previa 3 years ago. She has period every 32– 50 days & has not used contraception for 3 yrs. Pelvic ultrasound and her partner’s semen analysis are normal.
Follicular phase FSH = 25 IU/L,
LH = 18 IU/L,
day 21 progesterone = 3 ng/ml,
prolactin = 15 ng/ml.

9. A healthy 32 yr old with secondary amenorrhoea. She had been using depo-injection for contraception, last injection was 2 yrs ago. Her BMI is 24 kg/m2. Pelvic ultrasound shows increased ovarian volume.
Serum prolactin = 50 ng/ml,
testosterone = 3.6 nmol/L,
FSH = 2.2 IU/L,
LH = 2.0 IU/L,
TSH = 1.5 mIU/L,
SHBG = 12 nmol/L.
All other investigations normal

10.A 17 yr old with primary amenorrhoea. She is sexually active & normal breast, axillary, pubic hair development. Her height is 1.65m and BMI is 19 kg/m2. Pelvic ultrasound scan shows that the uterus is absent. Serum testosterone = 16 nmol/L.

11.A healthy 35 yr old with rapidly progressive hirsutism & male pattern baldness. She has period every 22-65 days, her BMI is 34 kg/m2. Pelvic ultrasound: bilateral complex ovarian cysts of 5.6cm and 6.4cm. Follicular phase FSH = 5.5 IU/L, total serum testosterone = 6.5 nmol/L, prolactin = 15ng/ml.