EBCOG Part 1 – ESHRE Guidelines Day 1 SBA

1. A 30-year-old woman presents complaining of secondary amenorrhea of 6 months duration. She has a BMI of 22 kg/m2, while her serum FSH is 45.0 IU/l (normal <12 IU/l) and LH 17.1 IU/l (normal <10 IU/l). Which of the following fits best to her gonadotrophin profile:

2.  A 30-year-old woman presents complaining of secondary amenorrhea of 6 months duration. She has a BMI of 22 kg/m2, while her serum FSH is 5.6 IU/l (normal <12 IU/l) and LH 12.2 IU/l (normal <10 IU/l). Which of the following fits best to her gonadotrophin profile:

3.  A 19-year-old woman was seen in the gynaecology clinic with a history of excessive growth of facial hair, needing to wax every 2-3 weeks. Her menstrual periods last 7-8 days every 24-35 days. There is no change in her voice. Her BMI is 28 kg/m2 . Examination shows Ferriman-Gallwey grade 2-3 hirsutism over chest and abdomen. A pelvic ultrasound showed no abnormality. Her day two hormone tests showed LH level 7.4IU/L, FSH level 5.2IU/L, serum testosterone level 2.3nmol/l, SHBG 24 nmol/L. What is the most likely diagnosis?

4.  A 38-year-old woman presents to the gynaecology clinic with a 6-month history of amenorrhoea and hot flushes. A pregnancy test is negative. Her serum follicle-stimulating hormone (FSH) is measured and found to be 45 IU/1. What further result would confirm a diagnosis of premature ovarian insufficiency (POI)? 

5.  What is the first-line pharmacological treatment for anovulatory polycystic ovary syndrome? 

6.  A 21 year old presents to the gynaecology outpatient clinic with pelvic pain. The general practitioner referral suggests possible endometriosis. What is the estimated prevalence of endometriosis in women of reproductive age?

7. An 18-year-old tall girl with a BMI of 19 presents with primary amenorrhoea at your clinic. On examination, her breast development is Tanner 5, pubic and axillary hair development is Tanner 2 and her external genitalia appears normal. A small inguinal swelling is detected on her right groin

18. A 17-year-old girl attends the adolescent gynaecology clinic with a history of primary amenorrhoea. She has normal secondary sexual characteristics and is of average height and normal BMI. Further investigations show normal FSH, LH and estrogen levels. What is the most likely diagnosis?

9. A 17-year-old girl is brought to the gynaecology clinic by her mother as she has not yet started menstruation. She has a short stature. Blood tests show high FSH and LH. Secondary sexual characteristics have not yet developed.

10. A 35-year-old woman with a BMI of 24 has been referred to the infertility clinic with a history of 3 years of primary infertility. Her menstrual cycle is irregular and she has been diagnosed with polycystic ovaries. Semen analysis is normal for her partner. She has tried clomiphene citrate with no success. 

What would be the best initial management option among the following?

11.  A 35-year-old woman with normal BMI presents with a history of secondary amenorrhea. She had regular periods 2 years back. Abdomino-pelvic examination is normal. Blood tests reveal LH 10 iU/ML (1-20), FSH 8 iU/ml (1-20), prolactin 3000 Mu/ML (50-500).  A CT head demonstrates a hypoattenuating round tumour embedded in the parenchyma of the pituitary gland.

What is the most appropriate management option?

12. An 18-year-old woman presents with primary amenorrhea. She has normal thelarche and pubarche. On examination, external genitalia are normal. Ultrasound shows normal ovaries but uterus not visualised.

What is the most likely cause?

13.  A 16-year-old girl presents with recurrent abdominal pain and primary amenorrhea. On examination, both breast development and pubic hair distribution are noted to be Tanner Stage V. An abdominal mass is detected on palpation. Speculum examination showing a bluish colour at the end of the speculum

What is the most likely cause?