Epidemiology and Statistics Ethics and Legal Issues Amenorrhea More Amenorrhea Potpourri (Extremes in Age)

100

What is case-control? (Office 50) Remember: Case-control studies go backward from outcome to exposure. They are good for less common outcomes.
This is the type of study described below. Investigators assessed risk factors for ovarian cancer. THey didi this by comparing 300 women with ovarian cancer to 900 age-matched women without ovarian cancer.

100

What is inform the patient and apologize for the error? (Office 73)
After removing a right ovary for a suspected dermoid, the pathology is consistent with normal ovary. Postoperative review of the ultrasound shows that the dermoid was on the left, but the radiologist incorrectly said it was on the right. Risk management is notified. The physician should now....

100

What is premature ovarian failure? (REI 31)
This is the most likely diagnosis for the following patient. A 16-year-old presents with primary amenorrhea. She is 56 in tall and weighs 110 lb. She has Tanner 2 breast development and Tanner 3 axillary and pubic hair. US shows small uterus and ovaries. E2 is 12, FSH is 82, LH is 76 and prolactin is 5.

100

What is PCO? (REI 40)
An obese 26-year-old female is oligomenorrheic. She has failed to conceive despite 2 years of unprotected intercourse. This is her most likely diagnosis.

100

What is repeat ultrasound in 6 months? (Gyn 13)
This is the appropriate management for a 57-year-old with a 5 cm simple cyst in the left adnexa. The right adnexa and the patient's CA 125 are normal.

200

What is Sensitivity? (Office 104) Sensitivity=TP/(TP+FN) Specificity=TN/(TN+FP)
This parameter describes the proportion of individuals with a condition who are correctly identified with a screening test. A good screening test will have a high number for this value.

200

What is documentation of the diagnosis and proposed procedure? Including risks, benefits, and alternatives, as well as risks and benefits of not having the procedure? This should be discussed in plain language by the physician performing the procedure. (Office 154-156)
The following is an essential part of informed consent.

200

What is androgen insensitivity syndrome? (REI 17)
This is the most likely diagnosis for a 17-year-old with primary amenorrhea. She has Tanner stage 4 breast development and Tanner stage 1-2 pubic hair development. She has no axillary hair and a blind-ending vagina.

200

What is 17 alpha-hydroxyprogesterone? (REI 72)
A 20-year-old Ashkenazi woman with secondary amenorrhea has worsening hirsutism. She has no acanthosis nigricans or evidence of clitoromegaly. TSH and prolactin levels are normal. This is the best next test.

200

What is an SSRI (selective serotonin reuptake inhibitor)? Examples include: fluoxetine, paroxetine, venlafaxine. (Gyn 52, Office 67)
This is the most appropriate NONHORMONAL therapy for a 50-year-old postmenopausal female with worsening vasomotor symptoms.

300

What is Type II? (This is the only question not reviewed in the Prologs. Sorry.) The probability of making Type II error is called Beta, usually set at 0.1 or 0.2. Power=1-Beta. Type I error is the probability of saying a difference exists when it really doesn't. (false-positive error). Probability of type I error is called Alpha, usually set at 0.05.
This is the type of error present in a study when a difference between two groups is not found but really exists. (A false-negative error.)

300

What is autonomy? (Gyn 87) The four main principles are: autonomy, beneficence, non-maleficence and justice.
What ethical principle is at work in the following case? An 18-year-old G0 comes in with her mother and is started on Sprintec. She asks for the HPV vaccine. Her mother objects to her receiving the vaccine, but you offer it anyway.

300

What is CT urogram? (REI 49)
A 19-year-old presents with primary amenorrhea. She denies cyclic pelvic pain. She has adult breast development and hair pattern. She lacks a vaginal opening and rectal exam is notable for a non-palpable uterus. Labs show low testosterone. This imaging study will best detect the most commonly associated extragenital abnormalities.

300

What is hypothalamic amenorrhea? (REI 104)
A 15-year-old cheerlead has secondary amenorrhea. She is seen in the ETC with fracture of her right fifth metatarsal. Her BMI is currently 17.9. Her DXA shows a Z-score of -3. This is the most likely cause of her amenorrhea.

300

What is removal of the vaginal foreign body? (Gyn 181-184)
This is the appropriate treatment for a 4-year-old with the new-onset of a blood-tinged, malodorous vaginal discharge.

400

What is positive (or negative) predictive value? (Office 104) Why? PPV will be lower in populations with lower prevalence because there will be a greater proportion of false positives to true positives. PPV=TP/(TP+FP) (Prob that if a person tests positive they really DO have the disease.) NPV=TN/(TN+FN) (Prob that if a person tests negative they really DON'T have the disease.)
This parameter is affected by the prevalence of a disease in a population.

400

What is improvement of patient safety? (Gyn 127)
This is the purpose of policies for the disclosure and discussion of medical errors among colleagues, for example "Quality assurance" meetings and "Root cause analysis" meetings.

400

What is Y-sequence analysis identification? (Or anything relating to seeing if she has Y-chromosome material present?) (REI 84) If Y-chromosome material is present, she should be managed with gonadectomy to prevent gondadoblastoma.
This describes the appropriate next step in managing the following patient. This is an 18-year-old G0 with phenotypic Turner syndrome. Initial karyotype assessment shows a mosaic genotype: 45,X/46,X?.

400

What is Clomid? (REI 42)
A 31-year-old woman with oligomenorrhea (menses every 45-120 days), acne, and hirsutism has been unable to conceive after 18 months. Her male partner has a normal SA and she has a normal HSG. This is the medication that will be most likely to lead to her ovulating.

400

What is a bisphosphonate? (Office 96) REMEMBER: FRAX is for T-score -1 to -2.5. Plan to treat when risk of major osteoporotic fracture is >/= 20% or risk of hip fracture >3%. (Office 96)
This is the appropriate management for a 60-year-old postmenopausal female with a recent DXA scan with a T-score of -1.2. According to the FRAX tool her 10-year probability of major osteoporotic fracture is 24%, and risk of hip fracture is 1.6%.

500

What is an unpaired t-test? (REI 170-173) The t-test compares two sets of measurements. Paired t-tests (two-sample) compare 2 different populations. One-sample (unpaired) t-tests compared observations made once in 2 parallel groups.
This is the best statistical test to assess the validity of a study comparing live birth rates after IVF with and without pretreatment acupuncture.

500

What is negotiation? (Gyn 6) The representatives of both parties attempt to negotiate a settlement fair to both parties. Other methods include: mediation and arbitration.
This is the most frequently used method in alternative dispute resolution. It helps to avoid lengthy medical-legal processes.

500

What are human menopausal gonadotropins? (Or exogenous FSH and LH?) (REI 22) Kallmann syndrome is hypogonadotropic hypogonadism and anosmia. Her problem that her GnRH doesn't make it to the hypothalamus.
This is the best medical therapy a 29-year-old with Kallmann syndrome conceive.

500

What is and androgen-secreting adrenal mass? (REI 56) She has virilization-suggesting tumor as well as more rapid onset.
An 18-year-old woman with normal puberty and 3 years of normal cycles presents with 6 months of amenorrhea. She has clitorimegaly, increased muscle mass and temporal balding. Serum testosterone is 250. DHEAS is 1,500. Pelvic US shows normal ovaries. This is her most likely diagnosis.

500

What is mebendazole (Vermox)? (Gyn 181-184)
This is the medication to give a 5-year-old with one week of vulvar and perianal pruritus. The patient has nonspecific vulvar erythema. Wet mount is negative. A tape test is positive.

CREOG Jeopardy

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