CASE # 3

You are in the outpatient health center where a 32 years old woman, arrives
referring the presence of intense vaginal itching accompanied by occasional
burning like symptom during intercourse. She refers menarche at 11 years old,
gravida 0, onset of sexual activity at 17, SP 3, negative PAP two years ago, not
using family planning method. A physical examination shows hyperemic vagina
lumpy abundant leucorrhoea, no foul, cervix appeared normal.
The most likely diagnosis in this patient is:
a) Trichomonas vaginalis infection
b) Gardnerella vaginalis infection
c) Candida albicans infection
d) Chlamydia trachomatis infection
The characteristic clinical finding of this infection is:
a) Leucorrhoea
b) Itching
c) A foul smell
d) Strawberry appearance of the cervix
A microscopic observation you expect to find is:
a) Clue Cells
b) hyphae and pseudomycelia
c) koilocytes
d) trophozoites
The treatment of choice for this patient is:
a) Metronidazole
b) Amoxicillin
c) Clindamycin
d) Clotrimazole

Case # 4
29 year old patient comes to your hospital, because desire for pregnancy since 3
years ago. She has diabetic mother, rest refused, gynecology obstetric history
menarche at 12 years, cycles 60-90 x 4, no dysmenorrhea, onset of sexual activity
at age of 20, SP 2, Pap smear a year ago, not using family planning method, on
physical examination, the patient presents Height 1.54 m, weight 72kg, BP 120/70
mmHg,
acne, acanthosis nigricans on the neck, cardiopulmonary normal,
depressible soft abdomen painless, apparently normal external genitalia, vaginal
examination utero normal size and situation, no adnexal mass are palpated. The
patient reported having sporadic irregular menstrual cycles.
The menstrual pattern of this patient is defined as:
a) Hypermenorrhea
b) Oligomenorrhoea
c) Proiomenorrhea
d) Opsomenorrhea
If applying laboratory and imaging study, which of the following is the most
appropriate:
a) FSH, LH, Estradiol, blood chemistry, VDRL
b) FSH, LH, Estradiol, abdominal and pelvic ultrasound
c) FSH, LH, estradiol, thyroid profile, prolactin, androgenic profile and
transvaginal ultrasound, progesterone.
d) FSH, LH, Estradiol, lipid profile, prolactin, and vaginal ultasound, and liver
enzymes.
Among the studies requested, testosterone and androstenedione are
elevated, which is your diagnostic suspicion:
a) Amenorrhea
b) Metabolic syndrome
c) Hyperandrogenism
d) Polycystic Ovarian Syndrome

The menstrual pattern in this patient is usually due to:

a) levels of FSH
b) Presence of acanthosis nigricans
c) Age at menarche
d) Anovulation
The treatment indicated for this patient is:
a) Combined Oral Contraceptives
b) Hormone Replacement Therapy
c) Ovulation induction
d) GnRH analogues
Case # 5
A 19 years old patient, consult you for never having menstrual period presented as
antecedents, mother with type 2 diabetes, the patient complains of always being
the shortest of their classroom, denies having initiated sexual life. On physical
examination, the patient is 1.41 m, 45 kg, poor breast development, low set ears
and hair, cubitus valgus, broad chest, short neck, apparently normal external
genitalia, speculoscopy not done.
The menstrual pattern of this patient is known as:
a) Primary amenorrhea
b) Secondary amenorrhea
c) Tertiary Amenorrhea
d) Opsomenorrhea
The clinical picture of the patient agrees with the diagnosis of:
a) Polycystic Ovary Syndrome
b) Noonan Syndrome
c) Turner Syndrome
d) Klinefelter Syndrome

To confirm the suspected diagnosis you request:

a) Hormonal profile
b) Abdominal ultrasound
c) Serology
d) Karyotype

This condition is due to:

a) Chromosome 12 deletion
b) Loss of one of the X chromosomes
c) Loss of Y chromosome
d) Duplication of X chromosome
Case # 6
You are in the dysplasia clinic of a regional hospital, where patient comes with a
Pap smear report indicating NIC 2, the patient is 31 years old, as history menarche
at 10 years, onset of sexual activity at 17 years old, SP 9, no pregnancies, not
using family planning method, unsatisfied parity. At physical examination, patient
similar to the chronological age, cardiopulmonary without compromise, abdomen
unaltered, normal vaginal examn, at the speculoscopy no apparent abnormalities.
The most appropriate behavior to do next in this patient is:
a) Repeat cervical cytology
b) Conization
c) Colposcopy
d) Re-evaluation in six months.
You did the previous study and found, white area in a radius from 2 to 4,
raised edges, thick tile, you decide:
a) Colposcopy in three months
b) Taking biopsy
c) Trichloroacetic acid application
d) New cytology
The pathology report indicates and confirms NIC 2, this classification
belongs to:
a) low-grade intraepithelial lesion
b) intermediate grade intraepithelial lesion
c) high-grade intraepithelial lesion
d) severe intraepithelial lesion
The therapeutic conduct in this patient should be:
a) Hysterectomy
b) Re-evaluation in three months with new biopsy
c) Esferolisis
d) Cervical conization