Students Corner Article 2

Dr. Punit Bhojani

Q. 1) A 9 year old girl presents for evaluation of regular vaginal bleeding. History reveals thelarche at age 7 and adrenarche at age 8. The most common cause of this condition is:

1. Idiopathic
2. Gonadal tumors
3. McCune-Albright syndrome
4. Hypothyroidism

Q. 2) Emergency contraception prevents pregnancy by all of the following mechanisms, EXCEPT :

1. Delaying/inhibiting ovulation
2. inhibiting fertilization
3. Preventing implantation of the fertilized egg
4. Interrupting an early pregnancy

Q. 3) A 24 year old woman presents with new onset right lower quadrant pain and you palpate an enlarged, tender right adnexa. Which of the following sonographic characteristics of the cyst in this patient suggests the need for surgical exploration now instead of observation for one menstrual cycle?

1. Lack of ascites
2. Unilocularity
3. Papillary vegetation
4. Diameter of 8 cm
   Ans. 1) – (1)
   Pubertal changes before the age of 8 years in girls and 9 years in boys are regarded as precocious. Although the most common type of precocious puberty in girls is idiopathic, it is essential to ensure close long-term follow up of these patients to ascertain that there is no serious underlying pathology, such as tumors of the central nervous system or ovary. Only 1 to 2% patients with precious puberty have an estrogen producing ovarian tumor as the causative factor. McCune Albright syndrome is also relatively rare and consists of fibrous dysplasia and cystic degeneration of the long bones, sexual precocity, and cafe au lait spots on the skin. Hypothyroidism is a cause of precocious puberty in some children, making thyroid function tests mandatory in these cases. Tumors of the central nervous system as a cause of precious puberty occur more commonly in boys than in girls; they are seen in about 11% of girls with precious puberty. (Ref. Speroff, 7th Edition, Pg. 392-400)Ans. 2) – (4)
   Emergency contraception is used to prevent pregnancy after the act of an unprotected intercourse. It is an interceptive. Its main action is to make the endometrium unsuitable for implantation. It may also prevent or delay ovulation and prevent fertilization of the egg by the sperms . It has however no role in the interruption of early pregnancy once conceived. They are not abortifacients or contagestives. They cannot interrupt an early pregnancy and hence a pregnancy test is recommended if the woman does not bleed within 7 days of the usage.

   Ans. 3) – (3)
   Approximately 20% of ovarian neoplasms are considered malignant on pathologic examination. However, all must be considered as placing the patient at risk. Given that most ovarian tumors are not found until significant spread has occurred, it is not unreasonable to attempt to operate on such patients as soon as there is a suspicion of tumor. Papillary vegetation, size greater than 8 cm, ascites, possible torsion, or solid lesions within the cysts are automatic indications for exploratory laparotomy. In a younger woman a simple unilocular cyst can be a follicular cyst which would regress after onset of the next menstrual period. If regression does not occur, then surgery is appropriate. Doppler ultrasound imaging allows visualization of arterial and venous flow patterns superimposed on the image of the structure being examined.

Smart Study Series in Obstetrics & Gynecology by Dr Punit S Bhojani. An Elsevier publication