TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Endocrinonology:physiology and pathophysiology Goto page Previous  1, 2, 3, 4, 5  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:02 pm    Post subject: I could say the fact I had to correct it made me forget to underline it but that would be a big lie! Lethargy is such a non-specific complaint I did not realise the significance in all honesty. Your question is a very good one but a little too obvious here with this list of options. However, it would be a tough one in a pregnancy question! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:05 pm    Post subject: Question 5 You are asked to review the results of a patient in the absence of your consultant. The results are as follows: FSH 35 IU/L LH 23 IU/L Oestradiol 12,458 pmol/L What is the likely diagnosis? Last edited by Nick Raine-Fenning on Fri Jul 13, 2007 5:19 pm; edited 1 time in total Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:09 pm    Post subject: Question 6 A 34-year woman is referred by her GP with secondary amenorrhoea. Examination is unremarkable but her test results show a raised prolactin (750 U/L) and testosterone (3.0 nmol/L). Last edited by Nick Raine-Fenning on Sat Jul 14, 2007 6:15 am; edited 2 times in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri Jul 13, 2007 5:12 pm    Post subject: Nick Raine-Fenning wrote: - it does not really matter when it was taken as 'all other tests are normal' - what else could it be?? Agree with you--Ovulation! ( I guess I was trying to be a bit cranky maybe ) Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:13 pm    Post subject: Question 7 You are referred a 15-year old girl as she has not started to menstruate and her parents are concerned. She has absent secondary sexual characteristics. Last edited by Nick Raine-Fenning on Fri Jul 13, 2007 5:19 pm; edited 1 time in total Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Jul 13, 2007 5:13 pm    Post subject: Question 5, I would go for pituitary adenoma. It could also be acromegaly but not sure if Growth Hormone can stimulate gonadotrophins that much. Also exogenous GnRH stimulation? Craniopharyngioma can also cause similar picture with premature puberty. How old is the patient? I think I need more information Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:16 pm    Post subject: Question 8 You are referred a 15-year old girl as she has not started to menstruate. Her parents, who are concerned, attribute this to her weight which is low at 45 kg. She is of normal height and has some breast development. Examination of her external genitalia reveals pubic hair and clitoromegaly. Abdominal ultrasound is normal. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:20 pm    Post subject: wolverine wrote: Question 5, I would go for pituitary adenoma. It could also be acromegaly but not sure if Growth Hormone can stimulate gonadotrophins that much. Also exogenous GnRH stimulation? Craniopharyngioma can also cause similar picture with premature puberty. How old is the patient? I think I need more information You always need more information but that is all I am giving you!! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:27 pm    Post subject: wolverine wrote: Question 4 FSH 0.5, LH 0.8, PRL 900 IU/l, Oestradiol 1850 nmol/l, Testosterone 2.7, progesterone 96. Raised prolactin / oestradiol Low FSH / LH Rest normal You leave me with ... I Acromegaly N Pituitary adenoma R Hyperprolactinaemia S Mixed pituitary adenoma T Craniopharyngioma However, Testosterone is upper limit of normal and with a low SHBG this could be 'biochemical hyperandrogenaemia' and PCOS although the Prolactin is too high for this. However, it is also too low for a pituitary adenoma. Which all makes me want to go for T Craniopharyngioma. I am not sure how the FSH and LH can be low with a high oestradiol unless there is a peripheral source of oestradiol and then we have the prolactin to deal with??? I am lost. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:29 pm    Post subject: Question 9 You are asked to see a 21-year old with secondary amenorrhoea. Her FSH and LH are low and she has an abdominal mass. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:32 pm    Post subject: Question 10 A 32-year old woman with irregular periods wants to conceive. She has acne and some facial hair but normal serum androgen levels and SHBG. A TV ultrasound scan shows normal ovaries. Her day 3 FSH is 8.0 IU/L and her LH 4.2 IU/L. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:34 pm    Post subject: Question 11 A 25-yar old woman is referred to the infertility clinic with secondary amenorrhoea. She complains of galactorrhoea and her prolactin is 850 IU/L. Her husband comments that her appearance has recently changed. She has had tingling in her fingers that did not improve when she had her rings cut off. Last edited by Nick Raine-Fenning on Fri Jul 13, 2007 5:37 pm; edited 2 times in total Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:34 pm    Post subject: Question 12 You are referred an anxious 15-year old with delayed puberty and anosmia. Her FSH level is 2.1 IU/L and her LH 0.8 IU/L. Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri Jul 13, 2007 5:37 pm    Post subject: Nick Raine-Fenning wrote: No longer true - LH has no role in the modern (i.e. post-Rotterdam consensus) diagnosis of PCO or in prediction of outcome or response to treatment. Nick -- Totally agree with you about the Rotterdam Criteria. In the revised criteria, two out of three of the following are required to make the diagnosis: 1. Oligo- and/or anovulation 2. Clinical and/or biochemical signs of hyperandrogenism 3. Polycystic ovaries (by ultrasound) In addition, other etiologies (congenital adrenal hyperplasias, androgen-secreting tumors, Cushing's syndrome) must be excluded. What I meant is a raised LH /FSH ratio is only one among the manyindicator or a clue. Definitely not a criteria used for diagnosis and LH, FSH need not be measured for making a diagnosis. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:39 pm    Post subject: cpeedahsa wrote: In addition, other etiologies (congenital adrenal hyperplasias, androgen-secreting tumors, Cushing's syndrome) must be excluded. This is another very important point that people often miss. Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri Jul 13, 2007 5:41 pm    Post subject: Nick Raine-Fenning wrote: Question 10 A 32-year old woman with irregular periods wants to conceive. She has acne and some facial hair but normal serum androgen levels and SHBG. A TV ultrasound scan shows normal ovaries. Her day 3 FSH is 8.0 IU/L and her LH 4.2 IU/L. I would go for PCOS--she has 2 criteria Rotterdam Criteria. In the revised criteria, two out of three of the following are required to make the diagnosis: Oligo- and/or anovulation Clinical and/or biochemical signs of hyperandrogenism Polycystic ovaries (by ultrasound) In addition, other etiologies (congenital adrenal hyperplasias, androgen-secreting tumors, Cushing's syndrome) must be excluded. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:42 pm    Post subject: Question 13 You are asked to see a 34-year old woman who has not resumed menstruation following the birth of her daughter 8 months earlier. After an uneventful delivery she breast fed for 5 months but did suffer with post-natal depression which required admission to the mother and baby unit. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:45 pm    Post subject: Question 14 You are asked to see a woman with secondary amenorrhoea and to review the results of the tests undertaken the previous month. Unfortunately her dog at the envelope with your letter in that outlined the findings! What uis the likely diagnosis. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Jul 13, 2007 5:48 pm    Post subject: Question 15 Having recovered from the shock of the news you gave the lady in question 14 she then has to face another dilemma. Her youngest daughter has suddenly developed acne and facial hair. Examination reveals frontal balding. The mother is surprised as this did not happen with her other two children. Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri Jul 13, 2007 6:27 pm    Post subject: Nick Raine-Fenning wrote: Question 11 A 25-yar old woman is referred to the infertility clinic with secondary amenorrhoea. She complains of galactorrhoea and her prolactin is 850 IU/L. Her husband comments that her appearance has recently changed. She has had tingling in her fingers that did not improve when she had her rings cut off. Mixed Pituitary adenoma Last edited by cpeedahsa on Sat Jul 14, 2007 5:00 pm; edited 1 time in total Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions All times are GMT Goto page Previous  1, 2, 3, 4, 5  Next Page 2 of 5   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group