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Chapter 41 – Gynecological Disorders (QE) Sample Questions

1. MB is a 36 year old female who presented to her family physician with symptoms of recurrent pelvic pain that progresses to severe cramps during her menstrual period. MB further described having heavy menstrual bleeding for the last few months when asked. The doctor then conducted pelvic examination and afterwards, wrote a prescription of nafarelin 200 mcg (1 spray) into 1 nostril QAM and 200 mcg into the other nostril QPM × 6 months to treat MB’s recurrent endometriosis-associated pain. Which of the following is a significant side effect of gonadotropin-releasing hormone agonist like nafarelin?

A. Infertility
B. Pelvic pain
C. Decreased bone mineral density
D. Increased risk of infections

Answer

Ans: C

TIPS: Bone loss (if used for 6 months, reversible upon cessation of treatment). Vasomotor symptoms: hot flashes, vaginal dryness, insomnia, loss of libido, emotional lability. A temporary increase in pain upon initiation of therapy may occur. Usually given for 6 months as long-term use is associated with significant decrease in BMD. Symptoms may recur within 9–12 months after stopping therapy; add-back hormonal therapy improves hypoestrogenic symptoms and controls bone loss.

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