A 25-year-old female named Emma arrives at the endocrinology clinic with concerns about her health. She has never had a menstrual period (primary amenorrhea) and has not developed secondary sexual characteristics like breast development. Emma also mentions she has never been able to smell anything, a condition she’s had since birth. She recalls her brother also experienced delayed puberty, which further adds to her suspicion that there might be a genetic component to her condition. Laboratory results show low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are critical hormones for reproductive function. Which of the following genetic mutations is most commonly associated with Kallmann syndrome?
Seventeen-year-old Sarah comes to her pediatric endocrinologist with concerns about her development. She’s never had a menstrual period (primary amenorrhea), and her physical development has not progressed as expected for her age. Sarah has only slight breast budding without any significant breast development (Tanner stage 2), and she lacks pubic or axillary hair, indicating delayed or absent puberty. Additionally, Sarah mentions she has never been able to smell, which she thought was normal until she learned it was not. Her family history is unremarkable for similar issues, but her mother recalls her uncle having fertility issues. Genetic testing is pursued, and it reveals a mutation in the KAL1 gene. Which of the following best explains the pathophysiology of her condition?
A 21-year-old college student presents with fever, joint pain, and a painful swollen knee. She also reports a few small, pustular skin lesions on her hands and forearms. She had vaginal discharge 1 week ago, which she ignored. Physical examination reveals a warm, swollen right knee with limited range of motion. Joint aspiration reveals cloudy synovial fluid with neutrophil predominance. Blood cultures are pending. Which of the following is the most likely diagnosis?
A 30-year-old woman presents with lower abdominal pain, purulent vaginal discharge, dysuria, and intermenstrual bleeding for 1 week. She reports multiple recent sexual partners. On examination, she has cervical motion tenderness (positive chandelier sign) and a mucopurulent discharge from the cervix. A nucleic acid amplification test (NAAT) is positive for Neisseria gonorrhoeae. Which of the following complications is she most at risk for if left untreated?
A 30-year-old woman presents to the clinic because her partner was recently diagnosed with genital herpes. She reports being sexually active with him but does not recall any prior episodes of genital ulcers or vesicles. She is otherwise healthy, takes no medications, and has no significant past medical history. Her physical examination, including a pelvic exam, is normal. She is concerned about her risk of herpes and asks for testing. What is the most appropriate next step in management?
A 34-year-old woman presents to the emergency department with abdominal pain. She denies fever, nausea, or vomiting but reports mild bloating and a feeling of heaviness in her pelvis over the past week. She has no significant medical history. A transvaginal ultrasound revealed a twisted suspensory ligament of the ovary among other findings. Which of the following clinical conditions involves the suspensory ligament of the ovary?
A 45-year-old woman presents to the gynecology clinic with chronic pelvic pain and bloating over the past 6 months. She has a history of irregular menstrual cycles and recently noted a gradual increase in abdominal discomfort. An ultrasound performed by her primary care provider revealed a 10 cm complex ovarian cyst on the left ovary. Based on these findings, a decision is made to proceed with a laparoscopic left oophorectomy for diagnosis and treatment. During surgery, the left ovary is visualized and found to be enlarged and adherent to the pelvic sidewall. The suspensory ligament of the ovary is identified and carefully ligated. Why is it essential to carefully ligate the suspensory ligament of the ovary?
A 34-year-old woman presents to the emergency department with sudden-onset, severe right lower abdominal pain that began 6 hours ago. The pain is sharp, constant, and radiates to her back. She denies fever, nausea, or vomiting but reports mild bloating and a feeling of heaviness in her pelvis over the past week. She has no significant medical history but is being evaluated for an ovarian cyst noted during a routine ultrasound 3 months ago. On physical examination, the patient is in distress. Her vital signs are stable, with no fever or hypotension. Abdominal examination reveals tenderness in the right lower quadrant without rebound tenderness or guarding. A transvaginal ultrasound revealed a twisted suspensory ligament of the ovary among other findings. What important structures are contained within the suspensory ligament of the ovary?
You are attending to a 30-year-old woman who presents to the emergency department. She denies fever, vaginal bleeding, or recent illness. Her last menstrual period was 2 weeks ago and was normal. Her medical history is unremarkable except for the diagnosis of an ovarian cyst 6 months ago, when a pelvic ultrasound revealed a 6 cm sized dermoid cyst. Physical Examination: •Abdominal Exam: Right lower quadrant tenderness without rebound or guarding. •Pelvic Exam: Reveals tenderness in the right adnexa with a palpable mass. •Vital Signs: BP 120/80 mmHg, HR 92 bpm, RR 17, Temp 98.6°F. You suspect ovarian torsion in this patient based on her history and presentation. Which clinical symptom is most characteristic of ovarian torsion?
A 28-year-old woman presents to the emergency department with sudden-onset, severe, sharp pain in her lower right abdomen that began 6 hours ago. The pain radiates to her lower back and is accompanied by nausea and vomiting. She denies fever, vaginal bleeding, or recent illness. Her last menstrual period was 2 weeks ago and was normal. She has no history of similar pain, and her medical history is unremarkable except for the diagnosis of an ovarian cyst 6 months ago, when a pelvic ultrasound revealed a 6 cm sized dermoid cyst. Physical Examination: The patient appears uncomfortable and is clutching her abdomen. •Abdominal Exam: Right lower quadrant tenderness without rebound or guarding. •Pelvic Exam: Reveals tenderness in the right adnexa with a palpable mass. •Vital Signs: BP 90/60 mmHg, HR 134 bpm, RR 25, Temp 98.6°F. What is the most definitive diagnostic and therapeutic intervention for this disorder?
