10: Puberty, Menstrual Disorders

Question 1

Ovarian cycle - follicular phase

Answer 1

Onset of menstruation to LH surge

Question 2

Ovarian cycle - luteal phase

Answer 2

LH surge to 1st day menses

Question 3

At what point in the menstrual cycle does estrogen peak?

Answer 3

Just prior to LH surge

Question 4

At what point in the menstrual cycle does progesterone peak?

Answer 4

5-7 days after ovulation

Question 5

Corpus luteum

Answer 5

Formed after ovulation and secretes progesterone

Question 6

Corpus albicans

Answer 6

Avascular scar that replaces corpus luteum in absence of pregnancy

Question 7

Menstrual phase

Answer 7

RBC extravasation, sloughing of functionalis layer and compression of basalis layer

Question 8

Proliferative phase

Answer 8

Endometrial growth, estrogenic stimulation, increase in arteries, increase in mitoses

Question 9

Secretory phase

Answer 9

Following ovulation, progesterone secretion increases, glands are tortuous, mucus and glycogen secreted, endometrial lining at maximum thickness

Question 10

Median age of menarche

Answer 10

12.43 years

Question 11

Primary amenorrhea

Answer 11

No menstruation by 13 y/o without secondary sexual development OR by 15 years with secondary sexual characteristics

Question 12

When is menses likely associated with anemia?

Answer 12

Greater than 80cc blood loss/changing pad q1-2 hours

Question 13

Stages of normal pubertal development

Answer 13

TAG-ME: Thelarche, Adrenarche, Growth, MEnarche

Question 14

Thelarche

Answer 14

Breast development; 1st sign puberty, requires estrogen

Question 15

Adrenarche

Answer 15

Development of pubic/axillary hair; requires androgens

Question 16

Maximal growth

Answer 16

Occurs ~1 year before onset menses

Question 17

Menarche

Answer 17

Onset of menses

Question 18

Tanner stage 1

Answer 18

Breast: Preadolescent, elevation of papilla only
Hair: Preadolescent, absence of pubic hair

Question 19

Tanner stage 2

Answer 19

Breast: Breast bud, small mound with enlarged areola
Hair: Sparse hair along labia, downy/slight pigment

Question 20

Tanner stage 3

Answer 20

Breast: Further enlargement of breast/areola without contour separation
Hair: Spreads sparsely over unction of pubes, darker and coarser

Question 21

Tanner stage 4

Answer 21

Breast: Projection of areola from papilla to form secondary mound
Hair: Adult-type hair, no spread to medial thigh

Question 22

Tanner stage 5

Answer 22

Breast: Mature, projection of papilla only
Hair: Adult-type hair with spread to medial thighs

Question 23

Precocious puberty

Answer 23

Development of secondary sexual characteristics prior to an age 2.5 standard deviations earlier than expected age of pubertal onset (8 y/o in girls)

Question 24

Causes of heterosexual precocious puberty

Answer 24

Virulizing neoplasms, CAH, exposure to androgens

Question 25

Causes of isosexual precocious puberty

Answer 25

Constitutional or organic brain disease; often idopathic

Question 26

Treatment of isosexual precocious puberty

Answer 26

GnRH agonist (Leuprolide) to suppress FSH/LH - prevents stunted growth

Question 27

McCune-Albright syndrome

Answer 27

Polyostotic fibrous dysplasia; present with bone defects, cafe au lait spots, adrenal hypercortisolism

Question 28

Peutz-Jeghers syndrome

Answer 28

Gastrointestional poyposis and mucocutaneous pigmentation

Question 29

Hypergonadotropic hypogonadism

Answer 29

FSH is elevated, gonadal dysgenesis; Turner's

Question 30

Hypogonadotropic hypogonadism

Answer 30

FSH and LH are low; many causes

Question 31

Secondary amenorrhea

Answer 31

Patient with prior menses has absent menses for 6+ months

Question 32

Treatment of microadenomas and macroadenomas causing prolactinemia

Answer 32

Bromocriptine (Dopamine agonist)

Question 33

Progesterone challenge test

Answer 33

Given in secondary amenorrhea if normal TSH/PRL Positive: bleeding - PCOS Negative: inadequate estrogenization or outflow tract abnormality

Question 34

Estrogen/progesterone challenge test

Answer 34

Given after negative PCT Negative: outflow tract obstruction Positive: abnormality in HPA or ovaries

Question 35

Leading cause of female anovulatory infertility

Answer 35

PCOS

Question 36

Diagnostic criteria for PCOS

Answer 36

At least 2 of the following: 1. Oligomenorrhea/amenorrhea 2. Biochemical or clinical signs of hyperandrogenism 3. US revealing multiple small cysts beneath cortex of ovary

Question 37

Treatment of PCOS

Answer 37

Weight loss, OC, clomiphene citrate, spironolactone, metformin

Question 38

Polymenorrhea

Answer 38

Abnormally frequent menses at intervals of less than 21 days

Question 39

Menorrhagia

Answer 39

Excessive and/or prolonged bleeding (>80 mL and 7 days) at normal intervals

Question 40

Metrorrhagia

Answer 40

Irregular episodes of uterine bleeding

Question 41

Menometrorrhagia

Answer 41

Heavy and irregular uterine bleeding

Question 42

Intermenstrual bleeding

Answer 42

Scant bleeding at ovulation for 1-2 days

Question 43

Oligomenorrhea

Answer 43

Menstrual cycles occurring >35 days but less than 6 months

Question 44

PALM-COEIN

Answer 44

Polyp-Adenomyosis-Leiomyoma-Malignancy | Coagulopathy-Ovulatory dysfunction-Endometrial-Iatrogenic-Not yet classified

Question 45

Treatment of abnormal uterine bleeding

Answer 45

Massive: hospitalization and transfusions, hormones Moderate: combination OCPs, Mirena Unresponsive to conservative therapy: D&C, polypectomy, myomectomy, endometrial ablation, hysterectomy