OBGYN- Amenorrhea

Question 1

Define Amenorhea

Answer 1

Amenorrhea is the absence or cessation of menstruation

Question 2

types of amenorhea

Answer 2

Primary
secondary

Question 3

Define Primary Amenorrhea

Answer 3

Primary amenorrhea is defined as no menses by age 14 years associated with the absence of the development of secondary sexual characteristics,

or no menses by age 16 years even in the presence of normal secondary sexual characteristics

Question 4

Define secondary amenorrhea

Answer 4

Secondary amenorrhea is defined as the absence of menses for a period of three cycles, or 6 months in a woman with previously normal menstruation

Question 5

Cause of primary amenorrhea?

Answer 5

Primary amenorrhea is often caused by chromosomal irregularities that lead to ovarian insufficiency (e.g., Turner syndrome) or anatomic abnormalities (e.g., Müllerian agenesis).

Disorders arising from the hypothalamus, anterior pituitary, ovary, and genital tract make up the pathological causes of amenorrhea.

extreme weight loss or gain

Question 6

why amenorhea during lactation ?

Answer 6

In the case of lactation, milk production r_elies on a rise in prolactin_, which inhibits GnRH release thereby preventing normal ovarian stimulation.

Question 7

impairement of the GnRH pulsatile secretion occurs form ———————————————————-

Answer 7

reversible condition such as weight loss related amenorrhea, exercise related amenorhea. This cause functional hypothalamic amenrhea

Question 8

What is functional hypothalamic amenorhea?

Answer 8

low /normal level of FSH and LH; and low estrogen

normal prolactin level

normal imaging of the pituitary foss

Question 9

Mensturation is regulated by

Answer 9

healthy level of fat- healthy body

Question 10

Who are mostly impacted by

Answer 10

Calorie restricted diet

athlete ( strenous activities

Question 11

Athlete women are risk for———————-

Answer 11

disordered eating

amenorhea

osteoporosis

Question 12

Most common pathological cause of secondary amenorhea

Answer 12

result of PCOS

hypothalamic amenorhea

hyperprolactinemia

primary ovarian insufficiency

Question 13

PITUITARY DISODER- High leve of prolacti level in pituitary cause

Answer 13

secondary amenoreah

Question 14

tumors in anterior pituitary gland cause high prolactin level and —————————————

Answer 14

galactorreha

Question 15

medication that increase prolactin level are——————————

Answer 15

antihistamine

phenothiazide

methyl dopa

metoclopromide

cimetidine

Question 16

Sheehan’s syndrome

Answer 16

necrosis of anterior pituitary gland

Question 17

OVARIAN DISORDER- Premature ovarian failure is defined as?

Answer 17

cessation of ovarian function before the age of 40 years

Question 18

Characterstics of POF are

Answer 18

amenorhea

increased gonadotropin level

Question 19

Polycystic ovary syndrome - Ultrasound

Answer 19

enlarged ovaries with fluid filled

Question 20

what are elevated and decreased in PCOS?

Answer 20

Elevated- ——- LH, Testosterone, androstetenedione and dehydroepiasndrosterone, prolactine level

normal—————— Estrogen and FSH are normal

Question 21

Hallmark of PCOS

Answer 21

Androgen biosynthesis

insulin resistance

Question 22

How PCOS is diagnosed?

Answer 22

Should have 2/3 criteria

1. light or irregular menses
2. Evidence of hyperandrogenism
3. cysctic appearing in US examination

Question 23

Asherman’s syndrome

Answer 23

Post partum hemorrhage leading to curatage/ dialattion that cause scaring to endometrium. This leads to amenorhea

Question 24

Hidden menstruation

Answer 24

Cervical stenosis that blocks the menstrual flow.

Question 25

cause of cervical stenosis

Answer 25

1. infection
2. Imperate hymen
3. transverse vaginal septum

Question 26

Headache with galactorhea and visual disturbance is —————-

Answer 26

pituitary tumor

Question 27

Cyclic abdominal pain without menstruation can be diagnosed as - —-

Answer 27

imperforate hymen

Question 28

Amenorehea with Truncal obesity ( abdominal fat) and Increased BMI is diagnosed

Answer 28

Cushing syndrome

PCOS

Question 29

hirsutism, acanthosis nigricans, acne

2. Purple strae
3. webbed neck, widely spaced nipple or short stature

Answer 29

PCOS

2. Cushing syndrome
3. Turner syndrome

Question 30

Wowen physical examination indicate hyperadrogenic state, what labs should you order

Answer 30

Orderfree and total testosterone and DHEA concentration

Question 31

diagnostic test for amenorhea

Answer 31

1. Progestational challenge test

Question 32

why progestational challenge test

Answer 32

1. To evaluate the endogenous estrogen present
2. to assess outflow tract abnormalities

Question 33

How progesterone challenge test is done?

Answer 33

The progesterone challenge test is done by giving oral medroxyprogesterone acetate (Provera) 10 mg daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil. A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given.

Question 34

If there is no bleeding after progesterone test, what it is?

Answer 34

outlflow problem and inadequate estrogen production

Question 35

Step 2 diagnostic wok up

Answer 35

administering second round of estorgen/progestin challenge tets.

Question 36

what is estrogen/progestin challeneg test

Adminitering estrogen/progestin— if bleed what is that?

Answer 36

problem with either HPO axis or ovary

Question 37

what is estrogen/progestin challeneg test

Adminitering estrogen/progestin— if does not what is that?

Answer 37

Problem with HPO axis or Ovary

Question 38

STEP 3- What diagnostic test is done?

Answer 38

The gonadotropin assay ( FSH and LH ) is drawn and sent fro laboratory analyiss