Dunn OB/GYN XI

Question 1

50yo F LMP 3 weeks ago

• bleeding everyday since last period - 1 pad/day
• irregular periods last year
• hot flashes, fatigue, cranky
• 20 pack years smoker

Answer 1

labs - CBC, TSH, FSH, preg test, pap, endometrial bx

menopausal**

Question 2

tx of menopause

Answer 2

HRT

Question 3

perimenopause

Answer 3

time leading up to menopause

ovarian function and hormone production declining but not stopped

Question 4

menopause

Answer 4

permanent cessation of menstrual cycle

not having period 12 months

Question 5

post menopause

Answer 5

time in womens life after last period

Question 6

premature menopause

Answer 6

before age 40

Question 7

median age perimenopause

Answer 7

47

Question 8

average age reach menopause

Answer 8

51

Question 9

menopause changes

Answer 9

vasomotor sx
sleep quality
mood change
urogenital symptoms
sexual disinterest
skin changes

Question 10

hot flashes

Answer 10

may continue years after menopause

Question 11

with decreased estrogen at menopause

Answer 11

bone loss/osteoporosis - HRT tx (estrogen)

more CV disease

Question 12

decreased progesterone

Answer 12

irregular periods

PMS

Question 13

decreased androgens at menopause

Answer 13

mood
energy
libido
muscle weak
osteopenia

Question 14

HRT

Answer 14

does not increase cardiovascular disease if started within 5 years of menopause

Question 15

risks of HRT

Answer 15

VTE -very low

greatest risk of venous thrombolic events - 1st year of use of HRTs

Question 16

associated with menopause

Answer 16

coronary heart disease
osteoporosis

breast ca, colon ca, dementia

Question 17

coronary artery disease

Answer 17

HRT reduced risk of death

Question 18

age of initiation of HRT

Answer 18

important in determining cardiovascular risk

Question 19

dementia

Answer 19

estrogen taken early in menopause is protective**

Question 20

breast cancer

Answer 20

HRT no different risk - E/P

Question 21

estrogen only hormone therapy

Answer 21

different risk for breast ca

protect against breast ca

unopposed estrogen

Question 22

route of admin

Answer 22

transdermal vs. oral

less VTE - patch use

no CV disease risk difference with two routes of admin

Question 23

mild vasomotor symptoms

Answer 23

lifestyle changs
isoflavones
black cohosh
vit E

Question 24

moderate to severe vasomotor symptoms

Answer 24

HRT - gold standard**
SSRIs and gabapentin
progesterone
clonidine

Question 25

no estrogen

Answer 25

osteoporosis

Question 26

24yo F G0 LMP 3 months ago

• CC irregular periods
• denies pain with menses
• very heavy period
• obese
• fam hx DM II
• acne and virilization
• acanthosis nigricans

Answer 26

amenorrhea with irregular menses

hCG - pregnancy test first
TSH, LH, FSH, PRL
US
androgen levels

string of pearls on US and high testosterone levels

Question 27

acne and virilization with acanthosis nigricans

Answer 27

high androgens

Question 28

string of pearls

Answer 28

PCOS

US finding

Question 29

diagnosis of PCOS

Answer 29

rotterdam criteria - need 2 of 3

oligoovulation/anovulation
excess androgen activity
polycystic ovaries on US

Question 30

PCOS

Answer 30

don’t need an US

-can diagnose clinically

Question 31

PCOS pathology

Answer 31

high levels of testosterone
and estrogen

don’t ovulate - so make estrogen - lots of estrone - increase LH production (positive feedback)

FSH not depressed - follicular growth stimulated

follicules last several month

feedback - LH high and FSH low - no surge

Question 32

causes of PCOS

Answer 32

dont know

maybe insulin
maybe inflammation
maybe genetics
maybe fetal androgen exposure

Question 33

complications of PCOS

Answer 33

abnormal bleeding
infertility
risk endometrial cancer
incrased CRP
metabolic syndrome
DM II, HTN, HLD,

Question 34

tx of PCOS

Answer 34

patient - contraception - give contraception

patient - bleeding - progesterone daily to cause endometrial shedding

patient - hirsutism - oral contraceptive suppress ovarian and adrenal production