Menstrual irregularities

Question 1

Age of pt w/ Primary amenorrhea in the absence of breast bud

Answer 1

14 y/o

Question 2

Age of primary amenorrhea w/ breast

Answer 2

16 y/o

Question 3

Secondary amenorrhea: No menses for ___ mos if prev menses were regular

Answer 3

3

Question 4

Secondary amenorrhea: No menses for ___ mos if prev menses were irregular

Answer 4

6

Question 5

Absent breast

Present uterus

Answer 5

hypo/hypergonadotropic hypogonadism

Question 6

Isolated gonadotropin (GnRH) deficiency assoc w/ anosmia

Answer 6

Kallman’s syndrome

Question 7

Give an example of a condition involving hypergonadotropic hypogonadism

Answer 7

Turner syndrome

Premature ovarian failure

Question 8

Cessation of ovarian fx before 40 y/o

Answer 8

Premature ovarian failure

Question 9

Tx for AUB secondary to Turner syndrome

Answer 9

Estrogen therapy w/ cyclic progestin

Question 10

Failure of ovaries to respond to FSH and LH secondary to receptor defect

Answer 10

Savage syndrome/ ovarian resistance syndrome

Question 11

46 XX, present breast, absent uterus

Answer 11

Mullerian agenesis

/ Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

Question 12

46 XY, present breast, absent uterus

Answer 12

Androgen insensitivity

/testicular feminization

Question 13

At what age should the gonads be removed in a patient with androgen insensitivity to prevent malignant transformation?

Answer 13

18 y/o

Question 14

Cause of absent uterus in MRKH syndrome?

Answer 14

Failure of mullerian duct formation

Question 15

Cause of absent uterus in androgen insensitivity

Answer 15

Mullerian inhibiting factor

Question 16

Outflow tract abN in w/c the hymen fails to canalize

PE: bulging membranes w/ hematocolpos, cyclical abd and pelvic pain

Answer 16

Imperforate hymen

Question 17

Outflow tract abN in w/c the mullerian duct fails to fuse with the urogenital sinus

Answer 17

Transvaginal septum

Question 18

25% of patients with breast but without uterus has…

Answer 18

hyperprolactinemia and prolactinomas

Question 19

Triad of PCOS

Answer 19

Hirsutism
Ammenorhea
Obesity

Question 20

Expected lab finding of LH and FSH in PCOS

Answer 20

Inc LH (Androgens inhibit negative feedback)
Dec FSH

Question 21

Increase in LH that acts on theca cells may produce ___ in PCOS

Answer 21

Hirsutism

Question 22

AACE 2015 Diagnostic criteria for PCOS

Answer 22

Chronic anovulation
Hyperandrogenism
Polycystic ovaries (>12 cysts)

Question 23

1st line monotherapy for adolescent girls with PCOS

Answer 23

Metformin

Question 24

Pituitary necrosis secondary to hypotensive episode during pregnancy

Answer 24

Sheehan’s syndrome

Question 25

Pituitary cell destruction unrelated to pregnancy

Answer 25

Simmond’s Disease

Question 26

Most frequent antecedent factor in Asherman’s syndrome

Answer 26

Endometrial currettage

Question 27

Withdrawal bleeding w/in 7 days from progesterone challenge test is due to…

Answer 27

anovulation

Question 28

Next dx test to order upon (+) withdrawal bleeding from progesterone challenge test

Answer 28

Prolactin and TSH

Consider prolactinoma and hypothyroidism

Question 29

Next dx test to order after (-) withdrawal bleeding from progesterone challenge test

Answer 29

Estrogen-progesterone challenge test

Question 30

(+) EPCT, high FSH

Answer 30

Ovarian failure

Question 31

(+) EPCT, low FSH

Answer 31

HP failure

Question 32

(-) EPCT

Answer 32

Outflow tract obstruction
Cervical stenosis
Endometrial adhesions

Question 33

Pathology of primary dysmenmorrhea

Answer 33

Prostaglandin F2a