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COMLEX PE > Amenorrhea > Flashcards

Amenorrhea Flashcards

1
Q

What key history would you obtain from a patient who complains of amenorrhea?

A

Primary vs. secondary
Duration
Possible pregnancy
ASSOCIATED SYMPTOMS (headache, decreased peripheral vision, galactorrhea, hirsuitism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease)
History of anorexia nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs uterine infections
Drug use
Medications

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2
Q

What key physical exams would you perform on a patient who complains of amenorrhea?

A

Vital signs
Breast exam
Complete pelvic exam

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3
Q

40 yo F presents with amenorrhea, morning nausea and vomiting, fatigue and polyuria. Her last menstrual period was six weeks ago and her breasts are full and tender. She uses the rhythm method for contraception. Differentials?

A 
Pregnancy
Anovulatory cycle
Hyperprolactinemia
UTI
Thyroid disease
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4
Q

40 yo F presents with amenorrhea, morning nausea and vomiting, fatigue and polyuria. Her last menstrual period was six weeks ago and her breasts are full and tender. She uses the rhythm method for contraception. Differentials: pregnancy, anovulatory cycle, hyperprolactinemia, UTI, thyroid disease. Workup?

A 
Pelvic exam
Urine hCG
U/S - pelvis
CBC, electrolytes
UA, urine culture
Prolactin
TSH
Baseline Pap smear, cervical culture, rubella antibody, HIV antibody, hepatitis B surface antigen, and VDRL/RPR
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5
Q

23 yo obese F presents with amenorrhea for six months, facial hair and infertility for the past three years. Differentials?

A 
Polycystic ovary syndrome
Thyroid disease
Hyperprolactinemia
Pregnancy
Ovarian or adrenal malignancy
Premature ovarian failure
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6
Q

23 yo obese F presents with amenorrhea for six months, facial hair and infertility for the past three years. Differentials: polycystic ovary syndrome, thyroid disease, hyperprolactinemia, pregnancy, ovarian or adrenal malignancy, premature ovarian failure. Workup?

A 
Pelvic exam
Urine hCG
Prolactin
LH/FSH
TSH
MRI - brain
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7
Q

35 yo F presents with amenorrhea, galactorrhea, visual field defects and headaches for the past six months. Differentials?

A 
Amenorrhea secondary to a prolactinoma (cabergoline -1st; bromocriptine - 2nd)
Pregnancy
Thyroid disease
Premature ovarian failure
Pituitary tumor
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8
Q

35 yo F presents with amenorrhea, galactorrhea, visual field defects and headaches for the past six months. Differentials: amenorrhea secondary to a prolactinoma, pregnancy, thyroid disease, premature ovarian failure, pituitary tumor. Workup?

A 
Pelvic and breast exam
Urine hCG
Prolactin
LH/FSH
TSH
MRI - brain
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9
Q

48 yo F presents with amenorrhea for the past six months accompanied by hot flashes, night sweats, emotional lability, and dyspareunia. Differentials?

A

Menopause
Pregnancy
Pituitary tumor
Thyroid disease

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10
Q

48 yo F presents with amenorrhea for the past six months accompanied by hot flashes, night sweats, emotional lability, and dyspareunia. Differentials: menopause, pregnancy, pituitary tumor, thyroid disease. Workup?

A 
Pelvic exam
Urine hCG
LH/FSH
TSH
Prolactin, testosterone, DHEAS
CBC
MRI - brain
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11
Q

35 yo F presents with amenorrhea, cold intolerance, coarse hair, weight loss and fatigue. She has a history of abruptio placentae followed by hypovolemic shock and failure of lactation two years ago. Differentials?

A 
Sheehan's syndrome
Premature ovarian failure
Pituitary tumor
Thyroid disease
Asherman's syndrome
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12
Q

35 yo F presents with amenorrhea, cold intolerance, coarse hair, weight loss and fatigue. She has a history of abruptio placentae followed by hypovolemic shock and failure of lactation two years ago. Differentials: Sheehan’s syndrome, premature ovarian failure, pituitary tumor, thyroid disease, Asherman’s syndrome. Workup?

A 
Pelvic exam
Urine hCG
CBC
LH/FSH
Prolactin
TSH, FT4
ACTH
MRI - brain
Hysteroscopy
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13
Q

18 yo F presents with amenorrhea for the past four months. She has lost 95 pounds and has a history of vigorous exercise and cold intolerance. Differentials?

A

Anorexia nervosa

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14
Q

18 yo F presents with amenorrhea for the past four months. She has lost 95 pounds and has a history of vigorous exercise and cold intolerance. Differentials: anorexia nervosa. Workup?

A

CBC
TSH, FT4
ACTH
FSH/LH

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15
Q

29 yo F presents with amenorrhea for the past six months. She has a history of occasional palpitations and dizziness. She lost her fiance in a car accident. Differentials?

A

Anxiety-induced amenorrhea

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16
Q

29 yo F presents with amenorrhea for the past six months. She has a history of occasional palpitations and dizziness. She lost her fiance in a car accident. Differentials: anxiety-induced amenorrhea. Workup?

A 
CBC
TSH, FT4
ACTH
Urine cortisol level
Progesterone challenge test
FSH/LH/estradiol levels

COMLEX PE (34 decks)

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