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RDS Test 1 > B8-062 CBCL Female Missed Period > Flashcards

B8-062 CBCL Female Missed Period Flashcards

(83 cards)

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1
Q

[…] withdrawal leads to the bleeding and sloughing of endometrial tissue

A

progesterone

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2
Q

in hypergonadotrophic hypogonadism, FSH and LH levels are […]

A

normal

(ovary is not responding to produce estrogen/progesterone)

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3
Q

in hypogonadotropic hypogonadism, FSH and LH levels are […]

A

both low

(leads to insufficient estradiol/progesterone production in the ovaries)

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4
Q

how does elevated cortisol due to stress cause primary hypothyroidism?

A

decreased TRH and TSH
and inhibits the conversion of T4 to T3

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5
Q

how does stress impact the menstrual cycle and cause anemorrhea?

A

stress stimulates PVN in hypothalamus to increase CRH synthesis

CRH –> ACTH –> cortisol

Cortisol inhibits GnRH release —> decreased FSH –> decreased estrogen

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6
Q

how does hypothyroidism impact the menstrual cycle leading to amenorrhea?

A

low T3/T3 stimulates TRH release
TRH stimulates prolactin release
Prolactin stimulates CRH release
CRH inhibits GnRH release

–> decreased FSH —> decreased estrogen

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7
Q

how does hyperthyroidism impact the menstrual cycle leading to amenorrhea?

A

high T3/4 triggers SHBG
SHBG binds circulating estrogen
reduced free estrogen

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8
Q

how does starvation impact the menstrual cycle leading to amenorrhea?

A

reduced caloric intake –> reduced adipose mass –> reduced leptin

reduced leptin —> reduced kisspeptin –> reduced GnRH release

reduced GnRH –> reduced FSH –> reduced estrogen

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9
Q

reduced leptin and elevated FGF21 from the liver causes reduced […]

A

kisspeptin

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10
Q

2 causes of hyperprolactemia causing amenorrhea

A

pregnancy
breast feeding

(elevated prolactin inhibits GnRH)

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11
Q

what hormones are responsible for breast development? [2]

A

estrogen
progesterone

(from ovary, can be used to determine cause if one stage of Tanner development lags behind another)

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12
Q

what hormones are responsible for pubic hair development? [2]

A

androgens
DHEA

(from adrenal gland, can be used to determine cause if one stage of Tanner development lags behind another)

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13
Q

major causes of amenorrhea [6]

A

outflow obstruction
POI
pituitary
hypothalamic
physiologic
endocrine

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14
Q

medication classes that can cause amenorrhea [3]

A

antidepressants
antipsychotics
opiates

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15
Q

[what Tanner stage]
no pubic hair
flat chest with raised nipple

A

Stage 1 prepubescent

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16
Q

[what Tanner stage]
pubic hair appears
breast bud forms

A

Stage 2 (8-11.5 years)

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17
Q

[what Tanner stage]
coarsening of pubic hair
breast enlarges

A

Stage 3 (11.5-13 years)

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18
Q

[what Tanner stage]
coarse hair across pubis, sparing thigh
breast enlarges, raised areola

A

Stage 4 (13-15 years)

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19
Q

[what Tanner stage]
coarse hair across pubis and medial thigh
adult breast contour, areola flattens

A

Stage 5 (over 15 years)

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20
Q

in what Tanner stage do 2/3 of female reach menarche?

A

stage 4

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21
Q

definition of primary amenorrhea

A

no menarche by age 14 in the absence of pubertal development
OR
no menarche by 16 regardless of pubertal development

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22
Q

inadequate release of LH and FSH from the pituitary

A

hypogonadotropic hypogonadism

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23
Q

inadequate ovarian response to gonadotropins

A

hypergonadotropic hypogonadism

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24
Q

growth parameters important to assess in evaluation of primary amenorrhea [2]

A

BMI
short stature

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25
absent breast development indicates inadequate [...] production
estrogen
26
absence of uterus is caused by [2]
abnormal Mullerian development XY karyotype
27
presence of uterus and breast with primary amenorrhea suggests [2]
obstruction of menstrual flow HPO axis problems
28
what hormone levels are evaluated in primary amenorrhea?
androgens thyroid prolactin
29
treatment of hyper/hypogonadotropic hypogonadism
estrogen & progesterone therapy
30
absence of menses for > 6 months in previously menstruating female
secondary amenorrhea
31
secondary amenorrhea is generally caused by
disruption of HPO axis
32
clitoromegaly can result from excess
androgens
33
organic causes of secondary amenorrhea [5]
prolactinoma hyper/hypothyroidism PCOS late onset congenital adrenal hyperplasia virilizing tumors
34
what is considered a positive response to a progesterone challenge test?
bleeding that occurs within 2 weeks after progestin is given usually occurs within 2-7 days (more than light spotting)
35
what does positive response to a progesterone challenge test mean?
patient likely has anovulation consider PCOS
36
what does negative response to a progesterone challenge test mean?
consider HPO axis or obstructive problem
37
treatment for PCOS
oral contraception (restores regular menses, decreases testosterone, and protects against endometrial hyperplasia)
38
most common site of implantation in ectopic pregnancy?
ampulla
39
risk factors for ectopic pregnancy
tubal pathologies (scarring, PID) previous ectopic pregnancy IUD IVF
40
implantation of the fertilized ovum in a site other than the uterus
ectopic pregnancy
41
suspect in patients with history of amenorrhea and lower than expected rise in hCG
ectopic pregnancy
42
diagnosis of ectopic pregnancy can be confirmed via
ultrasound
43
treatment for ectopic pregnancy
methotrexate (unruptured) surgery (ruptured)
44
ectopic pregnancy implanted in the [...] presents the highest risk of tubal rupture
isthmus
45
spontaneous abortion in the first trimester is most often caused by
chromosomal abnormalities
46
the process of menstruation is brought about by what hormonal change?
decreased progesterone
47
estrogen and progesteron stimulate [...] development
breast
48
androgens and DHEA stimulate [...] development
pubic hair
49
the most common cause of amenorrhea in women of child bearing age
pregnancy
50
primary amenorrhea in patients without secondary sex characteristics is typically due to
anovulation
51
[...] replacement therapy may be effective for female athletes suffering from hypothalamic amenorrhea
leptin
52
primary amenorrhea due to absence of the uterus is most likely a result of [2]
abnormal Mullerian development XY karyotype
53
first line therapy in treating female athletes with hypothalamic dysregulation
modification of diet/exercise
54
a prolactinoma would cause [...] prolactin and [...] estrogen levels
high prolactin low estrogen
55
a positive progesterone challenge test indicates a likely [...] problem
anovulation
56
elevated levels of TRH lead to [...] levels of prolactin
elevated
57
prolactin inhibits [...] production by the hypothalamus
GnRH
58
classic clinical triad for ectopic pregnancy
abdominal pain amenorrhea vaginal bleeding
59
MOA of methotrexate
deplete embryo of folic acid (stops growth)
60
in the case of inevitable SAB/misscarriage, the cervix would be [...] and the POC passage would be [...]
open retained
61
in the case of missed SAB/misscarriage, the cervix would be [...] and the POC passage would be [...]
closed retained
62
in the case of incomplete SAB/misscarriage, the cervix would be [...] and the POC passage would be [...]
open partially passed
63
testes present, but external genitalia is feminized or atypical
46, XY androgen insensitivity syndrome | gonadal dysgenesis
64
female appearing genetic male (46, XY) is most commonly due to
androgen insensitivity syndrome
65
ovaries replaced by fibrous tissue no ovarian estrogen secretion | (streak ovary)
turner syndrome (45, XO)
66
external female genitalia, uterus, and fallopian tubes develop normally until puberty when estrogen induced maturation fails
turner syndrome (45, XO)
67
acquired condition of having scar tissue in the uterus or cervix which impedes menstruation
Asherman's syndrome
68
how does hypothyroidism cause galactorrhea?
low T4 and T3 lead to increased TRH and prolactin increased prolactin causes excess milk production
69
insomnia, mood swings, and weight loss are symptoms associated with
hyperthyroidism
70
how does hyperthyroidism cause amenorrhea?
increased T3/4 increase hepatic production of SHBG reduces amount of biologically active estrogen
71
b-hCG leves should double every [...] hours in pregnancy
48
72
corticosteroids inhibit [...] which causes amenorrhea
GnRH
73
hypogonadotrophic hypogonadism is characterized by [...] E2 and [...] FSH
low low
74
how does stress cause amenorrhea?
stress increases CRH which increases ACTH and cortisol cortisol decreases GnRH and FSH/LH
75
untreated imperforate hymen may lead to the development of
endometriosis
76
most common symptoms of imperforate hymen
abdominal pain cramping
77
patients on dopamine antagonists can experience hyper[...]
hyperprolactinemia (above 25 ng/ml)
78
scaring/adhesion within the uterus/endometrium often caused by procedures such as D&C or untreated STI
asherman's syndrome
79
breastfeeding stimulates [...] release, leading to amenorrhea
prolactin
80
grave's disease and hyperthyroidism are characterized by [...] TSH and [...] free T4
low TSH high free T4
81
anti-psychotics increase prolactin by blocking [...] production
dopamine
82
risk factors for ectopic pregnancy
GYN surgery smoking PID or other scarring prenatal exposure to DES
83
high levels of [...] during pregnancy prevent menstruation
progesterone

RDS Test 1 (23 decks)

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