Development/Menopause/Contraception

Question 1

Between what ages should females begin puberty?

Answer 1

8 - 13

Question 2

What is the order of puberty for females?

Answer 2

Thelarche
Pubarche
Growth spurt
Menarche

Question 3

Between what ages should females begin menses?

Answer 3

10 - 16

Question 4

Stage 1 puberty

Answer 4

Pre-puberty adolescence

Question 5

Stage 2 puberty

Answer 5

Breast buds + pubic hair

Question 6

Stage 3 puberty

Answer 6

Breast mounds + coarsening of pubic hair

Question 7

Stage 4 puberty

Answer 7

Breast enlarges with raised areola

Question 8

Stage 5 puberty

Answer 8

Adult breast contour with flat areola + pubic hair on the medial thighs

Question 9

What occurs in the Follicular phase of the menstrual cycle?

Answer 9

Increased GnRH –> Increased FSH –> Estrogen production and growth of follicles

Question 10

Day 14 is Ovulation. What occurs?

Answer 10

Estradiol reaches its peak –> LH surge –> rupture of a follicle which releases an ovum and then becomes the corpus luteum

Question 11

After Ovulation, what is the next stage of the menstrual cycle?

Answer 11

Luteal phase

Question 12

During the follicular phase, estradiol dominates. During the luteal phase, progesterone dominates. Why?

Answer 12

Corpus luteum produces progesterone to prepare endometrium for implantation

Question 13

If pregnancy does occur, how long will the corpus luteum produce progesterone? What takes over?

Answer 13

8 weeks
–> Placenta takes over

Question 14

If pregnancy does not occur, the corpus lutuem dies and what happens to the hormone levels?

Answer 14

DROP –> sloughing of the endometrial lining (menses) and the cycle starts over again

Question 15

What defines Precocious Puberty?

Answer 15

Onset of secondary sex characteristics BEFORE 8 years of age

Question 16

What should be done to evaluate Precocious Puberty?

Answer 16

Wrist X-ray to assess bone age

Question 17

If bone age is > 2 years ahead of chronological age, what diagnostics should be pursued?

Answer 17

FSH
LH
Estrogen
Brain/Ovarian studies

Question 18

If DHEAS is high, the etiology is likely where?

Answer 18

Adrenal glands

Question 19

What medication class can be used to treat Precocious Puberty that is not due to another cause?

Answer 19

GnRH Analogs

Question 20

What defines Menopause? When is it considered Premature?

Answer 20

No menses for 12 monthes
– Premature if this occurs before age 40

Question 21

List symptoms of Menopause

Answer 21

• Hot flashes
• Insomnia
• Mood changes and poor concentration
• Vaginal atrophy and dryness
• Low libido

Question 22

What will the levels of FSH and LH be with Menopause?

Answer 22

HIGH

Question 23

When is Hormone Replacement Therapy likely indicated for Menopause?

Answer 23

Vasomotor symptoms

Question 24

With HRT, what is important to know about your patient?

Answer 24

Do they have a Uterus?

Question 25

With HRT, if your patient DOES have a uterus, what should be given?

Answer 25

Estrogen + Progestin

Question 26

With HRT, if your patient does NOT have a uterus, what should be given?

Answer 26

Estrogen only

Question 27

HRT increases risk for what complications? (4)

Answer 27

- Breast cancer - Endometrial cancer - DVT - Cardiovascular mortality

Question 28

List 3 drug/classes that can be used for Menopause?

Answer 28

1. SSRIs/SNRIs 2. Clonidine 3. Gabapentin

Question 29

What can be used for vaginal atrophy, dryness or dyspareunia with Menopause?

Answer 29

Estrogen cream

Question 30

With Menopause, women are at an increased risk for _____ due to low estrogen. What supplements should they be given?

Answer 30

Osteoporosis -- Calcium + Vitamin D

Question 31

If you start Bisphosphonates for Osteoporosis, what are 2 possible complications?

Answer 31

Esophagitis Jaw osteonecrosis

Question 32

When should women be screened with a DEXA scan?

Answer 32

65

Question 33

Nexplanon is a progestin implant in the upper arm. How long does it last? Side effects?

Answer 33

3 years -- irregular periods

Question 34

Progestin IUDs last for how long?

Answer 34

5 years

Question 35

What is the benefit of Progestin only contraceptive methods?

Answer 35

Safe with breastfeeding

Question 36

How long does a Copper IUD last? Side effect?

Answer 36

10 years -- HEAVY bleeding

Question 37

Medroxyprogesterone injections are given how often? What is a complication that is reversible?

Answer 37

q3 months -- Decreases bone mineral density but this is reversible

Question 38

OCPs protect against what cancers?

Answer 38

Endometrial and Ovarian

Question 39

What are contraindications for beginning OCPs?

Answer 39

- Age > 35 + smoker - History of DVT - Migraines with aura - Hypertension - GERD

Question 40

What are contraindications for beginning OCPs?

Answer 40

- Age > 35 + smoker - History of DVT - Migraines with aura - Hypertension - GERD