Dunn OB/GYN X

Question 1

amenorrhea

Answer 1

no menses for 3 cycles

Question 2

17yo F no menses

• cramping monthly with breast tender
• fam hx late menarche
• suprapubic tenderness
• rectal mass

Answer 2

primary amenorrhea

pregnancy test, CBC, US, FSH/LH, E2, karyotype

exam under anesthesia - imperforate hymen**

Question 3

hematocolpos

Answer 3

retained menstruation by imperforate hymen

female who just reached puberty

tx - cup open

Question 4

thelarche

Answer 4

onset of female breast development

Question 5

appearance of sex hair

Answer 5

pubarche

Question 6

onset of axillary and pubic hair, body odor, acne

Answer 6

adrenarche

Question 7

onset of menstruation

Answer 7

menarche

Question 8

tanner stage

Answer 8

1 - prepubertal
to
5 - mature

breast and pubic hair analysis

Question 9

failure to menstruate by age 16

Answer 9

primary amenorrhea

Question 10

secondary amenorrhea

Answer 10

absence of menses 3 cycles or >6 months

more common

Question 11

no secondary sex characteristics

Answer 11

FSH and LH

low -hypogonadotropic gypogonadism

high - karyotype

Question 12

yes secondary sex characteristics

Answer 12

genetic male or female?

female - mullerian anomaly - no uterus - renal issues as well

male - androgen insensitivity - complete vs. partial

Question 13

secondary amenorrhea work up

Answer 13

had menstruation, but then stopped

pituitary and thyroid - normal
-then do progestin challenge

Question 14

causes of primary amenorrhea

Answer 14

constitutional delay
45XO - turner
46XY
pituitary tumor

congenital adrenal hyperplasia**most common cause

second most common cause - Mayer-Rokitansky-Küster-Hauser syndrome

Question 15

webbed neck, amenorrhea

Answer 15

turner syndrome

45X

Question 16

Mayer-Rokitansky-Küster-Hauser syndrome

Answer 16

absent uterus

Question 17

clue to diagnosis of primary amenorrhea

Answer 17

karyotype patient

FSH, LH, PRL levels

Question 18

headache and visual field defect

Answer 18

pituitary tumor

Question 19

diagnosis of primary amenorrhea

Answer 19

height, weight, BP
secondary sex characteristics
look for androgen excess - virilization
visual fields
chromosomes
FSH, LH, E2
hydroxyPROG, androgen, PRL, TSH

Question 20

causes of secondary amenorrhea

Answer 20

stressed - hypothalamic
weight loss/gain - anorexia
post pill
PCO syndrome
premature menopause - idiopathic
hyperPRL
drug induced
pregnancy**
thyroid disease

Question 21

sheehans

Answer 21

infarct pituitary

cause of secondary amenorrhea

Question 22

asherman

Answer 22

adhesions/fibrosis of uterine cavity after D and C

cause of secondary amenorrhea

Question 23

evaluation of secondary amenorrhea

Answer 23

life events
weight/exercise
pregnant
drugs
galactorrhea
hot flashes

PE - height weight BP secondary sex characters

• virsutism/virilization
• cervical stenosis

Question 24

tests for secondary amenorrhea

Answer 24

primary - FSH, LH, E2, TSH PRL, androgens, US, visual fields

secondary - CT pituitary, dexamethasone suppression test, hydroxyPROG

Question 25

32yo LMP 1 month ago, irregular menses - trying to get pregnant 1 year - ruptured appendix, age 14 - smoker

Answer 25

primary infertility endometriosis - subfertility - painful menses

Question 26

peritonitis

Answer 26

tubal issues

Question 27

work up for primary infertility

Answer 27

FSH, LH, progesterone, semen analysis, HSG -diagnostic laparoscopy FSH day 3 progesterone day 22

Question 28

endometriosis

Answer 28

amount present does not predict amount of pain powder burn appearance hemosiderin laden macros

Question 29

endometriosis

Answer 29

endometrium outside the uterus have seen in lungs, bowel, vagina - how did it get there? metaplasia? symptoms do not always correlate to grading**

Question 30

diagnosis of endometriosis

Answer 30

laparoscopy and biopsy -gold standard** careful history US - of little help elevated CA125 - but lacks sensitivity

Question 31

dysmenorrhea, dyspareunia, infertility

Answer 31

triad of endometriosis also - abnormal bleeding - pain with defecation during menses - disordered cycles

Question 32

etiology of endometriosis

Answer 32

retrograde menstruation | peritoneal metaplasia

Question 33

predisposing fx endometriosis

Answer 33

family hx disordered immunity toxins recurrent ovulation

Question 34

management of endometriosis

Answer 34

based on patient pain - medical management infertility - surgical management no problem - no tx

Question 35

medical tx endometriosis

Answer 35

progestins continuous oral contraceptives provera mirena danazol - GnRH suppression -like inducing menopause

Question 36

cochrane conclusions

Answer 36

chinese rectal/herbl medicine - better than danazol - pain and shrinkage of masses auricular acupuncture - pain relief NSAIDs - better than placebo COC as effective GnRH agonist

Question 37

laparoscopy with diathermy

Answer 37

improves infertility and pain surgical burn it off

Question 38

menopause patient on HRT with E2

Answer 38

endometriosis can come back

Question 39

chocolate cyst

Answer 39

ovaries with endometriosis endometrioma

Question 40

12 months sex without contraception

Answer 40

infertility

Question 41

biggest influence on infertility

Answer 41

age of women

Question 42

subfertility

Answer 42

failing to conceive when expect to

Question 43

main causes infertility

Answer 43

``` ovulation issue sperm issue tubal problem cervical problem endometriosis ```

Question 44

patient with regular cycle

Answer 44

ovulating normally

Question 45

test for ovulation

Answer 45

basal body temperature char progesterone - raises temp LH surger in urine endometrial biopsy

Question 46

test for tubal patency

Answer 46

hysterosalpingogram laparoscopy with dye all of these tests potentially therapeutic

Question 47

testing cervical factor

Answer 47

sample of mucous of cervix | -good backup for men who don't want semen sample

Question 48

semen analysis

Answer 48

``` examined 1-2 hours at room temp count >20 mil motility >50% morphology >15% normal repeat if abnormal ```