Menstrual Cycle

Question 1

Primary amenorrhea

Answer 1

No menarche at 15 yrs despite nrml 2nd sexual characteristics

Or

No menarche at 13 plus no 2nd sexual characteristics

Question 2

FSH stimulates?

Answer 2

Granulosa cells to prod progesterone & androstenedione

Question 3

FSH inhibition by?

Answer 3

(Negative feedback) -Inhibin B & estradiol

Question 4

In the menstrual cycle LH surge due to?

Answer 4

Positive feedback (estradiol secreted by maturing follicle)

Question 5

Normal menstrual cycle length

Answer 5

24 - 38 days

Question 6

Menses duration and blood loss?

Answer 6

3-7 days

35 - 50 ml

Question 7

Follicular phase?

Answer 7

Day 1 - 14

Question 8

Fate of Graffian follicle

Answer 8

Corpus Luteum

Question 9

Length of Luteal phase

Answer 9

14-15 days

Question 10

Primary dysmenorrhea

Answer 10

Lower abdominal/before or during menses

Absence of pathological findings

Question 11

Primary dysmenorrhea diagnosis?

Answer 11

Diagnosis of exclusion

Question 12

1mry dysmenorrhea treatment?

Answer 12

• NSAIDS

- hormonal contraceptives (COCP, IUD w/levonorgestrel)

Question 13

Uterine causes of 2ndry dysmenorrhea?

Answer 13

-PID
-IUD
-Adenomyosis
•Leiomyoma
•Cervical Polyps

Question 14

Extrauterine causes of 2ndry dysmenorrhea?

Answer 14

-ENDOMETRIOSIS
- Adhesions
- functional ovarian cyst
•IBD

Question 15

Causes of Primary Amenorrhea

Answer 15

• Constitutional Growth delay
• Hypogonadotrophic hypogonadism
• Hypergonadotrophic hypohonadism
  •Anatomic anomalies
  •receptor enzyme abnormalities

Question 16

Deficient GnRH syndromes

Answer 16

• Kallmann syndrome (anosmia)
• Prader willi syndrome (hyperphagia)
• Stress/sports eating disorders
-CNS tumors (craniopharyngioma)

Question 17

Most common cause of 1ry amenorrhea

Answer 17

Gonadal dysgenesis

• Turner syndrome 45X0
• Swyer syndrome
• 46XY gonadal dysgen

Question 18

Anatomic anomalies causing 1mry amenorrhea?

Answer 18

-Mulerian agenesis
- Imperforate Hymen
-Vaginal atresia
•Transverse vaginal Hymen

Question 19

Receptor enzyme abnormalities causing 1mry amenorrhea?

Answer 19

• Complete androgen insensitivity syndrome
• 5 alpha reductase deficiency
• Congenital adrenal hyperplasia (17alpha hydrolase deficiency)

Question 20

Abnormal lab result in primary ovarian insufficiency (hypergonadotrophic)

Answer 20

Elevated FSH

Question 21

Lab finding in androgen secreting tumor?

Answer 21

Elevated dehydroepiandrosterone sulfate (DHEA-S)

Question 22

Congenital adrenal hyperplasia clinical finding?

Answer 22

High blood pressure

Question 23

2ndry amenorrhea definition

Answer 23

Regular cycle: Absent menses for > 3 months

Irregular cycle: Absent menses for > 6 months

Question 24

Most common cause of 2ndry amenorrhea?

Answer 24

Pregnancy

Question 25

Medications causing amenorrhea?

Answer 25

* antipsychotics * chemo * OCP

Question 26

Pathology of hypothyroid amenorrhea?

Answer 26

dec. T3/T4 — ^TRH — ^Prolactin — dec. GnRH — dec. Estrogen

Question 27

Syndromes causing 2ndry amenorrhea?

Answer 27

• Sheehan syndrome (ischemia) • Asherman syndrome • Cushing syndrome - Adrenal insufficiency

Question 28

Functional hypothalamic amenorrhea? Etiologies?

Answer 28

Dysfunction in pulsatile secretion of GnRH * excess exercise * reduced calorie intake * stress * Female athlete triad syndrome*

Question 29

``` Cause of.. • Menstrual dysfunction • Decreased bone density • Calorie deficit in Athletic adolescent? ```

Answer 29

Female athlete triad syndrome | (dec. Leptin / increased Cortisol)

Question 30

Medical tax for prolactinoma? Mechanism of drug?

Answer 30

* Bromocriptine * Cabergoline D2 agonist

Question 31

Structural causes of AUB

Answer 31

* Polyps * Adenomyosis * Leiomyomas * Malignancy and hyperplasia

Question 32

Non-structural causes of AUB

Answer 32

* Coagulopathies * Ovulation disorders * Endometrial disorders * Iatrogenic * Not otherwise classified

Question 33

Chronic AUB definition

Answer 33

Uterine bleed of abnormal frequency, regularity and or volume for > 6 months

Question 34

Initial laboratory tests in AUB and reason

Answer 34

•CBC (rule out anemia) •Beta hCG (r/o pregnancy) •PT, PTT (r/o coauglopathy) -TFT’s

Question 35

Indications for endometrial biopsy in AUB

Answer 35

* Endometrial thickness >4mm * >45y with freq. heavy/ prolonged bleed * < 45y, freq. heavy/prolonged bleed + risk of endometrial Ca. - Obesity - T2 DM - PCOS - tamoxifen therapy - Lynch syndrome

Question 36

Tx of acute AUB | Hemodynamically stable

Answer 36

High dose IV conjugated estrogen Or OCP, progestin, tranexamic acid (2nd line)

Question 37

Non surgical tx of ovulatatory bleeding

Answer 37

* OCP’s, progestin * NSAID * Transxamic acid

Question 38

Surgical tx options for AUB

Answer 38

* D&C * Endometrial Ablation * Transcatheter uterine artery embolizatiom (first line in AVM) - Hysteroscopy (polyps) - Hysterectomy

Question 39

First line tx of PMS

Answer 39

NSAIDS (napronex) | OCP’s