Menstruation and PMS

Question 1

what is the order of pubertal landmarks?

Answer 1

thelarche (breast budding), pubarche (axillary and pubic hair growth), and menarch (first menses)

Question 2

what is the hormone responsible for the onset of thelarche?

Answer 2

estradiol

Question 3

what is the hormone responsibile for the onset of pubarche?

Answer 3

adrenal hormones

Question 4

what is the hormone responsible for menarche?

Answer 4

estradiol

Question 5

a female of 13 years or older without any breast developement is in deficiency of which hormone?

Answer 5

estrogen

Question 6

what is the etiology behind puberty?

Answer 6

believed to begin with DISINHIBITION of the pulsatile gonadotropin releasing hormone (GnRH) secretion from the hypothalamus

Question 7

at what tanner stage of development is the prepubertal child?

Answer 7

tanner stage 1

Question 8

at what tanner stage of development is the developmental child?

Answer 8

stages 2-4

Question 9

at what tanner stage of development is “adulthood” classified?

Answer 9

stage 5

Question 10

what is the definition of precocious puberty?

Answer 10

appearance of secondary sex characteristics before 8 years of age

Question 11

what is the most common etiology behind precocious puberty?

Answer 11

unknown

Question 12

many follicles are stimulated by FSH but which egg is actually released?

Answer 12

the follicle that secretes more estrogen than androgen

Question 13

in terms of the menstrual cycle what is the pathology behind endometrial sloughing?

Answer 13

withdrawal of progesterone

Question 14

which hormone is responsible for endometrial proliferation?

Answer 14

estrogen

Question 15

which hormone causes the oocyte to be released? (ovulation)

Answer 15

LH surge

Question 16

which hormone is responsible for follicle maturation and estrogen secretion?

Answer 16

FSH

Question 17

during the luteal phase, what is responsible for secreting progesterone? what is the result?

Answer 17

the corpus luteum which causes endometrial maturation and a drop in FSH and LH

Question 18

what is the pathology behind the LH surge?

Answer 18

the dominant follicle releases the most estradiol so that its positive feedback causes an LH surge

Question 19

what is the average length of menses?

Answer 19

4 to 7 days

Question 20

what is average blood loss during mense?

Answer 20

30-50 mL

Question 21

_____ released from the endometrium causes dysmeorrhea

Answer 21

prostaglandins

Question 22

ovulation takes place approximately how many hours after LH surge? after LH peak?

Answer 22

24-36 hours; 12 hours

Question 23

which phase is more variable in nature - follicular or luteal?

Answer 23

follicular (the luteal phase is usually around 11 days due to the length of time the corpus luteum is able to secret progesterone

Question 24

what maintains the corpus lutuem after fertilization?

Answer 24

hCG, released by the embryo

Question 25

what is the start of the follicular phase?

Answer 25

the first day of the menses

Question 26

at the very beginning of menses (the start of the follicular phase) at what levels are the hormones?

Answer 26

they are all very low - and so w/out any negative feedback, GnRH from the hypothalamus causes FSAH release from the pit gland

Question 27

FSH stimulates which cells in the ovary? what is the response?

Answer 27

stimulates maturation of granulosa cells; estrogen secretion

Question 28

as the estradiol levels increase during the follicular phase, what is happening with LH and FSH levels?

Answer 28

estradiol inhibits FSH and LH due to negative feedback

Question 29

which hormone acts on the theca cells to increase secretion of androgens?

Answer 29

LH

Question 30

t or f: androgens are eventually converted to estradiol

Answer 30

TRUE

Question 31

t or f: progesterone causes inhibition of FSH and LH

Answer 31

TRUE

Question 32

symptoms during which phase of the menstrual cycle is classic for PMS?

Answer 32

luteal phase

Question 33

what is the main difference between PMS and PMDD in terms of symptoms?

Answer 33

PMS does NOT impair daily activities

Question 34

when do symptoms go away for PMS/PMDD?

Answer 34

once menses begins - w/in 4 days (this is also a good way to clinically rule out other causes ...IOW if the pt has affective and somatic complaints that go away with menses) - pts are adviced to keep a prospective sx diary for two months

Question 35

t or f: PMDD/PMS can be diagnosed after one cycle

Answer 35

FALSE; must be after two prospectively monitor cycles

Question 36

what is the therapy with most evidence for effectiveness for PMS/PMDD?

Answer 36

SSRI and ovulation blocking agents

Question 37

t or f: calcium with help to relive PMS/PMDD symptoms

Answer 37

TRUE

Question 38

what medication can be given for SEVERE PMS?

Answer 38

GnRH agonists