Naz teaches Amenorrhea Flashcards Preview

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Flashcards in Naz teaches Amenorrhea Deck (38):
1

What defines amenorrhea

No period for 3 cycles.
OR 6 months

2

Primary amenorrhea is ?

the absence of menarche by age 16 or 4 years after thelarche.

3

_______ is the onset of female breast development.

Thelarche

4

_________ is the onset of androgen-dependent body changes such as growth of axillary and pubic hair, body odor, and acne.

Adrenarche

5

______ is the appearance of pubic hair.

Pubarche

6

Etiologies of Primary Amenorrhea
Outflow tract abnormalities

Imperforate hymen
Transverse vaginal septum
Vaginal agenesis
Vaginal atresia
Testicular feminization
Uterine agenesis with vaginal dysgenesis
MRKH syndrome

7

Etiologies of Primary Amenorrhea
End-organ disorders

-Ovarian agenesis
-Gonadal agenesis 46,XX
-Swyer syndrome/gonadal agenesis 46,XY
-Ovarian failure
-Enzymatic defects leading to decreased steroid biosynthesis
-Savage syndrome—ovary fails to respond to FSH and LH
-Turner syndrome

8

Etiologies of Primary Amenorrhea
Central disorders

Trauma
Tuberculosis
Sarcoidosis
Irradiation
Kallmann syndrome—congenital absence of GnRH
Pituitary
Damage from surgery or radiation therapy
Hemosiderosis deposition of iron in pituitary
Hypothalamic
Local tumor

9

Swyer syndrome/gonadal agenesis 46,XY is?

congenital absence of the testes in an XY, testes never develop, have normal internal and external female genitalia.
NO estrogen--> will not develop breasts.

phenotypical picture similar to that of ovarian agenesis.

10

Mayer-Rokitansky-Küster-Hauser syndrome is?

it is Müllerian agenesis

They may have
complete vaginal agenesis and absence of a uterus or partial
vaginal agenesis with a rudimentary uterus and distal vagina.

11

"female" without uterus and Amenorrhea

Karyotype:
testicular feminization,
Müllerian agenesis,
46,XY steroid enzyme defects,
pure gonadal dysgenesis, or anorchia

12

androgen insensitivity vs mullerian agenesis

androgen insensitivity will have no pubic hair (they do have testes so go cut em out)

both have blind pouch vagina and breasts

13

Vaginal atresia is?

where the Müllerian system is developed but the distal vagina is composed of fibrosed tissue.

14

Describe progesterone challenge

progesterone or oral medroxyprogesterone acetate given.

If sufficient serum estradiol (greater than 50 pg/mL), withdrawal bleeding 2-7 days after the progestin is withdrawn, indicating that the patient's amenorrhea is due to anovulation.

If no bleeding occurs after withdrawal, then the patient's amenorrhea is likely to be due to either a) low serum estradiol, b) hypothalamic-pituitary axis dysfunction, c) a nonreactive endometrium or d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae

15

If no bleeding occurs after progesterone challenge withdrawal, then the patient's amenorrhea is likely to be due to either ?

a) low serum estradiol
b) hypothalamic-pituitary axis dysfunction
c) a nonreactive endometrium
d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae

16

Patients with hyperprolactinemia require rx?

bromocriptine

17

With progesterone challenge failure, the differential diagnosis becomes:

hypergonadotropic or hypogonadotropic hypogonadism
that can be differentiated by an FSH measurement.

18

Anatomic abnormalities including Asherman syndrome and cervical stenosis may lead to secondary amenorrhea. These patients
_________ to estrogen and progesterone withdrawal.

fail to respond to estrogen and progesterone withdrawal.

19

In the absence of breasts and presence of a uterus, FSH will differentiate between

hypergonadotropic and hypogonadotropic
hypogonadism. Karyotype may be necessary to rule out gonadal agenesis in a 46,XY.

20

The causes of hypothalamic-pituitary amenorrhea are:

-functional (weight loss, obesity, excessive exercise)
-drugs (marijuana and tranquilizers)
-neoplasia (pituitary adenomas)
-psychogenic (chronic anxiety and anorexia nervosa)

21

PCOS cancer risks

unopposed estrogen exposure that accompanies women with PCOS, these individuals carry a higher risk of developing endometrial hyperplasia and cancer.

PCOS is considered to increase the risk of ovarian cancer.

22

PCOS labs

Testosterone levels will be helpful to confirm the diagnosis

An increased LH/FSH ratio is observed to be elevated in PCOS

progesterone levels are helpful during medical treatment to check if the woman is ovulating.

23

____________ are the first-line of treatment for ovulatory dysfunction in PCOS patients.

Metformin and ovulation induction agents

24

what is imipramine.

TCA
s/e= hyperprolactinemia

25

exercise-induced hypothalamic amenorrhea, which is characterized by ____ (labs)

normal FSH and low estrogen levels

26

A clomiphene challenge test, which consists of ?0,

giving clomiphene citrate days five to nine of the menstrual cycle and checking FSH levels on day three and day 10

27

When do you have sex if you want a baby

The day you ovulate
egg is good for 24 hours
sperm are good for 3 days

Women are most fertile during the middle of their cycle when they are ovulating. Assuming normal cycles every 28 days, a woman is most likely to ovulate on day 14.

28

Women are most fertile during the middle of their cycle when they are ovulating. Assuming normal cycles every 28 days, a woman is most likely to ovulate on day ____?

14 of her cycle

29

Women aged 21-29 years should have a Pap test every ?

three years.

30

Women aged 30-65 years should have a Pap test and an HPV test (co-testing) every ___________

every five years (preferred). It is acceptable to have a Pap test alone every three years.

31

Women should stop having cervical cancer screening when?

-after age 65 years
-if no hx of dysplasia/ cancer
-three negative Pap test results in a row or...
-two negative co-test results in a row within the past 10 years,
need to meet all criteria

32

The major symptom associated with myomas is ?

menorrhagia,
1) ↑ uterine cavity size that leads to greater surface area for endometrial sloughing;
2) an obstructive effect on uterine vasculature that leads to endometrial venule ectasia and proximal congestion in the myometrium/endometrium resulting in hypermenorrhea.

*Most uterine fibroids are asymptomatic and do not require any treatment.

33

___________ myomas are most likely to cause lower pregnancy and implantation rates.

Submucosal or intracavitary

34

Growth of uterine fibroids is stimulated by _________

estrogen

35

________________ inhibit endogenous estrogen production by suppressing the hypothalamic-pituitary-ovarian axis. They can result in a 40-60% reduction in uterine size.

Gonadotropin-releasing hormone agonists

Hot flashes are experienced by >75% of patients

36

abnormally heavy bleeding at menstruation

Menorrhagia

37

Gonadotropin-releasing hormone agonists s/e

Hot flashes are experienced by >75% of patients

38

_________ is the surgical removal of fibroids from the uterus

Myomectomy