زنان و زایمان Flashcards
1
Q
If alpha- fetu protein is high in 16th week, what will be the next step?
A
𝑼𝒍𝒕𝒓𝒐𝒔𝒐𝒏𝒐𝒈𝒓𝒂𝒑𝒉𝒚 𝒇𝒐𝒓 𝒅𝒆𝒕𝒆𝒄𝒕𝒊𝒏𝒈 𝒈𝒆𝒔𝒕𝒂𝒕𝒊𝒐𝒏𝒂𝒍 𝒂𝒈𝒆
2
Q
What is the first step in managing abnormal maternal serum alpha-fetoprotein (MSAFP) levels at 18 weeks gestation?
A
Confirm gestational age using ultrasound.
3
Q
After confirming a discrepancy in gestational age via ultrasound, what is the next step in managing abnormal MSAFP levels?
A
Proceed with amniocentesis
4
Q
What screening should be offered if there is a risk factor for chromosomal abnormalities?
A
Cell-free DNA screening
5
Q
What is the role of ultrasound in managing high MSAFP levels?
A
Ultrasound is used to confirm gestational age and identify the cause of elevated MSAFP.
6
Q
What measurements are typically used in an ultrasound to calculate gestational age?
A
Femur length, crown-rump length, and other fetal measurements.
7
Q
In managing vaginal bleeding at 38 weeks, what are the key initial interventions?
A
Obtain IV access, fetal monitoring, and prepare for cesarean section if necessary
8
Q
What are some non-reassuring fetal patterns during continuous fetal monitoring (CTG)?
A
Bradycardia, tachycardia, and decelerations.
9
Q
How should non-reassuring fetal heart patterns be managed?
A
Discontinue medications, provide IV fluids, change the patient’s position, and perform vaginal exams to check for cord prolapse
10
Q
What should be done if cord prolapse is detected during labor?
A
Immediate intervention is required, potentially including a cesarean section
11
Q
What is the importance of fetal scalp stimulation?
A
To observe for fetal acceleration, indicating well-being, or to assess the need for intervention.
12
Q
What is the protocol if fetal acidosis is confirmed?
.
A
Provide IV fluids, change patient position, and proceed with timely delivery.
13
Q
How is patient positioning used to manage variable deceleration and cord compression during labor?
A
Positions such as left lateral or knee-chest are used to relieve cord compression
14
Q
What is the role of continuous fetal monitoring in labor?
A
To detect non-reassuring patterns and fetal distress, which may require immediate intervention.
15
Q
What are the criteria for performing a cesarean delivery in labor?
A
Non-reassuring fetal patterns or confirmed fetal acidosis.
16
Q
What prenatal tests are used for Down syndrome screening in high-risk patients?
A
Cell-free DNA testing and chorionic villus sampling (CVS).
17
Q
What are IPS 1 and IPS 2 in prenatal testing?
A
Integrated Prenatal Screening (IPS) 1 and 2 are sequential screenings combining ultrasound and blood tests to assess risk for chromosomal abnormalities.
18
Q
When is quadruple testing used in prenatal care?
A
It is used for non-high-risk patients between 15 and 20 weeks gestation to screen for chromosomal abnormalities
19
Q
What is the next step if cell-free DNA screening is positive for Down syndrome?
A
Confirm the results with diagnostic testing like amniocentesis for karyotyping
20
Q
Why is karyotyping important after a positive screening test?
A
It provides a definitive diagnosis of chromosomal abnormalities
21
Q
What should be included in routine antenatal care?
A
Monthly visits, blood pressure monitoring, urine tests, fetal growth assessments, and patient education.
22
Q
When should a patient be referred to an obstetrician during pregnancy?
A
Around 36 weeks gestation or earlier if any abnormalities are detected.
23
Q
How is polyhydramnios identified and managed?
A
Through ultrasound to measure amniotic fluid levels and identify potential etiologies.
24
Q
In the case of vaginal bleeding at 38 weeks, what preparations should be made?
A
Establish IV access, initiate continuous fetal monitoring, and prepare for possible cesarean section.
25
What factors determine the induction of labor?
Cervical readiness (Bishop score), fetal condition, presence of infections, and membrane status.
26
How is oxytocin administered for labor induction?
Via intravenous infusion with careful titration to stimulate contractions
27
What are variable decelerations, and what do they indicate?
Fluctuations in fetal heart rate due to umbilical cord compression.
28
How should variable decelerations be managed during labor?
Change maternal position, administer IV fluids, and perform a vaginal exam to rule out cord prolapse.
29
What is the purpose of fetal scalp stimulation?
To assess fetal well-being by observing accelerations in heart rate.
30
What steps are taken if fetal acidosis is suspected?
Perform fetal scalp blood sampling for pH testing and prepare for timely delivery if acidosis is confirmed.
31
Why is patient positioning important during labor complications?
Positions like left lateral or knee-chest can alleviate cord compression and improve fetal oxygenation.
32
What is cord prolapse, and why is it an emergency?
When the umbilical cord descends through the cervix before the fetus, leading to compromised blood flow; it requires immediate delivery.
33
How does continuous fetal monitoring contribute to labor management?
As It detects fetal distress early, allowing for prompt interventions to prevent complications.
34
How is gestational age calculated using ultrasound measurements?
By measuring femur length, crown-rump length, and other fetal parameters
35
What are the initial steps when managing a patient whose labor story changes upon arrival?
Reassess the patient, confirm fetal well-being, and adjust the management plan accordingly.
36
What factors might prompt earlier referral to an obstetrician before 36 weeks?
Detection of any abnormalities or high-risk factors during prenatal care.
37
Why is it important to confirm gestational age when abnormal MSAFP levels are detected?
Incorrect gestational dating can affect the interpretation of MSAFP levels and subsequent management.
38
What is the purpose of chorionic villus sampling (CVS)?
Early diagnostic testing for chromosomal abnormalities, typically performed between 10-13 weeks gestation.
39
How should healthcare providers proceed if non-reassuring fetal heart rate patterns persist despite initial interventions?
Consider expedited delivery, such as cesarean section, to prevent fetal compromise.
40
Why is patient education an essential part of antenatal care?
It empowers patients to understand their pregnancy, recognize warning signs, and engage in healthy behaviors
41
What are some risk factors for chromosomal abnormalities that may warrant cell-free DNA testing?
- advanced maternal age
- family history of genetic disorders
- previous child with chromosomal abnormalities
42
How does amniocentesis assist in prenatal diagnosis?
It analyzes fetal cells for genetic and chromosomal information.
43
What are some signs of fetal distress during labor?
Non-reassuring fetal heart rate patterns like prolonged decelerations or persistent tachycardia.
44
What does the term 'bifid scrotum' refer to?
A condition where the scrotum is split or divided
45
What is primary amenorrhea?
The absence of menstruation by age 15 or 16
## Footnote
Primary amenorrhea can be evaluated through various hormonal tests.
46
What hormonal levels are typically high in primary amenorrhea?
High FSH
## Footnote
High FSH levels may indicate primary ovarian insufficiency or other conditions.
47
What is 17-alpha-hydroxylase deficiency?
A condition affecting steroid hormone synthesis
## Footnote
It can lead to specific features such as lack of sexual development.
48
What should be evaluated if 17-alpha-hydroxylase deficiency is suspected?
Evaluate for 17-alpha-hydroxylase (CYP17) deficiency
## Footnote
This evaluation helps in diagnosing adrenal and gonadal disorders.
49
What is the karyotype associated with Turner syndrome?
45,X karyotype
## Footnote
Turner syndrome can also present with mosaics like 45,X/46,XX or 45,X/46,XY.
50
What are individuals with Turner syndrome at risk for?
Gonadoblastoma
## Footnote
This risk is particularly noted in those with atypical karyotypes.
51
What is hypogonadotropic hypogonadism?
A condition characterized by low gonadotropin levels
## Footnote
It can result from functional hypothalamic amenorrhea or systemic illnesses.
52
What systemic illnesses can cause hypogonadotropic hypogonadism?
Celiac disease or type 1 diabetes mellitus
## Footnote
These conditions can impact hormone regulation and menstrual function.
53
What imaging study is recommended to rule out a sellar mass in amenorrhea cases?
Pituitary MRI
## Footnote
This imaging helps in identifying potential pituitary tumors or abnormalities.
54
What is the significance of low LH and normal FSH in evaluating amenorrhea?
Indicates 46,XX primary ovarian insufficiency
## Footnote
This hormonal pattern guides further diagnostic considerations.
55
What does a karyotype of 46,XY indicate in the context of gonadal dysgenesis?
Gonadal dysgenesis
## Footnote
This condition can lead to underdeveloped or absent gonads.
56
What does low or normal FSH indicate in terms of breast development?
Breast development ≥ Tanner stage 2? No
## Footnote
This indicates that low or normal FSH levels are associated with the absence of breast development beyond Tanner stage 1.
57
What is the percentage of individuals with primary amenorrhea when the uterus is present and FSH levels are high?
100%
## Footnote
This suggests a strong correlation between high FSH levels and primary amenorrhea in individuals with a present uterus.
58
What is indicated by high FSH levels?
Features of 17-alpha-hydroxylase deficiency? No
## Footnote
High FSH levels do not suggest the presence of 17-alpha-hydroxylase deficiency.
59
What should be evaluated if high FSH is present?
Repeat FSH, add LH
## Footnote
This indicates the need for further evaluation of hormonal levels to assess the condition more accurately.
60
What test should be ordered to further investigate hormonal deficiencies?
Order karyotype
## Footnote
A karyotype test can help identify chromosomal abnormalities that may be linked to hormonal conditions.
61
What is primary amenorrhea?
The absence of menstruation by age 15 while having some secondary sexual characteristics present.
## Footnote
This condition indicates that a female has not started menstruating despite having developed some physical traits associated with puberty.
62
What are two differential diagnoses for a phenotypically female patient with absent uterus and primary amenorrhea?
* Mülerian agenesis
* Androgen insensitivity
## Footnote
These conditions can explain the absence of menstruation in a female patient with specific physical characteristics.
63
What is the significance of labio-scrotal fusion in this patient?
It suggests the presence of androgen insensitivity, specifically partial androgen insensitivity.
## Footnote
Labio-scrotal fusion indicates that the patient may have been exposed to male hormones during development.
64
What studies are most appropriate to confirm a diagnosis of androgen insensitivity?
* Serum testosterone
* Dihydrotestosterone
* Karyotype
## Footnote
These tests help determine the hormonal profile and genetic makeup of the patient to confirm the diagnosis.
65
What testosterone levels would indicate a diagnosis of androgen insensitivity?
Male-appropriate testosterone levels.
## Footnote
High testosterone levels in a phenotypically female patient can indicate that the patient has androgen insensitivity.
66
What karyotype would confirm a diagnosis of androgen insensitivity?
46 XY karyotype.
## Footnote
This genetic pattern indicates male chromosomal characteristics despite the female phenotype.
67
What testosterone levels would suggest Mülerian agenesis?
Female-appropriate testosterone levels.
## Footnote
Normal female testosterone levels in a patient with primary amenorrhea suggest that the uterus is absent due to Mülerian agenesis.
68
What karyotype would confirm a diagnosis of Mülerian agenesis?
46 XX karyotype.
## Footnote
This genetic pattern indicates typical female chromosomal characteristics, aligning with the diagnosis.
69
What is primary amenorrhea?
Absence of menstruation by age 15 or failure to develop secondary sexual characteristics by age 13
## Footnote
Primary amenorrhea can indicate various underlying conditions or disorders.
70
What indicates a low or normal FSH level in primary amenorrhea?
Presence of uterus and breast development at Tanner stage 2
## Footnote
This may suggest conditions like congenital GnRH deficiency or hypothalamic disorders.
71
What is evaluated when high prolactin (PRL) is present in primary amenorrhea?
Evaluate for high TSH or high testosterone levels
## Footnote
These could indicate thyroid dysfunction or adrenal issues.
72
What anatomic abnormalities can be identified on ultrasound in primary amenorrhea?
Perforate hymen, transverse vaginal septum
## Footnote
These conditions affect the normal flow of menstrual blood.
73
What are the potential causes of low LH and FSH levels?
Congenital GnRH deficiency, constitutional delay of puberty, other hypothalamic-pituitary disorders
## Footnote
These conditions can disrupt normal hormonal signaling.
74
Fill in the blank: High PRL, abnormal TSH, or high T _______ can indicate issues in primary amenorrhea.
testosterone
## Footnote
These hormone levels can provide clues to underlying endocrine disorders.
75
What does the presence of low LH and normal FSH suggest in primary amenorrhea?
46,XX primary ovarian insufficiency
## Footnote
This indicates a problem with ovarian function rather than a hypothalamic or pituitary issue.
76
What conditions can lead to functional hypothalamic amenorrhea?
Systemic illness, such as celiac disease or type 1 diabetes
## Footnote
These illnesses can impact the hypothalamus and disrupt menstrual cycles.
77
What diagnostic tool is suggested for evaluating pituitary-related causes of amenorrhea?
Pituitary MRI
## Footnote
This imaging can identify structural abnormalities affecting hormone production.
78
What is primary amenorrhea?
Lack of menses by age 13 and no breast development, or lack of menses by age 15 with breast development present
## Footnote
Primary amenorrhea is a condition where menstruation has not occurred by the expected ages, indicating a potential underlying health issue.
79
What are the initial steps to evaluate a patient with primary amenorrhea?
1) Perform history and physical examination
2) Initial lab tests: hCG, FSH, TSH, PRL
3) Pelvic ultrasound
## Footnote
These steps help identify possible causes of amenorrhea and assess reproductive health.
80
What karyotype is associated with complete androgen insensitivity syndrome?
46,XY
## Footnote
Individuals with this karyotype may present with a female phenotype despite having male chromosomes due to insensitivity to androgens.
81
What is the presentation of 5-alpha-reductase deficiency at birth?
Female or ambiguous genitalia, unable to convert T to DHT
## Footnote
This condition affects the development of male genitalia, leading to atypical external characteristics.
82
What hormone levels would be expected in complete androgen insensitivity syndrome?
Serum testosterone in normal range
## Footnote
Despite the XY karyotype, individuals typically have normal testosterone levels but do not respond to it.
83
What is the significance of assessing breast development in patients with primary amenorrhea?
To determine the presence of estrogen activity and assess for potential causes of amenorrhea
## Footnote
Breast development indicates that certain hormonal functions are occurring, which can guide diagnosis.
84
Fill in the blank: The initial lab tests for evaluating primary amenorrhea include hCG, FSH, TSH, and _______.
PRL
## Footnote
Prolactin (PRL) levels are measured to assess for potential endocrine disorders affecting menstruation.
85
True or False: A pelvic ultrasound is not necessary in the evaluation of primary amenorrhea.
False
## Footnote
A pelvic ultrasound is important to visualize the reproductive organs and identify any anatomical abnormalities.
86
What is the role of FSH in the evaluation of primary amenorrhea?
To assess ovarian function and reserve
## Footnote
Follicle-stimulating hormone (FSH) levels help determine if the ovaries are producing eggs and responding to hormonal signals.
87
What is the Tanner stage 2 in breast development?
Beginning stages of breast budding and areola enlargement
## Footnote
Tanner stages are used to assess sexual maturity and development in adolescents.
88
What is primary amenorrhea?
Absence of menstruation by age 15 or 16.
## Footnote
Primary amenorrhea can be evaluated through various tests including hCG levels.
89
What does a positive hCG indicate?
Pregnancy.
## Footnote
hCG (human chorionic gonadotropin) is a hormone produced during pregnancy.
90
What is the significance of an absent uterus in a patient with primary amenorrhea?
It suggests possible congenital conditions such as Mullerian agenesis.
## Footnote
Further evaluation may include karyotyping and serum testosterone levels.
91
What is Mullerian agenesis?
Congenital absence of the vagina and usually the uterus.
## Footnote
Also known as Mayer-Rokitansky-Küster-Hauser syndrome.
92
What are the serum testosterone levels in a patient with Mullerian agenesis?
Normal female range.
## Footnote
FSH levels are also normal, and breast development is typically normal.
93
What characterizes complete androgen insensitivity syndrome?
Female phenotype with serum testosterone in normal male range.
## Footnote
This condition results from a defect in the androgen receptor.
94
What is the presentation of 5-alpha-reductase deficiency at birth?
Female or ambiguous genitalia.
## Footnote
This condition prevents the conversion of testosterone to dihydrotestosterone (DHT).
95
What happens at puberty in a patient with 5-alpha-reductase deficiency?
Virilization occurs with serum testosterone in normal male range.
## Footnote
This can lead to the development of male secondary sexual characteristics.
96
What imaging study is often ordered for assessing pelvic anatomy?
Pelvic ultrasound.
## Footnote
This imaging can help visualize the presence or absence of reproductive structures.
97
Fill in the blank: 46,XX indicates a _______.
Normal female karyotype.
## Footnote
Karyotyping is essential for diagnosing various intersex conditions.
98
Fill in the blank: 46,XY indicates a _______.
Normal male karyotype.
## Footnote
This karyotype is typically associated with male phenotypes unless other conditions are present.
99
What is primary amenorrhea?
Absence of menstruation by age 15 or by age 13 with no secondary sexual characteristics
## Footnote
Primary amenorrhea can be due to various causes, including genetic conditions or anatomical abnormalities.
100
What are the key features of primary amenorrhea?
Presence of uterus, low or normal FSH, breast development at least at Tanner stage 2
## Footnote
Tanner stages are a scale of physical development in children, adolescents, and adults.
101
What is the significance of Tanner stage 2 in breast development?
Indicates the onset of breast development in females
## Footnote
Tanner stage 2 is characterized by breast buds and some enlargement of the areola.
102
What should be assessed if a patient has primary amenorrhea with a uterus present?
Repeat FSH and add LH testing
## Footnote
FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) are critical in evaluating ovarian function.
103
If breast development is not at least Tanner stage 2, what might this indicate?
Possible anatomical abnormality
## Footnote
Anatomical abnormalities may include issues such as Mayer-Rokitansky-Küster-Hauser syndrome.
104
True or False: Low or normal FSH levels are consistent with primary amenorrhea.
True
## Footnote
Abnormal FSH levels can indicate various conditions affecting the ovaries or pituitary gland.
105
Fill in the blank: Primary amenorrhea is diagnosed when menstruation has not occurred by age _______.
15
## Footnote
Additionally, it can be diagnosed by age 13 if there are no secondary sexual characteristics.
106
What imaging technique can help identify anatomical abnormalities in primary amenorrhea?
Ultrasound
## Footnote
Ultrasound can visualize the reproductive organs and identify structural issues.
107
What indicates adequate estrogen production in a physical exam?
Presence of breasts
## Footnote
Breasts are a secondary sexual characteristic influenced by estrogen levels.
108
What is assessed during a physical exam and ultrasound regarding the reproductive system?
Presence or absence of breasts and uterus
## Footnote
These assessments help evaluate sexual development and reproductive health.
109
Which tests are included in the evaluation of reproductive health?
Karyotype, testosterone, FSH
## Footnote
These tests provide insights into genetic and hormonal status.
110
Fill in the blank: Breasts indicate adequate _______ production.
estrogen
111
True or False: The absence of a uterus on ultrasound suggests a normal reproductive system.
False
## Footnote
The absence of a uterus may indicate developmental issues or certain medical conditions.
112
What is primary amenorrhea?
Absence of menstruation by age 15 in girls with secondary sexual characteristics or by age 13 without them.
## Footnote
Primary amenorrhea can indicate various underlying conditions, including hormonal imbalances or anatomical abnormalities.
113
What is complete androgen sensitivity syndrome?
A condition where individuals have a female phenotype but are genetically male (46,XY) due to a defect in the androgen receptor.
## Footnote
Serum testosterone levels are typically in the normal male range despite the female phenotype.
114
What is 5-alpha-reductase deficiency?
A genetic condition resulting in ambiguous genitalia at birth and virilization during puberty due to an inability to convert testosterone to dihydrotestosterone (DHT).
## Footnote
Individuals typically present with normal serum testosterone levels during puberty.
115
What are the characteristics of outflow tract disorders?
Includes conditions such as imperforate hymen and transverse vaginal septum.
## Footnote
These conditions can lead to primary amenorrhea due to obstruction.
116
What laboratory tests are recommended for evaluating amenorrhea?
Repeat FSH, add LH, and assess for high prolactin, abnormal TSH, or high testosterone levels.
## Footnote
These tests help to determine the underlying cause of amenorrhea.
117
What is hypogonadotropic hypogonadism?
A condition characterized by low levels of gonadotropins (LH and FSH) due to issues in the hypothalamus or pituitary gland.
## Footnote
It can be caused by functional hypothalamic amenorrhea, systemic illnesses, or congenital conditions.
118
What are common systemic illnesses associated with amenorrhea?
Celiac disease and type 1 diabetes mellitus.
## Footnote
These conditions can lead to functional hypothalamic amenorrhea.
119
What imaging study is used to rule out sellar mass in amenorrhea evaluation?
Pituitary MRI.
## Footnote
This imaging study helps identify potential tumors or abnormalities affecting pituitary function.
120
True or False: High prolactin levels can indicate a cause for amenorrhea.
True.
## Footnote
Hyperprolactinemia can disrupt normal menstrual function and is an important factor to evaluate.
121
Fill in the blank: The hormone responsible for stimulating the ovaries is _______.
Luteinizing hormone (LH).
## Footnote
LH, along with FSH, plays a crucial role in regulating the menstrual cycle and ovulation.
122
What does a normal FSH level indicate in the context of amenorrhea?
May indicate ovarian insufficiency or hypothalamic dysfunction.
## Footnote
FSH is typically elevated in primary ovarian insufficiency.
123
What are the implications of low LH and normal FSH levels?
May suggest conditions such as congenital GnRH deficiency or constitutional delay of puberty.
## Footnote
This hormonal profile can help direct further testing and diagnosis.
124
What are some secondary sexual characteristics that may be absent in certain types of amenorrhea?
Breast development, body hair, and menstrual cycles.
## Footnote
The absence of these characteristics can help indicate specific types of amenorrhea.
125
What is primary amenorrhea?
Lack of menses by age 13 without breast development or lack of menses by age 15 with breast development
## Footnote
Primary amenorrhea is a condition where menstruation has not occurred by the expected age.
126
What initial lab tests should be performed for a patient with primary amenorrhea?
hCG, FSH, TSH, PRL
## Footnote
These tests help assess hormonal levels and rule out certain conditions.
127
What imaging study is recommended for evaluating primary amenorrhea?
Pelvic ultrasound
## Footnote
Ultrasound helps visualize the reproductive organs.
128
What does a normal karyotype and serum testosterone level indicate in a patient with breast development?
Possible Mayer-Rokitansky-Küster-Hauser syndrome
## Footnote
This syndrome is characterized by congenital absence of the vagina and often uterine agenesis.
129
What is complete androgen insensitivity syndrome?
Female phenotype with serum testosterone in normal male range, resistant to testosterone due to a defect in androgen receptor
## Footnote
This condition leads to a female external appearance despite having male XY chromosomes.
130
What is the presentation of 5-alpha-reductase deficiency at birth?
Female or ambiguous genitalia, unable to convert testosterone to DHT
## Footnote
This condition affects male genital development.
131
What might indicate an outflow tract disorder in primary amenorrhea?
Anatomic abnormality identified on ultrasound such as imperforate hymen or transverse vaginal septum
## Footnote
These conditions can obstruct menstrual flow.
132
What features are associated with 17-alpha-hydroxylase deficiency?
High blood pressure, absence of secondary sexual characteristics, or minimal body hair
## Footnote
This condition can affect adrenal hormone production.
133
What karyotype is associated with Turner syndrome?
45,X
## Footnote
Turner syndrome can also present as mosaics such as 45,X/46,XX or 45,X/46,XY.
134
What is hypogonadotropic hypogonadism?
Condition characterized by low levels of gonadotropins due to hypothalamic or pituitary disorders
## Footnote
It can be caused by functional hypothalamic amenorrhea or systemic illness.
135
True or False: MRI is always required for patients with hypogonadotropic amenorrhea.
False
## Footnote
MRI is not required if there is a clear explanation for the hypogonadotropic amenorrhea.
136
Fill in the blank: The hormone abbreviated as TSH is known as _______.
thyroid-stimulating hormone
## Footnote
TSH is crucial for regulating thyroid function.
137
What is primary amenorrhea?
Absence of menstruation by age 15 or lack of secondary sexual characteristics by age 13
## Footnote
It is a condition often evaluated in the context of various underlying disorders.
138
What is the significance of low or normal FSH in the context of complete androgen sensitivity syndrome?
Indicates a female phenotype with normal serum testosterone levels
## Footnote
This condition results from a defect in the androgen receptor, leading to resistance to testosterone.
139
What are the characteristics of 5-alpha-reductase deficiency at birth?
Female or ambiguous genitalia due to inability to convert testosterone to dihydrotestosterone
## Footnote
Virilization occurs at puberty with normal serum testosterone levels.
140
What is the Tanner stage criterion for breast development in amenorrhea evaluation?
Breast development should be ≥ Tanner stage 2
## Footnote
This is used to assess secondary sexual characteristics in patients.
141
What anatomical abnormalities can be identified on ultrasound in outflow tract disorders?
Imperforate hymen, transverse vaginal septum
## Footnote
These conditions can lead to primary amenorrhea due to obstruction.
142
What hormonal levels are indicative of hypogonadotropic hypogonadism?
LH and FSH very low or low
## Footnote
This condition may be due to congenital GnRH deficiency or other hypothalamic-pituitary disorders.
143
What are potential causes of functional hypothalamic amenorrhea?
Systemic illness such as celiac disease or type 1 diabetes mellitus
## Footnote
These conditions can impact the hypothalamic-pituitary axis.
144
What should be done if there is a suspicion of a sellar mass in the pituitary gland?
Pituitary MRI should be performed
## Footnote
This is important to rule out structural causes of amenorrhea.
145
What are the potential symptoms associated with polycystic ovary syndrome (PCOS)?
Hypertension, absence of secondary sexual characteristics, minimal body hair
## Footnote
PCOS is a common endocrine disorder that can lead to various reproductive and metabolic issues.
146
True or False: High prolactin (PRL) levels can be a cause of secondary amenorrhea.
True
## Footnote
Hyperprolactinemia can disrupt normal menstrual cycles.
147
Fill in the blank: The hormone that stimulates the thyroid gland is _______.
TSH
## Footnote
TSH stands for thyroid-stimulating hormone.
148
What is the hardware model mentioned in the assembly instruction?
Gx4
## Footnote
Gx4 is the specific hardware model referred to in the instructions.
149
What step number is indicated in the assembly instruction?
Step 14
## Footnote
This indicates the sequence in the assembly process.
150
What is the fraction mentioned in the assembly instruction?
11/12
## Footnote
This may refer to a measurement or completion status in the assembly process.
151
What is the age of the girl brought to the clinic?
17 years old
152
What is the main concern of the mother regarding her daughter?
Never had a menstrual period
153
What does the girl report as a possible reason for her delayed period?
Stress
154
What physical developments are noted in the girl during the examination?
Adult breast development and pubic hair present
155
What abnormal finding is noted during the pelvic examination?
Foreshortened vagina
156
What was not seen on the ultrasound of the girl?
No uterus
157
What is the most appropriate advice regarding the girl's condition?
Surgical removal of intra-abdominal testes is recommended
158
True or False: Estrogen and progesterone supplementation is indicated for the girl.
False
159
Fill in the blank: The absence of a uterus in this case suggests _______.
Müllerian agenesis
160
What might be a future consideration for the girl's fertility?
In vitro fertilization is an option
161
What could be performed for the girl's anatomical issue?
Vaginal reconstruction may be performed
162
What is the significance of the girl's good grades and studying hard?
Indicates she is well-adjusted despite stress
163
What imaging study might be considered to evaluate for a pituitary tumor?
CT scan of the brain
164
What does REC stand for?
REC
## Footnote
This acronym may refer to a specific medical term or protocol but requires context for precise definition.
165
What is the term for the absence of menstruation?
Amenorrhea
## Footnote
Amenorrhea can be classified into primary and secondary types.
166
What should be assessed during a physical exam for amenorrhea?
Breast development and uterine presence
## Footnote
Adequate breast development may indicate adequate estrogen levels.
167
What imaging technique is used to determine the presence of a uterus?
Ultrasound
## Footnote
Ultrasound helps visualize the reproductive organs and assess abnormalities.
168
What laboratory tests are commonly conducted in the evaluation of amenorrhea?
Karyotype, testosterone, FSH
## Footnote
These tests help evaluate chromosomal abnormalities and hormonal levels.
169
True or False: A physical exam can indicate whether a uterus is present.
True
## Footnote
Physical exams can provide initial insights before imaging studies.
170
What is primary amenorrhea?
Absence of menstruation by age 15 or failure to develop secondary sexual characteristics by age 13
## Footnote
It is diagnosed when there is no menstruation and secondary sexual characteristics are not developed.
171
What is the significance of 46,XY in the context of androgen sensitivity syndrome?
Indicates a genetic male with complete androgen insensitivity syndrome presenting with a female phenotype
## Footnote
Serum testosterone levels are in the normal male range, but the individual is resistant to testosterone due to a defect in the androgen receptor.
172
What is 5-alpha-reductase deficiency?
A condition where individuals may present with female or ambiguous genitalia at birth and virilization at puberty
## Footnote
This occurs due to the inability to convert testosterone to dihydrotestosterone (DHT).
173
What are the characteristics of the outflow tract disorder?
Includes imperforate hymen and transverse vaginal septum
## Footnote
These conditions can lead to primary amenorrhea due to obstruction.
174
What is hypogonadotropic hypogonadism?
A condition characterized by low levels of LH and FSH leading to insufficient gonadal function
## Footnote
It can result from functional hypothalamic amenorrhea, systemic illness, or congenital deficiencies.
175
What laboratory findings are associated with hypothalamic-pituitary disorders?
LH and FSH very low, normal TSH, and possibly high PRL
## Footnote
Conditions such as celiac disease or type 1 diabetes mellitus can provide clear explanations for hypogonadotropic amenorrhea.
176
What is the typical presentation of polycystic ovary syndrome (PCOS)?
Hypertension, absence of secondary sexual characteristics, or minimal body hair
## Footnote
It is important to differentiate PCOS from other causes of amenorrhea.
177
What should be evaluated in a patient with suspected hypogonadotropic hypogonadism?
Pituitary MRI to rule out sellar mass
## Footnote
This helps determine if there is an underlying structural cause for the hormone deficiency.
178
Fill in the blank: The hormone abbreviated as T refers to _______.
[testosterone]
179
True or False: Breast development at Tanner stage 2 indicates normal puberty.
True
## Footnote
Tanner stages are used to assess sexual maturity and development.
180
What is the role of follicle-stimulating hormone (FSH)?
Stimulates the growth of ovarian follicles in females and spermatogenesis in males
## Footnote
FSH is critical for reproductive health and function.
181
What is the age of the girl brought to the clinic?
17 years old
182
What is the main concern of the mother regarding her daughter?
Never had a menstrual period
183
What does the girl report as a possible reason for her delayed period?
Stress
184
What physical developments are noted in the girl during the examination?
Adult breast development and pubic hair present
185
What abnormal finding is noted during the pelvic examination?
Foreshortened vagina
186
What was not seen on the ultrasound of the girl?
No uterus
187
What is the most appropriate advice regarding the girl's condition?
Surgical removal of intra-abdominal testes is recommended
188
True or False: Estrogen and progesterone supplementation is indicated for the girl.
False
189
Fill in the blank: The absence of a uterus in this case suggests _______.
Müllerian agenesis
190
What might be a future consideration for the girl's fertility?
In vitro fertilization is an option
191
What could be performed for the girl's anatomical issue?
Vaginal reconstruction may be performed
192
What is the significance of the girl's good grades and studying hard?
Indicates she is well-adjusted despite stress
193
What imaging study might be considered to evaluate for a pituitary tumor?
CT scan of the brain
194
What is the diagnosis characterized by no pubic or axillary hair, a male karyotype, and the presence of testes?
Androgen Insensitivity Syndrome
## Footnote
This syndrome results in the body being unable to respond to androgens, leading to the development of female secondary sexual characteristics despite having a male genotype.
195
What are the hormone levels produced by the testes in Androgen Insensitivity Syndrome?
* Normal levels of estrogen for a female
* Normal levels of testosterone for a male
## Footnote
The testes function normally in terms of hormone production, but the body cannot utilize these hormones effectively.
196
What is the recommended management for individuals diagnosed with Androgen Insensitivity Syndrome before the age of 20?
Removal of testes
## Footnote
This is to mitigate the increased risk of testicular cancer associated with retained testes.
197
What type of replacement therapy is needed after the removal of testes in Androgen Insensitivity Syndrome?
Estrogen replacement
## Footnote
This therapy is necessary to maintain female secondary sexual characteristics after the testes are removed.
198
What condition results in the absence of uterus, cervix, and upper vagina?
Müllerian agenesis
## Footnote
Müllerian agenesis is a congenital condition affecting female reproductive anatomy.
199
What is the status of the ovaries in a patient with Müllerian agenesis?
Intact and normal levels of estrogen are present
## Footnote
Although the uterus and vagina are absent, ovarian function remains unaffected.
200
What surgical procedure may be performed for a patient with Müllerian agenesis?
Vaginal reconstruction
## Footnote
This procedure aims to elongate the vagina for satisfactory sexual intercourse.
201
Fill in the blank: Müllerian agenesis results in an absence of the _______.
uterus, cervix, and upper vagina
## Footnote
This condition is also known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
202
True or False: Patients with Müllerian agenesis typically have abnormal estrogen levels.
False
## Footnote
Patients usually have normal estrogen levels despite the absence of certain reproductive structures.
203
What is Müllerian agenesis?
A diagnosis characterized by the absence of all Müllerian duct derivatives (fallopian tubes, uterus, cervix, and upper vagina) while having a normal female karyotype and secondary sexual characteristics.
204
What are the normal hormone levels in a patient with Müllerian agenesis?
Normal estrogen and testosterone levels.
205
What is the primary abnormality in Müllerian agenesis?
Absence of all Müllerian duct derivatives.
206
What surgical management is involved in Müllerian agenesis?
Surgical elongation of the vagina for satisfactory sexual intercourse.
207
What counseling is recommended for individuals with Müllerian agenesis?
Counseling about infertility.
208
True or False: In Müllerian agenesis, the ovaries are intact.
True
209
What does the presence of breasts indicate?
Adequate estrogen production
## Footnote
Breasts are a secondary sexual characteristic influenced by estrogen levels.
210
What is assessed during a physical exam and ultrasound in this context?
Presence or absence of breasts and uterus
## Footnote
The evaluation helps determine hormonal levels and sexual development.
211
What is checked via ultrasound in this assessment?
Presence or absence of uterus
## Footnote
Uterine presence is crucial for evaluating reproductive health.
212
Which three tests are mentioned for further evaluation?
Karyotype, testosterone, FSH
## Footnote
These tests help assess genetic, hormonal, and reproductive status.
213
True or False: The absence of breasts suggests low estrogen production.
True
## Footnote
Breast development is closely tied to estrogen levels.
214
What is Gonadal Dysgenesis commonly known as?
Turner Syndrome
## Footnote
Turner Syndrome is characterized by the absence of one X chromosome.
215
What karyotype is associated with Turner Syndrome?
45, X
## Footnote
This karyotype indicates the absence of one X chromosome.
216
What are the clinical features of Turner Syndrome?
Absence of secondary sexual characteristics and elevated FSH
## Footnote
Patients often do not develop breasts and have underdeveloped ovaries.
217
What develops in the absence of a second X chromosome in Turner Syndrome?
Streak gonads
## Footnote
Streak gonads are non-functional gonadal tissue.
218
What is the management for Turner Syndrome?
Estrogen and progesterone replacement
## Footnote
This treatment is crucial for the development of secondary sexual characteristics.
219
What is the diagnosis when there are no sexual characteristics but the uterus is normal on ultrasound and FSH levels are low?
Hypothalamic-pituitary failure
## Footnote
This condition may be due to stress, excessive exercise, or anorexia nervosa.
220
What syndrome is likely diagnosed when anosmia is also present?
Kallmann syndrome
## Footnote
In this case, the hypothalamus doesn't produce GnRH.
221
What imaging technique is used to rule out a brain tumor in cases of hypothalamic-pituitary failure?
CT head
## Footnote
This imaging helps assess potential central nervous system issues.
222
What is secondary amenorrhea?
Absence of menses for more than three months in girls who previously had regular menstrual cycles or for more than six months in girls who had irregular menses.
223
What is the first step in evaluating secondary amenorrhea?
Determine if the patient has signs or symptoms suggesting major causes of secondary amenorrhea.
224
What are some history factors to consider in secondary amenorrhea evaluation?
* Weight change
* Eating disorder
* Excessive exercise
* Galactorrhea
* Hot flashes
* Acne
* Hirsutism
* Systemic illness
* History of uterine instrumentation
225
What physical exam findings may suggest secondary amenorrhea?
* Low BMI
* Obesity
* Signs of hyperandrogenism
* Galactorrhea
226
What initial lab tests should be performed for secondary amenorrhea?
* FSH
* E2
* TSH
* PRL
227
When should serum total testosterone be added to lab tests in secondary amenorrhea?
If there is evidence of hyperandrogenism.
228
True or False: An elevated prolactin level is a common finding in secondary amenorrhea.
True
229
Fill in the blank: Secondary amenorrhea is defined as the absence of menses for more than _______ months in girls who previously had regular cycles.
three
230
Fill in the blank: Secondary amenorrhea is defined as the absence of menses for more than _______ months in girls who had irregular menses.
six
231
What is secondary amenorrhea?
The absence of menstruation for three or more cycles in a woman who has previously menstruated regularly.
232
What does an elevated TSH indicate?
Possible thyroid disease requiring further evaluation and treatment.
233
What does an elevated FSH level suggest in the context of amenorrhea?
It is commonly seen with a low E2 level, indicating potential ovarian failure.
234
What are common symptoms associated with high FSH and low E2?
* Hot flashes
* Vaginal dryness
235
True or False: Low or normal FSH levels are indicative of primary ovarian insufficiency.
False
236
Fill in the blank: In the setting of amenorrhea, a high FSH is often seen with a low _______.
E2
237
What is REC Management?
Management involves estrogen and progesterone replacement for development of secondary sexual characteristics.
238
What is the diagnosis when there are no sexual characteristics but the uterus is normal on ultrasound and FSH levels are low?
Hypothalamic-pituitary failure
## Footnote
This condition may be due to stress, excessive exercise, or anorexia nervosa.
239
What syndrome is likely diagnosed when anosmia is also present?
Kallmann syndrome
## Footnote
In this case, the hypothalamus doesn't produce GnRH.
240
What imaging technique is used to rule out a brain tumor in cases of hypothalamic-pituitary failure?
CT head
## Footnote
This imaging helps assess potential central nervous system issues.
241
What defines primary amenorrhea?
Lack of menses by age 13 and no breast development, or lack of menses by age 15 with breast development present
242
What are the initial steps in evaluating a patient with primary amenorrhea?
1) Perform history and physical examination
2) Initial lab tests: hCG, FSH, TSH, PRL
3) Pelvic ultrasound
243
What does a positive hCG test indicate in the context of primary amenorrhea?
Pregnancy
244
What is the significance of an absent uterus in a patient with primary amenorrhea?
Order karyotype and serum total testosterone
245
What is Mayer-Rokitansky-Küster-Hauser syndrome?
Congenital absence of vagina, usually with uterine agenesis
246
What are the lab results typically associated with Mayer-Rokitansky-Küster-Hauser syndrome?
Serum testosterone in normal female range, normal FSH, normal breast development
247
What defines complete androgen insensitivity syndrome?
Female phenotype, serum testosterone in normal male range, resistant to testosterone due to defect in androgen receptor
248
What is 5-alpha-reductase deficiency?
At birth: Female or ambiguous genitalia, unable to convert testosterone to dihydrotestosterone; virilization at puberty with serum testosterone in normal male range
249
What is Tanner stage 2 breast development?
Breast development stage indicating progress in sexual maturation
250
What indicates an anatomic abnormality on ultrasound in the context of primary amenorrhea?
Identified anatomic abnormality
251
What are examples of outflow tract disorders?
* Imperforate hymen
* Transverse vaginal septum
252
What lab results might indicate a need for further evaluation in primary amenorrhea?
High prolactin, abnormal TSH, or high testosterone
253
What is the primary concern of the mother in the case presented?
The daughter has never had a menstrual period
## Footnote
This indicates a potential underlying medical issue.
254
What is the height of the 16-year-old girl in the case?
5 feet 8 inches
## Footnote
This height may be relevant in assessing growth and development.
255
What physical development has the girl achieved?
Mature adult breast development
## Footnote
This suggests some degree of estrogen exposure.
256
What is noted about the girl's pubic and axillary hair?
Scant to no pubic nor axillary hair
## Footnote
This can indicate a lack of androgen exposure.
257
What was difficult to identify during the vaginal exam?
Cervix and uterus
## Footnote
This may suggest a congenital anomaly.
258
Which diagnosis is most likely in this case?
Complete androgen insensitivity syndrome
## Footnote
This condition is characterized by normal female external genitalia and lack of menstruation.
259
Fill in the blank: The most likely diagnosis for a girl with mature breast development but no menstruation and difficulty identifying internal reproductive organs is _______.
Complete androgen insensitivity syndrome
260
True or False: Turner syndrome is the most likely diagnosis for the girl described.
False
## Footnote
Turner syndrome typically presents with short stature and other distinct features.
261
List three possible diagnoses based on the symptoms described.
* Androgenital syndrome
* Imperforate hymen
* Rokitansky Kuster Hauser syndrome
262
What is secondary amenorrhea?
Absence of menses for more than three months in girls with previously regular cycles or more than six months in those with irregular cycles
263
What are the key initial lab tests for evaluating secondary amenorrhea?
FSH, E2, TSH, PRL
264
What should be assessed in the patient's history when evaluating secondary amenorrhea?
Weight change, eating disorder, excessive exercise, galactorrhea, hot flashes, acne, hirsutism, systemic illness, history of uterine instrumentation
265
What physical exam findings may indicate secondary amenorrhea?
Low BMI or obesity, signs of hyperandrogenism, galactorrhea
266
What is the significance of elevated prolactin levels in the context of secondary amenorrhea?
It may indicate a major cause of secondary amenorrhea
267
What additional test should be added if there is evidence of hyperandrogenism?
Serum total testosterone
268
True or False: Secondary amenorrhea can occur after three months of missed periods in girls with previously regular cycles.
True
269
Fill in the blank: Secondary amenorrhea is defined as the absence of menses for more than _______ in girls with regular cycles.
three months
270
What is secondary amenorrhea?
Absence of menses for more than three months in girls or women who previously had regular menstrual cycles or more than six months in those with irregular menses.
271
What are the major signs or symptoms to assess in a patient with secondary amenorrhea?
Weight change, eating disorder, galactorrhea, hot flashes, history of uterine instrumentation.
272
What physical exam findings might be relevant for a patient with secondary amenorrhea?
Low BMI or obesity, galactorrhea.
273
What initial lab tests should be conducted for a patient with secondary amenorrhea?
FSH, E2, TSH, PRL.
274
Fill in the blank: Secondary amenorrhea is defined as the absence of menses for more than _______ in girls or women with irregular cycles.
six months
275
True or False: A positive serum hCG test indicates that the patient is not pregnant.
False
276
True or False: Low BMI in a patient with secondary amenorrhea can be a relevant physical exam finding.
True
277
What is secondary amenorrhea?
The absence of menstrual periods for three months or longer in women who have previously had regular cycles.
278
What is the significance of elevated FSH levels in the context of amenorrhea?
A high FSH is typically seen with a low E2 and indicates primary ovarian insufficiency.
279
What are common symptoms associated with primary ovarian insufficiency?
Hot flashes and vaginal dryness.
280
What should be evaluated further in patients with amenorrhea?
Thyroid disease.
281
Fill in the blank: In the setting of amenorrhea, a high FSH is typically seen with a low _______.
E2
282
True or False: Diagnosis of primary ovarian insufficiency is based on low or normal FSH levels.
False
283
What is secondary amenorrhea?
The absence of menstruation for three cycles or more in a woman who previously had regular menstrual periods.
284
What are common signs or symptoms to assess for major causes of secondary amenorrhea?
* Weight change
* Eating disorder
* Excessive exercise
* Galactorrhea
* Hot flashes
* Acne
* Hirsutism
* Systemic illness
* History of uterine instrumentation
285
What are the initial lab tests recommended for secondary amenorrhea?
* FSH
* E2
* TSH
* PRL
286
When should serum total testosterone be added to the lab tests for secondary amenorrhea?
If there is evidence of hyperandrogenism.
287
What does elevated prolactin indicate in the context of secondary amenorrhea?
Hyperprolactinemia.
288
If prolactin levels are normal, what should be done next?
Repeat prolactin testing.
289
What is the significance of abnormal TSH levels in the evaluation of secondary amenorrhea?
Indicates potential thyroid dysfunction affecting menstrual cycles.
290
Fill in the blank: The diagnosis of elevated prolactin levels is known as _______.
Hyperprolactinemia.
291
True or False: A low BMI can be a sign of a potential cause of secondary amenorrhea.
True.
292
True or False: Signs of hyperandrogenism are irrelevant in the evaluation of secondary amenorrhea.
False.
293
What is the condition characterized by the absence of menstruation?
Amenorrhea
294
What percentage of disease cases does secondary amenorrhea account for?
86%
295
In the context of amenorrhea, what does a high FSH level indicate?
Primary ovarian insufficiency
296
What symptoms are common with primary ovarian insufficiency?
Hot flashes and vaginal dryness
297
What is the FSH level in the case of gonadotropic hypogonadism?
Low or normal FSH
298
What does a low E2 level indicate when FSH is low or normal?
Functional hypothalamic amenorrhea
299
Name a systemic illness that can lead to amenorrhea.
Celiac disease or type 1 diabetes mellitus
300
What may indicate hypothalamic or pituitary disorders?
Evidence of hyperandrogenism
301
Fill in the blank: A high FSH level with a low E2 indicates _______.
Primary ovarian insufficiency
302
True or False: Hot flashes and vaginal dryness are symptoms of secondary amenorrhea.
False
303
What is secondary amenorrhea?
The absence of menstruation for three or more cycles in women who previously had regular cycles.
304
What is the significance of low estradiol (E2) levels in the context of secondary amenorrhea?
It helps in determining the underlying cause of amenorrhea.
305
What indicates evidence of hyperandrogenism?
History, physical examination, or a high serum testosterone (T) level.
306
What is the most likely diagnosis if evidence of hyperandrogenism is present?
Polycystic Ovary Syndrome (PCOS).
307
What serum testosterone level indicates the need for additional evaluation?
If serum T >150 ng/dL.
308
What should be ruled out if there is evidence of virilization?
More serious causes of hyperandrogenemia.
309
What does it indicate if all labs are normal and there is a history of uterine instrumentation?
Possible uterine scarring or other complications related to the instrumentation.
310
True or False: Hyperandrogenism can be diagnosed solely by serum testosterone levels.
False.
311
Fill in the blank: The presence of _______ alongside high serum testosterone may suggest a diagnosis of PCOS.
hyperandrogenism
312
What is secondary amenorrhea?
A condition characterized by the absence of menses after previously regular or irregular cycles.
## Footnote
Secondary amenorrhea is specifically diagnosed when either regular menses are absent for 3 months or irregular menses are absent for 6 months.
313
How long must regular menses be absent to diagnose secondary amenorrhea?
3 months
## Footnote
This absence of regular menses for 3 months is a key diagnostic criterion.
314
How long must irregular menses be absent to diagnose secondary amenorrhea?
6 months
## Footnote
This absence of irregular menses for 6 months is another key diagnostic criterion.
315
What is the likely diagnosis if there is evidence of hyperandrogenism and elevated serum testosterone?
PCOS
## Footnote
Hyperandrogenism can be identified by history, exam, or a high serum T level.
316
What serum testosterone level indicates a strong likelihood of PCOS?
Serum T >150 ng/dL
## Footnote
This level is a key indicator in diagnosing PCOS.
317
What is the first step in evaluating secondary amenorrhea?
Perform progestin withdrawal test.
## Footnote
This test helps determine if the uterus is responsive to hormonal changes.
318
What is the next step if there is no uterine bleeding after the progestin withdrawal test?
Perform an estrogen/progestin withdrawal test.
## Footnote
This further evaluates the uterine response to hormones.
319
What procedure is done if there is still no bleeding after the estrogen/progestin withdrawal test?
Hysteroscopy
## Footnote
This is performed for a presumed diagnosis of intrauterine adhesions.
320
What is the significance of a history of uterine instrumentation in the evaluation of secondary amenorrhea?
It helps rule out more serious causes of hyperandrogenemia.
## Footnote
This history is crucial for differential diagnosis.
321
What hormone levels should be monitored in the diagnosis of secondary amenorrhea?
LH, E2, TSH, PRL
## Footnote
These hormones play a role in assessing the underlying causes of amenorrhea.
322
True or False: A normal lab result rules out the diagnosis of PCOS.
False
## Footnote
Normal lab results do not exclude PCOS, especially when hyperandrogenism is present.
323
Fill in the blank: If a patient presents with secondary amenorrhea and no evidence of hyperandrogenism, the next step is to rule out _______.
nonclassic 21-hydroxylase deficiency
## Footnote
This is a specific condition that can affect menstrual cycles.
324
What is secondary amenorrhea?
The absence of menstruation for three consecutive cycles or six months in a woman who previously had normal menstrual periods.
325
What is the first step in evaluating secondary amenorrhea?
A pregnancy test to rule out pregnancy.
326
Which condition is characterized by the presence of intrauterine adhesions leading to menstrual dysfunction?
Asherman syndrome
## Footnote
Asherman syndrome occurs when scar tissue forms in the uterus, often after surgery or trauma.
327
What hormonal disorder can lead to secondary amenorrhea by disrupting normal menstrual cycles?
Hypothyroidism
## Footnote
Hypothyroidism can cause an imbalance in hormones, affecting menstrual regularity.
328
True or False: A negative pregnancy test rules out all causes of secondary amenorrhea.
False
## Footnote
A negative pregnancy test eliminates pregnancy but does not exclude other causes like hormonal imbalances or structural issues.
329
Which of the following is a likely cause of secondary amenorrhea in a 27-year-old woman with negative pregnancy test: a) Abnormal chromosomes, b) Asherman syndrome, c) Hypothyroidism, d) Prolactinoma, e) Ovarian dysfunction?
Ovarian dysfunction
## Footnote
Ovarian dysfunction can lead to insufficient estrogen and cause amenorrhea.
330
What is the most common pituitary disorder that can cause secondary amenorrhea?
Prolactinoma
## Footnote
Prolactinoma is a benign tumor of the pituitary gland that secretes excess prolactin, leading to menstrual irregularities.
331
Fill in the blank: The absence of menstruation for six months in a woman who previously had regular cycles is termed _______.
secondary amenorrhea
332
What is the typical FSH level in primary ovarian insufficiency?
High FSH with low E2
## Footnote
Hot flashes and vaginal dryness are common symptoms.
333
What does low or normal FSH indicate in the setting of amenorrhea?
Hypogonadotropic hypogonadism
## Footnote
This can include functional hypothalamic amenorrhea, systemic illness (like celiac disease or type 1 diabetes), and other hypothalamic or pituitary disorders.
334
What is the significance of a low E2 level?
Indicates hypogonadotropic hypogonadism
## Footnote
Further evaluation may include checking for systemic illnesses or other disorders.
335
What imaging study is performed to rule out a sellar mass?
Pituitary MRI
## Footnote
This is done if FSH is low or normal and E2 is low.
336
What is the most likely diagnosis if FSH is low and E2 is low?
PCOS
## Footnote
If serum testosterone is greater than 150 ng/dL or if there is evidence of virilization, further evaluation is needed.
337
What test should be performed if all labs are normal and there is a history of uterine instrumentation?
Progestin withdrawal test
## Footnote
This helps assess the response of the endometrium.
338
What are common symptoms associated with high FSH in amenorrhea?
Hot flashes and vaginal dryness
## Footnote
These symptoms are indicative of primary ovarian insufficiency.
339
What conditions can lead to functional hypothalamic amenorrhea?
Systemic illness, stress, significant weight loss
## Footnote
These factors can disrupt the hypothalamic-pituitary-gonadal axis.
340
In the context of amenorrhea, what does elevated serum testosterone suggest?
Possible hyperandrogenemia
## Footnote
This may necessitate additional evaluation to rule out serious causes.
341
Fill in the blank: In primary ovarian insufficiency, FSH is _______ and E2 is _______.
High; Low
## Footnote
This pattern is crucial for diagnosis.
342
True or False: A normal prolactin level rules out prolactinemia.
True
## Footnote
Normal prolactin levels indicate that prolactinemia is not the cause of amenorrhea.
343
What is the age and demographic of the patient described?
17 year old white female
344
How long has the patient not had a menstrual period?
6 months
345
What significant medical history does the patient report?
History of irregular periods since menarche at age 14
346
What was the result of the urine pregnancy test?
Negative
347
What did the physical examination reveal?
Unremarkable
348
What is the most appropriate initial workup for this patient?
Measurement of serum TSH, prolactin
349
Fill in the blank: The initial workup of the patient should include measurement of _______.
serum TSH, prolactin
350
True or False: Administration of conjugated estrogens is the most appropriate initial workup for the patient.
False
351
Which imaging study is NOT the first step in evaluating this patient's condition?
A CT scan of the brain
352
What is the typical timeframe for menstrual cycles to become regular after menarche?
Usually within 2 years after menarche
## Footnote
Menarche is the first occurrence of menstruation in a female.
353
What is secondary amenorrhea?
When a female who has been menstruating has not had a period for more than three cycle intervals, or 6 months
## Footnote
Secondary amenorrhea differs from primary amenorrhea, which is the absence of menstruation in someone who has never menstruated.
354
What should be investigated if a female experiences secondary amenorrhea after ruling out pregnancy?
A disturbance in the hypothalamic-pituitary-ovarian axis
## Footnote
This axis is crucial for regulating the menstrual cycle and reproductive hormones.
355
Which hormones are typically the first line of testing for evaluating secondary amenorrhea?
* Thyroid-stimulating hormone (TSH)
* Prolactin
* Follicle-stimulating hormone (FSH)
* Luteinizing hormone (LH)
* Testosterone
* Estradiol (E2)
## Footnote
These hormone levels help assess the functioning of the endocrine system related to menstruation.
356
What is the second most common cause of secondary amenorrhea in a reproductive age woman?
Anovulation
## Footnote
Anovulation is a condition where the ovaries do not release an oocyte during the menstrual cycle.
357
What is the most common cause of secondary amenorrhea after excluding pregnancy?
Ovarian disease
## Footnote
Ovarian disease accounts for 40 percent of cases of secondary amenorrhea.
358
List the common causes of secondary amenorrhea and their respective percentages.
* Ovarian disease - 40 percent
* Hypothalamic dysfunction - 35 percent
* Pituitary disease - 19 percent
* Uterine disease - 5 percent
* Other - 1 percent
## Footnote
These percentages represent the distribution of causes among women experiencing secondary amenorrhea.
359
True or False: Uterine disease is the most common cause of secondary amenorrhea.
False
## Footnote
Uterine disease accounts for only 5 percent of cases.
360
Fill in the blank: Prolactinomas are rare causes of amenorrhea and are often associated with _______.
galactorrhea
## Footnote
Galactorrhea is the production of breast milk in individuals who are not breastfeeding.
361
What is a rare cause of amenorrhea often secondary to intrauterine trauma?
HP DAT
## Footnote
HP DAT refers to a condition related to intrauterine procedures such as dilation and curettage.
362
What percentage of secondary amenorrhea cases is attributed to pituitary disease?
19 percent
## Footnote
Pituitary disease is one of the less common causes of secondary amenorrhea.
363
What is amenorrhea an indicator of?
Inadequate calorie intake
364
What may cause amenorrhea?
Either reduced food consumption or increased energy use
365
Is amenorrhea a normal response to training?
No
366
What may be the first indication of a potential developing problem in young athletes?
Amenorrhea
367
What combination of conditions may young athletes develop?
Eating disorders, amenorrhea, and osteoporosis
368
What is the term for the combination of eating disorders, amenorrhea, and osteoporosis in young athletes?
Female athlete triad
369
How does amenorrhea usually respond to treatment?
Increased calorie intake or a decrease in exercise intensity
370
Fill in the blank: Amenorrhea is usually treated by increasing _______.
calorie intake
371
True or False: Amenorrhea can be considered a normal physiological response in trained athletes.
False
372
What is Polycystic Ovary Syndrome (PCOS)?
A hormonal disorder causing enlarged ovaries with small cysts on the outer edges
## Footnote
PCOS is often associated with irregular menstrual cycles and excess androgen levels.
373
What does DHEAS stand for?
Dehydroepiandrosterone sulfate
## Footnote
DHEAS is produced by the adrenal glands.
374
What hormones are produced by the pituitary gland?
LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone)
## Footnote
These hormones play key roles in regulating the menstrual cycle and ovulation.
375
What is the significance of 17-OHP in hormone synthesis?
It is a precursor in cortisol synthesis and is converted peripherally to androgens
## Footnote
17-OHP levels are often measured to evaluate adrenal function.
376
What is the normal range for testosterone production?
Produced by the ovary and adrenal gland
## Footnote
Testosterone levels can vary based on age and gender.
377
What is the first step in the management of suspected adrenal tumors?
Ultrasound/CT to image the tumor
## Footnote
Imaging helps in determining the presence and extent of the tumor.
378
Fill in the blank: The ACTH stimulation test _______ the diagnosis.
confirms
## Footnote
This test assesses adrenal function and helps in diagnosing conditions like Congenital Adrenal Hyperplasia.
379
What screening tests should be performed in the management of PCOS?
Screen lipids and fasting blood glucose
## Footnote
These tests help assess the risk of metabolic syndrome in patients with PCOS.
380
What is the role of ultrasound in the diagnosis of ovarian tumors?
To rule out other disorders/tumors
## Footnote
Ultrasound is a non-invasive imaging technique that provides valuable information about ovarian structure.
381
True or False: LH and FSH levels are normal in a healthy individual.
True
## Footnote
Normal levels of these hormones indicate proper pituitary function.
382
What is the second most common cause of secondary amenorrhea in a reproductive age woman?
Anovulation
## Footnote
Anovulation is a significant factor to consider after excluding pregnancy.
383
What percentage of secondary amenorrhea cases are due to ovarian disease?
40 percent
## Footnote
Ovarian disease is the most common cause of secondary amenorrhea.
384
What percentage of secondary amenorrhea cases are attributed to hypothalamic dysfunction?
35 percent
## Footnote
Hypothalamic dysfunction is the second most common cause of secondary amenorrhea.
385
What percentage of secondary amenorrhea cases are caused by pituitary disease?
19 percent
## Footnote
Pituitary disease is another significant cause of secondary amenorrhea.
386
What percentage of secondary amenorrhea cases are due to uterine disease?
5 percent
## Footnote
Uterine disease is a less common cause of secondary amenorrhea.
387
What percentage of secondary amenorrhea cases are classified as 'other' causes?
1 percent
## Footnote
This category includes rare causes not specified in the main categories.
388
True or False: Prolactinomas are common causes of amenorrhea.
False
## Footnote
Prolactinomas are considered rare causes of amenorrhea.
389
Fill in the blank: This is often secondary to intrauterine trauma (dilation and curettage, infection, etc). _______
Uterine disease
## Footnote
Uterine disease can arise from various intrauterine traumas.
390
What is a common association with prolactinomas?
Galactorrhea
## Footnote
Galactorrhea is often seen in patients with prolactinomas.
391
What is the age and height of the woman presenting with primary amenorrhea?
18 years old and 158 cm tall
392
What physical examination finding was noted in the woman with primary amenorrhea?
A small uterus
393
Which laboratory tests should be done to investigate the case of primary amenorrhea?
TSH and Prolactin levels, Progesterone test, FSH and LH levels, Karyotype
## Footnote
Laparoscopy is the only investigation that should not be done in this case.
394
Which investigation is NOT indicated for the woman with primary amenorrhea?
Laparoscopy
395
Fill in the blank: The woman has normal _______ development.
breast
396
What does PCOS stand for?
Polycystic Ovary Syndrome
397
What is the primary hormone produced by the ovary and adrenal gland?
Testosterone
398
Which glands produce DHEAS?
Adrenal glands
399
What hormones are produced by the anterior pituitary gland?
LH and FSH
400
What is the role of 17-OHP in cortisol synthesis?
Precursor converted peripherally to androgens
401
Fill in the blank: 17-OHP is a precursor in _______ synthesis.
cortisol
402
True or False: Testosterone is produced only by the ovaries.
False
403
What does DHEAS stand for?
Dehydroepiandrosterone sulfate
404
What condition is characterized by high levels of testosterone and irregular menstrual cycles?
Polycystic Ovary Syndrome (PCOS)
405
What is the significance of LH and FSH?
They regulate reproductive processes
406
Which two types of tumors can be associated with elevated testosterone levels?
*Ovarian tumor*
*Adrenal tumor*
407
What are the normal levels of LH and FSH in a healthy individual?
NL/NL
408
True or False: DHEAS is primarily produced by the ovaries.
False
409
Fill in the blank: Congenital adrenal hyperplasia is a condition that affects _______ production.
hormonal
410
What is amenorrhea?
Absence of menstruation
## Footnote
Amenorrhea can be classified as primary or secondary, depending on whether menstruation has never occurred or has stopped after a period of normal cycles.
411
What is the usual cause of amenorrhea?
Endocrine dysfunction resulting in anovulation
## Footnote
Anovulation may often be associated with mild estrogen deficiency and hyperandrogenism.
412
What are the key components of diagnosing amenorrhea?
Clinical assessment, pregnancy testing, measurement of hormone levels, progesterone challenge
## Footnote
Hormone levels typically include TSH, Prolactin, FSH, and LH.
413
What is the purpose of a progesterone challenge in diagnosing amenorrhea?
To assess the response of the endometrium to progesterone
## Footnote
A positive response indicates that the endometrium is capable of responding to hormonal signals.
414
What routine tests are included in the evaluation of amenorrhea?
Pregnancy test, progesterone challenge, measurement of hormone levels
## Footnote
Hormone levels should include TSH, Prolactin, FSH, and LH.
415
If a genetic defect is suspected in primary amenorrhea, what test is performed?
Karyotype determination
## Footnote
This test can identify chromosomal abnormalities that may lead to amenorrhea.
416
What is the primary goal of treating amenorrhea?
Correct any underlying disorder and minimize excess androgenic effects
## Footnote
Treatment may vary depending on the specific cause identified during diagnosis.
417
What is hirsutism?
Excessive male-pattern hair growth in a woman
## Footnote
Hirsutism is often associated with hormonal imbalances.
418
What does virilization refer to?
Excessive male-pattern hair growth in a woman plus other masculinizing signs such as:
* Clitoromegaly
* Baldness
* Lowering of voice
* Increasing muscle mass
* Loss of female body contours
## Footnote
Virilization indicates a more severe hormonal imbalance than hirsutism alone.
419
What is hirsutism?
Excessive male-pattern hair growth in a woman
## Footnote
Hirsutism is often associated with hormonal imbalances.
420
What does virilization refer to?
Excessive male-pattern hair growth in a woman plus other masculinizing signs such as:
* Clitoromegaly
* Baldness
* Lowering of voice
* Increasing muscle mass
* Loss of female body contours
## Footnote
Virilization indicates a more severe hormonal imbalance than hirsutism alone.
421
What is the first line of treatment to induce ovulation in women with PCOS?
Clomiphene citrate
## Footnote
Clomiphene citrate is commonly used for ovulation induction in women with Polycystic Ovary Syndrome (PCOS)
422
What is the starting dose of clomiphene citrate for ovulation induction?
25 mg
## Footnote
Clomiphene citrate is typically started at a low dose of 25 mg
423
For how many days is clomiphene citrate administered during the follicular phase?
Five days
## Footnote
Clomiphene citrate is administered for five days during the follicular phase of the menstrual cycle
424
Clomiphene citrate administration can follow which types of menstruation?
Spontaneous menstruation or withdrawal bleed
## Footnote
Withdrawal bleed may be induced by a progestagen or after a cycle of oral contraceptives
425
Fill in the blank: Clomiphene citrate is used for _______ induction in women with PCOS.
ovulation
426
What is Bridget's primary concern?
To become pregnant as quickly as possible
427
Which treatment is suggested to stimulate ovulation in Bridget?
The use of clomiphene citrate
428
Fill in the blank: To stimulate ovulation, Bridget could use _______.
clomiphene citrate
429
True or False: A crash diet is a recommended method to stimulate ovulation.
False
430
Which of the following is NOT suggested for stimulating ovulation: a) A crash diet, b) The use of insulin, c) The use of clomiphene citrate, d) The use of cyproterone acetate, e) The use of spironolactone?
a) A crash diet
431
List the suggested methods to stimulate ovulation.
* The use of insulin
* The use of clomiphene citrate
* The use of cyproterone acetate
* The use of spironolactone
432
What is Bridget's primary concern?
To become pregnant as quickly as possible
433
Which treatment is suggested to stimulate ovulation in Bridget?
The use of clomiphene citrate
434
Fill in the blank: To stimulate ovulation, Bridget could use _______.
clomiphene citrate
435
True or False: A crash diet is a recommended method to stimulate ovulation.
False
436
Which of the following is NOT suggested for stimulating ovulation: a) A crash diet, b) The use of insulin, c) The use of clomiphene citrate, d) The use of cyproterone acetate, e) The use of spironolactone?
a) A crash diet
437
List the suggested methods to stimulate ovulation.
* The use of insulin
* The use of clomiphene citrate
* The use of cyproterone acetate
* The use of spironolactone
438
What is the definition of post-pill amenorrhea?
The absence of periods after discontinuing oral contraceptives.
439
What condition is diagnosed when a woman under the age of 40 fails to menstruate with a raised follicle stimulating hormone?
Premature ovarian failure.
440
Is premature ovarian failure a highly likely diagnosis for Bridget?
No, it is not a highly likely diagnosis.
441
What type of tumors can result in amenorrhea?
Androgen secreting tumors.
442
What is a classical history for polycystic ovary syndrome?
Late menarche, irregular periods, development of androgenic side effects, and failure to resume menstruation after stopping oral contraceptives.
443
What condition can result in amenorrhea associated with cessation of periods and is often linked with galactorrhea?
Hyperprolactinaemia.
444
Fill in the blank: The absence of periods after discontinuing oral contraceptives is known as _______.
post-pill amenorrhea.
445
True or False: Androgen secreting tumors cause a gradual onset of amenorrhea.
False.
446
What are the four key characteristics of polycystic ovary syndrome?
* Late menarche
* Irregular periods
* Development of androgenic side effects
* Failure to resume menstruation after stopping oral contraceptives.
447
What syndrome is characterized by hormonal imbalance and ovarian dysfunction?
Polycystic ovary syndrome (PCOS)
## Footnote
PCOS is a common endocrine disorder affecting women of reproductive age.
448
What is the role of testosterone in the female body?
Produced by ovary & adrenal gland
## Footnote
Testosterone is involved in various bodily functions including libido and bone health.
449
What hormone is produced by the adrenal glands and is a precursor to androgens?
DHEAS
## Footnote
DHEAS (Dehydroepiandrosterone sulfate) plays a role in the synthesis of sex hormones.
450
Which hormones are produced by the pituitary gland that regulate reproductive functions?
LH and FSH
## Footnote
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are critical for ovulation and fertility.
451
What is the normal range for 17-OHP in cortisol synthesis?
NL
## Footnote
17-Hydroxyprogesterone (17-OHP) is a steroid hormone involved in the production of cortisol.
452
What is the next step in management for suspected adrenal or ovarian tumors?
Ultrasound/CT to image tumor
## Footnote
Imaging is essential to confirm the presence of tumors and guide treatment.
453
Fill in the blank: The ACTH stimulation test confirms the _______ diagnosis.
[key learning term]
## Footnote
This test helps distinguish between different types of adrenal dysfunction.
454
What tests should be conducted to assess metabolic risk in patients with PCOS?
Screen lipids and fasting blood glucose
## Footnote
Patients with PCOS are at higher risk for metabolic syndrome.
455
True or False: The diagnosis of PCOS can be confirmed solely through hormonal levels.
False
## Footnote
Diagnosis often requires a combination of clinical, hormonal, and imaging assessments.
456
Which tests would you not order?
All of the following tests, except:
* FSH, LH, Prolactin
* GTT, Fasting Insulin
* Total cholesterol, HDL, LDL
* Abdominal ultrasound
* Vaginal ultrasound
## Footnote
The question implies a context where certain tests are relevant, but one option is excluded from the order.
457
What does FSH stand for?
Follicle Stimulating Hormone
## Footnote
FSH is a hormone involved in the regulation of the reproductive processes.
458
What does LH stand for?
Luteinizing Hormone
## Footnote
LH plays a crucial role in regulating the menstrual cycle and ovulation.
459
What does GTT stand for?
Glucose Tolerance Test
## Footnote
GTT is used to assess how well the body processes glucose.
460
What are the components of a lipid panel?
* Total cholesterol
* HDL
* LDL
## Footnote
A lipid panel is important for evaluating cardiovascular health.
461
What is the purpose of an abdominal ultrasound?
To visualize internal organs and structures within the abdomen
## Footnote
Abdominal ultrasounds are non-invasive imaging tests.
462
What is the purpose of a vaginal ultrasound?
To visualize reproductive organs and structures within the pelvis
## Footnote
Vaginal ultrasounds are often used in obstetrics and gynecology.
463
True or False: Prolactin is a hormone that regulates lactation.
True
## Footnote
Prolactin is essential for milk production in breastfeeding.
464
What are the initial steps in workup for REC?
Testosterone, DHEAS, LH/FSH, 17-hydroxyprogesterone
## Footnote
REC stands for a specific clinical context where hormonal evaluation is necessary.
465
What does DHEAS stand for?
Dehydroepiandrosterone sulfate
## Footnote
DHEAS is an important steroid hormone involved in the production of androgens and estrogens.
466
What is the role of LH and FSH in the body?
Regulation of the reproductive system
## Footnote
LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) are critical in the functioning of the ovaries and testes.
467
Fill in the blank: The hormone measured that is a precursor to testosterone is _______.
17-hydroxyprogesterone
## Footnote
17-hydroxyprogesterone is a steroid hormone that can indicate issues in steroidogenesis.
468
True or False: Testosterone is one of the hormones evaluated in the initial workup for REC.
True
## Footnote
Testosterone levels can provide insights into various endocrine disorders.
469
What is the primary clinical indication of anovulatory cycles?
Infertility
## Footnote
Anovulatory cycles can lead to difficulty in conceiving.
470
What is primarily used for the diagnosis of anovulatory cycles?
Clinical examination
## Footnote
Diagnosis is mostly based on clinical findings.
471
What laboratory ratio is elevated in cases of anovulatory cycles?
LH/FSH ratio
## Footnote
An elevated LH/FSH ratio is used for confirmation of the diagnosis.
472
What physical findings are expected on exam and ultrasound in anovulatory cycles?
Bilaterally enlarged ovaries
## Footnote
Enlargement of the ovaries is a key indicator during examination.
473
True or False: Anovulatory cycles can be diagnosed solely through laboratory tests.
False
## Footnote
Diagnosis is primarily clinical, with laboratory tests supporting confirmation.
474
What is the ultrasound finding associated with ovarian enlargement?
A necklacelike pattern of multiple peripheral cysts (20-100 cystic follicles in each ovary)
## Footnote
This finding indicates a specific pattern related to ovarian enlargement.
475
What hormonal influence is suggested in cases of ovarian enlargement?
Androgens
## Footnote
Androgens contribute to multiple follicles in various stages of development.
476
What are the characteristics of the ovaries in cases of ovarian enlargement?
Stromal hyperplasia, thickened ovarian capsule, bilaterally enlarged ovaries
## Footnote
These characteristics are commonly observed in cases of ovarian enlargement.
477
Fill in the blank: Ovarian enlargement shows a _______ pattern of multiple peripheral cysts.
necklacelike
## Footnote
This pattern is indicative of the presence of numerous cystic follicles.
478
True or False: Ovarian enlargement is characterized by a single cystic follicle in each ovary.
False
## Footnote
Ovarian enlargement is characterized by multiple cystic follicles.
479
What is the classical presentation of anovulation?
History of amenorrhea followed by unpredictable bleeding
## Footnote
Prolonged unopposed estrogen stimulates the endometrium
480
List some potential diagnoses for anovulation.
* Polycystic ovary syndrome (PCOS)
* Hypothyroidism
* Pituitary adenoma
* Elevated prolactin
* Medications (e.g., antipsychotics, antidepressants)
## Footnote
These conditions can lead to hormonal imbalances affecting ovulation.
481
True or False: Anovulation can be caused by medications such as antipsychotics.
True
## Footnote
Certain medications can disrupt hormonal balance, leading to anovulation.
482
Fill in the blank: Anovulation classically presents with a history of _______.
amenorrhea
483
What hormonal condition is characterized by elevated prolactin levels?
Anovulation
## Footnote
Elevated prolactin can disrupt normal ovulatory cycles.
484
What is a common endocrine disorder associated with anovulation?
Polycystic ovary syndrome (PCOS)
## Footnote
PCOS is one of the most common causes of anovulation.
485
What is the LH:FSH ratio in REC diagnostic testing?
3:1
## Footnote
Normal LH:FSH ratio is 1.5:1
486
What is the testosterone level in REC diagnostic testing?
Mildly elevated
487
What does a pelvic ultrasound show in REC diagnostic testing?
Bilaterally enlarged ovaries with multiple subcapsular small follicles and increased stromal echogenicity
488
Fill in the blank: The normal LH:FSH ratio is _______.
1.5:1
489
What is required for a diabetes diagnosis?
Two abnormal tests: fasting glucose ≥7 mmol/L or HbA1c ≥6.5%
## Footnote
These thresholds are established to identify individuals with diabetes, allowing for timely intervention.
490
What is the fasting glucose level that indicates a diabetes diagnosis?
≥7 mmol/L
## Footnote
Fasting glucose is measured after not eating for at least 8 hours.
491
What HbA1c level indicates a diabetes diagnosis?
≥6.5%
## Footnote
HbA1c reflects average blood glucose levels over the past 2 to 3 months.
492
Fill in the blank: A diabetes diagnosis requires two abnormal tests: fasting glucose ≥7 mmol/L or _______.
HbA1c ≥6.5%
## Footnote
These criteria help in diagnosing diabetes accurately.
493
True or False: A single abnormal test is sufficient for a diabetes diagnosis.
False
## Footnote
A diagnosis requires two abnormal test results.
494
What is the age of the patient presenting with pelvic pain?
21 years old
495
What symptom is the patient experiencing during intercourse?
Pelvic pain
496
How long has the patient been trying to get pregnant with the same partner?
6 months
497
What is significant about the patient's menstrual history?
Started periods at 14 but has only had a couple since then
498
What family history is noted regarding the patient's menstrual pattern?
Her mother had the same pattern
499
What additional symptoms does the patient want treatment for?
Facial hair and acne
500
What is the physical exam finding related to the patient's weight?
Centrally obese
501
What type of hair growth is noted on the patient?
Excess hair down the side of her face and under her chin
502
What skin condition is observed on the patient's cheeks?
Erythematous pustules
503
Which lab result would be most consistent with the patient's history and exam findings?
LH: FSH ratio >3:1
504
Fill in the blank: The patient has never used _______ of any type.
birth control
505
True or False: The patient's pelvic pain has been consistent over the past few months.
False
506
What is the patient's complaint regarding her attempts to conceive?
Not getting pregnant
507
What is the patient's temperature during the physical exam?
Afebrile
508
What is the significance of the LH: FSH ratio in this case?
It indicates a potential hormonal imbalance often associated with PCOS
509
What is the condition characterized by hyperpigmented areas in skin folds suggesting significant insulin resistance?
Acanthosis nigricans
## Footnote
Acanthosis nigricans is often associated with metabolic disorders, including insulin resistance.
510
What recent evidence points to the underlying cause of PCOS?
Insulin resistance
## Footnote
Insulin resistance is a key factor in the pathophysiology of Polycystic Ovary Syndrome (PCOS).
511
How can insulin resistance be quantified?
By calculating the ratio of fasting glucose to insulin
## Footnote
A ratio of <4.5 indicates decreased insulin sensitivity.
512
What stimulates ovarian androgen production leading to anovulation?
Insulin resistance
## Footnote
Increased androgen levels can disrupt normal ovulation processes.
513
What can prolonged anovulation lead to in terms of ovarian changes?
Enlarged ovaries with multiple cysts
## Footnote
These changes were first identified through ultrasound imaging.
514
What two conditions interfere with the secretion of gonadotropins from the pituitary gland in PCOS?
Hyperinsulinemia and hyperandrogenemia
## Footnote
These conditions can alter the normal hormonal feedback mechanisms in the reproductive system.
515
True or False: A ratio of fasting glucose to insulin greater than 4.5 indicates decreased insulin sensitivity.
False
## Footnote
A ratio of <4.5 indicates decreased insulin sensitivity.
516
Fill in the blank: The hyperpigmented areas in the skin folds are known as _______.
Acanthosis nigricans
517
What is the most common cause of amenorrhea in reproductive age women?
A positive pregnancy test
## Footnote
This is the primary consideration before exploring other causes.
518
What condition is consistent with a clinical history and appearance that includes irregular periods, acne, and central obesity?
Polycystic ovarian syndrome (PCOS)
## Footnote
These symptoms can be early indicators in adolescents.
519
What are the clinical features of polycystic ovarian syndrome (PCOS)?
* Oligomenorrhea (90%)
* Hirsutism (80%)
* Obesity (50%)
* Amenorrhea (40%)
* Infertility (40%)
## Footnote
These percentages indicate how common each feature is among patients with PCOS.
520
What LH:FSH ratio supports the diagnosis of PCOS?
Greater than 3:1
## Footnote
This hormonal ratio is a key diagnostic marker.
521
What test should be ordered first for a patient suspected of having amenorrhea?
Urine HCG test
## Footnote
This test helps rule out pregnancy as a cause of amenorrhea.
522
What can a low TSH level indicate?
Hyperthyroidism
## Footnote
Hyperthyroidism may cause more frequent, heavy menses and weight loss.
523
What is CA-125 used to follow?
Ovarian cancer and sometimes severe endometriosis
## Footnote
CA-125 is not a reliable screening test due to lack of sensitivity.
524
What could a prolactin level three times normal indicate?
It may cause amenorrhea and galactorrhea
## Footnote
This level would typically not be seen in PCOS.
525
True or False: Hirsutism is a common symptom of hyperthyroidism.
False
## Footnote
Hyperthyroidism does not cause hirsutism.
526
What is the role of the oral contraceptive pill in treatment?
Treats irregular bleeding and hirsutism
## Footnote
The progestin component prevents endometrial hyperplasia.
527
Which medication is used to suppress hair follicles?
Spironolactone
528
What is the treatment of choice for infertility?
Clomiphene citrate or human menopausal gonadotropin (HMG)
529
What effect does Metformin have in treatment?
Enhances ovulation and manages insulin resistance
530
What condition is diagnosed with gradual-onset hirsutism without virilization in the second or third decade?
Congenital adrenal hyperplasia (21-hydroxylase deficiency)
## Footnote
This condition is typically associated with menstrual irregularities and anovulation.
531
What is markedly elevated in serum levels for congenital adrenal hyperplasia (21-hydroxylase deficiency)?
17-hydroxyprogesterone
## Footnote
Elevated levels of this hormone are a key diagnostic indicator.
532
What common physical development is associated with congenital adrenal hyperplasia in children?
Precocious puberty with short stature
## Footnote
This condition can lead to early onset of puberty in affected individuals.
533
What type of family history may be positive in cases of congenital adrenal hyperplasia (21-hydroxylase deficiency)?
Positive family history
## Footnote
Genetic factors may play a role in this condition.
534
What is the primary management approach for congenital adrenal hyperplasia (21-hydroxylase deficiency)?
Corticosteroid replacement
## Footnote
This treatment helps to arrest the signs of androgenicity and restore ovulatory cycles.
535
True or False: Anovulation is a common symptom of congenital adrenal hyperplasia (21-hydroxylase deficiency).
True
## Footnote
Anovulation is often associated with menstrual irregularities in this condition.
536
What is the relationship between elevated testosterone levels and hirsutism and acne?
Elevated testosterone levels correlate with findings of hirsutism and acne
## Footnote
However, elevated testosterone does not contribute to the development of acanthosis nigricans.
537
What does DHEAS elevation indicate?
DHEAS elevation may represent a virilizing tumor
## Footnote
It is also associated with conditions like adult onset congenital adrenal hyperplasia.
538
Does serum 17-OHP cause acanthosis nigricans?
No, serum 17-OHP is associated with adult onset congenital adrenal hyperplasia but does not cause acanthosis nigricans.
539
What condition is indicated by an elevated prolactin level?
An elevated prolactin level is consistent with a pituitary adenoma
## Footnote
It is not related to acanthosis nigricans.
540
What is the diagnosis when rapid onset hirsutism and virilization are described without a family history?
Adrenal or ovarian tumor.
541
What laboratory finding is markedly elevated in an adrenal tumor?
DHEAS is markedly elevated in an adrenal tumor.
542
What laboratory finding is markedly elevated in an ovarian tumor?
Testosterone is markedly elevated in an ovarian tumor.
543
What is the next step after diagnosing an adrenal or ovarian tumor?
Order an ultrasound (adnexal mass) or CT (adrenal mass).
544
What is the management approach for adrenal or ovarian tumors?
Surgical removal of the tumor.
545
What is the treatment of choice when there is no virilization and all laboratory findings are normal?
Spironolactone is the treatment of choice.
546
What is the first-line topical drug for the treatment of unwanted facial and chin hair?
Eflornithine (Vaniqa).
547
What is the diagnosis associated with the presence of polycystic ovaries?
Polycystic ovary syndrome
## Footnote
This condition is characterized by hormonal imbalance and metabolism problems that may affect overall health and appearance.
548
What condition is indicated by congenital adrenal hyperplasia?
Adrenal gland dysfunction
## Footnote
This condition affects cortisol production and can lead to an excess of androgens.
549
What type of tumors can be associated with hormonal imbalances in women?
Ovarian tumor and adrenal tumor
## Footnote
These tumors can produce hormones such as testosterone, affecting overall hormone levels.
550
Where is testosterone produced in the body?
Ovary and adrenal gland
## Footnote
Testosterone is a key androgen involved in various bodily functions.
551
What does DHEAS stand for and where is it produced?
Dehydroepiandrosterone sulfate; produced by adrenal glands
## Footnote
DHEAS is an androgen that serves as a precursor to other hormones.
552
What hormones are produced by the anterior pituitary gland?
LH and FSH
## Footnote
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) play critical roles in reproductive processes.
553
What is the next step in management for diagnosing hormonal disorders?
Ultrasound to rule out other disorders/tumors
## Footnote
Imaging can help confirm the presence of tumors or other abnormalities.
554
What is 17-OHP a precursor for?
Cortisol synthesis
## Footnote
17-OHP can also be converted peripherally to androgens.
555
What tests should be done to screen for metabolic issues in patients with hormonal disorders?
Screen lipids and fasting blood glucose
## Footnote
This screening helps identify potential metabolic syndrome or diabetes.
556
What does ACTH stimulation test confirm?
The diagnosis of adrenal disorders
## Footnote
This test assesses the adrenal glands' response to adrenocorticotropic hormone.
557
True or False: Ultrasound and CT imaging are used to confirm the presence of tumors.
True
## Footnote
These imaging techniques provide detailed views of internal structures.
558
What are the initial lab tests for menopause evaluation?
FSH, E2, TSH, PRL
## Footnote
These tests help assess hormone levels and diagnose conditions related to menopause.
559
What should be added to the lab tests if there is evidence of hyperandrogenism?
Serum total testosterone
## Footnote
Hyperandrogenism can indicate conditions like polycystic ovary syndrome (PCOS).
560
What is the diagnosis if prolactin levels are elevated?
Hyperprolactinemia
## Footnote
Elevated prolactin can lead to various symptoms, including amenorrhea and galactorrhea.
561
What is the next step after diagnosing hyperprolactinemia?
Pituitary MRI
## Footnote
This imaging is used to check for pituitary tumors or other abnormalities.
562
What is the diagnosis when FSH is elevated in the setting of amenorrhea?
Primary ovarian insufficiency
## Footnote
This condition is characterized by a decrease in ovarian function before age 40.
563
What symptoms are commonly associated with primary ovarian insufficiency?
Hot flashes, vaginal dryness
## Footnote
These symptoms result from decreased estrogen levels.
564
If FSH is low or normal, what is the next question to consider?
Is E2 low?
## Footnote
This helps determine if there is a problem with estrogen production.
565
True or False: If the repeat prolactin is normal, further evaluation is different than for those with an initial normal prolactin level.
False
## Footnote
The evaluation remains the same regardless of the initial prolactin levels.
566
What is the typical FSH level seen with low E2 during menopause?
High FSH
## Footnote
This indicates the body is trying to stimulate the ovaries due to low estrogen levels.
567
Fill in the blank: In the context of thyroid disease evaluation, if TSH is abnormal, _______.
Further evaluation and treatment are required
## Footnote
Thyroid disorders can significantly affect menstrual cycles and overall health.
568
What is secondary amenorrhea?
Absence of menses for more than three months in girls or women who previously had regular menstrual cycles or absence for more than six months in those with irregular menses.
569
What is the significance of serum hCG in evaluating secondary amenorrhea?
A positive serum hCG indicates pregnancy.
570
What are some major causes to consider when evaluating secondary amenorrhea?
Signs or symptoms such as:
* Weight change
* Eating disorder
* Galactorrhea
* Hot flashes
* Acne
* Hirsutism
* History of uterine instrumentation
571
What is the minimum duration of absence of menses to define secondary amenorrhea in regular cycles?
More than three months.
572
What is the minimum duration of absence of menses to define secondary amenorrhea in irregular cycles?
More than six months.
573
True or False: A negative serum hCG test rules out pregnancy in cases of secondary amenorrhea.
True.
574
What physical exam findings might suggest hyperandrogenism in patients with secondary amenorrhea?
Signs of hyperandrogenism such as:
* Low BMI
* Obesity
575
What is the diagnosis when prolactin levels are elevated?
Hyperprolactinemia
## Footnote
Follow-up with a Pituitary MRI is recommended.
576
What should be done if the repeat prolactin test is normal?
Further evaluation is the same as for those with normal initial prolactin levels
## Footnote
This indicates a need for continued assessment of thyroid disease.
577
What is indicated by elevated FSH levels?
Primary ovarian insufficiency
## Footnote
Common symptoms include low or normal FSH and vaginal dryness.
578
What is the first step in evaluating hyperprolactinemia?
Repeat prolactin test
## Footnote
This helps confirm the diagnosis before further imaging or evaluation.
579
What does E2 stand for in the context of hormone evaluation?
Estradiol
## Footnote
Estradiol levels can be assessed to further evaluate ovarian function.
580
Fill in the blank: The acronym TSH stands for _______.
Thyroid-stimulating hormone
## Footnote
TSH is important in evaluating thyroid function.
581
What does FSH stand for?
Follicle-stimulating hormone
## Footnote
FSH is crucial for reproductive processes.
582
True or False: Vaginal dryness is a common symptom of primary ovarian insufficiency.
True
## Footnote
This symptom often accompanies hormonal changes.
583
What imaging study is recommended for evaluating hyperprolactinemia?
Pituitary MRI
## Footnote
This imaging helps assess for pituitary tumors or other abnormalities.
