03a: Amenorrhea

Question 1

Top three causes of secondary amenorrhea

Answer 1

1. Pregnancy
2. PCOS (30-35%)
3. Hypothalamic (20-25%)

Question 2

List some less common causes (10% or less) of secondary amenorrhea

Answer 2

1. Premature ovarian insufficiency (early menopause)
2. Hyperprolactinemia
3. Asherman’s syndrome (uterine adhesions)
4. Hypothyroid/endocrine

Question 3

Hypothalamic amenorrhea: (high/low) FSH, (high/low) LH, (high/low) E.

Answer 3

All low

Question 4

PCOS: (high/low) FSH, (high/low) LH, high (E/T).

Answer 4

normal, high, Testosterone

Question 5

PCOS is often the result of (X) resistance. What’s the mechanism/pathogenesis behind this?

Answer 5

X = insulin

High insulin causes high IGF to bind ovary theca cells, resulting in high androstenedione (and high testosterone)

Question 6

Criteria for PCOS:

Answer 6

2/3 of:

1. Oligo/an-ovulation
2. Clinical OR biochem hyperandrogenism
3. Polycystic ovary, 1 or both (and exclusion of other etiologies)

Question 7

T/F: Insulin resistance appears in up to 70% of obese and non-obese PCOS women.

Answer 7

True (so check HbA1c if suspecting PCOS); 5-10% have DMII

Question 8

Infertility is defined as inability to conceive after (X) (days/months/years) of regular, unprotected intercourse.

Answer 8

X = 1y

Question 9

Of couples with female under 30 yo, (X)% are infertile.

Answer 9

X = 10

Question 10

Of couples with female between 40-44 yo, (X)% are infertile.

Answer 10

X = 30-40

Question 11

Window of time in menstrual cycle that’s considered “high risk” for pregnancy is (X) day(s) before and (Y) day(s) after ovulation.

Answer 11

4-5 day window
X = 3
Y = 1

Question 12

Rx for unexplained/minor causes of infertility:

Answer 12

1. Intrauterine insemination of washed/concentrated sperm with female on fertility drug (Letrozole, clomid)
2. IVF

Question 13

One milestone related to teratogens is the increase in incidence of phocomelia, aka (X), linked to (Y) exposure.

Answer 13

X = flipper limb
Y = thalidomide (prescribed for morning sickness in europe)

Question 14

FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: fetal risk, but acceptable benefit/risk

Answer 14

D

Question 15

FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: no fetal risk, based on human studies

Answer 15

A

Question 16

FDA Lettering Classification of Benefit/Risk of drugs in pregnancy: fetal risk outweighs benefits

Answer 16

X

Question 17

T/F: Effect of maternal smoking on fetus is dose-dependent.

Answer 17

True

Question 18

List some abnormalities that occur as result of maternal smoking during pregnancy

Answer 18

1. Low birth weight (fetal growth retardation in trim 3 and increased risk of pre-term delivery)
2. Teratogenic effects (heart defects)

Question 19

T/F: About 2% of smokers among women are giving birth, according to 2014 data.

Answer 19

False - 8.4%!

Question 20

T/F: Effect of maternal ethanol consumption on fetus is dose-dependent.

Answer 20

True

Question 21

Pre-term infant has microcephaly and some abnormal facial features (low nasal bridge, indistinct philtrum, thin upper lip). This is characteristic of (X). What other issues are you worried this infant might have?

Answer 21

X = fetal alcohol syndrome

Neurodevelopment disorders

Question 22

FDA restriction on fish consumption during pregnancy is due to:

Answer 22

teratogenic effects of mercury

Question 23

List some examples of teratogenic meds.

Answer 23

1. ACEi/ARBs
2. Statins
3. Anti-seizure (valproate, phenytoin)
4. Retinoids
5. Chemo
6. Warfarin

Question 24

ACEi/ARBs have teratogenic effects primarily in (X) trimester(s), by causing which abnormalities?

Answer 24

X = 2nd, 3rd

Renal dysgenesis/failure (fetal/neonatal death)

Question 25

Valproate is considered Category (X) for teratogenicity.

Answer 25

X = D (benefit of drug may outweigh risk of teratogenicity since seizures are dangerous for mom and baby)

Question 26

Valproate has teratogenic effects primarily in (X) trimester(s), by causing which abnormalities?

Answer 26

X = 1st

NTD (spina bifida)

Question 27

Statins is considered Category (X) for teratogenicity.

Answer 27

X = X

Question 28

Why are certain vitamin A analogues (tertinoin) relatively less teratogenic than others (isotretinoin, etretinate)?

Answer 28

Depends on administration route (topical v. po)