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Gynecology > 2 - Reproductive Physiology > Flashcards

2 - Reproductive Physiology Flashcards

1
Q

Heavy menses occurring in the context of ovulatory cycles with no other etiology is most likely caused by what?

A
  • Endometrial pathology

* diagnoses of exclusion

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2
Q

What is the difference between menorrhagia and metrorrhagia?

A
  • menorrhagia = excessive flow/duration

- metrorrhagia = irregular intervals

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3
Q

If a childbearing age patient presents with acute abnormal bleeding they need to be ruled out for what?

A
  • ectopic pregnancy
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4
Q

Ovulation follows the LH surge by how many hours?

A

24-36 hr

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5
Q

A surge in this hormone causes oocyte in the dominant follicle to complete the first meiotic division (ovulation).

A
  • Luteinizing hormone (LH)
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6
Q

What non surgical treatment option for fibroids is available for patients of non child-bearing age?

A
  • uterine artery embolization
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7
Q

Why can’t you diagnose PCOS within 2 years of menarche in adolescents?

A
  • menstrual irregularities during adolescents are common and cycles are frequently anovulatory
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8
Q

A peak in this hormone leads to the LH surge causing ovulation.

A
  • Estradiol (E2)
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9
Q

What is the ultrasound diagnostic criteria for PCOS?

A
  • > 12 follicles 2-9mm in diameter
  • ovarian volume > 10 ml

*need only 1 ovary for diagnosis

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10
Q

Anovulation is defined as an absence of bleeding for greater than how many months?

A

2 months

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11
Q

What is the medical treatment for hyperprolactinemia?

A
  • dopamine agonists (e.g. bromocriptine, cabergoline)
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12
Q

Which of the following is the most common location for fibroids?

a. subserosal (in serosa)
b. intramural (within uterine wall)
c. submucosal (in endometrial cavity)

A

b. intramural

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13
Q

What is on the differential for abnormal menstrual bleeding? (hint: PALM-COEIN)

A
  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy
  • Coagulopathy
  • Ovulatory Dysfx
  • Endometrial
  • Iatrogenic
  • Not yet classified
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14
Q

What type of hyperplasia has the highest risk of malignant transformation?

a. simple
b. complex
c. atypical

A

atypical

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15
Q

For adenomyosis:

  1. what is the main symptom?
  2. what is the main diagnostic method?
  3. what is the main treatment?
A
  1. pelvic pain
  2. biopsy
  3. go through menopause or hysterectomy
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16
Q

What hormone induces the production of ovarian androgens and progesterone?

A
  • Luteinizing hormone (LH)
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17
Q

What test is used to diagnose diabetes in patients with PCOS? What do the results mean?

A
  • oral glucose tolerance test (75 gm)
  • <140 = negative
  • 140-199 = intolerant
  • > 200 = diabetic
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18
Q

How is estrogen breakthrough bleeding treated?

A
  • give progesterone
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19
Q

What time of day do you want to check prolactin levels?

A
  • early morning
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20
Q

What hormone is used as a marker of ovarian health and aging?

A
  • Anti-mullerian hormone
21
Q

How is hirsutism secondary to PCOS best treated?

A
  • OCs or anti-androgens (spironolactone)
22
Q

What drug is well known to cause elevated prolactin levels?

A
  • respiradone
23
Q

What is the most common diagnosis for a hysterectomy?

A
  • Leiomyomas (Fibroids)
24
Q

How can excessive exercise result in anovulation?

A
  • excessive exercise can decrease GnRH secretion
25
Depo-povera (progesterone>estrogen) can result in which of the following: a. estrogen withdrawal bleeding b. estrogen breakthrough bleeding c. progesterone withdrawal bleeding d. progesterone breakthrough bleeding
d. progesterone breakthrough bleeding
26
Normal ovulation occurs in which of the following: a. estrogen withdrawal bleeding b. estrogen breakthrough bleeding c. progesterone withdrawal bleeding d. progesterone breakthrough bleeding
c. progesterone withdrawal bleeding
27
When does the folllicular phase begin and end?
- begins at cycle day 1 and ends with LH surge
28
What are the 3 main characteristics of prolactinomas?
- galactorrhea - amenorrhea/oligomenorrhea - visual field defects
29
How is primary amenorrhea defined?
- no menses by 16 years
30
What is the most common solid pelvic tumors in women?
- Leiomyomas (Fibroids)
31
What causes oligomenorrhea and a hypoestrogenic state in patients with prolactinoma?
- prolactin suppresses GnRH secretion which suppress LH/FSH
32
What is the surgical treatment of hyperprolactinemia?
- transphenoidal resection
33
What is the most common cause of anovulation?
Polycystic ovarian syndrome (PCOS)
34
In adolescents within 2 years of menarche how should you treat suspected PCOS?
- treat individual manifestations | e. g. obesity, hirsutism, irregular menses
35
Polycystic ovarian syndrome (PCOS) is defined by these 3 findings.
- hyperandrogenism (hirsutism) - ovulatory dysfunction (amenorrhea/ oligomenorrhea) - polycystic ovaries
36
A hysterectomy for treatment of fibroids should only be performed after a patient has completed this stage in her life.
- child bearing stage
37
When does the luteal/secretory phase begin and end?
- begins with LH surge | - ends with onset of menses
38
How is the first day of menses defined?
- first day of previous period (not the last day)
39
What hormone increases the production of estrogen?
- Follicle stimulating hormone (FSH)
40
What surgical treatment is available for patients with fibroids who desire an option for future fertility?
- myomectomy (resection of fibroids by laparotomy/laparoscopy) * pt will need C-section for delivery after this procedure
41
What is the most common gynecologic malignancy in women in the USA?
- Carcinoma
42
Hyperplasia results from an unopposed increase in this hormone.
- estrogen
43
ACOG now recommends testing for vWD in these 2 situations:
1. adolescents with severe menorrhagia before hormonal treatment 2. adult women with undiagnosed cause of menorrhagia
44
What is the main difference between menstruation in adults and adolescents?
- adolescent = occurs from negative feedback (E2/FSH cycling) - adults = occurs from positive feedback (LH surge)
45
How is progesterone breakthrough bleeding (Depo-provera) treated?
- add estrogen or progestin that is testosterone derivative
46
Menses ensues when the corpus luteum stops making this hormone.
- progesterone
47
What is the most common bleeding disorder causing heavy menstrual bleeding?
- Von Willebrand's disease
48
What is the hallmark sign of insulin resistance in patients with PICO?
- acanthosis nigricans

Gynecology (8 decks)

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