amenorrhea

Question 1

absence of normal menses for 3 normal menstural cycles of 6 mo or longer

Answer 1

amenorrhea

Question 2

absence of menses in a woman who has never menstruated by 15y/o regardless if px has 2ndary sex char or not

Answer 2

primary amenorrhea

Question 3

absence of menses by 13 y/o when there is no visible 2ndary sex char dev or by 15 y/o in the presence of normal 2ndary sex char

Answer 3

primary amenorrhea

Question 4

absence of menses for an arbitrary period usu longer than 6-12mo;
those who have previously menstruated

Answer 4

secondary amenorrhea

Question 5

for a female to develop breast, she should have

Answer 5

estrogen stimulation from ovaries

Question 6

most common cause of primary amenorrhea

Answer 6

gonadal failure

Question 7

gonadal failure is most commonly caused by

Answer 7

chromosomal disorder rarely by 17 a hydoxylase deficiency

Question 8

enzyme that is needed in the production of mineralocorticoids and glucocorticoids

Answer 8

17a hydroxylase

Question 9

what is the char of the chromosomes and gonads in pure gonadal dysgenesis

Answer 9

normal chromosomes

gonads do not develop

Question 10

do px with gonadal failure have internal genitalia?

Answer 10

yes, and they will look grossly female

Question 11

karyotype of px with turner syndrome

Answer 11

45XO missing X chromosome

Question 12

what is the effect on height if the deletion occurs on the long arm

Answer 12

no effect on height

short arm - short stature

Question 13

px 20y/o came in. PE shows webbed neck, low set ears and widely spaced nipples. Ht = 4’2”. This px can have associated problems such as

Answer 13

Coarc
tricuspid valve probs
renal ab
autoimmunde disorders like thyroiditis and myesthenia gravis
hypothyroidism (most common)

Question 14

px 20y/o came in. PE shows webbed neck, low set ears and widely spaced nipples. Ht = 4’2”. This px can have associated problems such as

Answer 14

(TURNER syndrome)
Coarc
tricuspid valve probs
renal ab
autoimmunde disorders like thyroiditis and myesthenia gravis
hypothyroidism (most common)

Question 15

in px w/ hypothalamic disorder, low estrogen lvls are due to

Answer 15

very low gonadotropin release from the pituitary

Question 16

Causes of hypothalamic disorder causing primary amenorrhea

Answer 16

Lesions
inadequate release and/or synthesis from hypothalamus
isolated gonadotropin deficiency in pituitary gland

Question 17

most common lesion that can cause hypothlamic pituitary disorder

Answer 17

prolactinoma - pituitary adenoma

Question 18

in this disorder, the deficient is only FSH or LH

Answer 18

isolated gonadotropin deficiency in pituitary gland

Question 19

isolated gonadotropin deficiency in pituitary gland is associated with

Answer 19

thalassemia major or retinitis pigmentosa

Question 20

what hypothalamic disorder can be secondary to mumps encephalitis

Answer 20

isolated gonadotropin deficiency in pituitary gland

Question 21

androgen resistance syndrome is aka

Answer 21

testicular feminization/ androgen insensitivity

Question 22

karyotype of px with androgen resistance syndrome

Answer 22

XY

Question 23

in this disorder, there is an absence of an X chromosome gene resp for the cytoplasmic or nuclear testosterone receptor function

Answer 23

Androgen resistance syndrome

Question 24

main problem in androgen resistance syndrome

Answer 24

testosterone RECEPTOR

Question 25

px came in with amenorrhea as cc. PE showed normal breast. scanty to absent pubic and axillary hair. No internal female organs upon examination. what could be the testosterone level of this px

Answer 25

This px has androgen resistance syndrome, testosterone lvls are normal since the problem is on the receptors. there is breast dev bcoz they still produce little estrogen

Question 26

abnormal gonads have a high risk of malignancy esp

Answer 26

gonadoblastoma and dysgerminoma

Question 27

karyotype of px with congenital absence of the uterus

Answer 27

46XX

Question 28

karyotype of px with Mayer Rokitansky Kuster Hauser Syndrome

Answer 28

46XX

Question 29

if there is regression of the mullerian ducts the px may have

Answer 29

absent uterus
absent or short vagina
normal ovaries

Question 30

in px with vanishing testes syndrome why do they have absent male and female ganitalia

Answer 30

these px have AMH in utero which prevents dev of female genitalia, upon birth the testes would disappear and there is regression of gonads hence male genitalia is also absent

Question 31

very high FSH and low estrogen results in

Answer 31

ovarian failure

Question 32

medication for px with 17a hydorxylase deficiency

Answer 32

estrogen progestin replacement and cortisol replacement
estrogen - breast dev
progestin - protection of uterus vs mitotic proliferaton by estrogen

Question 33

px came in complaining with amenorrhea even she has premenstrual symptoms. PE showed normal breast dev . She asked if can she still get pregnant, what would be your answer?

Answer 33

Yes since she has ovaries she can get pregnant thru IVF and transfer of fertilized ova to a surrogate recipient.

Question 34

why gonads must be fremoved after epiphyseal closure and breast dev what medication can you give after removal

Answer 34

there is a tendency of malignancies (gonadoblastoma and dysgerminoma);
estrogen therapy progestin is not needed bcoz px don’t have uterus

Question 35

in px with functional hypothalamic amenorrhea the abnormal GnRH pulsatility is caused by

Answer 35

increased opiod activity

Question 36

In px with anorexia the decrease in leptin would result in an increase in

Answer 36

Neuropeptide Y

Question 37

common lesions found in secondary amenorrhea

Answer 37

craniopharyngiomas, TB sarcoidosis

Question 38

how can Craniopharyngiomas cause secondary amenorrhea

Answer 38

they interfere with GnRH release and low gondatotropin and estrogen lvls

Question 39

almost all pituitary tuimors secrete

Answer 39

prolactin

Question 40

most common non-prolactin secreting tumor

Answer 40

chromophobe adenoma

Question 41

treatment in px who have chromophobe adenoma where surgery is contraindicated

Answer 41

bromocriptine

Question 42

common cause of amenorrhea in px who are <40

Answer 42

premature ovarian failure

Question 43

in px who are 25 who has amenorrhea you should screen for

Answer 43

immunologic d/o

Question 44

Asherman’s syndrome is usually secondary to

Answer 44

uterine surgery

Question 45

Gold standard for the diagnosis of intrauteirine syndrome/adhesions

Answer 45

hysterescopy

Question 46

most common cause of endometritis causing adhesions

Answer 46

Pelvic TB