Amenorrhea Flashcards

1
Q

Key history in amenorrhea

A

Primary vs. secondary, duration, possible pregnancy, associated symptoms (headache, decreased peripheral
vision, galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease);
history of anorexia nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs, uterine infections;
drug use; medications

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2
Q

Key physical exam in amenorrhea

A

Vital signs; breast exam; complete pelvic exam

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3
Q

40 yo F with amenorrhea, morning nausea, vomiting, fatigue and polyuria
+ LMP was six weeks ago
+ breast fullness and tenderness
+ uses rhythm method for contraception

A
Pregnancy
Anovulatory cycle
Hyperprolactinemia
UTI
Hypothyroidism
Pelvic exam
Urine hCG
U/S—abdomen/pelvis
CBC
UA, urine culture
Prolactin, TSH
Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen and VDRL/RPR
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4
Q

23 yo obese F with amenorrhea over last six months, facial hair and infertility over last three years

A
Polycystic ovary syndrome
Thyroid disease
Hyperprolactinemia
Pregnancy
Ovarian or adrenal malignancy
Premature ovarian failure

Pelvic exam
Urine hCG
LH/FSH, TSH, prolactin
Testosterone, DHEAS

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5
Q

35 yo F with amenorrhea, galactorrhea, visual field defects and HAs over last six months

A
Amenorrhea secondary to
prolactinoma
Pregnancy
Thyroid disease
Premature ovarian failure
Pituitary tumor

Pelvic and breast exam
Urine hCG
LH/FSH, TSH, prolactin
MRI—brain

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6
Q

48 yo F with amenorrhea over last six months with hot flashes, night sweats, emotional lability and dyspareunia

A

Menopause
Pregnancy
Pituitary tumor
Thyroid disease

Pelvic exam
Urine hCG
LH/FSH, TSH, prolactin, testosterone, DHEAS
CBC
MRI—brain
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7
Q

35 yo F with amenorrhea, cold intolerance, coarse hair, weight loss and fatigue
+ Hx of placental abruption followed by hypovolemic shock and failure to lactate two years ago

A
Sheehan’s syndrome
Premature ovarian failure
Pituitary tumor
Thyroid disease
Asherman’s syndrome
Pelvic exam
Urine hCG
CBC
LH/FSH, prolactin
TSH, FT4
ACTH
MRI—brain
Hysteroscopy
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8
Q

18 yo F with amenorrhea over last four months
+ 5’6” and weighs 90 pounds
+ Hx of vigorous exercise
+ cold intolerance

A

Anorexia nervosa
Pregnancy
Hyperthyroidism

Urine hCG
CBC
TSH, FT4
LH/FSH

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9
Q

29 yo F with amenorrhea over last six months
+ occasional palpitations and dizziness
+ lost fiance in car accident in which she was a passenger

A

Anxiety-induced amenorrhea
PTSD
Depression
Hyperthyroidism

CBC
TSH, FT4
Urine cortisol level
Progesterone challenge test
LH/FSH, estradiol levels
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