Amenorrhea and endometriosis/infertility

Question 1

labs to order for primary amenorrhea

Answer 1

serum pregnancy test
CBC
US
FSH/LH
E2
karyotype

Question 2

whats telarche

Answer 2

onset of female breast development

Question 3

what is pubarche

Answer 3

appearance of sexual hair

Question 4

what is adrenarch

Answer 4

growth of axillary hair

Question 5

what is primary amenorrhea

Answer 5

failure to menstruate by age 16

Question 6

what is secondary amenorrhea

Answer 6

absence of menstruation for 3 cycles> 6 mo

Question 7

common causes primary amenorrhea

Answer 7

constitutional delay
45XO, 46XY
pituitary tumor
congenital adrenal hyperplasia
genital tract anomaly

Question 8

signs pituitary tumor

Answer 8

headaches, blurry vision

Question 9

Dx steps primary amenorrhea

Answer 9

height weight BP
evaluate secondary sexual characteristics
look for signs androgen excess
visual fields
chromosomes
FSH LH E2
androgens TSH and PRL

Question 10

common causes secondary ammenorrhea

Answer 10

stress
weight loss/gain
post pill and depo provera
PCOS
premature menopause or premature ovarian failure
hyperPRL
pituitary adenoma
drug induced
PREGNANCY

Question 11

what is sheehans

Answer 11

post partum hemorrhage, infarct pituitary

stop menstruating

Question 12

uncommon causes secondary amenorrhea

Answer 12

kallmans
sheehans
cushings
ashermans
thyroid disease
post encephalitis
androgen producing tumors
cervical stenosis

Question 13

clincal evaluation for secondary amenorrhea

Answer 13

life events, weight exercise, pregnancy

visual fields, secondary sexual characteristics

Question 14

primary labs for secondary amenorrhea

Answer 14

FSH LH E2 TSH PRL
androgens
US
visual fields

Question 15

secondary tests secondary amenorrhea

Answer 15

CT pituitary
DXM suppression
hydroxyPROG
hysteroscopy

Question 16

labs for primary infertility

Answer 16

FSH LH Progesterone, semen analysis
HSG
diagnostic laparoscopy

Question 17

when is progesterone done

Answer 17

day 21

Question 18

hemosiderin laden macrophages in spots found on ligaments on uterus

Answer 18

endometriosis

Question 19

endometriosis

Answer 19

ectopic endometrium

Question 20

how to Dx endometriosis

Answer 20

laparoscopy +/- Bx

Question 21

Sx endometriosis

Answer 21

dysmenorrhea
dyspareunia
infertility

pre-menstrual staining
pain with defection during menstruation
intermenstrual pain
disordered cycles

Question 22

most important in Dx of endometriosis

Answer 22

careful Hx

Question 23

gold standard for endometriosis Dx

Answer 23

laparoscopy

Question 24

differenctial Dx for endometriosis

Answer 24

primary dysmenorrhea
IBS
ovulation pain
PID

Question 25

theories that cause endometrium

Answer 25

retrograde menstruation | peritoneal metaplasia

Question 26

predisposing factors endometriosis

Answer 26

``` familial disordered immunity environmental toxins recurrent ovulation infertile partner obstructed menstrual flow ```

Question 27

hwo to mange endometriosis

Answer 27

if pain use medical Rx if infertility then surgery no problem, don't need to tx

Question 28

what type of medical Rx would you use in endometriosis

Answer 28

progestins: OCP, provera or norethisterone, mirena IUD

Question 29

benefits of laparoscopy with diathermy in endometriosis

Answer 29

dec pain | dec infertility

Question 30

what is infertility

Answer 30

12 mo of regular sex without contraception

Question 31

principal causes of infertility

Answer 31

``` ovulation sperm tubal cervical factor endometriosis ```

Question 32

how to test ovulation

Answer 32

check body temperature- progesterone check progesterone at day 21 LH surge in urine

Question 33

how to test if tubes are still open

Answer 33

hysterosalpingogram laparoscopy with dye studies (both can open tube up if mild obstructin)

Question 34

testing cervix

Answer 34

around day 12 or 13 sample mucous after intercourse can also use this to look at sperm

Question 35

what is semen analysis

Answer 35

``` 48-72 hours collect whole sample examined 1-2 hours at room temp look at count, motility and morphology if abnormal- repeat. ```

Question 36

labs if suspec tmenopause

Answer 36

``` CBC FSH LH TSH Pregnancy endometrial Bx and pap ```

Question 37

Tx for menopause with Sx

Answer 37

HRT

Question 38

perimenopause

Answer 38

time leading up to menopause, time when ocarian function and hormone production are declining

Question 39

premature menopause

Answer 39

before age 40

Question 40

menopause Sx

Answer 40

``` vasomotor Sx sleep changes mood changes UG Sx, dryness and atrophy sexual well being, libido skin changes ```

Question 41

decreased E can lead to

Answer 41

vasomotor Sx, urogenital disorders, CHD risk factors, skin changes CV disease bone loss/osteoporosis

Question 42

decreased P can cause

Answer 42

irregular periods | PMS

Question 43

decreased androgen Sx

Answer 43

decrease mood, energy msucle weakness dec libido osteopenia

Question 44

what is better HT at time of menopause or after menopause

Answer 44

HT does not increase CHD if started within 5 years of onset | does increase risk CHD if initiated late

Question 45

when is risk of VTE with HT occur

Answer 45

1st year of use

Question 46

When should E be taken to prevent dementia of menopause

Answer 46

perimenopause or very onset menopause

Question 47

when do we give P as well as E for HRT

Answer 47

still have uterus because protects against uterine CA

Question 48

Tx for menopausal patients with mild vasomotor Sx

Answer 48

lifestyle changes dietary isoflavones black cohosh Vit E

Question 49

Tx for mod-severe vasomotor Sx

Answer 49

HT "gold standard" SSRIs and gabapentin Progestogens