Ammenorrhea

Question 1

Order of Pubertal Changes

Answer 1

Growth Spurt, Thelarche, Adrenarche, Menarche

Question 2

First sign of puberty

Answer 2

Appearance of breast buds

Question 3

Last sign of puberty

Answer 3

Menarche

Question 4

Most relevant factor for onset of puberty and menstruation

Answer 4

Ratio of fat to both TBW and lean BW

Question 5

Hormone produced by adipocytes which affects LH pulpability and restore mens cycle

Answer 5

Leptin

Question 6

Cut off to investigate if there is no thelarche yet

Answer 6

13

Question 7

Menarche delayed up to ______

Answer 7

if involved in strenuous exercise before menarche

Question 8

______ can inhibit GnRH axis as Corticotropin releasing hormone inhibits GnRH

Answer 8

Emotional stress

Question 9

No mens by age 15

No mens within 5 years of breast development, if occurring by age 10

Answer 9

Primary amenorrhea

Question 10

No menses due to anatomic disorders (Hematocolpos - blood at uterus)

Answer 10

Cryptomenorrhea

Question 11

Secondary amenorrhea

Answer 11

Skipped menses longer than 6-12 hours

Question 12

Hypothalamic failure -> Inadequate GnRH synthesis
Hypogonadotropic, Hypogonadism
Assoc with:
Anosmia
Inc growth in long bones
Greater wingspan to height ratio

Answer 12

Kallman syndrome

Question 13

Pituitary failure -> Pituitary neoplasia

Hypogonadotropic, Hypogonadism

Answer 13

Pituitary neoplasia

Question 14

Gonadal Failure  -> 45X
Hypergonadotropic, Hypogonadism
Assoc with:
Short stature
Webbed Neck
Gonadal Streak

Answer 14

Turner’s Syndrome

Question 15

Hypothalamic Failure

Answer 15

Kallmann Syndrome

Craniopharyngioma

Question 16

Pituitary Failure

Answer 16

Chromophobe adenoma
Mumps/ Encephalitis
New Born Kernicterus

Question 17

Ovarial Failure

Answer 17

Turner’s Syndrome

Gonadal dysgenesis

Question 18

Lack of androgen receptor synthesis
46XY
No internal male/female genitalia
Normal External female genitalia

Answer 18

Androgen resistance (Testicular Feminization)

Question 19

2nd most Common
46XX
Shortened or absent Vagina
Skeletal deformity - bones in middle ear (deafness)

Answer 19

Ureterovaginal Agenesis/ Muller

Mayer- Rokitansky- Kuster- Hauser

Question 20

Management for Ureterovaginal Agenesis/ Muller

Mayer- Rokitansky- Kuster- Hauser

Answer 20

Surrogacy
Uterine transplantation
Creation of neovagina

Question 21

Management for Androgen resistance (Testicular Feminization)

Answer 21

Removal of Gonads

Creation of Neovagina

Question 22

Karyotype: Male
External Genitalia: Female
Internal Genitalia: Absent
(+) Testes, AMH - IMS

Answer 22

17a-OHase deficiency

Question 23

Karyotype: Male
External Genitalia: Female
Internal Genitalia: Absent
(-) Gonads, Internal female genitalia

Answer 23

Agonadism (Vanishing testes syndrome)

Question 24

Neoplastic Pituitary (Hypoestrogenic Amenorrhea): Most common non PRL secreting

Answer 24

Chromophobe adenoma

Question 25

Non -Neoplastic Pituitary (Hypoestrogenic Amenorrhea):

Pituitary destruction due to hypotensive episode during pregnancy

Answer 25

Sheehan Syndrome

Question 26

Non -Neoplastic Pituitary (Hypoestrogenic Amenorrhea): Not related to pregnancy

Answer 26

Simmonds disease

Question 27

Ovarian (Hypergonadotropic, Hypogonadism)

Answer 27

Cystic degeneration - cystetcomies

Premature ovarian failure/insufficiency - Menopause before 40

Question 28

Intrauterine adhesions or synechiae

Answer 28

Asherman syndrome

Question 29

the most common antecedent factor of IUA

Answer 29

Endometrial curettage from pregnancy