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RDS Test 1 > B8-062 CBCL Female Missed Period > Flashcards

B8-062 CBCL Female Missed Period Flashcards

1
Q

[…] withdrawal leads to the bleeding and sloughing of endometrial tissue

A

progesterone

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2
Q

in hypergonadotrophic hypogonadism, FSH and LH levels are […]

A

normal

(ovary is not responding to produce estrogen/progesterone)

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3
Q

in hypogonadotropic hypogonadism, FSH and LH levels are […]

A

both low

(leads to insufficient estradiol/progesterone production in the ovaries)

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4
Q

how does elevated cortisol due to stress cause primary hypothyroidism?

A

decreased TRH and TSH
and inhibits the conversion of T4 to T3

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5
Q

how does stress impact the menstrual cycle and cause anemorrhea?

A

stress stimulates PVN in hypothalamus to increase CRH synthesis

CRH –> ACTH –> cortisol

Cortisol inhibits GnRH release —> decreased FSH –> decreased estrogen

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6
Q

how does hypothyroidism impact the menstrual cycle leading to amenorrhea?

A

low T3/T3 stimulates TRH release
TRH stimulates prolactin release
Prolactin stimulates CRH release
CRH inhibits GnRH release

–> decreased FSH —> decreased estrogen

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7
Q

how does hyperthyroidism impact the menstrual cycle leading to amenorrhea?

A

high T3/4 triggers SHBG
SHBG binds circulating estrogen
reduced free estrogen

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8
Q

how does starvation impact the menstrual cycle leading to amenorrhea?

A

reduced caloric intake –> reduced adipose mass –> reduced leptin

reduced leptin —> reduced kisspeptin –> reduced GnRH release

reduced GnRH –> reduced FSH –> reduced estrogen

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9
Q

reduced leptin and elevated FGF21 from the liver causes reduced […]

A

kisspeptin

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10
Q

2 causes of hyperprolactemia causing amenorrhea

A

pregnancy
breast feeding

(elevated prolactin inhibits GnRH)

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11
Q

what hormones are responsible for breast development? [2]

A

estrogen
progesterone

(from ovary, can be used to determine cause if one stage of Tanner development lags behind another)

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12
Q

what hormones are responsible for pubic hair development? [2]

A

androgens
DHEA

(from adrenal gland, can be used to determine cause if one stage of Tanner development lags behind another)

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13
Q

major causes of amenorrhea [6]

A

outflow obstruction
POI
pituitary
hypothalamic
physiologic
endocrine

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14
Q

medication classes that can cause amenorrhea [3]

A

antidepressants
antipsychotics
opiates

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15
Q

[what Tanner stage]
no pubic hair
flat chest with raised nipple

A

Stage 1 prepubescent

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16
Q

[what Tanner stage]
pubic hair appears
breast bud forms

A

Stage 2 (8-11.5 years)

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17
Q

[what Tanner stage]
coarsening of pubic hair
breast enlarges

A

Stage 3 (11.5-13 years)

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18
Q

[what Tanner stage]
coarse hair across pubis, sparing thigh
breast enlarges, raised areola

A

Stage 4 (13-15 years)

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19
Q

[what Tanner stage]
coarse hair across pubis and medial thigh
adult breast contour, areola flattens

A

Stage 5 (over 15 years)

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20
Q

in what Tanner stage do 2/3 of female reach menarche?

A

stage 4

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21
Q

definition of primary amenorrhea

A

no menarche by age 14 in the absence of pubertal development
OR
no menarche by 16 regardless of pubertal development

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22
Q

inadequate release of LH and FSH from the pituitary

A

hypogonadotropic hypogonadism

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23
Q

inadequate ovarian response to gonadotropins

A

hypergonadotropic hypogonadism

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24
Q

growth parameters important to assess in evaluation of primary amenorrhea [2]

A

BMI
short stature

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25
Q

absent breast development indicates inadequate […] production

A

estrogen

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26
Q

absence of uterus is caused by [2]

A

abnormal Mullerian development
XY karyotype

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27
Q

presence of uterus and breast with primary amenorrhea suggests [2]

A

obstruction of menstrual flow
HPO axis problems

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28
Q

what hormone levels are evaluated in primary amenorrhea?

A

androgens
thyroid
prolactin

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29
Q

treatment of hyper/hypogonadotropic hypogonadism

A

estrogen & progesterone therapy

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30
Q

absence of menses for > 6 months in previously menstruating female

A

secondary amenorrhea

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31
Q

secondary amenorrhea is generally caused by

A

disruption of HPO axis

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32
Q

clitoromegaly can result from excess

A

androgens

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33
Q

organic causes of secondary amenorrhea [5]

A

prolactinoma
hyper/hypothyroidism
PCOS
late onset congenital adrenal hyperplasia
virilizing tumors

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34
Q

what is considered a positive response to a progesterone challenge test?

A

bleeding that occurs within 2 weeks after progestin is given

usually occurs within 2-7 days

(more than light spotting)

35
Q

what does positive response to a progesterone challenge test mean?

A

patient likely has anovulation

consider PCOS

36
Q

what does negative response to a progesterone challenge test mean?

A

consider HPO axis or obstructive problem

37
Q

treatment for PCOS

A

oral contraception

(restores regular menses, decreases testosterone, and protects against endometrial hyperplasia)

38
Q

most common site of implantation in ectopic pregnancy?

A

ampulla

39
Q

risk factors for ectopic pregnancy

A

tubal pathologies (scarring, PID)
previous ectopic pregnancy
IUD
IVF

40
Q

implantation of the fertilized ovum in a site other than the uterus

A

ectopic pregnancy

41
Q

suspect in patients with history of amenorrhea and lower than expected rise in hCG

A

ectopic pregnancy

42
Q

diagnosis of ectopic pregnancy can be confirmed via

A

ultrasound

43
Q

treatment for ectopic pregnancy

A

methotrexate (unruptured)
surgery (ruptured)

44
Q

ectopic pregnancy implanted in the […] presents the highest risk of tubal rupture

A

isthmus

45
Q

spontaneous abortion in the first trimester is most often caused by

A

chromosomal abnormalities

46
Q

the process of menstruation is brought about by what hormonal change?

A

decreased progesterone

47
Q

estrogen and progesteron stimulate […] development

A

breast

48
Q

androgens and DHEA stimulate […] development

A

pubic hair

49
Q

the most common cause of amenorrhea in women of child bearing age

A

pregnancy

50
Q

primary amenorrhea in patients without secondary sex characteristics is typically due to

A

anovulation

51
Q

[…] replacement therapy may be effective for female athletes suffering from hypothalamic amenorrhea

A

leptin

52
Q

primary amenorrhea due to absence of the uterus is most likely a result of [2]

A

abnormal Mullerian development
XY karyotype

53
Q

first line therapy in treating female athletes with hypothalamic dysregulation

A

modification of diet/exercise

54
Q

a prolactinoma would cause […] prolactin and […] estrogen levels

A

high prolactin
low estrogen

55
Q

a positive progesterone challenge test indicates a likely […] problem

A

anovulation

56
Q

elevated levels of TRH lead to […] levels of prolactin

A

elevated

57
Q

prolactin inhibits […] production by the hypothalamus

A

GnRH

58
Q

classic clinical triad for ectopic pregnancy

A

abdominal pain
amenorrhea
vaginal bleeding

59
Q

MOA of methotrexate

A

deplete embryo of folic acid

(stops growth)

60
Q

in the case of inevitable SAB/misscarriage, the cervix would be […] and the POC passage would be […]

A

open
retained

61
Q

in the case of missed SAB/misscarriage, the cervix would be […] and the POC passage would be […]

A

closed
retained

62
Q

in the case of incomplete SAB/misscarriage, the cervix would be […] and the POC passage would be […]

A

open
partially passed

63
Q

testes present, but external genitalia is feminized or atypical

A

46, XY androgen insensitivity syndrome

gonadal dysgenesis

64
Q

female appearing genetic male (46, XY) is most commonly due to

A

androgen insensitivity syndrome

65
Q

ovaries replaced by fibrous tissue
no ovarian estrogen secretion

(streak ovary)

A

turner syndrome (45, XO)

66
Q

external female genitalia, uterus, and fallopian tubes develop normally until puberty when estrogen induced maturation fails

A

turner syndrome (45, XO)

67
Q

acquired condition of having scar tissue in the uterus or cervix which impedes menstruation

A

Asherman’s syndrome

68
Q

how does hypothyroidism cause galactorrhea?

A

low T4 and T3 lead to increased TRH and prolactin

increased prolactin causes excess milk production

69
Q

insomnia, mood swings, and weight loss are symptoms associated with

A

hyperthyroidism

70
Q

how does hyperthyroidism cause amenorrhea?

A

increased T3/4 increase hepatic production of SHBG

reduces amount of biologically active estrogen

71
Q

b-hCG leves should double every […] hours in pregnancy

A

48

72
Q

corticosteroids inhibit […] which causes amenorrhea

A

GnRH

73
Q

hypogonadotrophic hypogonadism is characterized by […] E2 and […] FSH

A

low
low

74
Q

how does stress cause amenorrhea?

A

stress increases CRH which increases ACTH and cortisol

cortisol decreases GnRH and FSH/LH

75
Q

untreated imperforate hymen may lead to the development of

A

endometriosis

76
Q

most common symptoms of imperforate hymen

A

abdominal pain
cramping

77
Q

patients on dopamine antagonists can experience hyper[…]

A

hyperprolactinemia

(above 25 ng/ml)

78
Q

scaring/adhesion within the uterus/endometrium often caused by procedures such as D&C or untreated STI

A

asherman’s syndrome

79
Q

breastfeeding stimulates […] release, leading to amenorrhea

A

prolactin

80
Q

grave’s disease and hyperthyroidism are characterized by […] TSH and […] free T4

A

low TSH
high free T4

81
Q

anti-psychotics increase prolactin by blocking […] production

A

dopamine

82
Q

risk factors for ectopic pregnancy

A

GYN surgery
smoking
PID or other scarring
prenatal exposure to DES

83
Q

high levels of […] during pregnancy prevent menstruation

A

progesterone

RDS Test 1 (23 decks)

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