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OB/GYN Boards by Subject > Contraception, prolactin, ectopic pregnancy, amenorrhea > Flashcards

Contraception, prolactin, ectopic pregnancy, amenorrhea Flashcards

1
Q

Main hormone producing contraceptive effect

A

Progesterone

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2
Q

How do OCPs decrease androgenic signs?

A

Estrogen increases SHBG, which binds more free testosterone

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3
Q

Age cut off for not giving a smoker OCPs

A

35 y/o

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4
Q

How long to wait for combined methods after delivery?

A

21 days (or longer if breastfeeding)

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5
Q

Meds that stimulate hepatic metabolism of sex hormones (and thus can make OCPs fail)

A

Rifampin, phenobarbital, phenytoin, cabamazepine, primidone

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6
Q

Mean time of return to menses after stopping OCPs

A

32 days

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7
Q

Time frame for emergency contraception

A

3 days for levonorgestrel (Plan B)

5 days for ulipristal (Ella) or IUD

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8
Q

Site of prolactin production

A

Anterior pituitary

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9
Q

Effect of dopamine on prolactin

A

Decreases

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10
Q

Ddx for galactorrhea

A
  1. Medications
  2. Pituitary tumors
  3. Hypothalamic lesions, stalk lesions, compression
  4. Estrogen (from OCPs, rare)
  5. Prolonged suckling
  6. Stress
  7. Non-pituitary sources of prolactin (lung or renal tumor)
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11
Q

What meds can cause galactorrhea?

A

Dopamine receptor blockers: antipsychotics, metoclopramide, SSRIs, TCAs
Dopamine depleting agents: methyldopa, reserpine
Dopamine release inhibitors: opiates, cimetidine

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12
Q

Effect of hyperprolactinemia on the menstrual cycle

A

Inhibits pulsatile secretion of GnRH -> often amenorrhea, low estrogen (and its complications like osteoporosis)

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13
Q

Micro vs macroadenoma

A

1 cm

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14
Q

Treatment for hyperprolactinemia

A

Dopamine agonists: bromocriptine (safe in pregnancy if symptomatic) or cabergoline

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15
Q

Discriminatory zone

A

Beta hcg 3500

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16
Q

Progesterone levels and use in PUL

A

< 5 almost always nonviable

> 20 almost always normal IUP

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17
Q

Relative contraindications to MTX

A

GS > 3.5 cm
Embryonic cardiac activity
Beta hcg > 5000

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18
Q

Primary amenorrhea definition

A

No menstruation…
By 15 y/o with normal secondary sex characteristics
By 13 y/o without normal secondary sex characteristics

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19
Q

Secondary amenorrhea

A

At least 3 months / cycles without menses

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20
Q

Mullerian agenesis vs androgen sensitivity on exam

A

Pubic hair

21
Q

What does a positive progestin challenge (bleeding within 2-7 days) prove?

A

Estrogen and functional outflow tract

22
Q

What FSH tells you about amenorrhea

A

> 20 suggests ovarian failure
< 5 suggests hypogonadotrophic state
Low-normal with low estradiol suggests hypothalamic dysfunction

23
Q

High FSH and low estradiol

A

Hypergonadotrophic hypogonadism - ovarian failure (gonadal dysgenesis if primary)

24
Q

Low FSH and low estradiol

A

Hypogonadotrophic hypogonadism - hypothalamic amenorrhea, pituitary or CNS tumor

25
Q

Normal FSH and estradiol

A

Anovulation (PCOS), anatomic defect (Asherman)

26
Q

Causes of primary ovarian insufficiency

A

Chromosomal, autoimmune, radiation, chemotherapy

27
Q

Autoimmune associations with POI

A

Adrenal disease (test for anti-CYP21 antibodies), thyroid disease (test for thyroid peroxidase and anti-thyroglobulin)

28
Q

Chemo most associated with POI

A

Alkylating agents and procarbazine

29
Q

Treatment for POI

A

HRT, include progesterone if has a uterus

30
Q

How to achieve pregnancy with hypothalamic dysfunction

A

May try ovulation induction agents, may need LH + FSH

31
Q

Anosmia plus delayed puberty and sexual development, normal pubic hair

A

Kallman syndrome (congenital GnRH deficiency)

32
Q

DHEAS is produced exclusively by…

A

Adrenals

33
Q

DHEA is made mostly by, and also by…

A

Adrenals (90%) and ovary (10%)

34
Q

Criteria for PCOS

A

2 of 3:

  • Hyperandrogenism
  • Ovarian dysfunction
  • Polycystic ovaries on ultrasound
35
Q

Molecular cause of hirsutism

A

DHT (converted from testosterone by 5 alpha reductase)

36
Q

Definition of polycystic ovary on ultrasound

A

20 more follicles 2-9 mm

Ovarian volume > 10 mL

37
Q

Hirsutism causes in pregnancy

A 
Pregnancy luteoma (can cause female infants to be virilized), rapidly regresses after delivery
Theca-lutein cysts (can cause maternal but not fetal virilization)
38
Q

Ovulation induction in PCOS

A

Letrozole

39
Q

Mechanism of spironolactone

A

Aldosterone antagonist diuretic, inhibits androgen synthesis, competes for androgen receptor, inhibits 5 alpha reductase

40
Q

Treatment for hirsutism

A

Flutamide - nonsteroidal anti-androgen
Finasteride - 5 alpha reductase inhibitor
Eflonithine cream - blocks ornithine decarboxylase

41
Q

What is ovarian drilling?

A

Destroys theca cells and lowers androgen production, can help restore ovulatory cycles but not clearly supported by evidence

42
Q

Enzyme most commonly deficient in congenital adrenal hyperplasia

A

21-hydroxylase (95% of cases)

43
Q

Lab findings for 21-hydroxylase deficiency

A

Low aldosterone, low cortisol, [most important] elevated 17OHP (which leads to higher androgens)

44
Q

Treatment for congenital adrenal hyperplasia

A

Supply deficient cortisol and aldosterone

45
Q

Treatment prenatally for suspected congenital adrenal hyperplasia

A

Diagnosed by CVS or amnio

High-dose steroids

46
Q

Non-classical CAH presentation

A

Puberty or later, similar to PCOS

47
Q

Differential diagnosis for hirsutism

A 
PCOS
Idiopathic hirsutism
CAH
HAIR-AN syndrome
Androgen-secreting neoplasm
Androgen use
Cushing syndrome (rarely)
48
Q

Initial work-up for hirsutism

A

Total testosterone, SHBG, DHEAS, 17-OH progesterone

OB/GYN Boards by Subject (22 decks)

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