Day 13 - Gyn1 Quiz

Question 1

Distinguishing true (central) precocious puberty from pseudopercocious puberty

Answer 1

CENTRAL - Elevations of LH & FSH, Dose of GnRH further increases LH & FSH; PSEUDO - Low FSH & LH (due to exogenous hormones suppressing them), No response to GnRH.

Question 2

Definition of precocious puberty

Answer 2

In females, puberty or pubertal changes at younger than 8 yo; In males, its younger than 9 yo

Question 3

Causes of pseudoprecocious puberty

Answer 3

Exogenous hormone administration, adrenal tumors, congenital adrenal hyperplasia, hormone-secreting tumors (e.g., Sertoli-Leydig tumors, Granulosa-Theca tumors), McCune Albright syndrome

Question 4

Definition of premature ovarian failure

Answer 4

Absence of menses for at least 6 mo (really 1 yr to be considered “menopasual”) at age younger than 40 yo

Question 5

Hormone level assoc with increase in basal body temp

Answer 5

Progesterone

Question 6

How increase in basal body temp assoc w/ ovulation

Answer 6

Occurs 24 hrs prior to ovulation

Question 7

4 different options for emergency contraception

Answer 7

(1) 4-5 estradiol/progestin combined OCPs within 24 hrs (2) Levonorgestrel (Plan B = progestin alone) (3) Copper IUD (4) Mifepristone (RU46, anti-progestin)

Question 8

Contraindications for OCPs

Answer 8

Pregnancy, History of thromboembolism or thrombophilia, History of estrogen-dependent tumor (e.g., breast/endometrial cancers), History of vascular disease or CAD, Poorly controlled HTN, Smoker over age 35, Hepatic disease, Abnormal vaginal bleeding of unknown etiology, Migraine w/ aura/neurologic sx/vascular involvement

Question 9

Meds known for reducing effectivness of OCPs

Answer 9

Rifampin, Griseofulvin, Antiepileptics, St. John’s wort

Question 10

Define primary amenorrhea

Answer 10

Absence of menses by age 16 w/ secondary sexual characteristics present OR Absence of menses & secondary sexual characteristics by age 13

Question 11

First step of any workup for amenorrhea

Answer 11

Beta-HCG

Question 12

Basic components of workup for secondary amenorrhea

Answer 12

B-HCG, Prolactin, TSH, FSH; If signs of hyperadrogenism (e.g., deepening of voice, facial hair, clitoromegaly), testosterone level & DHEA-S to rule out adrenal tumor; If all above negative, check progestin withdrawal test

Question 13

Primary amenorrhea, absent secondary sex characteristics, anosmia (inability to smell)

Answer 13

Kahllmann’s syndrome (congenital absence of GnRH secretion)

Question 14

Initial step in mgt F p/w secondary amenorrhea & new galactorrhea when B-HCG is negative

Answer 14

TSH (r/o hypothyroidism); Prolactin