For PassRACGP Flashcards
Testing
- Primary and secondary
- Differentials and investigations
- Infertility more high yield ddx and investigations
Hypothalamus - mental stress/anxiety, over exercising, anorexia
Pituitary - prolactinoma, hypothyroid, pregnancy, illicit substances
Ovaries - prem ovarian failure, PCOS, karyotype (Turners)
Uterus/vagina - vaginal outflow obstruction, ashermans (endometriosis, PID)
Delayed puberty**
History
- Cold intolerance
- Possibility of pregnancy
- Nipple discharge
- Rapid weight loss / intense fear of gaining weight
- Hirsutism, acne
- Emotional / physical stress
- Breast development
- Cyclical disco
Hypothalamus - mental stress/anxiety, over exercising, anorexia
Pituitary - prolactinoma, hypothyroid, pregnancy, illicit substances
Ovaries - prem ovarian failure, PCOS, karyotype (Turners)
Uterus/vagina - vaginal outflow obstruction, ashermans (endometriosis, PID)
Delayed puberty**
History
- Cold intolerance
- Possibility of pregnancy
- Nipple discharge
- Rapid weight loss / intense fear of gaining weight
- Hirsutism, acne
- Emotional / physical stress
- Breast development
- Cyclical disco
- Cyclical discomfort in vagina*
- Family history of POF / PCOS / delayed puberty / CAH
- Illicit substance use
- Headaches, visual field defects
Examination
- Imperforate hymen*
- Goitre*
- BMI
- Breast development
- Hirsutism, acne
- Abdo exam (preg)
- Dental caries, dry skin (anorexia)
* - good points easily forgotten
Investigations (all initial inc primary amen)
- FSH +/- LH, TSH, b-hcg, prolactin*
- Above modmed/GPA/UTD ans
- Increased LH/FSH ratio indicative PCOS
pelvic US
- In 1ry t
Shaun
8:42 PM
- In 1ry to assess for presence of uterus
total testosterone/FAI
- PCOS
- 17-hydroxyprogesterone and DHEAS
- CAH - incr levels expected of both
- DHEAS only mild elevation in PCOS
- DHEAS v high elevation in CAH
- Estradiol
- Low in prem ovarian failure, norm in PCOS
- POF can be dx with FSH alone
- Modmed says not as important as fluctuates. no marks in RACGP below.
Infertility (more relevant)
- Semen analysis of husband
- Abstinence 2-3d prior. sample to be analysed in lab within 1hr. kee
nfertility
- Important to ask re intercourse w cycle, use of lubricants, contraception (depo), husband infertility
- Ovulation occurs 14d prior to bleed; 21d cycle = day 7, 35d cycle = day 21
- Fertile window 5 days pre ovulation and day of ovulation (2nd daily better than daily)
- STI, fhx intertility, endometriosis more likely
- HypoT, PCOS, substance use also
- Can do hysterosalpingogram (HSG) to exc tubal occl
NB.
- 17-hydroxyp important to exclude
- DHEAS is produced specifically in adrenal glands
if virilisation (deep voice, citoromegaly - more extensive than hirsutism) then consider adrenal instead of just PCOS cause of hypertesterone
- AMH prod by cells in ovarian follices (marker of oocyte quant)
- estradiol prod by oocytes. low = prem ov failure. high also not good as can supp FSH axis.
- imperf hymen: cyclical discomfort in vagina
- anorexia: sudden change in weight, intense fear of gainin
Amenorrhea
- Primary and secondary
- Differentials and investigations
- Infertility more high yield ddx and investigations
Hypothalamus - mental stress/anxiety, over exercising, anorexia
Pituitary - prolactinoma, hypothyroid, pregnancy, illicit substances
Ovaries - prem ovarian failure, PCOS, karyotype (Turners)
Uterus/vagina - vaginal outflow obstruction, ashermans (endometriosis, PID)
Delayed puberty**
History
- Cold intolerance
- Possibility of pregnancy
- Nipple discharge
- Rapid weight loss / intense fear of gaining weight
- Hirsutism, acne
- Emotional / physical stress
- Breast development
- Cyclical disco
Hypothalamus - mental stress/anxiety, over exercising, anorexia
Pituitary - prolactinoma, hypothyroid, pregnancy, illicit substances
Ovaries - prem ovarian failure, PCOS, karyotype (Turners)
Uterus/vagina - vaginal outflow obstruction, ashermans (endometriosis, PID)
Delayed puberty**
History
- Cold intolerance
- Possibility of pregnancy
- Nipple discharge
- Rapid weight loss / intense fear of gaining weight
- Hirsutism, acne
- Emotional / physical stress
- Breast development
- Cyclical disco
- Cyclical discomfort in vagina*
- Family history of POF / PCOS / delayed puberty / CAH
- Illicit substance use
- Headaches, visual field defects
Examination
- Imperforate hymen*
- Goitre*
- BMI
- Breast development
- Hirsutism, acne
- Abdo exam (preg)
- Dental caries, dry skin (anorexia)
* - good points easily forgotten
Investigations (all initial inc primary amen)
- FSH +/- LH, TSH, b-hcg, prolactin*
- Above modmed/GPA/UTD ans
- Increased LH/FSH ratio indicative PCOS
pelvic US
- In 1ry t
Shaun
8:42 PM
- In 1ry to assess for presence of uterus
total testosterone/FAI
- PCOS
- 17-hydroxyprogesterone and DHEAS
- CAH - incr levels expected of both
- DHEAS only mild elevation in PCOS
- DHEAS v high elevation in CAH
- Estradiol
- Low in prem ovarian failure, norm in PCOS
- POF can be dx with FSH alone
- Modmed says not as important as fluctuates. no marks in RACGP below.
Infertility (more relevant)
- Semen analysis of husband
- Abstinence 2-3d prior. sample to be analysed in lab within 1hr. kee
nfertility
- Important to ask re intercourse w cycle, use of lubricants, contraception (depo), husband infertility
- Ovulation occurs 14d prior to bleed; 21d cycle = day 7, 35d cycle = day 21
- Fertile window 5 days pre ovulation and day of ovulation (2nd daily better than daily)
- STI, fhx intertility, endometriosis more likely
- HypoT, PCOS, substance use also
- Can do hysterosalpingogram (HSG) to exc tubal occl
NB.
- 17-hydroxyp important to exclude
- DHEAS is produced specifically in adrenal glands
if virilisation (deep voice, citoromegaly - more extensive than hirsutism) then consider adrenal instead of just PCOS cause of hypertesterone
- AMH prod by cells in ovarian follices (marker of oocyte quant)
- estradiol prod by oocytes. low = prem ov failure. high also not good as can supp FSH axis.
- imperf hymen: cyclical discomfort in vagina
- anorexia: sudden change in weight, intense fear of gainin
