Gynecology

Question 1

17 year old female with increased hair - beard, mid chest, linea alba, upper back.
Amenorhea for 5 months.
Irregular menses for 2 years.
Menarche at 12 and half yrs old.

What labs to do?
What areas to examine?

Answer 1

LH/FSH ratio, free/total testosterone, DHEAS

Hair all over and see if clitoromegally (>5mm)

Question 2

Total testosterone 30 (5- 40)
Free testosterone 5 (0.9 to 3.2)
DHEAS 450 (149 - 395)
LH 20
FSH 4
Prolactin 30 (5-25)
Clitoromegally

Answer 2

PCOS

Question 3

16 yo with primary amenorhea
Normal breast development - Tanner 5
normal pubic hair - Tanner 5
No hymen opening
Uterus palpable on recto-abdominal exam

Answer 3

Imperforate Hymen

Hematocolpos

Hematoneutria

Question 4

16 yr ol with renal transplant due to horseshoe kidney.
Now has pelvic kidney
normal breast development, primary amenorhea.
No hymen opening.
No uterus palpable on recto-abdominal exam

Answer 4

Blind pouch

Rokitansky Meyer

Question 5

16 yo with amenorhea for 6 mths.
Menarche at 11 yo
Weight gain 5 kg over 6 mths.
breast discharge.
Normal visual fields
Constipation.

Prolactin 5 (5-25). TSH 15 (0.3-4.7)
t3/t4 TPO (pending)

Answer 5

Hypothyroidism {or Hyperprolactinemia}.
TRH or Prolactin are similar both dopaminergic.
Can cause galactorhea & amenorhea.

Question 6

17 yo athletic female
Runs 30-60 miles/week
Amenorhea for one year
UPT negative

Answer 6

Progesterone challenge (-) No bleeding
TSH/Prolactin normal
Fsh low normal
Athletic amenorhea

Question 7

15 yo female - amenorhea for 6 mths
tanner V breasts, pubic hair, UPT negative.
TSH/Prolactin normal.
Progesterone challenge (-)
FSH high

Answer 7

Anti-ovarian antibodies (+)

premature ovarian failure

Question 8

16 yo liver transplant patient comes in for routine care. Stable on her immunosuppresive meds. Her transplant was 5 years ago. Menarche at 11 and regular periods for last 3 years with the exception that she hasnt had one in 6 mths. She denies being sexually active. Not hirsute, no acne. Weight is stable with BMI at 50%. What tests next?

Answer 8

r/o preg
TSH wnl
Prolactin 60 (5-25)
LH/FSH normal.
Next test ----

MRI - pituitary macro adenoma

Question 9

13 yo worried about irregular periods. Menarche at 12. Menses every one to two months, lasts 5-6 days, no cramps.
LMP 10 days ago, lasted 5 days
PMP 39 days ago, lasted 7 days

What advise?

Answer 9

Normal for her gynecological age. Give Reassurance.

Question 10

13 yo with vaginal bleeding for 2 weeks.
First period.
HGB 10.
Bright red blood.
No significant orthostatic BP/HR changes.
What tests?

Answer 10

platelets - normal
PT/PTT - normal

Ristocetin co-factor normal
Factor VIII activity normal
Factor VIII antigen normal (VWF antigen)
von willebrand factor multimers type IIA