Menarche, Puberty, and Menstrual Disorders Flashcards

1
Q

The drop in progesterone and estradiol occurs towards the end of the luteal phase if conception does not occur, This causes a rise in ____ which will initiate new follicular growth for next cycle

A

FSH

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2
Q

Assuming you are a female and have normal, regular menstrual cycles. What day of the menstrual cycle is the best time to have intercourse in order to get pregnant?

A. 7 days after start of your period

B. 14 days after start of your period

C. 28 days after start of your period

D. 4 weeks after start of your period

A

B. 14 days after start of your period

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3
Q

Which of the following hormones is the most ominant during the follicular phase of ovarian cycle?

A. estrogen

B. progesterone

A

estrogen

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4
Q

Although both hormones reach there maximum levels in the luteal phase about 5-7 days after ovulation, which on is the dominant hormone in luteal phase?

A. estrogen

B. progesterone

A

progesterone

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5
Q

When does estrogen peak in the menstrual cycle?

A. 1 day before midcycle LH peak

B. 5-7 days after ovulation (luteal phase)

C. ~ Day 19-22 of menstrual cycle

D. All of the above

A

All of the above

5-7 days after ovulation is about Day 19-22 of mesntrual cycle

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6
Q

During the follicular phase, the ovary secretes a very small amount of progesterone, and the bulk of the progesterone comes from perupheral conversion of what? (2)

A

Adrenal pregenolone

Pregenolone sulfate

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7
Q

T/F: All females make ovarian cysts normally, the concerining cysts are the ones that persist

A

True

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8
Q

The proliferative phase of the uterine cycle is characterized by growth of the endometrium secondary to stimulation from what hormone?

A

Estrogen

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9
Q

In which of the following phases are numerous mitoses seen?

A. Menstrual phase

B. Proliferative Phase

C. Secretory Phase

A

Proliferative Phase

  • mitosis wasn’t mentioned in menstrual phase, and was noted to be rare in the secretory phase
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10
Q

If conception doesn’t happen by _______, the CL regresses which leads to decrease in prog and estro, and we start to see the endometrium undergoing involution (shrinking)?

A. Day 14

B. Day 17

C. Day 23

D. Day 28

A

Day 23

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11
Q

All of the following is accurate in terms of the average age of menarche, EXCEPT?

A. 12.43 years old

B. 2-3 years after Thelarche at Tanner stage IV

C. before Tanner stage III

D. 90% start 13.75 years old

A

before Tanner stage III

  • VERY RARE for it to start before Tanner stage III
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12
Q

What 2 things qualify as primary amenorrhea?

A

absence of menarche by age 13 WITHOUT secondary sex characteristics

absence of menarche by age 15 WITH secondary sexual characteristics

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13
Q

What qualifies as secondary amenorrhea?

A

absence of menstruation for 6 months

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14
Q

A 13 year old female patient comes into the office. Her mother explains that she had her first period when she was 12, but recently hasn’t had her period in over 3 months. Her mom is worried that she’s holding it in, in order to scare her mother cause she’s been quite a rebel lately. Which of the following is your next step?

A. Diagnose her with primary amenorrhea

B. Diagnose her with secondary amenorrhea

C. Check urine hCG to rule out pregnancy

D. Probably has just been holding her period in to annoy her mom

A

C. Check urine hCG to rule out pregnancy

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15
Q

What is oligomenorrhea?

A

abnormally infrequent menses at interbals greater than 35 days

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16
Q

Define intermenstrual bleeding

A

a little bleeding at ovulation for 1-2 days

17
Q

Define menometrorrhagia

A

Heavy and irregular uterine bleeding

18
Q

Define metrorrhagia

A

irregular episodes of uterine bleeding

19
Q

Define menorrhagia (hypermenorrhagia)

A

excessive and/or prolonged menses (basically last greater than 7 days), but occurs at regular intervals

20
Q

Define polymenorrhea

A

abnormally frequent menses at intervals less than 21 days

21
Q

A patient comes in explaining that she recently noticed shes been bleeding through 10+ tampons, and her uterine bleeding seems sporadic and hard to track. What is the most likely term used for what she’s describing?

A. Menorrhagia

B. Metrorrhagia

C. Menometrorrhagia

D. Oligomenorrhea

A

A. Menorrhagia- heavy, prolonged bleeding more than 7 days

B. Metrorrhagia- irregular bleeding

C. Menometrorrhagia- heavy and irregular bleeding

D. Oligomenorrhea- >35 days between cycles

22
Q

What is the acronynm for the classification system of abnormal bleeding causes in reproductive age women?

What are the general causes of the first half of the acronym?

What are the indicated causes of the seconda half of the acronym?

A

PALM-COEIN

PALM: structural causes

COEIN: nonstructural causes

23
Q

A 67 year old post-menopausal woman comes in with some uterine bleeding. Upon performing an untral sound you think you see a focal thickening of endometrial stripe, however, once you perform a saline hysterosonography you are sure you know what you saw. What did you see?

A. Adenomyosis

B. Leiomyoma

C. Polyp

D. None of the above

A

Polyp

24
Q

A patient comes in with symptoms of excesssive uterine pressure, pelvic pain, and a history of infertility. Upon investigation you are able to confirm the presence of a Leiomyoma in the patient’s uterus. Which of the following correctly characterizes a leiomyoma?

A. a malignant tumor derived from endometrium basal layer

B. a benign tumor derived from myometrium smooth muscle cells

C. a bening tumor derived from myometrium skeletal muscle cells

D. None of the aobve

A

a benign tumor derived from myometrium smooth muscle cells

NOTE: Leiomyomas are the most common neoplasm of the uterus, and >45% of women will have leiomyomas by the 5th decade

  • feels like a bouncy ball
  • may calcify especially in postmenopausal women
25
Q

Hyperplasia of the endometrium is excessive growth of the endometrial lining usually as a result of persistent unopposed estrogen. What are some causes that lead to unnoposed estrogen?

A

PCOS

tumors in theca cells

obesity

exogenous estrogens without progesterone

Tamoxifen

26
Q

Which of the following is the extrusion of the endometrial glands and stroma into the uterine musculature?

A. Polyps

B. Adenomyosis

C. Leiomyoma

D. Hyperplasia of Endometrium

A

Adenomyosis

27
Q

Endometrial hyperplasia can be a precursor to malignancy, endometrial adenocarcinoma being the most common. There are 4 different precursors, that have different risk %. What are those 4 types and their relative % of cahnce of becoming malignant

A

simple without atypia 1%

complex without atypia 3%

simple with atypia 9%

complex with atypia 27%

28
Q

Which of the following non structural causes of AUB is commonly associated with Von Willibrand disease?

A. Coagulopathies

B. Ovulatory dysfunction

C. Endometrial causes

D. Iatrogenic

E. Not yet classified

A

Coagulopathies

29
Q

Which of the following non structural causes of AUB is is associated with unpredictable menses with variable flow, as seen in people with PCOS?

A. Coagulopathies

B. Ovulatory dysfunction

C. Endometrial causes

D. Iatrogenic

E. Not yet classified

A

Ovulatory dysfunction

30
Q

Which of the following AUB treatment options would be used to normalize prostaglandins?

A. NSAIDs prior to and during menses

B. Tranexxamic acid

C. Medoroxyprogesterone (MPA) or combined oral contraceptives (OCP)

D. Daily progesterone, IUS, or continuous OCP

A

NSAIDs prior to and during menses

31
Q

Which of the following AUB treatment options would be used to coordinate endometrial slpughing?

A. NSAIDs prior to and during menses

B. Tranexxamic acid

C. Medoroxyprogesterone (MPA) or combined oral contraceptives (OCP)

D. Daily progesterone, IUS, or continuous OCP

A

C. Medoroxyprogesterone (MPA) or combined oral contraceptives (OCP)

NOTE: Option D is for endometrial suppression

32
Q

The use of Tranexamic acid would be a treatment used to address what?

A. overabundance of prostaglandins

B. antifibrinolytic therapy

C. suppress endometrial growth

D. encourage sloughing of endometrium

A

antifibrinolytic therapy

33
Q

Look at this chart

A

Dope

34
Q

What is the first physical sign of puberty in females?

A. Menarche

B. Pubarche/Adrenarche

C. Thelarche

D. None of the above

A

Thelarche

35
Q

Know this

A

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