Menopause/Infertility/Virilization

Question 1

Hirsutism

Answer 1

mild masculinization = fat and hairy

Question 2

Virilization

Answer 2

hirsutism +! = fat, hairy, enlarged clitoris, deep voice, amenorrhea + increase in muscle mass

Question 3

where does DHEA come from?

Answer 3

Adrenals in response to ACTH

Question 4

5 common causes of Hirsutism/virilization

Answer 4

1. PCOS
2. Sertoli-Leydig Tumor
3. Adrenal Tumor
4. CAH
5. Familial hirsutism

Question 5

explain why you get hirsutism in PCOS. how would you dx? labs?

Answer 5

lack of progest = elevated LH trying to produce progest but just making excess testosterone!
Labs: elevated test, norm DHEA, LH >FSH, bilateral ovary cysts on U/S

Question 6

How do you tx PCOS? why?

Answer 6

1. OCP = regulate cycle and prevent breakthrough bleeding
2. Clomiphene if trying to get prego to stimulate ovulation(no progest no ovulation!)
3. Metformin = helps w/ovulation(no idea why) + helps w/insulin resistance
4. Spironolactone = antiandrogen fx

Question 7

What labs would you see w/hirsutism caused by sertoli-leydig tumor? tx?

Answer 7

HIGH test, normal DHEA, unilateral ovarian mass on U/S. must resect

Question 8

What labs would you see w/hirsutism caused by Adrenal Tumor? tx?

Answer 8

normal test, HIGH DHEAS, unilateral adrenal mass on CT scan. must resect

Question 9

What labs would you see w/hirsutism caused by CAH? which one? tx?

Answer 9

normal test, elevated DHEA, bilateral adrenal enlargment on CT scan. Often 21 OH Prog. Tx: cortisol + fludrocortisone

Question 10

What labs would you see w/hirsutism caused by familial hirsutim?

Answer 10

everything is normal but ur still fat in hairy bc ur genes suck

Question 11

Whats the trick to figuring out the CAH’s? so whats 17, 11, 21?

Answer 11

1st number is mineralo/aldo, 2nd is sex.

• 17 = high aldo, no sex
• 21 = no aldo, high sex
• 11 = some aldo, high sex

Question 12

elevation of —- is consitant with ovarian failure.

Answer 12

FSH

Question 13

tx of vaginal atrophy

Answer 13

estrogen cream

Question 14

tx of hot flashes

Answer 14

SSRI = venlafaxine

Question 15

osteoporosis prophylaxis @ 50

Answer 15

Vit D3 + Ca

Question 16

when do you do Osteoporosis screening?

Answer 16

dexa @ 65 or 60 if smoker

Question 17

Osteoporosis tx

Answer 17

bisphosphonates

Question 18

define Infertility

Answer 18

inability to conceive after 1 year

Question 19

Which do you work up 1st in infertility M or F?

Answer 19

Male!

Question 20

male workup for infertility includes…

Answer 20

1. ED - look @ nighttime tumescence test. If psyc = counciling; If not = Sildenafil
2. Semen analysis = look @ number + Motility

Question 21

when should you advise a couple who wants to get pregnant to have sex?

Answer 21

5 days prior to ovulation and throughout the day of ovulation

Question 22

ICSI vs IVD vs IUI

Answer 22

• Intracytoplasmic Sperm Injection(ICSI) = manual sperm + egg + implant
• In Vitro Fert(IVD) = Egg + sperm in dish, let fertilize nat + implant
• Intrauterine Injection(IUI) = sperm injected into uterus

Question 23

Female causes of infertility workup

Answer 23

1. hostile mucous 6cm this is good. tx Estrogen

2. Anovulation

Question 24

What is a smush test? what is this used for?

Answer 24

tests infertility due to hostile cervical mucus = <6 cm on smush test = too thick =( idealy want >6cm this is good. tx Estrogen to thin mucus if too thick

Question 25

Define Menopause

Answer 25

1yr w/o period

Question 26

Primary ovarian insufficiency definition

Answer 26

Menopause(1yr w/o period) before age 40