Menstruation & Irregularities

Question 1

What feature is always seen with an accessory cavitated uterine malformation?

Answer 1

A normal uterus

• This is presence of a cavity in the myometrium, laterally placed and below the insertion of the round ligament, that is lined by endometrium and surrounded by myometrium-like smooth muscle cells.
• Causes severe dysmenorrhea and chronic pelvic pain

Question 2

What is Tanner staging?

Answer 2

It is used to stage secondary sexual characteristics.

Question 3

Which tanner stage is associated with a public hair in a small triangle? What are the other features of that stage?

Answer 3

Tanner Stage 4 - is also associated with “breast mounds”

Question 4

Which tanner stage is associated with a breast buds? What are the other features of that stage?

Answer 4

2 stages are associated with breast buds:
- Tanner stage 2: forming breast buds and few, long downy pubic hairs on the labia majora

• Tanner stage 3: larger breast buds with pubic hair located centrally

Question 5

Prepuberty is associated with which Tanner stage?

Answer 5

Tanner Stage 1
- both the breasts and pubic hair growth are prepubertal

Question 6

Describe the features of Tanner stage 5?

Answer 6

Fully formed breasts and pubic hair in the adult triangle shape, adult quantity and type with spread to the inner thighs.

Question 7

Which condition is associated with Streak gonads?

Answer 7

Gonadal dysgenesis - 46 XX or 46 XY

Normal karyotype and streak gonads on u/s

Question 8

Which condition is associated
with streak ovaries?

Answer 8

Turner’s syndrome

XO karyotype and streak ovaries on u/s.

Question 9

When evaluating primary amenorrhea, what is very important to ask to develop differential diagnoses?

Answer 9

Are secondary sexual characteristics are present?

Question 10

What is primary amenorrrhea?

Answer 10

Failure to establish menstruation by:
Age 16 if secondary sexual characteristics are present and Age 14 if secondary sexual characteristics (SSC) are not present

Question 11

Does anorexia nervosa affect thyroid hormone levels?

Answer 11

Yes, decreased fT3.

– anorexia results in starvation, which significantly slows thyroid function.

Question 12

What are the s/es of bromocriptine?

Answer 12

From head down:

1. Headache
2. Postural hypotension
3. Dizziness
4. Drowsiness
5. Psychiatric symptoms (esp aggression)
6. Nausea
7. Vomiting
8. Pleural effusion
9. Constipation
10. Retroperitoneal fibrosis
11. Raynaud’s phenomenon