Obgyn - Menstrual disorders Flashcards
OBG - 2.2
Which are the physiological states of amenorrhea?
A) before puberty
B) during pregnancy
C) while breastfeeding
D) after the menopause
E) all of them
ANSWER
E) all of them
EXPLANATION
The physiological states of amenorrhea are before puberty, after the menopause, during pregnancy and breastfeeding.
OBG - 2.3
Which is the most common cause of secondary amenorrhea?
A) hypothalamo-hypophyseal
B) ovarian
C) uterine
D) vaginal
E) adrenal
ANSWER
A) hypothalamo-hypophyseal
EXPLANATION
The most common cause of secondary amenorrhea is hypothalamo-hypophyseal with 61%, not included the hyperprolactinaemia, which represents further 18%. The uterine cause represents only 9%.
OBG - 2.5
Which are the symptoms of premenstrual syndrome?A) increased irritability, psychic instability
B) predisposition to depression
C) painful breast tension
D) headache and back pain
E) any of them can appear in various degrees
ANSWER
E) any of them can appear in various degrees
EXPLANATION
This condition has an endocrine and psychosomatic origin. The changing levels of estrogen and progesterone have effect on mood and pain through neurotransmission modulation in the central nervous system.
OBG - 2.6
Which can cause Asherman’s syndrome?
A) infections leading to endometrial sclerosis (e.g. genitalis tuberculosis)
B) ovarian dysfunction
C) destruction of the endometrial basal layer (e.g. after curettage of the uterus)
D) all of them are correct
E) A and C
ANSWER
E) A and C
EXPLANATION
In the Asherman’s syndrome, the front and back walls of the uterus stick to one another, which leads to amenorrhea. The most common cause of this condition is iatrogenic because of the destruction of the endometrial basal layer e.g. after curettage of the uterus. Genital tuberculosis may also lead to Asherman’s syndrome through the infection-related endometrial sclerosis, but it’s uncommon nowadays.
OBG - 2.7
Characteristics of the normal menstual cycle, except:
A) The typical length of the period is 21 to 35 days
B) The blood loss is no more than 80 ml
C) it may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains
D) the estimation of the blood loss is subjective, and has a large interpersonal variation
ANSWER
C) it may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains
EXPLANATION
The normal menstrual cycle can range in length from 21 days to about 35 days, where the blood loss is no more than 80 ml. The estimation of the blood loss is complicated, because it is subjective, and has a large interpersonal variation.
OBG - 2.8
Management of abnormal uterine bleeding in adolescents:
A) it is a temporary condition, neither the excessive and prolonged bleeding require treatment
B) may be caused by neoplasms, in order to receive histologic diagnosis curettage needed to perform
C) continuous or cyclic progesterone therapy and oral contraceptives
D) in case of frequent and excessive bleeding, anticoagulants may be effective
E) all of the treatments are correct
ANSWER
C) continuous or cyclic progesterone therapy and oral contraceptives
EXPLANATION
The abnormal uterine bleeding in adolescents is usually due to hormonal disturbances, so curettage is not recommended. The initial treatment, especially in case of excessive and prolonged bleeding are cyclic progesterone therapy, ovulation induction or oral contraceptives,
OBG - 2.9
Characteristics of dysmenorrhea, except:
A) The most characteristic symptom is the lower abdomen pain, other symptoms may include nausea and vomiting
B) The main symptom is nausea and vomiting, and the lower abdomen pain is an often co-occuring symptom
C) The symptoms may occur even after the first childbirth
D) The symptoms may occur after the menarche
E) The symptoms occur primarily in the anovulatory cycles
ANSWER
E) The symptoms occur primarily in the anovulatory cycles
EXPLANATION
The most characteristic symptom of dysmenorrhea is the lower abdomen pain, other symptoms may include headache, nausea and vomiting. It can be classified as either primary or secondary based on the absence or presence of an underlying cause. The most common cause of secondary dysmenorrhea is organic, it may occur even after the first childbirth. The symptoms does not occur in the anovulatory cycles because of the low prostaglandin level of the endometrium.
OBG - 2.10
Characteristics of an endometrial polyp, except:
A) benign mass in the inner lining of the uterus
B) can lead to infertility
C) the prevalence increases with age
D) the mass is benign, malignant transformation is not possible
E) can removed by hysteroscopic resection
ANSWER
D) the mass is benign, malignant transformation is not possible
EXPLANATION
The endometrial polyp is a benign mass in the inner lining of the uterus. Polyps are usually benign, but the prevalence increases with age, and the risk of malignant transformation is above 50% after the age of 65. Polyps can be surgically removed by curettage or hysteroscopy.
OBG - 2.11
Which are the characteristic symptoms of the adenomyosis?
A) dysmenorrhea
B) hypermenorrhea
C) infertility is a main symptom
D) uterine enlargement
E) all of the symptoms are characteristic
F) only A) and C) are correct
ANSWER
E) all of the symptoms are characteristic
EXPLANATION
The endometrial tissue infiltrates the myometrium deeply, causing dysmenorrhea and hypermenorrhea. The uterus is usually uniformly enlarged.
OBG - 2.12
This manner can be used in the diagnosis of endometriosis:
A) physical examination
B) ultrasound examination
C) MRI
D) laparoscopy
E) all of them are correct
ANSWER
E) all of them are correct
EXPLANATION
After suspecting endometriosis based on the medical history and a physical examination,ultrasound examination and MRI is advocated. Laparoscopy is the gold standard to diagnose endometriosis. If the growths are not visible, a biopsy may be taken to determine the diagnosis.
OBG - 2.13
Which treatment is not recommended in menorrhagia?
A) Combined oral contraceptive pills
B) Intrauterine system that contains progestogen
C) NSAIDs
D) Endometrial resection
E) In case of unsuccessful initial treatment, surgery can be an effective second line treatment
F) Copper intrauterin device (IUD)
ANSWER
F) Copper intrauterin device (IUD)
EXPLANATION
In the treatment of menorrhagia, combined oral contraceptive pills have an efficiency of about 50-60%. The IUS has about 90%, and the NSAIDs have about 25% of efficiency. If the initial therapy is unsuccessful, endometrial ablation is recommended. Copper intrauterin devices can increase the amount of bleeding, therefore they are not recommended
OBG - 2.14
Which are the main symptoms of premenopause?
A) abnormal uterine bleeding
B) anovulatory cycles
C) reduction of fertility, then infertility
D) A), B) and C) are all correct
E) Vulvovaginal atrophy
ANSWER
D) A), B) and C) are all correct
EXPLANATION
The female reproductive organs are not atrophic before menopause but the other symptoms are characteristics. The estrogen level continuously decreases after the menopause, leading to atrophy of the female reproductive organs.
OBG - 2.19
Which cannot cause dysmenorrhea?
A) endometriosis
B) adenomyosis
C) leiomyoma
D) cervical stenosis
E) long-term combined oral contraceptives
ANSWER
E) long-term combined oral contraceptives
EXPLANATION
The level of prostaglandines -responsible for the dysmenorrhea- is decreased in anovulatory cycles. Therefore the continuous use of oral contraceptives relieves or terminates dysmenorrhea.
OBG - 2.22
After menarche in case of imperforated hymen, the following can be seen:
A) Haematocolpos
B) mucocolpos
C) urinal retention
D) neither of them
E) A and C
ANSWER
E) A and C
EXPLANATION
After menarche the imperforated hymen first results heamatocolpos, which causes urinary disorder and retention due to the pressure applyed to the urethra and the bladder. Mucocolpos appears before the menarche, because of the obstruction of the the secretion.
OBG - 2.25
What is hypomenorrhoea?
A) period last longer with more bleeding
B) regular, but shorter menstruation with light bleeding
C) period is between 30 and 120 days
D) more than 120 days between two menstruations
E) less then 25 days between two menstruations
ANSWER
B) regular, but shorter menstruation with light bleeding
EXPLANATION
regular, but shorter menstruation with light bleeding