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OBGYN > Primary Amenorrhea > Flashcards

Primary Amenorrhea Flashcards

1
Q

Primary amenorrhea is diagnosed when ___

A
  1. Absence of menses by age 15 years old
  2. No menstruation within 5 years of breast development, if occuring by age 10
  3. No breast development occuring by age 13
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2
Q

[Sequence of prepubertal changes]

Breast development should happen at age

A

10-11

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3
Q

[Sequence of prepubertal changes]

appearance of pubic and axillary hairs

A

10.5 to 11.5

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4
Q

[Sequence of prepubertal changes]

maximal growth velocity

A

11-12 years old

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5
Q

[Sequence of prepubertal changes]

menarche

A

11.5 to 13 years old

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6
Q

What is the first sign of puberty

A

breast budding

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7
Q

What is the last sign of puberty

A

menarche

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8
Q

What is the most relevant factor for onset of puberty and menstruation?

A

Ratio of fat to lean BW and tbw

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9
Q

What hormone produced by adipocytes that directly affects LH pulsatility and restore menstrual cycle

A

Leptin

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10
Q

[Stage of breast growth]

breast budding

A

B2

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11
Q

[Stage of breast growth]

breast enlargement without separation of breast contours

A

B3

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12
Q

[Stage of breast growth]

secondary mound

A

B4

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13
Q

[Stage of pubic hair growth]

labial hair present

A

PH2

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14
Q

[Stage of pubic hair growth]

labial hair spreads over mons pubis

A

PH3

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15
Q

[Stage of pubic hair growth]

slight lateral spread

A

PH4

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16
Q

Delayed menarche is defined as ______

A

delayed up to 15 years old, if involved in strenuous exercise before menarche

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17
Q

[Diagnose: Primary amenorrhea]

No breast development, uterus well developed

A
  1. Hypothalamic failure - insufficient GnRH
  2. Pituitary failure - pituitary adenoma
  3. gonadal failure (Turners)

ovaries never secreted estradiol

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18
Q

[Diagnose: Primary amenorrhea]

breast well developed
no uterus

A
  1. Androgen resistance

2. Uterovaginal agenesis

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19
Q

[Diagnose: Primary amenorrhea]

breast and uterus not present

A
  1. 17,20 desmolase deficiency
  2. Agonadism
  3. 17a-OHase deficiency with 46XY
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20
Q

[Diagnose: Primary amenorrhea]

beast and uterus present, no menarch

A
  1. Secondary ammenorrha
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21
Q

[Diagnose: Primary amenorrhea]

anosmia
normal height
increase growth of long bones
greater wingspan to height ratio

A

Kallman Syndrome

22
Q

Hypogonadotropic Hypogonadism is associated with what disease condition?

A
  1. Thalassemia major

2. Retinitis pigmentosa

23
Q

Viral infection that can cause pituitary failure?

A

Mumps encephalitis

24
Q

What is the second most common cause of congenital absence of uterus?

A

Mayer-Rokitansky-Kuster-Hauser

25
Q

[Diagnose]

46XY
no internal male/female geintalia
lack pubic or axillary hair, breast present

A

Androgen Resistance (Testicular feminization)

Remove gonads, create neovagina

26
Q

[Diagnose]

46XX
present breast
absent mullerian ducts
present pubic hair
Testosterone is female level
A

Uterovaginal Agenesis

uterine transplant; create neovagina

27
Q

Secondary amenorrhea is diagnosed when there is absence of menses _____

A

longer than 6 months to 12 years

28
Q

[Cause of Secondary
Amenorrhea]

Hypergonadotropic hypogonadism

A

from ovary

29
Q

[Cause of Secondary Amenorrhea]

Hypoestrogenic amenorrhea

A

from the pituitary gland

30
Q

___ syndrome can happen due to hypotensive episode during pregnancy resulting to pituitary cell destruction

A

Sheehan Syndrome

31
Q

____ disease is a damage to pituitary gland unrelated to pregnancy

A

Simmonds disease

32
Q

___ refers to menopause before age 40

A

premature ovarian failure/ premature ovarian insufficiency

33
Q

[Diagnose]

obliteration of endometrial cavity refers to what syndrome

A

Asherman Syndrome

34
Q

What is the most frequent antecedent factor for intrauterine adhesions?

A

endometrial curettage

35
Q

Precocious puberty is diagnosed when there is appearance of any signs of secondary sexual maturation at an age

A

<8 years old

36
Q

True precocious puberty is GnRH ____ (dependent/independent)

A

GnRH dependent

if GnRH independent, its incomplete

37
Q

What are the primary concerns of parents with children having precocious puberty?

A
  1. Social stigma

2. Diminished ultimate height

38
Q

What is the Lh value that is diagnostic for true precocious puberty?

A

LH > 5mIU/Ml

39
Q

Lesions located at which sites at the brain is associated with GN

A
  1. Hypothalamus near 3rd ventricle
  2. Tuber cinereum
  3. Mamillary
40
Q

___ syndrome refers to increase TSH and gonadotophin with primary hypothyroidism

A

Van wyk-Grumbach syndrome

Unique: Bone age is retarded

41
Q

What is the most common cause of GNRH independent precocious puberty?

A

Ovarian tumor from Granulosa cell tumor

> 8cm

42
Q

___ syndrome

cafe au lait sponts
polyostotic fibrous dysplasia
cyst of skull and long bones

A

McCune Albright

Tx: Fulvestrant

43
Q

Premature thelarche is diagnosed when ___

A

isolated unilateral or bilateral breast development, no axillary or pubic hair development

44
Q

___ refers to early isolated development of pubic hair, non-progressive, no clitoral hypertophy, bone age not advanced

A

Premature pubarche

45
Q

____ refers to isolated early development of axillary hair which may evolve to PCOS

A

Premature Adrenache

46
Q

What is one of the earliest features of precocious puberty?

A

Acceleration of growth

47
Q

What test differentiates incomplete from true precocious puberty?

A

GnRH agonist stimulation test

48
Q

What are the indications for medical treatment of precocious puberty?

A
  1. menarche at <8 years old
  2. Progressive thelarce and pubarch
  3. Bone age >2 years of chronological age
49
Q

What is the DOC for true precocious puberty?

A

GnRH agonist (Leuprolide)

50
Q

____ refers to aromatase inhibitor used to treat precocious puberty

A

Letrozole

51
Q

___ drug is an estrogen receptor antagonist used to treat McCune Albright

A

Fulvesterant

OBGYN (33 decks)

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