Puberty And Menstrual Disorders 3

Question 1

How do we diagnose PCOS?

Answer 1

Need 2 of the following 3:
Oligomenorrhea or amenorrhea
Biochemical or clinical signs of hyperandrogenism (LH:FSH 2:1)
US revealing multiple small cysts beneath the cortex

Question 2

What is the problem with the elevated levels of insulin and androgen in the body? What is the state of insulin in the body with PCOS?

Answer 2

Reduce production of sex hormone biding globulins so testosterone is free and increases in circulation

Insulin sensitivity tanks so tons of insulin on board

Question 3

6 treatments for PCOS?

Answer 3

Weight loss
Oral contraceptives to suppress FSH and LH. Estrogen also increases SHBG
Clomiphene citrate for ovulation
Ovarian laser treatment
Spironolactone because it competes for testosterone binding sites at target tissues
Insulin sensitizing agents like metformin

Question 4

What 5 labs do you look at when a patient presents with hyper androgenism?

Answer 4

17 hydroxyprogesterone to rule out CAH
Prolactin and TSH to rule out thyroid/high prolactin causes
24 hour cortisol or dexamethasone for cushings
Glucose levels
Testosterone and DHEA levels

Question 5

Define poly menorrhea, menorrhagia, metrorrhagia, menometrorrhagia , intermenstrual bleeding, oligomenorrhea?

Answer 5

Abnormally frequent menses, less than every 21 days
Lots and excessive bleeding, over 80mls and more than 7 days
Irregular episodes of uterine bleeding
Heavy and irregular bleeding
Little bleeding at ovulation
Cycles greater than 35 days but less than 6 months

Question 6

Main cause of dysfunctional uterine bleeding and what two ages most commonly have dysfunctional bleeding?

Answer 6

Problems in the HPO axis resulting in anovulation

Menarche and perimenopause

Question 7

What is the acronym for abnormal uterine bleeding and what does each letter stand for?

Answer 7

PALM COEIN
Poly, adenomyosis, leiomyoma, malignancy and hyperplasia
Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified.

Question 8

What is the difference between the palm and coein groups?

Answer 8

Structural and non structural

Question 9

Stage 1-5 of tanner staging for breast development?

Answer 9

1. Preadolescent, elevation of papilla
2. Breast bud stage, breast and and Padilla grow
3. Further enlargement of breast and Areola.
4. Areola and papilla grow and produce a second mound
5. Projection of papilla only

Question 10

5 tanner stages of pubic hair

Answer 10

1. Nothing
2. Sparse hair on labia
3. More, darker, and coarser
4. Adult type hair but nothing on thighs
5. On medial thighs