Repro wk2

Question 1

the amount of blood lost during an average normal menses is about:

Answer 1

25-75ml. excessive blood loss is considered to be over 80ml per menstrual cycle

Question 2

causes of dysfunctional uterine bleeding includes all of the following except:
Anoculation secondary to PCOS
Perimenopausal anovulatory cycles
endometrial cancer

Answer 2

endometrial caner - dysfunctional uterine bleeding is defined as abnormal uterine bleeding UNRELATED to anatomic lesions of the uterus i.e uterine cancer

Question 3

a 44 yr old G1P1 has continuous vaginal bleeding for 21 days. she is hemodynamically stable. she normallly menses every 28 days. physical is normal, BhCG is negative. the next step in mgmt is:

Answer 3

1) endometrial sampling! the take home message from this questions is that it is important to rule our anatomical cause for her bleeding ( endometrial hyperplasia or cancer) before assuming that it is dysfunctinoal uterine bleeding and beginning treatment esp. in a non-urgent clinical scenario

Question 4

give aan accurate definition of amenorrhea-

Answer 4

no period by the age of 16 regardless of presence of normal growth and development with the appearance of secondary sex characteristics.

Question 5

a lab assessment of a non preg woman with secondar amenorrhea should include:

Answer 5

serum LH, FSH, TSH, prolactic, pregnancy test, estradiol

Question 6

patients with hypothalamic amenorrhea most commonly demonstrate what hormonal pattern?

Answer 6

decreased estrogen, decreased progesterone, ( the LH and FSH are low = no follicular stimulation, so there is low estrogen and progesterone).

Question 7

secondary amenorrhea in a 25 yr old woman with clinical exam suggesting hypoestrogenism and elevated FSH means she has:

Answer 7

premature ovarian failure. POF is defined as women who experience menopause before 40 years of age, and occurs in approx 1% of women. diagnosis should be suspected in women complaining of symptoms of low estrogen and can be confirmed by a lab test demonstrating menopausal FSH levels ( high FSH levels).

Question 8

natural menopause results from:

Answer 8

depletion of primoridal follicles in the ovaries. so it is really that your ovaries just conked out.

Question 9

what are the symptoms of yhypoestrogenism?

Answer 9

host flushes, insomnia, superficial dysparunea, lack of energy, urinary frequency. nausea is from high estrogen states

Question 10

the first sign of menopause is usualy:

Answer 10

change in menstrual pattern ( gets short, and then really really long, until gone)

Question 11

hot flush etiology is:

Answer 11

vasomotor instability

Question 12

physiological changes in postmeno women include increased levels of what?

Answer 12

gonadotropins ( FSH etc)

Question 13

estrogen deprivation in the female lower genital tract results in:

Answer 13

vaginal atrophy

Question 14

what happens to the lipid profile of menopausal women put on OCP?

Answer 14

total cholesterol decreases, HDL increases, LDL decreases

Question 15

what risks does not increase with POF ?

Answer 15

gallstones

Question 16

name the organ systems affected by the loss of ovarian function:

Answer 16

lower genital tract, skin and mucous membranes, cardiovascular system, skeleton, breasts, cognitions, metabolic.

Question 17

48 year old woman with previous hysterectomy is experiencing symptoms of menopause and wants HRT - hormone replacement therapy. what kind do you want to give her?

Answer 17

estrogen only - its safe as she doesnt have a uterus that could get endometrial cancer

Question 18

the 48 yr old wants to the know the common SEs of the estrogen therapy:

Answer 18

estrogen therapy SEs: breast tenderness, nipple sensitivity, vaginal discharge ( increased physiologic discharge). SE’s with progesterone : breast tenderness, fluid retention, bloating and increased appetite.

Question 19

the 48 yr old patient is at risk for what, if she doesnt get HRT?

Answer 19

osteoporosis, CV disease, sexual dysfunction, atrophic changes of the lower genital tract. not at risk for endometrial cacner though because she has had a hysterectomy

Question 20

what are the risks of HRT?

Answer 20

increased risk of venous thromboembolism, increased risk of gallbladder disease, increased risk pf unscheduled vaginal bleeding, increased risk of mastalgia. she will not have increased risk of alzheimers.