Uwise - REI

Question 0

Patient with primary amenorrhea. Tanner stage one breast and pubic hair. Shield chest, widely spaced nipples, no genital tract abnormalities. Cause?

Answer 0

Noonan

Question 1

Three critical environmental elements for reaching menarche?

Answer 1

Bodyweight, sleep, sunlight

Question 2

Premature menses before breast and pubic hair development?

Answer 2

McCune-Albright syndrome

Question 3

Patient with primary amenorrhea. Cagina leads to blind pouch. Normal ovaries, but absence of uterus and cervix. Most appropriate next step?

Answer 3

Renal ultrasound – patient has Mullerian agenesis, associated with renal anomalies

Question 4

Primary Amenorrhea, patient complains of abdominal discomfort, and bluish mass is seen pushing labia open. Cause? Can lead to?

Answer 4

Imperforate hymen. Asherman’s

Question 5

41-year-old patient with history of uncomplicated spontaneous deliveries and tubal ligation who presents with increasingly heavy periods. Next step?

Answer 5

Pelvic ultrasound to look for polyps or fibroids

Question 6

Patient who hit menarche six months ago with increasingly heavy menstrual flow. OCP’s not controlling the bleeding – most likely etiology?

Answer 6

Coagulation disorder

Question 7

35 year old patient with a history of irregular menstrual periods, which had become heavier over the last year. No abnormalities detected pelvic exam – next step?

Answer 7

Endometrial biopsy

Question 8

Young woman with menstrual pain – attempts at management (in order)?

Answer 8

1. 600 mg of ibuprofen every 4 to 6 hours
2. OCP
3. Depo-provera
4. Diagnostic laparoscopy

Question 9

42-year-old patient progressively worsening menstrual pain. Very heavy flow. Enlarged, soft, boggy uterus. Diagnosis? Management in order?

Answer 9

Adenomyosis – menses cannot slough off, leading to increased bleeding and pain.

1. Gonadotropin releasing agents
2. Endometrial ablation or progesterone IUD if woman wants to maintain fertility
3. Hysterectomy (definitive)

Question 10

Patient over 41 years with irregular bleeding – next step?

Answer 10

Always get in endometrial biopsy

Question 11

Major Risk factors for osteoporosis? Treatment in these patients?

Answer 11

Fracture as an adult, low bodyweight, current smoker

Begin bisphosphonate therapy

Question 12

Was common reason why women stop hormone therapy?

Answer 12

Vaginal bleeding

Question 13

Effect on hormone therapy on lipid profile?

Answer 13

HDL increases, LDL decreases

inhibits hepatic lipase, preventing HTL breakdown; increases LDL catabolism