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30 Cards in this Set
- Front
- Back
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1. Primary amenorrhea?
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a. Absence of menarche by age 16 or 4 years after thelarche.
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2. Causes of primary amenorrhea?
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a. Congenital abnormalities of the genital tract
b. Chromosomal abnormalities c. Enzyme or hormonal deficiencies d. Gonadal agenesis e. Ovarian failure f. Disruption of the hypothalamic-pituitary axis. |
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3. Primary amenorrhea with absence of a uterus and breasts?
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a. Karyotype usually reveals 46, XY.
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4. Primary amenorrhea with absence of uterus and presence of breasts?
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a. Karyotype will differentiate between mullerian agenesis and testicular feminization.
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5. Testicular feminization or androgen insensitivity results from?
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a. Absence of testosterone receptors.
b. Phonotypical FM with 46 XY. c. Bc these pts have testes, Mullerian Inhibiting Factor (MIF) was secreted early in development. d. They, therefore have absence of all mullerian-derived structures. e. Testes may be in inguinal canal or in labia. f. Usually oestrogen is produced, and these pts develop breasts but present w/primary amenorrhea bc they have no uterus. g. Commonly have a vagina that ends in a blind pouch. |
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6. Primary Ovarian failure?
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a. Results in low levels of estradiol but elevated levels of gonadotropins (FSH and LH).
b. Hypergonadotropic hypogonadism. c. Variety of causes: 1. Savage syndrome 2. Turner syndrome |
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7. Savage syndrome?
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a. Failure of ovaries to respond to FSH and LH secondary to receptor defect.
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8. Gonadal Agenesis with 46 XY?
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a. Defect in 17-α-hydroxylase or 17,20 desmolase.
b. These pts will not produce androgens but will produce MIF. c. Hence, there will be no female internal reproductive organs. d. These pts will otherwise be phenotypically FM. e. Usually w/o breast development. |
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9. What is the congenital absence of testes in a genotypic male called?
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a. Swyer syndrome.
b. Results in a phonotypical picture similar to that of ovarian agenesis. c. However, w/o oestrogen, they will not develop breasts. |
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10. Pathophys and symptoms of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome?
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a. Mullerian agenesis or dysgenesis.
b. May have complete vaginal agenesis and absence of uterus or partial vaginal agenesis w/a rudimentary uterus and distal vagina. c. Differs from vaginal atresia where the Mullerian system is developed, but the distal vagina is composed of fibrosed tissue. |
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11. Diagnosis of MRKH?
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a. With physical exam that reveals:
i. No patent vagina b. Ovaries are visualized on U/S. c. Uterus is present. d. Chromosomes: 46, XX. |
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12. Primary amenorrhea with absence of breasts and presence of uterus?
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a. FSH will differentiate between:
i. Hypergonadotropic and hypogonadotropic hypogonadism. ii. Karyotype may be necessary to r/o gonadal agenesis in a 46xy. |
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13. Evaluation of pts w/both a uterus and breasts?
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a. Should be evaluated as if presenting w/2º amenorrhea.
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14. Anatomical causes of 2º amenorrhea?
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1. Asherman syndrome
2. Cervical stenosis b. These pts fail to respond to oestrogen and progesterone withdrawal. |
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15. Note: prolactinemia is a common cause of secondary amenorrhea.
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15. Note: prolactinemia is a common cause of secondary amenorrhea.
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16. Progesterone challenge for 2º amenorrhea?
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a. Pts w/normal prolactin levels may be given a progesterone challenge to investigate whether or not the endometrium is oestrogenized.
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17. Differential diagnosis with progesterone challenge failure?
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a. Hypergonadotropic or hypogonadotropic hypogonadism that can be differentiated by an FSH measurement.
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18. Note: for pts not seeking current fertility, it is important to tx the specific cause of amenorrhea and to consider hormone replacement in the hypoestrogenic pt.
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18. Note: for pts not seeking current fertility, it is important to tx the specific cause of amenorrhea and to consider hormone replacement in the hypoestrogenic pt.
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19. Tx of amenorrhea in pts desiring fertility?
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a. Ovulation induction can usually be achieved.
b. Pts w/hyperprolactinemia require bromocriptine. c. Pts w/other forms of hypogonadism may respond to clomiphene and gonadotropins |
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20. Asherman syndrome?
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a. Presence of intrauterine synechiae or adhesions, usually 2º to intrauterine surgery or infection.
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21. Stein-Leventhal syndrome (PCOS)?
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a. Anovulatory
b. Oligomenorrhea or amenorrhea c. Hirsutism d. Obesity e. Enlarged polycystic ovaries. |
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22. Rx for PCOS pts desiring fertility?
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a. Clomiphene citrate.
b. Also lose weight and use metformin. |
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23. Kallman syndrome?
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a. Involves the congenital absence of GnRH and is commonly associated w/anosmia.
b. GnRH transport may be disrupted w/compression or destruction of the pituitary stalk or arcuate nucleus. c. Can cause primary amenorrhea. No FSH or LH. |
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24. Congenital absence of testes in a genotypical male?
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a. Swyer syndrome.
b. Results in a phenotypical picture similar to that of ovarian agenesis. c. These pts have both internal and external female genitalia. d. However, w/o oestrogen, they will not develop breasts. |
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25. Premature ovarian failure?
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a. Any time menopause occurs w/o another etiology before 40.
b. Can be from ovarian torsion, surgery, infection, radiation, chemo. c. Often idiopathic |
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26. In what Female condition is there absence of a uterus?
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a. Mullerian agenesis.
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27. Secondary Amenorrhea?
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a. Absence of menses for >6 months or the equivalent of 3 menstrual cycles for women who previously had them.
b. Most common cause is pregnancy. |
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28. 2 Anatomical causes of 2º amenorrhea?
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a. Asherman syndrome
b. Cervical stenosis. (usually from scarring of cervical os) |
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29. Asherman syndrome?
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a. A physical cause of 2º amenorrhea.
b. The presence of intrauterine adhesions, usually 2º to intrauterine surgery or infection. |
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30. Possible etiologies of Asherman syndrome:
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1. D&C
2. Myomectomy 3. Cesarean delivery 4. Endometritis |
