Obgyn - Apgo Rei

Front 1

LH stimulates the _____ cell, which produces the hormones ___ and ____

Back 1

theca cell
androstenedione, testosterone

Front 2

FSH stimulates the _____ cell, which produces the hormones ___ and ____

Back 2

granulosa cell
estrone, estradiol

Front 3

from what substrate does the granulosa cell produce estrone/estradiol?

Back 3

androgens produced by theca cell

Front 4

four stages of menstrual cycle

Back 4

menstruation
follicular phase (estrogen-driven)
ovulation
luteal phase (progesterone-driven)

Front 5

two stages of endometrial cycle...what stage of ovarian cycle does each correspond to?

Back 5

proliferative -> corresponds to ovarian follicular phase
secretory -> corresponds to luteal phase

Front 6

how does progesterone change the endometrium from proliferative to secretory phase?

Back 6

-endometrial stroma becomes loose/edematous
-blood vessels become tortuous

Front 7

what is the relationship between body fat content and pubertal onset?

Back 7

fat - earlier onset
thin - later onset

Front 8

dx:
-bone fx
-cafe au lait spots
-precocious puberty

Back 8

McCune Albright Syndrome

one cause of GnRH-independent precocious puberty

Front 9

pathognomonic finding for 21OH deficiency

Back 9

elevated 17OHprogesterone

Front 10

2x main goals of treatment in precocious puberty

Back 10

-arrest and diminish sexual maturation until a normal pubertal age
-maximize adult height

Front 11

3x possible criteria to dx delayed puberty in a girl

Back 11

-2ry sex chars haven't appared by 13y
-no menarche by 15-16
-menses have not begun by 5y after onset of thelarche

Front 12

most common cause of delayed puberty with elevated FSH

Back 12

gonadal dysgenesis (turner's)

="hypergonadotropic hypergonadism"

Front 13

most common cause of hypogonadotropic hypogonadism

Back 13

constitutional (physiologic) delay

DDX: Kallman syndrome, anorexia, exercise/stress, pituitary tumor/disorder, hyperPRL, drug use

Front 14

why do pts with Kallman's have hypogonadotropic hypogonadism?

Back 14

abnormal arcuate nucleus doesn't secrete GnRH

Front 15

most common cause of primary amennorhea in pt with normal breast development

Back 15

Mullerian agenesis

Front 16

another name for mullerian agenesis

Back 16

Mayer-Rokitansky-Kuster-Hauser syndrome

Front 17

appropriate order of four stages of sexual development

Back 17

Thelarche-Adrenarche-Growth spurt-Menarche

Front 18

dx:
anosmia, delayed puberty

Back 18

Kallman's syndrome

Front 19

dx:
premature menses before breast and pubic hair development

Back 19

McCune-Albright syndrome

Front 20

dx:
17 yo primarily amennorheic F with normal breast/pubic hair development; exam shows small vaginal opening wtih blind pouch, normal ovaries, no uterus and cervix

Back 20

Mullerian agenesis
46,XX

Front 21

17 yo primarily amennorheic F with normal breast/pubic hair development; exam shows small vaginal opening wtih blind pouch, normal ovaries, no uterus and cervix

what is the most appropriate next study in this pt?

Back 21

renal ultrasound

25-35% of pts with mullerian agenesis have renal abnormalities

Front 22

dx:
31 year-old G3P0 whose last pregnancy 7 mos ago ended in miscarriage presents with amenorrhea for 6 months

Back 22

intrauterine adhesions
(Asherman's)

Front 23

dx:
irregular cycles, obesity, hirsutism

Back 23

PCOS

Front 24

mgmt:
PCOS

Back 24

weight loss, OCPs

Front 25

patients with anovulatory bleeding have predominantly _____________ endometrium from unopposed stimulation by _____________

Back 25

proliferative
estrogen

pts with anovulatory bleeding have predominantly proliferative endometrium from unopposed stimulation by estrogen

Front 26

anovulatory bleeding - by what mechanism does medroxyprogesterone acetate (MPA) help control periods?

Back 26

converts proliferative endometrium to secretory

Front 27

most common clotting disorder

Back 27

von Willebrand disease

Front 28

dx:
14yo G0 adolescent with menorrhagia uncontrolled by OCPs

Back 28

coagulation disorder

"Disorders of clotting may present with menstrual symptoms in young women, with Von Willeberand disease being most common."

Front 29

observation of an endometrial polyp not recommended if it's > _____ cm

Back 29

> 1.5 cm

Front 30

what do YOU always forget to ask about a patient's menstrual history that you should try to remember to ask?

Back 30

intermenstrual bleeding?

Front 31

mgmt:
35yo morbidly obese female with irregular menstrual periods, now with daily bleeding 4 mos

Back 31

endometrial bx

r/o endometrial hyperplasia/carcinoma

Front 32

Intermenstrual bleeding is frequently caused by structural abnormalities of the _________________

Back 32

endometrial cavity

structural abnormalities = myomas, polyps, malignancy

Front 33

insulin resistance, chronic anovulation, and hirsutism are hallmarks of this disorder

Back 33

PCOS

Front 34

pts with PCOS have elevation of this hormone

Back 34

testosterone

re/in hirsutism

Front 35

def:
irregular or increased menstrual bleeding without identified etiology

Back 35

dysfunctional uterine bleeding

all workup - including exam, urine pregnancy test, TSH/PRL, pelvic US, endometrial bx - should be normal for this dx to be made

Front 36

Which of the following is a contraindication to tx of menopausal symptoms with hormone therapy?

A. Vaginal bleeding
B. Hypertension
C. Diabetes
D. Osteoporosis
E. Hyperthyroidism

Back 36

A. vaginal bleeding

principal symptom of endometrial cancer is abnormal vaginal bleeding...must discern cause of bleeding before starting HRT

Front 37

Premature ovarian failure occurs before age ____

Back 37

35y

Front 38

56yo pt should take _____ to ______g Ca to maintain optimal bone health

Back 38

1000 to 1200g

Front 39

mgmt:
58yo woman who started menopause at 54 with hx of fracture as an adult, BMI 22, current smoker

Back 39

bisphosphonates to prevent bone loss
baseline DEXA before starting

Front 40

most common reason women stop HRT?

Back 40

irregular vaginal bleeding in 1st 6 mos after starting therapy

Front 41

effects of HRT on LDL/HDL?

Back 41

HDL increases
LDL decreases

Front 42

risk factors for fracture

Back 42

risk factors for fracture include prior fracture, family history of osteoporosis, race, dementia, history of falls, poor nutrition, smoking, low body mass index, estrogen deficiency, alcoholism, and insufficient physical activity.

Front 43

dx:
-hirsutism, irregular menses, obesity
-purplish stretch marks, flushed cheeks

Back 43

Cushing's syndrome

(signs and symptoms assoc w prolonged exposure to inappropriately high levels of CORTISOL)

Front 44

review causes of Cushing's syndrome

Back 44

EXOGENOUS
-glucocort administration

ENDOGENOUS
-pituitary: benign adenoma secretes ACTH
-adrenal: hyperplastic glands or tumor secretes CORTISOL

Front 45

why might a postpartum woman have some excessive hair loss/balding?

Back 45

estrogen levels in pregnancy -> hair grows in same phase, shed at same time

Front 46

dx:
34 yo with rapid onset hirsutism and a R flank mass on exam

Back 46

Sertoli-Leydig cell tumor

Front 47

dx:
more severe form of PCOS

Back 47

hyperthecosis

high androstenedione -> VIRILIZATION (balding, clitoral enlargement, deepening of voice)

Front 48

mgmt:
pt with idiopathic hirsutism not responding to OCP

Back 48

SPIRONOLACTONE
-aldosterone antagonist
-add to OCP to increase effect

Front 49

exercise induced hypothalamic amennorhea is characterized by normal FSH and low _____ levels

Back 49

estrogen

Front 50

ovulation kits work by measuring this hormone

Back 50

LH

basically, kit helps to detect LH surge