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40 Cards in this Set
- Front
- Back
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What is true precocious puberty?
Treatment? |
Diagnosis of exclusion where sex steroids increased by Hypothalamic-pituitary-gonadal axis, with inc'd GnRH secretion
Tx: GnRH agonist to suppress pituitary production of FSH and LH |
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Karyotype for patient with Mullerian agenesis.
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46 XX
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17 yo presents with never having menstrual cycle
Normal breast, pubic hair development Small vaginal opening with blind pouch Normal ovaries No uterus, cervix Next step in management? |
Need renal u/s
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What is the normal age range for menarche?
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9-17
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What body weight is required for menses?
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85-106 lbs
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Karyotype for Turner's Syndrome.
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Absence of one of X chromosomes
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Presentation of Turner's Syndrome.
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Failure to establish secondary sexual characteristics. Shield chest.
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Presentation of Rokitansky-Kuster-Hauser Syndrome.
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Vaginal and uterine agenesis
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What defines Kallmann Syndrome?
Treatment? |
Olfactory tract hypoplasia
Arcuate nucleus that doesn't secrete GnRH No sense of smell, no secondary sexual characteristics Often a dx of exclusion Tx: Pulsatile GnRH |
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What is the normal sequence of sexual maturation in women?
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Thelarche (breast bud)
Adrenarche Growth Spurt Menarche |
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Presentation of imperforate hymen.
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Menstrual blood collects in vagina and uterus causing pain.
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Presentation of transverse vaginal septum.
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Normal vaginal opening with short blind vagina and pelvic mass may be located above level of obstruction
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What is synechiae of the uterine cavity?
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Asherman's!
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33 yo G0
Amenorrhea x 12 mos Recent onset dyspareunia Previous normal menstrual cycles Normal BMI Diagnosis |
Premature Ovarian Failure leading to vaginal dryness secondary to estrogen deficiency
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How does anorexia result in amenorrhea?
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Anorexia or significant weight loss results in loss of pulsatile GnRH release
Leads to dec'd stimulation of pituitary gland Thus dec'd FSH/LH Leads to anovulation and amenorrhea |
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When is clomiphene citrate indicated in PCOS?
What drug class is also acceptable? |
Can use clomiphene if patient desires fertility.
If pt wants to stabilize menstrual cycles, prescribe OCPs. |
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Lab workup for a patient with amenorrhea and no other symptoms or findings on PE.
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beta-hCG
TSH PROLACTIN (prolactinoma is most common pituitary tumor causing amenorrhea) |
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Acanthosis nigricans is associated with elevated ______.
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Insulin and androgen
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This drug can be combined with OCPs to treat hirsutism.
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Spironolactone
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What test should be ordered is Cushing's Syndrome is suspected?
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Overnight dexamethasone suppression test
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Why do women commonly experience hair loss post-partum?
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High levels of estrogen in pregnancy increase syncrhony of hair growth, thus, hair grows in same phase and is shed at same time
This can result in significant postpartum hair loss Note: in non-pregnant state, asyncrhonous hair growth occurs such that a portino of hair is in one of the three hair growth cycles at all times |
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What is hyperthecosis?
Signs? |
More severe form of PCOS
A/w virilization due to high androstenedione produciton and testosterone levels Signs include temporal balding, clitoral enlargement, and deepening of the voice |
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18 yo G0
1-year h/o hirsutism, acne Menarche at 14, irregular menses Obese Hursitism Normal TSH, PL, Testosterone, DHEAS Diagnosis |
Need to check 17-OH-P to r/o late onset 21-OHase deficiency.
The normal PL, Test, DHEAS r/o pituitary and adrenal tumors Normal testosterone makes PCOS unlikely |
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34 yo G2P2
Rapid onset of hirsutism and virilization Diagnosis |
Sertoli-Leydig Cell tumor
Will see acne, hirsutism, amenorrhea, clitoral hypertrophy, deepening of voice Suppressed FSH, LH, elevated testosterone, presence of ovarian mass |
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Granulosa cell tumors exhibit an elevated ______.
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Beta-hCG
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Describe the endometrial epithelium in a woman with anovulatory bleeding.
What is the effect of medroxyprogestrone acetate on these patients? |
Proliferative endometrium from unopposed stimulation by estrogen
Progestins inhibit further endometrial growth and convert proliferative to secretory endometrium Withdrawal of the progestin mimics effect of involution of the corpus luteum, creating a normal sloughing of the endometrium |
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Patients over ____ that smoke cannot be on OCPs.
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35
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What is dysfunctional uterine bleeding?
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Irregular or INCREASED menstrual bleeding without a clear etiology
Patient would have to have normal TSH, PL, pelvic u/s, endometrial bx |
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What is mid-cycle bleeding?
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Mid-cycle bleeding occurs at time of ovulation and is due to drop in estrogen
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2 cm simple cyst on right ovary found on patient during ovulation
Diagnosis |
Likely a functional cyst
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35 yo G0
Irregular menstrual periods Inter-menstrual bleeding Morbidly obese Next step in management? |
Perform endometrial biospy to r/o endometrial hyperplasia or carcinoma
hx of irregular bleeding + obesity = risk for cancer! LH/FSH/Testosterone wouldn't be useful unless there were signs of hirsutism or virilization |
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14 yo G0
Menarche x 6 months Heavy flow-->anemia Continues to bleed heavily despite OCPs Diagnosis |
Likely a coagulation disorder (vW Dz)
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How long can leuprolide be used in dysfunctional uterine bleeding?
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Up to 6 months bc of risk of osteoporosis
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42 yo G2P2
Menorrhagia OCPs Normal uterus, no masses Anemic Diagnosis |
Dysfuncitonal uterine bleeding
Can still treat with endometrial ablation! |
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Blue-black powder burn lesions seen on laparoscopy:
Diagnosis Histology |
Endometriosis:
Endometrial glands or stroma and hemosiderin-laden macrophages |
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19 yo G0
Dysmenorrhea not relieved with NSAID, OCP, or Depo Next step in management? |
Ex Lap
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Presentation of adenomyosis.
Histology? |
Severe, WORSENING menstrual pain
Histology shows invasion of endometrial glands into myometrium |
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Histology of uterine fibroids.
Leiomyosarcoma? |
Well-circusmcribed, non-encapsulated myometrium
Leiomyosarcoma will have >10 mitotic figures per high power field |
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Why does adenomyosis result in dysmenorrhea?
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Gland tissue grows (in muscle of uterus) during menstrual cycle and, at menses, tries to slough, but can't escape uterine muscle and flow out of cervix as part of normal menses
Trapping of blood and tissue causes uterine pain in form of monthly menstrual cramps |
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Why does OCP relieve pain in primary dysmenorrhea?
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OCPs create endometrial atrophy; since prostaglandins produced in endometrium, there would be less produced. Dysmenorrhea should improve.
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