Deck 19: Amenorrhea

Question 1

You are taking care of a 33-year-old patient with a diagnosis of secondary amenorrhea. Her past medical, family, and psychosocial histories are not contributory. Her pregnancy test is negative, and she just had thyroid-stimulating hormone (TSH) and prolactin testing, which are normal. Your next step in the work-up of secondary amenorrhea for this woman will be to order:

A) Follicle-stimulating hormone and estradiol
B) MRI of sella turcica
C) Estradiol and free testosterone
D) Pelvic sonogram

Answer 1

A

Question 2

Management of a 28-year-old woman diagnosed at your visit with premature ovarian failure/insufficiency includes:

A) Requesting an endovaginal sonogram
B) Performing an endometrial biopsy
C) Referring her for an MRI of the sella turcica
D) Referring her for karyotype evaluation

Answer 2

D

Question 3

Polycystic ovarian syndrome should be suspected in a woman who has hyperandrogenic symptoms and:

A) An LH:FSH ratio lower than 2 to 1
B) 12 or more follicles in one ovary observed on sonogram
C) An abnormally high fasting 17-hydroxyprogesterone
D) Serum levels of total and free testosterone more than three times the normal level

Answer 3

B

Question 4

A 30-year-old woman reports a 6-month history of amenorrhea preceded by a 2-year history of oligomenorrhea. She also reports recent onset of galactorrhea, vision changes, and headaches. The etiology of her amenorrhea is most likely due to:

A) Hyperthyroidism
B) Asherman's syndrome
C) A pituitary adenoma
D) Polycystic ovarian syndrome

Question 5

Which of the following is a serious consequence of polycystic ovarian syndrome (POCs)?

A) Metabolic syndrome
B) Ovarian cancer
C) Tubal obstruction
D) Increased stroke risk

Question 6

A 16-year-old presents to the clinic with a history of heavy and prolonged menstrual bleeding since her menarche at 13 years of age. Her cycles have been regular for the last year, but they have always been heavy. Her family history is relevant for heavy menstrual bleeding in both her mother and sister. The most likely explanation for her menorrhagia is:

A) Immature hypothalamic pituitary ovarian axis
B) Von Willebrand disease
C) Hypothyroidism
D) Ovulatory dysfunction

Question 7

Which of the following cancers should be investigated in women with postmenopausal bleeding?

A) Breast
B) Ovarian
C) Endometrial
D) Colon

Question 8

Persistent anovulation in a woman with polycystic ovarian syndrome may lead to which of the following consequences/complications?

A) Adult onset adrenal hyperplasia
B) Osteopenia and osteoporosis
C) Hyperprolactinemia
D) Endometrial cancer

Question 9

A 25-year-old G0 P0 female presents for evaluation of missed menses. Her LMP was 4 months ago. Her cycles have been irregular over the last 3 years, ranging in length from 40-60 days. She is sexually active in a monogamous relationship with one male partner for the past 2 years. They use the withdrawal method for contraception; the patient states that the method has been effective, and she denies any symptoms of pregnancy. Other history is not contributory. Her physical exam is unremarkable and a pregnancy test is negative. She does not desire pregnancy now. Her initial laboratory tests are normal, including a positive progesterone challenge test. Your assessment is anovulation. Which of the following therapeutic options would be the most appropriate for this patient?

A) Premarin 0.625 mg q day X 21 days of the month, Provera 10 mg on days 16-21
B) Any low-dose monophasic combined oral contraceptive, 1 pill q day, monthly
C) Medroxyprogesterone acetate 10 mg q day, first 10 days of the month
D) Estradiol 2 mg q day X 21 days followed by micronized progesterone X 12-14 days

Question 10

Which of the following are common clinical manifestations of polycystic ovarian syndrome?

A) Hypermenorrhea and dysmenorrhea
B) Obesity and acanthosis nigricans
C) Deepening of the voice and balding
D) Adnexal pain and persistent luteal cyst

Question 11

Which of the following conditions is most important to rule out when investigating a woman with suspected polycystic ovarian syndrome, in which one of the cardinal symptoms is recent onset of hirsutism?

A) Long-standing hypothyroidism
B) Pituitary prolactin producing tumor
C) Adult onset adrenal hyperplasia
D) Metabolic syndrome

Question 12

A 30-year-old female G0 P0 has a history significant for oligomenorrhea. For the last 6 months she has not had any bleeding. She is not sexually active. Her physical exam is significant for a BMI of 28 but otherwise unremarkable. Her TSH and prolactin are normal, her serum estradiol is low and FSH is elevated, and she did not have withdrawal bleeding with the progesterone challenge test. The most likely etiology of secondary amenorrhea in this case is:

A) A pituitary adenoma
B) Hypothalamic amenorrhea
C) Asherman's syndrome
D) Ovarian insufficiency