Exam 2: NU664D/ NU 664D (Latest 2025/ 2026 Update) Primary Care Adult Woman I Review| Questions & Answers | Grade A (100% Correct Solutions)- Regis

Exam 2: NU664D/ NU 664D (Latest 2025/ 2026 Update) Primary Care Adult Woman I Review| Questions & Answers | Grade A (100% Correct Solutions)- Regis Question: when does menarche typically begin? Answer: 2-3 years after thelarche (breast buds) Question: thelarche Answer: breast buds Question: average age of menarche in the US Answer: 12-13 Question: what can lead to earlier menarche? Answer: high BMI Question: what regulates the menstrual cycle? Answer: HPO axis Question: three characteristics of menstrual bleeding Answer: frequency, volume, length Question: normal menstrual bleeding frequency Answer: 24-38 days with each new cycle within 7-9 days of the last Question: normal menstrual volume Answer: 5-80 ml Question: normal length of menstruation Answer: 4.5-8 days Question: what happens during follicular phase Answer: hypothalamus releases gonadotropin releasing hormone anterior pituitary releases FSH and LH follicles start developing estrogen increases one follicle dominates and produces more estrogen other follicles go through atresia estrogen and LH levels peak 24 hrs before ovulation ovulation occurs Question: when does the luteal phase begin Answer: with ovulation Question: what happens in the luteal phase Answer: shift from estrogen to progesterone dominance follicle ruptures corpus luteum forms progesterone is produced the follicle ceases growth and endometrium secretes Question: how long is luteal phase Answer: 14 days (14-28) Question: how long/when is follicular phase Answer: days 1-14 Question: what triggers end of luteal phase and beginning of menses? Answer: drop in progesterone (and estrogen too but less important) Question: what do estrogen levels do throughout follicular and luteal phases? Answer: surges with ovulation (end of follicular phase and beginning of luteal phase) Question: what happens to the egg at the end of luteal phase and how long after ovulation does this change take place? Answer: corpus luteum turns into corpus albicans approx 9-11 days after ovulation Question: what phase of the uterine cycle corresponds with the follicular phase of the ovarian cycle? Answer: proliferative phase same time as follicular phase Question: what is happening to endometrium during proliferative phase and why? Answer: surge in estrogen thickens endometrial lining to prepare for pregnancy also forms progesterone receptors to increase endometrial blood flow Question: what phase of the uterine cycle corresponds with the luteal phase of the ovarian cycle? Answer: secretory phase same time as luteal phase Question: what is the first phase of the ovarian cycle and first phase of the uterine cycle? Answer: follicular phase and proliferative phase Question: what is the second phase of the ovarian cycle and second phase of the uterine cycle? Answer: luteal phase and secretory phase Question: what is happening to the endometrium during secretory phase and why? Answer: progesterone causes endometrium to differentiate and secrete proteins that help with embryo implantation Question: what causes menstruation, aka sloughing of the endometrium? Answer: end of secretory/luteal phase, drop in progesterone*** and estrogen Question: amenorrhea Answer: absence of menstrual bleeding for 3 or more usual cycles Question: oligomenorrhea Answer: infrequent menstrual bleeding happening greater than every 38 days Question: polymenorrhea Answer: frequent menstrual bleeding happening 21-24 days or fewer Question: hypomenorrhea Answer: regular menstrual bleeding less than normal volume Question: HMB Answer: heavy menstrual bleeding greater than 80 ml per cycle or lasting longer than 7 days or irregular heavy bleeding Question: IMB Answer: intermenstrual bleeding bleeding at any time in between normal cycles Question: primary amenorrhea Answer: no menses by age 16 Question: reasons to evaluate 14 year old with no menses Answer: hirsuitism Question: reasons to evaluate 13 year old with no menses Answer: no breast buds at all Question: secondary amenorrhea Answer: new onset of absence of menses 3+ months for hx of regular periods 6+ months for hx of irregular periods Question: differentials for primary amenorrhea Answer: flow obstruction mullerian agenesis chromosomal (turners) androgen insensitivity Question: differentials for amenorrhea normal life changes vs abnormal underlying causes Answer: pregnancy (ectopic, MAB) lactation menopause Question: thyroid dysfunction (hypo or hyper) Answer: pituitary dysfunction (tumor such as prolactinoma) drug related hypothalamic (ED, athleticism, weight loss more than 10%) disease/stress (celiac, depression/anxiety, diabetes) congenital syndromes (rare) primary ovarian insufficiency (menopause is usually age 51) adrenal dysfunction (tumor or PCOS) anatomic abnormalities (asherman's) Question: most important/telling part of amenorrhea visit data Answer: subjective history Question: what is virilization? Answer: male sex characteristics hirsutism, alopecia, acne, voice changes Question: diagnostic tests for amenorrhea Answer: hCG TSH and prolactin FSH, LH, estradiol DHEA-S, 17-OHP, testosterone, cortisol, fasting BG Question: TSH that would indicate hypothyroidism Answer: usually above 4 Question: prolactin level that would indicate hyperprolactinemia Answer: greater than 50 Question: HPO axis lab results that would indicate ovarian insufficiency Answer: elevated FSH and LH low estradiol Question: which labs are drawn for evaluation of hypothalamic-pituitary-ovarian axis (HPO axis)? Answer: FSH LH estradiol Question: HPO axis lab results that would indicate hypogonadotropic hypogonadism Answer: low FSH, LH, and estradiol Question: HPO axis lab results that would indicate hypothalamic amenorrhea Answer: low to normal FSH, LH, and estradiol Question: typical FSH Answer: 5-20 mlU/ml Question: typical LH Answer: 5-20 mlU/ml Question: typical estradiol Answer: 25-75 pg/ml Question: when in cycle to check HPO axis labs Answer: day 2-6 of menstrual cycle with day 1 being first day of period Question: LH:FSH ratio that may be seen with PCOS Answer: 3:1 Question: typical total testosterone Answer: 6.0-86 ng/dl Question: typical free testosterone Answer: 0.7-3.6 pg/ml Question: typical DHEA-S Answer: 35-430 ug/dl suspect adrenal tumor if above 700 Question: typical prolactin Answer: less than 25 ng/ml Question: meds that cause hyperprolactinemia Answer: antipsychotics antidepressants opiates antihypertensive agents GI meds chronic cannabis Question: drugs that cause irregular menses Answer: cocaine chronic cannabis Question: what is asherman's syndrome Answer: uterine scars from multiple D&Cs Question: what is primary dysmenorrhea Answer: cramping/pain in lower abdomen associated with menstruation without evidence of pelvic pathology Question: what is secondary dysmenorrhea Answer: cramping/pain in lower abdomen associated with pelvic pathology... often pain occurs even in between menstrual cycles Question: what is the patho behind dysmenorrhea Answer: prostaglandins released during menstruation causes contractions of the uterus... when the uterus contracts, ischemia occurs and pain is felt Question: sxs that often accompany dysmenorrhea Answer: N/V, diarrhea, H/A, malaise, fatigue Question: physical exam findings for primary dysmenorrhea Answer: usually only tender uterus if no pelvic pathology possible exam findings for secondary dysmenorrhea r/t endometriosis Answer: nodularity, thickening, or focal tenderness of uterosacral ligament cervical stenosis fixed ovaries/uterus due to adhesions ovarian fullness Question: diagnostic testing for sexually active woman with dysmenorrhea Answer: gonorrhea, chlamydia wet mount UA, UC pelvic U/S hCG Question: differentials for secondary dysmenorrhea before diagnosis of primary dysmenorrhea can be made Answer: pelvic infection adenomyosis fibroid (leiomyoma) IUD polyps ovarian cysts MAB pelvic adhesions ectopic UTI kidney stone Question: IBS Answer: constipation diverticulitis cervical stenosis endometrial/ovarian carcinoma retained tampon congenital abnormalities dermoid tumors Question: lifestyle changes to help with dysmenorrhea and why they help Answer: exercise decreases prostaglandin release, decreases endometrial proliferation, and shunts blood away from uterus decrease salty food, increase water intake and fiber with fruits and veggies... natural diuretic heat applied to abdomen to relax muscles Question: meds for dysmenorrhea Answer: NSAIDs COCs DMPA (good for endo) Implant (good for endo) IUD (good for endo) Vitamin B and magnesium Question: what is PALM COEIN used for? Answer: AUB classification Question: what does PALM COEIN stand for? Answer: Polyps Adenomyosis Leiomyoma Malignancy and hyperplasia Question: Coagulopathy Answer: Ovulation dysfunction (can be r/t HPO axis, thyroid, or PCOS) Endometrial Iatrogenic (infection, meds, IUD) Not classified Question: at what point should adolescents expect AUB to subside and why? Answer: by the third year before this, HPO axis is immature and it is likely bleeding up until this point has been anovulatory Question: why is AUB seen in perimenopausal women? Answer: HPO axis fluctuations r/t decline in follicular number Question: AUB physical exam VS Answer: pelvic exam: site of bleeding, appearance of cervix, characteristics of uterus (contour, size, tenderness) Question: initial diagnostic testing AUB Answer: wet prep KOH (trich) updated pap (cervicitis r/t HPV) Question: hCG Answer: CBC (anemia/thrombocytopenia) coags, factor VIII, and VW gonorrhea, chlamydia (cervicitis)... herpes??? TSH (hypo or hyper) prolactin (hyperprolactinemia from meds or pituitary tumor) DHEA-S (adrenal cancer) testosterone (PCOS) Question: U/S Answer: endometrial biopsy Question: hysteroscopy Answer: sonohysterogram D&C Question: who is receiving an endometrial biopsy for AUB? Answer: *women over 45 with AUB (r/o endometrial cancer) women under 45 with risk factors (obesity, chronic anovulation, tamoxifen use, lynch or cowden syndrome) Question: meds for active HMB, hemodynamically stable Answer: low dose COC twice daily (Q12) for 5-7 days followed by once daily for remainder of pack then withdrawal bleed then continue with the next pack once daily Question: patch or ring Answer: mirena high dose POP TXA NSAIDs Question: what would you suspect in an adolescent who has to be hospitalized to control HMB and needs a blood transfusion? Answer: coagulation disorder!!!!!!! Question: surgical interventions for AUB Answer: myomectomy ablation uterine artery embolization hyst