MSN 621 - Women's Health Exam
Questions With Correct Answers
What |is |amenorrhea? |- |CORRECT |ANSWER✔✔-The |absence |of |menstruation |during |the |
female |during |the |reproductive |ages |of |approximately |12 |to |49 |years |is |known |as |amenorrhea.
In |general, |if |a |female |does |not |have |menses |for |6 |months, |she |has |amenorrhea.
What |is |the |difference |between |primary |and |secondary |amenorrhea? |- |CORRECT |
ANSWER✔✔-Primary |amenorrhea |is |the |absence |of |initiation |of |menses, |and |secondary |
amenorrhea |is |an |absence |of |menses |in |a |previously |normal |menstruating |female.
What |causes |primary |amenorrhea? |- |CORRECT |ANSWER✔✔--Turns |syndrome: |most |common |
when |sexual |development |is |absent. |Have |only |one |normal |X-chromosome
-hormonal |imbalances
Pregnancy
Hypogonadtrophichypogonadism
Endocrine |lesions
Congenital |abnormalities
Tumors
What |causes |secondary |amenorrhea? |- |CORRECT |ANSWER✔✔-Weight |loss
Chronic |ovulation
Pituitary |tumor
Cushing |syndrome
Ovarian |tumors
,What |are |patients |with |amenorrhea |at |high |risk |for? |- |CORRECT |ANSWER✔✔-Loss |of |the |
menstrual |cycle |is |associated |with |wrist |and |hip |fractures, |bone |thinning, |declining |fertility, |
and |premature |ovarian |failure.
Describe |the |patho |of |amenorrhea. |- |CORRECT |ANSWER✔✔-The |absence |of |menses |in |a |
female |of |reproductive |age |is |related |to |the |disturbance |of |normal |hormonal, |physiological |
mechanism, |or |female |anatomic |abnormalities. |The |normal |physiological |mechanism |works |by
|balancing |hormones |and |providing |feedback |between |the |hypothalamus, |pituitary, |ovaries, |
and |uterus.
During |normal |female |menstruation |cycle, |gonadotropin-releasing |hormone |(GnRH) |is |released
|from |the |hypothalamus, |and |it |works |on |the |pituitary |to |release |follicle-stimulating |hormone |
(FSH) |and |luteinizing |hormone |(LH) |and |these |2 |hormones |from |the |pituitary |act |on |ovaries |
and |ovaries |finally |make |estrogen |and |progesterone |to |work |on |the |uterus |to |carry |out |the |
follicular |and |secretory |phase |of |the |menstrual |cycle. |Any |defect |at |any |level |of |this |normal |
physiology |of |females |can |cause |amenorrhea.
On |the |other |hand, |deviation |from |the |normal |anatomy |of |the |reproductive |organs |of |a |
female |can |also |cause |amenorrhea.
What |are |some |questions |to |ask |a |woman |who |is |having |amenorrhea? |- |CORRECT |
ANSWER✔✔-1. |What |age |did |you |start |your |period |- |this |differentiates |between |primary |and |
secondary |amenorrhea. |
2. |determine |is |the |psychosocial |age |of |the |patient, |as |well |as |their |intelligence |quotient |(IQ) |
to |rule |out |any |chromosomal |cause |of |primary |amenorrhea. |
3. |other |aspects |of |growth |like |breast |bud |development |because |an |absence |of |breast |bud |by |
the |age |of |13 |to |14 |years |indicates |estradiol |deficiency, |and |there |is |a |need |for |further |
investigation.
4. |To |rule |out |secondary |amenorrhea, |physicians |need |to |determine |the |time |frame |of |the |
absence |of |menses |in |the |previously |normal |menstruating |female. |The |most |important |cause |
of |secondary |amenorrhea |is |pregnancy, |so |it |should |be |ruled |out |first. |They |should |then |ask |
about |previous |surgeries |for |Asherman |syndrome.
What |are |some |symptoms |of |ovarian |cancer |that |can |cause |amenorrhea? |- |CORRECT |
ANSWER✔✔-History |of |night |sweats, |sleep |disturbance, |and |hot |flushes |for |premature |
,ovarian |failure, |history |of |chemotherapy, |and |radiation |therapy |for |neoplasm |should |be |
obtained |because |these |can |also |cause |ovarian |failure |in |young |females.
Amenorrhea: |History |and |physical |- |CORRECT |ANSWER✔✔-Vision |test |and |sense |of |smell |
should |be |performed |for |pituitary |adenoma |and |Kallman |syndrome. |A |history |of |medication |is
|very |important |because |antipsychotics |are |one |of |the |most |common |causes |of |high |prolactin |
levels, |which |lead |to |amenorrhea. |The |use |of |contraception, |cocaine, |opioids, |antiepileptics |
can |cause |the |failure |of |menstruation |to |occur, |dieting, |strenuous |exercise, |history |of |weight |
loss, |and |anorexia |nervosa |can |be |determined |by |proper |history |taking |to |ascertain |the |cause |
of |amenorrhea.
History |of |neurosarcoidosis, |hemochromatosis, |and |presence |of |any |chronic |illness |should |be |
detected |to |determine |the |exact |reason |as |these |diseases |greatly |affect |the |hypothalamic-
pituitary |axis, |which |plays |a |vital |role |in |controlling |the |female |menstrual |cycle.
What |are |some |physical |exam |findings |for |amenorrhea? |- |CORRECT |ANSWER✔✔-Physical |
examination |includes |the |general |physical |examination, |which |can |be |used |to |determine |
causes |like |malnutrition |or |hepatomegaly. |The |examination |also |should |include:
- |Measuring |height, |weight, |and |fat |index |of |the |patient |to |look |for |the |presence |of |any |
chronic |illness
- |Checking |body |mass |index |(BMI) |to |rule |out |anorexia |nervosa |and |malnutrition
- |Checking |for |dental |erosions
- |Looking |for |metacarpophalangeal |calluses |or |bruises
- |Checking |the |skin |for |hirsutism, |hair |loss, |or |acne |to |investigate |possible |hyperandrogenemia
Acanthosis |nigricans |(a |skin |condition) |can |also |provide |a |clue |for |PCOS. |Examing |the |breasts, |
pubic |hair, |and |the |clitoral |index |is |also |an |important |part |of |the |physical |examination |in |the |
female |with |amenorrhea. |Turner |syndrome |can |be |ruled |out |through |a |normal |chest |
examination. |Clinicians |should |also |perform |a |fundal |examination |to |rule |out |pregnancy |and |a |
vaginal |examination |to |check |for |hematocolpos |in |an |imperforate |hymen.
What |tests |should |be |done |on |a |woman |with |amenorrhea? |- |CORRECT |ANSWER✔✔-- |Beta |
hCG |to |rule |out |pregnancy |because |pregnancy |is |the |most |common |cause |of |amenorrhea
, - |Prolactin |level |to |rule |out |prolactinoma
- |Testosterone |and |DHEAS |to |rule |out |hyperandrogenism
- |FSH |and |LH |for |hypothalamic |amenorrhea, |BMI |(to |look |for |malnutrition, |anorexia |nervosa, |
and |excessive |strenuous |exercise)
- |Pelvic |ultrasound |and |adrenal |CT |for |androgen-secreting |tumors |and |other |anatomical |
defects |like |Mayor-Rokitansky-Kauser-Hauser |syndrome
- |Progesterone |challenge |test: |This |test |is |performed |to |differentiate |between |the |anovulation,
|anatomic, |and |estradiol |deficiency |as |causes |of |amenorrhea. |Progesterone |is |administrated |to
|the |patient |in |the |form |of |intramuscular |injection |and |after |progesterone |is |withdrawn. |If |
bleeding |takes |place |within |2 |to |7 |days, |the |cause |must |be |the |anovulation, |but |if |no |bleeding
|takes |place |after |progesterone |withdrawal, |the |causes |are |other |than |anovulation |or |
premature |ovarian |failure. |These |other |causes |can |include |estradiol |deficiency |or |anatomic |
defects |like |cervical |stenosis |and |Asherman |syndrome.
- |Karyotyping |is |sometimes |an |important |test |for |Turner |and |androgen |insensitivity |
syndromes.
What |is |the |treatment |for |amenorrhea? |- |CORRECT |ANSWER✔✔-o |Treatment |mainly |depends
|on |the |cause |of |amenorrhea. |If |the |cause |of |amenorrhea |is |estrogen |deficiency, |estrogen |can |
be |administered. |If |amenorrhea |is |due |to |malnutrition, |a |proper |diet |plan |can |cure |the |patient
|successfully. |For |anorexia |nervosa |and |stress-induced |amenorrhea, |cognitive-behavioral |
therapy |and |SSRIs |can |help. |Dopamine |agonist |drugs |like |cabergoline |can |treat |prolactinoma, |
and |if |large, |surgery |can |provide |a |full |cure. |The |appropriate |surgical |procedure |can |treat |
anatomical |causes |of |amenorrhea. |PCOS |can |be |handled |by |combined |oral |contraceptives |and |
metformin. |SSRI |can |treat |stress-induced |hypothalamic |amenorrhea.
o |There |is |good |evidence |that |patients |with |menstrual |irregularities |are |at |high |risk |for |bone |
fractures, |and |hence |osteoporosis |prevention |should |be |the |next |step. |Patients |should |be |
offered |vitamin |D |and |calcium |supplements.
o |Because |amenorrhea |can |also |affect |self-esteem, |a |mental |health |consult |is |necessary.
o |Women |with |stress, |eating |disorders |should |undergo |behavior |modification.
What |is |genitourinary |syndrome |of |menopause? |Atrophic |vaginitis? |- |CORRECT |ANSWER✔✔-
Genitourinary |syndrome |of |menopause, |a |group |of |chronic, |progressive, |hypoestrogenic |
Questions With Correct Answers
What |is |amenorrhea? |- |CORRECT |ANSWER✔✔-The |absence |of |menstruation |during |the |
female |during |the |reproductive |ages |of |approximately |12 |to |49 |years |is |known |as |amenorrhea.
In |general, |if |a |female |does |not |have |menses |for |6 |months, |she |has |amenorrhea.
What |is |the |difference |between |primary |and |secondary |amenorrhea? |- |CORRECT |
ANSWER✔✔-Primary |amenorrhea |is |the |absence |of |initiation |of |menses, |and |secondary |
amenorrhea |is |an |absence |of |menses |in |a |previously |normal |menstruating |female.
What |causes |primary |amenorrhea? |- |CORRECT |ANSWER✔✔--Turns |syndrome: |most |common |
when |sexual |development |is |absent. |Have |only |one |normal |X-chromosome
-hormonal |imbalances
Pregnancy
Hypogonadtrophichypogonadism
Endocrine |lesions
Congenital |abnormalities
Tumors
What |causes |secondary |amenorrhea? |- |CORRECT |ANSWER✔✔-Weight |loss
Chronic |ovulation
Pituitary |tumor
Cushing |syndrome
Ovarian |tumors
,What |are |patients |with |amenorrhea |at |high |risk |for? |- |CORRECT |ANSWER✔✔-Loss |of |the |
menstrual |cycle |is |associated |with |wrist |and |hip |fractures, |bone |thinning, |declining |fertility, |
and |premature |ovarian |failure.
Describe |the |patho |of |amenorrhea. |- |CORRECT |ANSWER✔✔-The |absence |of |menses |in |a |
female |of |reproductive |age |is |related |to |the |disturbance |of |normal |hormonal, |physiological |
mechanism, |or |female |anatomic |abnormalities. |The |normal |physiological |mechanism |works |by
|balancing |hormones |and |providing |feedback |between |the |hypothalamus, |pituitary, |ovaries, |
and |uterus.
During |normal |female |menstruation |cycle, |gonadotropin-releasing |hormone |(GnRH) |is |released
|from |the |hypothalamus, |and |it |works |on |the |pituitary |to |release |follicle-stimulating |hormone |
(FSH) |and |luteinizing |hormone |(LH) |and |these |2 |hormones |from |the |pituitary |act |on |ovaries |
and |ovaries |finally |make |estrogen |and |progesterone |to |work |on |the |uterus |to |carry |out |the |
follicular |and |secretory |phase |of |the |menstrual |cycle. |Any |defect |at |any |level |of |this |normal |
physiology |of |females |can |cause |amenorrhea.
On |the |other |hand, |deviation |from |the |normal |anatomy |of |the |reproductive |organs |of |a |
female |can |also |cause |amenorrhea.
What |are |some |questions |to |ask |a |woman |who |is |having |amenorrhea? |- |CORRECT |
ANSWER✔✔-1. |What |age |did |you |start |your |period |- |this |differentiates |between |primary |and |
secondary |amenorrhea. |
2. |determine |is |the |psychosocial |age |of |the |patient, |as |well |as |their |intelligence |quotient |(IQ) |
to |rule |out |any |chromosomal |cause |of |primary |amenorrhea. |
3. |other |aspects |of |growth |like |breast |bud |development |because |an |absence |of |breast |bud |by |
the |age |of |13 |to |14 |years |indicates |estradiol |deficiency, |and |there |is |a |need |for |further |
investigation.
4. |To |rule |out |secondary |amenorrhea, |physicians |need |to |determine |the |time |frame |of |the |
absence |of |menses |in |the |previously |normal |menstruating |female. |The |most |important |cause |
of |secondary |amenorrhea |is |pregnancy, |so |it |should |be |ruled |out |first. |They |should |then |ask |
about |previous |surgeries |for |Asherman |syndrome.
What |are |some |symptoms |of |ovarian |cancer |that |can |cause |amenorrhea? |- |CORRECT |
ANSWER✔✔-History |of |night |sweats, |sleep |disturbance, |and |hot |flushes |for |premature |
,ovarian |failure, |history |of |chemotherapy, |and |radiation |therapy |for |neoplasm |should |be |
obtained |because |these |can |also |cause |ovarian |failure |in |young |females.
Amenorrhea: |History |and |physical |- |CORRECT |ANSWER✔✔-Vision |test |and |sense |of |smell |
should |be |performed |for |pituitary |adenoma |and |Kallman |syndrome. |A |history |of |medication |is
|very |important |because |antipsychotics |are |one |of |the |most |common |causes |of |high |prolactin |
levels, |which |lead |to |amenorrhea. |The |use |of |contraception, |cocaine, |opioids, |antiepileptics |
can |cause |the |failure |of |menstruation |to |occur, |dieting, |strenuous |exercise, |history |of |weight |
loss, |and |anorexia |nervosa |can |be |determined |by |proper |history |taking |to |ascertain |the |cause |
of |amenorrhea.
History |of |neurosarcoidosis, |hemochromatosis, |and |presence |of |any |chronic |illness |should |be |
detected |to |determine |the |exact |reason |as |these |diseases |greatly |affect |the |hypothalamic-
pituitary |axis, |which |plays |a |vital |role |in |controlling |the |female |menstrual |cycle.
What |are |some |physical |exam |findings |for |amenorrhea? |- |CORRECT |ANSWER✔✔-Physical |
examination |includes |the |general |physical |examination, |which |can |be |used |to |determine |
causes |like |malnutrition |or |hepatomegaly. |The |examination |also |should |include:
- |Measuring |height, |weight, |and |fat |index |of |the |patient |to |look |for |the |presence |of |any |
chronic |illness
- |Checking |body |mass |index |(BMI) |to |rule |out |anorexia |nervosa |and |malnutrition
- |Checking |for |dental |erosions
- |Looking |for |metacarpophalangeal |calluses |or |bruises
- |Checking |the |skin |for |hirsutism, |hair |loss, |or |acne |to |investigate |possible |hyperandrogenemia
Acanthosis |nigricans |(a |skin |condition) |can |also |provide |a |clue |for |PCOS. |Examing |the |breasts, |
pubic |hair, |and |the |clitoral |index |is |also |an |important |part |of |the |physical |examination |in |the |
female |with |amenorrhea. |Turner |syndrome |can |be |ruled |out |through |a |normal |chest |
examination. |Clinicians |should |also |perform |a |fundal |examination |to |rule |out |pregnancy |and |a |
vaginal |examination |to |check |for |hematocolpos |in |an |imperforate |hymen.
What |tests |should |be |done |on |a |woman |with |amenorrhea? |- |CORRECT |ANSWER✔✔-- |Beta |
hCG |to |rule |out |pregnancy |because |pregnancy |is |the |most |common |cause |of |amenorrhea
, - |Prolactin |level |to |rule |out |prolactinoma
- |Testosterone |and |DHEAS |to |rule |out |hyperandrogenism
- |FSH |and |LH |for |hypothalamic |amenorrhea, |BMI |(to |look |for |malnutrition, |anorexia |nervosa, |
and |excessive |strenuous |exercise)
- |Pelvic |ultrasound |and |adrenal |CT |for |androgen-secreting |tumors |and |other |anatomical |
defects |like |Mayor-Rokitansky-Kauser-Hauser |syndrome
- |Progesterone |challenge |test: |This |test |is |performed |to |differentiate |between |the |anovulation,
|anatomic, |and |estradiol |deficiency |as |causes |of |amenorrhea. |Progesterone |is |administrated |to
|the |patient |in |the |form |of |intramuscular |injection |and |after |progesterone |is |withdrawn. |If |
bleeding |takes |place |within |2 |to |7 |days, |the |cause |must |be |the |anovulation, |but |if |no |bleeding
|takes |place |after |progesterone |withdrawal, |the |causes |are |other |than |anovulation |or |
premature |ovarian |failure. |These |other |causes |can |include |estradiol |deficiency |or |anatomic |
defects |like |cervical |stenosis |and |Asherman |syndrome.
- |Karyotyping |is |sometimes |an |important |test |for |Turner |and |androgen |insensitivity |
syndromes.
What |is |the |treatment |for |amenorrhea? |- |CORRECT |ANSWER✔✔-o |Treatment |mainly |depends
|on |the |cause |of |amenorrhea. |If |the |cause |of |amenorrhea |is |estrogen |deficiency, |estrogen |can |
be |administered. |If |amenorrhea |is |due |to |malnutrition, |a |proper |diet |plan |can |cure |the |patient
|successfully. |For |anorexia |nervosa |and |stress-induced |amenorrhea, |cognitive-behavioral |
therapy |and |SSRIs |can |help. |Dopamine |agonist |drugs |like |cabergoline |can |treat |prolactinoma, |
and |if |large, |surgery |can |provide |a |full |cure. |The |appropriate |surgical |procedure |can |treat |
anatomical |causes |of |amenorrhea. |PCOS |can |be |handled |by |combined |oral |contraceptives |and |
metformin. |SSRI |can |treat |stress-induced |hypothalamic |amenorrhea.
o |There |is |good |evidence |that |patients |with |menstrual |irregularities |are |at |high |risk |for |bone |
fractures, |and |hence |osteoporosis |prevention |should |be |the |next |step. |Patients |should |be |
offered |vitamin |D |and |calcium |supplements.
o |Because |amenorrhea |can |also |affect |self-esteem, |a |mental |health |consult |is |necessary.
o |Women |with |stress, |eating |disorders |should |undergo |behavior |modification.
What |is |genitourinary |syndrome |of |menopause? |Atrophic |vaginitis? |- |CORRECT |ANSWER✔✔-
Genitourinary |syndrome |of |menopause, |a |group |of |chronic, |progressive, |hypoestrogenic |
