PAEA OBGYN EOR TOPICS QUESTIONS AND VERIFIED
ANSWERS
Follicular Phase vs. Luteal phase - CORRECT ANSWER✅✅✅1. Estrogen dominant (Day
1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH - CORRECT ANSWER✅✅✅1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone - CORRECT ANSWER✅✅✅1. Thickens endometrium
2. Enhances lining of uterus to prepare for implantation
In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a
_______ to develop which produces ________ to help proliferate the lining of the endometrium;
at the end of this phase _______ surges causing ovulation - CORRECT ANSWER✅✅✅1.
Primary ovarian follicle
2. Estrogen
3. LH
In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________
which produces _________ which maintains the endometrial lining for fertilization - CORRECT
ANSWER✅✅✅1. Corpus luteum
2. Progesterone
In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the
corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________
begins - CORRECT ANSWER✅✅✅1. Corpus luteum
2. Menstruation
In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus
luteum; if fertilization does occur __________ gets released by the developing
,trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen
- CORRECT ANSWER✅✅✅1. hCG
2. Corpus luteum
Cryptomenorrhea - CORRECT ANSWER✅✅✅Light flow or spotting
Metrorrhagia vs. Menometrorrhagia - CORRECT ANSWER✅✅✅1. Irregular bleeding
between expected menstrual cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
Oligomenorrhagia - CORRECT ANSWER✅✅✅Infrequent menstruation *(prolonged cycle
length >35 days but <6 months)*
Chronic anovulation (90% of DUB) is due to disruption of the hypothalamus-pituitary axis
which causes what hormal imbalances? And what kind of menstrual regularity? (3) - CORRECT
ANSWER✅✅✅1. No ovulation
2. Unopposed *estrogen* (no progesterone) → *risk of carcinoma*
3. *irregular*, unpredictable bleeding due to endometrial overgrowth
*REMEMBER this is a Dx of exclusion*
What is the pathophysiology of ovulatory DUB (10% of Dysfunctional UB)? (4) - CORRECT
ANSWER✅✅✅1. Still ovulate
2. Prolonged *progesterone* (decreased estrogen)
3. *Regular* cyclical shedding
4. Increased blood loss (due to endometrial vessel dilation and prostaglandins) = *menorrhagia*
*REMEMBER this is a Dx of exclusion*
,Primary Amenorrhea Definition (2) - CORRECT ANSWER✅✅✅1. No menstruation by
*age 15* in the *presence* of 2° sex characteristics
2. No menstruation by *age 13* in the *absence* of 2° sex characteristics
In a pt with primary amenorrhea, who's uterus & breasts are present, what may be the cause? -
CORRECT ANSWER✅✅✅Outflow obstruction (transverse vaginal septum, imperforated
hymen)
In a pt with primary amenorrhea, who's uterus is present but breasts are not, what may be the
cause? (2) - CORRECT ANSWER✅✅✅1. If elevated FSH and LH = *Ovarian causes*
(Premature ovarian failure, gonadal dysgenesis)
2. If normal/low FSH and LH = *Hypothalamus-Pituitary failure*
In a pt with primary amenorrhea who's uterus is absent but breasts are present, what may be the
cause? (2) - CORRECT ANSWER✅✅✅1. Mullerian agenesis (46XX)
2. Androgen Insensitivity (46XY)
In a pt with primary amenorrhea who's uterus and breasts are absent, what may be the cause? -
CORRECT ANSWER✅✅✅*RARE*
Defect in testosterone synthesis; presents like a phenotypic immature girl but will often have
*intraabdominal testes*
Secondary Amenorrhea Definition (2) - CORRECT ANSWER✅✅✅1. No menstruation for
*> 3 months* in a pt with previously normal menstruation
2. No menstruation for *> 6 months* in a oligomenorrheic pt
Amenorrhea caused by Ovarian Disorders Sx + Dx - CORRECT ANSWER✅✅✅Elevated
FSH/LH, Decreased estradiol
*Dx: Progesterone challange test* (10 mg for 10 days; if has withdrawal bleeding = ovarian; if
no withdrawal bleeding = hypoestrogenic or uterine disorder
, Amenorrhea caused by Hypothalamus Dysfunction Sx (3) + Tx (2) - CORRECT
ANSWER✅✅✅1. Normal or decreased FSH/LH
2. *Normal prolactin*
3. Low estradiol
*Tx: Stimulate GnRH (Clomiphene, Menotropin)*
Amenorrhea caused by Pituitary Dysfunction Sx (2) + Tx (2) - CORRECT
ANSWER✅✅✅1. Decreased FSH/LH
2. *Elevated prolactin* (Prolactin inhibits GnRH)
*Tx: Tumor removal; Bromocriptine*
Amenorrhea caused by Uterine Disorder Sx + Tx - CORRECT ANSWER✅✅✅Asherman's
Syndrome (scarring of the uterine cavity)
*Tx: Estrogen*
Primary vs. Secondary Dysmenorrhea - CORRECT ANSWER✅✅✅1. *NOT* due to pelvic
pathology → due to *↑ prostaglandin*
2. Due to *pelvic pathology* (ex: endometriosis)
Premenstrual Syndrome (PMS) Tx (5) - CORRECT ANSWER✅✅✅1. Supportive
2. SSRI (for emotional symptoms)
3. OCP including *Drosperinone*
4. GnRH *(if no response to SSRI or OCP)
5. Spironolactone *(for bloating)*
ANSWERS
Follicular Phase vs. Luteal phase - CORRECT ANSWER✅✅✅1. Estrogen dominant (Day
1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH - CORRECT ANSWER✅✅✅1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone - CORRECT ANSWER✅✅✅1. Thickens endometrium
2. Enhances lining of uterus to prepare for implantation
In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a
_______ to develop which produces ________ to help proliferate the lining of the endometrium;
at the end of this phase _______ surges causing ovulation - CORRECT ANSWER✅✅✅1.
Primary ovarian follicle
2. Estrogen
3. LH
In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________
which produces _________ which maintains the endometrial lining for fertilization - CORRECT
ANSWER✅✅✅1. Corpus luteum
2. Progesterone
In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the
corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________
begins - CORRECT ANSWER✅✅✅1. Corpus luteum
2. Menstruation
In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus
luteum; if fertilization does occur __________ gets released by the developing
,trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen
- CORRECT ANSWER✅✅✅1. hCG
2. Corpus luteum
Cryptomenorrhea - CORRECT ANSWER✅✅✅Light flow or spotting
Metrorrhagia vs. Menometrorrhagia - CORRECT ANSWER✅✅✅1. Irregular bleeding
between expected menstrual cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
Oligomenorrhagia - CORRECT ANSWER✅✅✅Infrequent menstruation *(prolonged cycle
length >35 days but <6 months)*
Chronic anovulation (90% of DUB) is due to disruption of the hypothalamus-pituitary axis
which causes what hormal imbalances? And what kind of menstrual regularity? (3) - CORRECT
ANSWER✅✅✅1. No ovulation
2. Unopposed *estrogen* (no progesterone) → *risk of carcinoma*
3. *irregular*, unpredictable bleeding due to endometrial overgrowth
*REMEMBER this is a Dx of exclusion*
What is the pathophysiology of ovulatory DUB (10% of Dysfunctional UB)? (4) - CORRECT
ANSWER✅✅✅1. Still ovulate
2. Prolonged *progesterone* (decreased estrogen)
3. *Regular* cyclical shedding
4. Increased blood loss (due to endometrial vessel dilation and prostaglandins) = *menorrhagia*
*REMEMBER this is a Dx of exclusion*
,Primary Amenorrhea Definition (2) - CORRECT ANSWER✅✅✅1. No menstruation by
*age 15* in the *presence* of 2° sex characteristics
2. No menstruation by *age 13* in the *absence* of 2° sex characteristics
In a pt with primary amenorrhea, who's uterus & breasts are present, what may be the cause? -
CORRECT ANSWER✅✅✅Outflow obstruction (transverse vaginal septum, imperforated
hymen)
In a pt with primary amenorrhea, who's uterus is present but breasts are not, what may be the
cause? (2) - CORRECT ANSWER✅✅✅1. If elevated FSH and LH = *Ovarian causes*
(Premature ovarian failure, gonadal dysgenesis)
2. If normal/low FSH and LH = *Hypothalamus-Pituitary failure*
In a pt with primary amenorrhea who's uterus is absent but breasts are present, what may be the
cause? (2) - CORRECT ANSWER✅✅✅1. Mullerian agenesis (46XX)
2. Androgen Insensitivity (46XY)
In a pt with primary amenorrhea who's uterus and breasts are absent, what may be the cause? -
CORRECT ANSWER✅✅✅*RARE*
Defect in testosterone synthesis; presents like a phenotypic immature girl but will often have
*intraabdominal testes*
Secondary Amenorrhea Definition (2) - CORRECT ANSWER✅✅✅1. No menstruation for
*> 3 months* in a pt with previously normal menstruation
2. No menstruation for *> 6 months* in a oligomenorrheic pt
Amenorrhea caused by Ovarian Disorders Sx + Dx - CORRECT ANSWER✅✅✅Elevated
FSH/LH, Decreased estradiol
*Dx: Progesterone challange test* (10 mg for 10 days; if has withdrawal bleeding = ovarian; if
no withdrawal bleeding = hypoestrogenic or uterine disorder
, Amenorrhea caused by Hypothalamus Dysfunction Sx (3) + Tx (2) - CORRECT
ANSWER✅✅✅1. Normal or decreased FSH/LH
2. *Normal prolactin*
3. Low estradiol
*Tx: Stimulate GnRH (Clomiphene, Menotropin)*
Amenorrhea caused by Pituitary Dysfunction Sx (2) + Tx (2) - CORRECT
ANSWER✅✅✅1. Decreased FSH/LH
2. *Elevated prolactin* (Prolactin inhibits GnRH)
*Tx: Tumor removal; Bromocriptine*
Amenorrhea caused by Uterine Disorder Sx + Tx - CORRECT ANSWER✅✅✅Asherman's
Syndrome (scarring of the uterine cavity)
*Tx: Estrogen*
Primary vs. Secondary Dysmenorrhea - CORRECT ANSWER✅✅✅1. *NOT* due to pelvic
pathology → due to *↑ prostaglandin*
2. Due to *pelvic pathology* (ex: endometriosis)
Premenstrual Syndrome (PMS) Tx (5) - CORRECT ANSWER✅✅✅1. Supportive
2. SSRI (for emotional symptoms)
3. OCP including *Drosperinone*
4. GnRH *(if no response to SSRI or OCP)
5. Spironolactone *(for bloating)*
