RH Actual Exam 2 NEWEST UPDATE
2026\COMPLETE QUESTIONS AND ACCURATE
DETAILED ANSWERS \LATEST UPDATE ||ALREADY
GRADED A+
Day 11-15
What is the "fertile window"? - sperm can live up to 5 days in the female tract and
egg can survive ab 24 hrs after ovulation
Regularity:
• 18-25 years old: ≤ 9 days difference
• 26-41 years old: ≤ 7 days difference (cycles are most stable at
this age)
• 42-45 years old: ≤ 9 days difference
What is the regularity of a
normal menstrual cycle?
Duration:
Duration and frequency?
8 days or less
Frequency:
Every 24-
38 days
Primary:
- by age 13: no periods AND no puberty signs
- by age 15: no periods but puberty is progressing
What is primary vs secondary
amenorrhea? Secondary:
- no periods for 3 cycles in someone with normally regular cycles
- no periods in 6 months in someone who has irregular periods
infrequent menstruation
- year
0 to <1 after menarche: fewer than 6 periods/year; avg cycle
> 60 days apart
What is oligomenorrhea?
- year
1 to < 3 after menarche: fewer than 8 periods/year; cycles >
45 days apart
, - year
3 to perimenopause: fewer than 9 periods per year; cycles
>38 days apart
Determine by PE or US/MRI if a uterus is present:
What is the single most
important step in the • If uterus is present → likely hormonal or ovarian issue
evaluation is someone with • If uterus absent → think congenital causes (e.g.,
primary amenorrhea? Müllerian agenesis, androgen insensitivity)
All causes of secondary primary amenorrhea
amenorrhea can also
present as what?
What is the MCC of primary Turner syndrome
amenorrhea?
, - periods are happening but blood cannot get out
What is an obstructed - ex. imperforate hymen and transverse vaginal septum
outflow tract? What are - clues = normal breast development, FSH normal, US
examples and clues? or MRI shows blood stuck in uterus or vagina
1. Confirm uterus is present on pelvic US, hCG neg
(not pregnant), get FSH, TSH, prolactin, total
testosterone
2. Look at FSH
3.High FSH: brain working but ovaries are NOT responding
- get karyotype chromosome test (stop here if results show
something)
4. Low or normal FSH: check breast development
5. Breasts developed = ovaries are making estrogen
How do you evaluate so get an US to check for uterine abnormality
primary amenorrhea when - Uterine abnormality = outflow obstruction
- No abnormality = endocrine disorder
the uterus is PRESENT?
6.Breasts not developed = estrogen is low, repeat FSH and add
LH
- LH low, FSH normal or low: hypothalamic problem
- LH and FSH very low: congenial GnRH deficiency or
pituitary disorder (may need MRI)
• HighFSH → ovarian failure (Turner, gonadal dysgenesis, POI)
• Low/normal FSH + breast development → outflow
tract problem or endocrine issue (PCOS, thyroid,
prolactin)
• Low/normal FSH + no breast
development → central cause
(hypothalamus/pituitary)
, 1. Confirm uterus is absent
2. Get karyotype + serum testosterone
3. If karyotype is 46, XY
- 5-alpha reductase deficiency or
- complete androgen insensitivity sydnrome
How do you evaluate
primary amenorrhea when 4. If karyotype 46, XX
the uterus is NOT - Müllerian agenesis (MRKH syndrome)
PRESENT?
• Uterus absent + 46,XX, normal female T → MRKH (Müllerian
agenesis)
• Uterus absent + 46,XY, male T levels → depends on phenotype:
• Virilization at puberty → 5-alpha-reductase deficiency
• Female appearance, breasts, but no uterus → Androgen
Insensitivity Syndrome
2026\COMPLETE QUESTIONS AND ACCURATE
DETAILED ANSWERS \LATEST UPDATE ||ALREADY
GRADED A+
Day 11-15
What is the "fertile window"? - sperm can live up to 5 days in the female tract and
egg can survive ab 24 hrs after ovulation
Regularity:
• 18-25 years old: ≤ 9 days difference
• 26-41 years old: ≤ 7 days difference (cycles are most stable at
this age)
• 42-45 years old: ≤ 9 days difference
What is the regularity of a
normal menstrual cycle?
Duration:
Duration and frequency?
8 days or less
Frequency:
Every 24-
38 days
Primary:
- by age 13: no periods AND no puberty signs
- by age 15: no periods but puberty is progressing
What is primary vs secondary
amenorrhea? Secondary:
- no periods for 3 cycles in someone with normally regular cycles
- no periods in 6 months in someone who has irregular periods
infrequent menstruation
- year
0 to <1 after menarche: fewer than 6 periods/year; avg cycle
> 60 days apart
What is oligomenorrhea?
- year
1 to < 3 after menarche: fewer than 8 periods/year; cycles >
45 days apart
, - year
3 to perimenopause: fewer than 9 periods per year; cycles
>38 days apart
Determine by PE or US/MRI if a uterus is present:
What is the single most
important step in the • If uterus is present → likely hormonal or ovarian issue
evaluation is someone with • If uterus absent → think congenital causes (e.g.,
primary amenorrhea? Müllerian agenesis, androgen insensitivity)
All causes of secondary primary amenorrhea
amenorrhea can also
present as what?
What is the MCC of primary Turner syndrome
amenorrhea?
, - periods are happening but blood cannot get out
What is an obstructed - ex. imperforate hymen and transverse vaginal septum
outflow tract? What are - clues = normal breast development, FSH normal, US
examples and clues? or MRI shows blood stuck in uterus or vagina
1. Confirm uterus is present on pelvic US, hCG neg
(not pregnant), get FSH, TSH, prolactin, total
testosterone
2. Look at FSH
3.High FSH: brain working but ovaries are NOT responding
- get karyotype chromosome test (stop here if results show
something)
4. Low or normal FSH: check breast development
5. Breasts developed = ovaries are making estrogen
How do you evaluate so get an US to check for uterine abnormality
primary amenorrhea when - Uterine abnormality = outflow obstruction
- No abnormality = endocrine disorder
the uterus is PRESENT?
6.Breasts not developed = estrogen is low, repeat FSH and add
LH
- LH low, FSH normal or low: hypothalamic problem
- LH and FSH very low: congenial GnRH deficiency or
pituitary disorder (may need MRI)
• HighFSH → ovarian failure (Turner, gonadal dysgenesis, POI)
• Low/normal FSH + breast development → outflow
tract problem or endocrine issue (PCOS, thyroid,
prolactin)
• Low/normal FSH + no breast
development → central cause
(hypothalamus/pituitary)
, 1. Confirm uterus is absent
2. Get karyotype + serum testosterone
3. If karyotype is 46, XY
- 5-alpha reductase deficiency or
- complete androgen insensitivity sydnrome
How do you evaluate
primary amenorrhea when 4. If karyotype 46, XX
the uterus is NOT - Müllerian agenesis (MRKH syndrome)
PRESENT?
• Uterus absent + 46,XX, normal female T → MRKH (Müllerian
agenesis)
• Uterus absent + 46,XY, male T levels → depends on phenotype:
• Virilization at puberty → 5-alpha-reductase deficiency
• Female appearance, breasts, but no uterus → Androgen
Insensitivity Syndrome
