clinical manifestations of primary amenorrhea correct answers absence of menarche by age 15
differential diagnoses for primary amenorrhea correct answers pregnancy, turner syndrome,
mullerian agenesis, delay of puberty, PCOS, weight loss, excessive exercise, anorexia
diagnostic workup for primary amenorrhea correct answers pelvic US, HCG, FSH, TSH,
prolactin
clinical manifestations of secondary amenorrhea correct answers absence of menses for more
than 3 cycle intervals or 6 months in women who were previously menstruating
what is the provera challenge? correct answers start with progestin for 10 days and then stop. if
bleeding starts again, she has estrogen but is not ovulating. If she does not start bleeding again,
she is ovulating but has outflow tract problem like scarring or adhesions.
bleed = not ovulating
no bleed = ovulating, scarring adhesions
when is the provera challenge used? correct answers for diagnostic of secondary amenorrhea
with normal labs and history of uterine instrumentation
turner's syndrome clinical manifestations correct answers 1. hypogonadism
-absent/non functioning sex chromosome (45X0) -> gonadal dysgenesis -> rudimentary, fibrosed
ovaries -> primary amenorrhea in 80% (menopause before menarche) or early ovarian failure
with secondary amenorrhea (20%), delayed secondary sex characteristics (absence of breasts),
infertility in a majority of patients
2. physical exam
, -short stature, webbed neck, prominent ears, posterior hairline, broad chest with hypoplastic
widely spaced nipples, (congenital lymphedema seen in neonates), short 4th metacarpals, high
arched palate, nail dysplasia, may have hearing loss
3. cardiovascular
-coarctation of the aorta
-MVP
-bicuspid aortic valves
-aortic dissection
-HTN
4. renal
-congenital abnormalities (horseshoe kidney)
-hydronephrosis
5. endocrine
-osteoporosis
-hypothyroidism
-DM
-dyslipidemia
6. GI
-telangiectasis (may present with GI bleeding)
-IBD
-colon CA
-liver disease