NU 664D Primary Care of the Adult Woman
I Final Exam 2025/2026 Questions And
Answers Graded A+
clinical manifestations of dysmenorrhea
pelvic pain associated with the onset of menses, two days before bleeding; nausea,
fatigue, diarrhea, headache, malaise
differential diagnoses of dysmenorrhea
miscarriage, ectopic, PID, UTI, IBS, appendicitis
diagnostic workup for dysmenorrhea
chlamydia/gonorrhea, urine dip, wet prep, HCG, TVUS
,treatment of dysmenorrhea
increase water, take 600 mg ibuprofen q 6 h for 2-5 days, COC
differential diagnoses of dysmenorrhea
polyps, hypertropy or atrophy, carcinoma, fibroids
clinical manifestations of primary amenorrhea
absence of menarche by age 15
differential diagnoses for primary amenorrhea
pregnancy, turner syndrome, mullerian agenesis, delay of puberty, PCOS, weight
loss, excessive exercise, anorexia
diagnostic workup for primary amenorrhea
pelvic US, HCG, FSH, TSH, prolactin
,clinical manifestations of secondary amenorrhea
absence of menses for more than 3 cycle intervals or 6 months in women who were
previously menstruating
what is the provera challenge?
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?
for diagnostic of secondary amenorrhea with normal labs and history of uterine
instrumentation
turner's syndrome clinical manifestations
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
I Final Exam 2025/2026 Questions And
Answers Graded A+
clinical manifestations of dysmenorrhea
pelvic pain associated with the onset of menses, two days before bleeding; nausea,
fatigue, diarrhea, headache, malaise
differential diagnoses of dysmenorrhea
miscarriage, ectopic, PID, UTI, IBS, appendicitis
diagnostic workup for dysmenorrhea
chlamydia/gonorrhea, urine dip, wet prep, HCG, TVUS
,treatment of dysmenorrhea
increase water, take 600 mg ibuprofen q 6 h for 2-5 days, COC
differential diagnoses of dysmenorrhea
polyps, hypertropy or atrophy, carcinoma, fibroids
clinical manifestations of primary amenorrhea
absence of menarche by age 15
differential diagnoses for primary amenorrhea
pregnancy, turner syndrome, mullerian agenesis, delay of puberty, PCOS, weight
loss, excessive exercise, anorexia
diagnostic workup for primary amenorrhea
pelvic US, HCG, FSH, TSH, prolactin
,clinical manifestations of secondary amenorrhea
absence of menses for more than 3 cycle intervals or 6 months in women who were
previously menstruating
what is the provera challenge?
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?
for diagnostic of secondary amenorrhea with normal labs and history of uterine
instrumentation
turner's syndrome clinical manifestations
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
