PAEA OBGYN EOR TOPICS EXAM
QUESTIONS WITH COMPLETE
SOLUTIONS
Follicular Phase vs. Luteal phase - ANSWER1. Estrogen dominant (Day 1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH - ANSWER1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone - ANSWER1. 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 -
ANSWER1. 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 - ANSWER1. 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 - ANSWER1. 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 - ANSWER1. hCG
2. Corpus luteum
Cryptomenorrhea - ANSWERLight flow or spotting
Metrorrhagia vs. Menometrorrhagia - ANSWER1. Irregular bleeding between expected
menstrual cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
,Oligomenorrhagia - ANSWERInfrequent 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)
- ANSWER1. 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) -
ANSWER1. 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) - ANSWER1. 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? - ANSWEROutflow 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) - ANSWER1. 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) - ANSWER1. 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? - ANSWER*RARE*
Defect in testosterone synthesis; presents like a phenotypic immature girl but will often
have *intraabdominal testes*
Secondary Amenorrhea Definition (2) - ANSWER1. 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 - ANSWERElevated 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) - ANSWER1. 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) - ANSWER1. Decreased
FSH/LH
2. *Elevated prolactin* (Prolactin inhibits GnRH)
*Tx: Tumor removal; Bromocriptine*
Amenorrhea caused by Uterine Disorder Sx + Tx - ANSWERAsherman's Syndrome
(scarring of the uterine cavity)
*Tx: Estrogen*
Primary vs. Secondary Dysmenorrhea - ANSWER1. *NOT* due to pelvic pathology →
due to *↑ prostaglandin*
2. Due to *pelvic pathology* (ex: endometriosis)
Premenstrual Syndrome (PMS) Tx (5) - ANSWER1. Supportive
2. SSRI (for emotional symptoms)
3. OCP including *Drosperinone*
4. GnRH *(if no response to SSRI or OCP)
5. Spironolactone *(for bloating)*
Premenstrual Dysphoric Disorder (PMDD) - ANSWERSevere PMS with functional
impairment
Menopause Sx (2) - ANSWER1. ↑ FSH, LH *(FSH > LH)* → *FSH > 30*
2. ↓ Estrogen
*Premature menopause = <40 years old*
Hormonal Replacement Therapy for Menopause (2) - ANSWER1. Estrogen only (most
effective symptomatic tx; Transdermal/vaginal preferred) → No risk of breast CA but
*risk of endometria CA*
, 2. Estrogen + Progesterone → protect against endometrial CA but *risk of breast CA
and DVT*
Endometrial Hyperplasia is caused by - ANSWERUnopposed estrogen causing
thickening/build up of endometrial lining
A 55 yo women with post-menopausal bleeding, menometrorrhagia receives a TVUS
showing a *>4mm* endometrial stripe... what is the most likely Dx? -
ANSWEREndometrial hyperplasia/gland proliferation
*Do an endometrial Bx to confirm*
How is endometrial hyperplasia WITHOUT atypia treated? WITH atypia? - ANSWER1.
WITHOUT atypia: *progestin* (po or IUD Mirena) stops estrogen from being unopposed
and limits endometrial growth; repeat EMBx in 3-6 mos
2. WITH atypia: hysterectomy (TAH +/- BSO) progestin tx if pt not surgical candidate or
if wishes to preserve fertility
Pelvic Inflammatory Disease (PID) Sx (4) - ANSWER*Ascending infection of upper
reproductive tract*
1. Lower abdominal tenderness
2. Purulent cervical discharge
3. *Chandelier sign*
4. Infection present
Chandelier Sign - ANSWERExtreme *CMT* that they seem to rise off the bed
Pelvic Inflammatory Disease (PID) Tx (2) - ANSWER1. Outpatient → *Doxycycline +
Ceftriaxone* +/- Metronidazole
2. Inpatient → *IV Doxycycline + 2nd Gen Cephalosporin*
Pelvic Inflammatory Disease (PID) Complications (3) - ANSWER1. *Fitz-Hugh Curtis
Syndrome*
2. Infertility
3. Ectopic pregnancy
Fitz-Hugh Curtis Syndrome Sx (2) - ANSWER*Hepatic fibrosis and peritoneal
involvement*
1. *Violin string* adhesion on anterior liver surface
2. RUQ pain, may radiate to right shoulder
Bacterial Vaginosis Sx (3) + Tx (2) - ANSWER1. MCC of vaginitis
2. *(+) Whiff test* → fishy odor
3. *Clue cells* → epithelial cells covered with bacteria
*Tx: Metronidazole, Clindamycin*
QUESTIONS WITH COMPLETE
SOLUTIONS
Follicular Phase vs. Luteal phase - ANSWER1. Estrogen dominant (Day 1-14)
2. Progesterone dominant (Day 14-28)
FSH vs. LH - ANSWER1. Causes follicle & egg maturation
2. Stimulate maturing follicle to produce estrogen
Estrogen vs. Progesterone - ANSWER1. 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 -
ANSWER1. 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 - ANSWER1. 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 - ANSWER1. 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 - ANSWER1. hCG
2. Corpus luteum
Cryptomenorrhea - ANSWERLight flow or spotting
Metrorrhagia vs. Menometrorrhagia - ANSWER1. Irregular bleeding between expected
menstrual cycles
2. Irregular EXCESSIVE bleeding between expected menstrual cycles
,Oligomenorrhagia - ANSWERInfrequent 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)
- ANSWER1. 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) -
ANSWER1. 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) - ANSWER1. 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? - ANSWEROutflow 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) - ANSWER1. 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) - ANSWER1. 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? - ANSWER*RARE*
Defect in testosterone synthesis; presents like a phenotypic immature girl but will often
have *intraabdominal testes*
Secondary Amenorrhea Definition (2) - ANSWER1. 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 - ANSWERElevated 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) - ANSWER1. 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) - ANSWER1. Decreased
FSH/LH
2. *Elevated prolactin* (Prolactin inhibits GnRH)
*Tx: Tumor removal; Bromocriptine*
Amenorrhea caused by Uterine Disorder Sx + Tx - ANSWERAsherman's Syndrome
(scarring of the uterine cavity)
*Tx: Estrogen*
Primary vs. Secondary Dysmenorrhea - ANSWER1. *NOT* due to pelvic pathology →
due to *↑ prostaglandin*
2. Due to *pelvic pathology* (ex: endometriosis)
Premenstrual Syndrome (PMS) Tx (5) - ANSWER1. Supportive
2. SSRI (for emotional symptoms)
3. OCP including *Drosperinone*
4. GnRH *(if no response to SSRI or OCP)
5. Spironolactone *(for bloating)*
Premenstrual Dysphoric Disorder (PMDD) - ANSWERSevere PMS with functional
impairment
Menopause Sx (2) - ANSWER1. ↑ FSH, LH *(FSH > LH)* → *FSH > 30*
2. ↓ Estrogen
*Premature menopause = <40 years old*
Hormonal Replacement Therapy for Menopause (2) - ANSWER1. Estrogen only (most
effective symptomatic tx; Transdermal/vaginal preferred) → No risk of breast CA but
*risk of endometria CA*
, 2. Estrogen + Progesterone → protect against endometrial CA but *risk of breast CA
and DVT*
Endometrial Hyperplasia is caused by - ANSWERUnopposed estrogen causing
thickening/build up of endometrial lining
A 55 yo women with post-menopausal bleeding, menometrorrhagia receives a TVUS
showing a *>4mm* endometrial stripe... what is the most likely Dx? -
ANSWEREndometrial hyperplasia/gland proliferation
*Do an endometrial Bx to confirm*
How is endometrial hyperplasia WITHOUT atypia treated? WITH atypia? - ANSWER1.
WITHOUT atypia: *progestin* (po or IUD Mirena) stops estrogen from being unopposed
and limits endometrial growth; repeat EMBx in 3-6 mos
2. WITH atypia: hysterectomy (TAH +/- BSO) progestin tx if pt not surgical candidate or
if wishes to preserve fertility
Pelvic Inflammatory Disease (PID) Sx (4) - ANSWER*Ascending infection of upper
reproductive tract*
1. Lower abdominal tenderness
2. Purulent cervical discharge
3. *Chandelier sign*
4. Infection present
Chandelier Sign - ANSWERExtreme *CMT* that they seem to rise off the bed
Pelvic Inflammatory Disease (PID) Tx (2) - ANSWER1. Outpatient → *Doxycycline +
Ceftriaxone* +/- Metronidazole
2. Inpatient → *IV Doxycycline + 2nd Gen Cephalosporin*
Pelvic Inflammatory Disease (PID) Complications (3) - ANSWER1. *Fitz-Hugh Curtis
Syndrome*
2. Infertility
3. Ectopic pregnancy
Fitz-Hugh Curtis Syndrome Sx (2) - ANSWER*Hepatic fibrosis and peritoneal
involvement*
1. *Violin string* adhesion on anterior liver surface
2. RUQ pain, may radiate to right shoulder
Bacterial Vaginosis Sx (3) + Tx (2) - ANSWER1. MCC of vaginitis
2. *(+) Whiff test* → fishy odor
3. *Clue cells* → epithelial cells covered with bacteria
*Tx: Metronidazole, Clindamycin*
