obg: Menstrual Disorders (share)

Which are the physiological states of amenorrhea?

A) before puberty

B) during pregnancy

C) while breastfeeding

D) after the menopause

E) all of the

E) all of them

EXPLANATION

The physiological states of amenorrhea are before puberty, after the menopause, during pregnancy and breastfeeding.

Which is the most common cause of secondary amenorrhea?

A) hypothalamo-hypophyseal

B) ovarian

C) uterine

D) vaginal

E) adrenal

A) hypothalamo-hypophyseal

EXPLANATION

The most common cause of secondary amenorrhea is hypothalamo-hypophyseal with 61%, not included the hyperprolactinaemia, which represents further 18%. The uterine cause represents only 9%.

What are the symptoms of premenstrual syndrome?

A) increased irritability, psychic instability

B) predisposition to depression

C) painful breast tension

D) headache and back pain

E) any of them can appear in various degrees

E) any of them can appear in various degrees

EXPLANATION

This condition has an endocrine and psychosomatic origin. The changing levels of estrogen and progesterone have effect on mood and pain through neurotransmission modulation in the central nervous system.

Which can cause Asherman's syndrome?

A) infections leading to endometrial sclerosis (e.g. genitalis tuberculosis)

B) ovarian dysfunction

C) destruction of the endometrial basal layer (e.g. after curettage of the uterus)

D) all of them are correct

E) A and C

E) A and C

infections leading to endometrial sclerosis (e.g. genitalis tuberculosis)

destruction of the endometrial basal layer (e.g. after curettage of the uterus)

EXPLANATION

In the Asherman’s syndrome, the front and back walls of the uterus stick to one another, which leads to amenorrhea. The most common cause of this condition is iatrogenic because of the destruction of the endometrial basal layer e.g. after curettage of the uterus. Genital tuberculosis may also lead to Asherman’s syndrome through the infection-related endometrial sclerosis, but it’s uncommon nowadays.

Characteristics of the normal menstrual cycle, except:

A) The typical length of the period is 21 to 35 days.

B) The blood loss is no more than 80 ml.

C) It may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains.

D) The estimation of the blood loss is subjective, and has a large interpersonal variation.

C) It may occur more frequent, than 21 days, although the bleeding lasts for 7 days, so the 28-day cycle remains.

EXPLANATION

The normal menstrual cycle can range in length from 21 days to about 35 days, where the blood loss is no more than 80 ml. The estimation of the blood loss is complicated, because it is subjective, and has a large interpersonal variation.

Management of abnormal uterine bleeding in adolescents:

A) it is a temporary condition, neither the excessive and prolonged bleeding require treatment

B) may be caused by neoplasms, in order to receive histologic diagnosis curettage needed to perform

C) continuous or cyclic progesterone therapy and oral contraceptives

D) in case of frequent and excessive bleeding, anticoagulants may be effective

E) all of the treatments are correct

C) continuous or cyclic progesterone therapy and oral contraceptives

EXPLANATION

The abnormal uterine bleeding in adolescents is usually due to hormonal disturbances, so curettage is not recommended. The initial treatment, especially in case of excessive and prolonged bleeding are cyclic progesterone therapy, ovulation induction or oral contraceptives,

Characteristics of dysmenorrhea, except:

A) The most characteristic symptom is the lower abdomen pain, other symptoms may include nausea and vomiting

B) The main symptom is nausea and vomiting, and the lower abdomen pain is an often co-occuring symptom

C) The symptoms may occur even after the first childbirth

D) The symptoms may occur after the menarche

E) The symptoms occur primarily in the anovulatory cycles

E) The symptoms occur primarily in the anovulatory cycles

EXPLANATION

The most characteristic symptom of dysmenorrhea is the lower abdomen pain, other symptoms may include headache, nausea and vomiting. It can be classified as either primary or secondary based on the absence or presence of an underlying cause. The most common cause of secondary dysmenorrhea is organic, it may occur even after the first childbirth. The symptoms does not occur in the anovulatory cycles because of the low prostaglandin level of the endometrium.

Characteristics of an endometrial polyp, except:

A) benign mass in the inner lining of the uterus

B) can lead to infertility

C) the prevalence increases with age

D) the mass is benign, malignant transformation is not possible

E) can be removed by hysteroscopic resection

D) the mass is benign, malignant transformation is not possible

EXPLANATION

The endometrial polyp is a benign mass in the inner lining of the uterus. Polyps are usually benign, but the prevalence increases with age, and the risk of malignant transformation is above 50% after the age of 65. Polyps can be surgically removed by curettage or hysteroscopy.

Which are the characteristic symptoms of the adenomyosis?

A) dysmenorrhea

B) hypermenorrhea

C) infertility is a main symptom

D) uterine enlargement

E) all of the symptoms are characteristic

F) only A) and C) are correct

E) all of the symptoms are characteristic

EXPLANATION

The endometrial tissue infiltrates the myometrium deeply, causing dysmenorrhea and hypermenorrhea. The uterus is usually uniformly enlarged.

This manner can be used in the diagnosis of endometriosis:

A) physical examination

B) ultrasound examination

C) MRI

D) laparoscopy

E) all of them are correct

E) all of them are correct

EXPLANATION

After suspecting endometriosis based on the medical history and a physical examination,ultrasound examination and MRI is advocated. Laparoscopy is the gold standard to diagnose endometriosis. If the growths are not visible, a biopsy may be taken to determine the diagnosis.

Which treatment is not recommended in menorrhagia?

A) Combined oral contraceptive pills

B) Intrauterine system that contains progestogen

C) NSAIDs

D) Endometrial resection

E) In case of unsuccessful initial treatment, surgery can be an effective second line treatment

F) Copper intrauterin device (IUD)

F) Copper intrauterin device (IUD)

EXPLANATION

In the treatment of menorrhagia, combined oral contraceptive pills have an efficiency of about 50-60%. The IUS has about 90%, and the NSAIDs have about 25% of efficiency. If the initial therapy is unsuccessful, endometrial ablation is recommended. Copper intrauterin devices can increase the amount of bleeding, therefore they are not recommended.

What are the main symptoms of premenopause?

A) abnormal uterine bleeding

B) anovulatory cycles

C) reduction of fertility, then infertility

D) A, B and C are correct

E) vulvovaginal atrophy

D) A, B and C are correct

abnormal uterine bleeding

anovulatory cycles

reduction of fertility, then infertility

EXPLANATION

The female reproductive organs are not atrophic before menopause, but the other symptoms are characteristics. The estrogen level continuously decreases after the menopause, leading to atrophy of the female reproductive organs.

Which cannot cause dysmenorrhea?

A) endometriosis

B) adenomyosis

C) leiomyoma

D) cervical stenosis

E) long-term combined oral contraceptives

E) long-term combined oral contraceptives

EXPLANATION

The level of prostaglandines -responsible for the dysmenorrhea- is decreased in anovulatory cycles. Therefore the continuous use of oral contraceptives relieves or terminates dysmenorrhea.

After menarche in case of imperforated hymen, the following can be seen:

A) haematocolpos

B) mucocolpos

C) urinal retention

D) neither of them

E) A and C answers are correct

E) A and C answers are correct

haematocolpos

urinal retention

EXPLANATION

After menarche the imperforated hymen first results heamatocolpos, which causes urinary disorder and retention due to the pressure applyed to the urethra and the bladder. Mucocolpos appears before the menarche, because of the obstruction of the the secretion.

What is hypomenorrhoea?

A) period last longer with more bleeding

B) regular, but shorter menstruation with light bleeding

C) period is between 30 and 120 days

D) more than 120 days between two menstruations

E) less then 25 days between two menstruations

B) regular, but shorter menstruation with light bleeding

EXPLANATION

regular, but shorter menstruation with light bleeding

What is menorrhagia (hypermenorrhea)?

A) painful menstruation

B) shorter menstruation with less bleeding than usual

C) longer (>7 days) mentruation with more bleeding (>80ml) than usual

D) more than 120 days between two menstruations

E) less then 25 days between two menstruations

C) longer (>7 days) mentruation with more bleeding (>80ml) than usual

EXPLANATION

Heavy bleeding, which last longer than usual.

What is oligomenorrhea?

A) more than 35 days between two menstruations

B) shorter menstruation with less bleeding than usual

C) longer menstruation with more bleeding than usual

D) less than 120 days between two menstruations

E) less than 25 days between two menstruations

A) more than 35 days between two menstruations

EXPLANATION

In oligomenorrhea the periods are longer than 35 days

What is polymenorrhea?

A) period is between 35 and 90 days

B) shorter menstruation with less bleeding than usual

C) longer menstruation with more bleeding than usual

D) more than 120 days between two menstruations

E) less then 21 days between two menstruations

E) less then 21 days between two menstruations

EXPLANATION

In polymenorrhoea the periods are shorter than 21 days.

What is menorrhagia (hypermenorrhoea)?

A) withdrawl bleeding after oestrogen and/or progesteron therapy

B) regular, light bleeding

C) irregular menses

D) normal menstruation with cramps

E) regular menses with significant bleeding

E) regular menses with significant bleeding

EXPLANATION

Menorrhagia (hypermenorrhoea) heavy bleeding with regular periods (>80 ml blood and/or > 7 days), with normal ovulatory cycle.

Does the GnRH puls frequency change in different parts of the normal menstruational period?

A) higher in follicular phase

B) higher in luteal phase

C) no difference

A) higher in follicular phase

EXPLANATION

The GnRH pulsfrequency is more frequent in the follical phase, unlike in the lutal phase, in which it is less frequent.

What is the cause of the raised temperature in the second half of the menstruational period?

A) progesteron increases the metabolism

B) oestrogen increases the metabolism

C) combined effect of progesteron and oestrogen increases the metabolism

D) progesteron stimulates the thermoregulation centre

E) prolactine stimulates the thermoregulation centre

D) progesteron stimulates the thermoregulation centre

EXPLANATION

The thermogenic effect of progesterone is responsible to the higher basic temperature, which last about 10 days and causes the characteristic biphase cycle.

Which sympthom does not fit in PCO syndrome?

A) obesity

B) polycystic ovaries with ultrasound

C) increased hair growth

D) oligomenorrhoea

E) seborrhoea

F) hyperbilirubinaemia

F) hyperbilirubinaemia

EXPLANATION

The PCO syndrome is the group of symptoms with characteristic ultrasound image, increased hair growth due to testosterone production and seborrhoea on the skin, oligo-, or amenorrhea and obesity. No effect on the bilirubin metabolism.

Hysteroscopy is suitable for detecting the cause of irregular uteral bleeding in following:

A) focal lesion of the endometrium

B) developmental failure of the uterus

C) endometrial polyp

D) submucosal leiomyomas

E) all of them

E) all of them

EXPLANATION

During hysteroscopy the uterine wall and the source of the bleeding can be visualised.

Contraindication(s) of hysteroscopy:

A) retroflected uterus

B) uterinal septum

C) heavy uterinal bleeding

D) acut pelvic inflammatory diaseas

E) all of them are correct

F) only C and D answers are correct

F) only C and D answers are correct

heavy uterinal bleeding

acut pelvic inflammatory diaseas

EXPLANATION

Neither the retroflexion nor the uterine septum are not contraindications of hysteroscopy. Acute pelvic inflammation or heavy bleeding are contraindications.

Recommended drugs to treat dysmenorrhea:

A) hormonal contraceptive pills

B) inhibitors of the prostaglandine synthesis

C) terbutalin or phenoterol

D) Diazepam

E) only A and B answers are correct

F) all of them are correct

E) only A and B answers are correct

hormonal contraceptive pills

inhibitors of the prostaglandine synthesis

EXPLANATION

The prostaglandins play a huge role in the developing of dysmenorrhea. So the inhibitors of the prostaglandin synthesis and hormonal contraceptives (by interrupting the ovulation they decrease the prostaglandin emission) treat the cause unlike fenoterol or diazepam.

What is the LH:FSH ratio in PCO syndrome?

A) 1:4

B) at least 3:1

C) 1:1

B) at least 3:1

EXPLANATION

Physiologically the LH/FSH ratio is 2:1. In PCO syndrome is rather 3:1 or above.

Match the following situatons with the proper reactions.

A) Stop taking the pills, then continue taking them after 7 days

B) Continue taking the pills as usual

C) You have to continue taking the pills and combine it with another contraceptive methode

D) Take 1 more pill

E) Stop taking the pills and medical examination is needed

OBG - 2.39 - Nausea during the first period of using the tablets

OBG - 2.40 - Scratching all over the body

OBG - 2.41 - Missed one day taking the tablet

OBG - 2.42 - Light bleeding during the second part of the menstruational period

OBG - 2.39 - Nausea during the first period of using the tablets - B) Continue taking the pills as usual

OBG - 2.40 - Scratching all over the body - E) Stop taking the pills and medical examination is needed

OBG - 2.41 - Missed one day taking the tablet - C) You have to continue taking the pills and combine it with another contraceptive methode

OBG - 2.42 - Light bleeding during the second part of the menstruational period - B) Continue taking the pills as usual

What are the usual hormone changes in PCO syndrome?

A) increased

B) decreased

C) no change

OBG - 2.43 - Testosterone

OBG - 2.44 - Androstendion

OBG - 2.45 - TSH

OBG - 2.46 - SHBG

OBG - 2.47 - insulin

OBG - 2.48 - LH/FSH ratio

OBG - 2.43 - Testosterone - A) increased

OBG - 2.44 - Androstendion - A) increased

OBG - 2.45 - TSH - C) no change

OBG - 2.46 - SHBG - B) decreased

OBG - 2.47 - insulin - A) increased

OBG - 2.48 - LH/FSH ratio - A) increased

In case of primer amenorrhea genetical examination has to be done, in order to indentify the disease.

A) both are correct, there is a causal relationship between the two,

B) both are correct, there is no causal relationship between the two,

C) the first is correct, the second is incorrect

D) the first is incorrect , the second is correct

E) both are incorrect

A) both are correct, there is a causal relationship between the two,

EXPLANATION

More than 30% of primer amenorhea is caused by genetical failure. Among these, Turner-syndrome (45 X0) is most common one, so during examination genetical examination is always recommended.