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What is McCune-Albright syndrome
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Section II: Topics in Gynecology
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DELAYED SEXUAL MATURATION
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What is delayed sexual maturation Absence of pubertal changes after 25 times the standard deviation of the mean age for a population (eg, absence of thelarche by age 13 and menarche by age 15) 1 History: previous growth patterns and pubertal development, other medical disorders 2 PE: height and weight, Tanner staging, pelvic examination (for congenital anomalies and obstruction) 3 Labs/imaging: vaginal smear (for cytohormonal evaluation), karyotype, pelvic ultrasound, FSH Prior gonadal function Androgen insensitivity Pregnancy; anatomic genital abnormalities; inappropriate positive feedback; complete androgen insensitivity syndrome By their FSH level
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What is the proper evaluation for a patient with delayed sexual maturation
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What does breast development signify What does the absence of pubic hair signify What is the differential diagnosis of a patient with delayed menarche and adequate secondary sexual characteristics How are patients with delayed menarche and inadequate secondary sexual characteristics classified What is the differential diagnosis of a patient with delayed menarche and inadequate secondary sexual characteristics
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Low FSH: constitutional delay; weight loss (extreme dieting, drug abuse, extreme exercise); kallman syndrome; pituitary destruction High FSH: Turner syndrome; Ovarian destruction (chemotherapy, radiation, infection, autoimmune); Resistant ovary syndrome
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What is Kallman syndrome
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A rare genetic syndrome causing hypogonadotropic hypogonadism and anosmia 1 Enzyme deficiency (such as 21 -hydroxylase deficiency) 2 Neoplasia 3 Male pseudohermaphroditism
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What is the differential diagnosis of a patient with delayed menarche and virilization
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7: Reproductive Endocrinology and Infertility
Disorders of the Menstrual Cycle, Uterus, and Endometrium
What is premenstrual syndrome Premenstrual syndrome (PMS) is a cyclical pattern of emotional, physical, and/or behavioral changes that occur in the luteal phase of the menstrual cycle and remit during menses Symptoms cause significant disability, and it is not an exacerbation of an underlying psychiatric disorder It is best characterized as an abnormal response to normally fluctuating hormones A more severe variant is described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as premenstrual dysphoric disorder The reported incidence of PMS ranges from 5% to 90% of women Approximately 70% have some symptoms of PMS and 5% have the more severe PMDD It occurs mostly in women in their mid-20s to 40s PMS is characterized by various constellations of symptoms including at least one of the following which is temporally related to the menstrual cycle: 1 Affective lability 2 Anxiety or tension 3 Depressed mood, hopelessness, or self-deprecating thoughts 4 Persistent anger or irritability Other symptoms include decreased interest/avoidance of usual activities, decreased productivity, lethargy, changes in appetite/ cravings, reproducible patterns of physical complaints (such as headaches, weight gain, breast
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What is the incidence of PMS and in whom does it occur
What are the symptoms of PMS
Section II: Topics in Gynecology
tenderness), difficulty concentrating, sleep disturbances (hypersomnia or insomnia), and a sense of being overwhelmed How is PMS diagnosed The patient is asked to keep a daily menstrual diary to document her symptoms and their severity The patient must demonstrate at least 5 of the above symptoms She also must demonstrate a symptom-free follicular phase and problems with notable changes in the luteal phase A comprehensive history and physical examination must be done to rule out any other illness Education of the patient and her family, dietary changes (emphasizing fresh foods), exercise, medications to prevent ovulation (such as oral contraceptive pills), progesterone suppositories, NSAIDs, diuretics, anxiolytic/antidepressant medications, and vitamin B6 GnRH agonists and surgical intervention are a last resort for severe refractory PMS
What are the treatment options for PMS
Dysmenorrhea
What is dysmenorrhea and what are the two types Dysmenorrhea is pain with menses either due to pelvic pathology (secondary dysmenorrhea) or without pelvic pathology (primary dysmenorrhea) Dysmenorrhea occurs in approximately 15% to 75% of women Primary dysmenorrhea is most common in younger women, whereas the incidence of secondary dysmenorrhea increases with age Primary dysmenorrhea is caused by an excess of prostaglandin F2a produced in the endometrium It stimulates smooth muscle, leading to uterine contractions and uterine ischemia Pain typically begins at menstruation and subsides after
What is the incidence of dysmenorrhea and in whom does it occur
What is the etiology of primary dysmenorrhea
What are the clinical signs and symptoms of primary dysmenorrhea
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7: Reproductive Endocrinology and Infertility
1 3 days It is characterized as cramping, labor-like pain, typically in the lower abdomen and suprapubic area, radiating to the back The pain can be associated with nausea, vomiting, and diarrhea Fatigue and headache are often also associated In general, the physical examination is normal What is the treatment of primary dysmenorrhea NSAID therapy is first line Other options include heat, exercise, and oral contraceptives In severe, refractory cases, presacral neurectomy is a last resort However, secondary dysmenorrhea should be suspected if symptoms are refractory to NSAIDs or OCPs NSAIDs work by inhibiting prostaglandin production OCPs work by decreasing prostaglandin production through suppression of ovulation Extrauterine causes: Endometriosis Neoplasm Inflammation (eg, PID) Adhesions Intramural causes: Adenomyosis Leiomyomata Intrauterine causes: Leiomyomata Polyps IUDs Infection Cervical stenosis/lesions For a patient with dysmenorrhea, what primary diagnosis do each of the following findings suggest: Uterine asymmetry Symmetrical enlargement of uterus Painful nodules in posterior cul-de-sac Restricted motion of the uterus What is the treatment for secondary dysmenorrhea Myomas or other tumors Adenomyosis Endometriosis Endometriosis or pelvic scarring/ adhesions from prior infection Treatment of the underlying condition is the primary modality
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